College of Saint Rose

Three is Key:

A Three-Part Recommendation for Holistic Aid, Development, and Intervention Practices and

Policies in Sub-Saharan Africa and Elsewhere

Wayde Dazelle

PBH 490-01

Dr. Richard Pulice

12/18/15

Three is Key 1

Introduction

This past October, the World Bank (WB) published the first of two sequential reports on

African poverty. Entitled Poverty in a Rising Africa, this report detailed the data-based

challenges facing the African continent while actively reviewing the status of monetary and

nonmonetary poverty and inequality in the region (Beegle, Christiaensen, Dabalen, and Gaddis,

Poverty in a Rising Africa). As its title implies, Poverty in a Rising Africa argues that despite the

drop in the relative prevalence of poverty in the region (share of Africans in poverty fell from 56

percent in 1990 to 43 percent in 2012), and the robust 4.5 percent average economic growth per

year, the total population living in poverty has dramatically increased due to regional population

growth (from 280 million in poverty in 1990 to 330 million in 2012) (Ibid. pp. 3-4. It appears as

though celebrations may be premature, for although the global burden of poverty has dropped

significantly (well before the Millennium Development Goals 2015 deadline), the African-

regional burden of poverty has only increased in number (United Nations, Millennium

Development Goals Report 2015 p. 4). While the world celebrates, Africa Weeps.

The report also indicates that even if the impressive 1995-2014 economic growths rates

are maintained, the world’s poor will come to be increasingly concentrated in Africa in years to

come (Beegle et al, Ibid. p.3). Nonmonetary aspects of well-being have increased dramatically,

the report contends, despite what the population statistics may lead you to believe. Between 1995

and 2012, literacy rates rose by 4 percent, life expectancy at birth rose by 6.2 years, and the

prevalence of chronic malnutrition in children under 5 dropped by 6 percent (Ibid. p. 11). The

total number of deaths resulting from politically motivated violence also noticed a 75 percent

decline from the previous metric (Ibid. p. 12). The decline in political violence notwithstanding,

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these improvements are mere pennies, water droplets lost in the bucket, not nearly enough to

quench one’s thirst.

The report also details more troubling statistics. More than two in five adults cannot read

or write, despite a statistical increase in school enrollment (Ibid.). The report states that, “Health

outcomes mirror the results for literacy: progress is happening, but outcomes remain the worst in

the world.” (Ibid.) The increases in immunization and bednet coverage seen in previous metrics

are slowing to a near halt (Ibid.). Almost two in five children are malnourished, one in eight

women are underweight, and at the opposite side of the spectrum, obesity is rising as a major

health concern (Ibid.). Rates of violence and suffering facing women and other groups

vulnerable to exploitation and abuse remain discouraging as well.

But how can this be so? How can it be the case that the growth and prosperity of the

world, and in some cases that of the region itself, fails to be indicative of the actual situations

facing the various African peoples? How can it be that despite investment, despite aid, and

despite international attempts at intervention, the region fails to secure its peoples well-being and

elevate them from poverty’s grips? Although I will not pretend to have found the answer to this

question, I do maintain that I have at least found some part of it. The answer as I understand it is

to be found in the improvement practices and policies themselves.

Throughout this paper I will maintain that the path to the remedy of poverty and its

disempowering effects is to be found in the impoverished people themselves; however, I urge

you not confuse mine with the relativist’s thesis, these two could not be any further apart. What I

will be arguing throughout this paper is that the remedy of poverty and its disempowering effects

will require an understanding of the cognitive/behavioral implications of poverty for the

impoverished individual. I purpose, backed by significant research in behavioral/organizational

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psychology and economics, that there are numerous identifiable and quantifiable psychological

and physiological implications of poverty on the individual that would impact how receptive

they are to some types of interventions. These implications must be understood, and the

understanding that results must be integrated into our attempts at providing alleviative remedy to

poverty and its burdens if we are to maximize the utility of these attempts.

Throughout this paper I will attempt to integrate the findings of this research into a

comprehensive and holistic three-level recommendation for the remedy of poverty/the securing

of well-being in sub-Saharan Africa. I will do so in three parts: the local, the national, and the

international. At the local level, I will explore the research on poverty and its implications for the

individual and apply that research to fiscal, educational, and health-based strategies for the

alleviation of that burden. Following this, I will engage state actors at the national level to

actively resist predatory international mass land acquisitions (often referred to as “land-grabs”),

as these practices have been shown to have disastrous effects on food/fiscal independence, only

adding to the burden of poverty facing impacted nations and their people. Following this I

examine and critique the World Trade Organization’s (WTO) Trade-Related Aspects of

Intellectual Property Rights (TRIPS) agreement, and the subsequent Doha Development Agenda,

as it relates to the potentially devastating implications for public health disaster response on the

part of many impoverished sub-Saharan African nations due to the content of these agreements,

further challenging the well-being of these nation’s peoples, propelling them further into the

grips of poverty.

I will conclude this paper by asserting that the successful implementation of these

recommendations and others like them will help to significantly to alleviate poverty and its

burdens. We will no longer settle for the celebration of mere pennies and water drops in a

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bucket, as we are going for something far greater than this. Something greater than what’s

already been achieved is indeed possible, provided that you listen to and understand the plights

of the impoverished, and it is exactly this that I set out to achieve.

Poverty Findings and Local Implementation

I would like to begin by discussing the research and findings of Sendhil Mullainathan and

Eldar Shafir. Mullainathan, a professor of economics at Harvard University specializing in

developmental and behavioral economics, and Shafir, the William Stewart Todd Professor of

Psychology and Public Affairs at Princeton University, attempt to combine their specialties in

order to provide a holistic understanding of poverty and its effect on the impoverished

individual. Together, they wrote a book entitled Scarcity: The New Science of Having Less and

How it Defines Our Lives detailing the fruits of their combined efforts. I would like to detail the

results of this research and it’s implications for further study and intervention on behalf of the

impoverished.

Mullainathan and Shafir argue that the study of scarcity and its impact on people is

something beyond economics, although its study surely integrates the truths of the social science.

In economics, we “use our limited means to achieve our unlimited desires” in a sort of

ubiquitous limited resource give and take (Maullainathan and Shafir, Scarcity: The New Science

of Having Less and How it Defines Our Lives p.11). Although the physical manifestation of

scarcity is often ubiquitous for the resource scarce (impoverished individual), it’s impact is often

less constant (Ibid.). This impact and the subsequent experience of scarcity may vary from time

to time and individual to individual, depending on the context (Ibid.). Scarcity may then be

understood to be having less than what we want/need, and its experience, the feeling of scarcity,

may make us unhappy, leading to dissatisfaction, struggle, and other consequences of varying

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degrees (Ibid. p. 12). Scarcity may also capture the mind of the individual, changing how we

think, “Whether it is at the level of milliseconds, hours, or days and weeks. “ (Ibid). There is a

very real change that occurs in those experiencing scarcity, a change that that may impact their

ability to elevate themselves above the scarce situation.

