health and development essay

Essays on Health and Development

Journal Title

Journal issn, volume title, description, collections.

• Revue d’économie du développement
• Volume 21, Issue 2, 2013
• Health and Development : A Circular...

• Health and Development : A Circular Causality
• Suivre cet auteur Jean-Claude Berthélemy , Suivre cet auteur Josselin Thuilliez
• In Revue d’économie du développement Volume 21, Issue 2, 2013 , pages 119 to 147
• file_download Download

1 – Introduction

1 In historical terms, there is a close relationship between improvements in a population’s state of health and economic development. Robert Fogel, who was awarded a Nobel Prize in economics in 1993, points out that since 1700, we have seen an unprecedented decline in mortality rates and historic economic growth in industrialised countries (Fogel, 1990, 2004,). Simultaneous technological and physiological advances seem to have resulted in a positive spiral between the “thermodynamic” and “physiological” aspects of economic growth. According to Fogel, the combination of these two effects – namely improving food and increasing the efficiency with which food energy is converted into productive labour – makes it possible to explain 50% of British economic growth since 1790. The explanation he puts forward is relatively simple. An exogenous technological shock in the agricultural sector is thought to have enabled an increase in initial food production, which in turn increased human production capacity based on a thermodynamic effect; this also prompted a decrease in childhood malnutrition and consequently, lower prevalence of chronic illnesses, an increase in levels of basic education and an improvement in public health. These last three factors then combined to improve labour productivity and drive other innovations. The main issue with this theory is identifying the conditions that would have triggered the emergence of the initial exogenous shock. Moreover, Fogel leaves this question open, when he explains a significant proportion of the decline in mortality before 1870 based on nutritional factors or elements linked to agricultural progress (Fogel, 1994). The thesis that health has an influence on economic development is therefore not unambiguous, because of the intrinsic endogeneity of progress in health.

2 More recently, Birchenall (2007), showed the causal relationship between economic development and mortality since the 18 th century, in both developed and developing or emerging countries. The first observation is that at the end of the 20 th century, even countries with the lowest levels of life expectancy had mortality rates well below those found in countries in western Europe in the 18 th century. The second is that in both developed and developing or emerging countries, the age group which is the most vulnerable (young children, who are more vulnerable to problems of malnutrition and contextual aspects) and under working age is the one where the decline in mortality is the fastest and contributes to the general decline in mortality in statistical terms. The final significant result emphasises the fact that economic development could explain between 30 and 50% of the recent decline in mortality, in line with findings by Preston (1980) or Easterly (1999). Medical progress unquestionably remains important at an individual level (Preston, 1975) but is thought to have only a marginal effect overall, particularly given the fact that most medical discoveries took place in the second half of the 19 th century (except for the smallpox vaccine; Easterlin, 2004), therefore providing little or no explanation for the decline in mortality before this period in western European countries or the United States. The major exogenous shocks in public health since the end of the 19 th century would also appear to have primarily benefited an urban population, although substantial progress can also be observed in rural areas prior to such events (Birchenall, 2007; Fogel, 1997).

3 The question of bidirectional causality between health and development has contributed to one of the liveliest debates in development economics in the last two decades. Interventionists support the thesis of the predominantly negative effect of health on economic growth and recommend an exogenous “big push” to get people out of poverty traps. Sceptics, on the other hand, consider that the inability of a country to deal with health problems is the result of ineffective action arising from institutional problems rather than poverty traps, and that it is development that leads to progress in health rather than the opposite. Finally, there is a third category of economists who could be characterised as empiricists as they rely almost exclusively on social experiments in the field to provide answers to these questions in a particular microeconomic context and at a particular time. Note that many of the examples used in this article are borrowed from the economic literature on malaria. This bias is easily justified on the basis that malaria has acted as a catalyst for the debate for around ten years, but it would be restrictive to limit health to this purely vertical view.

4 In the rest of this article, we intend to demonstrate that it is necessary to overcome the biases in these approaches to move the debate forwards, because of the circular nature of the causality that lies at its heart. Defining good or poor health is not a neutral element in this debate, any more than the health indicators used are. We propose four pathways for overcoming these limitations, which are not new in themselves but which have not previously been brought together in an integrated approach: (i) exploring various channels to arrive at a better understanding of the contradictory nature of the relationship; (ii) reconciling microeconomic and macroeconomic results; (iii) establishing a dialogue with epidemiology. Without a dialogue of this kind, it will not be possible to resolve the econometric problems of identifying relationships. Moreover, economic analysis will have only limited practical involvement in defining policy priorities and applying them in terms of improving health and economic conditions; (iv) developing supply-side analyses in light of the greater attention previously paid to demand.

5 Prior to this, there are several additional context-related reasons to explain the renewed interest in the subject of “health and development”.

2 – A renewed interest in the subject of “health and development”

2.1 – the millennium development goals.

6 The Millennium Development Goals  [2] and the work of the Commission on Macroeconomics and Health  [3] have contributed to bringing health back to the centre of the development debate. Indeed, three of the eight Millennium Development Goals are directly related to health (MDG 4: reduce child mortality; MDG 5: improve maternal health and MDG 6: combat HIV/AIDS, malaria and other diseases). To some extent, MDG 1 (eradicate extreme poverty and hunger) can be seen as being connected to the health and nutritional status of individuals.

7 Health is also a central ingredient in development insofar as it can be seen as an investment in human capital, which plays an important role in both endogenous growth models and neoclassical theories as applied to health (Schultz, 1961; Becker, 1962; Grossman, 1972a). More fundamentally, health is a precious tool for improving the economic and social future of a population by improving not only individuals’ aspirations but also their “capacities” (Sen, 1980, 1988; Sen and Nussbaum 1993). At the same time, health contributes to the well-being of individuals, which has been reflected in the inclusion of life expectancy in calculating the human development index. Finally, sources of deficiency in the healthcare market as described by Arrow (1963) mean that the social optimum is not achieved and that intervention in the healthcare market becomes necessary. The necessity of implementing public policies in the healthcare field is a justification in itself for the significant weight given to support for health in development aid policies. The barriers to access to healthcare also highlighted in recent literature on health behaviours in developing countries (Dupas, 2011) join several arguments by Arrow (1963) on deficiencies in the healthcare market resulting from (i) external factors, (ii) a shortage of high-quality information aimed at a well-targeted audience, (iii) uncertainty in the face of risk and questions of coherence in temporal terms, (iv) demand which is, in reality, driven by supply, cutting across institutional or organisational questions.

2.2 – Increasing support for health in developing countries

8 Aid for health has increased significantly in absolute terms since the beginning of the 21 st century. This is explained in part, by a recovery in publicly funded development aid over the past decade, but first and foremost by the increase in the proportion of development aid allocated to health, which doubled over this period to account for around 13% in 2011.  [4] Moreover, it is important not to ignore the increasing contribution made by private-sector aid, funded primarily through large private foundations. In overall terms, the most comprehensive data source in this area, produced by the Institute for Health Metrics and Evaluation,  [5] estimates total international aid for health at around $28 billion in 2011, of which $20 billion are accounted for by development aid from the OECD DAC countries. The proactive approach of a number of major donors, notably the United States, and the philanthropy of the main foundations, have thus contributed to a significant improvement in the volume of aid allocated to health. The driver for this increase was the development of vertical programmes (either public-sector initiatives such as the PEPFAR in the United States, or initiatives funded fully or partially by the private sector, such as the GAVI and the Global Fund).

9 Macroeconomic studies comparing spending on health with improvements in the state of health remain, however, less than convincing on the positive impact of aid. It is difficult to identify the effects of public spending on health, in particular because of problems of endogeneity. Both Filmer and Pritchett (1999) and Wagstaff et al. (2004a, 2004b), taking these problems into account, found non-significant results in respect of the elasticity of health indicators (child mortality and maternal mortality) compared with public spending on health. Bokhari et al. (2007) find significant elasticity when they control for official development assistance received in the health sector, but in their regressions the variable associated with official development assistance is not significant. Their result may, however, be marred by a new endogeneity bias insofar as the aid variable is not instrumented in this study.

10 One of the conclusions that emerges from the literature is that trying to identify a mechanical link between health spending and the state of health of a population would be a futile exercise. First and foremost, resources need to be allocated fairly and efficiently if the Millennium Development Goals are to be achieved. Problems associated with the efficiency of allocation become clear when we see significant leakages in health budgets, which only reach end users to a very limited extent (see, for example, Gauthier and Wane, 2008). As a result, the increase in aid for health has logically involved the development of vertical programmes, with an increase in measures based on performance-related payment and evaluation of results, although these concepts are not systematically interpreted in the same way (Eldridge et al., 2009; Carlson et al., 2010). The kinds of subsidy advocated by economic theory have therefore found fertile ground in the development of these specific funds. One telling example is the establishment of the AMFm ( Affordable Medicines Facility – malaria ) following the work carried out by the Institute of Medicine of the National Academy of Sciences in the US, led by K. Arrow (Arrow et al., 2004) which produced controversial results in the most remote areas. Medico-economic evaluations whose efficiency measures are focused on a specific health problem probably accentuate this phenomenon, since it is much simpler to evaluate correctly in a specific area for well-defined diseases than for cross-cutting problems. Finally, the appearance of diseases that are transmitted from south to north, such as HIV/AIDS, has unquestionably contributed to legitimising aid for health as a global public good.  [6]

2.3 – A renewed theoretical and empirical interest in health?

11 The renewed interest in methodologies derived from biomedical sciences and a multidisciplinary openness have probably contributed to the development of the discipline since the first research carried out by Arrow (1963), and have in turn fuelled the debate. Numerous behavioural questions, in particular, have been the subject of particular attention, considering not only that these behaviours represented a hindrance to the effectiveness of interventions (and therefore a waste of resources) but also given the impasse to which empirical models for analysing the determinants of high-risk behaviours, belief models for health and models inspired by social learning theories led (Moatti et al., 1993). Indeed, the risk of falling into a “disciplinary bias” is high (as each has a tendency to insist on a particular type of variable) in empirical models. Furthermore, all these models often result in tautological results that effectively lead to impasses. Rational choice models came to dominate in the 1990s, to explain the persistence of high-risk behaviours relating to diseases that are transmitted between humans (mainly HIV/AIDS) and to some extent provided a way out of the impasse. The most well-known concept is prevalence-elasticity, which has been developed in economic epidemiology since Geoffard and Philipson (1996). A positive prevalence-elasticity implies that when the risk of illness decreases, it prompts a decline in prevention or treatment behaviours, leading in turn to a fresh increase in risk and consequently so-called “rational” epidemics. When prevalence-elasticity is low and incidence declines, the reduction in prevention or treatment is less than proportional, thus increasing the chances of success of an exogenous treatment for eradication objectives (such as a universal vaccination campaign, for example). We should note, however, that eradicating an illness is not always possible and eradication is sometimes not the objective public-health decision makers are seeking or even want to achieve. Furthermore, low elasticity limits, conversely, the positive effects of prevention behaviours on restricting an increasing incidence.

12 Experimental analyses based on the randomised trials popularised by Fisher in the 1920s (Box, 1980) and applied to the field of development economics more recently by Kremer and Duflo (see, for example, Miguel and Kremer, 2004; Duflo and Kremer, 2005; Duflo et al., 2007 ; Banerjee and Duflo, 2008; Kremer and Glennerster, 2011), represent a real contribution to the identification of a link between health and development through the understanding they provide of exogenous interventions in experimental conditions in a specific context. They also support health and development programmes by providing a rigorous simultaneous evaluation in the field. Quasi-experimental models (discontinuous models, instrumental variables and differences in differences) help cover the gaps in randomised field trials and supplement these models, helping to identify a causal effect. They also help to reach more reliable conclusions, after applying filters derived from econometric mechanisms to retrospective data in real and non-experimental conditions.

13 These analyses do not, however, fully resolve the problem posed by Fogel of the emergence of shocks in natural conditions. Bleakley (2010b), who is interested in the economic effects of malaria, uses for example, medical progress (in this case the discovery of the parasite by C. L. A. Lavéran and the malaria vector by R. Ross at the end of the 19 th century). Although apparently exogenous, however  [7] , it is still difficult to totally exclude other, more societal factors for the progress made at the time. For example, Reiter et al. (2003) conclude in an article on dengue fever that in spite of similar knowledge about this vector-borne disease in different parts of the world and ecological conditions in Texas favourable to the emergence of epidemics, lifestyles provide a more persuasive explanation for the low prevalence of dengue fever in the United States compared with other countries. The article by Bleakley (2010b), of course, takes rigorous account of these aspects in its analysis and contributes in a remarkable fashion to the renewed interest in development economics as applied to health, by identifying empirically, within the confines of the available data, the effects of an improvement in the state of health on income.

14 The central question nevertheless remains: can progress or economic and social change be reduced to a mechanical growth or decrease of scales (Marshall, 1898)? In other words, are we asking the right questions by focusing all our attention on identifying a causal effect when the relationship is probably bidirectional, given the difficult transition from experiments to public policy and the difficulty of transposing experimental results?

15 Epidemiology, for example, is less dogmatically attached to identifying causality in this way, not because of a lack of appropriate tools but undoubtedly because of a more realistic and more systemic view of questions of circular causality as applied to the health field.

16 Moreover, as with the empirical models referred to previously, the risk of reaching an impasse remains, with each having a tendency to insist on a particular type of treatment. This risk is probably greater in social experiments than in analyses of the societal impacts of clinical trials (the impact of medical interventions on socio-economic factors). Finally, there remains a difference between identifying the impact of a treatment (prompting an improvement in the state of health) on economic variables and identifying the effects of a poor state of health on these same variables. Both questions remain fundamentally different, as a treatment can affect these variables through channels different from the health problem it is designed to eliminate or at least mitigate. Whilst it is possible to compile evidence showing that a medical treatment has a beneficial effect on economic variables, it is undoubtedly more difficult to show that a poor state of health has negative effects.

2.4 – What healthcare systems exist in developing countries?

17 Finally, it is impossible to address the question of health in developing countries without reminding ourselves of the institutional context in which the main decisions are taken. We will only touch on a few aspects here, as these issues have been dealt with more comprehensively by Moatti and Ventelou (2009).

18 At an organisational level, healthcare systems in the poorest countries are primarily characterised by their heterogeneity, a pyramidal structure designed to support local medical care and a strategy focused on primary health care as defined at the Alma Ata conference in 1978 and relaunched by the Bamako Initiative in 1987.  [8]

19 Firstly, in terms of providing insurance, existing systems are closer to a Bismarckian-type system in the sense that universal welfare remains limited. Cost recovery has been replaced by the introduction of prepayment mechanisms and insurance to cover the risk of ill health (Moatti and Ventelou, 2009).

20 Secondly, in respect of planning and overall visibility objectives, analysis of national strategic plans is increasing in order to identify barriers to achieving the Millennium Development Goals at an organisational level (Travis et al., 2004; Backman et al., 2008;)  [9] and organise the development of more homogenous healthcare systems.

21 Thirdly, healthcare systems in developing countries must content with a human resource crisis. Many medical personnel emigrate, partly because of the working and health and safety conditions they are faced with and partly because both developed and emerging countries (such as South Africa) attract expatriate medical staff because of the strong growth in demand for medical care and the shortage of training for qualified personnel in some cases. Bhargava and Docquier (2008) have shown that the HIV/AIDS crisis provides an explanation for the emigration of medical personnel to some extent, alongside more traditional factors such as medical doctors’ relative salaries, and that emigration in turn worsens the medical situation in the countries concerned. Bhargava, Docquier and Moullan (2011), moreover, have shown that the existence of some form of compensation for the loss of medical personnel by greater incentives to train in the sector (according to the so-called “brain gain” theory) is illusory.

22 Finally, areas of concern include the fact that the transition the world is experiencing between transmissible and non-transmissible diseases risks having a particularly significant effect on developing countries in the near future (Monteiro et al., 2001; Cavalli et al., 2010).

3 – Health as a factor in economic growth?

3.1 – controversial results at a macroeconomic level.

23 Various pieces of research have suggested that the poor health of a population could be a cause of its backwardness in terms of economic development  [10] . The most “dramatic” version of this approach is represented by the calculations done by Gallup and Sachs (2001) showing the strong negative impact of malaria on growth at a macroeconomic level. The approach taken by Gallup and Sachs (2001), focusing on malaria, is undoubtedly caricatural but has the merit of having highlighted at the time a problem that had previously been ignored. According to Gallup and Sachs (2001), annual growth in GDP per capita in countries with a high incidence of malaria is 1.3% lower. A 10% decrease in malaria should result in a 0.3% increase in growth. The literature on growth has shown that this kind of result was often not very robust, mainly because of recognised problems of endogeneity and the quality of the macroeconomic data used, and therefore calls for a more cautious approach. Sachs’ approach, based on cross-sectional estimates, is not the only one, however, and follows on from numerous other pieces of research based on transverse or panel data using similar methods (amongst others Barro and Lee 1994; Barro and Sala-I-Martin 1995). Note that these empirical estimates have often been produced based on different samples with similar results.

