GPH NOTES 10-8
1) Essay
1 page outline due week of october 22nd
do NOT write a book report
do NOT write a book review
write a 7-9 page ESSAY that jumps off from the book, develops your own ideas, and presents them to the audience in a clear and coherent way
-1, 2, or 3 ideas, no more
-oy vey
-use these ideas as a platform and go from there
use the universal outline for essays
-what is he talking about?
-go like THIS!!
-awesome, he's a senile old man
submit a first draft of the essay on the week of october 29th
-he's gonna get angry
-oy vey
-don't write for the professor, don't write an 'insider essay', write it for the general reader
late papers get molested
-no such thing as a writing block
-HE'S GONNA KILL US ALL
-HE'S GONNA KILL ME
-omgomgomg
-i think he just threatened to kill us all
2) Questions about resistance
what the fuck is he talking about?
i think his opthamologist exploded
when did this start?
-starts with introduction of new antibiotics
-doctors were really really really happy that they could effectively treat internal malaises
-they just started pumping antibiotics into people
-so much so that they would actually refuse vaccines because they could treat pneumonia
3)When did this start?
-baaaaaaad idea
-treatment is more important than prevention?
-resistance is not a problem?
-FALSE
-what the fuck?
-in the 1940s, the FDA did NOT require drugs to actually be effective to be on the market
-it was left to the doctors to distinguish between solvent and insolvent medicines
-there was no concentrated campaign against resistance
4) When did resistance become threatening?
late, in the 1950s, 60s, fda required that drugs be effective
-AND safe!
3 developments really changed the way medicine was done
-1) discovery about biochemistry, now made possible to target diseases through enzyme inhibition
-2) molecular genetics, changed knowledge of bacteria, large molecule drugs, etc
-3) the ability to actually SEE viruses with the electron microscope, and the ability to self-culture vaccines and viruses
now, we can develop a much better understanding about resistance
-but we didn't at first
-it moved really slowly
first in-depth analysis of antibiotic use and resistance was published in 1987!
-wtf? took 4 decades to get this going
-why did it take so long, go so slow?
-even as late as the late 1980s, the professional response was skeptical
-for the most part, the problem was ignored in the late 1980s
-professionals were convinced the problem was overstated
-this was extremely important because this meant congress didn't end up caring
-this was basically because the doctors (their advisers) told them not to care
from the 1980s on, there have been many reports and such about this problem
-still, shit is moving SLOOWWWWLLLYYY
-why?
-probably because antibiotics are so easy to come by
-bacterias develop resistances much more easily
-another problem- widespread use of anti-microbials in livestock food supply
-still don't know what the full effects of this are
-another problem rises from wanting to provide healthcare for all
-now, we send people home after surgery very quickly
-just give them prescriptions, they should be good
-they've still got drains in them!
-now, people don't actually follow the medicinal regimens
-this also helps resistance
the WHO declared in 2001 that resistance is one of the three top health problems in the world
-as of 2003, we've still done nothing about it
there are lots of problems with resistance
-it's expensive to deal with!
-you need new, expensive drugs!
-holy shit it's expensive! much cheaper to just ignore it!
-when a country is only spending $1/year on healthcare per person, they're not gonna deal with resistance
one of the problems- problems are not developed evenly around the world
-scandinavia, for instance, there's tight central control of prescriptions, so not as much overuse of antibiotics
the fight for control of general medical practice is still being waged
-the doctors want MASSIVE AUTONOMY
-they're extremely well organized
-they fight vigorously to oppose any change to the system that doesn't benefit them
the doctor's problem
-liability!!!!!!
-they overprescribe to cover their asses
-even though 80% of pinkeye cases may be viral, the lawsuit comes from the 20%, so they'll prescribe antibiotics just in case
-resistance is in the future, lawsuits and insurance payments are right now
-even the doctors themselves have issues
-washing hands doesnt occur nearly as often as it should
-a higher percentage of people will wash their hands if there's someone else in the bathroom with them
-did you know soap doesn't matter when you wash hands? haha
we're now in a 'flat period' in innovation
-the professions are confident that there'll be a burst of innovation soon
-this idea works against doing shit at all
5) What can be done about it?
LOTS of institutional support
-cdc, nih, who, etc
-NGOs are working against resistance as well
why the FUCK is he talking about gazelles and cheetahs!!
-arms race? what the fuck?
6) Will this work?
dd
Saturday, October 13, 2007
GPH NOTES 10-3
1. Brief history of the IMF
Growth was pretty positive over the 80s and 90s, in most places
-asia was growing, good stuff like that
-life expectancy was declining in africa and eastern europe, however
-there was some improvement though, just not as general or as marked as in previous years
So classical economists say that in the event of recession or depression, the right course of action is to 'wait it out'
-basically, shit will fix itself
-Keynes disagreed (i think?)
-his thing was that even though in the long run shit might fix itself, in the long run we're all dead
-the GOVERNMENT needs to step in to fix shit
-to shield the people from the vicissitudes of the market
-the IMF was conceived in this vein
IMF was concerned with macroeconomic stability
-distinct from the World Bank- which dealt with structural issues
-IMF is headed in the US
-pretty much dominated by western developed countries (like WB)
-its head is traditionally a european
In 1981, the bank introduced a new financial instrument- structural adjustment loans (SAL)
-they would provide finance to a country for a certain number of years, while requiring the countries to make certain reforms that were thought to be beneficial to growth
2. The Washington Consensus
The idea of coordinated intervention in the economies of nations failing economically came to be called the "washington consensus"
-loans tend to be advanced to countries that follow the tenets set forth by the world bank/imf
-many of these ideas came out of the experience that the IMF had with latin america in the 1980s
-by the early 80s, the good growth experienced in the 50s and 60s was faltering
-the IMF's directives to cut spending, cut deficits, increase savings, open markets, etc, worked pretty decently for a while, but then failed long term
Planks of the washington consensus include vvvvv
3. Fiscal austerity, privatization, liberalization
One of the planks of the washington consensus was privatization
-governments just aren't that great at certain things- private industry is better
-this is not always necessarily true, however
-in smaller, less developed countries, there often isn't enough competition to provide a true market economy
-local monopolies are created, create even GREATER inefficiencies
-for the market structure to work in the first place, you have to have certain preconditions
-roads, availability of loans, etc
-less developed countries just don't have this
Fiscal austerity is another plank of the washington consensus
-don't have budget deficits
-the US doesn't really do this, which is understandable
-for a less-developed nation to do this, it either has to raise taxes or cut spending
-raising taxes is not really effective, especially with less developed countries
-they end up cutting spending
-this is baaaaaad, cause they cut social services and shit
-user fees are one way that countries cut spending (they reduce availability of services to the poorest)
-while this may be good fiscal policy, is it good development policy?
Trade Liberalization, liberalization of capital markets
-opening up to world trade is a good thing, generally
-this is not always a good thing all at once, though
-even the US shielded its weaker industries from the world market, at least initially, until they were able to compete on their own
-there is glaring inequality here, especially in the fields of agriculture and textiles, where the US and EU still practice protectionism
Capital market liberalization
-free capital flows have always been seen as more problematic than trade flows
-financial markets can be very fragile
-once capital markets get liberalized, you very easily get speculative flows, which is a problem
-when huge amounts of capital flow in and out rapidly, it can screw a country's economy
4. Evaluation
Overall, what does the record look like?