Mullainathan and Shafir draw a distinction between two consequentially different

responses to scarcity: the largely positive focus response, and the largely negative tunnel

response (Ibid. p. 29). When a lack of time or resources is realized we are often compelled to

focus, to settle down and work more efficiently. This is often the case in business meetings,

where according to research by organizational researcher Connie Gersick a “midcourse

correction” often occurs halfway through a largely unproductive meeting when the group realizes

that time is running out and a major jump in progress occurs (Gersick, Time and Transitions in

Work Teams: Toward a New Model of Group Development). Similarly, a study by psychologist

Jamie Kurtz found that “perceived temporal scarcity”, the realization of an imminent deadline

(graduation in this case), compelled more college students to more actively engage in college

activities, getting more out each day and the college experience as a whole. These students also

reported being happier (Kurtz, Looking to the Future to Appreciate the Present: The Benefits of

Percieved Temporal Scarcity). In good times, scarcity may compel us to work more productively

and to achieve far more. These consequentially positive scarcity responses are what

Mullainathan and Shafir refer to as “focus dividends”, and they are largely contrasted by the

overwhelmingly negative tunnel response (Ibid. p. 24).

Mullainathan and Shafir define “tunneling” as focusing “single-mindedly on managing

the scarcity at hand” (Ibid. p. 29). They provide us with an example occurring in the firefighting

community. Between 1984 and 2000, motor vehicle accidents accounted for between 20 and 25

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percent of all firefighter fatalities. In 79 percent of the cases these fatalities resulted from those

firefighters not wearing seatbelts (oftentimes truck doors will swing open when taking tight

corners, those not wearing seatbelts fall out of the struck, striking their head on the pavement,

dying). This critical misstep, contend Mullainathan and Shafir, is the direct result of tunneling,

focused solely on donning their gear and arriving at the fire scene as soon as possible, wearing a

seatbelt fails to enter their deeply tunneled focus and is thus overlooked (Ibid. p. 28). Tunneling

is a consequentially bad scarcity response. We often tunnel and focus to manage our scarcity,

often to our detriment or our benefit (Ibid. p. 35).

Mullainathan and Shafir contend that tunneling and its costs are to blame for much of the

plight resulting from poverty as well as the impoverished ‘s unreceptiveness to attempts at

remedying poverty, as it often precludes the making of “trade-offs using a careful cost-benefit

calculus” (Ibid.). This may explain farmer’s unwillingness to partake in largely subsidized

rainfall or health insurance programs. Mullainathan and Shafir state that, “To the farmer who is

struggling to find enough money for food and vital expenses this week, the threat of low rainfall

or medical expenses next season seems abstract.” (Ibid. p. 36). This illustrates their central

hypothesis, that “because the focus on scarcity is involuntary, and because it captures our

attention, it impedes our ability to focus on other things.” (Ibid. p. 41).

Mullainathan and Shafir utilize the umbrella term “bandwidth” to be the measure for “our

computational capacity, our ability to pay attention, to make good decisions, to stick with our

plans, and to resist temptations,” (Ibid. p. 42). Bandwidth can thus be thought of as being a

correlate of intelligence, test performance, impulse control, and diet success (Ibid.). Mullainathan

and Shafir contend “that by constantly drawing us back into the tunnel, scarcity taxes our

bandwidth and, as a result, inhibits our most fundamental capacities.” (Ibid.). Mullainathan and

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Shafir contend that bandwidth is made up of two broad components of mental functioning:

cognitive capacity and executive control (Ibid. p. 47).

Cognitive capacity relates to the underlying psychological mechanisms dealing with

problem solving, information retention, and logical reasoning (Ibid.). The most prominent

member of this category is “fluid intelligence”, “the ability to think and reason abstractly and

solve problems independent of any specific learning or experience.” (Ibid.). Executive control

relates to the underlying psychological mechanisms dealing with the management of cognitive

activities, these activities include planning, attention, initiating and inhibiting actions, and

controlling impulses (Ibid.). Executive control functions like a computers central processor,

determining how well we focus, shift our attention, retain things in memory, multitask, and self-

monitor (Ibid.). Each of these psychological mechanisms are rich and nuanced, and as studies

performed by Mullainathan and Shafir will show, scarcity (poverty) negatively affects both

mechanisms.

Utilizing Raven’s Progressive Matrices Test (a common and reliable component of

standard IQ tests, named after its creator, 1930’s British psychologist John Raven), Mani,

Mullainathan, Shafir, and Zhao tested the effects of scarcity on fluid intelligence in a New Jersey

Mall (Ibid. p. 49). Researchers divided study participants into two groups based on self-reported

household income, utilizing a median split (rich and poor). They then provided some participants

from both groups with a hypothetical car repair scenario that would require the commitment of

$150; participants were asked questions relating to the difficulty of the financial commitment

and how they would go about gathering the money necessary. Following this scenario, the

participants completed a series of Raven’s Matrices problems. There was no statistically

significant difference in performance between those in the rich or poor categories. They repeated

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the test with the remaining participants; however, the scenario was slightly altered, $1500

replaced $150. Following the scenario and related questions the participants completed a set of

Raven’s Matrices questions with far different results. Those in the rich group performed just as

well within either scenario; however, the poor performed significantly worse in the test applied

after the $1500 than the $150. When tests were replicated the results were largely the same

(Mani, Mullainathan, Shafir, and Zhao, Poverty Impedes Cognitive Function).

The researchers contended that the lower Raven’s Matrices results corresponded to a

difference of approximately 13 to 14 IQ points in the poor group between the two scenario’s

posttest, a rather significant change. Researchers contend, however, that this is not about the

intelligence of the rich being greater than that of the poor, rather, what they contend is that is that

the cognitive bandwidth, their total available cognitive capacity, were being used elsewhere (in

contemplating their self-reported financial woes). They do worse because their mental energies

are being depleted elsewhere, there is too much going on at the same time, and like the central

processor being slowed down by running too many applications the poor’s cognitive bandwidth

is being choked by their socioeconomic situations and the resultant internal mental processes

(Ibid.).

The researchers also conducted studies with Indian sugarcane farmers testing both

cognitive capacity and executive control. Unlike a large majority of workers who receive regular

pay, sugarcane farmers only get paid once or twice a year in a lump sum after harvest. In this

way it could be argued that at harvest time the farmer is “rich” and during the lean months after

harvest that same farmer is “poor” after their funds have been depleted. This provided an

excellent opportunity to study the implications that poverty and wealth have on the same

individual (Ibid.). Data showed that the farmers were indeed more cash-strapped pre-harvest,

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seventy-eight percent had pawned something in the month prior to harvest and ninety-nine

percent had taken out a loan; however, one month post-harvest only four percent pawned

something and only thirteen percent took out a loan (Ibid.). Researchers gave farmers Raven’s

Matrices tasks and Stroop tasks pre and post harvest. Researchers found that, unsurprisingly,

farmers performed far worse on these tests for fluid intelligence and executive control when they

were poor (pre-harvest) than when they were rich (post-harvest), much like the Mall study

indicated; however, unlike the mall study there was no artificially induced scarcity-related

thoughts or stress, the farmers own situation provided those scenarios, the farmers own stress and

financial situations choked their cognitive bandwidth, possibly leading to their decreased

performance (Ibid.). The very state of having less lead the farmers to perform less intelligently

(9-10 IQ points) and show less cognitive control (Stroop test results) (these results were detailed

on pages 49-60).