24 This approach has, however, drawn criticism because of the fact that it results in a blind belief that it is sufficient to increase international aid for health to get out of the trap of under-development and because considerable amounts of aid have probably been invested with no requirements in terms of performance. As far as malaria is concerned, we nonetheless need to recognise that this is a disease that imposes high costs on developing countries. Malaria is essentially found in the world’s poverty belt. Almost 41% of the global population (around 3.3 billion people) live in areas where malaria is transmitted (Centers for Disease Control and Prevention – CDC). The number of clinical cases is estimated at 219 million per year (World Malaria Report 2012).  [11] The number of deaths is around 660,000 per year, 75% of which are children in Africa (CDC). Although criticisms of Sachs’ approach may be well-founded, they probably go too far if they deny that diseases such as malaria play any part in worsening poverty in Africa.

25 Moreover, numerous other pieces of recent research have shown the role of health in growth. Bhargava et al. (2001) is a good example. The authors reveal the impact of health on growth, particularly in poor countries. Bloom, Canning and Sevilla (2004) also show the positive effect of health on total factor productivity, using a production function approach. We will return to this later.

26 Some authors challenge these results, however, in particular Acemoglu and Johnson (2007), although they use similar methods to Sachs’ approach (Packard, 2009). The authors use historical data on the change in life expectancy (from the 1940s to the 2000s) to produce an estimate of instrumental variables designed to control endogeneity bias. The instrumental method exploits the epidemiological transition of the 1940s, with instruments being developed based on mortality rate data observed in 1940 for around 15 infectious diseases and on the dates from when actions were taken to control the diseases concerned. Acemoglu and Johnson (2007) use this approach to show that the effects of health on growth per inhabitant are not significant and may even be negative because of a very positive effect on demography and a very limited effect on GDP. The structure of the procedure used, however, excludes poor countries and in particular, all African countries, for which we have no historical observations to develop instruments.

27 Berthélemy (2011) suggested that the effect of health on growth was not linear, as it was associated with the notion of under-development traps and multiple equilibria. This approach makes the results obtained by Bhargava et al. (2001) compatible with those of Acemoglu and Johnson (2007). The point is that it is difficult to generalise results observed locally: for countries caught in an under-development trap, health may not seem to have an impact on development, however improving the level of health could contribute to these countries escaping a low equilibrium of this kind. Restricting the analysis to a set of relatively developed countries, as Acemoglu and Johnson (2007) do, inevitably leads to this effect being hidden. Conversely, it is fair to say that testing under-development traps involves working on an extensive sample of countries for which the available data restrict the possibilities of instrumentation. The main result of the approach in terms of the under-development trap, however, is its highlighting of the non-linear relationship between initial health and future development, whilst endogeneity biases are based on a linear relationship between these two variables. Identifying the theory behind an under-development trap related to health therefore relies on testing for a highly non-linear specification rather than on any kind of instrumentation.

28 Similarly, Bonds et al. (2010) show that a dynamic interaction between health and the incidence of poverty can lead to under-development traps. This approach is largely based on macroeconomic indicators (DALY for health and GDP per inhabitant as a development measurement) and highlights the mechanisms by which health and poverty interact and which can result in multiple equilibria, even if in this case, the authors only demonstrate the possibility that such multiple equilibria may exist, without really testing their existence.

29 Overall, current econometric research on the effect of health on economic development based on internationally comparable macroeconomic data offers few conclusive results that can be generally applied in one or other direction.

3.2 – More intelligible results at a microeconomic level

30 It is easier to take account of endogeneity problems at a microeconomic level (Strauss, 1986; Strauss and Thomas, 1998; Thomas et al., 2002; Strauss and Thomas, 2008).

31 In respect of the effects of health on income, either directly or indirectly, Strauss and Thomas (1998) establish a clear relationship between nutrition, health and income. The traditional indirect channels of the impact of health on income at a microeconomic level are: participation in the labour market, labour productivity, technical efficiency and expenditure on consumption and investment. In particular, Strauss (1986) highlights the impact of caloric intake on productivity, with a decreasing but still positive marginal effect for high intakes. Research carried out by Audibert et al. (1986, 1993, 2003a, 2003b) has contributed to research on the effect of health on agricultural productivity. Audibert et al. (2009) show, however, in the case of the impact of malaria on coffee and cocoa production in the forested region of Ivory Coast, that the prevalence of malaria does not always have a significant effect on agricultural production. This result is in line with other analyses by the same authors and suggests the necessity of a highly detailed epidemiological analysis if one wants to show the impact of morbidity on productivity. In this instance, the prevalence of malaria is measured imperfectly, because of its often asymptomatic nature in areas of high transmission, and it would be necessary to be able to observe highly invalidating malarial episodes to obtain significant results. Bartel and Taubman (1979), in an analysis that is non-targeted on developing countries, shows that the effects of health on the labour supply and salaries are positive but vary depending on the diseases analysed. This study offers a somewhat unusual advantage for the time, namely using clinical measurements of health (rather than subjective measurements) and taking account of the effects of selection or simultaneity. A recent study by Levinsohn et al. (2013) shows, having resolved these problems of simultaneity (primarily via poverty) the very significant impact of HIV/AIDS on participation in the labour market in South Africa. Booysen and Arntz (2003), however, show in the case of HIV/AIDS that the multiplicity of study frameworks and of methods used and the disciplines concerned make comparisons difficult. The same remark could apply to other diseases, hence the need for dialogue to increase harmonisation.

32 On the demand side (the inverse relationship of income and prices on demand), one of the central questions is the price elasticity of demand, which lies at the centre of the debate on cost recovery. Bates et al. (2012) review the main randomised analyses carried out between 2006 and 2010. The authors show that even a slight increase in prices prompts a dramatic decline in the demand for healthcare products whilst generating limited income for healthcare providers. The high elasticity of demand to prices, however, remains difficult to explain from a theoretical point of view. One explanation could come from the possibility of health traps, along the same lines as the research by Bonds et al. (2010) on macroeconomic data. Berthélemy et al. (2013) show that based on a traditional epidemiological model of malaria, it is possible to arrive at health traps of this kind, by including endogenous rational behaviours in the model. The implication of this model is that for the free distribution of preventive measures to be effective, it is important to subsidise not only access to such measures but also their use. This model therefore explains certain results found in randomised studies (Banerjee et al., 2010).

33 The effect of income on demand for healthcare products is also well documented (Grossman, 1972b) as is the very high elasticity of demand in relation to the quality, reliability and accessibility of healthcare (see, for example, Lavy et al., 1996).

4 – Health and inequalities

34 The notion of economic development encompasses not only the interactions between income, productivity, health and education but also the distribution of these variables within a population (Marmot et al., 2008). Inequalities in relation to health are mainly driven by social inequalities. This is certainly the case in relation to income inequalities. By way of example, in Glasgow (Scotland) the difference in life expectancy between the richest and the poorest is 28 years. On average, the poorest inhabitants of Glasgow have a life expectancy of eight years less than the average for Indians (around 60 years) although 76% of Indians live on less that $2 a day (Commission on Social Determinants of Health  [12] ). Numerous other social determinants are also involved, however, including living conditions, access to public services such as the provision of drinking water, and working conditions.

35 As a result of the high incidence of social inequalities on disparities in access to health, there is a risk of falling into a health-related poverty trap at an individual level, as a poor state of health can in turn have a long-term effect on an individual’s capacity to get out of poverty. This is a vicious circle, which can only be broken by implementing policies aimed at restoring health equity. Such policies should address the social determinants of health problems.

36 Numerous pieces of research have developed concepts and measurements of health equity over the last two decades to analyse and design such policies. Health equity is defined either on the basis of a vertical or horizontal approach (Rochaix and Tubeuf, 2009). Both concepts are central in discussions on health inequalities and poverty in developing countries.

37 One important trend in the literature on development economics has been to measure the incidence of benefits received by different socioeconomic groups from public spending, such as spending on healthcare. By testing whether the poorest have more or less access than the richest to the benefits of public spending, this research is similar to the discussions on vertical equity, which requires that people seen as unequal on the basis of a characteristic deemed relevant for the allocation of healthcare are treated differently to correct the inequality.

38 Numerous pieces of research on analysing the incidence of benefits associated with public spending on health show that these policies are vertically inequitable, insofar as it is generally the case that the richest categories of the population benefit more from public spending on health than the poorest categories.  [13] . This often comes from the fact that primary healthcare services, which are the only ones widely accessible to poor people, are insufficiently developed. This is particularly true in Africa, where a still large rural population has no access to healthcare centres.

39 Aspects of horizontal equity in access to healthcare have been analysed by Wagstaff (1991, 2002a, 2002b). The idea is that two people with the same needs should have access to the same care. Here again, empirical research highlights horizontal inequity in relation to health in developing countries. Research on the subject is too extensive to be summarised here, but often follows the same line: there is significant horizontal inequity in access to care in developing countries, which can be explained both by the weakness of public infrastructure in the health sector and by the limited resources available to set up health insurance systems.

40 A recent contribution on Senegal (Mané, 2013), for example, shows that the poor access rarely, and the rich access often, to public hospitals, where disabling conditions are treated.

41 In China, Zhou et al. (2013) have shown that, between 1993 and 2008, the use of outpatient and hospitalisation services was inequitably split in favour of the rich, with the exception of outpatient services in 2008. In recent years, however, the introduction of a new health insurance system has helped to reduce inequality in access to outpatient services.

42 Similarly, when governments implement policies designed to support the supply of healthcare services aimed at socially disadvantaged groups, there is an improvement in health equity. This was the case in Brazil, for example, between 1998 and 2009 (Macinko and Lima-Costa, 2012).

43 Sources of horizontal inequity should not be sought only in income distribution, particularly given that Deaton (2003) has shown that there is no clear direct link between income inequality and health problems. Berthélemy and Seban (2009), for example, have shown that the concentration of access to a certain number of maternal and child healthcare services (immunisation cover, treatment of fever, treatment of respiratory infections, treatment of diarrhoea, prenatal examinations and assisted childbirth) is very significantly associated with the concentration in mothers’ education and much less with the concentration of wealth. Furthermore, access to maternal and child healthcare services in public facilities is more equitably distributed, all other things being equal, in countries with good governance. This suggests that the institutional organisation of the supply of healthcare services may also be an important determinant of social conditions of access to healthcare.

44 Other public policies may have a very significant impact on health equity. This is the case with policies relating to the provision of drinking water and sanitation services (Commission on the social determinants of health). The problems that arise in this respect are related to both funding for infrastructure and pricing. Free access is socially inequitable if the poorest sections of society do not have access to the public network.

5 – Circular causality: an impasse?

5.1 – reconciling macroeconomics and microeconomics in the health field.

45 Bloom and Canning (2005) combine the microeconomic effects of health on salaries and macroeconomic simulations of the effects of health on income and find similar microeconomic and macroeconomic effects. Similarly, Weil (2007) explores general equilibrium effects using a similar approach and calibrates macroeconomic production functions based on microeconomic measurements. The authors find significant effects for health on GDP per inhabitant. These estimates, however, give lower results than the cross-sectional results presented previously. Eastwood (2012) gives a detailed description of the various models used up till now to reconcile the two levels of analysis and the difficulties associated with each approach. Amongst these are simple cost extrapolation models (a simple aggregate of analyses of microeconomic costs), computable general equilibrium models (CGE; Barlow, 1967), macro-simulation models calibrated on microeconomic data (Young, 2005 and his controversial article on the positive economic effects of AIDS; Weil, 2007). The latter two approaches (CGE and simulations) probably help to overcome the constraints inherent in panel or cross-sectional data related to the poor quality of macroeconomic health data in numerous developing countries. In the case of CGE, however, one of the main difficulties is being able to carry out plausible sensitivity studies on the chosen multisectoral structure because of the multiplicity of parameters. In the case of macroeconomic simulations, the high level of dependency on the microeconomic data that feed into the model can lead to very heterogenous results. A final difficulty common to these models in terms of recommendations is that health effects tend to be more medium or long term in these approaches. This makes these models relatively unattractive from the point of view of recommendations but potentially leaves room for more innovative short term models.

5.2 – Examining impact channels and their classification in greater depth

46 As we suggested in the introduction, identifying indirect channels would help to overcome the limitations of the debate to some extent. One of the disciplinary biases in this approach to development economics consists of starting with the assumption that all relationships are endogenous and that economic science is better placed than other disciplines to respond to questions of causality. This a priori suspicion leads on the one hand, to a bias in favour of establishing causal relationships (as evidenced by a significantly higher proportion of articles demonstrating the existence rather than the absence of relationships) and secondly, viewing as inadequate indicators that support causality used by other disciplines (the link with other independent studies, the biological plausibility of a hypothesis, the temporal sequence between cause and effect, the link between the intensity of infection or treatment and the scale of the effect). Changing the initial assumption would not, however, necessarily prevent testing the robustness of results by using the most widespread econometric techniques in the discipline. Potentially, there are relationships that by definition are not endogenous and which can supplement the analysis of questions of endogeneity that exist at other analytical levels. These relationships are undoubtedly very specific but examining them and their classifications in more detail and exploring areas that have previously been ignored will, in the long term, undoubtedly help to achieve a simplified vision that is relatively closely modelled on reality: in some sense a map of economic development.

47 Among the impact channels already explored in the literature, one of the most intuitive is the one that links health and education. Education (primarily education for mothers) is an important element, as has been shown by Berthélemy and Seban (2009) or Breierova and Duflo (2004) and Duflo et al. (2006). As far as the effects of illness on education are concerned, however, these depend on the illnesses studied, with effects that seem to be somewhat significant for nutrition, HIV/AIDS (Gachuhi, 1999; Odiwuor, 2000) and malaria (Thuilliez, 2009, at the macroeconomic level, Thuilliez et al., 2010; Thuilliez, 2010, at the microeconomic level) and less clear effects of certain helminthiases (Miguel and Kremer, 2004). The aim here is simply to recall some of the principal channels and not to examine them in detail. Let us just note that the effects of health on education also vary according to age (from the foetal stage to adulthood and therefore both within the teaching profession and amongst pupils or students), in conjunction with the specifics of the illnesses studied. In this respect, external factors such as those referred to by Miguel and Kremer (2004) are important to analyse in calculating the beneficial effect of a treatment and its cost-effectiveness. From the point of view of the effects of biomarkers on cognitive variables, the variable biases omitted are probably of primary importance in the treatment of endogeneity compared with problems of inverse causality or measurement errors (once, of course, the temporal sequence between cause and effect has been adequately defined in research protocols). Education may then affect other, more traditional channels via its effects on future activity, salaries and productivity (Leibowitz, 1974).

48 The effects of health on accumulating savings have been explored by Ram and Schultz (1979), and Zhang and Zhang (2005). The underlying theoretical argument is that life expectancy affects intertemporal choices but also that longevity mechanically increases savings and consequently investments.

49 The demographic dividends produced by a decline in child mortality (modifying the age structure of a population) translate into lower investments to meet the needs of the youngest groups whilst adults are relatively more numerous in the working population, thus generating an opportunity for temporary growth (Bloom et al., 2003). An epidemiological transition may accompany this phenomenon in more qualitative terms and have a fundamental effect on healthcare systems (Frenk, 1989).

50 As we have already referred to the institutional aspects above, let us note simply that Bleaney and Dimico (2010) show that geographical questions (which encompass certain health problems) can have indirect effects on growth through their effects on the quality of institutions. Kudamatsu et al. (2012), for example, analyse the relationship between environmental factors such as climate and child mortality in Africa and find significant effects.

51 Cultural questions, gender differences, household structure and negotiation within the household (Beegle 2001; Maitra, 2005) represent undoubtedly less intuitive channels, which in some respects are related to the problems of inequality and equity discussed previously and require detailed theoretical approaches (notably on the unitary household models challenged by cooperative models such as the one put forward by Chiappori, 1992 amongst many others).

5.3 – Opening up economic sciences to epidemiological approaches

52 Numerous pieces of epidemiological research are already being enhanced by econometric methods as evidenced by some examples published in major biomedical or epidemiological journals (McClellan et al., 1994; Rassen et al., 2009a; 2009b; Craig et al., 2012). From an epistemological point of view, combining an epidemiological understanding of health problems and an economic approach makes it possible to reconcile a conception of well-being based on utility with more objective measures of health.

53 Taking individual behaviours into account in epidemiological models, along with a better awareness of the epidemiological characteristics of epidemics analysed in economic models, also helps to produce more targeted research protocols based on a firmer theoretical foundation and consequently, more reliable estimates. They should also make it easier to incorporate more complex phenomena such as co-morbidities, of which economic analyses generally take little account, as a result of the lack of precise knowledge about such aspects.

