Averting expenditure on malaria: effects on labour productivity of maize farmers in Bunkpurugu-Nakpanduri District of Ghana

The Macroeconomic Impact of Increasing Investments in Malaria Control in 26 High Malaria Burden Countries: An Application of the Updated EPIC Model

BACKGROUND

Malaria remains a major public health problem. While globally malaria mortality affects predominantly young children, clinical malaria affects all age groups throughout life. Malaria not only threatens health but also child education and adult productivity while burdening government budgets and economic development. Increased investments in malaria control can contribute to reduce this burden but have an opportunity cost for the economy. Quantifying the net economic value of investing in malaria can encourage political and financial commitment.

METHODS

We adapted an existing macroeconomic model to simulate the effects of reducing malaria on the gross domestic product (GDP) of 26 high burden countries while accounting for the opportunity costs of increased investments in malaria. We compared two scenarios differing in their level of malaria investment and associated burden reduction: sustaining malaria control at 2015 intervention coverage levels, time at which coverage levels reached their historic peak and scaling-up coverage to reach the 2030 global burden reduction targets. We incorporated the effects that reduced malaria in children and young adolescents may have on the productivity of working adults and on the future size of the labour force augmented by educational returns, skills, and experience. We calibrated the model using estimates from linked epidemiologic and costing models on these same scenarios and from published country-specific macroeconomic data.

RESULTS

Scaling-up malaria control could produce a dividend of US$ 152 billion in the modelled countries, equivalent to 0.17% of total GDP projected over the study period across the 26 countries. Assuming a larger share of malaria investments is paid out from domestic savings, the dividend would be smaller but still significant, ranging between 0.10% and 0.14% of total projected GDP. Annual GDP gains were estimated to increase over time. Lower income and higher burden countries would experience higher gains.

CONCLUSION

Intensified malaria control can produce a multiplied return despite the opportunity cost of greater investments.

Why did foraging, horticulture and pastoralism persist after the Neolithic transition? The oasis theory of agricultural intensification

Despite the global spread of intensive agriculture, many populations retained foraging or mixed subsistence strategies until well into the twentieth century. Understanding why has been a longstanding puzzle. One explanation, called the marginal habitat hypothesis, is that foraging persisted because foragers tended to live in marginal habitats generally not suited to agriculture. However, recent empirical studies have not supported this view. The alternative but untested oasis hypothesis of agricultural intensification claims that intensive agriculture developed in areas with low biodiversity and a reliable water source not reliant on local rainfall. We test both the marginal habitat and oasis hypotheses using a cross-cultural sample drawn from the 'Ethnographic atlas' (Murdock 1967 Ethnology 6, 109-236). Our analyses provide support for both hypotheses. We found that intensive agriculture was unlikely in areas with high rainfall. Further, high biodiversity, including pathogens associated with high rainfall, appears to have limited the development of intensive agriculture. Our analyses of African societies show that tsetse flies, elephants and malaria are negatively associated with intensive agriculture, but only the effect of tsetse flies reached significance. Our results suggest that in certain ecologies intensive agriculture may be difficult or impossible to develop but that generally lower rainfall and biodiversity is favourable for its emergence. This article is part of the theme issue 'Evolutionary ecology of inequality'.