White Man's Burden, by William Easterly

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White Man's Burden, by William Easterly

Postby Jason Rees » Fri Feb 04, 2011 7:34 am

IJ wrote:W.M.B. was a real eye opener for me too. Made me wish the entire enterprise was reconsidered down to the last cent, and driven entirely by rewarding locally successful projects and punishing failure with defunding, not double funding. And I realized there's no switch to be thrown; a proper state and economy has to slowly evolve, and can't be dropped into place. Poverty will be around for a while.

Sobering indeed.

Hey, it's a bummer foreign aid is only like, what is it, 1% of the budget?

Now you're throwing me for a loop. We can both clearly see that a ton (probably several literal tons in physical weight) of money has been completely wasted by governmental aid agencies (or worse, used to ill effect). Why on earth would anyone have wanted our government (or any other for that matter) to pour more into this [b]Money Pit?[b]
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Postby Jason Rees » Fri Feb 04, 2011 8:00 am

Regarding the loads of U.S. dollars going towards AIDS funding on the international aid scheme:

interventions like these (prevention measures) to range from five to forty dollars, compared with the fifteen-hundred-dollar cost of prolonging the life of an AIDS patient by a year with antiretroviral treatment.

The $4.5 billion the WHO plans to spend on antiretroviral treatment for one more year of life for three million could grant between seven and sixty years of additional life for five times that many people—fifteen million.

$4.5 billion dollars for treatments that...

The average length of effectiveness of the first-line treatment in Brazil, which has a large-scale treatment program, has been only fourteen months.

For people who were going to die of AIDS anyway? Freaking insane

The big question is whether poor Africans themselves would have chosen to spend scarce funds on prolonging some lives with AIDS treatment, as opposed to saving many lives with other health interventions.

Easterly did this alot. He always brought it back to feedback from recipients as one of the few valid measures of the success or failure of any program.

Finally, there remains the risk that treatment with imperfect adherence will result in emergence of resistant strains of HIV, so that treatment itself will sow the seeds of its own downfall... Europe and North America, 20 to 40 percent of AIDS patients do not take their drugs as prescribed. Resistance will emerge if there are lapses from the correct regimen...

To scale up antiretroviral therapy for HIV without ensuring infrastructure, including trained practitioners, a safe and reliable drug delivery system, and simple but effective models for continuity of care, would be a disaster, leading to ineffective treatment and rapid development of resistance...

By now I've got this big warm and fuzzy going on over these well-meaning, head-in-the-clouds 'helpful' people that push these things. But that warm and fuzzy feeling couldn't take that last run-on sentence.

Spending money on a mostly futile attempt to save all the lives of this generation of AIDS victims will take money away from saving the lives of the next generation, perpetuating the tragedy.

Meanwhile, it's not all doom and gloom. Some foreign aid money actually does some good (again, as Ian mentioned above, with small, focused interventions, foreign aid works):

HIVSA does the little things that make a difference. It provides the drug nevirapine to block transmission of the HIV virus from mothers to newborns... To follow up, HIVSA provides infant formula to HIV-positive new mothers, since breast-feeding can also transmit the HIV virus to newborns... HIVSA provides support groups meeting in health clinics throughout Soweto to help HIV-positive mothers confront the stigma of HIV and their many other problems.

Every once in a while, like between castigating the Reagan administration for fouling up developing countries during the Cold War, Easterly throws out some observations that might tweak a few noses:

There was plenty of despotism and vicious politics before the West ever showed up. Nor is the West the only source of imperial conquest—remember, say, the Aztecs, the Muslims, and the Mongols?

Some of it deals with more modern interventions, and tries to get to the meat of how the best intentions can still lead straight to hell.

Strategic interests also dictated that international peacekeepers avoid casualties to their own forces even if this effort magnified many times the local loss of life, a situation that writer Alex de Waal labels “humanitarian impunity... The widespread Somalian rage at UN/U.S. forces in 1993, shown in the book and the movie Black Hawk Down, had a lot to do with the humanitarian impunity that had killed many civilians.
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Postby IJ » Fri Feb 04, 2011 3:16 pm

I regret that foreign aid is only 1% of the budget because that means so little can be saved by cutting it. But in truth a lot of that is for Egypt's military and Israel's fighters and stuff anyway.

As for AIDS, yeah, agree, there are some things that can more cheaply be fought. The problem is with no reigning in of HIV, disaster takes over whole nations. Whereas the diarrhea is constant / chronic (except, say, cholera in Haiti recently), the HIV is an explosion. Throwing something on that before it consumes an entire generation is not that dumb. This is especially true because of the importance of treatment to reducing infection and creating some reason to get tested (hope for the positive) which is also key to slowing things down. HIV is also the primary driver of tuberculosis, which is a real nasty problem with its own drug resistance that can bite even your rich 1st world life hard in the arse if it's not headed off, as resistance makes its way around, say, from Mexico. So before totally giving up on such projects, or declaring an African life unworthy of antiretrovirals, I would read "Mountains beyond Mountains," as a companion book and settle somewhere in the middle.

YESTERDAY I listened to a grand rounds on HIV from someone who did research before the cause was known and has watched the 30 year epidemic unfold... good things are happening in the 3rd world. Perhaps not the most cost effective, but IF done right, HIV medicine elsewhere is a good thing.
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