Why are Africans getting shorter?

South Asia still posts the lowest average height for adults in the world (see image below). But a remarkable finding of a recent study is that adult Africans (among other low income regions of the world) have gotten shorter, on average, since the 1970s.

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

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What explains deceleration in average adult heights on the Continent?

One obvious explanation is a decline in nutrition amid rising populations and declining agricultural productivity (Africa barely registered a green revolution). Another major culprit is the economic disaster that visited the Continent from the late 1970s to the early 1990s — which resulted in poor nutrition and an unchecked disease burden. Lastly, there is the issue of water and sanitation, especially in the context of a rapidly urbanizing population, which has direct implications for the realized disease burden.

Angus Deaton wins the Economics Nobel Prize

Angus Deaton of Princeton University has won the Nobel Prize in Economics. Tyler Cowen over at MR summarized Angus Deaton’s immense contribution to the study of consumption, human welfare, and development:

A brilliant selection.  Deaton works closely with numbers, and his preferred topics are consumption, poverty, and welfare.  “Understanding what economic progress really means” I would describe as his core contribution, and analyzing development from the starting point of consumption rather than income is part of his vision.  That includes looking at calories, life expectancy, health, and education as part of living standards in a fundamental way.  I think of this as a prize about empirics, the importance of economic development, and indirectly a prize about economic history.

Think of Deaton as an economist who looks more closely at what poor households consume to get a better sense of their living standards and possible paths for economic development.  He truly, deeply understands the implications of economic growth, the benefits of modernity, and political economy.  Here is a very good non-technical account of his work on measuring poverty (pdf), one of the best introductions to his thought.

More on this here.

Deaton’s book, The Great Escape: Health, Wealth, and the Origins of Inequality is a must read for those interested in development.

Some readers of the blog may recall Deaton’s summer square off with Rwanda’s Health Minister Agnes Binagwaho over his comments on the Boston Review blog.

Deaton’s selection is a timely nod to the study of BIG PICTURE development.

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.