3.A Deadly Embrace: Famine and AIDS in Southern Africa
http://medilinkz.org/Features/Articles/aug2002/FamineandAIDS3.asp

4.The Missing Link? “The Spread of HIV/AIDS in Africa through Unsafe Medical Care”.
http://medilinkz.org/Features/Articles/oct2002/MissingLinkHIVAfrica.asp

and AIDS: Population Fallout (3)

Posted on September 13th, 2004

The AIDS epidemic has regularly caught epidemiologist and public health workers on the hop. Confounding them with its severity, it?s persistence and it?s resistance to all methods of intervention. And as it stands the arsenal of weapons to tackle the epidemic is looking bare indeed. With the prospect of a vaccine looking increasingly slim, the ambitious initiative of treatment stalled, the only quivers in the bow are the same methods as those proposed 20 years ago; abstinence, protection with condoms and education are the main ones being used. Oh wait, its only abstinence and education these days, condom use having fallen out of favour.

Faced by such a cunning enemy, it requires innovation and original thinking to be able to evade the enemy and get ahead of them. In the case of AIDS this means being able to predict what the epidemic is going to do in the next decade or so, something that seems to have eluded experts till now. Something to note about the epidemic, most figures that are given out are a historical snapshot of the epidemic, influenced by factors from perhaps a decade past. In the race against the virus, it seems we are always looking back, always behind.

And yet we know that factors such as demographics play an important part in the way the epidemic behaves. Demographic shifts also occur over long periods. So one would expect that health planners would pay attention to such changes. But they are not. I know they are not, because why else would they be focusing on rural areas in the fight against AIDS? I know, I know the rural areas are where most Africans live, for now, they have access to fewer services and it is just common sense to put effort in providing services to the rural poor. But that ignores one very important point, first, if one looks at the data,
the prevalence of HIV in rural areas across Africa has been nowhere near as high as in urban areas. Another important point is the rural/urban shift of population, migration again. All the plans for creating infrastructure, better access in the rural areas will amount to naught, as people vote with their feet to the cities. They?ll be living in unplanned slums, with even worse access to health, proximity and overcrowding will exacerbate all the factors that facilitate the spread of HIV/AIDS and we?ll see a rebound epidemic in cities, even as AIDS is controlled in the rural areas.

Predictions for the Future

1. As inner city and slum populations explode, look for more dumbfounded public policy makers, more recriminations at more AIDS conferences in the future as the epidemic has a savage rebound in inner cities and slums.

2. In spite of the abundance of cheaper AIDS drugs and generic treatment now at 10 cents a day, millions are without proper access to treatment, as a result of shortsighted planning leading to severe the lack of facilities,

3. I can?t go on too much gloom and doom, but you get the general idea?

Urban Folk, Food Insecurity – Population Fall Out

Posted on September 8th, 2004

Africa is a land of farmers, Africa is a land of rural people. Correction; Africa used to be a land of farmers and rural people. Now it is increasingly becoming a land of urban folk. To be more precise, slum dwellers according to UN Habitat – about 60 per cent of the estimated one billion slum dwellers worldwide are in Africa. And all these urban folk need food. Where does the food come from? The farms of course. But Africa’s farmers have traditionally been subsistence farmers, with low crop yields, antiquated agricultural methods and at the mercy of weather and the environment. The green revolution has not yet taken off in Africa. And if you’ve been following the news on plagues of locusts, flood, drought etc, it is no wonder famine and food insecurity is so common.

Land reform and redressing wrongs of the past has been perceived as a possible solution by some. Many claims both for and against the process of land reform have been made. How often have there been stories about the poor unprotected landowner unfairly stripped of their land only to see their (hard earned or stolen) land given to hapless (urban) folk who have no implements, experience and are expected to become farmers. The commercial farmers often claim that taking their land and giving it to the people will result economic collapse and greater food insecurity and famine.

The former may possibly be true, but the latter is nonsense. These are (or were) commercial farms, they do not grow food for the local population, but generally grew commercial cops for export. Equally the process of taking the land from these farmers, and putting them in the hands of the local indigenous population will not result in increased food security, because the new land owners will also probably carry out exactly the same practices to make money, that is assuming they even remain on the land long enough to become farmers.

The attempts by land reform to redress the wrongs of the past, though noble are ultimately doomed and can only end in tears. Why? It’s all about population. Land reform while nice in principle ignores the fact that most Africans are no longer living in rural areas. People are moving to the cities, so there are fewer and fewer farmers. The few farmers that remain will be tempted to become commercial farmers, so fewer farms will be devoted to food crops. Less food, increased food insecurity, shorter cycles between devastating famines.

Predictions for the Future – without interventions

1. In the short term there will be an increase in localized food shortages (sometimes artificial), particularly in peri-urban areas (slums), influenced by not only environmental effects but also economic outcomes.

2. There will be shorter cycles between regional famines. Eventually these will coalesce into chronic regional famines (Southern Africa was / is just a taste of the future)

3. Infant mortality will increase sharply as chronic hunger increases.

4. Food will increasingly become a political tool (as if it hasn’t already)

5. Increased political and physical insecurity, with food riots a regular occurrence.

Are there any solutions?

