• Global health and development
o How did the developed countries manage their “great escapes” from high mortality rates?
How did they go through the epidemiological transition?
• Through development (both economic and political)
• Development of agriculture, industrialization, development of cities with infrastructure
What was that basis of that development?
• How did rich countries become so successful in developing?
o Exploitation of slaves, natives, etc.
What is the model of aid to poor countries that is widely (and erroneously) adopted, according to
• Rich countries start to believe if they give poor countries aid these countries will be able to
decrease their issues
• International aid = development aid
o Development of industry, business, etc.
• Food aid,
o Aid for famine, etc.
• Immunization/health aid
o Help with epidemiological transition
• Economic development aid
o Deaton states that economic development aid is assumed to work under a particular model
• Rich country gives poor country $ and social change occurs
o Why doesn’t this model work?
Because many places are simply hostile to development
Places where when you put money in, the power structure there is as such that the
money will not help with positive outcomes
This aid typically bad fires, and keeps these power structures in power (suppressive)
o How does economic aid contribute to bad government?
The $ comes in, some gets taxed through bribes, even good governments, economic
development aid had distract from what’s important
o Deaton states that aid can make governments less responsive to the populations
o $ Goes to ruling elite, and makes them care less about the populations
From Consent to democracy, versus manipulation of aid givers by autocrats
• Without outside aid, governments need to raise money from the population (through taxes),
and this is much easier to do if the population gives consent
• Deaton argues that this movement towards democracy, political development will lead into
economic development (political base and a tax base) • Autocratic rulers have not been more accountable to aid giving agencies than to their own
people, they sometimes temporarily fake reforms when aid is cut, and populations of aid
giving countries demand reinstitution of aid
o This was especially true during the cold war period
Countries manipulated others by choosing a side
o Deaton states that health aid is different than developmental aid, but still had chances for
creating bad government
o When HIV hit Africa they flooded countries with HIV medical support, people in those
country start doing HIV treatment, therefore shifting away from primary health care to
HIV treatment, so general population health dropped
What happened in Africa?
• African economic growth has been, on the whole, inversely related to amount of aid
o Increase in aid, decrease in economic growth
• Since cuts in aid that following the end of the Cold War, there has been an upsurge in not only
economic growth, but also democracy
• HIV prevention Uganda vs. Botswana
o Swidler focuses on collectives, institutions and culture
Antenatal clinic attendees (pregnant women) prevalence of HIV by year:
Uganda: 29% (1992) 11% (2001) 7% (2005)
Botswana: 18% (1992) 36% (2001) 37% (2003)
o Uganda had recently gone through a bloody civil war, Botswana had made a fairly peaceful and
prosperous transition to postcolonial selfrule
o ABC programs
o Why did these programs work in some places and not in others?
o How did these two countries differ 19922001?
• B: topdown with disempowered local actors
• U: both bottomup and top down (autonomous local councils)
Relationship to NGOs:
• B: actions mediated by slowmoving bureaucracy
• U: local councils work flexibly with NGOs (grossroots level)
• U is much poorer than B