3 readings for next week

For Tuesday:

http://documents.worldbank.org/curated/en/442521523465644318/pdf/WPS8402.pdf

 

For Thursday:

 

https://sites.duke.edu/malaria/files/2012/10/Sachs_Malaney_2002.pdf

and

https://pubs.aeaweb.org/doi/pdfplus/10.1257/app.20150369

 

Please read both.  Your comment can be on either reading or a broader insight/question related to both.

 

 

 

Comments

[Beverley_xia]

“The economic and social burden of malaria” by Jeffery Sachs and Pia Malaney discusses the astonishing many ripple effects across economic and social realms of malaria.

Malaria's ability to infect wealthy and poor people alike may unite all in the country to fight against malaria. Malaria, unlike many other deadly diseases, spreads effectively through the air. As a result, wealthy people cannot shield the disease off through paying for more refined physical facilities like screened doors because when they leave home, they can still get infected. They must attempt to cure the disease so as to be safe. By curing malaria, poor people in the country can also benefit. Thus, when people understand the many burdens malaria brings better, the whole nation would likely collaborate to combat it. With money and motivation, it is possible to at least suppress malaria to a degree where it does not impede the majority’s productivity. In fact, suppressing malaria may not be too hard. Since, according to the authors, adding insecticide-treated bednets reduce child/infant mortality by up to 60%, reducing the severity of malaria may require only a relatively low amount of investment. When the rich realizes how malaria affects their lives not only by undermining their health, it is likely that they would willingly pay for bednets and other basic goods to suppress malaria and help save many children’s lives.

It is interesting how the failure to protect the environment affects economic development by providing the proper environment for malaria to prosper. By failing to maintain the balance in our ecosystem, temperature and sea level rise, making more portion of the Earth hot and damp. Such environment suits mosquitos, encouraging them to grow in vast numbers and spread malaria if they happen to carry it. To prevent more regions from turning into tropical or subtropical regions where it is hard to eliminate malaria, it is important and urgent to protect the environment.

The fact that malaria can affect cognitive abilities of children before and after birth should alarm politicians of developing countries. The 21st century appears to me the century of innovations and technological advancements. Countries that fall behind in the process of innovation may end up with a bigger gap with the developed countries since developed countries, holding innovative technology, can increase their productivity at an increasing rate. Malaria, however, makes it harder for developing countries to catch up by harming its children’s ability to understand and behave. With impeded cognitive abilities, children would have a harder time learning new knowledge, let alone creating more efficient means of productions. Thus, governments of lower-income countries should emphasize public health more so that the population is healthy enough to acquire knowledge and innovate.

[Margot McConnell]

One of the important things that comes from both of these articles is, more generally, the importance of investments in health and how these have much larger scale impacts on just about everything else within a country. Furthermore, what I generally saw across both articles is a particular focus in the benefits that come from children who are treated for these diseases. This is all tied together through human capital theory.

When Sachs and Malaney discuss that malaria effects both high income and low income countries, I think it really drives home the point of how big of an issue malaria is. In my Health in Developing Countries Economics class last year, we read an article about eradication of malaria in Sri Lanka. Malaria kills approximately 2% of the population within Sri Lanka. A few things in particular really stunned me when I realized just how complex the issue of eradicating malaria really is. The first is that, in Sri Lanka, they used a multidimensional approach to eradicating it. Additionally, as eluded to in Sachs and Malaney’s article, it was very expensive, costing millions to billions of dollars. However, the costs extend far past just the financial aspect. There are huge positive spillovers that arguably outweigh the large financial burdens. However, because this is ultimately a burden that effects both the rich and the poor, it is important for these countries to work together to try to fight against malaria because success stories like the one in Sri Lanka prove that the benefits outweigh the cost in the long run, especially because people are living longer. Sachs and Malaney also discuss how children are more at risk to die from malaria and that they are negative effects to fetal development when an adult has malaria. It is interesting to see how a mother’s exposure to malaria can have long term effects on the baby in the womb. Malaria is effectively “killing” two birds with one stone. Moreover, there appears to be long term cognitive effects due to malaria. These cognitive effects have an impact in education and labor market outcomes. Wellbeing and quality of life are two important things that are emphasized within human capital theory, and when there are negative cognitive effects due to the burden of disease that carry with you for the rest of your life, you are going to see those negative spillovers into education and the labor market as well.

Baranov and Kohler’s article about AIDS treatment works in conjunction with the malaria article because it emphasizes the importance of treatment for diseases that place a large impact on human lives. However, one thing I noticed in particular in relation to AIDS treatment that ties in to malaria treatment is access to healthcare to get treated for the disease but also access to information about the disease. In a lot of poorer countries, I think there is a large deficiency in knowledge about just how bad these diseases are and the impacts that these diseases will have especially in the long term. Especially in relation to AIDS, I think the social stigma surrounding it also plays a large barrier into getting treatment especially in countries like the United States. Besides just access to preventative care, education, and treatment for AIDS, I think there needs to be more movement towards figuring out how to reduce social stigma about AIDS. Again, I think this is all tied to human capital theory because it relates back to well-being and quality of life. Together, these two articles really emphasize the negative externalities of the burden of disease and how they negatively impact the quality of life for these individuals on a much larger scale than just suffering from the disease itself.

