Dr. Ismail Shariif

The Socioeconomic Implications of AIDS in Developing Countries in general and Africa in Particular

 The morality of altruism is backed by the practicality of self-interest. Ordinary people recognize that we are ultimately An interdependent single species and human security anywhere depends on  unified global action everywhere.

                                                                        -Joshua Lederberg

History makes a strong case that surveillance of infectious diseases is a global public good (McNeil, 1976).  The Athenian plague of 430 B.C. was the first recorded transnational epidemic with the pathogen probably spread from Ethiopia through Egypt by troop movements during the Peloponnesian War, although the exact cause is debated (Zinsser, 1963).  Since the European Black Death in 1347, successive waves of plague and Cholera have been associated with international trade, the most recent being the Latin America Cholera of the 1990’s (Lederberg, 1997).  In the 17^th Century European conquest of the new world introduced new viruses to previously unexposed indigenous populations.  Measles and Small Pox devastated Native Americans, exerting a death toll that greatly exceeded any form of combat (Berlinguer, 1992).  Indeed the 1969 update of the International Health Regulations by the World Health Organizations (WHO), marked more than a century of interstate cooperation in the control of infectious diseases for mutual health protection (Cooper, 1989).  The latest addition to the infectious disease is the AIDS virus of 1980, with far reaching ramifications to global health than ever before.

In a broader perspective the control of infectious diseases can be considered a global public good.  But can the same be said for noncommunicable diseases?  Are noncommunicable diseases primarily private rather than public goods?  Or in this era of globalization, have health circumstance so changed that the customary balance between public and private health is shifting?  In other words, can global health rather than a group of transmittable diseases be considered more a public than a private good?  And if so, what are the implications for global health?  How would such thinking affect international health cooperation and global health governance?

The dividing line between public and private among these diseases is traditionally believed to be rather clear-cut.  Because of externalities, the control of communicable diseases is a public good, but treatment for noncommunicable diseases and injury is mostly private. 

  In this context perhaps the most powerful dimension of globalization is the integration of the world economy compounding the equity issues in all aspects of world community.  It is also true that the spector of globalization is mostly driven by revolutionary scientific change, technological breakthroughs present exciting opportunities for global health.  In life science, the decoding of the human genome holds enormous promise for the development of new and powerful drugs, vaccines and diagnostic tests.  Some have even projected that gene typing will enable medical treatments to be tailored to the genome characteristics of individual patients.  Similarly, the communications revolution has the power to bring health information to all along with the drugs to cure it in an equitable basis?  Information may be global public good, but its meaning and utilization likely to vary with literacy education and above all the means to use to one’s own advantage.  Because information and communication systems are also commercially driven, neither information dissemenation nor its context is likely to cater to the health needs of the disadvantaged.

  Perhaps the most positive feature of globalization has been growing normative convergence on such basic issues as human rights democracy on such basic issues as human rights democracy and public demand for transparency and accountability in health decision-making.  Health is positive – sum game:  one person’s good health does not detract from another’s.  Indeed, better health usually has positive effects on the entire population.  Through say, less disease transmission, the worldwide diffusion of information and normative convergence that preventable human suffering should not be tolerated may increasingly move the public to perceive good health shared as a basic human rights.  Good health is both an instrument as well as an expression of global solidarity reflecting ultimately the indivisibiltity of universal health of the human species.

  Before on can try to cognitively provide answers to a plethora of questions raised in the very introduction of the brief paper, it is rather relevant to see the ongoing ravages of the AIDS virus particularly plaguing the developing countries in general and the African continent in particular.

  II

In the mid 1970’s, the scientific community first became aware of an illness that was striking predominantly adults in various parts of the world.  Those affected by the disease would gradually waste away and not respond well if treated for common illnesses.  But it was not until the early 1980’s that this syndrome was identified as the Acquired Immune Deficiency Syndrome (AIDS), the final and fatal stage of infection with the human immunodeficiency virus (HIV).  Now, barely a decade later, the AIDS epidemic has reached global proportions.  The World Health Organization (WHO) estimates that in 1991, there were nine million adults and almost one million children worldwide infected with the virus, with over 80 percent of those in developing countries.  As the numbers of those infected continues to increase – with the developing world accounting for a growing share – finding a cure, or vaccine, looms as one of the greatest challenges to modern science.

  To date, most of the discussion surrounding the AIDS epidemic has focused on the devastating human toll and the serious strains that no doubt will be placed on national health care systems.  But as many developing countries – particularly the poorer economies of Sub-Saharan Africa – are already discovering, the epidemic is not solely a health issue and cannot be dealt with as such.  Rather, it threatens to alter dramatically the economic and social fabric of many societies, raising serious questions about the development process itself.  Although not the biggest killer – far more people in the developing world succumb to childhood diseases, such as respiratory ailments, diarrhea, and measles – AIDS strikes young and economically productive adults.  Moreover, given the large numbers of individuals infected with the HIV virus, AIDS may well turn out to be the even more serious problem in the years to come.  This article takes a look at the potential social and economic consequences of AIDS for developing countries, drawing on initial World Bank work in this area.