As U.S. Secretary of State Hillary Clinton heads to Africa, the continent is in far better shape than most experts think.
"Conditions in Africa Are Medieval."
Not in the slightest. It's true that some countries in the region are as poor as England under William the Conqueror, but that doesn't mean Africa's on the verge of doomsday. How many serfs had a cellphone? More than 63 million Nigerians do. Millions travel on buses and trucks across the continent each year, even if the average African road is still fairly bumpy. The list of modern technologies now ubiquitous in the region also includes cement, corrugated iron, steel wire, piping, plastic sheeting and containers, synthetic and cheap cotton clothing, rubber-soled shoes, bicycles, butane, paraffin candles, pens, paper, books, radios, televisions, vaccines, antibiotics, and bed nets.
The spread of these technologies has helped expand economies, improve quality of life, and extend health. About 10 percent of infants die in their first year of life in Africa -- still shockingly high, but considerably lower than the European average less than 100 years ago, let alone 800 years past. And about two thirds of Africans are literate -- a level achieved in Spain only in the 1920s.
"Africa Is Stuck in a Malthusian Trap."
Hardly. Malthus's world was one of stagnant economies where population growth was cut short by declining health, famine, or war. Thanks to the spread of technologies and new ideas, African economies are expanding fast and population growth has been accompanied by better health.
The continent of Africa has seen output expand 6½ times between 1950 and 2001. Of course, the population has grown nearly fourfold, so GDP per capita has only increased 67 percent. But that's hardly stagnation. Indeed, only one country in the region (the Democratic Republic of the Congo) has seen GDP growth rates average below 0.5 percent up to this year -- the run-of-the-mill growth rate when Malthus was writing in early 19th-century Britain. And though there have been all too many humanitarian disasters in the region, the great majority of Africa's population has been unaffected. The percentage of Africans south of the Sahara who died in wars each year over the last third of the 20th century was about a hundredth of a percent. The average percentage affected by famine over the last 15 years was less than three tenths of a percent. Africa has seen child mortality fall from 26.5 to 15 percent since 1960 and life expectancy increase by 10 years.
"Good Health and Education Are Too Expensive for African Countries."
Only sometimes. Some widespread health conditions in the region -- notably HIV/AIDS -- are still expensive to treat. But the most effective interventions for promoting health in Africa are remarkably cheap. Breast-feeding, hand-washing, sugar-salt solutions, vaccines, antibiotics, and bed nets together save millions -- and could save millions more -- and none need cost more than $5 a pop. Rollout of a vaccination program, for example, has slashed annual measles deaths in the region from 396,000 to 36,000 in just six years. And though Chad isn't going to see universal college enrollment anytime soon, some very poor countries have already achieved near-universal primary education based in large part on free schooling. In Nigeria, an estimated 76 percent of children expected to be completing primary school, based on their age, did so in 2005.
That even the poorest countries can afford to provide a basic level of health services and education to all of their citizens is one reason why many African countries that are as poor today as ever have still seen considerable progress in health and education. Take Niger, a landlocked country largely made up of desert. With a per capita gross national income of $170, it was desperately poor in 1962. And it is not much richer today -- income per head is just $280. Yet life expectancy has increased from 40 to 57 years over that time, and literacy rates have more than tripled.
"Adding More Schools and Clinics Is the Key to Education and Healthcare."
If only. Building schools and increasing access to medical help is a vital first step -- and the thousands of new primary schools and the rollout of primary-care programs are real regional success stories that have played a big role in improving quality of life. But access is only the first step. For a start, the quality of provision is often atrociously low. A recent survey of primary-school math teachers from seven countries in southern Africa found them scoring lower on math tests than their students. Also, there are social forces that play a huge role in determining outcomes. Deon Filmer of the World Bank looked at school location and enrollment data across 21 countries and estimated that if every rural household was next door to a school, it would increase attendance just 3 percent. The bigger factor is attitudes: Some survey respondents in Burkina Faso, for example, suggested that sending girls to school was the surest way for them to end up as prostitutes.