[Maisie Strawn]

I found these articles to be perhaps the most fascinating we have read so far this semester. I found their ability to isolate the effects of one just one factors (malaria or access to ART) to be incredibly powerful, especially when you consider how consequential those effects are. At first, such an analysis can be overwhelming. Not only does malaria kill a child every 40 seconds, but there’s powerful evidence that it has effects on overall economic growth rate of a country, schooling, saving, trade, tourism, and foreign direct investment and overall investment in human capital. Malaria and poverty seem to interact in horrible negative cycle. In Malawi, one million people are living with HIV/AIDS, which has significant impacts on savings and investment in education among other factors. These negative impacts could lead to a feeling of despair. But the findings of these studies actually give reason for hope. There is no panacea for economic development, but there is so much that can be achieved if malaria is eliminated and access to ART is increased. Huge strides have already been made towards these goals even with extremely inadequate finding (especially in consideration of the huge social benefits of eliminating these diseases). I believe these two studies provide compelling evidence for the impacts of investing in health and general and the eradication of these two diseases specifically. I was particularly struck by the study on the impacts of ART facilities in Malawi and how something as simple as transportation can hinder people’s ability to access this life-saving drug. I won’t say that this is an easy problem to fix, but it IS solvable. To me, that gives so much reason for hope. Of course, it is also incredibly frustrating when you consider how relatively little funding has been devoted to these issues when their elimination would have such incredible impacts on entire countries. These diseases are so tied to so many other factors; their elimination would have broad positive effects on the entire economy: Sachs and Malaney write that, “in low-income settings [reducing malaria transmission] may well prove to be among the most effective available spur to overall economic development.”
The underlying role of psychology on savings rate, especially in the Baranov and Kohler article, was also fascinating. Just the mere perception of increased life expectancy is enough to affect savings rate. The availability of ART clinics increased savings rate for both individuals with and without HIV/AIDS. The availability/proximity of an ART clinic had significant effects on human capital investment in the form of expenditures on education for children. The researchers also found impacts on mental health, which makes sense, but is incredibly interesting. They hypothesized that these improvements in mental health could also affect productivity. Economics is truly interdisciplinary.

[Alec Horne]

Both articles bring up interesting issues about human capital investment in health and how increased health leads to greater life expectancy and for the most part, greater investment in education and earnings. I think the articles tie into the ideas of the economic lives of the poor to a great extent. Obviously, we know that people in Sub-Saharan Africa have a higher exposure to diseases such as malaria which can stimulate increased risk of HIV and AIDS. From the second paper, we know there are ART facilities to help combat the problem and bring about better health for people living in the regions. Even so, how easy is it for individuals to access these facilities given their economic status?

In the Aids Treatment and Investment paper, we see how those living closer to facilities are able to get treatment and have better health outcomes as a result of the treatment. However, those who are unable to get treatment might live too far away to know their own status of the disease, and even if they know their status, get physical treatment. This is because of the economic status of the individuals who are too poor in order to get transportation to a facility.

Take Nigeria for example. In Nigeria, 67% of the population is aware of their HIV status. 53% of those people aware of their status are getting treatment with 80% of the individuals getting treatment being virally suppressed (UNAIDS Data 2019). The problem arises from the lack of people not being able to access treatment centers. When individuals do know their status and they are positive it slowly becomes worse. Even for those who know their status, only half are getting treatment. There is a need for more ART centers in order to combat the issue. Stated in an article, “A push on the number of sites providing HTC services has resulted in a huge increase, from around 1,000 in 2010 to more than 8,000 in 2014. However, this number is woefully short of the estimated 23,600 sites needed to provide universal coverage” (Avert). The result is a continuation of poor health outcomes in the region hindering life expectancy and possibly economic growth. The only way to help suppress the issue further is a greater investment in health throughout the region.

[Sofia G. Cuadra]

Throughout “The economic and social burden of malaria,” both Sachs and Malaney make it clear that malaria negatively impacts almost every aspect of life and impedes hope for economic development in countries where the disease proves highly endemic. To me the article helped paint a more poignant picture on the importance of tackling malaria in an economic and social sense, because up to this point I didn’t really know the actual statistics behind the disease. Although many countries in temperate zones have succeeded in eradicating malaria, the disease still proliferates in tropical regions of the world to the point that there still exists between 300 and 500 million cases a year, where a child dies every 40 seconds to the disease. The high probability that the number of these cases will double in the next 20 years is highly alarming as an increase would further exacerbate the economic and social costs of the disease experienced by the world’s poor. Consequently, it proves highly appropriate that the eradication of malaria represented a major pillar in the 2015 UN Millennial Development Goals that we learned about at the beginning of this semester.

On a similar point, as Sachs and Malaney discuss in the article, the causal relationship between malaria and poverty can run in both directions. For example, poverty (as endemic in low-income countries) can promote malaria due to the costs related to treatment and prevention measures, while malaria can cause poverty by deterring education, jobs, and savings and investments. Even the outside perception and fear of malaria in a country can deter tourists from visiting and foreign businesses from investing in the country. Consequently, both these sectors in malaria-endemic countries lose potential profits that could go towards economic development.

These significant impediments then push you to ask why foreign aid for anti-malaria programs have not increased. A quick google, led to me to learn that an insecticide treated bednet costs around $2.00, and as the article included, bednets can reduce child mortality by up to 60% in some countries. To me (especially from a foreign aid perspective), bednets seem like a small price to pay in exchange for saving numerous lives and seeing significant returns to investments in human and physical capital. One could then argue that these bednets represent one small factor preventing major growth from occurring in these malaria-endemic countries, an idea very much reminiscent of Kremer's O-ring theory of development. A small solution could help ease the economic and social burden created by malaria.