-over the period of time where SALs were effective, the most active african countries took out over 200 loans
-their per capita growth rate was uniformly negative, inflation was high
-in eastern europe, the per capita growth rate was -1%, inflation was ~85%
-latin america- while the markets were becoming freer, the growth rates were also low or negative
this can be looked at as kind of a chicken and egg issue
-maybe these problems were underlying, and if the IMF hadn't stepped in it would have been even worse
-but this can be looked at statistically as well, and evaluated
-Easterly managed to do statistical analysis, found that the SALs failed to help in any way
many countries did not follow the washington consensus
-east asia, for instance
-high savings, massive promotion of exports, very gradual liberalization
-it happened to work...
-even china and india are by no means market economies
-relatively loose fiscal policies
-rather extensive industrial policies
-large amounts of protectionism
-etc, etc
5. Future Prospects
The Washington Consensus is DEAD
-what will replace it?
perhaps a lesson has been learned by the world bank
-there's more humility, interest in selective and modest reforms as opposed to massive, sweeping ones
the IMF?
-the institution is looking towards paying greater attention to input from developing nations, etc
-but it doesn't really know what's going on itself
-it's at a 'crossroads'
what do we do now?
-should we make a fresh start? ditch our current institutions and start anew?
-over the 20 year period we're looking at, the IMF/WB had a 'grand plan.' in what ways is the 'grand plan' similar to the UN millennium goals?
1. Brief history of the IMF
Growth was pretty positive over the 80s and 90s, in most places
-asia was growing, good stuff like that
-life expectancy was declining in africa and eastern europe, however
-there was some improvement though, just not as general or as marked as in previous years
So classical economists say that in the event of recession or depression, the right course of action is to 'wait it out'
-basically, shit will fix itself
-Keynes disagreed (i think?)
-his thing was that even though in the long run shit might fix itself, in the long run we're all dead
-the GOVERNMENT needs to step in to fix shit
-to shield the people from the vicissitudes of the market
-the IMF was conceived in this vein
IMF was concerned with macroeconomic stability
-distinct from the World Bank- which dealt with structural issues
-IMF is headed in the US
-pretty much dominated by western developed countries (like WB)
-its head is traditionally a european
In 1981, the bank introduced a new financial instrument- structural adjustment loans (SAL)
-they would provide finance to a country for a certain number of years, while requiring the countries to make certain reforms that were thought to be beneficial to growth
2. The Washington Consensus
The idea of coordinated intervention in the economies of nations failing economically came to be called the "washington consensus"
-loans tend to be advanced to countries that follow the tenets set forth by the world bank/imf
-many of these ideas came out of the experience that the IMF had with latin america in the 1980s
-by the early 80s, the good growth experienced in the 50s and 60s was faltering
-the IMF's directives to cut spending, cut deficits, increase savings, open markets, etc, worked pretty decently for a while, but then failed long term
Planks of the washington consensus include vvvvv
3. Fiscal austerity, privatization, liberalization
One of the planks of the washington consensus was privatization
-governments just aren't that great at certain things- private industry is better
-this is not always necessarily true, however
-in smaller, less developed countries, there often isn't enough competition to provide a true market economy
-local monopolies are created, create even GREATER inefficiencies
-for the market structure to work in the first place, you have to have certain preconditions
-roads, availability of loans, etc
-less developed countries just don't have this
Fiscal austerity is another plank of the washington consensus
-don't have budget deficits
-the US doesn't really do this, which is understandable
-for a less-developed nation to do this, it either has to raise taxes or cut spending
-raising taxes is not really effective, especially with less developed countries
-they end up cutting spending
-this is baaaaaad, cause they cut social services and shit
-user fees are one way that countries cut spending (they reduce availability of services to the poorest)
-while this may be good fiscal policy, is it good development policy?
Trade Liberalization, liberalization of capital markets
-opening up to world trade is a good thing, generally
-this is not always a good thing all at once, though
-even the US shielded its weaker industries from the world market, at least initially, until they were able to compete on their own
-there is glaring inequality here, especially in the fields of agriculture and textiles, where the US and EU still practice protectionism
Capital market liberalization
-free capital flows have always been seen as more problematic than trade flows
-financial markets can be very fragile
-once capital markets get liberalized, you very easily get speculative flows, which is a problem
-when huge amounts of capital flow in and out rapidly, it can screw a country's economy
4. Evaluation
Overall, what does the record look like?
-over the period of time where SALs were effective, the most active african countries took out over 200 loans
-their per capita growth rate was uniformly negative, inflation was high
-in eastern europe, the per capita growth rate was -1%, inflation was ~85%
-latin america- while the markets were becoming freer, the growth rates were also low or negative
this can be looked at as kind of a chicken and egg issue
-maybe these problems were underlying, and if the IMF hadn't stepped in it would have been even worse
-but this can be looked at statistically as well, and evaluated
-Easterly managed to do statistical analysis, found that the SALs failed to help in any way
many countries did not follow the washington consensus
-east asia, for instance
-high savings, massive promotion of exports, very gradual liberalization
-it happened to work...
-even china and india are by no means market economies
-relatively loose fiscal policies
-rather extensive industrial policies
-large amounts of protectionism
-etc, etc
5. Future Prospects
The Washington Consensus is DEAD
-what will replace it?
perhaps a lesson has been learned by the world bank
-there's more humility, interest in selective and modest reforms as opposed to massive, sweeping ones
the IMF?
-the institution is looking towards paying greater attention to input from developing nations, etc
-but it doesn't really know what's going on itself
-it's at a 'crossroads'
what do we do now?
-should we make a fresh start? ditch our current institutions and start anew?
-over the 20 year period we're looking at, the IMF/WB had a 'grand plan.' in what ways is the 'grand plan' similar to the UN millennium goals?
GPH NOTES 10-1
THE INSTITUTIONAL NETWORKS IN GLOBAL PUBLIC HEALTH
I. Good news and a cautionary aside for those planning a career
you'll hurt people in your career trying to help people
whoopdy fucking doo
II. The World Health Organization
an agency of the UN created in the late 1940s
-the news in the last few years about the UN has been pretty negative
-ex.- Oil for Food program was massively corrupt
-charges of nepotism that involved Kofi Anan's son making money off of Oil for Food programs
-concern that the UN hasn't moved fast enough to prevent genocide in Darfur
in the last 5-10 years, the WHO has thrived
-marvelously strong public image, as a contrast to the UN
-headquartered in Europe
-the WHO has had some successes and problems as well
-remember the MEP- malaria eradication program
-all the research was not done on the spray they used to kill mosquitoes
-turned out that it actually killed people
-oops
-so it still acts as a bureaucracy sometimes, so it's not that great
-instead of the spraying, they moved to giving people pills, which actually did work
issues
-WHO's task is much narrower than Sachs' proposal
-the WHO is a narrowly defined institution
-it has several mandates, but it keeps a relatively tight focus
-its' major task is to prevent and treat infectious diseases
-this is surprising- large-scale organizations that are successful tend to outgrow their mandates, broaden out too much
-WHO works for everybody, as long as they're UN member states
-now, more and more of its money (now up to 1/2) comes from voluntary contributions
-WHO focuses most of its money on preventive medicine
-this is different from US
-US is interesting, huge amounts of money is spent on people in the last few months of their lives
-relatively very little money is spent on preventative medicine
-the WHO spends huge amounts of money on vaccination
III. The Smallpox Campaign
one of the WHOs great successes
what problems did the WHO face?
