Also posted on End the Neglect, the Global Network for Neglected Tropical Disease blog
The damaging effects of HIV/AIDS and malaria on individuals, families, and communities in developing countries are well-documented. Public advocacy campaigns highlight the millions of deaths each year that can be prevented through basic immunizations that are taken for granted in developed countries. But did you know that 13 parasitic and bacterial infections, mostly worms and trachoma known as the “neglected tropical diseases,” are the most common afflictions of the world’s poorest people? “Neglected” tropical diseases affect about 1.4 billion people worldwide, mostly in rural areas of developing countries. Unlike AIDS and malaria, they aren’t fatal, but they are disabling, leading to lost income from missed work and lower IQs. A recent post on the Discovery magazine blog highlights recent research from the University of New Mexico that hypothesizes that the prevalence of these parasitic infections is the “most powerful predictor of average national IQ” – more than GDP, literacy rates, and school enrollment. The post questions whether correlation is causation and is skeptical about these diseases having effects on the IQ of entire countries:
“…a link between infections and IQ tells us nothing about whether infected people grow up to be less intelligent, or whether intelligent people are less likely to become infected. Intelligence, after all, could affect one’s understanding of what a disease is, how to avoid it, and how to seek help for an infection.”
I think the author misses the point here. The issue isn’t that intelligence may lead to greater knowledge and prevent infection. How does intelligence help in seeking treatment in the poorest rural areas in the world, with little or no medical care or resources to treat these diseases? In addition, lower IQs can have huge lifelong ramifications in terms of educational attainment and employment. Young children are often afflicted by these conditions, delaying mental and cognitive development. A wide body of research has shown that deficiencies in the first years of life have lifelong effects. Nutrition shortfalls have also proven to detrimentally affect IQ. For example, deficiency in iodine, an element that we take for granted in the United States, can lead to impaired cognitive development and is the leading cause of mental retardation worldwide. Given the sheer prevalence and disabling nature of these diseases, you would think there would be more discussion of their effects on productivity, economic development, and social stability. They are a major hidden root cause of poverty. Of course, lack of education and employment opportunities, weak markets for goods and foods for poor farmers, trade imbalances, and conflict over scarce resources are all major contributors to poverty, but without a foundation of good health, how can the other issues be overcome?
I recently interviewed Dr. Peter Hotez, research professor and the chair of the Department of Microbiology, Immunology, and Tropical Medicine at George Washington University about the effects of these diseases on economic development and the interesting potential for “vaccine diplomacy.” He’s also the president of the Sabin Vaccine Institute, an organization working to reach the millions of people affected by neglected tropical diseases. A “rapid impact package” of drugs that eliminate the seven most common tropical diseases can be administered for just 50 cents a person per year. Whether or not the neglected tropical diseases are the single “most powerful predictor of national IQ,” they are a major contributor to poverty.
by Marlene Lee, senior research associate, Domestic Programs
In response to my earlier blog post on immigration and social security, researcher Dowell Myers makes the valuable point that considering immigration as a solution to the Social Security financing problem is not an “all or nothing” proposition. Immigration may be part of a solution, reducing the old-age dependency and helping to reduce the deficit of the Social Security program (see Social Security Advisory Board’s estimate of reduction). In his work, Myers estimates that feasible levels of immigration could reduce the old-age dependency ratio by 25 percent. Both Myers and Reich in their NPR interviews suggest that the policy solutions for Social Security should include immigration.
However, research suggests that increased immigration may have drawbacks for vulnerable populations that other policy options do not. George Borjas and other scholars provide evidence that immigration is most likely to hurt low-income workers. (For information on immigrant characteristics, see MPI report on immigrants and recession, and for a readable account of Borjas’ argument see NYT Magazine contributor Roger Lowenstein’s article “The Immigration Equation”) If one accepts the premise that immigrants reduce job opportunities for low-income workers, particularly visible minorities—a big if —then a solution that includes high levels of immigration might well affect the Social Security earnings of low-income and minority workers. This is because individuals’ eligibility for and level of Social Security benefits are tied to their earnings history.
Teasing out the effect of policy on different population groups is always difficult. And certainly many economists would argue that to the extent immigrant workers contribute to small business growth and spend their earnings in the United States, they may ultimately increase job opportunities. In any case, other policy options such as raising the Social Security payroll tax or changing the rules so that high earners pay Social Security taxes on all earnings, not just the first $106,800, do not disproportionately affect low-income workers. Also, let’s not forget that part of the equation for Social Security solvency is the labor force participation rate. Increases in women’s labor force participation rates had a positive impact on labor force growth, thereby increasing contributions paid into Social Security. Certainly even with the same old-age dependency ratio, if women’s labor force participation rates had not risen over the previous four decades, the Social Security financing gap would be larger. But these rates have stabilized, and the women who helped fuel economic growth will be among those collecting Social Security in the next 30 years.
