Ideas & Debate

Nobel prize co-winner studied education, health plans in Kenya

Abhijit Banerjee, Esther Duflo
Abhijit Banerjee (left), Esther Duflo (centre) and Michael Kremer. PHOTO | NOBEL 

Compared to their rich counterparts, poor nations bear a disproportionately heavier disease burden, partly because being in the tropics, they are subject to a cocktail of factors that make their poor citizens vulnerable even to preventable and curable diseases like malaria and pneumonia.

Michael Kremer, this year's joint winner of the Nobel Prize for Economics traces the disease burden in poor countries to a wide range of factors, not least being accidents of geography, lack of sufficient resources to provide adequate health services, and, of course, dysfunctional governments.

Incidentally, he conducted some of his research in western Kenya, where he studied teacher incentives based on students’ test scores, primary school deworming and preventive health subsidy programmes.

According to the Harvard Gazette, Kremer's initial projects in Kenya came about from conversations with friends at nonprofit organisations who wanted to better understand the effectiveness of their programmes.

The awarding committe said the three were awarded the prize "for their experimental approach to alleviating global poverty".



"Despite recent dramatic improvements, one of humanity’s most urgent issues is the reduction of global poverty, in all its forms. More than 700 million people still subsist on extremely low incomes,” said the committee.

“Every year, around five million children under the age of five still die of diseases that could often have been prevented or cured with inexpensive treatments. Half of the world’s children still leave school without basic literacy and numeracy skills."

This citation goes to the very heart of the work that Kremer has done, not only to understand poverty but also to find ways in which it can be reduced.

"A disproportionate share of low-income countries are in the tropics and the high bio-diversity of the environment gives rise to more numerous — and more virulent— infectious diseases, as well as to vectors such as the African mosquitoes which spread malaria," he and his colleague, Rachel Glennerster write in their book, Strong Medicine, Creating Incentives for Pharmaceutical Research on Neglected Diseases.

They also make a self-evident, albeit poignant observation which, if unpacked and addressed through a targeted policy approach, can help nations like Kenya to ensure that their citizens live more economically empowered and healthier lives.

"Poverty leads to inadequate nutrition, sanitation and education, all of which contribute to the spread of infectious diseases," they argue.

Meaning that if policy makers could come up with programmes aimed at reducing poverty, they will solve three other problems simultaneously; they will have a population that has access to enough food that is also a balanced diet, they will have access to clean water and sanitation and they will keep their children in school longer, which will in the long run perpetuate a virtuous cycle in which every element feeds off each other.

This is something that the World Bank has pointed out in the past. Hafez Ghanem, the bank's vice-president for Africa, told the Business Daily earlier this year that the children whose parents drop out of school early are usually malnourished, underfed, stunted and more likely than not to be out of school themselves. Yet, studies conducted in Kenyan and South African schools have shown that there is a direct link between calorie intake and the ability of children to remain in school consistently. They are also more likely to enjoy better health in the long term.

Among the unique problems that African — and poor countries — face is a high incidence of infectious diseases.

"Infectious and parasitic diseases account for one-third of the disease burden in low-income countries — in fact, for over half of Africa's disease burden," write Kremer and Glennerster.

Only Africa, it appears, has this unenviable challenge, due to the twin evils of poverty and poor governance, which is in large part responsible for insufficient funding of health services in their national budgets.

That means public hospitals can, at most, offer basic health services.

"In contrast, infectious and parasitic diseases account for only 2.5 percent of disease in high-income countries," they write, quoting World Health Organisation (WHO) data.

Their data on malaria and the toll it takes each year in African countries is proof of all that is wrong in poor nations and how this tragedy leads to a human toll worse than genocide. WHO data shows that malaria kills 1.1 million people in Africa each year, a majority of them children.

Their finding on this one disease alone bears out what another Nobel Prize-winning economist, Angus Deaton, highlights in his book, The Great Escape, in which he points out that child mortality is way too high in poor countries compared to richer ones.

And even those who survive difficult and hazardous childhoods are not guaranteed either longevity or good health and adequate care when they grow old.

On all indices, including mortality and incidence of disease among the elderly, poor countries consistently perform worse than their richer counterparts.

The Harvard Gazette, reporting about Kremer's recognition by the Nobel committee, wrote that his work, and that of the other two awardees breaks down larger problems, such as deficiencies in education and child health, into component pieces, then designs targeted field experiments to determine the most effective solutions.