[Colby Boudreau]

I’m not sure why, but as has been the case with many of the issues that we have talked about this semester, it seems like malaria and the seriousness of the effects that it has are ignored and pushed to the side. This is a serious issue, one that appears to directly impede economic and social growth. Underdeveloped countries seem to always stay underdeveloped, and while they are working to improve their economic and living situations, most of the time the feeling is that these places are stuck treading water without actually doing anything to make legitimate improvements. Playing political games and following rigid economic policy has nothing to do with developing a country, instead just sends nations around in circles. While worrying about international relations and arguing about trade policy affects a nation’s performance, countries routinely ignore the economic, educational, and social empowerment of its citizens, young citizens, and women, all while neglecting to make the citizens health a national priority. It has been proven time and time again that focusing on individuals health and education is an essential step to start economic reform and development from the bottom while simultaneously reforming the underlying national institutions. Yet, somehow, countries continue to forgo simple steps to simple solutions that could drastically improve quality of living across the board. The most mind-boggling part of the whole paper is how cyclical poverty and malaria is. Malaria promote poverty because it renders so many people incapable of contributing to a community, in most cases is fatal, and on the other hand impoverished communities have little to no resources to prevent/treat malaria and are hit the hardest by it. With this in mind, the phenomenon where communities raise a fertility rate to combat a rising mortality rate is common, using the school of thought that parents need to have more children to account for the one that they know will pass away. In the case of malaria, this leads to larger families, larger numbers of diseases, and less resources (education, income, medicine) to allocate per children. So, while the increased fertility rate and number of children is a response to combat malaria, it just ends up allowing the disease to increase exponentially. Finally, going back to what we talked about in class, there shouldn’t have to be an economic reason to empower womens education or to prevent impoverished children and communities from contracting malaria, it should just be done. However, there is baffling economic evidence provided that says from 1965-1990 (35 years!) countries with a large portion infected by malaria grew at an astounding average rate of 0.4% a year compared to other countries average growth of 2.3% over the same time period. I don’t understand why countries refuse to address some of the simplest, yet most effective solutions to improving quality of living and starting a path towards development. If we truly want to help countries and populations begin their respective growth, a point needs to be made to stop overlooking the little things and address the issues that matter.

[Alice Chen]

The statistics in "The Economic and Social Burden of Malaria" were quite shocking and it's hard to believe that other diseases such as HIV and AIDS also impact those in poverty. The more we study these issues related to development economics, the more I'm realising how hard it is to maintain development.

The largest impact malaria seems to have on people (other than mortality rate) is school absenteeism. One study attributed 13-50% of school absenteeism to the disease, which puts a huge portion of children out of school. From our reading for Tuesday, we discussed how primary education has the highest social profitability in all world regions. However, if children, particularly school-age children, are missing school because of sickness, they may find it challenging to continue their education, leading to a continuous cycle of poverty. I found it fascinating how despite knowing all this information, we are still not spending enough on combatting malaria and keeping children in school. In fact, we are only spending around 100 million USD whereas the WHO predicts we should be spending an addition 2.5 billion USD. I understand that it is would be extremely costly to spend on vaccines and improving healthcare overall in impoverished nations, but in the case of malaria, providing basic preventions such as insect repellent and bed nets could easily decrease the risk of the disease.

I also wanted to look at the impact of malaria from the point of view of tourism and possibly other forms of industry that can spur economic development. I remember in high school I was interested in going on a service learning trip to Tanzania, but my parents were against it because they were scared I would catch an illness. A number of my other friends also were not allowed to travel to various locations such as India and Thailand because of the same fear. Though the article mentions that "linkages between malaria control and tourism have not been proven rigorously", I believe that decreasing the risk of catching certain diseases can help us increase tourism in a certain region, which can further spur development.

[Julia Moody]

“The Economic and Social Burden of Malaria,” by Jeffrey Sachs and Pia Malaney, explores the various effects of the deadly disease on the global population as a whole, delving into household wealth, education, climate patterns, gender inequalities, and economic growth. Sachs and Malaney discuss how poverty and malaria are correlated and the endogeneity between the two that make it difficult to assume causation in either direction. The lack of spending on malaria-prevention techniques in impoverished countries accounts for the higher malaria incidence, leading one to possibly believe that the lack of income in these countries leads to more disease. On the other hand, studies show that holding the countries with high malaria transmission constant, the economic growth is less than 1.3% of growth in other countries. Looking at malaria through the lens of economic growth made me wonder how malaria incidence changes depending on the type of political system in place. In class, we have discussed the trend of famines never occurring in countries with democratic governments and I am curious if democracies or other systems are more likely to have higher transmission of malaria. Obviously to study this, one would have to control for the region of the world the country is located and the climate patterns in that area, as tropical regions usually have a larger population of mosquitos. Because much of malaria prevention has to do with government spending on improved housing, environmental management, and indoor insecticide sprayings, the structure of the government and involvement of the government in society could greatly affect how widespread malaria transmission is in a country.

Another thought I had while reading “The Economic and Social Burden of Malaria” was of Kremer’s o-ring theory explaining the relationship between health and education in underdeveloped countries. Kremer found that a small factor like treating intestinal worms in children, which only cost $1 per child, increased class attendance and test scores of the students. He shows that investments in health improve education and therefore improve economic growth and productivity of the society. When discussing child mortality, Sachs and Malaney write that a lot of times, malaria can be easily prevented by using insecticide-treated bed nets. This simple change could have a huge impact on the health of children in countries with high malaria transmission and society as a whole.