-denial
-doctors just dont care about smallpox
-wouldn't use the vaccine
-this doesn't make any sense (his pneumonia analogy)
-smallpox was considered a 'lower class disease'
-this resulted a lack of statistics
-we don't know what's out there, and what is out there is underreported
-WHO estimated there were 10-15 million cases in this certain timespan, but national data represented only 1 million
-WHO was also at a loss because their reputation was shot after the malaria fiasco
-when the USSR proposed an eradication plan worldwide, they were slow at first
-there was a lack of funding to the WHO
-countries wouldn't give money
-WHO couldn't do this centrally
-did not have the funds, equipment, or manpower to do this
-they had to convince national bodies to do it themselves
-it had to be done very uniformly
-there weren't enough vaccines of high enough quality to give to everybody
-they needed to improve equipment, labs, etc
-they even needed to train technicians to work in labs to produce vaccines
measles got added to smallpox as a target of eradication
-they decided to persist
-they created an alliance and network structure with the CDC and other organization
-they managed to get a successful campaign going, against all odds
-they managed to get 47 million people vaccinated in one year
IV. The Results
it worked, essentially
-they let the CDC run almost all of the operations in Africa on the ground
-CDC let the WHO run the programs on the ground in Zaire
-WHO and CDC were effective most of the time in working with national governments
-WHO worked with partners in latin america and asia to get programs that they didnt have the funding for themselves
-as the program got underway, they started publishing statistics
-massive transparency took effect
-this was NOT something that the governments wanted published
-there was then OFFICIAL denial
-the governments didn't want to be associated with the statistics
-they started improving their own statistics
after the successes here
-the WHO was able to get more and more donations and support for its programs
-the WHO ended up broadening the program slightly by working on containing the disease when it did break out
This is a good example of decentralization
-in each country, the program ran in a slightly different way
-centralized programs achieve efficiency by working the same way everywhere
-decentralized programs promote innovation and flexibility
-decentralization took place under certain restrictions
-clean labs, good medicine, good science, etc
-there was still a great deal of bending and twisting to get shit done on the ground
-the WHO actually encouraged them to work out their own problems
-there was also almost no emphasis on paperwork
-this is HUGE
interestingly, the cold war context had very little impact on the campaign
-one of the labs was in moscow
-once they convinced the soviets that they weren't CIA, the program went great
the campaign lasted for 12 years, and at the end of the program, smallpox was eradicated
-last recorded case was in 1977
-this even shows up in life expectancy trends
less obvious results
-changed host country health services
-demonstrated what could be done if you went out into the field with this sort of campaign
-gave them up-to-date information
-gave more training, more experience
-changed how the WHO worked
-from massive horizontal campaigns (general health to everybody) to vertical campaign (eliminate smallpox everywhere)
-most of the rest of the campaigns end up being vertical
-an example- EPI- aimed to provide all of the children in the world 6 vaccines
-BCG- treatment for tuberculosis
-DPT- diptheria, pertussis (whooping cough), and tetanus
-Polio
-measles
-complication in this campaign
-some of the vaccines have to be refrigerated
-while this is easy in the US, this is EXTREMELY difficult in africa, for instance
-but, it worked
-by 1993, 77% of kids had been vaccinated
-by 2003- 80%
-this is HUGE
-another campaign- campaign against diarrheal diseases
-kills millions of kids every year
THE INSTITUTIONAL NETWORKS IN GLOBAL PUBLIC HEALTH
I. Good news and a cautionary aside for those planning a career
you'll hurt people in your career trying to help people
whoopdy fucking doo
II. The World Health Organization
an agency of the UN created in the late 1940s
-the news in the last few years about the UN has been pretty negative
-ex.- Oil for Food program was massively corrupt
-charges of nepotism that involved Kofi Anan's son making money off of Oil for Food programs
-concern that the UN hasn't moved fast enough to prevent genocide in Darfur
in the last 5-10 years, the WHO has thrived
-marvelously strong public image, as a contrast to the UN
-headquartered in Europe
-the WHO has had some successes and problems as well
-remember the MEP- malaria eradication program
-all the research was not done on the spray they used to kill mosquitoes
-turned out that it actually killed people
-oops
-so it still acts as a bureaucracy sometimes, so it's not that great
-instead of the spraying, they moved to giving people pills, which actually did work
issues
-WHO's task is much narrower than Sachs' proposal
-the WHO is a narrowly defined institution
-it has several mandates, but it keeps a relatively tight focus
-its' major task is to prevent and treat infectious diseases
-this is surprising- large-scale organizations that are successful tend to outgrow their mandates, broaden out too much
-WHO works for everybody, as long as they're UN member states
-now, more and more of its money (now up to 1/2) comes from voluntary contributions
-WHO focuses most of its money on preventive medicine
-this is different from US
-US is interesting, huge amounts of money is spent on people in the last few months of their lives
-relatively very little money is spent on preventative medicine
-the WHO spends huge amounts of money on vaccination
III. The Smallpox Campaign
one of the WHOs great successes
what problems did the WHO face?
-denial
-doctors just dont care about smallpox
-wouldn't use the vaccine
-this doesn't make any sense (his pneumonia analogy)
-smallpox was considered a 'lower class disease'
-this resulted a lack of statistics
-we don't know what's out there, and what is out there is underreported
-WHO estimated there were 10-15 million cases in this certain timespan, but national data represented only 1 million
-WHO was also at a loss because their reputation was shot after the malaria fiasco
-when the USSR proposed an eradication plan worldwide, they were slow at first
-there was a lack of funding to the WHO
-countries wouldn't give money
-WHO couldn't do this centrally
-did not have the funds, equipment, or manpower to do this
-they had to convince national bodies to do it themselves
-it had to be done very uniformly
-there weren't enough vaccines of high enough quality to give to everybody
-they needed to improve equipment, labs, etc
-they even needed to train technicians to work in labs to produce vaccines
measles got added to smallpox as a target of eradication
-they decided to persist
-they created an alliance and network structure with the CDC and other organization
-they managed to get a successful campaign going, against all odds
-they managed to get 47 million people vaccinated in one year
IV. The Results
it worked, essentially
-they let the CDC run almost all of the operations in Africa on the ground
-CDC let the WHO run the programs on the ground in Zaire
-WHO and CDC were effective most of the time in working with national governments
-WHO worked with partners in latin america and asia to get programs that they didnt have the funding for themselves
-as the program got underway, they started publishing statistics
-massive transparency took effect
-this was NOT something that the governments wanted published
-there was then OFFICIAL denial
-the governments didn't want to be associated with the statistics
-they started improving their own statistics
after the successes here
-the WHO was able to get more and more donations and support for its programs
-the WHO ended up broadening the program slightly by working on containing the disease when it did break out
This is a good example of decentralization
-in each country, the program ran in a slightly different way
-centralized programs achieve efficiency by working the same way everywhere
-decentralized programs promote innovation and flexibility
-decentralization took place under certain restrictions
-clean labs, good medicine, good science, etc
-there was still a great deal of bending and twisting to get shit done on the ground
-the WHO actually encouraged them to work out their own problems
-there was also almost no emphasis on paperwork
-this is HUGE
interestingly, the cold war context had very little impact on the campaign
-one of the labs was in moscow
-once they convinced the soviets that they weren't CIA, the program went great
the campaign lasted for 12 years, and at the end of the program, smallpox was eradicated
-last recorded case was in 1977
-this even shows up in life expectancy trends
less obvious results
-changed host country health services
-demonstrated what could be done if you went out into the field with this sort of campaign
-gave them up-to-date information
-gave more training, more experience
-changed how the WHO worked
-from massive horizontal campaigns (general health to everybody) to vertical campaign (eliminate smallpox everywhere)
-most of the rest of the campaigns end up being vertical
-an example- EPI- aimed to provide all of the children in the world 6 vaccines
-BCG- treatment for tuberculosis
-DPT- diptheria, pertussis (whooping cough), and tetanus
-Polio
-measles
-complication in this campaign
-some of the vaccines have to be refrigerated
-while this is easy in the US, this is EXTREMELY difficult in africa, for instance
-but, it worked
-by 1993, 77% of kids had been vaccinated
-by 2003- 80%
-this is HUGE
-another campaign- campaign against diarrheal diseases
-kills millions of kids every year
GPH NOTES 9-26
1. The links between globalization, income, and income equality
The economic arguments that globalization is good for health
look at the link between globalization and income, and then the link between income and health
Globalization -> income -> health -> income
sachs makes the argument that extremes of poverty are less than they were 50 years ago
-globalization is responsible for this
however, when you look at globalization's effect on income equality, it's not so nice
-so take a line of perfect equality when mapping % income to % population
-the curve that marks actual statistics is called the lorentz curve
-the ratio of the area between the curve and the line and the area of the triangle formed by the line and the y-axis is called the genie coefficient
