This is a quite fascinating argument, and quite unexpected when I'm reading this book, Mosquitoes, Malaria and Man.
As for typing public health efforts to development, WHO takes its stand on popular but treacherous ground. One reason eradication failed, the argument goes, is that governments were not convinced it was worthwhile and were unwilling to push it or pay for it. Malariologists, negelected to bring out cost-benefit models to prove that it may pay more than it costs to keep people healthy.
Now it is notoriously difficult to put a value on human life, though many economists are perennially willing to try. But the exercise becomes superficially plausible if you assume that development is the social objective, axiomatically to be considered good, by which other values are tested. Then the worth of a man may be reckoned as what he contributed during a normal life span to the gross national product. If he dies prematurely the years of useful labor cut off are lost and consistute a social cost. If he is by a measurable amount of his assumed potential. And that is economic loss. All these costs may be charged to a malaria if malaria is the villain, along with the direct expenses of treatment, and weighed against the cost of eliminating the disease or reducing it by any given amount.
If the model predicts that fighting disease pays, then the exercise can seem as harmless as it ought to seem superfluous. But suppose the fight is found not to pay. As the whole point of running a cost-benefit model is to sway governments presumed to be responsive to that kind of argument, would they not be under as strong pressure to forgo malaria control when the model lights turn red as to proceed when they are green?
Unpleasant as is that proffered choice, in the name of economic reason, to buy or not to buy lives, there is still a more unpleasant middle ground: To buy certain lives and sacrifice others. WHO has come perilously close to recommending that governments do just that. As a limited war against malaria by definition cannot extend to the protection of all people, a suggested strategy is to concentrate on protecting those people in society whose economic contributions are most important — workers in key industries, producers of cash crops, those who labor to build roads, dams and other capital improvements, in short all those who are useful for development.
This implies a curious and dismaying reversal of values. It used to be argued that development was a good thing because it benefited people; now we seem on the point of agreeing to have blushed at the implication that human life was to be protected only as it contributed to the gross national product. No politician appears to have protested the cynicism thus imputed to political leadership. Everyone is busy being "realistic." If you want to do good in a world so obsessed with development that it allows only two kinds of nation, the developed and the developing, you have to prove that doing good is one way to develop.
Failure of the idea of mosquito eradication has in truth left a vacuum. Nations such as India, that came such a long way toward abolishing the ancient malarial scourge, do not want it back; their governments in fact have no real political choice but to continue the fight. Yet the warriors remain disprited, badly in need of fresh purpose.
It may be that the most damaging legacy of eradication has been the mental conditioning it fostered. The eradicators developed military minds: The game, they thought, must go to them or to us, win or to be defeated. But there were skeptics of the eradication strategy all along who protested that this was not the real choice in the real world where man habitually copes with recurrent and perennial problems that he can never hope to resolve and put away forever. Protecting ourselves against the malarial plasmodium can be accepted as quite probably a task for all tiime without being daunted by the prospect.
Malarial fighters have been a mercurial lot, subject to intense enthusiasms and deep discouragements. Yet their own history should hearten them. Unless The End is finally here, current doldrums are also part of that history, they are therefore interlude not culmination.
So in name of development, as it is another "-ism", those that do not
benefit the course of it will be deemed unworthy. Again, I found
emphasis on individual, value and right of an individual, is
constantly being challenged, if not at all denied, by these "in the
I recall listening to Jeffery Sachs at BU when he argued that perpetual progress is neither possible nor practical — even if we believe in that universe is inifite, traveling straight towards one direction will only bring us back to where we are. Economy progress and development can not go upwards forever, and I think his point was that it should not, either. Implication is not only that all resources on earth will not be enough to support everyone living like Americans, but this story of malaria highlighted another aspect when things are viewed in a cost-benefit model.
Written in 1978, this argument has yet convinced mass to reconsider the path we are on, achievements we yearn for, value of life (as the Chinese have gone through mania of the age of success in the last few years, when preaching of success was the talk of the day), whether we can only go forward, in a forever motion of moving faster, growing bigger, richer.
I don't know whether there is a cap of human society, be it in population, in wealth, in resource consumption, in creativity, in imagination, in invention of disaster, in fostering bias and in correction of faults.... In theory I would think there is an upper limit. I'm just living at the tip of its early phase, I suppose. There is a long way to go, I hope.
— by Feng Xia