Paving Paradise

A little more concrete 
could save the world. 
Really.

BY CHARLES KENNY | JAN/FEB 2012

It's just a guess, but I doubt concrete would rank high on a list of the world's most loved materials. From Belgrade to Brixton, the antiseptic, brutalist tower blocks of wannabe Le Corbusiers have become eyesores -- vertical slums infested with graffiti and gangs. Twenty-lane highways in Houston are not generally considered a thing of beauty to anyone but transportation engineers. And for each megawatt of electricity produced by China's enormous Three Gorges Dam -- the world's largest concrete construction project -- roughly 77 people were booted from their homes. But what if, at the risk of infuriating Joni Mitchell, the path to paradise really is paving a parking lot?

If you've ever traveled, say, to a remote village in Swaziland and then returned years later to find that the charming dirt road is now paved over, there's a good chance you'll feel a bit of nostalgia for the way things were. Don't. There's also a good chance that the people there now are a lot healthier, happier, and wealthier than they were the last time you visited. All thanks to a little concrete.

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Consider what it's like to live in a mud-floor house, as nearly 80 percent of rural Kenyans, and hundreds of millions of people worldwide, do. It is effectively impossible to clean such floors, which is a big reason that more than half a billion people worldwide are infected with hookworm, according to scientist Peter Hotez of the Sabin Vaccine Institute. Walking barefoot on soil floors is one of the most common ways to get hookworm disease -- a parasitic infection in which larvae burrow through skin, lodging in the gastrointestinal tract, living off the host, and making children very sick. Kids with hookworm are less likely to go to school and become healthy adults. The economic impact can be considerable: University of Chicago economist Hoyt Bleakley estimates that children infected with hookworm in the American South in the early 1900s went on to earn 43 percent less in wages as adults.

There are cheap ways to combat such nasty diseases. A package of drugs covering hookworm and a range of parasitic infections costs as little as 50 cents per person per year. Reinfection, however, is frequent, and improper use of the medicine can create drug-resistant strains. What works best? Not drugs, but pavement; it typically costs just a few dollars per cubic foot and can last a lifetime.

Here's proof: Starting in 2000, a program in Mexico's Coahuila state called "Piso Firme" (Firm Floor) offered up to $150 per home in mixed concrete, delivered directly to families who used it to cover their dirt floors. Scholar Paul Gertler evaluated the impact: Kids in houses that moved from all-dirt to all-concrete floors saw parasitic infestation rates drop 78 percent; the number of children who had diarrhea in any given month dropped by half; anemia fell more than four-fifths; and scores on cognitive tests went up by more than a third. (Perhaps unsurprisingly, mothers in newly cemented houses reported less depression and greater life satisfaction.) By 2005, Piso Firme had spread to other states, and 300,000 households -- about 10 percent of dirt-floor houses in Mexico -- had taken part in the program.

Per-Anders Pettersson/Getty Images

 SUBJECTS:
 

Charles Kenny is a senior fellow at the Center for Global Development, a Schwartz fellow at the New America Foundation, and author, most recently, of Getting Better: Why Global Development Is Succeeding and How We Can Improve the World Even More. "The Optimist," his column for ForeignPolicy.com, runs weekly.

WMCCOMNINEL

9:32 AM ET

January 3, 2012

Wouldn't It Be Nice...

During my first enlistment in the US Army I was a Preventive Medicine Specialist. We went to Honduras in 1988 where we built a road through the mountains. We also built an orphanage, refurbished a church and held a weekly medical clinic at different remote mountain villages where dentists pulled teeth, doctors issued vitamins, aspirin and antibiotics and I deloused the locals. The veterinarians also inoculated livestock. The road from Yoro to Jocón, which is unpaved, is still there as I recently confirmed on Google Earth satellite imagery (my third enlistment I was a Military Intelligence Imagery Analyst). So what? The ‘Optimist’ is basically totally correct about his happy observations regarding improved sanitation and transportation. That however is no cause for optimism. When my first enlistment ended I tried to find a civilian job or college program to continue doing that same good work and was rejected at every turn. Even the Peace Corps rejected my application to continue my nascent work in providing basic public health support to those most in need. Instead I was pulled out of my college General Studies program during my graduating semester in January 1991 to serve during the First Gulf War. If the author wants me to continue reading his Pollyannaish musings I want something for my wasted time – perhaps a free download of the The Beach Boys singing “Wouldn’t it be nice…”.

 

FLUEIO2091

10:15 AM ET

January 4, 2012

Happy New Year

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WMCCOMNINEL

3:07 PM ET

January 5, 2012

 

GHODGIN

12:23 PM ET

January 4, 2012

Yes, exactly

A good, strong infrastructure is one of the most effective ways to combat poverty, raise life expectancy and most importantly (in post-conflict scenarios) hopefully reduce the reignition of civil conflict.

 

TORREYLEE1

1:23 PM ET

January 4, 2012

Never thought about it that way

Being somewhat of a naturist and being from Boston myself, I've always had a certain healthy level of disdain for "concrete jungles" as they are called, BUT this article does help me see the benefits of sometimes covering over nature.