1. Enter the GM food lobby (cue choir, hallelujah chorus, organ music) but that’s a story for another day….

2. Greater and better regional cooperation – some countries such as Uganda are potential bread baskets or countries that have surplus could help out their neighbors…

3. Proper land reform, not the political kind, but better use of the land. Give farmers the tools to use more modern agricultural methods. Better seeds, better fertilizers….

4. Better climate and environmental surveillance e.g. Famine Early Warning System Network (FEWS-NET) – http://www.cpc.ncep.noaa.gov/products/fews/africa/index.html

or the Global Information and Early Warning System – http://www.fao.org/giews/english/index.htm

Not just having the systems in place, after all they have been around for a while, but actually making the relevant information available to the right people in a timely manner.

Brain Drain or Brain Trade? Population Explosion Fall Out Effects (1)

Posted on September 3rd, 2004

The Brain Drain has been a hotly debated topic off and on for the past few years and is one of the more visible manifestations of the population explosion. How is the brain drain connected you ask? Through population migration, economics and a host of other factors. The brain drain is characterized by migration of brains (not necessarily nerds) from south (developing countries) to north (developed countries).

The brain drain is not a new phenomena, but it has assumed greater significance in recent times as the population explosion has fizzled out like a damp squib in developed countries. Faced with the prospect of a rapidly growing population of seniors who’ll need nurses, doctors and such to take care of them in the future, and a shrinking labour market, where do you think the developed countries will get a new supply of able, young bodies? You guessed it, the developing south. But they don’t just want anybody, they want the best, those who will help maintain their society without costing them a cent to train. Where the brain drain is concerned there are two kinds of population migration:

Legal: as in teach them, train them, we’ll drain them. Give us the brightest and the best of best and we’ll take them for free thank you very much. We need them to keep our economies from stagnating and imploding.

Illegal (immigration) – Don’t give us your poor, tired or sick. We don’t want them. Keep them. We have our own huddled masses.

But the developing nations showing a distinct lack of gratitude at the debt the West is imposing on them are insisting that the West cough up for all those brains they are taking. In effect converting the brain drain to a brain trade. But a leopard will never change it’s spots, so why pay for something you can get for free? Despite the noises coming from the West of making restitution to the developed countries, and setting up legal channels for accessing this labour pool, they are siphoning them off by other means, third parties entities, offering placements, setting up training institutions where the first part takes place in the home country, and the last part of the training ends in the host (developed country). The nearest parallel is another form of intellectual transactions, illegal and legal file sharing.

It will only get worse. Can only get worse as western populations shrink more and more, they’ll look to developing countries more and more for their future labour market, as the debate on how to stem the tide increases.

So third world public policy planners beware or be aware – those capacity building plans, institutions you are planning, know that you are also building them for the west. If you got the money as AID. It’s definitely got to be paid back somehow! Whatever budget plans you made double them.

Predictions for the next 10 to 50 years – the development of the brain trade

• There will be a huge increase in the Brain Trade mediated by “legitimate”recruitment agencies for not only traditional professional roles such as nurses, doctors, educators, but also other positions, such as skilled factory workers from third world countries to the developed countries. It will become a lucrative trade.

• Immigration policies will be changed as they often have in the past (most noticeably H1 Visas in the US for skilled it workers) to enable skilled workers from abroad to emigrate more easily from developing countries to developed countries.

• Free education zones created supposedly to build capacity, but in reality solely to churn out new talent for developed countries. Called free, because for those lucky (bright) enough to get in, it will be free.

A long shot this, but as the gap in labour increases, the developed world will go directly to the source for their labour. Under the guise of helping the developing world build capacity, they’ll create free education zones, much like free enterprise zones with all kinds of incentives and inducements to get new students signed up, including the possibility of traveling and living abroad.

They’ll have first pick of the best students, and be able to cream off the best of the crop. This will prove wildly popular with everyone in the country concerned, because the government will get their cut, it will prove popular with the citizens because they’ll have a chance to send their children to the best schools and very popular with the students themselves. An apparent win, win for everyone. Maybe not such a longshot…….

• A whole new branch of employment in the developing world will spring up of talent scouts, agents, looking for brains to trade. Some legitimate, many not, promising all sorts of financial rewards. Sporting recruitment agents will be well placed to reap the windfall. Look for the development of a whole slew of bogus intelligence tests, aptitude tests…….

• Transfer fees – a real long shot, but as the population explosion or should I say population fizzle widens, brains will become more scarce. Soon we’ll see an active transfer market, with sports agents taking the lead, in trading the best brains to countries and areas where there are shortages in particular fields. The more acute the shortage, the more the player, sorry brain is worth…..

Population Explosion; Fall Out Effects

Posted on September 1st, 2004

In most countries the population bomb detonated many decades ago and what we are now seeing are the fall out effects. The bomb didn’t go off at the same time everywhere, so there’ll be a lag time before the fallout effects are felt in these later areas. In some regions such as Africa even now there are secondary smaller explosions some of which are just as intense as the original explosion. Making predictions about how just the fallout will manifest is not easy to say the least. Especially in the light of how wide of the mark (wrong) previous predictions have been. It would take a brave person to venture down this path. I’m just that person.

Over the next few weeks, I’ll be discussing my predictions about how fall out from the population bomb will affect health and health systems in Africa. Why do this, I hear you ask. Well, Public health believe it or not includes planning services for future populations. One needs to having an inkling of what the future holds, so bear with me as I gaze into my crystal ball……..