-this is basically a measure of income inequality
2. Does income affect health, and if so, how?
in general, increase life expectancy and you increase gdp per capita, especially as you cross a threshold for gdp per capita
-for the poorer countries, even a small rise in gdp per capita results in a huge increase in gdp per capita
-income actually explains quite a bit of the variation we see in child mortality outcomes
-there are both direct and indirect links
-direct- higher income leads to better nutrition, higher income means more infrastructure, etc
-indirect- higher income leads to better education, education changes peoples' behavior in general, they take better care of their health, increase demand for health services
3. Growth and health outcomes
So when you look at gdp growth and life expectancy around the world over time, you see definite trends
-asia and to some degree the middle east have strong growth
-however, subsaharan africa shows stagnation, and then actual decrease in both life expectancy and in gdp
overall growth has been positive in the last fifty years, life expectancy has increased in teh last fifty years, but there's no one-to-one correlation
4. Inequality in income and inequality in health outcomes
look at std dev from average gdp per capita * life expectancy
-bigger it is, the worse the situation (the less equal)
-if you look at unweighted measure, inequality is increasing
-if you look at the weighted measure (corrects for population, basically shows inequality across PEOPLE), then inequality is DECREASING
-the obvious reason for this is china and india- relatively poor countries with huge populations that are skewing the numbers
look at std dev for life expectancy
-kind of stagnating, maybe increasing a tiny bit because of hiv/aids, for instance
5. Complications
globalization has independent effects on health
-travel's faster, plagues spread real quick
-look at sars
-also there are good things about globalization, like transmission of information
-LOL INTERNET
-pretty much knowledge is being transferred from the first to the third world, but it might go the other way in the future, as the third world moves up
to sum shit up
-world income has increased while poverty has fallen
-no strong relationship between growth and inequality
j
1. The links between globalization, income, and income equality
The economic arguments that globalization is good for health
look at the link between globalization and income, and then the link between income and health
Globalization -> income -> health -> income
sachs makes the argument that extremes of poverty are less than they were 50 years ago
-globalization is responsible for this
however, when you look at globalization's effect on income equality, it's not so nice
-so take a line of perfect equality when mapping % income to % population
-the curve that marks actual statistics is called the lorentz curve
-the ratio of the area between the curve and the line and the area of the triangle formed by the line and the y-axis is called the genie coefficient
-this is basically a measure of income inequality
2. Does income affect health, and if so, how?
in general, increase life expectancy and you increase gdp per capita, especially as you cross a threshold for gdp per capita
-for the poorer countries, even a small rise in gdp per capita results in a huge increase in gdp per capita
-income actually explains quite a bit of the variation we see in child mortality outcomes
-there are both direct and indirect links
-direct- higher income leads to better nutrition, higher income means more infrastructure, etc
-indirect- higher income leads to better education, education changes peoples' behavior in general, they take better care of their health, increase demand for health services
3. Growth and health outcomes
So when you look at gdp growth and life expectancy around the world over time, you see definite trends
-asia and to some degree the middle east have strong growth
-however, subsaharan africa shows stagnation, and then actual decrease in both life expectancy and in gdp
overall growth has been positive in the last fifty years, life expectancy has increased in teh last fifty years, but there's no one-to-one correlation
4. Inequality in income and inequality in health outcomes
look at std dev from average gdp per capita * life expectancy
-bigger it is, the worse the situation (the less equal)
-if you look at unweighted measure, inequality is increasing
-if you look at the weighted measure (corrects for population, basically shows inequality across PEOPLE), then inequality is DECREASING
-the obvious reason for this is china and india- relatively poor countries with huge populations that are skewing the numbers
look at std dev for life expectancy
-kind of stagnating, maybe increasing a tiny bit because of hiv/aids, for instance
5. Complications
globalization has independent effects on health
-travel's faster, plagues spread real quick
-look at sars
-also there are good things about globalization, like transmission of information
-LOL INTERNET
-pretty much knowledge is being transferred from the first to the third world, but it might go the other way in the future, as the third world moves up
to sum shit up
-world income has increased while poverty has fallen
-no strong relationship between growth and inequality
j
GPH SINCE WWII NOTES 9-24
1. Economists, health, and globalization
Economists downplay the way social and cultural institutions affect behavior, etc
-academic economists look at the world more broadly than most people
-i.e. economists like markets, but they do recognize situations where markets fail to provide even efficiency, where the government needs to step in
-economists talk about globalization, and about health, but usually not together
when economists talk about globalization they mean
-increase in services, goods, etc across national boundaries
-necessitates closer international ties between nations
-look at it in different ways, eg global trade between countries, etc
-in some ways, it's like creating a global market
-why are markets so wonderful?
2. What markets are good at
markets are good at getting efficiency up
-efficiency means maximizing output per given input
-markets do this well because they use profits as their regulatory system
'each market is related to every other market'
-if televisions come under increased demand, EVERYBODY gets richer, from the TV companies to the glass company that makes the fronting for them
dynamic efficiency
-prices are not just information, they also create incentives for risk-taking and innovation
-when energy prices go up, for example, entrepreneurs are incentivized to create new, more efficient forms of energy production
-another example, under artificial price fixing by the soviet union, there was little technological innovation, they couldn't keep up on the innovation scale
there's lots of freedom in a market economy
-milton friedman
-'private ownership of resources is fundamental to the operation of a market economy'
-it also guarantees a gap between economic and political power
-despite all the caveats there (people can move back and forth between economic and political sources of power), the concentration of economic/political power is much less than in other solutions
3. Some Qualifications
what is the rationale for the government to step into the economy?
