Post on 20-Dec-2015
Poverty Trap Formed by the Ecology of Infectious Disease
Matthew H. Bonds, Pejman Rohani, Donald Keenan, Jeffrey Sachs
The François-Xavier Bagnoud Center for Health and Human Rights
Harvard School of Public Health
Partners in Health
Under revision, Proc. Roy. Soc. B
Three Paradigms of Global Health
1. Health as a human right2. Public health as a public good3. Public health as economic development
Three Paradigms of Global Health
1. Health as a human right2. Public health as a public good3. Public health as economic development
Per capita Income
Public Health as Economic Development
Per capita Income
Malaria
Public Health as Economic Development
HIV
Per capita Income
Public Health as Economic Development
Hookworm
Per capita Income
Public Health as Economic Development
Explaining the Global Distribution of Wealth and Poverty
010
000
2000
030
000
4000
050
000
Per
Ca
pita
Inco
me
0 .2 .4 .6Disease Burden (Dalys)
Public Health as Economic Development
Per Capita Income Across Temperature
GEOGRAPHY MATTERSPublic Health as Economic Development
Income
Per Capita Income Across Latitudes
020
4060
lata
bs
0 10000 20000 30000 40000 50000GDP PC, USD
GEOGRAPHY MATTERSPublic Health as Economic Development
Income
Infectious Disease Burden Across Temperature
Burden of Infectious Diseases
Public Health as Economic DevelopmentGEOGRAPHY MATTERS
Burden of Infectious Diseases
020
4060
Latit
ude
(A
bso
lute
Val
ue)
0 .2 .4 .6Dalys
Infectious Disease Burden Across Latitude
Burden of Infectious Diseases
Public Health as Economic DevelopmentGEOGRAPHY MATTERS
1. Income determines health- Nutrition- Sanitation and Waste Management- Access to Clean Water- Prevention, such as mosquito nets
2. Health determines income- Labor Productivity- School Attendance Rates- Longevity, Savings, and Investments- Fertility, household size
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
From Economics Literature (Sachs, 2001, 2005, Bloom and Canning, 2005):
Explaining the Global Distribution of Wealth and Poverty
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0 .2 .4 .6Disease Burden (Dalys)
Poverty Trap
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
dt
dSS
I
transmission
naturaldeath
recovery
)( IS I
disease-induceddeath
dt
dI
SI )(
IS I Iv)(
birth
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
dt
dSS
I
transmission
naturaldeath
recovery
)( IS IM )(
disease-induceddeath
dt
dI
SIMM ))()((
ISM )( IM )( IvM ))((
birth
income
Public Health as Economic Development
1. Economics Determines Distribution of Diseases
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
vM
MMI
)(
)(1)(*
2. Diseases Determine Distribution of Income
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Time spent healthy(i.e., uninfected)
IIIM )()(*
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
PovertyTrap
Economic Growth
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Longterm impacts require substantial sustained interventions
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Sensitivity Analysis
PovertyTrap
Economic Growth
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
010
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2000
030
000
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Per
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pita
Inco
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0 .2 .4 .6Disease Burden (Dalys)
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Accordingly we can estimate the following linear equations for rich and poor countries:
Disease Burden = f(Income, Temp, Rain, Disease Burden of Neighbors)
Income = f(Disease Burden, Temp, Rain, Nat Res, Landlocked, ELF)
Estimates for Rich Countries
Estimates for Poor Countries
Impact of Disease on Income
-.43*** -.51***
Income of Income on Disease
-.91* -.57**
Public Health as Economic Development
Theory of a Disease-Driven Poverty Trap
Public Health as Economic Development
Summary
The infectious disease burden is determined simultaneously by ecological and socioeconoimic processes
Nonlinear feedbacks between income and disease have the potential to form poverty traps where initial epidemiological and economic conditions can have impacts on long-term health and development of the society