[Olivia Luzzio]

Both Sachs and Malaney’s article, “The Economic and Social Burden of Malaria” and Baranov and Kohler’s article, “The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi” unpack problems that are preventing economic development in Sub-Saharan Africa. Personally, the most intriguing aspect of Baranov and Kohler’s article was their subjective measure of life expectancy, based on participants’ own predictions about their lifespan. Rationally, the sooner someone believes they will die, the less it makes sense for them to save or invest in their own human capital. Without investment in human capital, markets in these regions cannot expand. Therefore, citizens’ personal perceptions of their chances are a crucial determinant in economic development in their communities. It would be interesting to observe if communities with easy access to anti-malaria interventions experience the same trend as communities with easy access to antiretroviral therapy for AIDS.
It would be useful to have more panel data in order to obtain a more accurate prediction of the impact of subjective perceptions of life expectancy on human capital investment and savings. This would eliminate the possibility of a chicken-egg phenomenon influencing the results. After all, if the communities with highest subjective lifespan estimates are those near ART facilities, it is likely those are more urbanized areas that already have relatively significant human capital investment. Another compelling test would be to disaggregate the AIDS/ART data by gender to see if there is a significant difference between females and male’s investments in their children’s human capital for both long and short expected lifespans.
It is clear from both articles that human capital investment in the area of health and particularly disease prevention and treatment is vital for economic development. Public health must be prioritized by governments and the international community in order to kickstart human capital investment at the individual level in underdeveloped communities.

[TevinPanchal]

A common theme In our class thus far has been the relationship between investing in health and education and economic growth. The article, "The economic and social burden of malaria" speaks to this point on the health side. The article brings up an interesting point in, "Poverty may promote malaria transmission; malaria may cause poverty by impeding economic growth or casualty may run in either direction". We talked about this in an earlier study which showed that investing in health care with removing intestinal worms led to higher graduation rates and test scores which down the road leads to economic growth. The reason Poverty and Malaria are interrelated is because one is a factor or outcome of the other. Just like intestinal worms and graduation rates were interrelated. Investing in the fight against Malaria can lead to economic growth in subtropical and tropical regions. Malaria is a big problem and I remember getting a Malaria shot before I was able to go to India when I was younger. Everyone in the world should be getting the vaccination and the outcomes would be beneficial to everyone, not just the people who would be getting vaccinated.
Another interesting point from the article is the quality quantity trade off with respect to the mortality rate of Malaria. The effects of malaria run further than just people dying, the high fertility rates that come about from the high child mortality rate leads to negative economy consequences. There is a relationship between high fertility rates and reduced investments in children. Not investing in health which in this case is Malaria also effects investment in education which are two huge factors in ultimate economic growth.

[Kate_groninger]

In continuing with the theme of human capital, both Sachs and Mulaney’s article, “The Economic and Social Burden of Malaria” and Baranov and Kohler’s article, “The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi” stress the linkage between human capital investment and economic development. Diseases such as Malaria and HIV/AIDS impede on economic growth by limiting human capital investment whether that be through missing school believing that your life expectancy is short. Sub-Saharan Africa seems to be hit the hardest by these diseases, and the region has suffered the consequences. I thought it was interesting how the Malawi study examined the subjective expectations on life expectancy, as those are the true determinants of decision making. If you expect to live longer, then you will invest more in your education because you will expect higher returns in the future. If you live in an environment where it is common to die at a young age, you might not have as much incentive to save your money or invest in your education.

Another element that stuck out to me was that foreign aid needs to not only be targeted at vaccines and medical treatments, but also in infrastructure and communication outlets. As observed in the Malawi study, transportation costs were one of the main reasons why patients failed to follow up on appointments. Even though ART was “free,” you still had to pay for it through finding transportation to the building where the treatment was being offered which was a struggle for many rural patients. Additionally, because of the heavy stigma surrounding HIV/AIDS, information about these clinics might not have spread as efficiently or might not have reached as many people as it potentially could have. Other methods of communication besides word-of-mouth could be useful in reaching more people and in helping to maintain the patient’s privacy.

[Caroline Florence]

Both articles emphasized the importance of investing in health to improve human capital. I thought that Baranov and Kohler in “The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi” made a particularly interesting point: life expectancy plays an important role in economic growth and influences decisions in savings and investments. I thought it was really fascinating that the authors used the introduction of AIDS treatment in Malawi as an exogenous shock that allowed them to observe how savings and investments in human capital changed. This was a really clever mechanism to determine whether these kinds of treatments actually work. I find it surprising that distance to an ART facility plays such a big role in changes in investments in human capital, even though people near and far both had access to the program. I would think that it would be worth the inconvenience to get AIDS treatment, but when transportation costs are high, this is not the case. It is sad that distance alone is a reason to compromise health and life expectancy.

This study provides evidence of the success of policies aimed at improving health in developing countries. This study found numerous positive spillover effects of AIDS treatment, such as increased savings and investments, increased schooling, mental health improvements, and a reduction of orphaned children. These effects could be even greater if people were better able to access ART facilities. The ART program and programs like it that aim to improve health in developing countries could provide tremendous economic growth. This paper made me hopeful that these kinds of programs are worth investing in. I hope that others look to the success of this program and try to mimic it in other countries.

