Health care: lessons from Cuba

Life expectancy and other measures of good health in Cuba are only slightly worse than those in the U.S. and Europe, despite the fact that Cubans spend much less money in health care and medical education. In an article in Science Paul K. Drain and Michele Barry suggest that this is because cheap preventive care as practiced in Cuba is more cost-effective than the expensive, high-tech cures typical of rich countries.

How can we move towards a Cuban-like, cost-effective care? By removing government regulations that limit the number and variety and inflate the fees of health care workers and hospitals, that limit the availability of medicines, and that generally ban cheap but effective care. You don't need Harvard-educated doctors, five-star hospitals and million-dollar machines to take your blood pressure.

Although it has nothing to do with the topic of their article, Drain and Barry call for lifting the U.S. trade embargo against Cuba. So do I. And I also call for lifting the trade embargoes, tariffs and regulations the European Union has erected against Cuba and all other countries.

Market-phobia and China-phobia to feed the world?

Nature recently published an interview (What it will take to feed the world) with Marion Guillou, the chief executive of France's National Institute for Agricultural Research, "Europe's largest agricultural-research agency." She says:

One really big research area is studying the volatility of prices. It is the main problem. Remember the food riots in several countries in 2008? We are still trying to understand what happened, but much of it was because of financial speculation. We already have enough food to feed everyone on the planet at 3,000 kilocalories per day, but it is a question of price. We need research to find out which economic tools are available to stabilize prices at the international level, and to ensure, for example, adequate available reserves of cereal. We need to propose economic solutions, and regulation of markets of agricultural foodstuffs to avoid the yo-yo whereby prices can go so high that people do not have access to food. We also have to guarantee minimum prices if farming is to remain viable.

A free market would guarantee that farming is viable and people have access to food. The main problem is not the "volatility" of prices. The problem is that important people believe that financial speculation causes price volatility, when it actually has the opposite effect, and that prices must be set by centralized research and regulation and not by supply and demand.

Market-phobics typically hate China. Guillou is no exception:

China is heavily involved in training and technology transfer to Africa, and in Europe we should be trying to offer Africans an alternative; we have the scientific capacity. It would be a pity if we were to leave all collaborations in the hands of the Chinese.

Increased funding to preserve linguistic diversity

In a letter to Nature Yoshina Gautam and Aashish Jha ask for "increased funding [...] to preserve language diversity, particularly in developing countries." They don't say why but refer to the United Nations Permanent Forum on Indigenous Issues. According to the UNPFII the protection of indigenous languages is important because

• As a result of linguistic erosion, much of the encyclopedia of traditional indigenous knowledge that is usually passed down orally from generation to generation is in danger of being lost forever. This loss is irreplaceable and irreparable.

• Customary laws of indigenous communities are often set out in their languages, and if the language is lost the community may not fully understand its laws and system of governance that foster its future survival.

• The loss of indigenous languages signifies not only the loss of traditional knowledge but also the loss of cultural diversity, undermining the identity and spirituality of the community and the individual. 

• Biological, linguistic and cultural diversity are inseparable and mutually reinforcing, so when an indigenous language is lost, so too is traditional knowledge on how to maintain the world’s biological diversity and address climate change and other environmental challenges.

We stop to speak a language when we die or when we switch to another language. In the latter case we can still pass down our knowledge and laws by translating them or by importing some words to our new language. (Curiously, the UNPFII does not advocate this but the opposite - "translating laws and key political texts into indigenous languages so that indigenous peoples may better participate in the political and legal fields.")

But let's say that in some cases it is linguistically impossible to translate something or import the relevant keywords. I trust that most people who voluntarily stop speaking a language do so for their own good and the good of their children, so any possible losses of traditional "indigenous" knowledge, laws, identity, spirituality, biodiversity and solutions to climate change must be relatively unimportant to them. The same goes for people who decide not to learn an "indigenous" language - the advantages of doing so are probably not worth the effort for them.

But it is possible that speaking a certain language is not worthy for an individual but good for the rest of society. For example, if speaking a given language is a key to alleviating the problem of climate change much of the benefit may go to society as a whole and not to the speakers. In this case, it makes sense to pay some people to speak that language.