Mullainathan and Shafir argue that their research demonstrates not that the poor are so

because they have less cognitive bandwidth than their more affluent counterparts, but rather that

“all people, if they were poor, would have less bandwidth.” (Mullainathan and Shafir, p. 66). It is

a symptom of their condition. But what are the neurophysiological implications of poverty that

lend themselves to difficulties in its remedy? Are there critical neurophysiological changes that

either result from poverty or are else poverty-induced that should be understood in the

development of an effective poverty remedy? I would argue that there is at least some data that is

indicative this, but that more is needed.

One study, conducted by Hair, Hanson, Wolfe, and Pollack, demonstrates a link found by

researchers between atypical structural brain development and lower performance on

standardized tests (Hair, Hanson, Wolfe, and Pollack, Association of Child Poverty, Brain

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Development, and Academic Achievement). Utilizing magnetic resonance imaging (MRI) scans

of 389 children and adolescents ranging from 4-22, researchers analyzed the impact on child

poverty on structural neurophysiological development by cross-referencing those scans with

sociodemographic and neuroimaging data. Researchers found that regional gray matter volumes

in the brains of children below 150 percent of the federal poverty level were 3 to 4 percent below

the developmental norm (Ibid.). For those children who fell below the federal poverty level the

disparity was greater, their gray matter volume was 8-10 percent below that of the developmental

norm (Ibid.). Researchers found that on average, those from low-income households scored 4 to

7 points lower on standardized tests than their peers, and that approximately 20 percent of that

gap in test performance could be explained by developmental lags in the frontal and temporal

lobes (Ibid.) which could account for at least some of the decreased intellectual performance of

Mullainathan and Shafir’s participants. If these findings are correct, this could mean than poverty

negatively affects childhood neurodevelopment in a way that possibly precludes cognition and

future academic achievement, meaning that impoverished children are already at a significant

developmental disadvantage as a direct result of their poverty. Thus, it appears that attempts at

remedying poverty must take on as a primary goal the altering of this link and the improvement

of the situations facing children.

A recent study conducted by neuroscientists from Harvard Medical School and its

affiliate McLean Hospital appears to suggest a link between constant stress/hypersecretion of

glucocorticoids and emotional/behavioral issues. Paul Ardayfio and Kwang-Soo Kim exposed

groups of mice to both acute (24 hour) and chronic (17-18 day) durations of the stress hormone

corticosterone (Ardayfio and Kim, Axiogenic-Like Effect of Chronic Corticosterone in the Light-

Dark Emergence Task in Mice). Researchers exposed 58 mice to the stress hormone in their

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drinking water, so as to avoid confounding their results with the stress response of the mice to

injection (Ibid.). When compared to the mice having received an acute dosage, those receiving a

chronic dosage too significantly longer to emerge from a small dark compartment into a more

brightly lit open area, which is a common behavioral-indicator of anxiety in the rodents (Ibid.).

The chronic-dosage mice appeared more so fearful and less willing to explore new environments

than their acute-dosage counterparts, keeping with similar research in humans suggesting that

chronic stress rather than acute stress is more so correlated with anxiety, depression and other

behavioral/emotional issues (Ibid.).

This research may have some dramatic implications for intervention aimed at providing

remedy to poverty. Poverty may act as a chronic stressor (a consistent or near-consistent state of

affairs for the individual), if this chronic stress is linked to permanent or semi-permanent

biochemical changes in the brain (hypothalamus and amygdala) which are correlated with

anxiety, depression and other mood disorders, then there may be sufficient reason to draw a

connection between poverty and chronic mood disorders resulting from chronic stress associated

with poverty. In which case, interventions must be concerned with remedying poverty in ways

that avoid adding to ones stress load, as that will further complicate the issue. Attempts at

remedy must account for poverty-induced stress. This adds a critical neurophysiological and

biochemical component to Mullainathan and Shafir’s social-psychological account of poverty

and its impact on impoverished individuals.

Local Aid

Attempts at remedying poverty must take into account the situations of the individuals

they seek to aid. In light of the research that I have explored in this section, I believe that in

addition to securing dependable safe food and water, providing children and adults with

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mosquito nets, subsidizing health programs etc., aid attempts should also aim at improving the

situations of impoverished individuals that avoids further stress/cognitive burden to those

individuals. In this way it could be argued that local aid-providers are to be concerned with

providing secondary and tertiary prevention and treatment to poverty, focusing on lessening the

impact of poverty on those for whom it already exists in. I believe that until this is achieved, until

aid efforts actively concern themselves with the stress effect/burdens of poverty, those efforts to

remedy poverty in sub-Saharan Africa and elsewhere will come up short, continuing to produce

only pennies in gains. Below I will detail some possible ways to design for this cognitive

scarcity/poverty-induced stress. I do not claim that these ideas are in anyway exhaustive, I intend

for them only to serve as possible examples of how this might be achieved.

One way of designing for scarcity (poverty) and stress might be to develop various sorts

of income disbursement and savings schemes, Mullainathan and Shafir allude to this possibility

in their book, but do not go far enough (Mullainathan and Shafir, p. 179). If it is possible to

identify a primary income provider for farmers (for Mullainathan and Shafir’s sugarcane

farmers, this would be the sugar producing factories) that provider should be encouraged by aid-

providing NGO’s to do business with a centralized banking or microlending institution, and to

develop responsible income disbursement practices and/or savings schemes. One possibility is

for the farmer’s lump sum earnings from the harvest to be smoothed out over the course the year,

with principle deductions made prepaying for fertilizer, seed, rain insurance etc. prior to

disbursement, ensuring that those essentials are covered and the farmers are not faced with the

stress of performing accounting practices and long-term planning with regularly disbursed

incomes, something different from the norm. This would assure that the farmers don’t

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profligately spend their income in “rich” post-harvest conditions, damning them for the later pre-

harvest conditions.

Another possibility is for primary income providers or lenders to provide low-level

savings-schemes. Perhaps 1 to 3.5 percent of each regularly disbursed payment made to the

individual is automatically invested into a newly created savings account, with penalties for

withdrawals over a certain percent, discouraging automatic withdrawal on the part of those

enrolled. These two financial recommendations essentially achieve the instituting of responsible

financial practices on the part of the impoverished individual; however, there is another nuance

to the plan that would hopefully serve to further alleviate stress.