[Travis_Dover]

Both of these readings immediately made me think of the Bill & Melinda Gates Foundation. Much of the mission of their charity is eradication of malaria and treatment of HIV and AIDS among other important tasks like empowering women’s education. I noticed the article on malaria was written in 2002, and I was relieved to read on the Gates Foundation website that deaths from malaria have been reduced by half since 2000 so I hope the appalling data presented in that article looks better today. The malaria article also made me think of the case study we discussed earlier in the course for the incredibly high rates of return to education if intestinal worms was also treated in the child. The fact that malaria is preventable and treatable, like intestinal worms, elicits an emotional response that we have a responsibility to help these people because it is so low cost to help. Moreover, it demonstrates the trend we have observed throughout the semester that ROI on various endeavors in low-income countries can be incredibly high because easily fixable things are hampering development. The malaria article also elicited an emotional response when it discussed the expansion of the malaria problem as the climate changes. I have often heard people proclaiming that climate change impacts individuals in low-income countries at a higher rate than those in higher-income countries, but I had never heard concrete examples. The fact that malaria will worsen in poor countries where it is already rampant as the earth warms is very sad and further demonstrates the dire need to do something to slow and stop climate change.
Both articles illuminated our flu shot example of the incredibly high marginal societal benefit of preventing and treating diseases like malaria and HIV/AIDS. When people are treated for malaria and HIV, this lessens the probability that they will spread the disease to others. As a side note, it was interesting and sad that the spread of these diseases actually often occurred together as malaria requires blood transfusions that sometimes inadvertently infect the recipient with HIV. The prevention and treatment of these diseases has huge positive implications for economic development as caretakers are freed to enter the labor market, workers become more effective as their mental health improves due to less worry of being infected with disease, and outside industries have the confidence that they can invest in an area without their people becoming sick. In sum, I had no idea that disease such a role in the poverty trap that occurs in some developing countries. Raising life expectancy and lowering the rate of disease in these countries with widespread disease is necessary to improve human capital investment and grow economically.

[EricDragon9]

In “The Economic and Social Burden of Malaria” by Jeffrey Sachs and Pia Malaney, the extent of which malaria has hampered economic growth and caused high social costs in regions in the tropics is highlighted through the diseases detrimental effects to society by increasing child mortality, increasing the dependency ratio, reducing school time and productivity, reducing the savings rate, reducing cognitive abilities, reducing investment in female education, increasing the mortality rates of other diseases, reducing foriegn investment into high malaria concentrated areas.

What surprised me the most about the impact of malaria on human populations in the tropics was how prevalent the impact is throughout major facets of society. As mentioned earlier, malaria has impacts from child mortality, education, cognitive abilities, the mortality of other diseases, and even foriegn investment. While I did know that malaria has likely been responsible for over a billion deaths in human history, I just contained that into a health issue and never really thought of it as education, GNP, and foriegn investment issue as well. This also concerns me, because, while I know there are some organizations working on ways to combat the disease, there has not been a lot of recent news (at least on my radar) about improvement in fighting malaria. I understand that the news has about a 30 second lifecycle and most of it only shows negatives to increase viewership, but I would still expect there to be at least one positive story popping onto my news feed now and then, since I do enjoy learning about how technology is improving lives.

Recently, I did stumble across a video about how scientists were able to introduce the bacteria called Wolbachia into mosquitoes that stopped them from carrying all four of the Dengue diseases. The fascinating part about this solution to Dengue is that when the Wolbachia mosquitoes breed with wild type mosquitoes, the resulting offspring are Wolbachia mosquitoes. Thus, over time and with enough releases of Wolbachia mosquitoes, there is a chance for the whole mosquito population to stop carrying Dengue. In order to test this out, the scientists made a smart choice by consulting local communities and explaining how releasing these new mosquitoes into the area would reduce cases of Dengue and even gave residents the opportunity to help raise Wolbachia mosquitoes. The results were a great success with a 70% reduction in Dengue cases in areas where the mosquitoes were released (that is an underestimate in its impact, since people in the community were highly mobile and often traveled to non Wolbachia mosquito areas). I’m not entirely sure if Wolbachia bacteria has the same effect on the transmission of malaria, but it is something that hopefully will get looked into. This approach works with nature, instead of fighting it, so while it may be costly in the short run, once it is able to take advantage of nature’s exponential growth, in the long run it will be relatively cheap.

[Kenza Amine Benabdallah]

“The economic and social burden of Malaria” details the multiple ways by which malaria impedes the development of many countries. The writer argues that “Where Malaria prospers most, human societies prospered least”. I was not surprised by the correlation between GDP and malaria, but I was surprised by the number of people who suffer from this disease every year.

I was astonished by fact that there are 300 to 500 million clinical cases of malaria every year. This is because the burden of this disease is not evenly distributed. The global pattern of malaria show that it is mainly found in the tropics, but also into the subtropical regions of the five continents. In the regions that were characterized by strong seasonality and cold winters, the attempts to eliminate malaria were successful. On top of that, malaria cease development completely at temperatures below 16°C. Therefore, we can assume that some countries are predisposed to face a certain economic obstacle.

There are two important categories of mechanisms by which malaria can impede development and cause economic costs beyond medical costs. First of all, as we talked about in our last class, health creates changes in household behavior, including investment in schooling, migration, and savings. The second one is the impact of malaria on trade, tourism, and foreign direct investment.