A high rate of labor force participation among immigrants is one of the reasons that more immigration might work as part of the answer to the gap in Social Security funding. Higher labor force participation rates among native-born minorities also have the potential to increase growth of the labor force and future contributions to Social Security, just as increased female labor force participation did. But, this potential solution is not often mentioned in the current debate, perhaps because it is not perceived to be as easy to achieve as expanding immigration.
The Millennium Village program has received a lot of media attention over the past few years. Through targeted health, education, agriculture, and infrastructure interventions for rural African villages, the program aims to serve as a model for how extreme poverty can be diminished. A recent article in The New York Times highlights the improvements in people’s lives in one village in Kenya since the program started – agricultural yields have doubled, fewer children are dying, more children are attending school, and four times more people have cell phones. However, it’s far from clear whether this approach and success can be “scaled-up” across the country. Will health, agriculture, and education programs be effective once the national government takes control or will corruption stymie progress? The lack of rigorous evaluation of the program is another criticism by some:
“Many aid experts have suggested that the only way to really know if the Millennium Villages are worth the expense (around $110 per capita, per year) is to collect data from similar ‘control’ villages that are receiving no help.
‘No one would dream of ‘scaling up’ the use of a new pharmaceutical in the U.S. without rigorous evidence comparing people who got the medicine to people who did not,’ said Michael Clemens, a research fellow at the Center for Global Development.”
The debate over replicating the success of Millennium Villages on a larger scale is a microcosm of a much larger debate over development aid in general. The article reiterates the need for rigorous monitoring and evaluation to determine what works in a specific environment with its own unique culture, politics, and needs. Too often, aid has been delivered with a “one-size-fits-all” approach, devised by Western NGOs and governments in conference rooms far from the villages and cities where programs are implemented. Donors want to know what their money is doing on the ground – how is success measured and what impact is funding having?
Thinking of this issue reminded me of how committed PRB is to strong evaluation of programs. For example, PRB is a partner in the Measurement, Learning & Evaluation (MLE) Project of the Urban Reproductive Health Initiative (URHI). Over the next four years, the MLE project will evaluate the impact of URHI programs that target the urban poor in four countries in South Asia and sub-Saharan Africa with family planning and reproductive health interventions. We’re also working with the William and Flora Hewlett Foundation to evaluate PRB’s programs by applying a randomized clinical trial model – taking principles for evaluating medical treatments administered to individuals and adapting them to evaluating programs aimed at large numbers of people – in the Gold Standard project.
New and innovative ways of measuring program impact and effectiveness are being implemented all over the world. Aid is becoming more scrutinized, as it should be. Even though the Millennium Village program has led to some success stories, without strong evaluation, it won’t be clear which programs have worked and why, and where funding should be directed – crucial questions to answer to determine their applicability in other settings. I hope those at the project are well aware of this. In fact, The Millennium Village project will publish their midterm review later this year.
by Jay Gribble, vice president, International Programs
More than 1,000 people have gathered on the shore of Lake Victoria at the Speke Conference Center outside of Kampala, Uganda, to discuss family planning—what we have learned from research and how to expand the implementation of best practices.
The opening plenary included a range of speakers, including the First Lady of Uganda. Many speakers have focused on family planning as a strategy to reduce maternal mortality. For years, family planning has been couched in terms of its health benefits to women and children. The idea of “too young, too old, too close, and too many” is familiar to family planning advocates because through helping avoid unplanned pregnancies, family planning is able to contribute to lower maternal and child mortality. These are critical to addressing the Millennium Development Goals, which aim to reduce poverty and improve the quality of life among the poor.
Yet there are other benefits of family planning that should not be overlooked. Not only is family planning a health strategy, but it is also a poverty reduction strategy. Evidence demonstrates that when women use family planning and have smaller families, their families are better off. Research from Bangladesh shows that through the long-term commitment to family planning and maternal-child health, families are healthier; they have greater assets; they live in more valuable houses; their children are better educated and have lower mortality rates. These benefits reinforce the importance of family planning as both a health strategy as well as one to reduce poverty and improve economic development.
We should also remember that family planning is intrinsically linked to women’s empowerment. When women can decide the timing, spacing, and number of children that they want to have, they and their children are healthier, but they are also more empowered. Recognizing that there are important gender aspects of health and development, family planning helps women better care for themselves, for their children, their families. It allows them to work and earn an income, to continue their education, and to have a say about their own lives and futures.
