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Toward a theory of economic development and malaria

June 12, 2013 - 21:27 -- William Jobin

We know in our hearts that economic development and malaria affect each other. And we can make a pretty good guess at the variables involved. Snowden's book on the suppression of malaria in Italy lists them fairly precisely: literacy, education, agricultural productivity, government stability, etc.

For me, the end of malaria will also coincide with the availability of affordable and reliable electricity, and improved housing with metallic screens on the windows and doors.

If we look at the history of malaria suppression in the northern countries, we should be able to make a chart showing when these factors changed, and when malaria disappeared. And if we study these factors in Africa right now, we might be able to assess their importance, and guess their future.

Having such a theory, and specifying the relation between these variables and malaria prevalence or deaths, would give us guidance on where to invest our money: drugs or drainage, spraying biocides or improving education, buying temporary bednets or improving housing, hydroelectric projects like the Rennaissance dam in Ethiopia or more bednets.

Before I go too far, I would solicit your comments on the important socioeconomic variables, and the links between them and malaria.

Let's give it a try.

Bill

Comments

Submitted by Luiz Ozaki on

I completely agree with the author. Economic development with its social implications, or best, with social objectives, demands effort and organization. No action, the entropy rises. Where the incidence of malaria is highest and for that matter, any other neglected disease? It would be interesting to see the chart mentioned above.

Jeff Juel's picture
Submitted by Jeff Juel on

Economic development and malaria clearly affect each other. A population chronically ill with malaria obviously hinders economic development; and less economic activity means that there are fewer resources available for drainage, screens, drugs, spraying, monitoring, etc.

This is the sort of thing that is, by dentition, a "viscous cycle".

Economic development is vitally important. In my humble opinion, the eradication of malaria in the absence of significant economic development is virtually impossible.

There will not be a Silver Bullet here. Defeating malaria will entail a google of contributing factors: economic development, good government, peace & stability, science, high-tech breakthroughs (maybe), education, chemicals, AND engineering. Engineering = safe clean water, drainage, flood control, sanitation, electricity, and modern infrastructure.

Engineering is extremely important - but I'm biased.

Jeff Juel, PE
www.jueltide.com

William Jobin's picture
Submitted by William Jobin on

I just got a private note from Lena Hulden of Finland who has published a fascinating study on the gradual disappearance of malaria from her home country. You should read it at http://www.malariajournal.com/content/8/1/94. She found that the decline correlated well with the decline in family size. Figure that out!

Thanks Luiz and Jeff for your encouraging comments.

Also, I remind you of Frank Snowden's book on the disappearance of malaria from Italy. He lists several factors as important, besides the direct attack by the Ministry of Health:
migrations
wars
literacy and education
political stability.

Another very interesting look at this is a recent paper by Gething, Smith and Hay which showed that urbanization correlates well with declines in malaria. It is easy to see how the contamination of water and air in urban areas would make life tough for mosquitoes. But I wonder if also the better availability of human services such as health care and education would not also be involved.

Any more ideas will be greatly appreciated. Maybe some day we can figure out what is going on.

Bill

William Jobin Director of Blue Nile Associates

William Jobin's picture
Submitted by William Jobin on

Further thoughts on a theory of socio-economic development and malaria

The historian Snowden describes the social matrix of malaria in Italy
during the Twentieth Century, and concludes that the Italians were
able to eliminate malaria because they attacked it with a holistic
strategy. Thus to fight malaria in Africa, he calls for a multi-
factorial approach that includes all the social determinants of
malaria, including attention to human ecology as well as mosquito
ecology.

Looking at its economic dimensions, malaria seems to cause poverty
and poverty seems to confirm malaria. Thus before we would try to
suppress malaria in Africa, we urgently need a broad understanding
of both its social and economic roots, as well as human and
mosquito ecology.

Electricity. Expansion of reliable and affordable electricity
undoubtedly is also important in reducing malaria transmission in
the torrid tropics. Electricity has broad public health benefits in
itself, because it improves the functioning of hospitals and health
centers, provides refrigeration for foods, medicines and vaccines,
and also powers electric pumps for safe water supplies.

Of direct relevance to malaria transmission, the availability of
affordable electricity allows families to sleep comfortably in closed
or screened rooms during the hot and humid malaria seasons, using
electric fans to give them protection against malaria mosquitoes. By
disturbing biochemical gradients in the air, fans also interrupt the
searching behavior of mosquitoes as they seek their warm-blooded
prey in darkened rooms.

One way to examine the relation of electricity to malaria in endemic
zones of Africa might be to measure the changes in malaria in
endemic countries where large hydroelectric dams have been built.
The first big African dams are well known: Akosombo Dam on the
Volta River, Aswan Dam on the Nile River, Kariba Dam on the
Zambezi River and Kainji Dam on the Niger River. More recently
there is Manantali Dam in the Senegal River basin, as well as Merowe
and Bujugali Dams on the Nile River.

There must be other important factors affecting changes in malaria
transmission such as education and literacy. Perhaps income and
quality of housing are important too. Maybe agricultural
development is important, as malarious marshes are converted to
crop production, or as lowlands are flooded by poorly controlled
irrigation.

Summary. We should probably consider the following factors in
developing a theory of economic development and malaria:
1. Electricity
2. Family size
3. Education or literacy
4. Income
5. Agricultural development (implying reclamation of malarious
marshes, or expansion of irrigation)
6. Housing quality (such as the switch from adobe to concrete
houses in Mauritius)
7. Urbanization and consequent pollution of air and water

William Jobin Director of Blue Nile Associates

Submitted by Fran (not verified) on

Hi Dr. Jobin! How are you?! . I came across this and am just reconnecting. And, about the important variables mentioned here, I think they all add up to creating an environment that supports human physical and mental health. I think when people have that, they are automatically, naturally more resistant to any kind of illness. Low-tech economic initiatives, good organization, and a lot of bt and netting. Well, that's a short version anyway. --
-- Fran, (from Foxborough NRRC)