The paper “The impact of AIDS treatments on savings and human capital investment” was a little harder for me to understand. I still found it fascinating the way they employed the “difference-in-difference” strategy to estimate the impact of ART availability on cash savings, education expenditures, and children’s schooling. It’s very interesting to see how much the ART availability improves educational attainment for children of the respondents.

[rrirwin]

Each reading—while discussing the effects of malaria and AIDS on overall human capital—pays a significant amount of attention to the effects on children. I found this to be quite interesting considering investments in child health and education play a particularly important role in economic development.

“The economic and social burden of malaria” explains how malaria has a greater negative effect on children, as they are unable to build immunity against the parasite in comparison to adults. Further, the article addresses the problem of increasing fertility rates as a result of high child mortality rates. This creates high population growth rates, resulting in aggressively high populations of low-income countries. High fertility rates also decrease the investments in education per child. As we know, investments in educations bring high returns in low-income countries where malaria is often present. This phenomenon reflects the circle of endogeneity low-income countries experience that we keep coming back to in class. I think it’s important to acknowledge that if malaria can be completely eradicated through policy intervention, it will help decrease fertility rates, increase investments in child education, and positively influence economic development.

“The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi” similarly acknowledges the influence of health dangers in the lives of children. The econometric results of this paper found increasing investment in child education following the implementation of ART facilities. They found that “reducing the distance by half increases expenditures on children’s education by US$2.5 in (quarterly) spending on education per child during 2004-2010).” This statistic is extremely impressive. Not only does the availability of an AIDS treatment benefit the health of the entire population, it leads to quality investments in the human capital of children. Again, in the context of our class on Tuesday, the returns to investment on education have potential to promote economic growth in low-income countries.

[Lauren Paolano]

The two articles exemplify the statements Sen has been preaching about how countries have been ignoring the importance of health and education. Country development is not only about economic growth and opportunities, but looking ahead, we must put our efforts and investments toward human capital in order to create more freedom and growth in education and health. "Economic and Social Burden of Malaria" by Sachs and Malaney, discusses the striking correlation between malaria and poverty, and malaria-endemic countries also have lower rates of economic growth. The article goes into the specifics are multiple channels by which malaria impedes development, including effects on fertility, population growth, saving and investment, worker productivity, absenteeism, premature mortality and medical costs.
It was interesting to me how economic development alone is not enough. And this is clear in even relatively wealthy countries with high year-round temperatures such as Oman and the UAE, have been unable to eliminate the disease. In order to increase education and health we must put more capital into research and development in order to receive the desired returns.

[William Chapman]

Malaria sometimes feels like a tired subject. It is a disease that we have as humans been fighting for centuries and yet have still not gotten close to irradiating the disease. The potential effect on the birth rate I found particularly fascinating. Knowing that there is a high likely hood of your child dying young would lead a rational mother to spend less time and resources on the child until the child reaches an age where he or she is likely to survive long-term. As terrible as it sounds, it is also reasonable for the family to give birth to potential replacements since they know that it is likely that the child will die before they do. This is just not something that we in the United States have to experience on a regular basis. A child dying here does happen, but it is considered a tragedy and an anomaly rather than a sad but expected part of everyday life. This leads to the quantity over quality of child-rearing in the affected countries and is likely a large part of what is holding them back from creating more human capital.

We have talked a lot about nutrition and health when looking at development and these issues strike me as similar but on a much larger and more deadly scale as the worms preventing students from attending school. Children cannot attend school and then become productive members of society if they are sickly or even die before reaching school age. Even as education rises, at least in years attended, this sickness and fear would certainly impact the quality of learning achieved by the children.

When looking at the maps showing the areas with a high risk of malaria infection over time, I noticed that the ‘Asian tigers’ were either never at risk or were no longer at risk as they began their long economic expansions. Japan Korea and most of China were no longer at risk in 1994 according to the map. In contrast, most of Africa and South America still were. This may have been a factor in the divergent growths of the developing economies of the three regions.

[Anne Riter]

In "The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi," the authors discuss the impact of having ART facilities nearby on human capital. They assert that living close to an ART facility will increase life-expectancy which will then increase education which positively impacts income, health, and well-being in a cyclical nature. In "The Economic and Social Burden of Malaria," the authors talk about the negative influence of malaria on families and how it hinders a family's ability to improve socially and economically. Both articles emphasize a need for investing in health care.
The first article found that for families who lived near ART facilities, their children were more likely to go to school longer, their life expectancy increased, and they also increased their savings. When children receive more education, their future prospects also improve and they're more likely to earn a higher income. Also, when girls are educated, their children's health will also improve. This reflects endogeneity and the fact that all of these factors are related and interconnected.
In the second article, it points out that children are the worst affected by malaria. Also, the prevalence of malaria in low-income countries inhibits future development since life expectancy is lower. Families who think their children won't live as long won't invest in their children's education and thus, the cycle of endogeneity negatively affects these families. Children who aren't educated won't earn a higher income and their health is typically worse.
Both of these articles to me stress the importance of not only investing in health care for low-income countries but specifically child health-care. Children are the future of these countries, and if they aren't living as long due to malaria or HIV, then what will become of those countries? There are so many positive spillover effects when children are healthy, such as attending school regularly, that their future incomes can rise, their future children will also be healthy, and their country will develop.