I visited Brazil 4 years ago and saw with my own eyes the lack of health of men, women and children living in the Favelas. Many case were this hookworm disease that this article brings to attention. I had no clue that the solution could be this simple. I think firstly, we should support organizations that provide shoes for the poor. I walked on some of these surface when I visited and it's unhealthy even from the way an uneven dirt floor affects your balance, atleast that was the case for me, but I'm naturally clumsy anyway, ha. But with that being said, these floors need concrete for for blocking disease carrying parasites and evening shoes didn't really stop me from feeling very unsafe while walking around in these poor "homes".

It's clear that this is a major problem and we can often feel overwhelmed, but we must fight for those who can't provide for themselves. If a kid is so sick that they can't even go to school, what chance do they have to make it out of their situation?

Great article...

 

FRANCISCOME

2:04 PM ET

January 4, 2012

Completely agree

Charles,

Could not agree more. So much so that we made basically the same point in our development Blog back in november although your piece is more persuasive.

http://bit.ly/xElOVY

So if your street is paved, your main asset can increase by more than 50% and if you replace your dirt floor with cement, your children will live better.

 

JSWEARINGEN

4:10 PM ET

January 5, 2012

Bad Reporting?

I've been discussing this article with some friends in the natural building arena. It appears to me the article contains bad reporting and jumps to unwarranted conclusions. First, a bare earth floor is more porous than concrete--unless it is sealed. Very inexpensive sealers (such as linseed oil) would do the job at much less expense.

More importantly, of the sources cited in the article, only one is drawn from scientific research, and that article itself questions the conclusions of "Paving Paradise". I'm taking the liberty to quote a friend's email here:

>That article, "Hookworm and Poverty" by Peter Hotez, offers no direct evidence to support the idea that hookworms are transmitted effectively by contact with earthen floors, and several direct and indirect reasons for supposing that the main transfer mechanisms require contact with soil outside the home. Specifically, the article says the hookworm larva need moist soil, and do best in soils with low clay content and low compaction. This means that an earthen floor would be far less conducive to hookworm transmission than exterior soils. The article also mentions that parasite infection levels vary with profession in a given area, with the highest levels found among agricultural workers who work on and in moist soils. The article says that parasite infection is very strongly linked to severe poverty, but the mechanisms are not well understood. The frequency of dirt floors is mentioned as a possibility, but even the validity of the statistical correlation is questioned in the article text.

>It is quite clear that contact with feces is the main problem and the primary element of infection and transmission. Addressing this problem would be far more valuable and far-reaching for the health of the people involved, compared to paving earthen floors, but it is more complex and harder to evaluate. Governments love concrete programs, in all senses of the word. A highly visible, easily countable program is easier to fund and justify, and you don't have to worry about proving primary and secondary effects, positive or negative.

>The linked article, "Inexpensive flooring change improves child health in urban slums" says, "replacing dirt floors with cement appears to be at least as effective for health as nutritional supplements". It reports "a nearly 20 percent reduction in the presence of parasites" in Torreon, along with "Almost 13 percent fewer episodes of diarrhea" and " A 20 percent reduction in incidences of anemia".

>"Paving Paradise" article cites this article as the source for the figures that it presents in this sentence: "Kids in houses that moved from all-dirt to all-concrete floors saw parasitic infestation rates drop 78 percent; the number of children who had diarrhea in any given month dropped by half; anemia fell more than four-fifths".

>I find it rather bizarre that the figures in "Paving Paradise" are so dramatically different from those in the article which it cites as evidence. I'm thinking it is evidence of really bad reporting. Both the numbers and the general conclusions of "Paving Paradise" don't seem to be justified by the supporting documents which it provides.

>The apparent, although questionable, statistical link between paving earthen floors and decreasing parasite levels, is worthy of more investigation. But until we have better evidence, I don't think any reliable conclusions are possible. <

I believe these criticisms warrant a response from Mr. Kenny.

 

CHARLES J KENNY

12:13 PM ET

January 6, 2012

response

I am justly accused of lazy linking. Below is a link to the underlying paper by Gertler and colleagues, you'll see the effects I'm talking about on p.21-22 ("We find high
elasticities for all the outcomes studied. The elasticity of parasites is -0.78, which means that a 100% increase in cement floors would reduce the presence of parasites by 78%. Similarly, we find that the share-of-cement-floors elasticity of diarrhea is 0.49 and that
for anemia is -0.81." )

The paper uses a pretty careful discontinuity design, a later version was deemed worthy of publication in the AER, but I'd welcome further comment on percieved weaknesses.

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=981822

 

09BAYKID

1:54 PM ET

January 24, 2012

Nice Job

I was doing a search for something totally unrelated and I stumbled across this Parent plus loan. Saw the headline and said, ok, I’ll bite. You hit the nail on the head. I would go on and say that the Euro is like a community stew that everyone contributed to, but those that primitive decor contributed the least have consumed their share and then some, and for some reason they think that the others should keep contributing to the stew while they keep consuming. The greediest people in the world are the socialists increase page rank.

 

HANNAWE

1:02 AM ET

February 3, 2012

A balance

I agree that some extra concrete can do miracles to the lifestyle of people in many areas. Think of the times when you had to walk through muddy paths and now you have nicely paved pedestrian paths. I'll take more concrete anytime. But when I lived in New York, I always yearn to see the trees outside my window and to hear the birds chirping. Guess it all comes down to a balance. Pips