Jeffrey D. Sachs

Economic Reform and the Process of Global Integration

WHEN T H E BROOKINGS Panel on Economic Activity began in 1970, the world economy roughly accorded with the idea of three distinct economic systems: a capitalist first world, a socialist second world, and a developing third world which aimed for a middle way between the first two. The third world was characterized not only by its low levels of per capita GDP, but also by a distinctive economic system that assigned the state sector the predominant role in industrialization, although not the monopoly on industrial ownership as in the socialist economies. The years between 1970 and 1995, and especially the last decade, have witnessed the most remarkable institutional harmonization and economic integration among nations in world history. While economic integration was increasing throughout the 1970s and 1980s, the extent of integration has come sharply into focus only since the collapse of communism in 1989. In 1995 one dominant global economic system is emerging. The common set of institutions is exemplified by the new World Trade Organization (WTO), which was established by agreement of more than 120 economies, with almost all the rest eager to join as rapidly as possible. Part of the new trade agreement involves a codification of basic principles governing trade in goods and services. Similarly, the International Monetary Fund (IMF) now boasts nearly universal membership, with member countries pledged to basic principles of currency convertibility. Most programs of economic reform now underway in the developing world and in the post-communist world have as their strategic aim the

The curse of natural resources

Abstract This paper summarizes and extends previous research that has shown evidence of a “curse of natural resources” – countries with great natural resource wealth tend nevertheless to grow more slowly than resource-poor countries. This result is not easily explained by other variables, or by alternative ways to measure resource abundance. This paper shows that there is little direct evidence that omitted geographical or climate variables explain the curse, or that there is a bias resulting from some other unobserved growth deterrent. Resource-abundant countries tended to be high-price economies and, perhaps as a consequence, these countries tended to miss-out on export-led growth.

The economic and social burden of malaria

Where malaria prospers most, human societies have prospered least. The global distribution of per-capita gross domestic product shows a striking correlation between malaria and poverty, and malaria-endemic countries also have lower rates of economic growth. There are multiple channels by which malaria impedes development, including effects on fertility, population growth, saving and investment, worker productivity, absenteeism, premature mortality and medical costs.

Geography and Economic Development

Location and climate have large effects on income levels and income growth through their effects on transport costs, disease burdens, and agricultural productivity, among other channels. Geography also seems to affect economic policy choices. Many geographic regions that have not been conducive to modern economic growth have high population densities and are experiencing rapid increases in population. At particular disadvantage are regions located far from coasts and ocean-navigable rivers, for which the transport costs of international trade are high, and tropical regions, which bear a heavy burden of disease. Moreover, a large portion of population growth over the next thirty years is expected to occur in these geographically disadvantaged regions.

Geography, Demography, and Economic Growth in Africa*

This paper presents the effects of climate, topography, and natural ecology on public health, nutrition, demographics, technological diffusion, international trade and other determinants of economic development in Africa. The goal of this paper is to emphasize the need for intensified research on the issues at the intersection of ecology and human society. Geography was given emphasis because of three reasons: the minimal gain from another recitation of the damage caused by statism, protectionism and corruption to African economic performance; negligence of the role of natural forces in shaping economic performance; and tailoring of policies to geographical realities. The paper also discusses the general problems of tropical development and the focus of Africas problems in worldwide tropical perspectives; demographic trends in Africa; use of standard cross-country growth equations with demographic and geographic variables, to account for the relative roles of geography; and the future growth strategies and the need for urban-based export growth in manufacturing and services. Lastly, the authors provide a summary of conclusions and discuss the agenda for future research.

The Current Account and Macroeconomic Adjustment in the 1970s

DURING THE PAST DECADE, the behavior of international capital flows, current account balances, and exchange rates have puzzled economists and preoccupied policymakers. The period has been marked by widely fluctuating exchange rates, huge OPEC surpluses, burgeoning debt of less developed coimtries (LDCs) and unprecedented current account deficits in many developed countries. The nature, direction, and scope of international borrowing have also shifted dramatically. The proportion of private to official capital inflows to LDCs has grown substantially; the international money market has expanded dramatically; and capital controls have been liberalized in many economies. The need for analysis is greatest on two sets of questions. First, what factors have determined the size and direction of current account imbalances in recent years? Second, what has been the relation between the current account and movements in the exchange rate? Answers to the first question have tended to focus on OPEC price increases and surpluses. Observing that the large surpluses must be balanced in the aggre-

Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria

Hotez et al. argue that achieving success in the global fight against HIV/AIDS, tuberculosis, and malaria may well require a concurrent attack on the neglected tropical diseases.

Community-based approaches to HIV treatment in resource-poor settings

Last year, HIV surpassed other pathogens to become the world’s leading infectious cause of adult death. More than 90% of deaths occur in poor countries, yet new antiretroviral therapies have only led to a drop in AIDS deaths in industrialised countries. The main objections to the use of these agents in less-developed countries have been their high cost and the lack of health infrastructure necessary to use them. We have shown that it is possible to carry out an HIV treatment programme in a poor community in rural Haiti, the poorest country in the western hemisphere. Relying on an already existing tuberculosis-control infrastructure, we have been able to provide directly observed therapy with highly-active antiretroviral therapy (HAART) to about 60 patients with advanced HIV disease. Inclusion criteria and clinical follow-up were based on basic laboratory data available in most rural clinics. Serious side-effects have been rare and readily managed by community-health workers and clinic staff. We discuss objections to the widespread use of HAART, and suggest that directly-observed therapy of chronic infectious disease with multidrug regimens can be highly effective in settings of great privation as long as there is sustained commitment to uninterrupted care that is free to the patient. Why AIDS prevention alone is insufficient The dimensions of the global HIV crisis are such that predictions termed alarmist a decade ago are now revealed as sober projections. 1

Trade and Jobs in U.S. Manufacturing

DURING THE PAST 15 years, the U.S. economy has become increasingly integrated with the rest of the world. Among other trends, imports and exports have risen significantly as a percentage of U.S. gross domestic product. Many manufacturing sectors have shrunk in the face of stiff international competition; others have grown in response to strong international demands for U.S. exports. One of the notable features of this internationalization is the growing importance of trade with the developing countries. In 1978, developing countries accounted for 29.0 percent of U.S. manufactured goods imports. By 1990, that ratio had risen to 36.4 percent. Seven countries in East Asia (China, Hong Kong, Korea, Malaysia, Singapore, Taiwan, and Thailand), together with Brazil and Mexico, accounted for 79 percent of the increase in U.S. trade with all developing countries between 1978 and 1990. Many observers have linked the growing internationalization of the U.S. economy to important rends in the U.S. labor market. Three labor

Expansion of cancer care and control in countries of low and middle income: a call to action

Substantial inequalities exist in cancer survival rates across countries. In addition to prevention of new cancers by reduction of risk factors, strategies are needed to close the gap between developed and developing countries in cancer survival and the effects of the disease on human suffering. We challenge the public health communitys assumption that cancers will remain untreated in poor countries, and note the analogy to similarly unfounded arguments from more than a decade ago against provision of HIV treatment. In resource-constrained countries without specialised services, experience has shown that much can be done to prevent and treat cancer by deployment of primary and secondary caregivers, use of off-patent drugs, and application of regional and global mechanisms for financing and procurement. Furthermore, several middle-income countries have included cancer treatment in national health insurance coverage with a focus on people living in poverty. These strategies can reduce costs, increase access to health services, and strengthen health systems to meet the challenge of cancer and other diseases. In 2009, we formed the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, which is composed of leaders from the global health and cancer care communities, and is dedicated to proposal, implementation, and evaluation of strategies to advance this agenda.