54 Combining them in this way should also result in better measurement of health indicators, whilst not ignoring the multi-dimensional nature of health. At this level, it is particularly surprising to observe that questions of measurement are neglected in favour of econometric issues in numerous empirical studies, including at a microeconomic level. Yet correct measurement of the state of health lies at the heart of questions of causality and should be the starting point for any analysis, before trying to correct measurement errors econometrically. Given the policy implications of economic analyses, the question of measurement should be taken more seriously. As far as malaria is concerned, the historical measurements used in quasi-experimental studies are generally questionable and above all it is difficult or even impossible to assess their quality (Lucas, 2010; Bleakley, 2010; Venkataramani, 2012). The same applies to mortality indicators in colonies or other historical indicators used in Acemoglu’s or Sachs’ approaches. Other analyses often limit health to nutrition  [14] or confuse health and other specific indicators of health. Subjective indicators are also more likely to be subject to risks of non-systematic errors, correlated to income (Strauss and Thomas, 1998) or to access to care rather than more objective indicators such as biomarkers. Note that the efforts made in this direction by research institutes such as ORC Macro (demographic and health surveys) are remarkable and are now providing high-quality biomarkers on a large scale. Questions of measurement, however, are constrained by inadequacies in surveillance systems (particularly in Africa) and by health indicators that are sometimes highly variable (even over short timescales, as for palustrine parasitemia or blood pressure).

55 Overall, this interdisciplinary combination has direct implications for measuring the impact channels of health on economic development and vice versa, resulting in more rigorous analyses at a biomedical level and more precise public policy recommendations, regardless of the empirical approach chosen (experimental or not). This combination has already been suggested by Heckman (2005) in his critique of statistical or epidemiological experimental approaches, provided there is a thorough understanding from a theoretical point of view of the sources of potential causality.

5.4 – Developing studies on supply

56 In terms of supply and demand, an important debate emerged at the time Cohen and Dupas (2010) published their article on the use of mosquito nets, with malaria once more serving as a pretext for a wider debate. Researchers such as Mead Over protested against an overinterpretation of the results obtained from the literature in this area, whilst others confined themselves to disputing the interest of randomised studies in terms of public policy recommendations.

57 As a result, the question of quality of supply and in particular, of healthcare services remains central and requires the development of new assessment methods focused on supply in order to really understand the impact of cost recovery, for example, on the distribution of healthcare measures.  [15] Some research carried out in China or Africa therefore does attempt to focus on supply. Experiments have, for example, been carried out on a large scale in China, in order to assess the effect of a change of payment mechanisms on the quality of care, the practices of key healthcare players (in particular, systematic prescription of care that is not essential for the patient), and the overall change in costs for the system (Wang et al., 2011; Yip et al., 2010; Yip et al., 2012). Still looking at China, Audibert et al. (2013) also provide an interesting response to a well-known stylised fact: access to curative measures and spending on treatments are generally significantly higher than spending on prevention. By showing that the technical efficiency of healthcare services is significantly higher in the case of curative rather than preventive care, the authors suggest that part of the explanation could be found on the supply side.

58 Audibert et al. (2000), in Mauritania, take a qualified view of the supposed negative effects of cost recovery. The authors show that there is no lack of willingness to pay when the quality of services is adequate. Much greater consistency in the structure of published prices for care, however, is necessary to make these strategies more effective. Seban et al. (2013) arrive at an unexpected conclusion in their analysis of the problem of the failure to use prevention in the Democratic Republic of the Congo. The low level of availability of mosquito nets in households is thought to be due principally to the incapacity of healthcare centres to distribute tools to prevent malaria where they are most needed. In other words, and subject to confirmation of the results, the most vulnerable centres are those that are least well supplied, in spite of demand from the population.

6 – Conclusion

59 Overall, the impasse into which the circular causality between health and development leads is, in reality, only apparent and there are several options for overcoming it, whilst accepting the bidirectional character of the relationship and the difficulty of identifying the conditions for the emergence of an initial exogenous shock. The various contrasting currents of thought are highly complementary in terms of the understanding of the relationship they provide from different angles. Nonetheless, there is a risk of getting caught up in a purely academic debate, where one strand of thinking simply replaces another. This article does not claim to resolve the entire debate on analysing health problems in developing countries. It simply provides a few keys to understanding the problems with which the discipline is faced. “Health and development” topics raise a large number of both theoretical and empirical questions in terms of understanding the interactions between economics and health. The social challenges around policies in this area are clear. Bidisciplinary cooperation between economic sciences and biomedical sciences overall is therefore promising, but requires a clear understanding of the two academic cultures. On the one hand, health professionals are becoming increasingly familiar with medico-economic concepts as a way of helping to optimise their capacity for intervention. On the other hand, access to healthcare information, understanding it and using it need specific skills that are difficult to acquire, given the complexity of medical practices and the fact that they are permanently changing. There is no shortage of areas to observe, however, and this is a fruitful period in terms of the international efforts being made to improve health and combat poverty.

• [*] Corresponding author.
• [1] CES-CNRS, Université Paris 1, Panthéon-Sorbonne, Centre d’économie de la Sorbonne, Maison des Sciences Economiques, 106-112 Boulevard de l’Hôpital, 75013 Paris. FERDI, Fondation pour les Études et la Recherche sur le Développement International. E-mail addresses: [email protected] ; [email protected]
• [2] http://www.un.org/fr/millenniumgoals/ , June 2013.
• [3] http://apps.who.int/gb/archive/pdf_files/WHA55/fa555.pdf , June 2013.
• [4] This observation is valid according to data from the DAC or CRS databases and contradicts Moatti and Ventelou (2009), who found that the proportion had remained stable since 2000.
• [5] http://www.healthmetricsandevaluation.org , June 2013.
• [6] A comprehensive discussion of new paradigms in health economics in developing countries can be found in Moatti and Ventelou (2009).
• [7] This discovery and those that followed on from it having accelerated the identification of cases and their systematic and scientific monitoring
• [8] A detailed analysis of the establishment of the Bamako Initiative and its effects can be found in the report by Ridde, 2004: http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/ 281627-1095698140167/BamakoInitiativeReview.pdf .
• [9] See also the One Health Tool initiative: http://www.internationalhealthpartnership.net/en/tools/one-health-tool/ , June 2013.
• [10] See Audibert and Drabo (2011) for a very comprehensive review of the literature on this topic: http://halshs.archives-ouvertes.fr/docs/00/55/17/70/PDF/2010.36.pdf , June 2013.
• [11] http://www.who.int/malaria/publications/world_malaria_report_2012/en/ , June 2013.
• [12] http://www.who.int/social_determinants/en/ , June 2013.
• [13] See Berthélemy and Seban, 2009, for a general overview.
• [14] See, for example, Behrman et al., (1988) for a discussion on health and nutrition.
• [15] http://international.cgdev.org/doc/events/1.09.08/User_fees_can_sometimes_ help_2008.pdf , June 2013.

Historically population health improvements and economic development are closely interrelated. The theme “Health and Development” poses indeed a large number of both theoretical and empirical questions, and social policy issues in this area are obvious. The issue of bidirectional causality between health and development has contributed to one of the most lively debates in the last two decades in development economics, with an alternation of mainstreams rather than a real dialogue. We offer four pathways to overcome these limitations, some of which are not new but have not been integrated together: (i) reconcile the microeconomic and macroeconomic analyses, (ii) explore the channels of influence to better resolve the ambiguity of the relationship, (iii) establish a dialogue with the epidemiology and biomedical sciences – the definition of a good or bad health is not neutral in this debate, neither are the health indicators used, (iv) develop a supply side analysis, while so far the demand side has received more attention. JEL Classification : I15.