The autonomy of individuals is still deserving of respect, regardless of their

socioeconomic status, forcing them into these roles would only serve to violate their autonomy,

providing further stress. Perhaps it could be designed as an opt-out program? Perhaps

employers/income providers automatically enroll their worker/suppliers in this program, they

send out a memo of sorts at the start of the income producing season alerting their employees of

their enrollment into the program and state that in order to opt-out they must fill out the required

paperwork on site, surely this would disincentivize at least some from opting-out. By making

these responsible financial practices the default option, those enrolled are forced to exert

moderate energies to opt-out; by making those practices the default it is easier for the individual

to make the right choice. They are given a choice but are strongly discouraged from making the

wrong one. By taking this decision out of their hands considerable stresses are avoided (in the

moment having to make a choice and later in the season when they would be more likely to take

out sizable loans due to their lump-sum income running out due to post-harvest profligate

spending practices).

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Another way that NGO’s could design for scarcity (poverty) and stress would be to re-

approach how they design anti-poverty educational class schedules. Mullainathan and Shafir

contend that the rigid class model, where each class builds of the previous, is not conducive to

those experiencing high degrees of poverty-induced stress (Ibid. p. 170). It is perceivable that

events may pop up interfering with the poor’s ability to go to a class, someone is sick, work

needs to be done at home or at the farm etc., the regular and rigid time commitment is incredibly

difficult for some to make (Ibid.). Perhaps you miss one or two classes, you’ll be so far behind in

your work (and already stressed due to whatever situation necessitated your missing those

classes) that you wont understand, getting back on track will be difficult, and it’ll be next to

impossible if you were already struggling. Programs structured like this, Mullainathan and Shafir

contend, are not “fault tolerant”, they “magnify your mistakes, which were predictable, and they

essentially push(ed) you out the door.” (Ibid.).

NGO’s could redesign their education attempts to empower those whom they seek to aid.

NGO’s operating educational programs could modify their curricula and scheduling practices,

following a multi-module approach. Educators could establish multiple staggered modules a

week or so apart, each being one to two classes behind the one before it, starting at different

times proceeding in parallel with one another (Ibid. p. 171). Were the poor to miss a class for

whatever reason, they would just need to wait a week or two and they could join back in with

another module. Designing for fault-tolerance like this “allows the opportunities people receive

to match the effort they put in and the circumstances they face.” (Ibid.). This would curb the

stress resulting from missing a class and falling behind that accompanies the traditional

educational model utilized.

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Another way in which NGO’s could redesign their aid attempts to fit their clientele while

relieving stress occurs in their medical efforts. Abhijit Banerjee and Esther Duflo in a

particularly revealing chapter in their book, Poor Economics: A Radical Rethinking of the Way to

Fight Global Poverty, detail the struggles facing not only public medical facilities, but also those

who seek to utilize them (Banerjee and Duflo, Poor Economics: A Radical Rethinking of the Way

to Fight Global Poverty). A study conducted by the authors and Angus Deaton determined that

the poor in Udaipur District, India largely eschew the free public health system. The average

poor adult interviewed by the researchers saw a healthcare provider once every two months;

however, despite this high rate of contact with health professionals, the poor only utilized a free

public health center a quarter of the time, whereas they utilized private facilities over half the

time and they utilized traditional healers for the remainder (Banerjee, Deaton, and Duflo, Wealth,

Health, and Health Services in Rural Rajasthan.). Those utilizing the private facilities seemed to

have selected an option more expensive in two ways, they opted for a private, for-profit provider,

and they opted for “cure” rather than prevention (Ibid.). This is also problematic as for-profit

providers and traditional healers show varying degrees of medical training, and in some cases

none at all. A semi-recently study conducted by Das and Hammer has attempted to ascertain just

how bad the situation really is.

Das and Hammer, in their study entitled Which doctor? Combining Vignettes and Item

Response to Measure Clinical Competence, assembled a sample group of doctors representative

of the situation in India and elsewhere (Das and Hammer, Which doctor? Combining Vignettes

and Item Response to Measure Doctor Quality). Comprising this were doctors from both the

private and the public sector with varying degrees of qualification. Researchers presented

participant doctors with five health-related “vignettes”. Each vignette depicted a hypothetical

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medical scenario, a patient comes in complaining of or displaying X symptoms, participants

were instructed to respond to the various scenarios presented in each vignette, their responses

were when checked against a set of “ideal” responses, evaluated by a panel of doctors (Ibid.).

The results of this study were startling. The top 20 percent of doctors only asked half the

questions they should have, and the worst asked only 16-17 percent of the questions they should

have. According to their metric, the unqualified private doctors performed the worst, the public

doctors performed somewhere in the middle, and the qualified private doctors performed the best

(Ibid.). The patterns in their errors indicated two things: the doctors tended to under-diagnose

and overmedicate.

These results were similar to those in the health study performed by Banerjee, Deaton,

and Duflo. In their study, researchers determined that patients receive a shot in sixty-six percent

of their visits to private facilities, and a drip in twelve percent. Tests are ordered and performed

in only three percent of cases. The standard treatment for diarrhea, vomiting or fever, their most

common complaints, is to prescribe antibiotics, steroids, or both, usually delivered via injection

(Banerjee, Deaton, and Duflo, Ibid.). This summons concerns over the transmission HIV, AIDS,

and other bloodborne pathogens via unsterilized needles, as well as antibiotic resistance, which is

a significant problem facing the developing and the developed world. Furthermore, incorrect

dosage and poor compliance (often the result of stress, its easy for the poor to forget to take

medicine when their concerns are elsewhere) may explain the rise of medication resistant

malaria-causing parasites (Talisuna, Boland, and d’Alessandro, History, Dynamics, and Public

Health Importance of Malaria Parasite Resistance).

So, considering the performance of doctors on these aptitude tests, it seems to be no

wonder that patients in India lack confidence in public health-providers. Another problem

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perhaps adding to this lack of confidence in public providers is the issue of absenteeism in the

medical field. A 2002-2003 global absenteeism survey conducted by the World Bank in

Bangladesh, Ecuador, India, Indonesia, Peru, and Uganda found that, on average, the

absenteeism rate for public healthcare providers in these countries was around thirty-five percent

(and that educator absenteeism is 19 percent, this must be remedied in educational attempts at aid

as well) (Chaudhury, Hammer, Kremer, Muralidharan, and Halsey, Missing in Action, Teacher

and Health Worker Absence in developing Countries). Adding to the problem is that these

absences are often unpredictable and unnecessary, further deterring people from utilizing free

public services (especially if the need to make a long trip to get there, if you can’t count on the

doctor to be there why make the trip? The poor may be forced to make an equally bad tradeoff,

money spent for guaranteed “service” or time wasted on unreliable “service”). Banerjee and

Duflo contend that this absenteeism in the public health sector may be in-part due to public

doctors receiving salaried wages regardless of their showing up to work/properly treating

patients, whereas private doctors are only paid if they treat patients, so they are incentivized to

show up (Banerjee and Duflo, Ibid. p. 55).