As for healthcare, survey data from across 45 developing countries suggests that if parents were a little better educated and knew more about treatments, this alone might reduce child mortality by about a third, according to analysis by Peter Boone and Zhaoguo Zhan. That suggests the importance of education and social marketing to health outcomes. In Bangladesh, for example, NGOs have encouraged the construction and use of latrines in rural areas by spreading the message that defecating in fields ends, in effect, with people eating their own feces. This approach has had more widespread success than traditional programs which just subsidized latrine construction.
"TV Is the New Opiate of the Masses."
That depends on what people are watching. More than a billion people worldwide have seen Baywatch, and you have to wonder whether that time could have been better spent. Still, the importance of knowledge and attitudes to development outcomes suggests a big role for communications technologies. And studies from around the world suggest TV watching in poor households can have a big impact. In Brazil, women watching soap operas on the Rede Globo network have fewer kids possibly as a result. In India, the majority of households in the state of Tamil Nadu have cable access -- and according to Emily Oster and Robert Jensen of the National Bureau of Economic Research, that access is associated with greater gender equality in the household, greater female schooling, and (once again) lower fertility. In Africa, TV campaigns have increased AIDS awareness in a number of countries. And it isn't just television that can change attitudes -- there have been considerable successes using community education programs to increase immunization, improve hygiene, raise land-mine awareness, and promote breast-feeding.
"Development Means Economic Growth."
It's more than that. The argument that sub-Saharan Africa is in a crisis of development is usually buttressed by grim statistics on the region's economic performance. Average per capita growth rates over the past 45 years have only just surpassed half a percentage point. About half of the people in the region still live on less than a dollar a day. They need more economic growth. But this is a limited perspective on what actually contributes to quality of life. If basic education and health services are affordable even in the poorest countries, and if there's a big role for knowledge and ideas in creating demand for these services, this suggests that income growth alone is unlikely to be a panacea.
And that's what the cross-country evidence points to as well. Economic growth is a comparatively minor factor in determining improvement in health and education as well as a whole range of other elements of the quality of life. Economist Bill Easterly's study of "life during growth" around the world found that changes in per capita income were the driving force behind improvements for perhaps three of 69 measures of broad-based development -- calorie and protein intake and fixed phones per person. But for the other 66 measures -- covering health, education, political stability, and the quality of government, infrastructure, and the environment -- income growth was not the driving force in change. There's much more to life than money, and people concerned with development need to think more broadly if they are to help sustain Africa's progress.
The United Nations' Millennium Development Goals, which set global targets for progress in areas including health, education, and the environment alongside income, are a welcome step in this direction. Some of the targets are too ambitious for a number of countries south of the Sahara to reach by the 2015 deadline, even with continued dramatic progress. But at least they help broaden the focus of the development community beyond GDP per capita.
"Aid Doesn't Work."
Sometimes. Sure, a lot of aid to Africa is wasted, and some goes to support silly ideas or countries that can't use it well. But aid has also supported some programs that have made a real difference in quality of life -- things like supporting the measles vaccination program, helping to eradicate smallpox, fighting river blindness, funding educational radio programs, building sewage networks, and providing scholarships so that poor children can afford to stay in school. Even the conclusion of the vast literature regarding aid's impact on economic growth is more positive than you might think. Researchers Hristos Doucouliagos and Martin Paldam recently conducted a "metastudy" of aid effectiveness that aggregates results from 543 estimates made in 68 papers. The exercise suggested a small positive impact of aid on per capita growth rates -- though the result is a statistically weak one. And with a greater understanding of what drives development in Africa and beyond, aid could play an even bigger role.
Too many people in Africa suffer under dictatorial regimes; too many parents see their children die of diseases that can be treated for cents; too many children leave school uneducated or never make it to class in the first place. Nonetheless, there is a lot of good news about Africa -- not least evidence of considerable improvements in average quality of life across the region and of a positive role played by both governments and donors in that process. Understanding that progress and its causes is an important step in ensuring it continues, so that ever fewer parents suffer the loss of a child, ever more children are educated, and an ever larger proportion of Africans can live life in peace.
Correction: The article originally stated, "In Nigeria, an estimated 72 percent of children who start primary school successfully complete it through the last year." In fact, 76 percent of children who were expected to be completing primary school in 2005, based on their age, did so. Foreign Policy regrets the error.
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