-most economists agree that for a market to operate well there must be certain regulations
-i.e. rules, regulations, LAWS that require contracts to be followed, etc
-consumer regulations to protect consumers from unsafe products
-workplace regulations to protect workers from unsafe workplaces
-another problem is basically the business cycle- macroeconomic instability
-economists for a long time just said that they should let the market self-correct
-in the middle of the great depression, classical economists made this same argument
-to cut a long story short, that didn't happen
-basically, now economists believe that some responsibility lies with the government to cushion the macroeconomic blows to the economy
-there are some places where the market just doesn't operate efficiently
-one is where social and private costs diverge
-environmental issues, for example
-if a firm pollutes a river, it's using and not paying for a public resource
-economists would say that if the firm pays for the cleanup costs, this rights itself
-healthcare market, for example
-if people are healthy, there are benefits beyond their own health
-if people are allowed to buy or not buy their own health care, efficiency in the system would be lower than would be optimal
-another are public goods that the market doesn't do well
-public goods mean that they are non-rival and non-excludable
-non-rival means that my use of the product has no bearing on your use of it
-non-excludable means that once put into place, it's very hard to prevent everybody from using it
-examples of this are roads, fire and police protection, knowledge of a vaccine
-a third is the fact that the market creates inequality
-there are always winners and losers
-some bill gates and some joe schmoes
-government now bails people out when there's bankruptcy, for instance
-the argument in favor of that is that when you keep these incentives in place and lower the risks (bankruptcy law), the 'pie gets bigger for everybody'
-everybody's made better off by helping the little guy, for example
-also, if the gap between winners and losers gets too wide, there is a basic concern for the stability of the system as a whole
4. Global markets
different countries behave differently around the world
-for example, europeans place more emphasis on public equity (socialized healthcare, education)
-asian countries rely much less on privately owned companies (more publicly owned companies)
in the past 20 years, though, there's a big move towards market forces as fixing public issues
-even in france, they're telling people to actually work- and the french are lazy!
globalization has allowed us to think of the world as a global marketplace
-look at the developing countries that have grown most rapidly- they're the ones who have opened their economies to the world most rapidly
-allows them to use resources MUCH more efficiently, import technology and resources
-export-led growth has propelled asian countries to prominence in the global system
globalization PROMOTES GROWTH
-sure, there are winners and losers, but everybody gets a piece of the bigger pie
-the link to health comes as an indirect one- through income, for instance
we've already seen, though, that markets aren't the only solution to economic problems
-there are issues in developing countries that require government involvement
-you need strong contract and patent law, for instance
-consumer regulations so that consumers will buy goods, workplace regulations so people will go to work
-the list goes on, there are some important public prerequisites
-we need government regulation and organizations to provide public goods, like roads or even prevention of global warming
-and there are winners and losers in any market economy
-pensions and healthcare are two really good examples of useful safety nets for the losers
but what's the alternative to the market?
-not really much to do
-the trick is to minimize the negatives while maximizing the positives
-economists are not necessarily TOTALLY free-market whores
-they look to the free market as one part of the solution, but you need mitigating solutions as well
dk
1. Economists, health, and globalization
Economists downplay the way social and cultural institutions affect behavior, etc
-academic economists look at the world more broadly than most people
-i.e. economists like markets, but they do recognize situations where markets fail to provide even efficiency, where the government needs to step in
-economists talk about globalization, and about health, but usually not together
when economists talk about globalization they mean
-increase in services, goods, etc across national boundaries
-necessitates closer international ties between nations
-look at it in different ways, eg global trade between countries, etc
-in some ways, it's like creating a global market
-why are markets so wonderful?
2. What markets are good at
markets are good at getting efficiency up
-efficiency means maximizing output per given input
-markets do this well because they use profits as their regulatory system
'each market is related to every other market'
-if televisions come under increased demand, EVERYBODY gets richer, from the TV companies to the glass company that makes the fronting for them
dynamic efficiency
-prices are not just information, they also create incentives for risk-taking and innovation
-when energy prices go up, for example, entrepreneurs are incentivized to create new, more efficient forms of energy production
-another example, under artificial price fixing by the soviet union, there was little technological innovation, they couldn't keep up on the innovation scale
there's lots of freedom in a market economy
-milton friedman
-'private ownership of resources is fundamental to the operation of a market economy'
-it also guarantees a gap between economic and political power
-despite all the caveats there (people can move back and forth between economic and political sources of power), the concentration of economic/political power is much less than in other solutions
3. Some Qualifications
what is the rationale for the government to step into the economy?
-most economists agree that for a market to operate well there must be certain regulations
-i.e. rules, regulations, LAWS that require contracts to be followed, etc
-consumer regulations to protect consumers from unsafe products
-workplace regulations to protect workers from unsafe workplaces
-another problem is basically the business cycle- macroeconomic instability
-economists for a long time just said that they should let the market self-correct
-in the middle of the great depression, classical economists made this same argument
-to cut a long story short, that didn't happen
-basically, now economists believe that some responsibility lies with the government to cushion the macroeconomic blows to the economy
-there are some places where the market just doesn't operate efficiently
-one is where social and private costs diverge
-environmental issues, for example
-if a firm pollutes a river, it's using and not paying for a public resource
-economists would say that if the firm pays for the cleanup costs, this rights itself
-healthcare market, for example
-if people are healthy, there are benefits beyond their own health
-if people are allowed to buy or not buy their own health care, efficiency in the system would be lower than would be optimal
-another are public goods that the market doesn't do well
-public goods mean that they are non-rival and non-excludable
-non-rival means that my use of the product has no bearing on your use of it
-non-excludable means that once put into place, it's very hard to prevent everybody from using it
-examples of this are roads, fire and police protection, knowledge of a vaccine
-a third is the fact that the market creates inequality
-there are always winners and losers
-some bill gates and some joe schmoes
-government now bails people out when there's bankruptcy, for instance
-the argument in favor of that is that when you keep these incentives in place and lower the risks (bankruptcy law), the 'pie gets bigger for everybody'
-everybody's made better off by helping the little guy, for example
-also, if the gap between winners and losers gets too wide, there is a basic concern for the stability of the system as a whole
4. Global markets
different countries behave differently around the world
-for example, europeans place more emphasis on public equity (socialized healthcare, education)
-asian countries rely much less on privately owned companies (more publicly owned companies)
in the past 20 years, though, there's a big move towards market forces as fixing public issues
-even in france, they're telling people to actually work- and the french are lazy!
globalization has allowed us to think of the world as a global marketplace
-look at the developing countries that have grown most rapidly- they're the ones who have opened their economies to the world most rapidly
-allows them to use resources MUCH more efficiently, import technology and resources
-export-led growth has propelled asian countries to prominence in the global system
globalization PROMOTES GROWTH
-sure, there are winners and losers, but everybody gets a piece of the bigger pie
-the link to health comes as an indirect one- through income, for instance
we've already seen, though, that markets aren't the only solution to economic problems
-there are issues in developing countries that require government involvement
-you need strong contract and patent law, for instance
-consumer regulations so that consumers will buy goods, workplace regulations so people will go to work
-the list goes on, there are some important public prerequisites
-we need government regulation and organizations to provide public goods, like roads or even prevention of global warming
-and there are winners and losers in any market economy
-pensions and healthcare are two really good examples of useful safety nets for the losers
but what's the alternative to the market?
-not really much to do
-the trick is to minimize the negatives while maximizing the positives
-economists are not necessarily TOTALLY free-market whores
-they look to the free market as one part of the solution, but you need mitigating solutions as well
dk
GPH NOTES 9-19
The World Bank Under Siege
I. 1994: The Celebration
1994 was the 50 year anniversary of the World Bank
-at the 25th year, they published the history of the bank thus far
-they decided to publish another 'scholarly account' of the world bank thus far
-2 volumes that are both huge
-1 volume on 'history' and one on 'something perspectives' -basically what's left over
-done by the Brookings Institution
-hahahahaha, the 2 volumes were released three years late
II. The Attack from the Left
the WHO (world health organization) was a UN organization that was formed to provide the world a new international health authority
-objective- 'to turn society away from the science of destruction to life-saving science'
-one thing they did was attempt to eradicate malaria
-they thought they could do this using DDT
-the guy who invented DDT won a Nobel Prize for it
-the WHO was not in washington, but in Geneva, to emphasize their non-affiliated orientation
-they started spraying DDT everywhere
-they started a program of standardization, because they didn't want to allow for resistance to form
-the idea was to kill all the mosquito vectors so the disease would just die out
-there was already evidence that DDT was a bit dangerous...