[Danh Nguyen]

In “The economic and social burden of malaria”, Sachs and Malaney analyzes how malaria and the failure to tackle viral diseases can lead to detriments to every element of society: health, economy, social equity. Looking back at historical evidence, viral diseases, such as the black death and tuberculosis have dealt quite a blow to many past civilizations, and thus, it is important to regard these diseases as a global problem rather than a local one. Yet, viral diseases, particularly malaria, disproportionately affects the poor, who are more exposed and vulnerable to the disease and lack access to effective treatments. Thus, malaria and poverty have a bidirectional relationship where malaria further impoverishes the community and more members in the community got malaria. Out of three measures of development, income, health, and education, I always believe that health is the most fundamental of the three, and it is disheartening to see how there are still so many people suffering from malaria. I think part of this issue can be tied back to urban bias, where people focus much spending on healthcare in urban areas, especially those where the more affluent concentrate, rather than rural areas where the natural and sanitary conditions of farmland increase exposure to malaria. Healthcare and insurance are also not offered to those that actually need them. It boils down to the cost-benefit analysis process of policymakers in their respective countries. It is more ethically sound to invest in healthcare for the poor, which will thus create a great positive economic development in the long run. Yet, policy makers tend to strive for short economic profit from industrialization and trade expansion. At this point, policymakers and the people in power in every country need to look beyond the election period to see through the needs of the people in the world, because in the end, borders divide us but empathy ties us together.

[Prakriti Panthi]

Both articles highlight how important it is to invest in health specially in developing countries. Using difference in difference model Baranov and Kohler show that ART availability not only saves lives but also has positive effect on investment and saving in children’s human capital, which directly transforms to investment and savings in the future. The cost of having an epidemic such as Malaria is great not just for a household, but for the entire nation. I see it vital to invest in public health and medical technology for malaria control. Along with that, knowing that bednets, sprays and environmental control measures are successful measures to control for prevention, I wonder how successful countries in Africa have been in spreading this knowledge and awareness in the most malaria-prone regions. Spreading knowledge and awareness is the most cost effective prevention measure and if done effectively I think can create a change in behavior. I know in Nepal, where Malaria epidemic has been a national problem, I know that along with investment in public health, malaria awareness programs and campaigns advocating behavior change has played a role in decreasing number of cases.
It was also interesting to read how malaria affects women, and pregnant women particularly, and contributes to higher fertility, which has additional costs associated with it.

[Kristina Lozinskaya]

Jeffrey Sachs and Pia Malaney’s work in “The economic and social burden of malaria” has left me quite shocked after I realized how much one curable disease can affect in international economics and world community. Some of the dimensions described by Sachs and Malaney as adversely impacted by malaria include fertility, savings and investment rates, crop choices, schooling, and migration decisions. In general, their work reminded me a lot of Kremer’s deworming research in terms of the similarity of the outcomes. Specifically, I am talking about one of the questions that we have also raised in class when discussing in what area we should focus our investments when considering how we can help the poor households most. I remember that in one of our very first classes, we have argued that directly investing in children’s healthcare rather than merely aiming at the increase of a household’s income potentially has more long-term benefits because of the strong causality between health and income. Just like the children in Kremer’s study who cannot focus on their studies because of malnourishment triggered by the intestinal worms, the children in Sachs and Malaney’s study suffer the same effects equally resulting in school absenteeism with one study attributing up to 50% of medically related school absences to malaria. Considering the fact that the quality of human capital is determined by the quality of schooling and that malaria’s effects on schooling go far beyond just absenteeism but also include increased failure and drop-out rates, malaria, through “depressing the rate of human capital accumulation,” impairs economic growth much more considerably than one can imagine if one only sees its direct effects on health and lower productivity triggered by the physical fatigue. Another surprising, sort of “concealed” negative spillover of malaria is the fact that its “tentacles” reach even fetal development. Because of the diminished immunity, pregnant women are especially likely to be infected, which presupposes the higher risk of miscarriages, neonatal and infant mortality, and underweight babies who, as it turns out, are two to four times more likely to experience failure in school later on.

There is also a lot that I would like to discuss here in terms of how the “child-survivor hypothesis” leads to high fertility rates that are in turn likely to lead to reduced investments in education (another striking linkage between how malaria affects social behavior and decision-making that is once again intertwined with children’s education that leads to impaired economic growth) but I am sure we will probably talk about it later in class, so for the sake of keeping it short, I will mention another thing that has impressed me most, namely, the failure of investment in malaria-endemic countries. The case with the 7,000 infected associates of the London-based Billiton company made it very clear why there are so not many incentives for the richer countries to expand their markets and invest in such regions. It is indeed a tragic linkage: because of the disease, other countries are afraid to get involved, so there are hardly any investments which hinders economic development and doesn’t help any of the aforementioned problems at all. However, although Sachs and Malaney state that “the world is now facing a rapidly increasing disease burden,” the situation with malaria looks more promising now than in February 2002 when this article was published. According to the latest World Health Organization’s report released in November 2018 (https://www.who.int/news-room/fact-sheets/detail/malaria), there were 219 million cases and 435,000 deaths from malaria as compared with the figures provided by Sachs and Malaney from 2002 or 300-500 million cases and more than one million deaths per year. It also seems like the $3.1 billion in funding for malaria control and prevention in 2017 is better than how much was allocated for that purpose in 2002, although it is, of course, far from enough, and we, as the world community, still have a very long way to go towards eliminating malaria and all its truly dire effects.

