There is a strong positive correlation between economic wealth and health status. This is true within, and across nations. Premature deaths are concentrated in places where poverty is endemic and people lack access to basic human necessities. Half a century ago, most of South-East Asia and sub-Saharan Africa experienced similar economic and health deprivations. Their per capita income were comparable. Countries in both regions were plagued by the same infectious agents and their populations endured similar outcomes: chronic malnutrition, poor sanitation, inadequate housing and poor health status.
In 1960, life expectancy for the average Chinese was 4 years less than that of the average sub-Saharan African, with life expectancies at 36 and 40 respectively 1. During the same period, Sierra Leone’s per capita income was $1081.00 annually, while China’s per capita income was $583.00. At the turn of the century, per capita income fell to $518.00 in Sierra Leone, and increased to $3012.00 in China. Today, life expectancy in China and Sierra Leone is 76 and 47 respectively 2. Similar trends exist between the Asian Tigers (Hong Kong, Taiwan, Singapore and South Korea) and many sub-Saharan countries.
The divergence in economic wealth and health status between these countries occurred rapidly, and has been heavily theorized. Many attempts to unpack this phenomenon have employed several interpretative frameworks that range from Asian culture, Asian values, and Confucian ethics to African corruption, clientelism, prebendalism, poor governance, harsh climate and so forth. There are few contestations that these factors do not exist. However, these factors alone cannot account for the noted divergence in wealth and health. China and other South-east Asian nations were never and are not immune from corruption, repression or harsh meteorological conditions. Any rigorous analysis would take into account historical, geopolitical, sociopolitical and other economic forces that propelled some countries to succeed and impeded others. Disentangling these forces is complex and requires one to move beyond common stereotypes and Afro-pessimism.
South Korea can be used as an example of how external forces and good public policy influence development and health outcomes. United States’ grant aid played a formative role in helping South Korea during its early post-independence, as the U.S. did for Europe in the post-war period. Such investments spur economic growth. Sen highlights that economic growth mediated development has the potential to reduce poverty, improve living standards and enhance health and wellbeing. Good public policy is key to fulfilling these objectives3. The South Koreans invested dividends of economic growth in basic public services. They were less constrained by powerful external forces. In contrast, many Sub-Saharan African countries were weak during the post-independence period and had no state institutions to provide basic services. Literacy rates were low. These new nation-states faced considerable internal and external pressures. By the 1980s, most of Africa was undergoing internal strife due to political and economic instability. The Bretton Wood Institutions imposed neoliberal policies requiring these underdeveloped states to de-invest in healthcare and education and to deregulate their markets. Further, international trade regimes and other multinational agreements were less favorable to the continent. These socio-economic disadvantages adversely affected the health status of Africans, especially of the most vulnerable. As WHO Director-General Margaret Chan stated, “the social conditions in which people are born and work are the single most important determinants of good health or ill health1.”
It is a myth to believe that approximately one billion people are content to live in abject poverty and misery. This notion is contrary to the human spirit which strives for progress. Contrary to common belief, Africans are working to improve their lives. There are more democratic processes on the continent today than ever before in history4. Six of the world’s ten fastest growing economies of the past decade are in sub-Saharan Africa 5. Botswana registered the world’s highest per capita growth rate in the past five decades6. Claims of corruption in Africa are valid but should not be used to minimize the social and economic progress being made. As former Malaysian Prime Minister Dr. Mahathir Mohamad claimed, had Asia failed in its economic goals, this failure would have been blamed on Asian values.
1. Birn, Pillay, and Holtz, 2008. Textbook of International Health, Third Edition.
2. GapMinder. http://www.gapminder.org/
3. Sen, A., 1999. Development as freedom, Oxford: Oxford University Press.
4. Bassett, T. and Straus, S., 2011. Defending democracy in Cote d’lvoire. Foreign Affairs.
5. The Economist, 2013. Development in Africa: Growth and other good things.
6. Easterly, W., 2006. The white man’s burden, Penguin Books.