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Does Malaria Make Poverty, or Vice Versa?

July 29, 2014 - 10:11 -- Patrick Sampao

About two years ago i met a friend who introduced me to the Bahai Faith, before then i had been a dormant Presbytarian. The ideals of the Bahai Faith have had so much impact in my life as a person. Anyhoo i came across this article, thought i would share it with you all.

Baha’u’llah, the prophet and founder of the Baha’i Faith, spent the last forty years of his life in exile and prison. The teachings of his new Faith—world unity, the common foundation of all religions, the equality of men and women, global peace and harmony—so angered the Islamic clerical authorities that they persecuted Baha’u’llah mercilessly, finally sentencing him and his family and followers to a notoriously malarial prison colony in Akka, Palestine:

We had no communication whatever with the out-side world. Each loaf of bread was cut open by the guard to see that it contained no message. All who believed in the Baha’i manifestation, children, men and women, were imprisoned with us. There were one-hundred and fifty of us together in two rooms and no one was allowed to leave the place with the exceptions of four persons, who went to the bazaar to market each morning, under guard. The first summer was dreadful. Akka is a fever-ridden town. It was said that a bird attempting to fly over it would drop dead. The food was poor and insufficient, the water was drawn from a fever-infected well and the climate and conditions were such, that even the natives of the town fell ill. Many soldiers succumbed and eight out of ten of our guard died. During the intense heat, malaria, typhoid and dysentery attacked the prisoners, so that all, men, women and children, were sick at one time. There were no doctors, no medicines, no proper food, and no treatment of any kind. – Abdu’l-Baha, Abdu’l-Baha in London, pp. 115.

Residents of that region of Palestine (now Israel) probably received infectious bites from Anopheles mosquitoes in cities and towns, because one species called Anopheles claviger had adapted to the underground cisterns used to hold fresh water. Another mosquito species and malaria carrier, Anopheles sacharovi, lived in the grassy, freshwater marshes of the rural plain between Akka and Haifa.

People have long suffered from malaria, historically associated with the emergence of human civilization. Sanskrit, Greek, and Chinese medical texts all gave detailed descriptions of the episodic fevers from malaria. The ancient Chinese called malaria “chang chi” which translates roughly to “malicious air,” precisely the meaning in the Italian from which the word “mal” (bad) “aria” (air) comes from.

These names relate to the idea that in swampy, wet areas one would breathe the bad air or miasma emanating from the environment, and the symptoms of malaria (acute cycles of chills and fevers in particular) would ensue. For thousands of years, though, no one knew the true cause of malaria. However, coincident with the explosion of scientific knowledge of the late 19th century, the French-Algerian physician Alphonse Laveran, working in North Africa in 1878, discovered the malaria parasite in the blood of an ill soldier. Later, the British colonial physician Ronald Ross in India in 1898 conducted experiments with bird malaria that proved parasite transmission by mosquitoes. The Italian entomologist Giovanni Battista Grassi did similar experiments with Anopheles mosquitoes and humans at the same time near Rome. These findings revolutionized the medical field; both Ross and Laveran were ultimately awarded the Nobel Prize for Medicine for their accomplishments—although poor Grassi unjustly didn’t share the prize.
Malaria endemic countries in the eastern hemisphere

Because scientists recognized malaria as not only a serious illness for individuals, but also a restraint on social development and intertwined with poverty, movements began to form, sometimes with colonial or military motivations but in other cases for humanitarian reasons, to control and eradicate the disease. These movements began shortly after Ross and Grassi made their discoveries and published them. Many regions successfully eradicated malaria, but it remains an extremely important problem in tropical areas and particularly in the so-called Lesser Developed Countries.

A world wide attempt to eradicate malaria began after World War II, under the auspices of the newly-organized World Health Organization. Based on the use of indoor sprays of long lasting insecticides such as DDT and new drugs such as chloroquine, which both emerged from scientific investigations demanded by the war effort, it worked effectively in many regions–but by the late 1960s many national programs had reversed and malaria resurged to pre-eradication levels.

A recent analysis by Dr. Justin Cohen of the Clinton Foundation indicates that insecticide and drug resistance did not cause these failures–but rather the inability to sustain the programs in the face of costs and the unchanged social context of poverty. Throughout this era, a divergence of thought occurred. One group, those who relied on material means, had faith in the new technical prowess provided by the chemical industry, and promoted certain post-colonial models of economic development. The other group, the less-heard but poignant voices of those who emphasized the humanitarian basis for malaria control, focused on the need to address the root of the problem: poverty.

A great debate still rages over whether malaria makes poverty, or poverty makes malaria.