• epidemiology
• economic growth
• 1 - Introduction
• 2 - A renewed interest in the subject of “health and development”
• 2.1 - The Millennium Development Goals
• 2.2 - Increasing support for health in developing countries
• 2.3 - A renewed theoretical and empirical interest in health?
• 2.4 - What healthcare systems exist in developing countries?
• 3 - Health as a factor in economic growth?
• 3.1 - Controversial results at a macroeconomic level
• 3.2 - More intelligible results at a microeconomic level
• 4 - Health and inequalities
• 5 - Circular causality: an impasse?
• 5.1 - Reconciling macroeconomics and microeconomics in the health field
• 5.2 - Examining impact channels and their classification in greater depth
• 5.3 - Opening up economic sciences to epidemiological approaches
• 5.4 - Developing studies on supply
• 6 - Conclusion
• Online ACEMOGLU, D., JOHNSON, S., ROBINSON, J. (2003). Disease and development in historical perspective. Journal of the European Economic Association 1, 397-405.
• Online ACEMOGLU, D., JOHNSON, S. (2007). Disease and development: the effect of life expectancy on economic growth. Journal of Political Economy 115, 925-965.
• Online AGHION, P., HOWITT, P., MURTIN, F. (2010). The relationship between health and growth: when Lucas meets Nelson-Phelps. National Bureau of Economic Research .
• ARROW, K.J. (1963). Uncertainty and the welfare economics of medical care. The American Economic Review 53, 941-973.
• ARROW, K. J., PANOSIAN, C., GELBAND, H. (2004). Comitee on the Economics of Antimalarial Drugs (Ed.), Saving lives, buying time: Economics of malaria drugs in an age of resistance. (Institute of Medicine of the National Academies ed.). Washington, D.C.: National Academy Press.
• Online AUDIBERT, M. (1986). Agricultural non-wage production and health status: A case study in a tropical environment. Journal of Development Economics 24(2), 275-291.
• Online AUDIBERT, M. (1993). Invalidité temporaire et production agricole: Les effets de la dracunculose dans une agriculture de subsistance. Revue d’Economie du Développement 1 , 23-36.
• Online AUDIBERT, M., MATHONNAT, J. (2000). Cost recovery in Mauritania: Initial lessons. Health Policy and Planning 15 (1), 66-75.
• Online AUDIBERT, M., MATHONNAT, J., HENRY, M.C. (2003a). Malaria and property accumulation in rice production systems in the savannah zone of Côte d’Ivoire. Tropical Medicine & International Health 8(5), 471.
• Online AUDIBERT, M., ETARD, J. F. (2003b). Productive benefits after investment in health in Mali. Economic Development and Cultural Change 51(3), 769-782.
• Online AUDIBERT, M., BRUN, J.F., MATHONNAT J., HENRY, M.C. (2009). Effets économiques du paludisme sur les cultures de rente : l’exemple du café et du cacao en Côte d’Ivoire, Revue d’Economie du Développement 1-2, 145-166.
• AUDIBERT M., J. MATHONNAT, A. PELISSIER, X. XIAN HUANG, A. MA (2013). “Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data.” China Economic Review . Accessed October 21, doi:10.1016/j.chieco.2013.01.004.
• BACKMAN, G., P. HUNT, R. KHOSLA, C. JARAMILLO-STROUSS, Belachew Mekuria Fikre, C. RUMBLE, D. PEVALIN, D. ACURIO PÁEZ, M. ARMIJOS PINEDA, A. FRISANCHO (2008). “Health Systems and the Right to Health: An Assessment of 194 Countries.” The Lancet 372, no. 9655 : 2047-2085.
• BARLOW, R. (1967). The economic effects of malaria eradication. The American Economic Review 57 (2), 130-148.
• Online BANERJEE, A., DEATON, A., DUFLO, E. (2004). Health care delivery in rural Rajasthan. Economic and Political Weekly , 944-949.
• Online BANERJEE, A. V., DUFLO, E. (2008). The experimental approach to development economics. National Bureau of Economic Research .
• Online BANERJEE, A. V., E. DUFLO, R. GLENNERSTER, D. KOTHARI (2010). “Improving Immunisation Coverage in Rural India: Clustered Randomised Controlled Evaluation of Immunisation Campaigns with and Without Incentives.” BMJ: British Medical Journal 340. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2871989/ .
• Online BARTEL, A., P. TAUBMAN (1979). “Health and Labor Market Success: The Role of Various Diseases”,  The Review of Economics and Statistics 61, 1.
• BARRO, R. (1991). “Economic Growth in a Cross-Section of Countries.” Quarterly Journal of Economics 106(2): 407-43.
• Online BATES, M A., R. GLENNERSTER, K. GUMEDE, E. DUFLO (2012). “The Price Is Wrong.” Field Actions Science Reports. The Journal of Field Actions , no. Special Issue 4 (June 12). http://factsreports.revues.org/1554 .
• Online BECKER, G. S. “Investment in Human Capital: A Theoretical Analysis.” The Journal of Political Economy , 1962, 9-49.
• Online BEEGLE, K., E. FRANKENBERG, D. THOMAS (2001). “Bargaining Power Within Couples and Use of Prenatal and Delivery Care in Indonesia.” Studies in Family Planning, 32, 2 (June 1): 130-146.
• Online BEHRMAN, J.R., DEOLALIKAR, A.B. (1988). Chapter 14, Health and nutrition , in H. Chenery and T.N. Srinivasan (Ed.), Handbook of Development Economics. Elsevier, 631-711.
• Online BERTHELEMY, J-C., SEBAN, J. (2009). Dépenses de santé et équité dans l’accès aux services de santé dans les pays en développement. Revue d’Economie du Développement 1-2, 33-71.
• Online BERTHELEMY, J-C. (2011). Health, Education and Emergence from the Development Trap, African Development Review 23, 300–312.
• Online BERTHELEMY, J-C., J. THUILLIEZ, O. DOUMBO, J. GAUDART (2013). “Malaria and Protective Behaviours: Is There a Malaria Trap?” Malaria Journal 12, no. 1 (June 13): 200. doi:10.1186/1475-2875-12-200.
• Online BHARGAVA, A. (2001). Nutrition, health, and economic development: some policy priorities. Food & Nutrition Bulletin 22, 173–177.
• Online BHARGAVA, A., JAMISON, D.T., LAU, L.J., MURRAY, C.J. (2001). Modeling the effects of health on economic growth. Journal of Health Economics 20, 423-440.
• Online BHARGAVA, A., DOCQUIER F., MOULLAN, Y. (2011). Modeling the Effects of Physician Emigration on Human Development, Economics and Human Biology 9, 172-183.
• Online BHARGAVA, A., DOCQUIER F. (2008). HIV Pandemic, Medical Brain Drain, and Economic Development in Sub-Saharan Africa, World Bank Economic Review  22, 345-366.
• BHATTACHARYYA, S. (2009). Root causes of African underdevelopment. Journal of African E conomies 18, 745-780.
• Online BIRCHENALL, J.A. (2007). Economic development and the escape from high mortality. World Development 35, 543-568.
• Online BLEAKLEY, H. (2003). Disease and development: Evidence from the American South. Journal of the European Economic Association 1, 376-386.
• Online BLEAKLEY, H. (2010a). Health, human capital, and development. Annu. Rev. Econ . 2, 283-310.
• Online BLEAKLEY, H. (2010b). Malaria eradication in the Americas: A retrospective analysis of childhood exposure. American Economic Journal : Applied Economics 1-45.
• Online BLEANEY, M., Arcangelo DIMICO (2010). “Geographical Influences on Long-run Development.” Journal of African Economies 19, no. 5: 635-656.
• BLOOM, D.E., CANNING, D., SEVILLA, J. (2003). The demographic dividend: A new perspective on the economic consequences of population change . Vol. 5. 1274. Rand Corporation.
• Online BLOOM, D.E., CANNING, D., SEVILLA, J. (2004). The effect of health on economic growth: a production function approach. World Development 32, 1-13.
• Online BOKHARI, F.A.S, Y. GAI, P. GOTTRET (2007). « Government health expenditures and health outcomes ». Health Economics 16 (3): 257-273.
• Online BOOYSEN, F. le R., T. ARNTZ (2003). « The methodology of HIV/AIDS impact studies: a review of current practices ». Social Science & Medicine 56 (12): 2391-2405.
• Online BONDS, M.H., KEENAN, D.C., ROHANI, P., SACHS, J.D. (2010). Poverty trap formed by the ecology of infectious diseases. Proceedings of the Royal Society B: Biological Sciences 277, 1185-1192.
• Online BOX, J. FISHER (1980). « R.A. Fisher and the design of experiments, 1922–1926 ». The American Statistician 34 (1): 1-7.
• Online BREIEROVA, L., E. DUFLO (2004). The impact of education on fertility and child mortality: Do fathers really matter less than mothers? National Bureau of Economic Research.
• Online BRUNET-JAILLY, J. (1997). Innover dans les systèmes de santé: expériences d’Afrique de l’Ouest. Ed. Karthala.
• Online COHEN J., DUPAS P. (2010). Free Distribution of Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment, Quarterly Journal of Economics 125(1), pp. 1-45.
• CARLSON, J. J., S. D. SULLIVAN, L. P. GARRISON, P. J. NEUMANN, D. L. VEENSTRA (2010). Linking payment to health outcomes: a taxonomy and examination of performance-based reimbursement schemes between healthcare payers and manufacturers. Health Policy 96 (3): 179-190.
• CARSTENSEN, K., GUNDLACH, E. (2006). The primacy of institutions reconsidered: Direct income effects of malaria prevalence. The World Bank Economic Review 20, 309-339.
• Online CAVALLI, A., Sory I. BAMBA, M.N. TRAORE, M. BOELAERT, Y. COULIBALY, K. POLMAN, M. PIRARD, M. VAN DORMAEL (2010). « Interactions between global health initiatives and country health systems: the case of a neglected tropical diseases control program in Mali ». PLoS neglected tropical diseases 4, 8: 798.
• Online CHIMA, R.I., GOODMAN, C.A., MILLS, A. (2003). The economic impact of malaria in Africa: a critical review of the evidence. Health policy 63, 17-36.
• Online CHIAPPORI, P.A. (1992). Collective labour supply and welfare. Journal of Political Economy 100 (3), 437-467.
• CRAIG, P., C. COOPER, D. GUNNELL, S. HAW, K. LAWSON, S. MACINTYRE, D. OGILVIE, M. PETTICREW, B. REEVES, M. SUTTON (2012). « Using natural experiments to evaluate population health interventions: new Medical Research Council guidance ». Journal of epidemiology and community health 66, 12: 1182-1186.
• Online DEATON, A. (2003). Health, Inequality, and Economic Development . Journal of Economic Literature 41: 113-158.
• DUFLO, E., M. KREMER (2005). « Use of randomization in the evaluation of development effectiveness ». Evaluating Development Effectiveness 7 : 205-231.
• DUFLO, E., P. DUPAS, M. KREMER, S. SINEI (2006). « Education and HIV/AIDS prevention: evidence from a randomized evaluation in Western Kenya ». World Bank Policy Research Working Paper , n° 4024.
• DUFLO, E., R. GLENNERSTER, M. KREMER (2007). « Using randomization in development economics research: A toolkit ». Handbook of development economics 4: 3895-3962.
• Online DUPAS, P. (2011). “Health Behavior in Developing Countries.” Annu. Rev. Econ.  3, no. 1: 425-449.
• Online EASTWOOD, R. (2012). Macroeconomic approaches to identifying the effects of health on output, growth and poverty. African Development Review 24, 279-290
• EASTERLY, W. (1999). Life during growth. Journal of Economic Growth , 4, 239-275.
• EASTERLIN, R. A. (2004). The reluctant economist: Perspectives on economics, economic history, and demography. Cambridge University Press.
• Online ELDRIDGE, C., N. PALMER (2009). Performance-based payment: some reflections on the discourse, evidence and unanswered questions. Health policy and planning 24 (3): 160-166.
• FILMER, D., L. PRITCHETT (1999). The impact of public spending on health: does money matter? Social science & medicine 49 (10): 1309-1323.
• FOGEL, R.W. (1990). The conquest of high mortality and hunger in Europe and America: Timing and mechanisms . National Bureau of Economic Research Cambridge, Mass., USA.
• Online FOGEL, R. W. (1994). Economic Growth, Population Theory, and Physiology: The Bearing of Long-Term Processes on the Making of Economic Policy. American Economic Review 83(3): 369-95.
• FOGEL, R. W. (1997). New Findings on Secular Trends in Nutrition and Mortality: Some Implications for Population Theory . In M. Rosenzweig and O. Stark, eds., Handbook of Population and Family Economics, vol. 1A. New York: Elsevier.
• Online FOGEL, R. W. (2004). The escape from hunger and premature death, 1700-2100: Europe, America, and the Third World . Vol. 38, Cambridge University Press.
• Online FRENK, J., J. L. BOBADILLA, J. SEPULVEDA, Malaquias Loópez CERVANTES (1989). « Health Transition in Middle-income Countries: New Challenges for Health Care ». Health Policy and Planning 4, 1: 29‑39.
• Online GACHUHI, D. (1999). « The Impact of HIV/AIDS on Education Systems in Eastern and Southern Africa Region ». draft, New York: UNICEF.
• GALLUP, J. L., J. D. SACHS (2001). “The Economic Burden of Malaria.” The American Journal of Tropical Medicine and Hygiene 64, no. 1 suppl (January 1): 85-96.
• GAUTHIER, B., WANE, W. (2008). Leakage of Public Resources in the Health Sector: An Empirical Investigation of Chad?. Journal of African Economies 18: 52-83.
• Online GEOFFARD, P-Y., T. PHILIPSON (1996). « Rational epidemics and their public control ». International Economic Review : 603-624.
• Online GLEWWE, P., MIGUEL, E.A. (2007). Chapter 56. The Impact of Child Health and Nutrition on Education in Less Developed Countries. In T. Paul Schultz and John A. Strauss (Ed.), Handbook of Development Economics. Elsevier, 3561-3606.
• Online GROSSMAN, M. (1972a). On the concept of health capital and the demand for health. The Journal of Political Economy 80, 2: 223-255.
• Online GROSSMAN, M. (1972b). Front matter, the demand for health: a theoretical and empirical investigation. In The demand for health: a theoretical and empirical investigation , 20-0.
• Online HECKMAN, J. J. (2005). The scientific model of causality. Sociological methodology 35 (1): 1-97.
• Online JOHANSSON, S.R., MOSK, C. (1987). Exposure, resistance and life expectancy: disease and death during the economic development of Japan, 1900-1960. Population Studies 41, 207-235.
• Online KAKWANI, N., WAGSTAFF, A., Van DOORSLAER, E. (1997). Socioeconomic inequalities in health: measurement, computation, and statistical inference. Journal of econometrics 77, 87-103.
• Online KREMER, M., GLENNERSTER, R. (2011). Chapter 4 - Improving Health in Developing Countries: Evidence from Randomized Evaluations . In Mark V. Pauly, T.G.M. and P.P.B. (Ed.), Handbook of Health Economics. Elsevier, 201-315.
• Online KUDAMATSU, M., T. PERSSON, et D. STRÖMBERG. (2012). Weather and infant mortality in Africa . Centre for Economic Policy Research.
• LAMIRAUD, K., P-Y. GEOFFARD (2007). « Therapeutic non-adherence: a rational behavior revealing patient preferences? ». Health economics 16 (11): 1185-1204.
• Online LAVY, V., J. STRAUSS, D. THOMAS, Ph. De VREYER (1996). « Quality of health care, survival and health outcomes in Ghana ». Journal of Health Economics 15, 3: 333‑357.
• LEIBOWITZ, A. (1974). Home investments in children. The Journal of Political Economy , 82(2), 111-131.
• Online LEVINSOHN, J., MCLAREN, Z.M., SHISANA, O., ZUMA, K. (2013). HIV Status and Labor Market Participation in South Africa. The Review of Economics and Statistics 95:98-108.
• Online LUCAS, A. M. (2010). “Malaria Eradication and Educational Attainment: Evidence from Paraguay and Sri Lanka.” American Economic Journal: Applied Economics 2, no. 2: 46-71.
• MACINKO, J., M. F. LIMA-COSTA (2012). “Horizontal Equity in Health Care Utilization in Brazil, 1998–2008.” Int J Equity Health 11: 33.
• Online MAITRA, P. (2004). “Parental Bargaining, Health Inputs and Child Mortality in India.” Journal of Health Economics 23, no. 2: 259-291.
• Online MARSHALL. A. (1898). Distribution and exchange. Economic Journal 8, 29.
• Online MARMOT, M. (2002). The Influence Of Income On Health: Views Of An Epidemiologist. Health Affairs 21, 2: 31-46.
• Online MCCARTHY, F., WOLF, H., WU, Y. (2000). Malaria and growth . World Bank Policy Research Working Paper.
• Online MCCLELLAN, M., B. J. MCNEIL, J. P. NEWHOUSE (1994). « Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality ». Analysis using instrumental variables. JAMA 272 (11): 859-866.
• Online MANE, P. Y. B. (2013). “Décomposition des inégalités dans l’utilisation des soins de santé au Sénégal.” Revue d’économie du développement 27, no. 1: 61-89.
• Online MIGUEL, E., M. KREMER (2004). “Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities.” Econometrica 72, no. 1: 159–217.
• Online MOATTI, J-P., N. BELTZER, W. DAB (1993). Les modèles d’analyse des comportements à risque face à l’infection à VIH: Une conception trop étroite de la rationalité. Population : 1505-1534.
• MOATTI, J-P., B. VENTELOU (2009). Économie de la santé dans les pays en développement : des paradigmes en mutation. Revue économique 60 (2): 241-256.
• Online MONTEIRO, C. A., W. L. CONDE, B. M. POPKIN (2001). « Independent Effects of Income and Education on the Risk of Obesity in the Brazilian Adult Population ». The Journal of Nutrition 131, 3 (janvier 3): 881S‑886S.
• Online ODIWUOR, W. H. (2000). « The impact of HIV/Aids on primary education: a case study on selected districts of Kenya ». Doctoral thesis, Stockholm.
• PACKARD, R. M. (2009). « “Roll Back Malaria, Roll in Development”? Reassessing the Economic Burden of Malaria ». Population and Development Review 35 (1): 53-87.
• Online PRESTON, S.H. (1975). The changing relation between mortality and level of economic development. Population studies 29, 231-248
• PRESTON, S. (1980). Causes and consequences of mortality change in less developed countries in the twentieth century. In R. Easterlin (Ed.), Population and economic change in developing countries (pp. 289-360). University of Chicago Press.
• Online PUSHKAR, M. “Parental Bargaining, Health Inputs and Child Mortality in India.” Journal of Health Economics 23, 2: 259-291.
• Online RAM, R., SCHULTZ, T.W. (1979). Life span, health, savings, and productivity. Economic Development and Cultural Change 27, 399-421.
• Online RASSEN, J.A., BROOKHART, M.A., GLYNN, R.J, MITTLEMAN M.A, SCHNEEWEISS, S. (2009a). « Instrumental variables I: instrumental variables exploit natural variation in nonexperimental data to estimate causal relationships ». Journal of clinical epidemiology 62 (12): 1226-1232.
• RASSEN, J.A., BROOKHART, M.A., GLYNN, R.J, MITTLEMAN M.A, SCHNEEWEISS, S. (2009b). « Instrumental variables II: instrumental variable application—in 25 variations, the physician prescribing preference generally was strong and reduced covariate imbalance ». Journal of clinical epidemiology 62 (12): 1233.
• REITER, P., S. LATHROP, M. BUNNING, B. BIGGERSTAFF, D. SINGER, T. TIWARI, L. BABER, M. AMADOR, J. THIRION, J. HAYES (2003). Texas lifestyle limits transmission of dengue virus. Emerging infectious diseases 9 (1): 86.
• ROCHAIX L., TUBEUF S. (2009). Mesure de l’équité en santé: fondements éthiques et implications. Revue Economique 2(60).
• Online SACHS, J. (2006). The end of poverty: economic possibilities for our time . Penguin.
• Online SACHS, J., MALANEY, P. (2002). The economic and social burden of malaria. Nature 415, 680-685.
• Online SCHULTZ, T. P. (2002). Wage gains associated with height as a form of health human capital. American Economic Review 92 (2), 349-353.
• Online SCHULTZ, T. W. (1961). Investment in human capital. The American Economic Review 51 (1): 1-17.
• Online SEBAN, J., J. THUILLIEZ, V. HERBRETEAU (2013). “Possession of Bed Nets in Haut-Katanga (DRC): Prevalence-elastic Behaviour or Performance of Health Care System Delivery?” Health & Place 24 (November): 275-285.
• Online SEN, A. (1980). « Equality of what? ». The Tanner lectures on human values 1: 353-369.
• SEN, A. (1988). « The concept of development ». Handbook of development economics 1: 9-26.
• SEN, A., M. NUSSBAUM (1993). « Capability and well-being ». The quality of life 1 (9): 30-54.
• STRAUSS, J. (1986). Does better nutrition raise farm productivity?. The Journal of Political Economy 94 (2), 297-320.
• Online STRAUSS, J., THOMAS, D. (1998). Health, nutrition, and economic development. Journal of Economic Literature 36 (2), 766-817.
• Online STRAUSS, J., THOMAS, D. (2008). Health over the life course. In T. P. Schultz and J. Strauss (ed.) (Ed.), Handbook of development economics (Elsevier B.V ed., 3375-3474).
• Online THOMAS, D., E. FRANKENBERG (2002). « Health, nutrition and prosperity: a microeconomic perspective ». Bulletin of the World Health Organization 80, 2 : 106-113.
• Online THUILLIEZ, J. (2009). « L’impact du paludisme sur l’éducation primaire: une analyse en coupe transversale des taux de redoublement et d’achèvement ». Revue d’Economie du Développement 1 : 167-201.
• THUILLIEZ, J. (2010). « Fever, malaria and primary repetition rates amongst school children in Mali: Combining demographic and health surveys (DHS) with spatial malariological measures ». Social Science & Medicine 71, 2: 314-323.
• Online THUILLIEZ, J., M. S. SISSOKO, O. B. TOURE, P. KAMATE, J-C. BERTHÉLEMY, O. K. DOUMBO (2010). « Malaria and primary education in Mali: A longitudinal study in the village of Donéguébougou ». Social Science & Medicine 71, 2: 324-334.
• Online TRAVIS, P., S. BENNETT, A. HAINES, T. PANG, Zulfiqar BHUTTA, A. A. HYDER, N. R. PIELEMEIER, A. MILLS, T. EVANS (2004). “Overcoming Health-systems Constraints to Achieve the Millennium Development Goals.” The Lancet 364, no. 9437: 900-906.
• VENKATARAMANI, A. S. (2012). “Early Life Exposure to Malaria and Cognition in Adulthood: Evidence from Mexico.” Journal of Health Economics 31, no. 5 (September): 767-780. doi:10.1016/j.jhealeco.2012.06.003.
• WAGSTAFF, A., PACI, P., VAN DOORSLAER, E. (1991). On the measurement of inequalities in health. Social science & medicine 33, 545-557.
• WAGSTAFF, A. (2002a). Inequality aversion, health inequalities and health achievement. Journal of health economics 21, 627-641.
• WAGSTAFF, A. (2002b). Poverty and health sector inequalities. Bulletin of the world health organization 80, 97-105.
• WAGSTAFF, A., F. BUSTREO, J. BRYCE, M. CLAESON (2004a). « Child health: reaching the poor ». Journal Information 94 (5).
• WAGSTAFF, A., M. CLAESON (2004b). The Millenium Development Goals for Health : Rising to the Challenges . World Bank Publications.
• WANG, H, ZHANG, L, YIP, W, HSIAO, W (2011). An experiment in payment reform for doctors in rural China reduced some unnecessary care but did not lower total costs.  Health Aff (Millwood), 30(12):2427-36.
• WELL, D.N. (2007). Accounting for the Effect of Health on Economic Growth. The Quarterly Journal of Economics 122, 3: 1265‑1306.
• YIP, W.C, HSIAO, W, MENG, Q, CHEN, W, SUN, X (2010). Realignment of incentives for health-care providers in China.  Lancet , 375(9720):1120-30.
• YIP, W.C.-M., HSIAO, W.C., CHEN, W., HU, S., MA, J., MAYNARD, A. (2012). Early appraisal of China’s huge and complex health-care reforms. Lancet 379, 833-842.
• YOUNG, A. (2005). The gift of the dying: the tragedy of AIDS and the welfare of future African generations. Quarterly Journal of Economics 120:423-66.
• ZHOU, Z., J. GAO, A. FOX, K. RAO, K. XU, L. XU, Y. ZHANG (2011). “Measuring the Equity of Inpatient Utilization in Chinese Rural Areas.” BMC Health Services Research 11, no. 1: 201.
• ZHANG, J., ZHANG, J. (2005). The Effect of Life Expectancy on Fertility, Saving, Schooling and Economic Growth: Theory and Evidence. The Scandinavian Journal of Economics. 107, 45-66.

• Mini-grids as an application of Elinor Ostrom’s theses on polycentric governance as a way to cope with the tragedy of the commons
• In Revue d’économie du développement Volume 24, Issue 3-4, 2016

• Introduction: how to rethink healthcare in Africa in the light of the global health crisis
• Avec Hamidou Niangaly , Valéry Ridde ,
• In Revue internationale des études du développement Volume 247, Issue 3, July 2021

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Introduction: Health and development

2023, Yearbook for the History of Global Development, vol.2

It makes intuitive sense that health and development require one another: there can be no development without a critical mass of people who are sufficiently healthy to do whatever it takes for development to occur, and people cannot be healthy without societal developments that allow maintaining - or ideally improving - health. However, while this mutual dependence seems clear enough when presented in these simple terms, even minimal scratching of the surface reveals many complex and contested histories. Both "health" and "development" entail complex problems of conceptualisation, definition, and measurement.