If NGO’s want to increase the utilization of their free or significantly subsidized health

services on the part of the poor (If these findings are taken to stand for sub-Saharan Africa, more

research is needed, but at least in Uganda we have data as to absenteeism), they will need to

work on inspiring confidence in their services. For public health-providers, purpose mandatory

seminars and clinics to train/introduce these providers to new/standard/important medical

practices/findings. Absenteeism will also need to be corrected, perhaps NGO’s could work

together with local officials to police public clinics to make sure that doctors are fulfilling the

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duties in their contracts (although this did improve the absenteeism situation in India, it didn’t

markedly improve utilization of the service) (Ibid. p. 56)?

Another option also might be to have regular highly publicized specialized health clinic

days, perhaps once a month have maternal health/vaccination/general practice days etc. that

would utilize well trained community health workers/public doctors in a public area, like a

school or in a market that people would recognize. This way services would be known in

advance, accountable due to the publicity, and placed in an area relatively easily accessed by

most. Building confidence and accountability will serve to reduce stress on the part of the

impoverished suffering from illness. Knowing that one will not have to risk traveling a

significant distance only to find an empty clinic will surely reduce the stress experienced by an

already stressed and sick poverty-stricken individual. Having those services provided by well-

trained and educated providers will also serve to actually prevent illnesses, curb the growth of

drug resistance, and to reduce other issues related to the utilization of improperly sterilized

equipment and overmedication.

National Level

Having explored research relating to the cognitive state of those in poverty, and having

provided at least some recommendations as to how NGO’s and other state/non-state actors may

improve their attempts at remedying poverty and it’s burdens keeping at least in part with this

research, I would now like to move onto larger scale concerns. If those operating at the local

level are to be concerned with poverty’s secondary and tertiary prevention and treatment, then

those at the national and international level must be concerned with the primary prevention of

poverty, the elimination of the harmful global circumstances that lend themselves to the initiation

and the continuation of poverty. In this section and the one that follows, I would like to provide

Three is Key 19

examples of two ways in which these primary preventative goals might be realized. In this

section I would like to detail one area in which state-actors might be able to stem the tide of

poverty, by preventing predatory mass land acquisitions.

Large tracts of land numbering in the hundreds of thousands to millions of hectares have

been bought up, and will continue to be bought up, by incredibly powerful foreign multinational

corporations, foreign governments and trade partners, state-actors, and other powerful entities

seeking to control large amounts of arable land in the global southern hemisphere (Kachika,

Land Grabbing in Africa: A Review of the Impacts and the Possible Policy Responses, p. 8).

Critics often refer to this process of predatory mass land acquisition as “land-grab”. It is my

belief that this practice is incredibly harmful to many (most notably the environment, rural

communities, women, and the governments of those at-risk nations) and beneficial to few, and

that its perseverance spells disaster for global attempts at eliminating poverty.

In order to curb these harmful practices, three questions must be answered: (1). What

needs are being [better] fulfilled abroad rather than in these land-acquiring parties homelands?

(2). What is drawing these land-acquiring parties to the global south (we will focus on the

African region)? (3). How are these motivations being satisfied/received in the affected nations?

Until these three critical questions are answered, it cannot be reasonably expected that this

harmful practice will be eliminated.

The answer to the first question is broad and multi-faceted, as such I will attempt to

highlight a few of the many possible answers, and to do so will require that we understand the

situations creating the needs that are better fulfilled abroad than at home. In 2009 the European

Union (EU) passed legislation requiring 20 percent of all energy used in the EU, and 10 percent

of each member state’s transportation fuel, come from renewable sources by 2020 (Ibid. p. 18).

Three is Key 20

Especially as it concerns transport and energy production, biofuels such as palm oil and corn-

based ethanol, appear to be the most desirable sources. However, the large majority of EU

nations exist in more temperate climates lacking the flexibility of the equatorial nations in their

growing seasons, or the right climate to produce some of the crops (palm). Member nations are

being compelled by the EU to enact this change irrespective of those nations

lacking/unwillingness to augment their production capacities. Augment these EU motivated

concerns with constantly rising populations requiring more resources (food/fuel), a lack of arable

land in those fast growing developed countries, and global concerns of the state of climate

change, and the necessity of looking abroad to satisfy these needs becomes more readily

apparent.

The answer to the second question is to be found in the prices of land. When the average

price of land per. hectare in various African nations is compared to that of the United States, the

United Kingdom, and other such nations, the answer is relatively easy to see. According to the

2011 The Wealth Report given by Citi Bank, the average cost of land per. hectare in England is

approximately $22,000, in the U.S. it is $16,000, in New Zealand it is $23,000, in Argentina it is

$4-5,000, in some areas of Brazil it is upwards of $12,000, just to name a few (Shirley, Shiel,

Bailey, Cookson, Willette, Spero, and Wall, The Wealth Report). Land is an expensive

commodity; this is why it’s safer and less expensive for cities to grow vertically rather than

horizontally.

Whereas the prices are staggeringly high, the opposite can be seen in some parts of the

African region. Purchase prices in some areas can be as little as $2-3 per. acre (Jones, Wall

Street’s Africa Land Grab). A Norwegian investor was recently granted a 99-year lease on

179,000 hectares of land in South Sudan at an annual cost of just $0.07 per. hectare (Provost,

Three is Key 21

New International Land Deals Database Reveals Rush to Buy Up Africa). If one takes a moment

to perform the math, they would see that in New Zealand, for example, a single hectare of land

costs about $23,000. For that very same amount you could lease approximately 328,571.429

hectares of land for 99 years in South Sudan. It’s easy to see the financial incentive for foreign

parties to engage in land-grab in the global south.

As it relates to the third question, when analyzing the situation the analyzer must be

careful not only to examine the benefits to the foreign parties themselves, as this runs the risk of

painting those parties as being those in distress, rather than the marginalized populations most

negatively impacted by the practice. Focus should thus be shifted towards the national

governments themselves, particularly focusing in on their lack of land policy, or their

problematic land policies that aid and abet the foreign parties. A large majority of the land that is

purchased or leased in these mass-acquisitions, although formally owned by the respective

governments, is actively utilized for farming, grazing, and/or living by members of various rural

communities predating the formal governments themselves, these communities as such lack

formal land-rights/deeds. Due to this incongruity between land use and land “ownership,

governments often target marginalized rural populations with eviction policies when the money

is right (Kachika, p. 18).

