Economic Human Rights (40): How Do Poor People Live?

floodwater in Srinagar, Kashmir, India

(source unknown)

The poor tend to become a number, a statistic, an undifferentiated mass, especially here on this blog. Talk of the “bottom billion” and the one-dollar-a-day people only makes things worse. Of course, it’s important to know the numbers, if only to see how well we are doing in the struggle against poverty. But to actually know what we have to do, we need to know what poverty actually means to poor people. How do these people live? Which problems do they face? Who are they? None of this can be captured in numbers or statistics. Pure quantitative analysis doesn’t help. We need qualitative stories here, and these stories will necessarily differentiate between groups of people because poverty means different things to different people.

Keeping in mind the caveat that poverty is “multidimensional” and that it varies with the circumstances, is it possible to give a more or less general impression of the “lives of the poor”? There’s an interesting attempt here. Banerjee and Duflo analyzed survey data from 13 countries in order to distill a picture of the way people live on less than one dollar a day, of the choices they have and the limits and challenges they face.

The countries are Cote d’Ivoire, Guatemala, India, Indonesia, Mexico, Nicaragua, Pakistan, Panama, Papua New Guinea, Peru, South Africa, Tanzania, and Timor Leste. Obviously, the lives of the poor are very different in these different countries, and vary even for different groups within each country. Still, some general information can be extracted:

• The number of adults (i.e. those over 18) living in a family ranges from about 2.5 to about 5, with a median of about 3, which suggests a family structure where it is common for adults to live with people they are not conjugally related to (parents, siblings, uncles, cousins, etc.). When every penny counts, it helps to spread the fixed costs of living (like housing) over a larger number of people. Poverty has consequences for family structure, and vice versa.
• Poor families have more children living with them. The fact that there are a large number of children in these families does not necessarily imply high levels of fertility, as families often have multiple adult women.
• The poor of the world are very young on average. Older people tend to be richer simply because they have had more time to accumulate resources.
• Food typically represents from 56 to 78 percent of consumption expenses among rural households, and 56 to 74 percent in urban areas.
• The poor consume on average slightly less than 1400 calories a day. This is about half of what the Indian government recommends for a man with moderate activity, or a woman with heavy physical activity. As a result, health is definitely a reason for concern. Among the poor adults in Udaipur, the average “body mass index” (that is, weight in kilograms divided by the square of the height in meters) is 17.8. Sixty-five percent of poor adult men and 40 percent of adult women have a body mass index below 18.5, the standard cutoff for being underweight. Eating more would improve their BMI and their health, and yet they choose to spend relatively large amounts on entertainment. Which just shows that the poor have the same desires as anyone else and choose their priorities accordingly.

collecting water from holes in the ground, Udaipur, India

(source unknown)

• The poor see themselves as having a significant amount of choice, and choose not to exercise it in the direction of spending more on food. The typical poor household in Udaipur could spend up to 30 percent more on food than it actually does, just based on what it spends on alcohol, tobacco, and festivals. Indeed, in most of the surveys the share spent on food is about the same for the poor and the extremely poor, suggesting that the extremely poor do not feel the need to purchase more calories. This conclusion echoes an old finding in the literature on nutrition: Even the extremely poor do not seem to be as hungry for additional calories as one might expect.
• Tap water and electricity are extremely rare among the poor.
• Many poor households have multiple occupations. They may operate their own one-man business, sometimes more than one, but do so with almost no productive assets. They also have jobs as laborers, often in agriculture. And they cultivate a piece of land they own. Yet, agriculture is not the mainstay of most of these households. Where do they find non-agricultural work? They migrate. The businesses they operate are very small, lacking economies of scale and without employment opportunities for people outside the family. That’s a vicious circle because it means that few people can find a job and are forced to start petty businesses themselves. This circle makes economies of scale very difficult.
• The poor tend not to become too specialized, which has its costs. As short-term migrants, they have little chance of learning their jobs better, ending up in a job that suits their specific talents or being promoted. Even the non-agricultural businesses that the poor operate typically require relatively little specific skills. The reason for this lack of specialization is probably risk spreading. If the weather is bad and crop yields are low, people can move to another occupation.
• The poor don’t save a lot, unsurprisingly. Some of it has to do with inadequate access to credit and insurance markets. Banks and insurers are unwilling to give access to the poor and saving at home is hard to do; it’s unsafe and the presence of money at home increases the temptation to spend (that’s true for all of us by the way).
• In 12 of the 13 countries in the sample, with the exception of Cote d’Ivoire, at least 50 percent of both boys and girls aged 7 to 12 in extremely poor households are in school. Schooling doesn’t take a large bite from the family budget of the poor because children in poor households typically attend public schools or other schools that do not charge a fee.