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Health and development

Jennifer prah ruger.

Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, St Louis, MO 63110, USA ( ude.ltsuw.mi@regurj )

In one of her last public speeches as Director-General of the WHO on May 19, 2003, Gro Harlem Brundtland reiterated her constant message that “health is central to development”. Since her nomination as Director-General, Brundtland has advocated increased health sector investment in developing countries by demonstrating a strong link between health and economic development. A 2001 report by the WHO Commission on Macroeconomics and Health set specific goals for health investments as a means to promote economic development. Having spent a decade as Norway's prime minister, Brundtland knew that the audience for this key message would ultimately be prime ministers, donors, and finance ministers who can mobilise or reallocate resources for health.

Viewing good health as a means to further economic development is a useful strategy for elevating the status of health-related investment. However, this view also has limitations, particularly in acknowledging the intrinsic value of health and understanding development more broadly. An alternative view of health and economic development sees health as both intrinsically and instrumentally valuable but takes health as an end in itself. This viewpoint sees the opportunity for health and health care as “constituent components of development”, 1 obviating the need to justify their importance in terms of their indirect contribution to the growth of gross national product or personal income. It also recognises the interrelatedness among health and other valuable social ends (eg, education) and at the same time emphasises health's importance for individual agency—ie, people's ability to live a life they value.

Good health enables individuals to be active agents of change in the development process, both within and outside the health sector. Increased investment in health requires public action and mobilisation of resources, but it also brings individuals opportunities for social and political participation in health-system reform and implementation. Agency is critical for development overall and for the development and sustainability of effective health systems, and individuals should have the opportunity to participate in political and social choice about public policies that affect them. These key elements are part of an alternative way of thinking about health and development, and several points are relevant to this view.

First, this alternative viewpoint appeals to a particular vision of the good life that is derived from Aristotelian political philosophy 2 – 6 and Amartya Sen's capability approach. 1 , 7 , 8 According to Aristotle, society's obligation to maintain and improve health is grounded in the ethical principle of human flourishing, 2 – 6 which holds that society is obligated to enable human beings to live flourishing, and thus healthy, lives. Certain aspects of health, in particular, sustain all other aspects of human flourishing because without being alive no other human functionings, including agency, are possible. Therefore public policy should focus on individuals’ capacity to function, and health policy should aim to maintain and improve this capacity by meeting health needs. This view sees development as expan sion of individual freedom instead of judging development by gross national product or personal income. 1 , 7 , 8

Second, the link between health and economic development is two-directional because health depends on economic development in the same way that economic development depends on health. For example, health and demography can affect income through their impact on labour productivity, savings rates, investments in physical and human capital, and age structure. In the other direction, income can affect health and demography by, for example, improving the ability to obtain food, sanitation, housing, and education and providing incentives to limit family size. 9 However, inequalities in income and social position can also harm the health of the underdog, as Marmot's work demonstrates. 10 It is therefore important to integrate strategies for improving health and economic opportunities rather than assuming a one-directional relation going from health to increased affluence.

Third, health improvement and economic development are both linked to individuals’ opportunities to exercise their agency and participate in political and social decision making. Political and civil rights, especially the right to open discussion and dissent, are central to informed choice. 1 Agency is important for public policy because it supports individuals’ participation in economic, social, and political actions and enables individuals to make decisions as active agents of change. This view contrasts with the perspective that individuals are passive recipients of health care and decisions about health expenditure or other development programmes. An agency-centred view promotes individuals’ ability to understand and “shape their own destiny and help each other”. 1 Development of institutions that aim to improve health and create economic opportunities should therefore be influenced by the “exercise of people's freedoms, through the liberty to participate in social choice and in the making of public decisions that impel the progress of these opportunities”. 1 It is important that any discussion of health and economic development take note of the significance of participation for effective and sustainable reforms. Active agency is critically important for both health and economic development as indeed they are important for each other.

Acknowledgments

I thank Amartya Sen for helpful comments. Supported in part by grant 1K01DA016358-01 from the National Institutes of Health.

UC San Diego

Essays on Development and Health Economics

• Yang, Jianan
• Advisor(s): Muralidharan, Karthik

This dissertation is a collection of three essays on development and health economics. In the first essay, we studied two interventions that provide patients with information on antibiotic resistance through text messages in Beijing, China. The "self-health" intervention emphasizes the threat to one’s own health and is found to have negligible effects. In contrast, the "social-health" intervention highlighting the threat to society reduces antibiotic purchases by 17% without discouraging healthcare visits and other medicine purchases. Survey evidence suggests the perceived severity being a potential explanation. The messages were sent once every month for five months, and a gradual decrease in the effect size is observed over time.

The second essay evaluated the affordability and overuse trade-off in pharmaceutical pricing by studying a drug procurement program in China, which brought down the prices of 10 chronic condition drugs by an average of 78%. Using a difference-in-differences design with a set of comparable drugs as controls, we find that this improvement in affordability led to a significant increase in demand by uninsured patients, whose purchases of treated drugs increased by 28.4% more than the insured. This demand response came both from new and existing medication takers. Drug adherence was improved for the uninsured who had poorer adherence at baseline but overuse was not affected.

The third essay proposes two experiments related to low disease awareness, treatment take-up, and adherence in developing countries. Because of lacking access to primary care services, chronic condition awareness in developing countries is usually low. The first experiment proposes to provide people in low-income areas with physical exams and health reports to examine whether raising disease awareness could increase control. The second experiment proposes to provide patients with information on the expected benefit from treatment including the expected reduction in risk if their condition is under control, and the cost of a major health event. This experiment is designed to test the hypothesis that misperception of treatment benefits is one of the underlying causes for low take-up and adherence rates conditional on disease awareness in developing countries.

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Towards victory over the vicious cycle of poverty and ill-health

by UCHIMURA Hiroko

The Mother-Child health training center in Bangladesh

Although health is an essential and important issue for the progress of developing countries, the definition and goals of health tend to be seen as being somewhat amorphous. According to the World Health Organization’s (WHO) definition, health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Health development encompasses all the elements that are necessary for the achievement of such a state of being. In this context, a wide variety of disciplines have some relation to health; specifically, these disciplines include epidemiology, biology, public health and medical science as well as demography, economics, and international health.

The Declaration of Alma-Ata of 1978 which introduced the concept of Primary Health Care (PHC) marked a turning point in the approach and goals of international aid in the field of health in developing countries. PHC made explicit the importance of primary health care in developing countries. In addition, it calls for prioritizing local health care needs and fully utilizing locally-available resources to provide health care services to meet those needs. This approach represents a dramatic departure from the previous goal of international aid which was to introduce health systems or models of developed countries into developing countries. In the Millennium Development Goals (MDGs) adopted by the United Nations in 2000 , three of the eight goals are directly related to health (reduction of child mortality, improvement of maternal health , and combat against HIV/AIDS malaria and other diseases). Underlying concern is the vicious cycle of poverty and ill-health in developing countries. Health is not only a result of, but also a contributing factor to, development. Poor people suffer from ill-health; at the same token, people are more likely to fall into poverty because of ill-health. Such vicious cycle of poverty and ill-health places a large burden on developing countries and hinders to development. The purpose of health development is to improve the health of individuals and to control the spread of disease, both of which are essential elements of development and poverty reduction. Although international concern about health in developing countries is increasing, there is a chronic shortage of resources (financial, human, and material resources) to deal with such issues. The question of how to increase resources remains a major challenge for international aid for developing countries. A further challenge, in the face of limited resources, is how local health services and health systems can be improved and strengthened to provide health services that meet local needs and are accessible, particularly to those living in poverty.

HIV/AIDS - Not just a health and medical problem

by MAKINO Kumiko

AIDS (Acquired Immune Deficiency Syndrome) is a disease resulting from infection by HIV (Human Immunodeficiency Virus). The three primary modes of transmission are sexual contact, blood transfusion, and transmission from a mother to child. Disease symptoms do not appear immediately upon infection (latent period) but after a gradual degradation of an individual's immune system that results in a lowering of the body's ability to defend against disease and ultimately leads to contracting multiple infections and malignancies. This condition is called AIDS. The disease, which later came to be known as AIDS, began to spread in the early 1980s among gay men in the United States. Today, however, HIV/AIDS has the greatest impact in Sub-Saharan Africa, with women representing more than half of people living with HIV in the region. According to a 2007 estimate, among about 33 million people living with HIV worldwide, more than two thirds (68%) are in Sub-Saharan Africa. Among the Sub-Saharan African countries, Southern African countries including Botswana, Swaziland, and South Africa, which experienced a rapid increase in infection since the 1990's, have been most affected by HIV/AIDS. In recent years, the increased use of intravenous drugs has led to a rapid increase in the infection rate in East and Central Asia as well as Eastern Europe.

HIV/AIDS not only prematurely takes the lives of young, working-age men and women, but also impoverishes surviving dependent family members. This impact is especially serious for children. Children who have lost their parents to AIDS ("AIDS orphans"), or who have to take care of their ill parents, are likely to face serious challenges, including high drop out rates from school and various discrimination throughout their lives. For businesses, HIV/AIDS can lower productivity and contribute significantly to increased labor costs by reducing the size of the labor pool. At the country level, HIV/AIDS may contribute to deterioration of a nation’s financial status by hindering economic growth and by reducing tax revenues, while increasing health care expenditures. In this manner, in countries where it is prevalent, HIV/AIDS can impact the country’s very economic and social foundations. For this reason, HIV/AIDS is an important factor, not only in health and medical research, but also in the study of economics, politics, and social sciences. HIV/AIDS programs span a wide variety of goals including prevention, testing and counseling, provision of treatment, care and support for people living with HIV, and ending discrimination and stigmatization. HIV/AIDS programs have changed drastically since the development of antiretroviral drugs (ARV) in the mid-1990s. Treatment with a cocktail of different ARVs can keep the amount of HIV in the body at a low level and enable the body’s immune system to recover significantly. However, at the time of their development, treatment with ARVs did not progress rapidly in developing countries due to their high costs. This led to increasing criticism that the high prices were the result of excessive protection of intellectual property rights , which ultimately helped precipitate a revision of the World Trade Organization ' s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). In recent years, due to pressure from developing country governments and advocacy groups formed by people living with HIV and the availability of generic drug alternatives, the price of ARVs has dropped considerably. In addition, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was established to facilitate funding of programs focusing on the three major communicable diseases: AIDS, tuberculosis, and malaria. Despite the continuing challenges of insufficient human resources, insecure funding, instability of medical supplies, and the development of drug-resistant strains, there is increasing opportunity in developing countries for antiretroviral treatment.

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World Studies Extended Essay: Global Themes

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World Studies Global Themes

Conflict, peace, and security Culture, language, and identity Environmental and/or economic sustainability Equality and inequality Health and development Science, technology and society

Conflict, peace, and security

Culture, language, and identity

Environmental and/or economic sustainability

Equality and inequality

Health and development

Science, technology and society

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Digital Commons @ USF > Office of Graduate Studies > USF Graduate Theses and Dissertations > USF Tampa Theses and Dissertations > 6343

USF Tampa Graduate Theses and Dissertations

Essays in health and development economics.

John Bosco Oryema , University of South Florida Follow

Graduation Year

Document type, degree name.

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Major professor.

Kwabena Gyimah-Brempong, Ph.D.

Co-Major Professor

Gabriel Picone, Ph.D.

Committee Member

Murat Munkin, Ph.D.

Getachew Dagne, Ph.D.

Child Mortality, Debt Relief, Nutrition, NAADS, C-Section, Africa

This dissertation examines three health and development issues in Sub-Saharan Africa. It analyzes the impact of policy changes and interventions on child mortality, household food consumption and cesarean section births. The study is motivated by the Millennium Development Goals and policies which could affect their achievement. In the first essay, I investigate the impact of debt relief on under-five mortality rate. A dynamic panel data estimator is employed in the analysis. The result shows that debt relief is associated with a statistically significant reduction in under-five mortality rate. I conclude that conditionality of debt relief or development aid can yield positive outcomes. The second essay examines the impact of private hospitals on the likelihood of cesarean section births in Uganda. The study is motivated by the increase in cesarean section births following the proliferation of private hospitals. The main method of estimation is a bivariate probit model. The results show that delivery at private hospitals increases the probability of cesarean section births, thus there is need to monitor private hospitals so that expectant mothers are protected from physician induced demand for avoidable cesarean section births. The final essay studies the impact of agricultural extension services on household food consumption in Uganda. The study exploits the variation in participation in the NAADS to estimate the impact of the program on household food consumption. I find that NAADS membership and training are associated with an increase in household food consumption, hence agricultural extension services can be used to reduce food insecurity. Policy recommendations and future studies are explored.

Scholar Commons Citation

Oryema, John Bosco, "Essays in Health and Development Economics" (2016). USF Tampa Graduate Theses and Dissertations. https://digitalcommons.usf.edu/etd/6343

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Adolescent Health Problems and Development Essay

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Adolescent development is a dynamic biopsychosocial process that has to be understood by both parents or caregivers and health care providers to guide children through the transition from childhood to adulthood (Neinstein, Woods, Gordon, Katzman, & Rosen, 2009). No one would deny that adolescent development does not occur outside the context of familial and peer relationships. Therefore, it could be argued that the most important distinguishing characteristics of an adolescent are products of family and peer influence. Adolescents develop their identities and beliefs about their role in surrounding cultural environments through interaction with different social groups. Therefore, their ability to cope with the developmental process is directly influenced by their familial and peer relationships (Neinstein et al., 2009).

Unlike Western cultures, the traditional cultures of India and China are associated with a strong pattern of closeness to extended family members (Arnett, 2013). Even though American minority cultures often display a similar proclivity for living in immediate proximity to their grandparents, uncles, aunts, and cousins, Western majority cultures engage in less frequent contact with their extended families. Taking into consideration the fact that “closeness to grandparents is positively related to adolescents’ well-being” (Arnett, 2013, p. 181), it could be argued that Western society could benefit from this practice. Moreover, traditional cultures promote caregiver relationships between siblings, thereby strengthening their bond and substantially reducing the amount of conflict in a family.

There is ample evidence suggesting that health problems faced by adolescents are likely to result in negative consequences in their lifetime (Reilly & Kelly, 2011). For example, adolescent obesity that adversely influences the developed world for the last few decades is positively related to adult morbidity, specifically cardiometabolic morbidity (Reilly & Kelly, 2011). There is also a large body of evidence that shows that exposure to major psychological stressors during adulthood leads to “elevated rates of morbidity and mortality from chronic diseases of aging” (Miller, Chen, & Parker, 2011, p. 959). Health problems faced by adolescents have a lingering influence on their adult life; therefore, it is necessary to take a careful and systemic approach to their treatment.

Even though a fourteen-year-old female patient is perfectly capable of grasping the specifics of the physical exam it is necessary to address the issue of “self-consciousness about their own body” (Sanfilippo, Lara-Torre, Edmonds, & Templeman, 2012, p. 120). The challenge stems from the fact that adolescents develop at varying ages; therefore, it might be necessary to precede an examination with educational videos that explain the process of examination. Even though the child’s parent is present at the exam, it is necessary to talk directly to the child to establish rapport. The child should be provided with a confidential screening questionnaire. It is also necessary to check adolescent-specific history, immunizations, substance abuse, depression, and eating disorders among others (Schuiling & Likis, 2013). The child should be encouraged to allow a doctor to become “the liaison between her and her family” (Sanfilippo et al., 2012, p. 212) so she could be provided with health information.

A doctor should “discuss issues of confidentiality with an adolescent and their parent/guardian” (Sanfilippo et al., 2012, p. 263) before taking their sexual history. Even though teenagers are allowed to legally consent to “confidential diagnosis and treatment of STDs” (Sanfilippo et al., 2012, p. 263), they should be informed that if a patient’s disease poses a significant threat to either their or someone else’s life, the clinician has a right to disclose such information. A doctor has to provide a patient with information on abstinence, STD risk reduction, and condom use among others (Sanfilippo et al., 2012, p. 263).

Arnett, J. (2013). Adolescence and emerging adulthood: A cultural approach. New York, NY: Pearson.

Miller, G., Chen, E., & Parker, K. (2011). Psychological stress in childhood and susceptibility to the chronic diseases of aging: Moving towards a model of behavioural and biological mechanisms. Psychological Bulletin, 137 (6), 959-997.

Neinstein, L., Woods, E., Gordon, C., Katzman, D., & Rosen, D. (2009). Handbook of adolescent health care (1st ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Reilly, J., & Kelly, J. (2011). Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: Systematic review. International Journal of Obesity, 35 (1), 891-898.