The UNPFII agrees and advocates "allocating the funding and resources needed to preserve and develop indigenous languages, and particularly for education [in the mother-tongue of indigenous children]." If we subsidize education in one language but not in other, then more people will get educated in the former, the risk of losing the language is smaller, and we are more likely to keep the key to the problem of climate change.

How much must we spend in those subsidies? If other things are equal and the administrative costs are small, the subsidies should be about as large as the benefits we all derive from climatic and environmental improvements brought about by knowledge that can't be translated. I don't know if that is a dollar or a billion dollars. Yoshina Gautam, Aashish Jha and the UNPFII don't say either.

Neoliberal food policies in Africa

In the PNAS article Neoliberal policy, rural livelihoods, and urban food security in West Africa: A comparative study of The Gambia, Côte d'Ivoire, and Mali William Moseley, Judith Carney and Laurence Becker (whom I will collectively call MCB) tell the story of what they call "neoliberal" policy reform of the food industry in those three countries. Their narrative is very interesting and, despite their politically correct language, very enjoyable. I summarize it below but I recommend reading the original. Then in the article's conclusions MCB advocate some neocommunist policies.

Between 1966 and 1984 the Gambian government, with the help of foreign governments and aid agencies, planned and financed rice production. As is typical of government-run enterprises, "projects often ran aground" by "ignoring sociocultural norms" and by insufficient attention to detail.

Then, starting in 1986, the government removed subsidies, price controls and import tariffs, and dismantled the state bureaucracy that run the rice trade. This left rice consumers "dependent" on imported rice. What MCB mean by "dependency" is that the removal of import tariffs and the other reforms suddenly made imported rice cheaper and more attractive than locally produced rice. Nobody forbade consumers to keep buying local rice, but they have since preferred the imported one. MCB tell a similar story about the Ivory Coast:

Gone was the state agency with a monopoly on importing rice, control of rice supplies, and the responsibility for regulating the national rice price. Privatization meant that the state’s monopoly on imports shifted to a small group of private importers close to the president. With regulation gone, imports rose, because consumers preferred the less expensive and lower quality (yet better milled) imported broken rice.

In 2006 rice in the international market was cheaper than in 1980 but then in 2007 and 2008 it got very expensive. MCB explain that Malians suffered less from this price hike than Gambians and Ivorians because "Mali’s landlocked status made imported rice relatively more expensive, a factor that favors domestic rice producers," because Malians find local rice more tasteful and because Mali's government banned rice exports to neighboring countries. I can understand why distance to ports makes imported stuff more expensive, but I can't figure out why landlockedness may have a similar effect. Anyway, MCB are effectively arguing that there was less of a price hike in Mali because rice was already expensive there and because the government decided to depress local prices at the expense of local farmers and consumers from neighboring countries (those bloody Ivorians be damned).

In their conclusions, and out of the blue, MCB advocate reestablishing tariff barriers and subsidies to local rice production. Tariffs would make rice more expensive to consumers. Subsidies would make farmers happier but taxpayers more "vulnerable" (I love to use MCB's terminology). MCB also advocate that new seed technologies "should be designed with the needs of the poorest farmers in mind, including women," which reveals that MCB think that food production is a goal in itself and not a means to feed people. Finally, they say that consumers are "unidimensionally obsessed with rice" and that governments should make sure that they eat more of other foods that, as MCB also note, are less affordable and less convenient to cook.

Just as the "neoliberal" policies criticized by MCB are small steps towards a liberal society, the neocommunist policies they advocate would be steps towards a society where consumption is a means to production and, as a result, rice is scarce and expensive, especially for those taxpayers who would pay for it without actually eating any.

Increasing equitability by culling the poor

I quote in full a letter to Science by Arthur H. Westing:

The special section on Food Security (12 February, p. 797) presents various technological fixes to address the problem of sustainably and equitably feeding the 9 billion humans now projected for 2050. However, population controls are not mentioned as a possible strategy. Suggestions for reducing demand are essentially limited to eating less meat and more insects, as well as establishing good governance and eliminating pervasive worldwide corruption. Why not make reduced world population a central part of the proposed mix of solutions for the future?

In the long term there can be as many humans as the food industry can support, and no more. Natural fecundity and mortality ensure this is the case in the absence of any "solutions." But the key to Westing's idea is to eat "equitably." So he is in fact arguing: "if you will not be able to eat as well as I do you do not deserve to live."