- Email: [email protected]
World Health Report 2002: Reducing Risks, Promoting Healthy Life
170
Book reviews
a wide variety of case-studies ranging from Cuba to Switzerland and from Viet Nam to Sri Lanka. Much of the substance of the book is drawn from an international study of sustainable agriculture carried out by Pretty and his colleagues at the Centre. This ‘audit [of] progress towards agricultural sustainability’ considered more than 200 projects in 52 countries. The results of the study are encouraging, particularly for small farmers: 90% of those studied farmed less than 2 ha each. In resolving the problems facing agriculture in the era of globalisation it is not sufficient to be cognisant with economics concepts, one also needs to learn what Pretty refers to in the title of one chapter as ‘Ecological Literacy’. This is a way of learning about the land to which he gives the word metis, meaning ‘forms of knowledge embedded in local experience’. This is similar to a distinction made by anthropologists between episteme, intellectual learning, and techne, a kind of learning by doing or by experience. The loss of this ‘traditional’ knowledge—whether it be the Tohono O’odham of the south-west US and their ability to name their indigenous plants and animals, or Indian healers’ knowledge of traditional plants—is, for Pretty, as serious as the loss of species or languages. Pretty describes in this chapter the importance of preserving such metis as survives and developing more such practical knowledge about the land if we are to build a sustainable future. Other chapters cover issues including the cultural importance of landscape and the impact on it of agribusiness; the economic costs of the globalised food system; and the controversy over GM food. Although the book is academically grounded, the material is treated in a way that does not deter the general reader, so many of the figures and tables are relegated to endnotes, which are long and detailed. I found this unhelpful and would have preferred linking the technical and philosophical aspects within the body of the book. Aside from this minor irritation I found the book packed with novel insights and interesting analyses and would recommend it whole-heartedly. Pretty’s conclusion is optimistic, yet challenging: “If we are to develop sustainable agricultural and food systems—even sustainable economies and societies at large—then we will need to develop new forms of social organization and ecological
literatures. Our knowledge of nature and land usually accrue slowly over time. Yet, the immediacy of the challenge means that we must move quickly in order to develop novel and robust systems of social learning. These collective systems can also promote significant personal changes. Ultimately, the barriers are inside each of us, and large-scale transformations of land and community can only occur if we cross these frontiers, too.” (p. 169). Pretty’s challenge to all who work in agricultural economics is to cross these internal frontiers. You never know: if you do, you might find yourself thinking like a wolf! Molly Scott Cato University of Wales Institute, Cardiff, UK E-mail address: [email protected] (M.S. Cato) doi: 10.1016/j.agecon.2003.11.005
World Health Report 2002: Reducing Risks, Promoting Healthy Life World Health Organization, Geneva, 2002, 250 pages, US$ 13.50, ISBN 9-2415-6207-2 The World Health Report 2002—Preventing Risks, Promoting Healthy Life—is a well researched and timely report which breaks new ground by identifying major principal global risks of disease, disability and death in the world today, quantifying their actual impacts from region to region, and providing examples of cost-effective ways to reduce them. The report sets the scene by defining risk assessment and explaining the different methods of quantifying risks to health. The report then quantifies some of the most important risks to health, globally and regionally, in terms of the burden of the diseases they cause. The 10 identified leading risk factors globally are: underweight; unsafe sex; high blood pressure; tobacco consumption; alcohol consumption; unsafe water, sanitation and hygiene; iron deficiency; indoor smoke from solid fuels; high cholesterol; and obesity. Together, these 10 health risks account for more than one-third of all deaths worldwide. Underweight closely followed by unsafe sex, are the leading risk factors in the developing countries of sub-Saharan Africa and South
Book reviews
East Asia, where poverty is a strong underlying determinant. In the most industrialised countries of North America, Europe and the Asian Pacific, the report indicates that at least one-third of all disease burdens are caused by tobacco, alcohol, blood pressure, cholesterol and obesity. The report assesses the cost-effectiveness of some of the strategies to reduce the risks to health. The report says that very substantial health gains can be made for relatively modest expenditures. It discusses different ways of attaining the same risk reducing goal; for example, the population-wide versus the individual-based approach and prevention versus treatment. Strategies to prevent childhood under-nutrition, such as micronutrient supplementation and treatment of diarrhoea and pneumonia, are reported to be cost-effective in all settings. Preventive interventions to reduce the incidence of HIV infections, including measures to encourage safer injection