AFRICA BREAKING DOWN
Chapter 10. Stabilizing Population by Reducing Fertility
Lester R. Brown, Eco-Economy: Building an Economy for the Earth
(W.W. Norton & Co., NY: 2001).
A generation ago, virtually the entire world
appeared to be progressing economically and socially. A better future
was in prospect for all. Now that has changed as the HIV epidemic
ravages Africa. It is not only causing millions of deaths, it is
undermining the continent's economic future. If issues rooted in
population growth, such as land hunger and water shortages, are
not addressed, they could be equally disastrous. By analyzing what
happened in Africa, perhaps we can avoid a social catastrophe of
similar dimensions elsewhere.
History offers few examples of leadership failure comparable to
that of Africa's in response to the HIV crisis. The HIV epidemic
that is raging across Africa is now taking some 6,030 lives each
day, the equivalent of 15 fully loaded jumbo jets crashing dailywith
no survivors. This number, climbing higher each year, is expected
to double during this decade.13
Public attention has initially focused on the dramatic rise in adult
mortality and the precipitous drop in life expectancy. But we need
now to look at the longer-term economic consequencesfalling
food production, deteriorating health care, and disintegrating educational
systems. Effectively dealing with this epidemic and the heavy loss
of adults will make the rebuilding of Europe after World War II
seem like child's play by comparison.
While industrial countries have held the HIV infection rate among
adults to less than 1 percent, in 16 African countries the figure
is over 10 percent. In South Africa, it is 20 percent. In Zimbabwe
and Swaziland, 25 percent. And in Botswana, which has the highest
infection rate, 36 percent of adults are HIV-positive. These countries
are expected to lose one fifth to one third of their adults by the
end of this decade.14
Attention is focusing on the high cost of treating those already
ill, but the virus is continuing to spread. As deaths multiply,
life expectancythe
sentinel indicator of economic developmentis
falling. Without AIDS, countries with high infection rates, like
Botswana, South Africa, and Zimbabwe, would have a life expectancy
of some 65 years or more. With the virus continuing to spread, life
expectancy could drop to 35 yearsa
medieval life span.15
Whereas infectious diseases typically take their heaviest toll among
the eldest and the very young who have weaker immune systems, AIDS
claims mostly young adults, depriving countries of their most productive
workers. In the epidemic's early stages, the virus typically spreads
most rapidly among the better educated, more socially mobile segment
of society. It claims the agronomists, engineers, and teachers needed
for economic development.
The HIV epidemic is affecting every segment of society, every sector
of the economy, and every facet of life. For example, close to half
of Zimbabwe's health care budget is used to treat AIDS patients.
In some hospitals in Burundi and South Africa, AIDS patients occupy
60 percent of the beds. Health care workers labor until the point
of exhaustion. This epidemic could easily produce 40 million orphans
by 2010, a number that will overwhelm the resources of extended
families.16
Education is also suffering. In Zambia, the number of teachers dying
with AIDS each year approaches the number of new teachers being
trained. In the Central African Republic, the reduction of the teaching
force by AIDS closed 107 primary schools, leaving only 66 open.
At the college level, the damage is equally devastating. At the
University of Durban-Westville in South Africa, 25 percent of the
student body is HIV-positive.17
In addition to the continuing handicaps of a lack of infrastructure
and trained personnel, Africa must now contend with the adverse
economic effects of the epidemic. AIDS dramatically increases the
dependency ratiothe
number of young and elderly who depend on productive adults. This
in turn makes it much more difficult for a society to save. Reduced
savings means reduced investment and slower economic growth or even
decline.
At the corporate level, firms in countries with high infection rates
are seeing their employee health care insurance costs double, triple,
or even quadruple. Companies that were until recently comfortably
in the black now find themselves in the red. Under these circumstances,
investment inflows from abroad are dwindling and could dry up entirely.18
Even as disease consumes Africa, food security is deteriorating.
Land hunger, water scarcity, and nutrient depletion are reducing
the grain produced per person. In East, Central, and Southern Africa,
the undernourished share of the population has increased over the
last two decades.19
Making matters worse, food security is declining as the epidemic
progresses. At the family level, food supplies drop precipitously
when the first adult develops full-blown AIDS. This deprives the
family not only of a worker in the fields, but also of the work
time of the adult caring for the AIDS sufferer. A survey in Tanzania
found that a woman whose husband had AIDS spent 60 percent less
time tending the crops. Declines in food production from the epidemic
have been reported in Burkina Faso, C�te d'Ivoire, and Zimbabwe.
In pastoral economies, such as Namibia, the loss of the male head
of household is often followed by the loss of cattle, the family's
livelihood.20
Sub-Saharan Africa, a region of 600 million people, is moving into
uncharted territory. There are historical precedents for epidemics
on this scale, but not for such a concentrated loss of adults. The
good news is that some countries are halting the spread of the virus.
The key is strong leadership from the top. In Uganda, where the
epidemic first took root, the active personal leadership of President
Yoweri Museveni over the last dozen years has reduced the share
of adults infected with the virus from a peak of 14 percent down
to 8 percent. In effect, the number of new infections has dropped
well below the number of deaths from AIDS. Senegal also responded
early to the threat from the virus. As a result, it prevented AIDS
from gaining momentum and held the infection rate to 2 percent of
its adults, a number only slightly higher than in industrial countries.21
Saving Africa depends on a Marshall Plan-scale effort on two fronts:
one to curb the spread of HIV and the other to restore economic
progress. Winning the former depends directly on Africa's national
political leaders. Unless they personally lead, the effort will
almost certainly fail. Once a leader outlines the behavioral changes
needed to contain the virussuch
as delaying first intercourse, reducing the number of sexual partners,
and using condomsthen
others can contribute. This includes the medical establishment within
the country, religious leaders, nongovernmental groups, and international
health and family planning agencies.
To compensate for the "missing generation," countries will need
assistance across the board in education. This is an area where
the U.S. Peace Corps and its equivalents in other countries can
play a central role, particularly in supplying the teachers needed
to keep schools open. Social workers are needed to work with orphans.
A program of financial assistance is necessary for the extended
families trying to absorb the projected millions of orphans.
Given the high cost of doing business in an AIDS-ridden society,
special incentives in the form of tax relief are needed to attract
corporate investors, incentives that could be underwritten by international
development agencies. And debt relief is essential to the rebuilding
of sub-Saharan Africa.
The bottom line is that there is no precedent in international development
for the challenge the world now faces in Africa. The question is
not whether we can respond to this challenge. We can. We have the
resources to do so. If we fail to respond to Africa's pain, we may
not only witness the economic decline of an entire continent, but
in the process we will forfeit the right to call ourselves a civilized
society.
ENDNOTES:
13.
UNAIDS, op. cit. note 5.
14. Ibid.
15. Ibid.
16. Ibid.; "AIDS, Diseases to Leave 44 Million Orphans by 2010," Reuters, 13 July 2000.
17. UNAIDS, op. cit. note 5, p. 29; university study from Prega
Govender, "Shock AIDS Test Result at Varsity," (Johannesburg) Sunday
Times, 25 April 1999; "South Africa: University Finds 25 Percent
of Students Infected," Kaiser Daily HIV/AIDS Report, 27 April 1999.
18. UNAIDS, op. cit. note 5.
19. Grain production from USDA, op. cit. note 11; information on
malnutrition from U.N. Food and Agriculture Organization (FAO),
The State of Food Insecurity in the World 2000 (Rome: 2000), pp.
27-28.
20. UNAIDS, op. cit. note 5, pp. 32-33.
21. Ibid.
Copyright
© 2001 Earth Policy Institute
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