Related Articles

• Victorian poor records go online (bbc.co.uk)
• What about the pursuit of happiness? | Mukoma Wa Ngugi (guardian.co.uk)

Human Rights Nonsense (23): Abortion = Anti-Black Genocide

In this photo made Thursday, Feb. 11, 2010, an anti-abortion billboard is shown in Atlanta. The eyebrow-raising ads featuring a young black child are an effort by the anti-abortion movement to use race to rally support within the black community. The reaction from black leaders has been mixed, but the "Too Many Aborted" campaign, which so far is unique to only Georgia, is drawing support from other anti-abortion groups across the country. (AP Photo/John Bazemore)

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Pro-life activists have propagated the narrative that the relatively free abortion rules in the U.S. are somehow a conspiracy to eliminate African-Americans. The organization that funded the billboard depicted above states that after the civil rights era, racists went “underground,” and that today “abortion is the tool they use to stealthily target blacks for extermination”; ” the black community is being targeted by abortionists for the purpose of ethnic cleansing” etc. (source).

In the U.S., black women do in fact have more abortions, but it’s a mighty leap to suggest that this should be explained by a genocidal conspiracy. And even if we would agree that there is a conspiracy at work, it’s an awfully unsuccessful one: fertility rates among black women remain higher than the national average and have inched up in recent years (source).

One piece of “evidence” for the conspiracy thesis is the location of abortion clinics: most are supposedly strategically located in black neighborhoods. However, that claim is incorrect.

It’s odd that those who are alleging racism are the ones being racist here: the conspiracy theory only holds if black women are either callous about their unborn children, or malleable tools in the hands of racist and coercive abortion doctors.

Also odd is the fact that most pro-lifers don’t seem all that worried about other, perhaps more real threats to black children – gun violence, incarceration rates and poverty – or about the general effects of racism on life prospects. If you want to worry about discrimination, racism or genocide, there’s lots of other places where you’ll have no difficulty finding it. And if you want to worry about abortion, maybe it’s good to focus on contraception, sex education, poverty and family stability instead of leaping to the most extreme and unlikely explanations. But perhaps you’re not interested in what you want to explain and only in how you explain it.

By the way, there’s a related and far more serious problem: sex-selective abortion, rather than race selective. But not in the US, fortunately. If you’re looking for the real abortion scandal, there you have it.

More on abortion. More human rights nonsense.

(image source)

Related Articles

• What A Horrible Doctor Can Teach Us About Abortion In America [Roe Vs. World] (jezebel.com)
• Anti-abortion push gains momentum (politico.com)
• Abortion foes upbeat; see chance for tougher curbs (sfgate.com)

The Causes of Poverty (36): Overpopulation (Because the Extent of Wrongness in Overpopulation Discourse is an Infinite Number)

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I never cease to be amazed by the persistence of overpopulation discourse in the face of irrefutable counter-evidence. The coming explosion of the population bomb is predicted time and again, with the same accuracy as the Christian Apocalypse. The spectacular failure of Paul Ehrlich‘s predictions in 1968, for example, seems to have had the same dissuasive effect on overpopulation discourse as Obama’s birth certificate on a large part of the Republican Party. Look at some of these statements:

Paul Ehrlich

The battle to feed all of humanity is over. In the 1970s and 1980s hundreds of millions of people will starve to death in spite of any crash programs embarked upon now. At this late date nothing can prevent a substantial increase in the world death rate … India couldn’t possibly feed two hundred million more people by 1980 … One general prediction can be made with confidence: the cost of feeding yourself and your family will continue to increase. There may be minor fluctuations in food prices, but the overall trend will be up … The United States would see its life expectancy drop to 42 years by 1980 because of pesticide usage, and the nation’s population would drop to 22.6 million by 1999. (source)

Most of these statements are regularly repeated in some form or other, even today. Now, confront this with the following basic facts:

When Paul Ehrlich wrote his famous book ["The Population Bomb"], women were having an average around the world of five or six children; now they’re having an average of 2.6. Fertility rates around the world have halved. That’s not just true in Europe and North America; they’re way below replacement levels in most of East Asia now. Not just China but Japan, Korea, Vietnam and Burma have replacement rates of fertility or below. Around the world, fertility rates have been coming down really sharply. So the population bomb as we’ve conceived it before really isn’t there. There’s still population growth going on, but that’s going to stabilize. … birthrates are coming down fast, with Indian women, for instance, having fewer than three children on average today; and even African women have falling fertility. Fred Pearce (source)

What’s causing this population bust?

[T]hanks to advances in sanitation and medicine, women no longer need to have five or six children to make sure that two of them will live to adulthood. … Urbanization is a factor. When you’re in the countryside, your kids are an economic resource very early. They can help in the fields, they can look after the animals; there are piles of stuff they can do from the age of 4 or 5. Kids are an economic resource, which is why rural families tend to be larger. Fred Pearce (source)

More on fertility rates and overpopulation is here. Now, you could argue that even with falling fertility rates overpopulation can still be a problem. Heck, even with falling population rates you could say that there’s still overpopulation. Overpopulation is then a problem of relative population numbers rather than absolute numbers: if there are more people than the number that can be fed, then you have overpopulation. But this is also wrong: planet earth could feed a number of people that’s a lot higher than the current number.

Africa faces a food crisis, but it’s not because the continent’s population is growing faster than its potential to produce food, as vintage Malthusians such as environmental advocate Lester Brown and advocacy organizations such as Population Action International would have it. Food production in Africa is vastly less than the region’s known potential, and that is why so many millions are going hungry there. African farmers still use almost no fertilizer; only 4 percent of cropland has been improved with irrigation; and most of the continent’s cropped area is not planted with seeds improved through scientific plant breeding, so cereal yields are only a fraction of what they could be. Africa is failing to keep up with population growth not because it has exhausted its potential, but instead because too little has been invested in reaching that potential. (source, source)

Famines in general have causes that are completely unrelated to overpopulation. Read more here.

Overpopulation discourse isn’t just the proverbial barking up the wrong tree; it’s keeping company with some seriously rotten fruit. Look who else worried about overpopulation:

What was Hitler’s argument for attacking other countries? You might think he didn’t have one, but he did. His argument is frankly Malthusian: Our population is growing, and we will run out of food unless we get more land. …

The annual increase of population in Germany amounts to almost 900,000 souls. The difficulties of providing for this army of new citizens must grow from year to year and must finally lead to a catastrophe, unless ways and means are found which will forestall the danger of misery and hunger. Hitler in Mein Kampf

Hitler then reviews various policies to deal with the threat of over-population:

1. Artificial birth control. Hitler rejects this because it short-circuits natural selection. Furthermore, there is an international prisoners’ dilemma: The one country that lets its numbers rise will outnumber and militarily dominate the rest…

2. Increasing productivity via “internal colonization.” Hitler rejects this on a priori Malthusian grounds – there is no way for productivity to permanently outpace population growth:

Adolf Hitler

It is certainly true that the productivity of the soil can be increased within certain limits; but only within defined limits and not indefinitely. By increasing the productive powers of the soil it will be possible to balance the effect of a surplus birth-rate in Germany for a certain period of time, without running any danger of hunger. But we have to face the fact that the general standard of living is rising more quickly than even the birth rate. The requirements of food and clothing are becoming greater from year to year and are out of proportion to those of our ancestors of, let us say, a hundred years ago. It would, therefore, be a mistaken view that every increase in the productive powers of the soil will supply the requisite conditions for an increase in the population. Hitler in Mein Kampf

3. Acquire new territory outside of Europe. The problem with this plan, says Hitler, is that other European countries have already taken the good non-European land. So you would have to attack European countries to get the land:

In the nineteenth century it was no longer possible to acquire such colonies by peaceful means. Therefore any attempt at such a colonial expansion would have meant an enormous military struggle. Consequently it would have been more practical to undertake that military struggle for new territory in Europe rather than to wage war for the acquisition of possessions abroad. Hitler in Mein Kampf

4. Acquire new territory inside Europe. At last, a solution to the imbalance between people and land that Hitler likes! And of course, he doesn’t contemplate buying the land:

Of course people will not voluntarily make that accommodation. At this point the right of self-preservation comes into effect. And when attempts to settle the difficulty in an amicable way are rejected the clenched hand must take by force that which was refused to the open hand of friendship. If in the past our ancestors had based their political decisions on similar pacifist nonsense as our present generation does, we should not possess more than one-third of the national territory that we possess to-day and probably there would be no German nation to worry about its future in Europe. Hitler in Mein Kampf (source)

Of course, you can’t judge people by the company they keep, especially not if it’s involuntary company. One wouldn’t want to commit the error of reductio ad hitlerum or fall into the trap of Godwin’s Law. It’s not because a stupid or despicable person happens to believe something that it’s necessarily wrong and that other people should feel the need to reject their beliefs simply because they are shared by someone like Hitler (I am and will continue to be a vegetarian for instance).

However, I think it should at least worry those who talk about overpopulation that they share the same concerns with a genocidal fool who was genocidal precisely because of those concerns. Maybe there is some kind of link between those concerns and genocide. Also, it should worry them that genocidal war for Lebensraum is only the most unlikely perverse effect of concerns about overpopulation. Look for example at the effects of the one-child policy in China on gender balances (something which has been called a kind of genocide, not without reason).

Jonathan Swift

As a throwaway, a satirical quote from Jonathan Swift’s 1729 work “A Modest Proposal“, suggesting feeding the children of poor Roman Catholic families to wealthy Protestant landowners to deal with Ireland’s unsustainable population growth:

I have been assured by a very knowing American of my acquaintance in London, that a young healthy child well nursed is at a year old a most delicious, nourishing, and wholesome food, whether stewed, roasted, baked, or boiled.

More on overpopulation is here.

Religion and Human Rights (25): The Eurabia Falacy

If immigration isn’t opposed because of bogus economic reasons (“importing poverty” and unfair wage competition – see also here ) or bogus law and order reasons (the criminal immigrant stereotype), it is on the grounds of equally bogus cultural reasons. Excessive immigration is said to fundamentally change the culture of the destination region: Europe will turn into Eurabia, just like the Protestant U.S. were once believed to be on the verge of a Catholic takeover following Irish and Southern European immigration.

But even limited immigration will not save us given the supposed “high fertility rates” of immigrants:

That Muslims are grinding out babies ready to take over Europe is an outdated canard. The Eurabia authors worry about declining European fertility, but in fact the Muslim decline is much sharper. In 1970, women in Algeria and Tunisia averaged about seven children each. Now, according to the CIA World Factbook, they average fewer than 1.8. The French rate is almost exactly two. Parisian demographers Youssef Courbage and Emmanuel Todd demonstrate in their 2007 book “Le Rendez-vous des Civilisations” that after most men in a country become literate, eventually a majority of women becomes literate, and then fertility plunges. This demographic transition has now happened in most Muslim states. At last count Algerian women living in France averaged an estimated 2.57 children, or only slightly above the French rate. Moreover, the fertility rate of north African women in France has been falling since 1981. Eurabia is not a demographic prospect. …