practices, are also reported to be cost-effective. In all settings, the absolute risk approach intervention to reduce the risks associated with cardiovascular disease is reported to be cost-effective. Populationwide strategies to lower cholesterol by reducing salt intake are reported to be very cost-effective both singly and in combination. Clear recommendations are suggested by the report. The report strongly recommends that priority be given to controlling those risks that are well known, common, substantial and widespread, and for which effective and acceptable risk reduction strategies available. If the ten main health risks are reduced by 25% within 10 years, life expectancy in industrialised and developing countries could increase by 10 and 5 years, respectively. Some of the key specific recommendations that the report suggests include the following: • Governments, especially health ministries, should play a stronger role in formulating risk prevention policies, including more support for scientific research, improved surveillance systems and better access to global information. • Countries should give top priority to developing effective, committed policies for the prevention of globally increasing high risks to health, such as tobacco consumption, unsafe sex in connection with HIV/AIDS, and, in some populations, unhealthy diet and obesity. For example, governments can
171
increase taxes on tobacco; or enact legislation to reduce the proportion of salt and other unhealthy components in foods. • Cost–benefit analyses should be used to identify high, medium and low priority interventions to prevent or reduce risks, with highest priority given to those interventions that are most cost-effective and affordable. The strength of the report lies in its ability to scientifically estimate the burden of the health risks, and present convincing evidence that can help governments of all countries to raise the life expectancy of their populations. Not only is the report an excellent advocacy tool, but it can also be used as a guide to plan allocation of resources across different risk reducing strategies. As an advocacy tool, the report can be used to challenge countries to reduce or eliminate the risk to health and raise the life expectancy of their populations. The report has objective and scientifically estimated information that shows that the cost of inaction is serious. For example, nine million deaths a year linked to smoking will be reported by 2020 if steps are not taken soon. Currently, about five million people die each year from diseases related to smoking. As a planning tool, the report can be used in defining priorities and selecting interventions, focusing on areas where the return in health gains is demonstrably greatest. The report is also an extremely valuable resource for academia. College professors and students have a practical example of how risk assessment and cost–benefit analysis can be empirically applied in real world settings and how the results can be used to identify crucial policy implications. The academic value of this report is not limited to those in the health field, but is applicable to everyone in applied economics. One shortcoming of the report is the failure to suggest in its recommendations broader strategies to address the underlying socio-economic causes of risks to health such as poverty. Yet in the reports’ analysis, there is strong evidence linking poverty to the leading health risks such as underweight and unsafe sex, suggesting that the alleviation of poverty is actually a precondition for improvements in health. Another shortcoming of the report is that its analysis is limited to global and regional levels. Many countries will require country-level analysis in order to develop
172
Book reviews
more country specific policy decisions and resource allocation. Hopefully, this report will serve as inspiration for governments to periodically undertake these analyses at the country level as part of their policy development. Overall, this report is well conceptualised and researched, and is an extremely valuable and timely contribution both to research and policy making. It should be of interest to professionals from governments, academia, donor community and non-governmental organisations. Gladys B. Mutangadura United Nations Economic Commission for Africa Southern Africa SRDC, P.O. Box 30647 Lusaka, Zambia, South Africa Tel.: +260-1-228502/3/4/5; fax: +260-1-236949 E-mail address: [email protected] (G.B. Mutangadura) doi:10.1016/j.agecon.2003.11.006
FAO Papers on Selected Issues Related to the WTO Negotiations on Agriculture UN Food and Agriculture Organization, Rome, 2002, 286 pages, US$ 20, TC/D/Y3733/E As mentioned in the preface of the volume, the papers collected in it were prepared and presented at various Round Tables in Geneva in 2001 and early 2002. These were attended by a specialised audience (mainly country representatives/negotiators in the WTO, representatives of international organisations and NGOs, policy advisers). The papers, often accompanied by invited comments, cover a wide range of issues, but share a common objective to deal with these issues from the point of view of the developing world. All issues relevant to developing counties in the current agricultural negotiations of the Doha round are covered, from market access (food security, special and preferential treatment, the special agricultural safeguard) to export competition (food aid, state trade enterprises, the special agricultural safeguard) and some issues of domestic support (although these are only briefly touched upon). This rather wide span of topics covered, and of the time period during which they were presented,