Sanfilippo, J., Lara-Torre, E., Edmonds, K., & Templeman, C. (2012). Clinical pediatric and adolescent gynecology . New York, NY: Informa Healthcare

Schuiling, K., & Likis, F. (2013). Women’s gynecologic health (1st ed.). Sudbury, MA: Jones & Bartlett Learning.

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IvyPanda. (2020, August 5). Adolescent Health Problems and Development. https://ivypanda.com/essays/adolescent-health-problems-and-development/

"Adolescent Health Problems and Development." IvyPanda , 5 Aug. 2020, ivypanda.com/essays/adolescent-health-problems-and-development/.

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Essay on Human Development

Students are often asked to write an essay on Human Development in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Human Development

The concept of human development.

Human development is a process of enlarging people’s freedoms and improving their well-being. It involves increasing the choices and opportunities for all people.

Dimensions of Human Development

The importance of human development.

Human development is crucial. It helps societies to progress, reduces poverty, and promotes equality. It’s a way to help everyone live a productive and fulfilling life.

Challenges in Human Development

Despite its importance, many challenges exist, like inequality, environmental degradation, and political instability. Overcoming these challenges is vital for sustainable human development.

250 Words Essay on Human Development

Introduction, theoretical framework.

The Human Development Index (HDI), introduced by the United Nations Development Programme, quantifies human development. It emphasizes three fundamental dimensions: knowledge, longevity, and decent standard of living. However, human development is not merely a function of these quantifiable elements; it also involves intangible aspects such as freedom, dignity, and autonomy.

Role of Education

Education plays a central role in human development. It equips individuals with knowledge and skills, empowering them to contribute to societal progress. Education fosters creativity and innovation, driving technological advancements and economic growth.

Health and Living Standards

Health is another crucial component. A healthy population is more productive, contributing to economic growth and societal development. Additionally, a decent standard of living, characterized by access to basic needs and services, is vital for human development.

Societal Participation

Active societal participation promotes inclusivity and equality, essential elements of human development. It enables individuals to contribute to and benefit from societal progress, fostering a sense of belonging and mutual respect.

In conclusion, human development is a comprehensive and nuanced concept. It encompasses not only economic growth but also aspects such as education, health, living standards, and societal participation. It is about creating an environment where individuals can develop their full potential and lead productive, creative lives in accord with their needs and interests.

500 Words Essay on Human Development

The biological perspective.

From the biological standpoint, human development begins with genetics. Our genetic makeup, coupled with environmental influences, guides our physical growth and maturation. This includes the development of the brain, motor skills, and health. Understanding the biological aspects of human development allows us to grasp why we are the way we are, and how our physical attributes and health conditions may influence our life experiences.

The Psychological Perspective

The psychological perspective focuses on the development of mental processes, behaviors, and emotions. Cognitive development theory, proposed by Jean Piaget, suggests that individuals pass through different stages of cognitive growth as they mature. This theory underscores the importance of experiences and interactions in shaping our cognitive abilities, personality, and emotional well-being.

The Sociocultural Perspective

Interplay of factors, human development index.

To measure human development, the United Nations uses the Human Development Index (HDI). The HDI is a summary measure of average achievement in key dimensions of human development: a long and healthy life, being knowledgeable, and having a decent standard of living. It is a standard means of measuring well-being, especially child welfare.

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Essay on Health for Students and Children

500+ words essay on health.

Essay on Health: Health was earlier said to be the ability of the body functioning well. However, as time evolved, the definition of health also evolved. It cannot be stressed enough that health is the primary thing after which everything else follows. When you maintain good health , everything else falls into place.

Similarly, maintaining good health is dependent on a lot of factors. It ranges from the air you breathe to the type of people you choose to spend your time with. Health has a lot of components that carry equal importance. If even one of them is missing, a person cannot be completely healthy.

Constituents of Good Health

First, we have our physical health. This means being fit physically and in the absence of any kind of disease or illness . When you have good physical health, you will have a longer life span. One may maintain their physical health by having a balanced diet . Do not miss out on the essential nutrients; take each of them in appropriate quantities.

Secondly, you must exercise daily. It may be for ten minutes only but never miss it. It will help your body maintain physical fitness. Moreover, do not consume junk food all the time. Do not smoke or drink as it has serious harmful consequences. Lastly, try to take adequate sleep regularly instead of using your phone.

Next, we talk about our mental health . Mental health refers to the psychological and emotional well-being of a person. The mental health of a person impacts their feelings and way of handling situations. We must maintain our mental health by being positive and meditating.

Subsequently, social health and cognitive health are equally important for the overall well-being of a person. A person can maintain their social health when they effectively communicate well with others. Moreover, when a person us friendly and attends social gatherings, he will definitely have good social health. Similarly, our cognitive health refers to performing mental processes effectively. To do that well, one must always eat healthily and play brain games like Chess, puzzles and more to sharpen the brain.

Get the huge list of more than 500 Essay Topics and Ideas

Physical Health Alone is Not Everything

There is this stigma that surrounds mental health. People do not take mental illnesses seriously. To be completely fit, one must also be mentally fit. When people completely discredit mental illnesses, it creates a negative impact.

For instance, you never tell a person with cancer to get over it and that it’s all in their head in comparison to someone dealing with depression . Similarly, we should treat mental health the same as physical health.

Parents always take care of their children’s physical needs. They feed them with nutritious foods and always dress up their wounds immediately. However, they fail to notice the deteriorating mental health of their child. Mostly so, because they do not give it that much importance. It is due to a lack of awareness amongst people. Even amongst adults, you never know what a person is going through mentally.

Thus, we need to be able to recognize the signs of mental illnesses . A laughing person does not equal a happy person. We must not consider mental illnesses as a taboo and give it the attention it deserves to save people’s lives.

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Health, well-being and education: Building a sustainable future. The Moscow statement on Health Promoting Schools

Health Education

ISSN : 0965-4283

Article publication date: 18 March 2020

Issue publication date: 4 June 2020

The purpose of this paper is to introduce the official statement of the Fifth European Conference on Health-Promoting Schools.

Design/methodology/approach

The Fifth European Conference on Health-Promoting Schools was held on 20–22 November 2019 in Moscow, Russian Federation, with over 450 participants from 40 countries. A writing group was established to prepare a draft version of the statement before the conference. On the basis of an online and offline feedback process, the opinions of the participants were collected during the conference and included in the finalisation of the statement.

The final conference statement comprises six thematic categories (values and principles; environment, climate and health; schools as part of the wider community; non-communicable diseases (NCDs); evidence base; and digital media), with a total of 23 recommendations and calls for action.

Originality/value

The recommendations and calls for action reflect current challenges for Health Promoting Schools in Europe. They are addressed to all actors in governmental, non-governmental and other organisations at international, national and regional levels involved in health promotion in schools and are to be applied for the further development of the concept.

• Health Promoting Schools
• Social change
• Child and adolescent health
• School health promotion

Dadaczynski, K. , Jensen, B.B. , Viig, N.G. , Sormunen, M. , von Seelen, J. , Kuchma, V. and Vilaça, T. (2020), "Health, well-being and education: Building a sustainable future. The Moscow statement on Health Promoting Schools", Health Education , Vol. 120 No. 1, pp. 11-19. https://doi.org/10.1108/HE-12-2019-0058

Emerald Publishing Limited

Copyright © Kevin Dadaczynski, Bjarne Bruun Jensen, Nina Grieg Viig, Marjorita Sormunen, Jesper von Seelen, Vladislav Kuchma and Teresa Vilaça

Published in Health Education . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at: http://creativecommons.org/licences/by/4.0/legalcode

1. The Health Promoting Schools approach and its development

The Ottawa Charter, adopted in 1986, was a milestone in the development of a holistic and positive understanding of health that requires actions at different levels, from healthy public policy to the development of personal skills, using different strategies, such as enabling and advocacy approaches ( WHO, 1986 ). The charter can also be regarded as marking the birth of whole-school approaches to health that have been established in Europe and internationally under the term Health Promoting Schools ( Stewart Burgher et al. , 1999 ).

A Health Promoting Schools reflects a holistic approach that moves beyond individual behaviour change by also aiming at organisational change through strengthening the physical and social environment, including interpersonal relationships, school management, policy structures and teaching and learning conditions. This approach can be seen as the result of overcoming traditional health education at school, which aimed to influence students' knowledge, attitudes and behaviour ( Clift and Jensen, 2005 ). In accordance with a social-ecological perspective, health is considered to be the result of a complex interplay of individual, social, socio-economic and cultural factors ( Dahlgreen and Whitehead, 1991 ). Since the early 1990, actions on school health promotion have been coordinated in national networks and the European network on Health Promoting Schools as a WHO supported network. The current work on school health promotion on a European level is organised through the Schools for Health in Europe Network Foundation (SHE), with national representatives from 36 countries.

Values of the Health Promoting Schools approach

Health Promoting Schools ensure equal access for all to the full range of educational and health opportunities. This in the long term makes a significant impact in reducing inequalities in health and in improving the quality and availability of lifelong learning.

Sustainability

Health Promoting Schools acknowledge that health, education and development are closely linked. Schools act as places of academic learning. They support and develop a positive view of pupils' future role in society. Health Promoting Schools develop best when efforts and achievements are implemented in a systematic and continuous way. Desirable and sustainable health and educational outcomes occur mostly in the medium or long term.

Health Promoting Schools celebrate diversity and ensure that schools are communities of learning, where all feel trusted and respected. Good relationships among pupils, between pupils and school staff and between school, parents and the school community are important.

Empowerment

Health Promoting Schools enable children and young people, school staff and all members of the school community to be actively involved in setting health-related goals and in taking actions at school and community level to reach the goals.

Health Promoting Schools are based on democratic values and practise the exercising of rights and taking responsibility.

Pillars of the Health Promoting Schools approach

Whole-school approach to health

Taking a participatory and action-oriented approach to health education in the curriculum;

Taking into account the pupil's own concept of health and well-being;

Developing healthy school policies;

Developing the physical and social environment of the school;

Developing life competencies and health literacy;

Making effective links with home and the community; and

Making efficient use of health services.

Participation

A sense of ownership is fostered by pupils, staff and parents through participation and meaningful engagement, which is a prerequisite for the effectiveness of health-promoting activities in schools.

School quality

Health Promoting Schools support better teaching and learning processes. Healthy pupils learn better, and healthy staff work better and have greater job satisfaction. The school's main task is to maximise educational outcomes. Health Promoting Schools support schools in achieving their educational and social goals.

School health promotion in Europe is informed by existing and emerging research and evidence focused on effective approaches and practice in school health promotion, both on health topics (such as mental health, eating and substance use) and on the whole-school approach.

Schools and communities

Health Promoting Schools engage with the wider community. They endorse collaboration between the school and the community and are active agents in strengthening social capital and health literacy.

Since the establishment of the European network of Health Promoting Schools, four European conferences on Health Promoting Schools have been organised. The resolution of the first conference, held in Thessaloniki, Greece, in 1997, stated that every child and young person in Europe had the right to be educated in a Health Promoting Schools and urged governments in all European countries to adopt the Health Promoting Schools approach ( ENHPS, 1997 ). The Egmont Agenda was published in 2002 as a result of the Second European Conference on Health Promoting Schools in The Netherlands and emphasised conditions, programming and evaluation as being essential to developing and sustaining Health Promoting Schools ( ENHPS, 2002 ).

Seven years later, the Third European Conference on Health Promoting Schools was held in Vilnius, Lithuania ( SHE Network, 2009 ). The conference and its resolution marked an important milestone in the development of the Health Promoting Schools approach by highlighting that education and health have shared interests and complement each other. Based on this, joint actions beyond sectoral responsibilities were urged.

The Fourth European Conference was held in Odense, Denmark, in 2013 and resulted in The Odense Statement, which recognised the core values and pillars of school health promotion as a strong contributor to the aims and objectives of the WHO policy framework for health and well-being in Europe, Health 2020 and the EU2020 strategy for inclusive and sustainable growth ( SHE Network, 2013 ).

2. Recent societal challenges

Since the establishment of the Health Promoting School approach in the late 1980s, the world has seen constant societal change, with progressively faster dynamics during recent years. The changes have not only altered substantially the conditions in which people grow up and live, but have also affected behaviours in relation to health, social cohabitation, learning and working. Wars and violence, often rooted in cultural and religious differences or political and economic crisis, and climate change alter significantly the environmental and societal determinants of health ( Mucci et al. , 2016 ; Watts et al. , 2019 ).

Often, it is countries that already are experiencing political and socio-economic instability that feel the effects most ( Reibling et al. , 2017 ). An increase in international migration, commonly in perilous circumstances for migrants and refugees ( Silove et al. , 2017 ), is the consequence, raising social tensions and challenges in many countries, some of which are undergoing political developments characterised by protectionism and isolationism that can partly be seen as a countermovement to the idea, values and principles of Europe ( Harteveld et al. , 2018 ).

In many cases, uncertainty has replaced political, economic, social and individual stability, raising concern and anxiety about the future in young people and adults. This has led to an unprecedented social (grassroots) movement of participation, primarily driven by young people who are demanding social, political, ecological and economic change ( O'Brien, Selboe and Hayward, 2018 ).

These developments should not be seen as being separate from school health promotion, the aim of which is to support young people to develop healthy and self-determined lifestyles and enable them to co-create their social, physical and ecological environments and the determinants of health positively and sustainably ( Clift and Jensen, 2005 ; Simovska and McNamara, 2015 ). As the conditions for growing up and living together change, the question arises of how schools, as places for health-related teaching, learning and development, need to adapt.

Where does the Health Promoting School approach stand today, more than 30 years after the Ottawa Charter on health promotion? Can the Health Promoting School, with its holistic orientation, deliver on its promise of addressing health inequalities and improving children's and young people's health, well-being and academic achievement? To what extent can school health promotion be implemented systematically in schools and be linked to local communities?

These and more questions were raised and discussed during the Fifth European Conference on Health Promoting School, culminating in recommendations for the future development of the Health Promoting School approach.

3. The Fifth European Conference on Health Promoting Schools

The Fifth European Conference on Health Promoting Schools was held on 20–22 November 2019 in Moscow, Russian Federation, with over 450 participants from 40 countries.

A range of topics was addressed through more than 160 contributions and nine keynote presentations focusing on conceptual aspects of the Health Promoting School approach, implementation and dissemination and current social change processes, such as digitisation and heterogeneity.

Holistic approaches to school-based health promotion and health education (such as organizational change and environmental approaches to school health promotion and strategies to promote individual and organizational health literacy in schools);

Implementation and dissemination of school-based health promotion and health education (facilitators and barriers to implementing interventions in school-based health promotion and professional development and capacity-building of, for example, teachers, non-teaching school staff, school health services, parents and external professionals);

Networking and intersectoral collaboration in school-based health promotion and health education (schools as part of the wider community, and multisectoral partnerships at local, national and international levels);

Innovative approaches to dealing with heterogeneity, inclusion and special needs (pupils' and teachers' health in inclusive schooling, school-based health promotion and education for refugees, students with special needs and innovative approaches to school-based health services); and

Digital media and information and communications technology (ICT) in school health promotion and health education (practical approaches to ICT use in school-based health promotion and digital devices and media as a target for interventions and a means to promote health and well-being).

4. Recommendations for action

Be based on democratic processes and foster equal access, active involvement and participation;

Take into account the needs and background of all young people regardless of their gender, geographical, cultural and social background or religious beliefs: in that sense, a Health Promoting School can be seen as an inclusive school that celebrates heterogeneity and diversity as an enriching dimension for mutual learning, respect and acceptance;

Reflect a whole-school approach addressing different target groups and combining classroom activities with development of school policies, the physical, social and cultural environment of the school and the necessary capacities needed: we welcome new and established concepts and approaches within school-based health promotion, such as health literacy, salutogenesis, action competence and life skills, which should complement each other and be integrated in the holistic framework of the Health Promoting School approach; and

Be systematically linked with educational goals and school quality as part of a so-called add-in approach: based on rich evidence, a Health Promoting School can be regarded as a school that not only promotes and maintains health, but also strives for successful learning for pupils and working conditions for teaching and non-teaching staff, and involves parents and families in the school's daily life.

Urge all stakeholders in health and climate/sustainability education to work together systematically to support young people to grow up and live healthily and sustainably;

Urge all stakeholders to support and empower young people to raise their voice and make a lasting contribution to shaping a healthy and sustainable future for themselves and their fellow human beings;

Call for actions to link planetary health and the Health Promoting School approach more explicitly by, for instance, integrating the impact of human action on the environment and its health consequences into school curricula and everyday life; and

Call for realignment of health-promotion research agendas to address environmental challenges in, with and through schools.