The other problem with forecasting numbers of European Muslims in 2100 is the presumption that sixth-generation European Muslims will still be a foreign body here: Islam as a bacillus that even secular former Muslims carry around, forever dangerous. This ignores the transition affecting many nominal Muslims in France. …

Although here and there Muslims have made France a little more north African or Islamic, the influence seems to be more the other way: Muslim immigrants are being infected by Frenchness. (source)

Remember also that people in the 1960s were saying that the higher birthrates among Catholics would mean a swift “Catholic takeover” of Europe and the US:

In the United States the lower birth rate of the Anglo-Saxons has lessened their economic and political power; and the higher birth rate of Roman Catholic families suggest that by the year 2000 the Roman Catholic Church will be the dominant force in national as well as in municipal or state governments. A similar process is helping restore Catholicism in France, Switzerland, and Germany; the lands of Voltaire, Calvin, and Luther may soon return to the papal fold. (source)

Now, of course I’m not insensitive to the plight of culture. A national or regional culture is an important source of identity and wellbeing, and I believe the whole world gains when even a small culture is allowed to survive. I have an older post here lambasting the demographic aggression of China in Tibet. My point is not that immigration can never be a cultural problem, but that the size of the problem is systematically inflated, possibly as a cover for outright xenophobia. In this respect, the “problem” resembles the two other “problems” caused by immigration: more poverty and more crime.

More on immigration, islamophobia and fertility rates.

Gender Discrimination (22): Gendercide

The Economist has a front page story this week on “gendercide”, the millions of girls missing in the world, especially in India and China. Perhaps as many as 100 million girls have disappeared in the last decades because of

• selective abortions encouraged by new medical technology (ultrasounds and fertility technology)
• childhood neglect of girls (nutritional, educational neglect and neglect in health care)
• prejudice, preference for male offspring and
• population policies such as the “one child policy” in China.

I’ve written about this several times before (see here, here and here), and even called it a “boomerang human rights violation“: the skewed sex ratios that result from gendercide (in some areas of China, 130 boys are being born for every 100 girls) are coming back to haunt the men that are responsible (although many mothers probably aren’t without fault either). Because of their relative scarcity, women have found an unlikely source of power. They have a competitive advantage in the marriage market, and can demand more in marriage negotiations, or at least be more selective when choosing a mate.

Causes

In my view, the word “gendercide” is somewhat overwrought because, contrary to genocide, the word that inspired the neologism of gendercide, there’s no centralized plan to exterminate women. Femicide would be a better term since it’s obviously only one of two genders that’s targeted, but it still sounds like a government organized campaign of extermination. Gendercide is the result of a combination of causes:

• individual choices based on
• plain prejudice against girls
• cultural and legal traditions, or
• economic incentives that have been formed by historical prejudice.

Perhaps girls still need a dowry, and poor parents may find it difficult to save enough and hence prefer a boy. Or perhaps they prefer a boy because the law of their country or tribe – inspired by age-old prejudice – says that only boys can inherit land or the family business. Again, the parents may prefer a boy for this reason, not because they dislike girls. Or perhaps tradition holds that girls marry off into their husbands families, and parents simply want to be sure to have someone in their home to care for them when they are old (“raising a daughter is like watering your neighbor’s garden”, is a Hindu saying).

Consequences

The consequences of gendercide are mixed. It’s obviously horrible to the girls that are aborted or neglected to death. But, as in the “boomerang” case cited above, gendercide may ultimately empower women. However, the skewed sex ratios also spell trouble: the presence of armies of men who can’t find wives and have children (“bare branches” or “guanggun” they are called in China) may result in more sexual violence, depression, suicide, human trafficking etc. It’s estimated that in 10 years time, one in five young Chinese men won’t be able to find a bride. On the other hand, a shortage of women will encourage immigration, and immigration may help some women escape poverty, and perhaps will also result in more intercultural tolerance.