has one side effect. Today these papers lack the timeliness that would strengthen the interest of the specialised reader with respect to their pertinence in the post-Harbinson/pre-Cancun situation. On the other hand, exactly because of this feature, the papers not only serve as a very good background into the various issues of concern regarding the impact of agricultural trade liberalisation for developing countries, but also provide a valuable insight into the extent to which these concerns are incorporated, or not, in the Harbinson modalities draft. Several of the papers are accompanied by a wealth of statistical information that sheds light on the vulnerability of the least developed of the developing countries with respect to expected impacts of trade liberalisation. Through a generally thorough identification of the issues at stake and the various aspects that relate to them, the papers reflect implicitly, but also often explicitly, the premise that potential risks from trade liberalisation outweigh expected benefits for most developing countries. This seems to also reflect the belief, based on presented facts, that there is something different about developing countries, and a differential treatment is warranted when it comes to trade liberalisation. Unfortunately, and despite its thoroughness, this identification of issues is often presented in a manner characteristic of papers prepared by and addressed to bureaucrats. And although the description of the problems is generally strong, the same cannot be said for the identification of potential solutions. One is often forced to search between the lines for a clear message, which is unfortunately often missing. Thus the reader is left to develop for him/herself the ranking of the various problems and the priorities for solutions. (It is worth mentioning an exception in this respect. Some of the liveliest pages in the volume are those relating to two papers on special and differential treatment. One, only the summary of which is included in the volume, was prepared by an (at that time) academic, S. Tangermann, while the response to it came from a representative of a country with vital interests at stake, St. Lucia’s representative to the WTO K.A. Brown.) This lack of clarity in proposed solutions is also evidenced by the fact that what could bring all this together, that is arguments that would convincingly promote the potential benefits of trade liberalisation to the developing countries, is also missing. To do
Book reviews
a wide variety of case-studies ranging from Cuba to Switzerland and from Viet Nam to Sri Lanka. Much of the substance of the book is drawn from an international study of sustainable agriculture carried out by Pretty and his colleagues at the Centre. This ‘audit [of] progress towards agricultural sustainability’ considered more than 200 projects in 52 countries. The results of the study are encouraging, particularly for small farmers: 90% of those studied farmed less than 2 ha each. In resolving the problems facing agriculture in the era of globalisation it is not sufficient to be cognisant with economics concepts, one also needs to learn what Pretty refers to in the title of one chapter as ‘Ecological Literacy’. This is a way of learning about the land to which he gives the word metis, meaning ‘forms of knowledge embedded in local experience’. This is similar to a distinction made by anthropologists between episteme, intellectual learning, and techne, a kind of learning by doing or by experience. The loss of this ‘traditional’ knowledge—whether it be the Tohono O’odham of the south-west US and their ability to name their indigenous plants and animals, or Indian healers’ knowledge of traditional plants—is, for Pretty, as serious as the loss of species or languages. Pretty describes in this chapter the importance of preserving such metis as survives and developing more such practical knowledge about the land if we are to build a sustainable future. Other chapters cover issues including the cultural importance of landscape and the impact on it of agribusiness; the economic costs of the globalised food system; and the controversy over GM food. Although the book is academically grounded, the material is treated in a way that does not deter the general reader, so many of the figures and tables are relegated to endnotes, which are long and detailed. I found this unhelpful and would have preferred linking the technical and philosophical aspects within the body of the book. Aside from this minor irritation I found the book packed with novel insights and interesting analyses and would recommend it whole-heartedly. Pretty’s conclusion is optimistic, yet challenging: “If we are to develop sustainable agricultural and food systems—even sustainable economies and societies at large—then we will need to develop new forms of social organization and ecological