[Adrian Lam]

Reading these papers on malaria and AIDS reminded me of our discussions of endogeneity, which seems to be a reoccurring theme in our class. For example, Sachs and Malaney’s piece “The Economic and Social Burden of Malaria” describes how poverty can promote malaria transmission and vice versa. My own perspective is that in countries where lethal diseases are rampant, making money is not the main focus nor priority. Instead, simply suriviving becomes the most important objective. If the health of individuals is in a poor state, these same unhealthy individuals will likely have low levels of productivity. Take the example of Europe when it was facing the Black Death, or bubonic plague. It makes sense that Europe’s economy suffered greatly during this time period because everyone was constantly worried about disease and death.

I was especially interested in the data from figure 1 about the global distribution of malaria. When I did some research, I found that malaria is still present strongly throughout many countries today, including Indonesia (International Association for Medical Assistance to Travelers:
https://www.iamat.org/country/indonesia/risk/malaria ). This came as quite a surprise to me because I had very little idea that a disease which has been eradicated in the US for so long is still such a rampant issue among the rest of the world. In this manner, these papers helped decreased my ignorance and helped me become more knowledgeable about the rest of the world.

I was also curious to compare the current distributions of AIDS and Malaria worldwide, and I was astonished by how much overlap there was between the two graphs. The world bank has time series data on HIV infection rates worldwide here: ( https://ourworldindata.org/hiv-aids ). African countries had especially high rates of both diseases. From there, I spiraled down a little rabbithole because I was really curious to see if other researchers had looked at the link between these diseases.

This is when I found an interesting paper published in 2018 that examines the coinfection of malaria and HIV in sub-Saharan Africa, which can be accessed here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067790/ . This paper described how malaria and HIV can each impact the transmission of the other disease. In areas where both of these diseases are prevalent, malaria can actually increase the “viral load of HIV” and its probability of transmission. One of the most interesting takeaways I got from this paper was how “it has been postulated without the amplification effect caused by malaria, HIV decreases to extinction.” These are the types of interesting hypotheses that cause me to take a step back and reexamine the plight of low-income countries with a set of new eyes. Now, I am able to better see the big picture of how endogeneity effects, even in the areas surrounding health (where malaria and HIV promote each other), can once again trap a country in a vicious cycle of poverty.

[Jack_curtis25]

The effects of malaria on economic growth are astounding but overall not surprising. The presence of such as deadly disease in the tropical regions, where it is most prevalent, deadly, and hard to eliminate is a significant impedance to growth. One can imagine the effects on returns to human capital investment if the likelihood of dying, or being very sick for a prolonged period of time must have. Under these circumstances, the rational decision is not to make large investments in human capital but rather in physical or natural resource capital. You wouldn’t invest heavily in a child’s education if there is a high probability that child may die before reaching working age, as morbid as that may sound. Poverty and malaria form a self-reinforcing endogenous process, a vicious cycle, which is extremely hard to break out of. I also think that the issue of malaria connects strongly with Michael Kremer’s O-Ring theory where no matter how much a developing nation say in Africa where Malaria infection rates are very high invests in say education and employment opportunities and training the returns will be significantly lower than expected. This could be due in part to the spillover effects malaria has on overall productivity of a person. As it mentions in the article missing school as a child because of malaria increases your likelihood and failure, repeat of grades, and eventual dropout of school. Perhaps what is most important to be done about the malaria crisis in developing nations should raising awareness about the issue so the global community can more readily asses the overall returns investment in decreasing cases of malaria would have. It is clear that the effected countries lack the funding and resources necessary to achieve the level of investment needed to combat this issue. This is a great opportunity for the global community to come together and make a strategic investment that is proven to have large returns to economies at large. Perhaps gaining control over malaria in sub-Saharan Africa along with AIDS is what is needed to provide the building blocks in order for the potential returns to human capital investment to exist therefore allowing the procurement of human capital to begin in a meaningful way.

Questions:
What is the best way to value/asses investments in health like in the cases of AIDs and malaria?
AIDs paper:
The paper stated that life expectancy affects decision making in terms of savings, investment, and lifetime labor supply. What other factors could this affect? In what ways does it impact economic growth?
Do increases in life expectancy also account for the increase in resource consumption?
Do increases in life expectancy by increasing savings further increase growth via more investment hence a multiplier effect?
If more investment is happening why aren’t we seeing higher earnings?
Malaria paper:
Has there been any progress in increasing funding for malaria prevention since the publishing of this article?

[Parker Skinner]

I have chosen to comment on the malaria paper. I find the proposed symbiotic correlation between high rates of malaria and low economic growth to be very interesting. Malaria has negative impacts on the development capabilities of affected nations, while simultaneously it can also be claimed that low incomes provide ample environments for malaria to devastate communities. Malaria only adds to the development roadblocks we have previously discussed; especially in relation to resource allocation to children. Higher child mortality rates lead to more children born in an attempt to maintain heirs to the family name and caretakers in old age. On the other hand, low incomes typically translate to unstable government budgets, and therefore, lacking social programs to combat malaria.

One aspect of the paper I would like to learn more about is the impact of high rates of malaria on resources allocation in the household. The paper reveals that having more children to combat high mortality rates can lead to worse conditions per child and that education can become an afterthought for girls as they are expected to raise children in adulthood. I would like to know more about the impact of malaria on other resource allocation to girls and women. Do boys disproportionately receive medical care, food, familial attention, etc. in comparison to girls in malaria afflicted nations? This would be yet another example of the dual causality between malaria and slow growth based on our previous discussions surrounding women and development.