The fourth category of questions involves the physical geography and human ecology (meaning the interface of society with the physical environment). Economists are surprisingly untrained in this area, despite its fundamental importance in diagnosing and overcoming extreme poverty. What are the transport conditions in the country, on average and by subregion? How much of the population is proximate to seaports and airports, navigable rivers, paved roads, and rail services? What are the costs of transporting freight (such as fertilizers, food crops, machinery, industrial products) within the country and internationally, and how do those costs compare with competitor countries? What is the distribution of population between coastal and interior areas, rural and urban settlements, and densely and sparsely populated areas? How does population density in various parts of the country affect the costs of infrastructure, for example bringing the population into road, rail, power, and telecom grids?
How are agronomic conditions affected by the physical environment? What is the length of the growing season, and how does that affect crop choice, nutrition, and income levels? What are the patterns of soils, topography, hydrology, and land use affecting crop yields, suitability for irrigation, and costs of land improvements? How are agronomic conditions affected by interannual climate variability linked, for example, to the El Nino fluctuations? How are agronomic conditions affected by long-term trends such as global warming and changes in precipitation patterns, like the evident decline in rainfall in the African Sahel?
How are ecosystem functions changing, and perhaps degrading, over time? Is deforestation threatening the functioning of ecosystems (for example, by exacerbating flooding and land degradation) and the livelihoods of the poor (for example, by exhausting the supplies of fuel wood)? Is the loss of biodiversity threatening ecosystem functions (for example, by reducing the pollination of agricultural products)? Are invasive species affecting the fertility of the land and fisheries? Is the introduction of toxins into the environment threatening the air and drinking water?
How does the ecology affect the burden of disease and its change over time? Malaria is a disease heavily conditioned by climate and mosquito species. Is malaria transmission epidemic or endemic (year-round), and is it changing over time as a result of population move ments and climate change? What are the key patterns of animal disease that may have major effects on agricultural productivity (such as African sleeping sickness, a classic example)? What plant pests and diseases pose the gravest threats to livelihoods, international trade, and human health?
The fifth category of the differential diagnosis involves patterns of governance beyond the specifics of the budget process and detailed economic policies. History has shown that democracy is not a prerequisite for economic development. On the other hand, a regime that is despotic, arbitrary, and lawless will easily destroy an economy. Is there a rule of law, or only the arbitrary command of a dictator? Do the systems of public management—for registering businesses, trading property, defending contracts, bidding for government tenders—work effectively? Are public services such as water and sanitation, power, and basic health and education efficiently provided (given the resources at hand), or are they subject to massive waste and fraud? Is corruption rampant, and at what levels of government? Is the succession of power from one government to the next regularized, or subject to the whim and abuse of the current rulers? Are public services run on behalf of a narrow elite, a subregion of the country, or particular ethnic groups?
The sixth category of issues involves possible cultural barriers to economic development. Is the society torn apart by class, caste, ethnicity, religion, or gender inequity? Do women and girls face severe discrimination in personal rights (for example, sexual and reproductive choices) and access to public services (education, health facilities, family planning services)? Are women deprived either legally or informally of the right to own and inherit property? Can women participate with substantial equality of opportunity in the economy beyond home production? Do cultural norms and practices define limits to the economic opportunities of minority groups? Is interethnic violence rampant? What role, if any, is played by a diaspora, such as the offshore Chinese and Indian communities, in terms of investment, remittances, and social networking?
The final category of the differential diagnosis involves geopolitics, the country's security and economic relations with the rest of the world. Is the country part of a security bloc that might define or limit its economic possibilities? Is the country subject to international sanctions, and if so, what are the consequences of the sanctions for economic development? Are there critical cross-border security threats, such as refugee movements, terrorism, or cross-border warfare? Do the contiguous neighbors cooperate regarding cross-border infrastructure? Is there an effective regional trade group, and if so, is it supporting an overall expansion of trade or merely a diversion of trade from nonmembers? What trade barriers in the rich world seriously impede development prospects?
The checklist is long. Answers to these questions cannot be ascertained in a fifteen-minute checkup at a clinic, nor, in practice, can they be addressed by a single international agency like the IMF. The answers must be systematic, continually updated, and put into a comparative framework for sound analysis. Many institutions, both within the low-income countries and internationally, should cooperate to address these diagnostic issues. Not only the IMF and World Bank, but also the specialized United Nations institutions such as the World Health Organization, UNICEF, the Food and Agriculture Organization, and many others, should cooperate in the diagnostics.
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