Solutions

Economic development won’t stop it. In China and India, the regions with the worst sex ratios are wealthy ones, with educated populations. Even in some population strata in the U.S. sex ratios are skewed. When people escape poverty, fertility rates drop, and when families have fewer children, the need to select for sex only becomes more important in order to realize their son preference. In poor societies with high fertility rates, families are almost destined to have a boy at some point. Female children will suffer relative neglect and may die more often and more rapidly (skewing the sex ratios), but selective abortions aren’t much of a risk: families don’t really feel the need to limit the number of children (on the contrary often, because children are a workforce), and ultrasound technology for sex determination of fetuses isn’t as readily available as in rich countries or regions. When families want few children – as they do in more developed regions – or are forced by the government to limit their number of children (as in China), they will abort female fetuses in pursuit of a son.

Ultimately, only a cultural change will help. The son preference has to die out. Education probably will help, as it always does. Ending pernicious policies such as the one child policy will also help, but then overpopulation hysterics will have to be dealt with. This policy didn’t help stop population growth anyway. Other East Asian countries reduced population pressure as much as China without brutal policies.

Old customs and discriminating laws should also be abolished. Think of the dowry system, or inheritance rights. Stigmatizing abortion, especially sex selective abortion, will also help.

More on gender discrimination, on prejudice, on India, and on China.

Gender Discrimination (18): Missing Women and Gendercide in China and India

Some more data following two earlier posts on the subject of gendercide (see here and here). The word gendercide describes the results of sex-selective abortions that take place on a massive scale in some countries, particularly India and China. These abortions have led to the “disappearance” of perhaps more than 100 million girls and women (or about 1 million a year). Evidence of this can be found in the abnormal sex-ratios in both countries:

The sex ratio at birth was only 893 female births per 1,000 male births in China and India and 885 in South Korea (as compared to 980 for Kenya and South Africa and 952 for Cambodia and Mexico). … In India, the juvenile sex ratio (often defined as the sex ratio among children aged 0-6 years) has been falling … over the last 3-4 decades – from 964 females per 1,000 males in 1971 to 927 in 2001. … In China, too, the problem has become more acute over time. A study based on a survey of over 5 million children in China found that among children born between 1985 and 1989, there were 926 female births for 1,000 male births. But, among children born between 2000 and 2004, the number had fallen to 806. Thus, in both countries, the situation appears to be worsening. (source)

The main reason for these gendercides seems to be a strong cultural preference for male offspring. This makes it difficult to do something about it. Cultures change very slowly. Outlawing sex-selective abortions and prenatal ultrasounds doesn’t seem to work very well. It has been tried in both China and India, but the sex-ratios don’t seem to improve much.

It might seem that improving literacy and schooling among women might reduce the parental preference for sons. However, here, too, the evidence is not encouraging. There is disturbing evidence from India which points to a worsening of the juvenile sex ratio with increased female education and literacy. Why the perverse effect? A possible explanation has to do with the negative effect of female literacy on fertility. Educated women tend to have fewer children than less-educated women, and, in the context of a strong son-preference culture, the lower levels of fertility lead to greater pressure on couples to have boys instead of girls. This relationship between fertility decline and lower juvenile sex ratios has also been observed in South Korea and China. (source)

The only successful counter-measures are those that tackle gender discrimination at the root. There will no longer be parental preference for male children when man and women are considered equal human beings.

It is important to recognize that one (although not the only) reason for son preference is that, historically, inheritance laws in both countries have favored sons over daughters. While both countries now do not restrict women’s access to parental property, customary practices which consider sons the natural heirs of land are still prevalent in much of rural China and India. India only recently (in 2004) removed the discriminatory provisions of earlier legislation and allowed parents to bequeath their property to their daughters.

What is needed in both countries to combat the scourge of low juvenile sex ratios is a package of interventions that includes stricter enforcement of equal inheritance laws, economic incentives for parents to have daughters and educate them, and an educational curriculum at the primary and middle school levels that highlights the importance of equal treatment of boys and girls in the family. Even with such a package, it will take years for attitudes to change and for the practice of prenatal sex selection and neglect of the girl child to end. (source)

More on gender discrimination.