literatures. Our knowledge of nature and land usually accrue slowly over time. Yet, the immediacy of the challenge means that we must move quickly in order to develop novel and robust systems of social learning. These collective systems can also promote significant personal changes. Ultimately, the barriers are inside each of us, and large-scale transformations of land and community can only occur if we cross these frontiers, too.” (p. 169). Pretty’s challenge to all who work in agricultural economics is to cross these internal frontiers. You never know: if you do, you might find yourself thinking like a wolf! Molly Scott Cato University of Wales Institute, Cardiff, UK E-mail address: [email protected] (M.S. Cato) doi: 10.1016/j.agecon.2003.11.005
World Health Report 2002: Reducing Risks, Promoting Healthy Life World Health Organization, Geneva, 2002, 250 pages, US$ 13.50, ISBN 9-2415-6207-2 The World Health Report 2002—Preventing Risks, Promoting Healthy Life—is a well researched and timely report which breaks new ground by identifying major principal global risks of disease, disability and death in the world today, quantifying their actual impacts from region to region, and providing examples of cost-effective ways to reduce them. The report sets the scene by defining risk assessment and explaining the different methods of quantifying risks to health. The report then quantifies some of the most important risks to health, globally and regionally, in terms of the burden of the diseases they cause. The 10 identified leading risk factors globally are: underweight; unsafe sex; high blood pressure; tobacco consumption; alcohol consumption; unsafe water, sanitation and hygiene; iron deficiency; indoor smoke from solid fuels; high cholesterol; and obesity. Together, these 10 health risks account for more than one-third of all deaths worldwide. Underweight closely followed by unsafe sex, are the leading risk factors in the developing countries of sub-Saharan Africa and South
Book reviews
East Asia, where poverty is a strong underlying determinant. In the most industrialised countries of North America, Europe and the Asian Pacific, the report indicates that at least one-third of all disease burdens are caused by tobacco, alcohol, blood pressure, cholesterol and obesity. The report assesses the cost-effectiveness of some of the strategies to reduce the risks to health. The report says that very substantial health gains can be made for relatively modest expenditures. It discusses different ways of attaining the same risk reducing goal; for example, the population-wide versus the individual-based approach and prevention versus treatment. Strategies to prevent childhood under-nutrition, such as micronutrient supplementation and treatment of diarrhoea and pneumonia, are reported to be cost-effective in all settings. Preventive interventions to reduce the incidence of HIV infections, including measures to encourage safer injection practices, are also reported to be cost-effective. In all settings, the absolute risk approach intervention to reduce the risks associated with cardiovascular disease is reported to be cost-effective. Populationwide strategies to lower cholesterol by reducing salt intake are reported to be very cost-effective both singly and in combination. Clear recommendations are suggested by the report. The report strongly recommends that priority be given to controlling those risks that are well known, common, substantial and widespread, and for which effective and acceptable risk reduction strategies available. If the ten main health risks are reduced by 25% within 10 years, life expectancy in industrialised and developing countries could increase by 10 and 5 years, respectively. Some of the key specific recommendations that the report suggests include the following: • Governments, especially health ministries, should play a stronger role in formulating risk prevention policies, including more support for scientific research, improved surveillance systems and better access to global information. • Countries should give top priority to developing effective, committed policies for the prevention of globally increasing high risks to health, such as tobacco consumption, unsafe sex in connection with HIV/AIDS, and, in some populations, unhealthy diet and obesity. For example, governments can
171
increase taxes on tobacco; or enact legislation to reduce the proportion of salt and other unhealthy components in foods. • Cost–benefit analyses should be used to identify high, medium and low priority interventions to prevent or reduce risks, with highest priority given to those interventions that are most cost-effective and affordable. The strength of the report lies in its ability to scientifically estimate the burden of the health risks, and present convincing evidence that can help governments of all countries to raise the life expectancy of their populations. Not only is the report an excellent advocacy tool, but it can also be used as a guide to plan allocation of resources across different risk reducing strategies. As an advocacy tool, the report can be used to challenge countries to reduce or eliminate the risk to health and raise the life expectancy of their populations. The report has objective and scientifically estimated information that shows that the cost of inaction is serious. For example, nine million deaths a year linked to smoking will be reported by 2020 if steps are not taken soon. Currently, about five million people die each year from diseases related to smoking. As a planning tool, the report can be used in defining priorities and selecting interventions, focusing on areas where the return in health gains is demonstrably greatest. The