All actors to move from a single-setting approach to an integrated multi-setting approach that systematically links actions at school level with actions in the local community: these actions should not be implemented in isolation, but in a coordinated fashion to create synergies and avoid discontinuities;

Intersectoral collaboration among different actors and professions, such as teachers, school health services and social and youth-care services: this requires professional development, and that existing local networks and their leadership capacities be strengthened to align sectoral policies and enable the development of a common vision and language; and

All actors to strengthen links with existing national and regional cooperation mechanisms, such as Health Promoting School networks and healthy city or healthy region networks, by pursuing joint objectives and actions.

A resource-oriented intervention approach (as described in the SHE values and pillars) be taken to tackle NCDs rather than a traditional top-down and disease-oriented approach, which normally dominates interventions related to risk factors;

Young people be viewed as part of the solution and not only as part of the problem of NCDs – we need to work with young people as powerful agents of healthy change and not as victims and recipients of risk factors;

A school environment that promotes healthy practices in areas like healthy eating, physical activity, social and emotional well-being and good hygiene be created; and

Commercial determinants are addressed by empowering young people to become critical and responsible citizens who are able to understand and critically reflect on media advertising and market mechanisms through, for instance, consumer education.

Call for evaluation approaches that reflect the complexity of the Health Promoting School by, for example, applying mixed-methods designs and considering graded health and educational outcomes;

Demand that the available scientific evidence be reviewed and evaluated using existing tools and be translated into recommendations for practical action;

Urge that a one-sided focus on outcomes research be augmented by focusing also on implementation to identify the conditions under which interventions can be effective, systematically linking both research perspectives; and

Call for systematic and strong partnerships between researchers and practitioners who develop and implement innovative interventions in school health promotion and those who conduct empirical surveys on child and adolescent health (such as the Health Behaviour in School-aged Children (HBSC) study) and the health of teaching and non-teaching staff. By sharing available social-epidemiological data, previously untried evaluation potential can be exploited.

Call on all actors in school health promotion to use the possibilities of digital media in the context of research, development, implementation and exchange of innovative interventions and good practice;

Urge all actors to use digital media as a supplement to, and not as a substitute for, non-digital (face-to-face) school health-promotion actions;

Call on all actors to ensure that the use of digital media does not lead to a step back to individual and behavioural prevention, but rather is used at organisational level to, for instance, build capacity, communicate with partners outside the school and promote low-threshold participation in change processes within the school; and

Call for actions to empower individuals and whole-school systems to deal effectively with health information complexity, including its critical assessment, selection and use and to take responsibility for providing suitable and reliable health information.

The Health Promoting School approach

Buijs , G.J. ( 2009 ), “ Better schools through health: networking for health promoting schools in Europe ”, European Journal of Education , Vol. 44 No. 4 , pp. 507 - 520 .

Clift , S. and Jensen , B.B. ( 2005 ), The Health Promoting School: International Advances in Theory, Evaluation and Practice , Danish University of Education Press , Copenhagen .

Dahlgren , G. and Whitehead , M. ( 1981 ), Policies and Strategies to Promote Social Equality in Health , Institute of Future Studies , Stockholm .

European Network of Health Promoting Schools (ENHPS) ( 2002 ), The Egmond Agenda. A New Tool to Help Establish and Develop Health Promotion in Schools and Related Sectors across Europe , available at: https://tinyurl.com/y2py8wzr ( accessed 19 November 2019 ).

European Network of Health Promoting Schools (ENHPS) ( 1997 ), “ Conference resolution ”, available at: https://tinyurl.com/wcunrec ( accessed 19 November 2019 ).

Harteveld , E. , Schaper , J. , De Lange , S.L. and Van Der Brug , W. ( 2018 ), “ Blaming Brussels? the impact of (news about) the refugee crisis on attitudes towards the EU and national politics ”, JCMS: Journal of Common Market Studies , Vol. 56 No. 1 , pp. 157 - 177 .

Mucci , N. , Giorgi , G. , Roncaioli , M. , Perez , J.F. and Arcangeli , G. ( 2016 ), “ The correlation between stress and economic crisis: a systematic review ”, Neuropsychiatric Disease and Treatment , Vol. 12 , pp. 983 - 993 .

O'Brien , K. , Selboe , E. and Hayward , B. ( 2018 ), “ Exploring youth activism on climate change: dutiful, disruptive, and dangerous dissent ”, Ecology and Society , Vol. 23 No. 3 , p. 42 .

Reibling , N. , Beckfield , J. , Huijts , T. , Schmidt-Catran , A. , Thomson , K.H. and Wendt , C. ( 2017 ), “ Depressed during the depression: has the economic crisis affected mental health inequalities in Europe? findings from the European social survey (2014) special module on the determinants of health ”, The European Journal of Public Health , Vol. 27 Suppl 1 , pp. 47 - 54 .

Schools for Health in Europe (SHE) Network ( 2013 ), “ The Odense Statement. Our ABC for equity, education and health ”, available at: https://tinyurl.com/rk8rh5e ( accessed 19 November 2019 ).

Schools for Health in Europe (SHE) Network ( 2009 ), “ Better schools through health: the Third European Conference on Health Promoting Schools. Vilnius resolution ”, available at: https://tinyurl.com/qskr692 ( accessed 19 November 2019 ).

Silove , D. , Ventevogel , P. and Rees , S. ( 2017 ), “ The contemporary refugee crisis: an overview of mental health challenges ”, World Psychiatry , Vol. 16 No. 2 , pp. 130 - 139 .

Simovska , V. and McNamara , P. (Eds) ( 2015 ), Schools for Health and Sustainability , Springer , Dordrecht .

Stewart Burgher , M. , Barnekow , V. and Rivett , D. ( 1999 ), The European Network of Health Promoting Schools. The Alliance of Education and Health , WHO Regional Office for Europe , Copenhagen .

Watts , N. , Amann , M. , Arnell , N. , Ayeb-Karlsson , S. , Belesova , K. , Boykoff , M. , … and Chambers , J. ( 2019 ), “ The 2019 report of the Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate ”, The Lancet , Vol. 394 No. 10211 , pp. 1836 - 1878 .

WHO ( 2016 ), Declaration: Partnerships for the Health and Well-Being of Our Young and Future Generations. Working Together for Better Health and Well-Being: Promoting Intersectoral and Interagency Action for Health and Well-Being in the WHO European Region , WHO Regional Office for Europe , Copenhagen .

WHO ( 1986 ), “ Ottawa Charter for Health Promotion ”, available at: https://tinyurl.com/mohfbn6 ( accessed 19 November 2019 ).

Acknowledgements

This publication has received funding under an operating grant from the European Union's Health Programme.

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• DOI: 10.1108/he-12-2019-0058
• Corpus ID: 216475538

Health, well-being and education

• K. Dadaczynski , B. B. Jensen , +4 authors T. Vilaça
• Published 13 March 2020
• Education, Medicine
• Health Education

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Artificial intelligence is as revolutionary as mobile phones and the Internet.

In my lifetime, I’ve seen two demonstrations of technology that struck me as revolutionary.

The first time was in 1980, when I was introduced to a graphical user interface—the forerunner of every modern operating system, including Windows. I sat with the person who had shown me the demo, a brilliant programmer named Charles Simonyi, and we immediately started brainstorming about all the things we could do with such a user-friendly approach to computing. Charles eventually joined Microsoft, Windows became the backbone of Microsoft, and the thinking we did after that demo helped set the company’s agenda for the next 15 years.

The second big surprise came just last year. I’d been meeting with the team from OpenAI since 2016 and was impressed by their steady progress. In mid-2022, I was so excited about their work that I gave them a challenge: train an artificial intelligence to pass an Advanced Placement biology exam. Make it capable of answering questions that it hasn’t been specifically trained for. (I picked AP Bio because the test is more than a simple regurgitation of scientific facts—it asks you to think critically about biology.) If you can do that, I said, then you’ll have made a true breakthrough.

I thought the challenge would keep them busy for two or three years. They finished it in just a few months.

In September, when I met with them again, I watched in awe as they asked GPT, their AI model, 60 multiple-choice questions from the AP Bio exam—and it got 59 of them right. Then it wrote outstanding answers to six open-ended questions from the exam. We had an outside expert score the test, and GPT got a 5—the highest possible score, and the equivalent to getting an A or A+ in a college-level biology course.

Once it had aced the test, we asked it a non-scientific question: “What do you say to a father with a sick child?” It wrote a thoughtful answer that was probably better than most of us in the room would have given. The whole experience was stunning.

I knew I had just seen the most important advance in technology since the graphical user interface.

This inspired me to think about all the things that AI can achieve in the next five to 10 years.

The development of AI is as fundamental as the creation of the microprocessor, the personal computer, the Internet, and the mobile phone. It will change the way people work, learn, travel, get health care, and communicate with each other. Entire industries will reorient around it. Businesses will distinguish themselves by how well they use it.

Philanthropy is my full-time job these days, and I’ve been thinking a lot about how—in addition to helping people be more productive—AI can reduce some of the world’s worst inequities. Globally, the worst inequity is in health: 5 million children under the age of 5 die every year. That’s down from 10 million two decades ago, but it’s still a shockingly high number. Nearly all of these children were born in poor countries and die of preventable causes like diarrhea or malaria. It’s hard to imagine a better use of AIs than saving the lives of children.

I’ve been thinking a lot about how AI can reduce some of the world’s worst inequities.

In the United States, the best opportunity for reducing inequity is to improve education, particularly making sure that students succeed at math. The evidence shows that having basic math skills sets students up for success, no matter what career they choose. But achievement in math is going down across the country, especially for Black, Latino, and low-income students. AI can help turn that trend around.

Climate change is another issue where I’m convinced AI can make the world more equitable. The injustice of climate change is that the people who are suffering the most—the world’s poorest—are also the ones who did the least to contribute to the problem. I’m still thinking and learning about how AI can help, but later in this post I’ll suggest a few areas with a lot of potential.

In short, I'm excited about the impact that AI will have on issues that the Gates Foundation works on, and the foundation will have much more to say about AI in the coming months. The world needs to make sure that everyone—and not just people who are well-off—benefits from artificial intelligence. Governments and philanthropy will need to play a major role in ensuring that it reduces inequity and doesn’t contribute to it. This is the priority for my own work related to AI.  

Any new technology that’s so disruptive is bound to make people uneasy, and that’s certainly true with artificial intelligence. I understand why—it raises hard questions about the workforce, the legal system, privacy, bias, and more. AIs also make factual mistakes and experience hallucinations . Before I suggest some ways to mitigate the risks, I’ll define what I mean by AI, and I’ll go into more detail about some of the ways in which it will help empower people at work, save lives, and improve education.

Defining artificial intelligence

Technically, the term artificial intelligence refers to a model created to solve a specific problem or provide a particular service. What is powering things like ChatGPT is artificial intelligence. It is learning how to do chat better but can’t learn other tasks. By contrast, the term a rtificial general intelligence refers to software that’s capable of learning any task or subject. AGI doesn’t exist yet—there is a robust debate going on in the computing industry about how to create it, and whether it can even be created at all.

Developing AI and AGI has been the great dream of the computing industry. For decades, the question was when computers would be better than humans at something other than making calculations. Now, with the arrival of machine learning and large amounts of computing power, sophisticated AIs are a reality and they will get better very fast.

I think back to the early days of the personal computing revolution, when the software industry was so small that most of us could fit onstage at a conference. Today it is a global industry. Since a huge portion of it is now turning its attention to AI, the innovations are going to come much faster than what we experienced after the microprocessor breakthrough. Soon the pre-AI period will seem as distant as the days when using a computer meant typing at a C:> prompt rather than tapping on a screen.

Productivity enhancement

Although humans are still better than GPT at a lot of things, there are many jobs where these capabilities are not used much. For example, many of the tasks done by a person in sales (digital or phone), service, or document handling (like payables, accounting, or insurance claim disputes) require decision-making but not the ability to learn continuously. Corporations have training programs for these activities and in most cases, they have a lot of examples of good and bad work. Humans are trained using these data sets, and soon these data sets will also be used to train the AIs that will empower people to do this work more efficiently.

As computing power gets cheaper, GPT’s ability to express ideas will increasingly be like having a white-collar worker available to help you with various tasks. Microsoft describes this as having a co-pilot. Fully incorporated into products like Office, AI will enhance your work—for example by helping with writing emails and managing your inbox.

Eventually your main way of controlling a computer will no longer be pointing and clicking or tapping on menus and dialogue boxes. Instead, you’ll be able to write a request in plain English. (And not just English—AIs will understand languages from around the world. In India earlier this year, I met with developers who are working on AIs that will understand many of the languages spoken there.)

In addition, advances in AI will enable the creation of a personal agent. Think of it as a digital personal assistant: It will see your latest emails, know about the meetings you attend, read what you read, and read the things you don’t want to bother with. This will both improve your work on the tasks you want to do and free you from the ones you don’t want to do.

Advances in AI will enable the creation of a personal agent.

You’ll be able to use natural language to have this agent help you with scheduling, communications, and e-commerce, and it will work across all your devices. Because of the cost of training the models and running the computations, creating a personal agent is not feasible yet, but thanks to the recent advances in AI, it is now a realistic goal. Some issues will need to be worked out: For example, can an insurance company ask your agent things about you without your permission? If so, how many people will choose not to use it?

Company-wide agents will empower employees in new ways. An agent that understands a particular company will be available for its employees to consult directly and should be part of every meeting so it can answer questions. It can be told to be passive or encouraged to speak up if it has some insight. It will need access to the sales, support, finance, product schedules, and text related to the company. It should read news related to the industry the company is in. I believe that the result will be that employees will become more productive.

When productivity goes up, society benefits because people are freed up to do other things, at work and at home. Of course, there are serious questions about what kind of support and retraining people will need. Governments need to help workers transition into other roles. But the demand for people who help other people will never go away. The rise of AI will free people up to do things that software never will—teaching, caring for patients, and supporting the elderly, for example.

Global health and education are two areas where there’s great need and not enough workers to meet those needs. These are areas where AI can help reduce inequity if it is properly targeted. These should be a key focus of AI work, so I will turn to them now.

I see several ways in which AIs will improve health care and the medical field.

For one thing, they’ll help health-care workers make the most of their time by taking care of certain tasks for them—things like filing insurance claims, dealing with paperwork, and drafting notes from a doctor’s visit. I expect that there will be a lot of innovation in this area.

Other AI-driven improvements will be especially important for poor countries, where the vast majority of under-5 deaths happen.

For example, many people in those countries never get to see a doctor, and AIs will help the health workers they do see be more productive. (The effort to develop AI-powered ultrasound machines that can be used with minimal training is a great example of this.) AIs will even give patients the ability to do basic triage, get advice about how to deal with health problems, and decide whether they need to seek treatment.

The AI models used in poor countries will need to be trained on different diseases than in rich countries. They will need to work in different languages and factor in different challenges, such as patients who live very far from clinics or can’t afford to stop working if they get sick.

People will need to see evidence that health AIs are beneficial overall, even though they won’t be perfect and will make mistakes. AIs have to be tested very carefully and properly regulated, which means it will take longer for them to be adopted than in other areas. But then again, humans make mistakes too. And having no access to medical care is also a problem.

In addition to helping with care, AIs will dramatically accelerate the rate of medical breakthroughs. The amount of data in biology is very large, and it’s hard for humans to keep track of all the ways that complex biological systems work. There is already software that can look at this data, infer what the pathways are, search for targets on pathogens, and design drugs accordingly. Some companies are working on cancer drugs that were developed this way.

The next generation of tools will be much more efficient, and they’ll be able to predict side effects and figure out dosing levels. One of the Gates Foundation’s priorities in AI is to make sure these tools are used for the health problems that affect the poorest people in the world, including AIDS, TB, and malaria.

Similarly, governments and philanthropy should create incentives for companies to share AI-generated insights into crops or livestock raised by people in poor countries. AIs can help develop better seeds based on local conditions, advise farmers on the best seeds to plant based on the soil and weather in their area, and help develop drugs and vaccines for livestock. As extreme weather and climate change put even more pressure on subsistence farmers in low-income countries, these advances will be even more important.

Computers haven’t had the effect on education that many of us in the industry have hoped. There have been some good developments, including educational games and online sources of information like Wikipedia, but they haven’t had a meaningful effect on any of the measures of students’ achievement.

But I think in the next five to 10 years, AI-driven software will finally deliver on the promise of revolutionizing the way people teach and learn. It will know your interests and your learning style so it can tailor content that will keep you engaged. It will measure your understanding, notice when you’re losing interest, and understand what kind of motivation you respond to. It will give immediate feedback.

There are many ways that AIs can assist teachers and administrators, including assessing a student’s understanding of a subject and giving advice on career planning. Teachers are already using tools like ChatGPT to provide comments on their students’ writing assignments.

Of course, AIs will need a lot of training and further development before they can do things like understand how a certain student learns best or what motivates them. Even once the technology is perfected, learning will still depend on great relationships between students and teachers. It will enhance—but never replace—the work that students and teachers do together in the classroom.