Noted in Kachika’s report is that in Tanzania, State President Kiwete is on record as

having exhorted rural villagers to identify communal to be put to use by investors in “mutually

beneficial” arrangements (Ibid.) These arrangements are often far from mutually beneficial. The

benefits more typically fall in favor of the investors/government officials, leaving the losses to be

tallied by the peoples who originally “possessed” the land that is now in the possession of

foreign investors. This can be viewed as exposing undereducated and impoverished people to

Three is Key 22

insidious advances by parties whom possess far more strategic knowledge of the land’s potential

values, and the implications of the land alienation these people risk facing. These people are, in

other words, coerced and manipulated. These are pressures similarly faced in Senegal and

elsewhere, where local agriculture, forestry, and rural development services report significant

pressure to allocate associated lands/properties for biofuels production (notoriously benefitting

on the investors and government brokers themselves). Farmers in Ethiopia also report pressures

from government officials to grow castor on their fertile farmland (which could be better utilized

for food production etc.) (Ibid. p. 19). Government officials/elites may have personal stakes

(kickbacks) in the investment project as well, further compelling them to pursue

eviction/relocation etc. for the at risk populations utilizing/occupying “national” lands.

Having thus far covered some of the reasoning behind predatory mass land acquisition

practices, I would now like to delve briefly into a discussion of its costs. Although the costs

immediately impact those directly affected (marginalized populations), creating a downward

spiral towards poverty, they also impact the nations themselves and global aid organizations.

They thus are deserving of multilateral considerations.

These types of predatory mass land acquisitions displace fragile rural populations already

practicing subsistence farming. When these populations occupy communal lands predating the

governments, those governments often sell that land regardless of that fact, ignoring the needs of

these communities. The displaced are often relocated to cities, or else they are forcibly relocated

to new village sites. A 2012 Human Rights Watch report detailed that in the previous year,

70,000 indigenous peoples in the western Gambella region of Ethiopia were forcibly relocated to

new villages lacking food, farmland, healthcare, and educational facilities. These mass

relocations occurred during what would be that year’s harvest, however, because they relocated

Three is Key 23

to land unprepared for farming, never mind the harvest, endemic hunger and cases of starvation

resulted (Human Rights Watch, “Waiting Here for Death”: Displacement and “Villagization” in

Ethiopia’s Gambella Region).

Those relocated to the cities also face significant difficulties. Impoverished,

undereducated, subsistence farmers possessing a very limited, yet specialized skillset often find

no home in the unfamiliar cities. These individuals are at an obvious disadvantage in the

competitive and already taxed job markets of those cities. Couple this unfamiliarity with their

limited skillsets and it’s easy to see that these individuals suffer through a tremendous upward

battle to establish themselves and thrive, forced to compete with those already established

possessing more well-rounded skillsets in an already difficult market. Add to this preexisting

language barriers and the situation becomes even more dismal. If these individuals fail to

succeed in this new situation (and who could blame them) they tax an already taxed social

security/services network. This mass influx taxes an already taxed system, money and service

based resources are tight as it is (as they are in all cities), compounding an already existing

problem. The communities suffer, the cities suffer, and the people suffer as they are cast into a

state of perpetual poverty. Yet no one seems to care.

It is largely a myth that when foreign investors purchase or lease these large tracts of

land, that arrangement benefits the selling/leasing nation. That land serves only the purposes of

those investors and their native countries while the costs remain in the nations housing that land.

If you take large amounts of arable land from nations, displace farmers providing food in an

already taxed system and you have a recipe for disaster. A recipe for food poverty as those

countries food independence is further threatened results. Madagascar provides us with a fitting

example.

Three is Key 24

Vivienne Walt, a TIME magazine writer covered the situation in Madagascar a few years

ago. The South Korean company, Daewoo Logistics, took out a 99-year lease on some 3.2

million acres of arable land in the island nation, that amounts to nearly half of it’s arable land.

The chief reason for this mass acquisition is that land is both scarce and expensive in South

Korea. This land was utilized to promote South Korean food independence and biofuel

production. These lands were not uninhabited or underutilized, however, they were held or used

by rural impoverished farmers. To take away half of a country’s arable land and displace

populations surviving off that land decreases the possibility for food independence in that

country. The prevailing thought was that this investment would produce jobs, and despite the fact

that Madagascar would no longer be food independent, it was contended that, “jobs will help the

people of Madagascar earn money to buy their own food — even if it is imported. (Walt, The

Breadbasket of South Korea: Madagascar). This is problematic.

These companies disguise their motives operating under a veil of “mutual benefit”, when

in reality the benefits only fall on the country and those who brokered the deal. If the money and

jobs do not fall into the hands of the people of Madagascar, or if those that do are less than those

lost then the deal sounds a whole lot less promising, all it achieves is the indebtedness of the

people of Madagascar to those nations from whom the country is supposed to purchase their food

from, at a greater price. The powerful nations again colonize the global south, imposing upon

them the chains of food scarcity, poverty, and indebtedness. This is a problem that needs to be

remedied, lest it add to the already sizable burden of poverty.

Recommendations at the National Level

I will provide three brief recommendations as to ways to possibly eradicate these

predatory practices, or at least to assure that the rights of those most dramatically impacted are

Three is Key 25

respected and that informed decisions are made. My first suggestion relates to land, the law and

indigenous peoples. I believe that nations party to the various UN human rights conventions

should seek to ratify these, or else draft and ratify new human rights related treaties concerning

indigenous people and land rights. The ratification of these treaties is absolutely integral to their

success, as ratification transitions these treaties over from being customarily binding to being

legally binding on the part of the state. This makes possible the identification of the state to

operate as duty-bearers, and when they fail to fulfill this role, the impoverished and the

indigenous may appeal to the global governance forums of discussion (the U.N./other regional

governance bodies) to remedy this violation of international law.

An obvious concern here would be that the impoverished often lack the funds necessary

to contract a lawyer or legal team to their aid. As such, I recommend the creation of no cost,

publically funded legal advisory committees performing pro-bono work on the part of those

peoples making rights violation claims. In this capacity, lawyers fulfill their proper role as public

servants. As members of historically manipulated and extorted populations, the needs of

indigenous and impoverished peoples cannot be ignored.

My second recommendation relates to governments and their interactions with foreign

investors and indigenous populations. There is an obvious financial incentive for these land

deals. In our analyses we cannot afford to be misled, these nations (foreign investors) are not

barren, they do not lack farmland, there is just more incentive seek land abroad as there are more

profits and fewer costs. Land policy in the nations hosting the land in question is in large part to

blame. Yes, there need to be guidelines established and laws drafted to prevent foreign

companies from exacting such great harms upon the communities/rural populations affected;

however, we cannot allow ourselves to falsely paint host countries as innocent victims, to a

Three is Key 26

certain extent, the buck stops with the seller. To charge so little for land that is so important to

the economically disadvantaged, to indigenous populations, is absolutely despicable, and to do

so for so little in return (pennies) is both foolish and offensive. The governments in the affected

African nations cannot allow their land to be sold for so little in return; this is what, in large part,

is creating the incentive for foreign investors, the countries are practically giving this land away.

