Angus Deaton and Rwanda’s Health Minister, Agnes Binagwaho, square off

Angus Deaton wrote a critique of Effective Altruism, in which he offered up Paul Kagame’s dictatorship as an example (read the whole thing, he makes some good points):

In today’s Rwanda, President Paul Kagame has discovered how to use Singer’s utilitarian calculus against his own people. By providing health care for Rwandan mothers and children, he has become one of the darlings of the industry and a favorite recipient of aid. Essentially, he is “farming” Rwandan children, allowing more of them to live in exchange for support for his undemocratic and oppressive rule. Large aid flows to Africa sometimes help the intended beneficiaries, but they also help create dictators and provide them with the means to insulate themselves from the needs and wishes of their people.

The industry does not ignore the evidence; indeed the World Bank, the U.S. Agency for International Development, and its European counterparts use the same evidence GiveWell does, and they help to create more. They are also infinitely better organized and funded than the NGOs, so if it were possible to use this sort of evidence to eliminate global poverty, they would be better placed to do so than a handful of wealthy individuals working through NGOs. Yet these official aid agencies cannot solve the political conundrum and must bear some of the burden of responsibility for the oppressive dictatorships that fester in Africa.

Rwanda’s Minister of Health, Dr. Agnes Binagwaho then wrote this response:

Deaton believes that we ‘provide health care for Rwandan mothers and children’ in order to ‘insulate ourselves from the needs and wishes of our people’. I can’t tell if he means that Rwandans don’t wish for good health, or that our country would be more democratic if we neglected basic needs.

…..  The issue is moral, and it concerns all of us. Deaton’s theory rests on the assumption that Africans don’t feel love for their children. It follows that President Kagame, being an African, sees children as a commodity, like copper or sweet potatoes, to be sold to people in the West who value their lives more highly. Rwandans have a proverb for such impertinence – Urusha nyina w’umwana imbabazi aba ashaka kumurya: “Whoever shows more compassion for a child than its own mother only wants to exploit it.”

Angus Deaton doesn’t know Paul Kagame from Kunta Kinte. The president is just a cartoon character he uses to argue against foreign aid. Deaton isn’t referring to the real Paul Kagame or the real Rwanda, but to a generic ‘other’ whose moral inferiority is so self-evident that it requires no elaboration.

To which Angus Deaton replied:

Dr. Agnes Binagwaho, firing off in all directions, misses her target. I am not a racist, and that she would stoop to such libel only highlights the weakness of her case, indeed the absence of any argument at all. And her fury has blinded her to the logic of my argument.

My target is not the Rwandan people, nor even Paul Kagame; I have no doubt that Rwandan parents love their children, and that the improvements in health and healthcare in Rwanda are a good thing. Dr. Binagwaho can be justifiably proud of her part in this. I did not argue that Rwandans do not want good health, nor that Rwanda would be more democratic if it neglected its basic needs. No one in their right mind would ever make such claims, certainly not I. The attack on Kagame is general, not personal: autocrats without accountability to their citizens face no constraints to behave well and have no structural incentives to do good things for their people.

The merits of either respective arguments aside, this exchange raises serious questions about how academics and practitioners working in development should approach or write about regimes like those in Rwanda and Ethiopia.

Here are some (tortured) quick general thoughts:

  • There is a strong positive relationship between strong state institutions and economic growth.
  • The jury is still out on the causal relationship between democracy and economic growth. And since institutional development takes time, simply democratizing doesn’t guarantee the emergence of good institutions. What seems to be necessary is freedom for the relevant economic actors. England on the eve of the industrial revolution provided freedom for the relevant actors, even as loads of men and women could not vote.
  • Dictatorships also have institutions that aren’t mere window-dressing. So we shouldn’t think of Kagame or Mugabe as unhinged omnipotent ghouls who can do whatever they can dream of. Lifetime presidents like Museveni and Mugabe are hostage to subsets of elites in their countries, just as much as the same elites are being held hostage by their rulers.
  • Most “good” institutions (like strong legislatures, for example) often have autocratic foundations. In other words, if Rwanda ever democratizes, its democratic institutions will be built upon the developments that have taken place going back to 1994 and beyond. This means that reformers are probably likely to succeed if they work along the grain, rather than against it.
  • The approach to governments like those in Rwanda and Ethiopia (unlike in Syria or Pol Pot’s Cambodia) should therefore not be one of everything sucks right now, lets get rid of them and start afresh. Instead, efforts to right the wrongs in these countries should focus on how to build on what has been achieved so far. Anyone who tells you that the governments of Rwanda and Ethiopia are 100% bad is lying to you. A couple of years ago an Ethiopian opposition leader who was visiting Stanford as a fellow told me that “you can’t argue against power lines and roads.” She had a point. The reductions in infant mortality in Rwanda are real. Those lives matter. And I don’t think Kagame’s regime worked to save those lives in order to use them as a bargaining chip.
  • The world should be united in its moral outrage in light of the jailing and killing of democracy activists in both Rwanda and Ethiopia.  Pressure should be applied on Kagame and the EPRDF to improve on their human rights record. But at the same time we should not fall into the temptation of singling out these regimes as particularly weird dictatorships like the world has never seen before. This is the line, I think, that Deaton crossed with his “farming children” argument.
  • Political change for the better is hard. Just look at the unimaginable injustices that take place in the United States, a robust democracy, with politicians and all manner of well-wishers unable to do anything meaningful about it. Just imagine for a second that until recently African-Americans in Charleston still lived under state-sanctioned humiliation in the name of the confederate battle flag. All reasonable people hated the fact. But they also acknowledged the political complexities involved. And appreciated the complexity of the actors involved. In the same vein, several governors in the United States currently deny their citizens healthcare benefits for purely political reasons. Why do commentators acknowledge the political complexities of these red states but somehow imagine politics elsewhere to be simpler? Why do we believe that countries like Rwanda and Ethiopia can be put on the right track with quick fixes? Why do we always simplify these places?
  • I have no idea of how to quickly get rid of Kagame or the EPRDF without going through a revolution, a reign of terror, and a restoration of dictatorship. So all I can do is criticize these regimes, but all the while acknowledging that they are complex systems composed of human beings with interests and who respond to incentives.
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3 thoughts on “Angus Deaton and Rwanda’s Health Minister, Agnes Binagwaho, square off

  1. Thank you Ken. For me, these points made Dr. Binagwaho’s point clearly

    > But at the same time we should not fall into the temptation of singling out these regimes as particularly weird dictatorships like the world has never seen before. This is the line, I think, that Deaton crossed with his “farming children” argument.

    > Why do commentators acknowledge the political complexities of these red states but somehow imagine politics elsewhere to be simpler? Why do we believe that countries like Rwanda and Ethiopia can be p

    The subtle racism that Dr. Binagwaho implied was in exactly above. Giving the benefit of the doubt to Western political complexities and not to African ones. That assumption of moral superiority is very problematic, and yes, often based on race and nationality. Angus Deaton misses that point by his quick cry of ” I am not a racist, and that she would stoop to such libel only highlights the weakness of her case”

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  2. Thanks Ken for a balanced viewpoint.

    The “farming children” point is far from being Africa specific. It is a policy quite a few states have used. It has been the case of pre World War II France and Germany. From 1850 to World War II both countries invested heavily in maternal and child health with the view of “farming” healthy children to fight wars. And they did.
    In the 1930s. Germany had the best health care system of Europe and produced very healthy children who ultimately were sent to war as early as age 8: the Hitler Youth.

    Rwanda is in this respect very comparable to Germany at the time. It has had some good results in health care (although not as good as reported as the Rwandan government has been falsifying statistics and the system is increasingly corrupt) However these results are used to buy the good will of the international community, while the state jails, tortures and kills. In this respect, “farming children” is not so far from the the atrocious reality.

    I do not think anybody would argue today that Hitler should have been allowed to torture and kill millions of people because Nazi Germany had a great child health policy.
    .
    There may be some good coming out of a benevolent authoritarian regime. But Rwanda is not one, it is a brutal totaitarian State. Kagame’s crimes are documented by Amnesty International, the US State Department, the UN, Human Rights Watch and his own advisors and military.

    Why would we Africans support this new incarnation of the worst dictators,?.

    https://www.amnesty.org/en/latest/news/2012/10/rwanda-must-investigate-unlawful-detention-and-torture-military-intelligence/

    http://www.nytimes.com/2014/06/18/opinion/why-are-rwandans-disappearing.html?_r=0

    http://www.nytimes.com/2015/07/20/opinion/war-crimes-and-rwandan-realities.html

    https://drive.google.com/file/d/0BzL0v-ZpWCAIMGM1MWVkMTQtMWY0Zi00NjNmLTgxZDgtOTI3NWNkZDhmYTMy/view?ddrp=1&pli=1

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  3. Pingback: Angus Deaton wins the Economics Nobel Prize « An Africanist Perspective

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