-killed birds, fish, helpful insects...
-these problems were ignored
-problems started to form in the 1960s
-when spraying worked, the gov'ts started cutting back on spending, perceiving that the crisis was over
-this is baaaad
-when DDT proved to be dangerous to the people they tried to protect, there were serious problems as well
Unfortunately, the World Bank ignored the problems with the Malaria Eradication Program and pushed ahead with its own shit
-MacNamara himself said that tension between development and the environment was 'not as serious as some would maintain'
-just forged ahead
-the solutions to these problems were: research, high-powered, precise analysis, and decisive day-to-day action
-environmental watchdogs in the bank set guidelines for construction and new projects
-unfortunately, the watchdogs were pretty much marginalized
-MacNamara wanted the money moved out the door NOW, not after it met some environmental standards
-as soon as MacNamara leaves, the World Bank comes under assault by environmental groups as an agent of globalization and capitalism
-this was especially true as the Bank failed to deal with the food crisis of the 1970s and the debt crisis that followed it
The Bank is under attack by the left here for failing with these crises
III. The Attack from the Right
Reagan was elected in 1980, which indicated a swing towards the right in American Politics
-a swing towards the use of market forces, rather than international regulatory agencies, to spur development
-conservatives rejected population control (one of MacNamara's programs)
-conservatives rejected the Bank's emphasis on PUBLIC rather than PRIVATE investment
-conservatives rejected the Bank's lack of transparency (where's the money going? how much goes to Swiss bank accounts?)
-basically, the Bank's form of international liberalism was under assault by the Right
-under attack on both ideological and practical grounds
The Bank wasn't the only organization under attack
-the UN and the IMF were both under withering assault
-the entire international development structure was under attack (even the WHO)
-this was not just a national movement in the United States, the UK had swung sharply to the right even sooner than the US
-basically, the whole world was shifting towards market forces rather than government enterprises
-fall of soviet communism symbolizes this
IV. The Counter-Attack
The Bank didn't just sit there and take it or quit, it counterattacks
How?
-starts to compromise
-changes policy a little bit
-shifts money to the private sector
-starts to buy stocks and bonds in private companies to spur growth (international finance corporation- IFC)
-if the money isn't used well, the companies will just go bankrupt, the market will provide ultimate accountability
-they compromise even more on the environmental front
-these means delay or cancellation of large projects that displace large amounts of people
-whereas these massive programs were implemented without question in the 60s and 70s, in the 80s and 90s, they're looked at with more scrutiny
-they start "talking to people" more
-more conferences with people who disagree, actually listen to suggestions
-this was extremely difficult for the Bank, but they were trying
-at the same time, the Bank begins putting forward a more aggressive approach to the media
-they start pumping money into media campaigns
-started putting out more information about their successes
-emphasizes things like the eradication of river blindness
-they saved over 600,000 people from blindness for only 58 cents/pill
-wow
-unfortunately, this publicity pulls the Bank towards these sorts of public health programs and away from the old infrastructure programs
-in the past, Bank programs were BANK PROGRAMS
-now, the Bank had to cooperate with other NGOs
-now, the engineers and lawyers and accountants and economists had NO expertise in this area
-they need people with public health and development expertise
-they begin to form relationships with institutions that had ties to global public health
-the Bank becomes heavily involved in fighting TB in China
-they figured that the existing program wasn't working (400 MILLION people had TB... holy fucking shit)
-they started to implement a new program, with the WHO and the chinese government
-began to implement a village-based program- DOTS- direct observation of treatment something
-the current estimate is that it costs <$100 per person
-and it WORKS- reduces TB by ~35% in the populations in question
V. The Resolution
60 years later, the Bank is still struggling to solve the development program
-so is everybody else, though
what're the results?
-the institutional framework has changed very rapidly
-60 years is not long, from a historian's standpoint
-you have to think about RIGHT NOW, not 60 years from now
-there have been massive mistakes in the course of the Bank's history, but also breakthroughs
-the institutional structure that we created after WWII is still there
-they're struggling, but they're still there
-what are some alternatives to the international development structure?
-well, you could eliminate the whole structure
-the failures and costs outweigh the benefits by far
-you could improve it
-there are lots of specific ways to do that
-you could invite steve sachs? what the fuck are you talking about, big guy?
The World Bank Under Siege
I. 1994: The Celebration
1994 was the 50 year anniversary of the World Bank
-at the 25th year, they published the history of the bank thus far
-they decided to publish another 'scholarly account' of the world bank thus far
-2 volumes that are both huge
-1 volume on 'history' and one on 'something perspectives' -basically what's left over
-done by the Brookings Institution
-hahahahaha, the 2 volumes were released three years late
II. The Attack from the Left
the WHO (world health organization) was a UN organization that was formed to provide the world a new international health authority
-objective- 'to turn society away from the science of destruction to life-saving science'
-one thing they did was attempt to eradicate malaria
-they thought they could do this using DDT
-the guy who invented DDT won a Nobel Prize for it
-the WHO was not in washington, but in Geneva, to emphasize their non-affiliated orientation
-they started spraying DDT everywhere
-they started a program of standardization, because they didn't want to allow for resistance to form
-the idea was to kill all the mosquito vectors so the disease would just die out
-there was already evidence that DDT was a bit dangerous...
-killed birds, fish, helpful insects...
-these problems were ignored
-problems started to form in the 1960s
-when spraying worked, the gov'ts started cutting back on spending, perceiving that the crisis was over
-this is baaaad
-when DDT proved to be dangerous to the people they tried to protect, there were serious problems as well
Unfortunately, the World Bank ignored the problems with the Malaria Eradication Program and pushed ahead with its own shit
-MacNamara himself said that tension between development and the environment was 'not as serious as some would maintain'
-just forged ahead
-the solutions to these problems were: research, high-powered, precise analysis, and decisive day-to-day action
-environmental watchdogs in the bank set guidelines for construction and new projects
-unfortunately, the watchdogs were pretty much marginalized
-MacNamara wanted the money moved out the door NOW, not after it met some environmental standards
-as soon as MacNamara leaves, the World Bank comes under assault by environmental groups as an agent of globalization and capitalism
-this was especially true as the Bank failed to deal with the food crisis of the 1970s and the debt crisis that followed it
The Bank is under attack by the left here for failing with these crises
III. The Attack from the Right
Reagan was elected in 1980, which indicated a swing towards the right in American Politics
-a swing towards the use of market forces, rather than international regulatory agencies, to spur development
-conservatives rejected population control (one of MacNamara's programs)
-conservatives rejected the Bank's emphasis on PUBLIC rather than PRIVATE investment
-conservatives rejected the Bank's lack of transparency (where's the money going? how much goes to Swiss bank accounts?)