Governments should be more resistant to pressures from foreign land investors as this is

land they will not get without paying a higher price, a price that their actions indicate is clearly

too high. Those nations and their people pay the environmental, the fiscal, and the social costs of

these transactions. Governments need to be encouraged to think more long-term, they should

focus more so on acquiring and retaining food-sovereignty which has much greater long-term

returns that the short-term, one-off, payment for that land provides. And in those cases where the

government does decide to displace indigenous populations, or rural communities (although, as a

rule, this should be avoided), long-term commitments to those populations following this

displacement must be maintained. A large majority (ideally all, but this would negate the

financial incentive) of the proceeds from that deal must necessarily be placed into a fund

benefiting those displaced individuals, financing specialized education, job training, public

health initiatives etc. on their behalf.

My final recommendation relates to the few cases where the communities possess their

own land and are capable of selling it (although they are somehow coerced into doing so).

Communities having decided upon this course of action require proper advisement to provide

just compensation for their land, pending a fair evaluation of the situation, and the full

consideration of its costs and benefits, those short and long-term. An NGO needs to be

established which could provide these communities with legal, policy, and economic advisors

Three is Key 27

readily at hand, whom do not profit either way the deal goes. This NGO needs to supply

community and tribal leaders with proper, non-biased information and assessments.

I have provided just one example of a situation that lends itself to the initiation and

continuation of poverty. I have provided a list of recommendations which will hopefully serve to

stem the tides of this practice, if implemented, decreasing the growth of poverty resulting from

these practices. My goal in making these specific recommendations is to ensure the right of all

peoples to an adequate standard of living for him/herself. This includes the providing of adequate

food, clothing, and housing, and to the continuous improvement of living conditions. In the next

section I will briefly discuss an international attempt to reduce poverty.

International Level

My final set of recommendations appears at the international level, specifically

concerning intellectual property laws (IPLs) applied at the international level, and their impact

on developing nations as it relates to pharmaceuticals and public health. The specific set of laws

with which I would like to engage with are those contained within the WTO’s TRIPS agreement,

and the subsequent Doha Development agenda. Within this final section, I would like to briefly

depict the history and the public health impacting content of these agreements, the problems of

these agreements, and a few suggestions for ways to improve on/get around the roadblocks that

result.

The WTO is the regulatory body governing international trade amongst its constituent

nations (about 80 percent of the worlds nations) (World Trade Organization, Accession in

Perspective). Because it is the only such organization of its type, it exerts extraordinary influence

over international trade, and trade policy (Subhan, Scrutinized: The TRIPS Agreement and Public

Health). The WTO is constructed to allow representatives from each of its constituent nations to

Three is Key 28

come together in order to form agreements central to WTO operations and the

procurement/expansion of global international trade (Ibid.). There are three such agreements on

the books: the GATT (the General Agreement on Tariffs and Trades), the GATS (the General

Agreement on Trade in Services), and the TRIPS agreement, with which I concern myself

(Ibid.).

The TRIPS agreement has been the subject of much debate and criticism as it relates to

its impact on the access to essentially, life-saving medications to countries in the developing

world (often the global south). A product of the Uruguay Round of negotiations having taken

place from 1986 to 1994, this agreement promulgates various rules relating to IPLs. As is

standard with relation to WTO agreements, once member nations agreed to the TRIPS

agreement, they ratified its contents so that they might be enshrined in both domestic and

international law, effectively creating a minimum world standard of intellectual property (IP).

Although legally binding, member nations reserve the right to go above and beyond this

agreement and others, so long as domestic legislative content does not controvert agreement

conditions (Ibid.).

The TRIPS agreement set out to establish set of globally uniform rules providing

standards of protections for IP, as well as to provide increased predictability and stability in

international economic relations (Ibid.). TRIPS covers all forms of IP, however, I will focus

strictly on its impact on patent protections and pharmaceuticals. The agreement’s provisions

cover all manner of topics, from the controversial and debate inspiring, to the mundane and

easily forgettable. The agreement, among other things, grants a 20-year minimum period of

protection from the filing date for patents. It also eliminates a specific class of patents (process

patents) by focusing specifically on the results of the process, the specifically patentable product.

Three is Key 29

Complimenting these provisions, the agreement specifically designates two mechanisms to deal

with global health crises, those being: compulsory licensing and parallel imports (Ibid.).

Article 31 of the agreement grants member governments the authority to grant a license

to a party willing to commercialize a patent protected invention, circumventing the patent

holders permission; however, this is only so in the case of “national emergencies” (public health

crises), otherwise the proposed licensee is required to make reasonable efforts at obtaining

voluntary licensing from the patent holder (World Trade Organization, TRIPS Council, Trade-

Related Aspects of Intellectual Property Rights (TRIPS)). If the patent holder refuses the

proposed license, governments may grant non-exclusive licenses. As a result, compulsory

licensing allows generic pharmaceutical producing companies to manufacture patented products

and sell them at a fraction of the price patent holders do, as these companies do not need to

recuperate the costs of research and development (RD), and only the costs of production apply

(Subhan, Ibid.).

Critics of the compulsory licensing provisions of the TRIPS agreement often identify

paragraph f’s assertion that compulsory licensing must be used “predominantly for the supply of

the domestic market of the Member state authorizing such use” (World Trade Organization,

Ibid.). Martin Khor argues in his paper entitled The Post Doha Agenda and the Future of the

Trade System argues that this clause makes it exceedingly difficult for governments of

developing nations (those often struck by these epidemics) to issue these compulsory licenses

because the [then] predominant interpretation of this clause would require that these

pharmaceuticals be manufactured only by those in-need developing countries, where often little

to no infrastructure exists as of yet to support this sophisticated production, making this

functionally impossible (Khor, The Post Doha Agenda and the Future of the Trade System).

Three is Key 30

Article 6 of the agreement concerns parallel importing. Parallel importing essentially

allows nations to take advantage of differential pricing of pharmaceuticals in different markets,

so as to acquire patented products at a price deemed preferable. (World Trade Organization,

Ibid.). Illustrating this, Subhan provides the example of the patented drug Nevirapine: if a

package of the drug costs only $250.00 in France and $275.00 in South Africa, a south African

company, or the government, can import the drug from France and sell it at a lower price without

requiring the prior authorization of the South African patent holder (Subhan, Ibid.).

These provisions, and indeed many of this contained within the TRIPS agreement, were

never interpreted with ways consistent with the promotion of global health. Several nations (most

notably the US towards South Africa), at the behest of the pharmaceutical industry, developed

nations routinely threatened sanctions against developing nations who attempted to take

advantage of the goods to be derived from compulsory licensing or parallel importing, as an

attempt at legally strong arming these weaker nations into ceasing these actions despite their

being TRIPS compliant due to the “risk” this posed to the profit-driven industry (Ibid.). These

situations and others led Birdsall, Rodrik, and Subramanian to contend, “An international

community that presides over TRIPS and similar agreements forfeits any claim to being

development-friendly.” (Birdsall, Rodrik, Subramanian, How to Help Poor Countries). These

interpretations harm those most in need; the developing world’s poor and sick. These complaints

and others necessitated the drafting of a new document, more specifically detailing rights and

responsibilities of member nations so as to avoid these contrasting interpretations. This new

document came to be on November 14, 2001 in Doha, Qatar.