All the research shows strong relationships between the two. My own research collaboration in southern Malawi demonstrated that marginal increases in the household wealth of poor people are associated with marked declines in risk of malaria. Fascinating research in western Kenya by Dr. Kacey Ernst of the University of Arizona showed that when women in poor, rural households have marginally higher levels of formal education, the risk of malaria for everyone in those households declines substantially. The questions now arising have to do with whether malaria can properly be controlled technically and with the right weapons; or if malaria needs to be viewed as a problem of social justice. The answer: undoubtedly both, with the latter required to balance the former.

Control of malaria, leading to elimination of it globally, became a renewed focus of international effort in 2000 with the Millennium Summit, with tremendous support from the public, private, and philanthropic sectors. New international networks and funding mechanisms emerged; and in one sense malaria itself became a unifying force, leading to some notable successes.

Malaria deaths globally have dropped by a third and the malaria distribution map has shrunk. Child survival is up. Women have become a primary focus, with distribution of insecticide treated bed nets by the millions through rural, antenatal clinics; and the provision of intermittent, preventive drug therapies to pregnant women, a particularly high-risk group. The current and recognizably ambitious Millennium goal aims to reverse malaria incidence (recruitment of new cases) from a positive to a negative number by 2015.

We still have a long way to go before we eliminate malaria, and many obstacles to overcome. But the collective decision-making involved, the global consciousness of the problem, and the concerted action across a wide spectrum of society all represent a great sign of our time, a true world undertaking that fulfills Abdu’l-Baha’s promise.

Comments

Submitted by Anton Alexander (not verified) on

The description of the malaria severity all those years ago in the Akka prison sounds likely. 100 years ago, medical officers with the British Army in Palestine had described Palestine as one of the most malarious countries in the world. Attempts by the Jewish Zionists before World War 1 to settle in Palestine had failed, beaten back mainly by malaria, and the discussions within Zionist circles in 1920 was of abandoning the thought of ever settling there. The place was either uninhabitable or very thinly or sparsely populated. But in 1920,a Dr Kligler, a public health scientist, a Zionist, arrived in Palestine, and commenced to destroy pessimism and raised hopes by demonstrating to the handful of wretched Jews and Arabs who had survived the disease,that malaria was not inevitable. He stressed that Education was as important as the anti-malaria work, and which is why Palestine became the place for the first start of a successful durable national malaria-eradication campaign anywhere in the world. Israel has been officially free of malaria since 1967. If malaria had not been eliminated, the disease would have probably maintained the grinding poverty that existed in Palestine 100 years ago, perhaps Israel would not have come into existence, and the world would have been denied Israel's scientific contributions.

Submitted by Bill Jobin (not verified) on

Thank you Patrick for your overview of malaria and poverty. I once analyzed the data from the US Presidential Malaria Initiative and the World Bank on the effort to suppress malaria in over a dozen African countries, and the impact on their per capita GDP. The impact was strong and direct, as I reported in a couple of papers.

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- On the balance between population growth and growth in agricultural productivity

We know some really good things about suppressing malaria in Africa. Suppressing malaria boosts the productivity of adults, so they can grow more rice, maize or corn. Suppressing malaria saves the lives of children whom we cherish.

But a question raised by Malthus around 1830 was whether increased productivity will keep ahead of the growing population in agricultural countries? Malthus was an English cleric and scholar who made the dismal prediction that increases in population would outstrip increases in productivity, leading to famine. And certainly by lowering the death rates, malaria suppression might increase this dismal spiral downward.

In this same dismal spirit, a recent very complex computer estimation of malaria deaths and disease - including extrapolations about impacts on economic consequences - led to the conclusion that it was not economically profitable to fight malaria in Africa (Ashraf et al from Brown Univ, USA in NBER Macroeconomics Annual 2009 April 23:157-294). He concluded that the increase in population because of suppressing malaria would eat up the increase in agricultural productivity, a la Malthus. Thus malaria suppression would increase malnutrition.

However we must be cautious - because of the myriad assumptions, coefficients and extrapolations inherent in such complex computerized simulations. Their predictions should always be compared with reality before basing any policy decisions on their predictions.

Perhaps according to Ashraf we should hand out condoms along with those bednets. And perhaps as part of our attack on the mosquitoes, we should use backhoes or shovel brigades or ditching, to reclaim swamps, and turn them into cornfields, or rice paddies.

Additionally, condoms prevent HIV transmission, and backhoes increase agricultural productivity, both good objectives by themselves and doubly so in the context of suppressing malaria. So maybe condoms and backhoes are good ideas anyway!

