Africa And Disease

I had never been to sub-Saharan Africa before 1995. After working in every other part of the world, I felt an increasing urgency to understand the development challenges in the world's most distressed region. What I found was a crisis much more severe than I had expected, with causes quite different from what is commonly assumed. A decade of work in Africa has taught me a considerable amount about extreme poverty, the power and limits of globalization, and the indomitable strength of the human spirit in the face of adversity.

By the time I had begun to work in Africa, I was prepared to see things more clearly than I would have a few years earlier. An intensive decade of economic advising from 1985 to 1995 taught me something of the art of differential diagnosis, so I could better appreciate how Africa's development crisis reflected the interactions of history, geography, domestic policies, and geopolitics. These interactions had left Africa stuck in a poverty trap. Worse, as of the mid-1990s, Africa was careening headlong into an HIV/AIDS pandemic, one of the most ferocious disease contagions in history.


The outside world has pat answers concerning Africa's prolonged crisis. Everything comes back, again and again, to corruption and misrule. Western officials, including the countless "missions" of the IMF and World Bank to African countries, argue that Africa simply needs to be have itself better, to allow market forces to operate without interference by corrupt rulers. An American talk show host, Bill O'Reilly, reflected a common view when he recently declared that Africa "is a corrupt continent; it's a continent in chaos. We can't deliver a lot of our systems that we send there. Money is stolen. Now when you have a situation like that, where governments don't really perform consistently, where there'sjust corruption everywhere, how can you cut through that?"

Western governments enforced draconian budget policies in Africa during the 1980s and 1990s. The IMF and World Bank virtually ran the economic policies of the debt-ridden continent, recommending regimens of budgetary belt tightening known technically as structural adjustment programs. These programs had little scientific merit and produced even fewer results. By the start of the twenty-first century Africa was poorer than during the late 1960s, when the IMF and World Bank had first arrived on the African scene, with disease, population growth, and environmental degradation spiraling out of control.

When it comes to charges of bad governance, the West should be a bit more circumspect. Little surpasses the western world in the cruelty and depredations that it has long imposed on Africa. Three centuries of slave trade, from around 1500 to the early 1800s, were followed by a century of brutal colonial rule. Far from lifting Africa economically, the colonial era left Africa bereft of educated citizens and leaders, basic infrastructure, and public health facilities. The borders of the newly independent states followed the arbitrary lines of the former empires, dividing ethnic groups, ecosystems, watersheds, and resource deposits in arbitrary ways.

As soon as the colonial period ended, Africa became a pawn in the cold war. Western cold warriors, and the operatives in the CIA and counterpart agencies in Europe, opposed African leaders who preached nationalism, sought aid from the Soviet Union, or demanded better terms on Western investments in African minerals and energy deposits. In 1960, as a demonstration of Western approaches to African independence, CIA and Belgian operatives assassinated the charismatic first prime minister of the Congo, Patrice Lumumba, and installed the tyrant Mobutu Sese Seko in his stead. In the 1980s, the United States supported Jonas Savimbi in his violent insurrection against the government of Angola, on the grounds that Savimbi was an anticommunist, when in fact he was a violent and corrupt thug. The United States long backed the South African apartheid regime, and gave tacit support as that regime armed the violent Renamo insurrectionists in neighboring Mozambique. The CIA had its hand in the violent overthrow of President Kwame Nkrumah of Ghana in 1966. Indeed, almost every African political crisis—Sudan, Somalia, and a host of others—has a long history' of Western meddling among its many causes.

The one thing that the West would not do, however, was invest in long-term African economic development. The die was cast in the 1960s, when senior U.S. policy makers decided that the United States would not support a Marshall Plan type of policy for Africa, even though such an effort was precisely what was needed to build the infrastructure for long-term growth. It was not that U.S. officials rejected the diagnosis—they knew it was needed—but the political leadership was not willing to pay the price.

In April 1965, the director of the Central Intelligence Agency submitted a National Intelligence Estimate on the "Problems and Prospects in Sub-Saharan Africa." The estimate accurately concluded the following about Africa's growth prospects:

Economic growth in most areas will be very slow; indeed, setbacks are probable in a number of countries. There is a desperate shortage of virtually all kinds of technical and managerial skills; indeed, the basic institutions and staff for economic development are often inadequate or absent. Moreover, it is highly unlikely that most African countries will obtain external assistance or investment on anything approaching the scale required for sustained economic development. (Emphasis added.)

As a National Security Council staffer noted in June 1965 in briefing Mc-George Bundy, President Lyndon Johnson's special assistant for national security affairs, the president's mandate to the State Department "cautions that substantial increases in U.S. foreign assistance expenditures [to Africa] are not envisaged."

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