The Doha Declaration sought to remedy three primary concerns resulting from the TRIPS

agreement. First, doubts were cast on whether or not member nations would interpret TRIPS in a

Three is Key 31

manner consistent with the promotion of global health (World Trade Organization, Doha

Ministerial Declaration on Trips and Public Health). To address these concerns, member

nations, in the fourth paragraph, asserted the agreements compatibility with global health and the

right of member nations in need to interpret the agreement with the aim of improving global

health (Ibid.).

The second concern addressed related to the pressures applied by developed nations

(backed by the pharmaceutical industry) on developing nations to cease their utilization of

declaration provisions to promote global health. This concern, it is argued, is “addressed” by

numerous references to the autonomy of nations to enact their own legislation without threats to

their sovereignty being made by aggressors (Subhan, Ibid.). The third concern addressed related

to the concerns of Khor demonstrated above. This concern was addressed by the Doha

assignment enacted on August 30, 2003. The assignment holds that U.N. designated “least

developed countries” are exempt from the requirement of producing their own patented drugs

under compulsory license, and that they may issue a license to a more developed country for the

supply of their own country provided they satisfy three criteria: (1) Evidence of a public health

concern, (2) Evidence that the importer’s pharmaceutical industry is non-existent or inadequate,

and (3) Proof that the drug will only be used for public, non-commercial purposes. This was a

most progressive pronunciation.

However, despite the perceived gains made by the Doha Declaration and assignment,

many issues remain. For example, Ellen F. M. ‘t Hoen, in her work entitled The Global Politics

of Pharmaceutical Monopoly Power, argues that significant barriers still remain that prevent the

full utilization of the Declaration for developing nation’s benefit (Hoen, The Global Politics of

Pharmaceutical Monopoly Power, p. 86). Among these barriers she cites economic sanctions

Three is Key 32

(trade-based retaliation) and political pressure as still ongoing (Ibid.). She is also careful to note

that our optimistic discussions of the Doha Declaration and its progressive components cannot

ignore that the TRIPS agreement is still “highly detrimental to access to medicines” (Ibid. p. 87).

This is an analysis of the situation that I share; these agreements do, at the end of the day, limit

access to essential medicines, especially in health-based disasters. The address of the second

concern in the Doha declaration is meaningless as well, as no frameworks for restitution are

created if a nation's autonomy is challenged. This consistent assertion of “autonomy” for these

nations is powerless fluff added to appease, anesthetize, and self-congratulate.

Change is needed, medicines need to be accessible to those who need them, and health is

a human right. Indeed, Martin Luther King is often credited with saying, “Of all the forms of

inequality, injustice in health care is the most shacking and inhumane”, and this is absolutely

true. The current system disadvantages developing nations, those lacking the pharmaceutical or

medical infrastructure to deal with the epidemics that plague their nations, this is true health-

based inequality. Surely this health based inequality, the stress of being sick, the developmental

issues facing early childhood malaria infection, contributes to global poverty, and

disproportionately so in the global south (Africa). Thus, international governments and aid-

providing organizations should concern themselves with the remedy of these situations, and that

remedy is to be found, at least in part, in reevaluating IPLs.

Various theorists have attempted to voice alternatives to the TRIPS agreement provisions.

Hoen, in her report, details a few that caught my attention. The first is the creation of a license of

right provision; much like was seen in the Canadian pharmaceutical compulsory licensing policy

in place from 1923 to 1993. Attaching a license of right provision to a patent means that the

patent holder is required to grant a production license to any qualifying applicant who requests it.

Three is Key 33

The advantage of this system would be that the parties entitlement to that license is automatic

and does not require justification by the license, even is a third-party takes on the producing role

on behalf of the in need nation. This avoids significant legal wrangling over a very black and

white issue (Hoen, Ibid. p. 89).

Hoen also recommends the creation of not-for-profit pharmaceutical development. If this

is the case, these not-for-profit’s may offer the outcomes of their research on a non-exclusive

basis to generic producers, further securing both health and also the idea of health as a human

right (Ibid. p. 94). Hoen also theorizes, ala proposals by Novartis, and by Barbados and Bolivia,

the creation of a global RD fund or the creation of a prize model, awarding prizes for innovative

research, and for that that benefits the common good, compensating RD and therefor reducing

costs of the medications themselves (as a large majority of what is charged for medication is RD-

related), making them more accessible to those who need them (Ibid. p. 95).

Subhan also makes recommendations, one of these being the utilization of process

patents for essential pharmaceutical development. Process patents protect the manner in which a

product is made, rather than the product itself. Subhan argues that process patents get to the very

core of what capitalism is about: competition, efficiency, and profitability. We all know the

horrors that capitalism can breed (namely a system like this that creates poverty inducing

healthcare/technology inequalities); however, Subhan assures us that if applied in the right way,

these patents can be exceptionally beneficial to the developing world, rather than the currently

developing-nation-damning model. Because process patents provide a lesser degree of IP

protection, they foster competition, which in turn decreases market prices as competing

companies will attempt as best they can to develop more efficiently inexpensive methods of

production to assure their marketability (Subhan, Ibid.). This drives prices down, making

Three is Key 34

pharmaceuticals more affordable. Incorporating the prizes discussed above could further reduce

these costs.

These are just a few recommendations, but the message remains the same: necessary

pharmaceuticals must be made available to those whom need them. This obviously cannot be the

only concern, as pharmaceutical developing and marketing firms do have somewhat legitimate

claims to the returns that their research produces, these claims must be considered. Considerably

more attention needs to be devoted to this this area, the global health implications of what goes

on as it relates to IPLs and pharmaceutical development and accessibility has a profound impact

on the preponderance of global poverty. Theorists need to further direct their attention towards

these issues.

Conclusion

I hope that the research that I have performed in writing this paper has been sufficient in

painting an adequate picture of poverty, its implications, and some of its wellsprings. I further

hope that the recommendations I have made are well received and deemed to be worthwhile

either in their direct impact on the reduction of global poverty (specifically that in Africa) or in

inspiring further, more legitimate thought. I hope that I have painted a more holistic picture of

poverty and its potential remedy than my predecessors have done. It is my ardent belief that in

order to correct poverty, you must work with rather than against the impoverished individuals,

understanding the plight of their situations and how it will impact the efficacy of your response.

When this is understood and incorporated into a direct response, the global circumstances

lending themselves to the preponderance of global poverty must be identified and corrected.

Here I have identified two of these circumstances; however, many more exist. Perhaps this is a

limit of my study. Had I more time and resources, it is with the identification and correction of

Three is Key 35

those circumstances, and specifically those that impact sub-Saharan Africa, that I would further

align myself.

Three is Key 36

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