Now, let us examine some recent data from Africa on malaria, food production and population to see if the dismal theory of Malthus and the dismal computer simulation of Ashraf should concern us in our attack on malaria.

Mali
The US Malaria Initiative began suppressing malaria in Mali in 2006. The population of Mali in 2006 was 12 million and by 2012 it had increased to 14 million people.

Rice production increased from 684,000 metric tones in 2006 to 1,310,000 mt in 2012. So the amount of rice produced per capita went from 56 kg/cap in 2006 to 94 kg/cap in 2012. Clearly Mali won the Malthusian race.

Liberia
The Malaria Initiative has also been working in Liberia, another country dependent on rice for food. From 2007 to 2012 the number of people went from 3.8 million to 4.7 million.
During those same years rice production went from 100,000 mt to 170,000 mt, and thus the per capita food production went from 27 kg/cap to 36 kg/cap. So Liberia won this one too.

Tanzania
In Tanzania maize or corn is the principal food. The population rose from 38 million to 43 million between 2005 and 2012, and maize production rose from 3.5 million mt to about 5.5 million mt during that same time. So the amount of food per person went from 93 kg/cap to 128 kg/cap. Again Tanzania beat Malthus.

The Good News

Thus the Good News about suppressing malaria in Africa – which we must celebrate enthusiastically – is that the additional population created by saving children’s lives will be fed by the increased agricultural productivity of their healthier parents. Isn't that Good News?

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Although the population also surged (because of a drop in infant mortality), the increase in GDP more than overcame the population increase, thus confounding Malthus!

So this is really good news. Even temporary (maybe 10 years) suppression of malaria in African countries with subsistence agriculture, can increase income, reinforcing the impact of improved income on malaria, and maybe giving us a 'virtuous' cycle, leading to the diminishment of malaria.
Bill

Submitted by Bill Jobin (not verified) on

HARVARD AFRICA POLICY JOURNAL
April 2014 INCREASED ECONOMIC PRODUCTIVITY AFTER SUPPRESSING MALARIA TRANSMISSION IN 14 AFRICAN COUNTRIES

By William R. Jobin, Sc.D., Director of Blue Nile Associates
Abstract
Several endemic tropical diseases retard economic progress by devastating childhood development and also by reducing productivity in adults, especially among agricultural workers. One of these diseases – malaria – a major cause of death and disability – has been under attack on a large scale in Africa since 2005. This attack has been accompanied by remarkable increases in economic productivity. Following annual expenditures of about $0.2 billion for suppressing malaria, the mean per capita Gross Domestic Product of 14 African countries increased 98% after 7 years of intervention, while it improved only 66% in 9 comparable but untreated countries. The observed increase was significantly above previous estimates for the economic impact of malaria suppression. Without correcting for population changes, the increase could be viewed as a huge return of $133 billion in economic growth on an expenditure for malaria suppression of only $1.4 billion in these 14 countries, a ratio of almost 100:1. Unfortunately there is a serious risk that the success of current malaria suppression methods – based on a narrowly conceived strategy using only bednets, biocides and drugs – will soon collapse, due to development of resistance by the mosquitoes and the malaria parasites. To reduce this risk, a more durable strategy should be developed. The current slippage in funding for malaria programs from outside donors suggests an opportunity for African countries to increase their contributions, which would also give them more control over their national strategies. Suppression of malaria in Africa is a very sound investment; it should be continued.

Submitted by Bill Jobin (not verified) on

Research: Economic aspects of suppressing malaria in Africa

September 22, 2014
Author(s): William R. Jobin
Reference: MWJ2014, 5, 8
Access: Open Access 2.0

The purpose of this study was to determine whether investments in suppressing malaria might produce significant benefits for African nations. Two epidemiologic analyses wereused in parallel to evaluate data from Africa: a before-after comparison of countries treated under the US President’s Malaria Initiative for Africa (PMI), and a simultaneous comparison of treated-untreated countries. From 2007 to 2012, relative increases in population and gross domestic product (GDP) were greater in 14 countries treated as part of PMI than in 9 similar, but untreated countries. In the treated countries the relative increase in the GDP of 0.61 before malaria suppression rose to 0.64 afterwards; whereas in the untreated countries it fell from 0.67 to 0.56. The increase in GDP in the 14 treated countries that was attributable to malaria suppression over the 5-year interval was about $4.77 billion. During that period, the mean cost of suppressing malaria had been about $1.43 billion, indicating a return on the investment of 3.4 to 1. However, the costs began rising steeply in 2012. Malaria suppression might be worthwhile for African countries to undertake themselves, as long as the biocides and drugs in current use remain effective.

Read full article: PDF icon MWJ2014_5_8.pdf