The conference theme makes an important statement: family planning—family health—family wealth. Let’s not limit the discussion of family planning to only one area of benefit. Good health is important, but family planning also reduces poverty and promotes gender equity.
by Mark Mather, associate vice president, Domestic Programs
Today the Census Bureau released another wave of economic data that showed a 13 percent increase in U.S. households receiving food stamps between 2007 and 2008. Who saw the biggest increase? It was families with two or more workers, who made up 26.9 percent of food stamp recipients in 2007 but jumped to 28.4 of recipients in 2008. The numbers, based on new data from the American Community Survey (ACS), provide more evidence of the recession’s wide-reaching impact, especially on lower-income working families.
Nationwide, about 9 percent of U.S. households reported receiving food stamps in 2008, according to ACS data. But ACS respondents are known to underreport participation in the Food Stamp Program. (For more information, see this report from the Census Bureau). The USDA’s Food and Nutrition Service, which administers the Supplemental Nutrition Assistance Program at the federal level, counted 12.7 million households receiving food stamps in 2008, compared with 9.8 million counted in the ACS. The latest numbers from the USDA, from June 2009, puts the number of households receiving food stamp benefits at nearly 16 million.
Our very own Mark Mather, associate vice president of Domestic Programs, has been getting a lot of media exposure recently based on his recent article on the social effects of the economic recession on the U.S. population on the PRB website.
As Mark notes in his article, recent data show that the recession is having an effect beyond employment and income, affecting homeownership rates, commuting patterns, marriage rates, and migration.
In 1995, the international community proclaimed the goal of reducing hunger by 50 percent by 2015. However, the Food and Agriculture Organization (FAO) estimates that while the number hungry fell from 900 million in 1970 to 875 million in 2005, it has risen to over 1 billion in 2009, related to the 2008 food price crisis. But do we really know the exact numbers of hungry and malnourished and the direct causal relationship to food prices, and now more recently the financial crisis?
After participating in an Institute of Medicine-organized workshop, “Mitigating the Nutrition Impacts of the Global Food Price Crisis,” held at the Kaiser Family Foundation in Washington, DC, I’m afraid to report that we don’t have the answer to either the statistical or the causal questions. After all the media frenzy in the last year, the international community, which was well represented at the workshop by particpants from the academic, UN, donor, foundation, private sector, and NGO worlds, has to admit: we don’t know the impact of the food price crisis!
There was agreement that poverty, hunger, and malnutrition are long-term chronic AND structural problems, and should not be considered crises. There is also a consensus that the predominant food-first, food-aid, and acute feeding focus (mainly by the U.S. government and World Food Program) needs to be reoriented toward agricultural productivity, and food and nutrition security policies and strategies. The numbers show that the geographic focus should be on sub-Saharan Africa and South Asia, among the most vulnerable populations, and that there should be NO artificial separation of food issues from nutrition issues. A final consensus was that the best group to ensure that crucial linkage is small-farmer women.
Very little was said by the many prominent speakers about the relevance of population, reproductive health, and family planning factors and policies to hunger and malnutrition. The comprehensive and professorial opening keynote speech on the current food price crisis and its future reported that population growth rates were “dropping, although not as rapidly as some would prefer” (P.P.Anderson). The U.S. congressman on the closing panel who co-sponsored the important report: “Roadmap to End Global Hunger” noted the need to ensure that nutrition and food security programs are integrated with global health interventions, mentioning eight of them, but reproductive health/family planning was not included in what he called a comprehensive package. Only one of the dozens of speakers emphasized long-term population, environmental, and water resource constraints on agriculture and food production.
There were three demographically relevant points made during the workshop:
Teaching an entire semester’s graduate course in three weeks at the end of the academic year seemed a dubious task under normal conditions. But teaching it at the end of Ethiopia’s long dry season with shortages of electricity and water, not to mention scarcity of recent publications and slow internet speed in the mountainous capital city of Addis Ababa, made it even more challenging.
I had taught at the Flagship University of Addis Ababa’s Institute of Population Studies for four years in the mid-to-late 1990s, and served as external thesis examiner off and on since then, but now the government really needed more Ph.D demographers as it greatly increased its student intake in higher education, even pushing to start a Ph.D program on top of an already overstretched masters degree program.
In one of the poorest countries in the world, with 13 million food insecure, the second largest population in Africa (nearly 80 million), and an annual population growth rate around 2.6 percent, we discussed theories of population and development and debated models of the demographic transition. In a secret ballot early on in the course, I was not surprised to find out most of the 22 mature graduate students were Malthusian pessimists or even alarmists.
The job of a good professor is to challenge his students into reconsidering their cynicism and, in this constrained setting, provide rays of hope that things might get better. In the past few years, my Ethiopian colleagues and I had published evidence that the country was unexpectedly progressing better along the demographic transition than most of its neighbors, and that it was surprisingly on track to meet many of the 2015 Millennium Development Goals (MDGs), especially in education and health.