-basically, the Bank's form of international liberalism was under assault by the Right
-under attack on both ideological and practical grounds
The Bank wasn't the only organization under attack
-the UN and the IMF were both under withering assault
-the entire international development structure was under attack (even the WHO)
-this was not just a national movement in the United States, the UK had swung sharply to the right even sooner than the US
-basically, the whole world was shifting towards market forces rather than government enterprises
-fall of soviet communism symbolizes this
IV. The Counter-Attack
The Bank didn't just sit there and take it or quit, it counterattacks
How?
-starts to compromise
-changes policy a little bit
-shifts money to the private sector
-starts to buy stocks and bonds in private companies to spur growth (international finance corporation- IFC)
-if the money isn't used well, the companies will just go bankrupt, the market will provide ultimate accountability
-they compromise even more on the environmental front
-these means delay or cancellation of large projects that displace large amounts of people
-whereas these massive programs were implemented without question in the 60s and 70s, in the 80s and 90s, they're looked at with more scrutiny
-they start "talking to people" more
-more conferences with people who disagree, actually listen to suggestions
-this was extremely difficult for the Bank, but they were trying
-at the same time, the Bank begins putting forward a more aggressive approach to the media
-they start pumping money into media campaigns
-started putting out more information about their successes
-emphasizes things like the eradication of river blindness
-they saved over 600,000 people from blindness for only 58 cents/pill
-wow
-unfortunately, this publicity pulls the Bank towards these sorts of public health programs and away from the old infrastructure programs
-in the past, Bank programs were BANK PROGRAMS
-now, the Bank had to cooperate with other NGOs
-now, the engineers and lawyers and accountants and economists had NO expertise in this area
-they need people with public health and development expertise
-they begin to form relationships with institutions that had ties to global public health
-the Bank becomes heavily involved in fighting TB in China
-they figured that the existing program wasn't working (400 MILLION people had TB... holy fucking shit)
-they started to implement a new program, with the WHO and the chinese government
-began to implement a village-based program- DOTS- direct observation of treatment something
-the current estimate is that it costs <$100 per person
-and it WORKS- reduces TB by ~35% in the populations in question
V. The Resolution
60 years later, the Bank is still struggling to solve the development program
-so is everybody else, though
what're the results?
-the institutional framework has changed very rapidly
-60 years is not long, from a historian's standpoint
-you have to think about RIGHT NOW, not 60 years from now
-there have been massive mistakes in the course of the Bank's history, but also breakthroughs
-the institutional structure that we created after WWII is still there
-they're struggling, but they're still there
-what are some alternatives to the international development structure?
-well, you could eliminate the whole structure
-the failures and costs outweigh the benefits by far
-you could improve it
-there are lots of specific ways to do that
-you could invite steve sachs? what the fuck are you talking about, big guy?
GPH NOTES 9/17
OUTLINE
I. What is the World Bank?
-not an actual bank
-can't take a loan out from it
-loans money only to governments
-initial defined function was to loan money for reconstruction after WWII
-planners were looking backwards, to the lessons learned by WWII
-the world bank would loan money at cheaper than market rates
-where would this money come from?
-the capital of the bank
-basically the only place this money could come from was the US
-the world bank could borrow money by selling bonds
-certificates of indebtedness
-expanded its lending capacity
-special provision, however
-to get a loan, you had to be a member of the bank
-the contribution you had to make was rated according to your economic capacity
-however, your votes in the bank were determined by your capital contribution
-this means that the US has the biggest not only capital share but also voting block
-US is massively dominant in the World Bank
II. The First Incarnation
-still today, every president of the Bank has been American
-also, the Bank has a particular ideology
-"a sort of watered down liberalism"
-their mission was to change the world
-viewed men by their professions, not their personality
-bank's liberalism was watered down because it wasn't tightly focused on particular reforms, but on general change
-bank was limited to public action
-immediately there was a schism
-communist nations decided not to join
-the Bank was a capitalistic structure, not good for Commies
-bank's job was made easier by the massive success of the Marshall Plan
-again, focused on the democratic capitalist nations of the world, not on the commies
-Bank gets a little boost there
-first group of projects taken on by the Bank were easy projects- infrastructure
-easy to base estimates on, easy to invest in, easy to calculate returns on
-this necessitated massive influx of engineers into the WB
-engineers became basically the guiding force behind the bank's decision making
-once they approved a project, it was almost certain that the project would get done
-the Bank was fairly certain that all of their loans would be repaid
-this was not because of military might or anything like that, but rather because they would refuse future loans to anyone who didnt pay back
-every loan was repaid
III. The Second Incarnation
-after post-war recovery, the Bank needed something else to do
-after recovery ended, the Bank became the world's largest development bank
-basically, it's function is to pull nations out of poverty
-there wasn't much data to base shit off of, so some of the shit that got done was kinda retarded...
-for example, they looked to the Industrial Revolution for inspiration
-the British started with textile industries, so they built infrastructure and government-funded textile industries
-they thought that this would spur sustainable growth
-most of the time, this just didn't happen
IV. The Third Incarnation and the poverty problem
-the Bank then decided that it was not enough just to loan money, but also to teach
-it was difficult for poor nations to implement programs of growth because of the relatively poor human capital
-because of this, they started an economic development program that basically imported professionals to the US to teach them what they need to know to spur growth
-they created the WORLD BANK GROUP
-created an institution that would provide a thrust for private ventures
-international finance corporation (IFC)
-never really got going, because there was a cultural ideology against private and towards public growth and development
V. The Fourth Incarnation of the World Bank Group and the problems of public health
-eventually they realized that private industry and growth could be useful as well
-IFC becomes very important here
-Walt Whitman Rostow think sthat "countries need to make heavier investments in infrastructure and would have to develop at least 2 or 3 manufacturing industries in order to get productivity increases that happened during the industrial revolution"
-once the productivity increases, the takeoff starts
-once the takeoff starts, the economy will continue to be driven ahead unless something interferes with it
-Rostow has examples of this
-the big question that wasn't exactly clear in Rostow's writing was what moved nations from one stage to the other
-what convinces nations to put more money in these sectors?
-never really answered
-despite this, Rostow becomes the best-known international economist, becomes one of the best and brightest in the Kennedy administration
-WB is inspired by Rostow, takes his shit and runs with it until around 1968
-1968- Robert MacNamara becomes the president of the WB, reorients the Bank entirely (third incarnation)
-shifts it from engineering to economics
-he makes poverty, not just development, it's main concern
-he makes programs, focuses on educations as a step to sustainable growth
-public health enters the picture now
-malaria eradication
-kills the black flies that cause river blindness through spraying campaigns
-population control
-population control essentially leads to efficiency gains
from 1968 to 1981, MacNamara and his economists worked to increase the lending capacity of the bank, it worked
-from less than $1 Billion to >$13 Billion
-macnamara was tremendously successful
-refocused the bank from bricks and mortar to people
-gotten around some of the problems of corrupt governments, etc
-this brought about the fourth incarnation of the Bank
-starts in 1990
4th incarnation
-focused on a massive global public health campaign
-interesting focus on HIV/AIDS
-the Bank initially stated that the third world "could not afford antiretrovirals"
-the bank then changed its mind about the HIV stuff
-starts getting more involved in public health directly
-this CHANGES THE BANK ON A MASSIVE SCALE
-now the Bank changes its focus on general economic development or the general elimination of poverty to more focused programs
-starts directly funding HIV/AIDS research, programs, etc
-IDA becomes massively important
-this sparks huge internal struggle within the Bank
-was kind of necessary, though
-with the collapse of communism and move away from state-owned enterprise, the Bank has to change radically
-the Bank becomes more involved in private enterprise
VI. Upward! Onward!
The Bank has a litany of failures, but also of successes
-China, India were both big borrowers, the Bank can claim some credit for that
-however, it and everybody else have failed in Sub-Saharan Africa
-the Bank is still extremely controversial, but it's still pressing on
OUTLINE
I. What is the World Bank?
-not an actual bank
-can't take a loan out from it
-loans money only to governments
-initial defined function was to loan money for reconstruction after WWII
-planners were looking backwards, to the lessons learned by WWII
-the world bank would loan money at cheaper than market rates
-where would this money come from?