Some More Population Growth Nonsense From India

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After all this, we now have the pleasure to receive the following statement:

If there is electricity in every village, then people will watch TV till late at night and then fall asleep. They won’t get a chance to produce children. When there is no electricity there is nothing else to do but produce babies. Don’t think that I am saying this in a lighter vein. I am serious. TV will have a great impact. It’s a great medium to tackle the problem … 80 per cent of population growth can be reduced through TV. Ghulam Nabi Azad, India’s Health and Family Welfare Minister. (source, via)

India – together with China – is the constant nightmare of population hysterics. India’s population has indeed trebled since independence in 1947 to about 1.2 billion, the result of an agricultural revolution which helped to end famine and extended life expectancy. Strange that a country which has seen simultaneous growth in population and welfare (see here for some poverty numbers) should be so worried about the incompatibility between the two.

The number cited by the Minister – 80% reduction of population growth – also falls under the header “non-evidence based statistics”. I guess as long as you cite a number – whatever number – you’ll be more persuasive. See here for more fun with statistics.

More on India.

The Causes of Poverty (23): Better Healthcare = More People = More Poverty?

I’ve already debunked this equation before. In short, the “argument”, if you can call it that, goes like this. Investment in better healthcare results in lower mortality rates (especially child mortality rates) and larger populations. If more people have to live from an equal amount of resources, every individual has less resources. Hence there will be more poverty.

This reasoning is typical of Malthusians and others who fret about overpopulation. They forget, however, that high mortality rates and inefficient insufficient healthcare lead to high fertility rates because people decide to have many children in order to offset the risk of mortality. Better healthcare brings down fertility rates because it reduces this risk, but also because it leads to less poverty and hence eliminates another reason to have a lot of children: extra labor force.

Read more about this here.

The Causes of Poverty (19): Does Better Healthcare Lead to More Poverty?

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This may look like a stupid – or, more kindly, counterintuitive – question. The answer is obviously “no”. At least when we focus on the level of the individual, better healthcare seems like the best way out of poverty rather than a cause of more poverty. With better health comes better education, better and more productive work, and hence less poverty. Even a society as a whole seems better off if less of its members are unhealthy. Overall productivity and wealth increase when there is less disease. Healthy people produce more, innovate more and contribute in other ways to social wealth. (See this and this post for more on the influence of health - good and bad – on wealth and income).

However, many people believe – wrongly in my view – that the question should be answered in the affirmative, especially when the topic is development aid. When a country drastically improves its healthcare system – thanks to development aid for instance – life expectancy rates will go up and child mortality rates will go down. This results in population growth which often outpaces GDP growth (for example because scarce development resources have been targeted at healthcare rather than GDP). GDP per capita will therefore decrease, which means increasing poverty levels and perhaps even famine. (See here for more on such and other worries of Malthusians).

This type of reasoning is sometimes used to justify limits on development aid in the field of healthcare. However, it’s plainly wrong. Better healthcare doesn’t lead to high population growth, and this non-existing population growth therefore cannot result in more poverty.

Now, why doesn’t better healthcare lead to population growth? With just a few exceptions, it’s the poor countries of the world that have high fertility rates, and when countries become richer, these rates drop dramatically. (See this post). Poverty leads to high fertility rates for a number of reasons (see also here), but the most important one is that people tend to have more children to offset the risk of high infant mortality rates that are typical for poor countries. See these graphs:

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This is corrobated by the folllowing graph, showing that countries with high infant mortality rates also have high population growth (contrary to intuition):

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Some other reasons why high fertility rates are correlated with poverty:

• More developed countries move away from agriculture and towards urban and industrialized economies, reducing the need for children as farmworkers.
• For the same reason, women become more active in the economy, increasing the cost (in money and time) of raising children.
• Also for the same reason, contraceptives and family planning become more common.

In this case, it seems that our initial intuitions are correct.