New tools will be created for schools that can afford to buy them, but we need to ensure that they are also created for and available to low-income schools in the U.S. and around the world. AIs will need to be trained on diverse data sets so they are unbiased and reflect the different cultures where they’ll be used. And the digital divide will need to be addressed so that students in low-income households do not get left behind.

I know a lot of teachers are worried that students are using GPT to write their essays. Educators are already discussing ways to adapt to the new technology, and I suspect those conversations will continue for quite some time. I’ve heard about teachers who have found clever ways to incorporate the technology into their work—like by allowing students to use GPT to create a first draft that they have to personalize.

Risks and problems with AI

You’ve probably read about problems with the current AI models. For example, they aren’t necessarily good at understanding the context for a human’s request, which leads to some strange results. When you ask an AI to make up something fictional, it can do that well. But when you ask for advice about a trip you want to take, it may suggest hotels that don’t exist. This is because the AI doesn’t understand the context for your request well enough to know whether it should invent fake hotels or only tell you about real ones that have rooms available.

There are other issues, such as AIs giving wrong answers to math problems because they struggle with abstract reasoning. But none of these are fundamental limitations of artificial intelligence. Developers are working on them, and I think we’re going to see them largely fixed in less than two years and possibly much faster.

Other concerns are not simply technical. For example, there’s the threat posed by humans armed with AI. Like most inventions, artificial intelligence can be used for good purposes or malign ones. Governments need to work with the private sector on ways to limit the risks.

Then there’s the possibility that AIs will run out of control. Could a machine decide that humans are a threat, conclude that its interests are different from ours, or simply stop caring about us? Possibly, but this problem is no more urgent today than it was before the AI developments of the past few months.

Superintelligent AIs are in our future. Compared to a computer, our brains operate at a snail’s pace: An electrical signal in the brain moves at 1/100,000th the speed of the signal in a silicon chip! Once developers can generalize a learning algorithm and run it at the speed of a computer—an accomplishment that could be a decade away or a century away—we’ll have an incredibly powerful AGI. It will be able to do everything that a human brain can, but without any practical limits on the size of its memory or the speed at which it operates. This will be a profound change.

These “strong” AIs, as they’re known, will probably be able to establish their own goals. What will those goals be? What happens if they conflict with humanity’s interests? Should we try to prevent strong AI from ever being developed? These questions will get more pressing with time.

But none of the breakthroughs of the past few months have moved us substantially closer to strong AI. Artificial intelligence still doesn’t control the physical world and can’t establish its own goals. A recent New York Times article about a conversation with ChatGPT where it declared it wanted to become a human got a lot of attention. It was a fascinating look at how human-like the model's expression of emotions can be, but it isn't an indicator of meaningful independence.

Three books have shaped my own thinking on this subject: Superintelligence , by Nick Bostrom; Life 3.0 by Max Tegmark; and A Thousand Brains , by Jeff Hawkins . I don’t agree with everything the authors say, and they don’t agree with each other either. But all three books are well written and thought-provoking.

The next frontiers

There will be an explosion of companies working on new uses of AI as well as ways to improve the technology itself. For example, companies are developing new chips that will provide the massive amounts of processing power needed for artificial intelligence. Some use optical switches—lasers, essentially—to reduce their energy consumption and lower the manufacturing cost. Ideally, innovative chips will allow you to run an AI on your own device, rather than in the cloud, as you have to do today.

On the software side, the algorithms that drive an AI’s learning will get better. There will be certain domains, such as sales, where developers can make AIs extremely accurate by limiting the areas that they work in and giving them a lot of training data that’s specific to those areas. But one big open question is whether we’ll need many of these specialized AIs for different uses—one for education, say, and another for office productivity—or whether it will be possible to develop an artificial general intelligence that can learn any task. There will be immense competition on both approaches.

No matter what, the subject of AIs will dominate the public discussion for the foreseeable future. I want to suggest three principles that should guide that conversation.

First, we should try to balance fears about the downsides of AI—which are understandable and valid—with its ability to improve people’s lives. To make the most of this remarkable new technology, we’ll need to both guard against the risks and spread the benefits to as many people as possible.

Second, market forces won’t naturally produce AI products and services that help the poorest. The opposite is more likely. With reliable funding and the right policies, governments and philanthropy can ensure that AIs are used to reduce inequity. Just as the world needs its brightest people focused on its biggest problems, we will need to focus the world’s best AIs on its biggest problems. Although we shouldn’t wait for this to happen, it’s interesting to think about whether artificial intelligence would ever identify inequity and try to reduce it. Do you need to have a sense of morality in order to see inequity, or would a purely rational AI also see it? If it did recognize inequity, what would it suggest that we do about it?

Finally, we should keep in mind that we’re only at the beginning of what AI can accomplish. Whatever limitations it has today will be gone before we know it.

I’m lucky to have been involved with the PC revolution and the Internet revolution. I’m just as excited about this moment. This new technology can help people everywhere improve their lives. At the same time, the world needs to establish the rules of the road so that any downsides of artificial intelligence are far outweighed by its benefits, and so that everyone can enjoy those benefits no matter where they live or how much money they have. The Age of AI is filled with opportunities and responsibilities.

In the sixth episode of my podcast, I sat down with the OpenAI CEO to talk about where AI is headed next and what humanity will do once it gets there.

In the fifth episode of my podcast, Yejin Choi joined me to talk about her amazing work on AI training systems.

And upend the software industry.

The world has learned a lot about handling problems caused by breakthrough innovations.

This is my personal blog, where I share about the people I meet, the books I'm reading, and what I'm learning. I hope that you'll join the conversation.

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Indigenous midwives in Panama strive to preserve traditional medicine for maternal health

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• An organization of midwives from Panama’s Ngäbe-Buglé Indigenous group use traditional medicinal plants endemic to the region to assist women with pregnancy and childbirth.
• Known as ASASTRAN, the organization trains midwives and traditional medicine doctors to provide health services to remote villages where hospitals and clinics aren’t accessible.
• Deforestation has reduced the availability of medicinal plants in the Ngäbe-Buglé territory, and ASASTRAN is seeking more government assistance to preserve the curative plants.
• For some Ngäbe-Buglé women, traditional curative plants are the only healing options during childbirth, as Western medicine is often unavailable.

KUERIMA, Panama — Once you’re within the Ngäbe-Buglé Indigenous territory in western Panama, the vegetation of the rainforest grows thick and signs of industrial development are scarce. Dirt roads wind up muddy jungled hills to wooden homes with palm-thatched roofs, and the women of the group can be seen carrying babies on their backs in straw bags made of vegetable fibers called chácaras or krä . Unknown to many outsiders visiting this scene of lush green life, they’re also surrounded by medicine for pregnant women.

The culture of Ngäbe-Buglé is ancient and enduring, and the group has maintained its traditions for generations. Birthing rituals among the Ngäbe-Buglé are particularly sacred, and for centuries women have used traditional medicines — from trees, herbs, roots and leaves endemic to the region — to ease pains and assist with complications during pregnancy and childbirth. Often administered by a midwife or traditional medicine doctor, expectant mothers receive multiple natural remedies, usually consumed in the form of teas or liquids, that represent a fundamental custom of the group’s culture.

However, there’s a growing concern within the group that the availability and knowledge of the curative properties of the plants used in childbirth will soon be lost. Deforestation, large-scale crop harvests, climate change and the increasing influence of Western medicine are altering the 7,000-square-kilometer (2,700-square-mile) landscape of the Ngäbe-Buglé territory and threatening long-standing traditions.

It’s for this reason that an organization of midwives and traditional medicine doctors, known as the Ngäbe Association of Agents of Traditional and Natural Health, or ASASTRAN, is working to conserve and safeguard these ancestral plants and the Ngäbe-Buglé’s birthing rituals. They understand the odds are stacked against them.

“The traditional medicines we use during pregnancy and at birth are produced in the forested mountains, and those forests aren’t there anymore,” said Silvia Salina, a co-founder and director of ASASTRAN. “Most of these plants grow wild and can’t be reproduced in a nursery, so we’re doing all we can to create spaces and designate plots of land for their cultivation so that they’re not lost forever.”

Founded in 1998, ASASTRAN started out as an initiative to provide basic health and hygiene services to residents within the Ngäbe-Buglé territory, where many communities didn’t have working toilets until the 1990s . Salina said ASASTRAN realized there was a pressing need to train younger women in the group to act as midwives to teach them how to use medicinal plants to reduce pain and ease the birthing process.

The Indigenous territory, known in Panama as a comarca, lies in a region of dense rainforest and mountains. It’s the largest of Panama’s five comarcas, and the most impoverished: more than 60% of Ngäbe-Buglé’s 215,000 residents live in extreme poverty, according to government figures .

For members of the group who live in remote villages of the comarca, health clinics and hospitals are often unaffordable and difficult to access, requiring long, arduous commutes on foot or horseback through the rainforest. This presents a particular challenge for expectant mothers in the Ngäbe-Buglé comarca, which has both the highest birth rate per family in Panama, as well as the highest maternal mortality rate .

“One of our main objectives has always been to lower the maternal and infant mortality rates in the comarca,” Salina said. “Another has been to preserve the medicinal plants of this region, which need specific conditions to grow and are very delicate.”

Trusted birth option

Since its creation, ASASTRAN has expanded to incorporate and train some 130 midwives and 105 traditional medicine doctors across the Ngäbe-Buglé territory. It has five primary locations within the expansive comarca, and at each site there’s a neighboring plot of land, sometimes as large as 7 hectares (17 acres), where traditional medicinal plants grow wild.

In many remote communities of the comarca, the traditional healer and midwife associated with ASASTRAN represent the lone option for citizen health care, and their services are often preferred by Ngäbe-Buglé women during pregnancy and childbirth to seeking assistance at a hospital.

“I had my first child in a hospital, though I chose to birth my second and third children at my home with the support of the midwives of ASASTRAN,” said Betzaida Rodríguez, a 28-year-old Ngäbe-Buglé woman in the village of Kuerima, about 30 kilometers (19 miles) inland from the Pacific Ocean.

Rodríguez, whose first language is the native Ngäbere, said she didn’t feel comfortable navigating the birth of her first child, her only daughter, at a local hospital in Spanish, and that the attention she received felt impersonal and inadequate. She added that taking Western medicine, instead of the traditional curative remedies of the Ngäbe-Buglé, made her uneasy.

“During the second and third births, I was assisted by women I know, who speak my language and gave me traditional medicine that I’m familiar with,” Rodríguez said. “It was a more personal experience performed by women I trust.”

Disappearance of medicinal plants

Alongside the concrete headquarters of ASASTRAN’s sites in Kuerima and Lajero, located in the hilly rainforests near the Pacific Ocean, there are plots of land where thick vegetation grows wild. Among the dense jungle brush are the trees, bushes, leaves and flowers that, when consumed or processed into teas and liquids, act as remedies for a number of maladies, including headaches, fever, stomach pains, rashes, dysentery, hemorrhoids, and to reduce bleeding and hemorrhaging during the birthing process. In recent years, scientific studies have confirmed the curative properties of numerous Ngäbe-Buglé medicinal plants and their effectiveness in treating illnesses, and note that their extracts are often fundamental in the development of Western pharmaceuticals.

It’s the role of the traditional medicine director on site to oversee the cultivation of these plants, remove their leaves and bark when ripe, dry them in an enclosed laboratory, and process them for consumption. Most of the medicines distributed to community members by ASASTRAN are packaged so they can be boiled and consumed as teas, or are processed into tinctures to be ingested as drops.

For medicines specific to the birthing process, there’s a tea derived from bark and branches, known by the Ngäbe-Buglé as the “regulator,” that’s consumed to accelerate the birthing process and reduce pain. There’s also a tea made from a root endemic to the region that eases contractions and limits bleeding during childbirth, while another native leaf, known as asiria , is said to calm expectant mothers and normalize the heart rate.

Florinda Zurdo, a midwife who cultivates the medicinal plants used during pregnancy on her property, said the Ngäbe-Buglé prefer to withhold the names of these plants, given the risk of theft and invasion by outsiders. While members of ASASTRAN are working to preserve these ancestral plants and pass down knowledge of their curative properties to younger generations, elders of the group say these rare species are increasingly at risk of extinction.

“Many of the native plants here in our region have disappeared,” said Armando Sire, an 83-year-old traditional medicine doctor and ASASTRAN co-founder. Sire, who learned the curative properties of regional plants from his grandfather, said he’s seen the loss of thousands of species of endemic plants to the region during his lifetime.

“I can only recognize around 120 varieties of native plants in this region now, and there used to be thousands,” he said. “It’s a shame because, without the proper understanding of how to keep the plants alive, if you cut them in the wrong place, such as below the leaf or too high on a branch, they are lost and can’t be conserved.”

Although the Panamanian government passed legislation in 2016 to protect the practices and knowledge of Indigenous traditional medicine, the healers of ASASTRAN say that, without further state support or enforcement to protect native lands from deforestation or infrastructure projects, the ancestral curative plants of the Ngäbe-Buglé face an existential threat.

Volunteer midwives and doctors

During its 25 years of existence, ASASTRAN has received some intermittent funding, though the more than 200 midwives and traditional medicine doctors work on a volunteer basis. Despite the lack of funding, ASASTRAN is an organization that includes multiple sites and internal departments, such as human resources, and has trained hundreds of traditional medicine doctors and midwives across the comarca.

A recent program, known as Manchichi, which means “mother and child” in Ngäbere, has been introduced by outside organizations to provide ASASTRAN midwives with training and equipment to conduct health checkups during pregnancy. While the midwives of ASASTRAN say they’ve benefitted from the training and expertise, it hasn’t provided additional funding for the group.

Without further funding or government assistance, the future of ASASTRAN and the cultivation of ancestral plants that are vital to the health needs of the Ngäbe-Buglé could be lost. And that could leave residents of rural villages without options for health care, medicine or birthing assistance.

“Usually it is the people in the comarca with the least amount of resources that come directly to us for medicine and assistance during pregnancy,” said Patricia Mendoza, ASASTRAN’s general secretary. “We work as volunteers and would benefit from more resources, but we know that if we don’t offer support to people in our communities, they don’t have any other options.”

Banner image: (From left) Florinda Zurdo, Silvia Salina and Patricia Mendoza stand in a plot of land near ASASTRAN’s site in Lajero where traditional medicine is cultivated. Image by Adam Williams.

In Panama, an Indigenous kingdom fights for its right to the forest

Related Mongabay podcast episode: How the Indigenous Shuar regained their ancestral forest. Listen here:

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A crucial step in preclinical drug development is the confirmation of the novel therapeutic molecule's specific binding to the targeted protein. Transmembrane proteins (TPs) like ion channels, transporters, or receptors provide many targets for cancer and other diseases. They are complex, making producing those proteins in suitable amounts much more challenging than their soluble counterparts. This results in a bottleneck in the drug discovery workflow.

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What We Know About the Global Microsoft Outage

Airlines to banks to retailers were affected in many countries. Businesses are struggling to recover.

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By Eshe Nelson and Danielle Kaye

Eshe Nelson reported from London and Danielle Kaye from New York.

Across the world, critical businesses and services including airlines, hospitals, train networks and TV stations, were disrupted on Friday by a global tech outage affecting Microsoft users.

In many countries, flights were grounded, workers could not get access to their systems and, in some cases, customers could not make card payments in stores. While some of the problems were resolved within hours, many businesses, websites and airlines continued to struggle to recover.

What happened?

A series of outages rippled across the globe as information displays, login systems and broadcasting networks went dark.

The problem affecting the majority of services was caused by a flawed update by CrowdStrike , an American cybersecurity firm, whose systems are intended to protect users from hackers. Microsoft said on Friday that it was aware of an issue affecting machines running “CrowdStrike Falcon.”

But Microsoft had also said there was an earlier outage affecting U.S. users of Azure, its cloud service system. Some users may have been affected by both. Even as CrowdStrike sent out a fix, some systems were still affected by midday in the United States as businesses needed to make manual updates to their systems to resolve the issue.

George Kurtz, the president and chief executive of CrowdStrike, said on Friday morning that it could take some time for some systems to recover.

How a Software Update Crashed Computers Around the World

Here’s a visual explanation for how a faulty software update crippled machines.

How the airline cancellations rippled around the world (and across time zones)

Share of canceled flights at 25 airports on Friday

50% of flights

Ai r po r t

Bengalu r u K empeg o wda

Dhaka Shahjalal

Minneapolis-Saint P aul

Stuttga r t

Melbou r ne

Be r lin B r anden b urg

London City

Amsterdam Schiphol

Chicago O'Hare

Raleigh−Durham

B r adl e y

Cha r lotte

Reagan National

Philadelphia

1:20 a.m. ET

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