-the capital of the bank
-basically the only place this money could come from was the US
-the world bank could borrow money by selling bonds
-certificates of indebtedness
-expanded its lending capacity
-special provision, however
-to get a loan, you had to be a member of the bank
-the contribution you had to make was rated according to your economic capacity
-however, your votes in the bank were determined by your capital contribution
-this means that the US has the biggest not only capital share but also voting block
-US is massively dominant in the World Bank
II. The First Incarnation
-still today, every president of the Bank has been American
-also, the Bank has a particular ideology
-"a sort of watered down liberalism"
-their mission was to change the world
-viewed men by their professions, not their personality
-bank's liberalism was watered down because it wasn't tightly focused on particular reforms, but on general change
-bank was limited to public action
-immediately there was a schism
-communist nations decided not to join
-the Bank was a capitalistic structure, not good for Commies
-bank's job was made easier by the massive success of the Marshall Plan
-again, focused on the democratic capitalist nations of the world, not on the commies
-Bank gets a little boost there
-first group of projects taken on by the Bank were easy projects- infrastructure
-easy to base estimates on, easy to invest in, easy to calculate returns on
-this necessitated massive influx of engineers into the WB
-engineers became basically the guiding force behind the bank's decision making
-once they approved a project, it was almost certain that the project would get done
-the Bank was fairly certain that all of their loans would be repaid
-this was not because of military might or anything like that, but rather because they would refuse future loans to anyone who didnt pay back
-every loan was repaid
III. The Second Incarnation
-after post-war recovery, the Bank needed something else to do
-after recovery ended, the Bank became the world's largest development bank
-basically, it's function is to pull nations out of poverty
-there wasn't much data to base shit off of, so some of the shit that got done was kinda retarded...
-for example, they looked to the Industrial Revolution for inspiration
-the British started with textile industries, so they built infrastructure and government-funded textile industries
-they thought that this would spur sustainable growth
-most of the time, this just didn't happen
IV. The Third Incarnation and the poverty problem
-the Bank then decided that it was not enough just to loan money, but also to teach
-it was difficult for poor nations to implement programs of growth because of the relatively poor human capital
-because of this, they started an economic development program that basically imported professionals to the US to teach them what they need to know to spur growth
-they created the WORLD BANK GROUP
-created an institution that would provide a thrust for private ventures
-international finance corporation (IFC)
-never really got going, because there was a cultural ideology against private and towards public growth and development
V. The Fourth Incarnation of the World Bank Group and the problems of public health
-eventually they realized that private industry and growth could be useful as well
-IFC becomes very important here
-Walt Whitman Rostow think sthat "countries need to make heavier investments in infrastructure and would have to develop at least 2 or 3 manufacturing industries in order to get productivity increases that happened during the industrial revolution"
-once the productivity increases, the takeoff starts
-once the takeoff starts, the economy will continue to be driven ahead unless something interferes with it
-Rostow has examples of this
-the big question that wasn't exactly clear in Rostow's writing was what moved nations from one stage to the other
-what convinces nations to put more money in these sectors?
-never really answered
-despite this, Rostow becomes the best-known international economist, becomes one of the best and brightest in the Kennedy administration
-WB is inspired by Rostow, takes his shit and runs with it until around 1968
-1968- Robert MacNamara becomes the president of the WB, reorients the Bank entirely (third incarnation)
-shifts it from engineering to economics
-he makes poverty, not just development, it's main concern
-he makes programs, focuses on educations as a step to sustainable growth
-public health enters the picture now
-malaria eradication
-kills the black flies that cause river blindness through spraying campaigns
-population control
-population control essentially leads to efficiency gains
from 1968 to 1981, MacNamara and his economists worked to increase the lending capacity of the bank, it worked
-from less than $1 Billion to >$13 Billion
-macnamara was tremendously successful
-refocused the bank from bricks and mortar to people
-gotten around some of the problems of corrupt governments, etc
-this brought about the fourth incarnation of the Bank
-starts in 1990
4th incarnation
-focused on a massive global public health campaign
-interesting focus on HIV/AIDS
-the Bank initially stated that the third world "could not afford antiretrovirals"
-the bank then changed its mind about the HIV stuff
-starts getting more involved in public health directly
-this CHANGES THE BANK ON A MASSIVE SCALE
-now the Bank changes its focus on general economic development or the general elimination of poverty to more focused programs
-starts directly funding HIV/AIDS research, programs, etc
-IDA becomes massively important
-this sparks huge internal struggle within the Bank
-was kind of necessary, though
-with the collapse of communism and move away from state-owned enterprise, the Bank has to change radically
-the Bank becomes more involved in private enterprise
VI. Upward! Onward!
The Bank has a litany of failures, but also of successes
-China, India were both big borrowers, the Bank can claim some credit for that
-however, it and everybody else have failed in Sub-Saharan Africa
-the Bank is still extremely controversial, but it's still pressing on
GPH Notes 9/12
Who are these people we're reading the writings of?
Jeffery Sachs
-economist by profession
-seems to be pretty successful
puts emphasis on two subjects
-development as a product of the first industrial revolution
-underdevelopment as a product of the 2nd and 3rd industrial revolutions
with the advent of steam power (rather than water power, because steam power is transferable)
-you get significant increases in production AND in productivity
-productivity- the efficiency of the system, not just the output
-for the same input, you get greater output
mid 19th century-20th century- second industrial revolution
-advances in electricity, chemicals, electrochemicals, standardized assembly line production
adam smith does one of the first real analyses of economic conditions and reasons behind them
Brown's method-
-immunize kids
-not really dedicated to getting rid of poverty, fixes the symptoms
Gates' method-
-massively supportive of public health initiatives
-also not really dedicated to ending poverty, persay
-just wants to fix the symptoms (which are also really causes)
Sachs-
-end POVERTY first, the symptoms will follow
-adequate sewage systems
-waste removal
-etc
Who are these people we're reading the writings of?
Jeffery Sachs
-economist by profession
-seems to be pretty successful
puts emphasis on two subjects
-development as a product of the first industrial revolution
-underdevelopment as a product of the 2nd and 3rd industrial revolutions
with the advent of steam power (rather than water power, because steam power is transferable)
-you get significant increases in production AND in productivity
-productivity- the efficiency of the system, not just the output
-for the same input, you get greater output
mid 19th century-20th century- second industrial revolution
-advances in electricity, chemicals, electrochemicals, standardized assembly line production
adam smith does one of the first real analyses of economic conditions and reasons behind them
Brown's method-
-immunize kids
-not really dedicated to getting rid of poverty, fixes the symptoms
Gates' method-
-massively supportive of public health initiatives
-also not really dedicated to ending poverty, persay
-just wants to fix the symptoms (which are also really causes)
Sachs-
-end POVERTY first, the symptoms will follow
-adequate sewage systems
-waste removal
-etc
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