TCS Daily

The Health and Wealth Puzzle

By James K. Glassman - February 4, 2004 12:00 AM

Early last December, I traveled to Kenya and Uganda with a delegation of health experts to look at efforts to fight AIDS in Africa. What I saw was both depressing and inspirational: overwhelming numbers of the dying and orphaned, but impressive attempts to save them by drug companies, faith-based charities, and U.S. government agencies.

When I returned home, however, I realized that I had missed a big part of the story.

President George W. Bush has committed $15 billion over the next five years to combat HIV and AIDS in Africa and the Caribbean, and well-meaning people are searching, through trial and error, to find the best programs to get the job done. But even if AIDS were eradicated tomorrow, Africa would still suffer terribly from disease, environmental degradation, and natural disasters.

Why do nearly half of all Africans contract malaria every year and 2 million get tuberculosis -- diseases practically non-existent in the developed world? It's not the climate. Malaria and TB were horrors in the United States a few decades ago. Why these disparities?

In a word, poverty. And poverty, as we learned in the twentieth century, does not stem from a lack of natural resources (look at Singapore) or a surfeit of bad weather (look at Minnesota). No, poverty grows from bad political and economic systems, and Africa has those in abundance.

And not just Africa. On December 22, 2003, an earthquake registering 6.5 on the Richter scale struck near San Luis Obispo, between Los Angeles and San Francisco. While there was extensive damage to property, only three people were killed.

Four days later, an earthquake of similar magnitude, 6.6 on the scale, hit near the historic city of Bam in Iran. The deaths are still being counted, and about 30,000 have already been confirmed.

Again, the disparity was no accident. Two larger, more urban quakes in California -- Loma Prieta in 1989, which devastated parts of San Francisco (6.9 magnitude), and Northridge in 1994, which caused about $30 billion in damage to suburbs northwest of Los Angeles (6.7 magnitude) -- killed a total of 120 people. Meanwhile, an earthquake in a far more remote region of Iran in 1997, registering just 5.5 on the Richter scale, killed 1,000.

The correlation between poverty and casualties from natural disasters is intense and glaringly obvious. Scan the database of the Centre for Research on the Epidemiology of Disasters, maintained by the University of Louvain in Belgium, and you'll find that -- in terms of loss of life in the past century -- nine of the ten worst floods, eight of the ten worst wind storms, and eight of the ten worst earthquakes occurred in poor countries. In 2002, half of the 30 deadliest natural disasters occurred in Africa and nine in South Asia (India, Iran, etc.). None took place in North America or Europe.

It's not that developed nations are immune to the forces of nature. To the contrary, in 2002 CRED listed 17 natural disasters in the United States -- wind storms, earthquakes, floods, and droughts. That was twice as many as in any other country. But in most of those disasters no one was killed, and deaths overall totaled only a few dozen.

According to the Red Cross, in the last ten years "on average 13 times more people die per reported disaster in [poor] countries than in [wealthy] countries." Very simply, wealth makes health. Richer countries have the resources to build stronger buildings, to maintain better emergency communications, to rescue the trapped, and to prevent the injured or sick from becoming the dead. Certainly, poorer countries benefit from the wealth of richer countries (through, for example, drugs developed by pharmaceutical firms), but they require their own prosperity.

The same formula applies to the environment. In his book, The Real Environmental Crisis, Jack Hollander, professor emeritus of energy and resources at the University of California at Berkeley, shows the link between poverty and environmental degradation. It's obvious to anyone who sees charcoal being burned as fuel in Uganda or dried dung in rural China.

The question is how to improve the economies of poorer nations, and the answer is to end government corruption, advance democracy, and promote free market principles. Ultimately, those measures will save more lives than noble emergency efforts to battle particular diseases and disasters.

A version of this article appeared in The American Enterprise Magazine.


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