report is also an extremely valuable resource for academia. College professors and students have a practical example of how risk assessment and cost–benefit analysis can be empirically applied in real world settings and how the results can be used to identify crucial policy implications. The academic value of this report is not limited to those in the health field, but is applicable to everyone in applied economics. One shortcoming of the report is the failure to suggest in its recommendations broader strategies to address the underlying socio-economic causes of risks to health such as poverty. Yet in the reports’ analysis, there is strong evidence linking poverty to the leading health risks such as underweight and unsafe sex, suggesting that the alleviation of poverty is actually a precondition for improvements in health. Another shortcoming of the report is that its analysis is limited to global and regional levels. Many countries will require country-level analysis in order to develop
172
Book reviews
more country specific policy decisions and resource allocation. Hopefully, this report will serve as inspiration for governments to periodically undertake these analyses at the country level as part of their policy development. Overall, this report is well conceptualised and researched, and is an extremely valuable and timely contribution both to research and policy making. It should be of interest to professionals from governments, academia, donor community and non-governmental organisations. Gladys B. Mutangadura United Nations Economic Commission for Africa Southern Africa SRDC, P.O. Box 30647 Lusaka, Zambia, South Africa Tel.: +260-1-228502/3/4/5; fax: +260-1-236949 E-mail address: [email protected] (G.B. Mutangadura) doi:10.1016/j.agecon.2003.11.006
FAO Papers on Selected Issues Related to the WTO Negotiations on Agriculture UN Food and Agriculture Organization, Rome, 2002, 286 pages, US$ 20, TC/D/Y3733/E As mentioned in the preface of the volume, the papers collected in it were prepared and presented at various Round Tables in Geneva in 2001 and early 2002. These were attended by a specialised audience (mainly country representatives/negotiators in the WTO, representatives of international organisations and NGOs, policy advisers). The papers, often accompanied by invited comments, cover a wide range of issues, but share a common objective to deal with these issues from the point of view of the developing world. All issues relevant to developing counties in the current agricultural negotiations of the Doha round are covered, from market access (food security, special and preferential treatment, the special agricultural safeguard) to export competition (food aid, state trade enterprises, the special agricultural safeguard) and some issues of domestic support (although these are only briefly touched upon). This rather wide span of topics covered, and of the time period during which they were presented,
has one side effect. Today these papers lack the timeliness that would strengthen the interest of the specialised reader with respect to their pertinence in the post-Harbinson/pre-Cancun situation. On the other hand, exactly because of this feature, the papers not only serve as a very good background into the various issues of concern regarding the impact of agricultural trade liberalisation for developing countries, but also provide a valuable insight into the extent to which these concerns are incorporated, or not, in the Harbinson modalities draft. Several of the papers are accompanied by a wealth of statistical information that sheds light on the vulnerability of the least developed of the developing countries with respect to expected impacts of trade liberalisation. Through a generally thorough identification of the issues at stake and the various aspects that relate to them, the papers reflect implicitly, but also often explicitly, the premise that potential risks from trade liberalisation outweigh expected benefits for most developing countries. This seems to also reflect the belief, based on presented facts, that there is something different about developing countries, and a differential treatment is warranted when it comes to trade liberalisation. Unfortunately, and despite its thoroughness, this identification of issues is often presented in a manner characteristic of papers prepared by and addressed to bureaucrats. And although the description of the problems is generally strong, the same cannot be said for the identification of potential solutions. One is often forced to search between the lines for a clear message, which is unfortunately often missing. Thus the reader is left to develop for him/herself the ranking of the various problems and the priorities for solutions. (It is worth mentioning an exception in this respect. Some of the liveliest pages in the volume are those relating to two papers on special and differential treatment. One, only the summary of which is included in the volume, was prepared by an (at that time) academic, S. Tangermann, while the response to it came from a representative of a country with vital interests at stake, St. Lucia’s representative to the WTO K.A. Brown.) This lack of clarity in proposed solutions is also evidenced by the fact that what could bring all this together, that is arguments that would convincingly promote the potential benefits of trade liberalisation to the developing countries, is also missing. To do