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Vietnamese people today are at roughly the same economic level as Americans in the 1880s, but they have the same life expectancy as Americans had in the 1980s. In health terms, Vietnam has stolen a march of 100 years. The reason this is possible is that knowledge is borderless. True, some medical interventions, such as expensive surgery or cutting-edge cancer treatment, are beyond the pockets of all but the Vietnamese elite. But many of the things that save and extend lives — running water, antibiotics, generic medicines, timely treatment, decent medical protocols and functioning health networks — are available to any moderately well organised society.
Vietnam has done well at converting gross domestic product into health. That makes it a great example for poor countries, especially in Africa, of what decent policies can achieve even with relatively low levels of income.
In Africa, many countries have lagged behind in terms of translating reasonably fast economic growth into improved health. That is largely because of poor institutions and shoddy infrastructure, a problem exacerbated, especially in southern Africa, by an Aids epidemic that knocked health indicators back by a generation. Yet despite the lag, the trend line in Africa is obvious, if under-acknowledged: things are getting better.
The two most basic indicators of a nation’s health are life expectancy and infant mortality. In 1980, people in Ethiopia, Mali and Niger had an average life expectancy of around 45, according to figures compiled by Gapminder, a data visualisation tool. By 2015, Mali’s life expectancy had jumped to 58, Niger’s to 62 and Ethiopia’s to 64. Kenyans, Sudanese and Mauritians live to 68, 70 and 74 respectively. Other regions improved over that time too. On average, though, African countries, coming from a lower base, have begun to close the gap.
The same is true of infant mortality. In 1980, about 175 of every 1,000 children in Guinea and Mozambique, then the world’s worst performers, died before the age of five. By 2015, that had dropped to 61 and 57, still appallingly high by the standards of, say, the US at 5.6, but a distinct improvement. The best in Africa, including Kenya, Rwanda, South Africa and Tanzania, are down to about 30, almost at the level of Vietnam, at 20.
The most important conclusion from these statistics, one shared by Hans Rosling, a public health expert and co-founder of Gapminder, is that we are too pessimistic about progress in Africa.
“It’s very clear that Africa is catching up with Europe in health . . . in spite of the fact that the poorest in Africa are not moving.”
Certainly, the picture is uneven. In health terms, a bigger gap exists between Ghana and Sierra Leone than between Accra, Ghana’s capital, and most of Europe. Within countries, the picture is incredibly diverse. The health of people living in the Ethiopian capital of Addis Ababa is on a par with western levels but, in the remote Ethiopian region of Somali, infant mortality rates remain gruesomely high.
Mr Rosling’s research suggests there is an 80 per cent correlation between infant mortality and GDP per capita. Health and wealth tend to move in tandem. Once improvements in health kick in, people have fewer children, devoting more resources to each child and allowing women to escape domestic drudgery. Growth generally follows. Overall, fertility rates in Africa remain too high. But the picture is improving. The number of children per woman in Ethiopia has fallen from 7 in 1960 to 4. In Addis Ababa, it has dropped below 2, lower than London.
The feedback loop works much better if policies improve. Governments need to stop conflict and invest in schools, sanitation and basic health. Then there is the more difficult stuff, such as strengthening institutions and eradicating crony capitalism so that businesses succeed through innovation, not through knowing whose palm to grease.
This is a strong, and potentially very positive, message to African governments. The basics are moving steadily, if slowly, into alignment. With the right policies, gains in health can be consolidated, propelling further economic growth and setting Africa, at long last, on a path towards prosperity.
Sadly, the link between health and wealth is not automatic. Mr Rosling tells a story about giving a lecture in Havana. After his speech, the health minister declared, to thunderous applause, that the Swedish professor had shown that Cuba was the healthiest poor nation in the world. “On the way out,” says Mr Rosling, “a very bright, brave young statistician whispered in my ear: ‘We are not the healthiest of the poor. We are just the poorest of the healthy.’”