In just a few weeks, in spite of the lack of computers, electricity, and inability to download publications from the internet, the students were able to work in teams of two to three to read recent literature and access demographic and development data through sharing CDs, photocopies, and handouts. They closely assessed the quality of differing estimates of progress since 1990 on the MDGs: the 1993 National Population Policy and its ICPD+15 (2008) goals, and the 2005-08 Poverty Reduction Strategy.
Ethiopian population graduate students prepare outside on campus at dark when electricity went out. (Photo by Charlie Teller)
In their final exam, I asked if any had changed their minds away from pessimism, and why. To my pleasant surprise, some had after seeing progress on the some of the MDGs and social change in their own younger generation, calling themselves revisionists, neutralists,or cautious optimists. They became convinced of the importance of using rigorous research methods and reliable indicators to closely monitor and evaluate the pace of the demographic transition and socioeconomic and gender inequities, as well as capacity building in research and training.
If these keen students in such a resource-constrained environment can learn so quickly, can’t a country under population pressure use its resilient and adaptive skills to begin to believe in their capacity to accelerate the demographic transition? ?
Few automobile introductions have attracted more media interest that Tata Motor’s new “one lakh” car, the Nano. That’s one lakh, or 100,000, rupees, roughly equivalent to US$ 2,000. The actual price to the consumer after taxes, dealer markup, etc. starts at about $2,500 for the Standard model. For $3,000, you’ll get the CX model with air conditioning and $3,500 will get you the LX, which adds power windows and electric central locking. So much for the $2,000 car.
In a sense, the Nano is an “almost car.” Its rear-mounted 33-horsepower two-cylinder engine is more like a motorbike engine and its tiny trunk area is accessible only by pulling the back seats forward. Despite its concept as a city car, few owners are likely to hesitate to take it on the open road. It is not at all unusual to see families of four travelling from city to city on a two-wheeler. Roof racks will likely be a popular accessory. But its appeal to those who now ride two-wheelers is that it gets one out of the rain.
The little car got off to a slow start when its planned factory in Singur, West Bengal was protested due to its need to take over agricultural lands. The protesting lasted for several years and Tata finally pulled out, leaving the partially-completed factory abandoned. Enticed by very generous (and controversial) financial incentives from Chief Minister Narendra Modi of the western state of Gujarat – no stranger to controversy himself – Tata is now building a new plant in Sanand in that state. So, full production has been subject to a serious delay.
The much-publicized first ordering period was held from April 9th to the 25th of this year when the first buyers could place a deposit or pay in cash in advance. A total of 203,000 vehicles were ordered – not bad at all for a car that promised something of a wait. Or a very long wait: A lottery will soon be held for the first 100,000 lucky buyers who can expect to receive their Nano anytime from this July to the end of next year. Many of those losing out in the lottery will likely have to wait until sometime in 2011 or when the new factory can come up to speed. Cancellations of up to 50 percent among the losers are being predicted although interest is being paid on all deposits.
The number of orders in April was considered well below expectations, although that number has never been well defined. And, interestingly, half of the orders were for the pricey LX and only 20 percent for the basic Standard model. It is likely that quite a few were purchased by comparatively wealthy non-resident Indians (NRIs) overseas as gifts, especially as huge numbers of weddings took place this April, an auspicious period.
So, the Nano may revolutionize Indian roads, but not right away. But where will most Nanos ply? Even at its low price, the car is well beyond the means of most Indians except some in big cities. It should become almost ubiquitous in Delhi, India’s richest city but, in other states the story is likely to be different. Uttar Pradesh, next door to Delhi with about 180 million population in 2004, boasted a grand total of 391,000 cars in 2004 while Delhi, with 14 million population, had 1.2 million.
Who bought Nanos? Given the preference for the LX model, it may just be that fewer owners of two-wheelers actually traded up than were expected. Perhaps the Nano will become India’s favorite second car among the upper middle class. That would be a real revolution while trying to park all those additional cars would be a real adventure.
“There are three kinds of lies: lies, damned lies, and statistics.” Benjamin Disraeli
“It is easy to lie with statistics, but it is easier to lie without them!” Frederick Mosteller
This series of posts from PRB experts focuses on some of the important measures researchers and policymakers use when dealing with population, health, and the environment. We discuss definitions and controversies, quirks in their uses, and pitfalls to avoid. Along the way we relate some of our own experiences with uses and misuses (just keep these stories to yourself!). Look out for upcoming posts on income, the homeless, undocumented immigration, population density, urban and rural, carrying capacity, carbon footprint, hunger and malnutrition, the elderly, race and ethnicity, and household and family.
Today the Census Bureau released 
