Bad weather in sub-Saharan Africa increases the spread of HIV, according to a study published in the June 2015 issue of the Economic Journal, co-authored by Stanford professor and FSE fellow Marshall Burke.

When the rains fail, farmers in rural areas often see their incomes fall dramatically and will try to make up for it however they can, including through sex work. Analysing data on more than 200,000 individuals across 19 African countries, the research team finds that by changing sexual behaviour, a year of very low rainfall can increase local infection rates by more than 10%.

The results have important policy implications for fighting the spread of the epidemic, as co-author Erick Gong of Middlebury College notes:

‘Existing approaches to stopping the spread of HIV – such as promoting condom use and the use of anti-retrovirals – remain critically important. But our results suggest that other policy approaches could be very useful too – in particular, approaches that provide safety nets to rural households when the weather turns bad.’

Policies and investments seemingly unrelated to HIV – such as the promotion of rural insurance or household savings schemes, or the development of drought-tolerant crops – might have surprising benefits in slowing the HIV epidemic. Co-author Kelly Jones of the International Food Policy Research Institute says:

‘The HIV/AIDS epidemic remains one of the world’s greatest health challenges, with over a million new infections per year in Africa alone. Our results expand the menu of options for addressing the epidemic, and highlight some surprising options that are not at the forefront of people’s minds.’

The research sheds valuable light on why HIV continues to spread in Africa. Previous studies have documented in limited settings that poor women often alter their sexual behaviour in response to an income shortfall. But until now, there has been little evidence that this response is big enough to affect the trajectory of the HIV epidemic.

To fill this gap, the researchers combined data on the HIV status of thousands of people across sub-Saharan Africa with data on the recent rainfall history in each individual’s location.

Because years of low rainfall can lead to much lower incomes in these locations, particularly in rural areas where people depend more heavily on agriculture for their livelihoods, variation in rainfall provides a way to study how changes in local economic conditions affect infection rates. Co-author Marshall Burke comments:

‘We were surprised by how strong the relationship is between recent rainfall fluctuations and local infection rates. As expected, the relationship is much stronger in rural areas, and particularly for women who report working in agriculture. These are the people who really suffer when the rains fail, and who are forced to turn to more desperate measures to make ends meet.’

Notes for editors: ‘Income Shocks and HIV in Africa’ by Marshall Burke, Erick Gong and Kelly Jones is published in the June 2015 issue of the Economic Journal.

Marshall Burke is an assistant professor of Earth System Science at Stanford University. Erick Gong is an assistant professor of economics at Middlebury College. Kelly Jones is a research fellow at the International Food Policy Research Institute (IFPRI).

For further information: contact Marshall Burke on +1-650-736-8571 (email: mburke@stanford.edu); Erick Gong on +1-802-443-5553 (email: egong@middlebury.edu); Kelly Jones on +1-202-862-4641 (email: k.jones@cgiar.org); or Romesh Vaitilingam on +44-7768-661095 (email: romesh@vaitilingam.com; Twitter: @econromesh).

Philanthropist and software giant Bill Gates spoke to a Stanford audience last week about the importance of foreign aid and product innovation in the fight against chronic hunger, poverty and disease in the developing world.

His message goes hand-in-hand with the ongoing work of researchers at Stanford’s Freeman Spogli Institute for International Studies. Much of that work is supported by FSI’s Global Underdevelopment Action Fund, which provides seed grants to help faculty members design research experiments and conduct fieldwork in some of the world’s poorest places.

Four FSI senior fellows – Larry Diamond, Jeremy Weinstein, Paul Wise and Walter Falcon – respond to some of the points made by Gates and share insight into their own research and ideas about how to advance and secure the most fragile nations.

Without first improving people’s health, Gates says it’s harder to build good governance and reliable infrastructure in a developing country. Is that the best way to prioritize when thinking about foreign aid?

Larry Diamond: I have immense admiration for what Bill Gates is doing to reduce childhood and maternal fatality and improve the quality of life in poor countries.  He is literally saving millions of lives.  But in two respects (at least), it's misguided to think that public health should come "before" improvements in governance.  

First, there is no reason why we need to choose, or why the two types of interventions should be in conflict.  People need vaccines against endemic and preventable diseases – and they need institutional reforms to strengthen societal resistance to corruption, a sociopolitical disease that drains society of the energy and resources to fight poverty, ignorance, and disease.  

Second, good governance is a vital facilitator of improved public health.  When corruption is controlled, public resources are used efficiently and justly to build modern sanitation and transportation systems, and to train and operate modern health care systems.  With good, accountable governance, public health and life expectancy improve much more dramatically.  When corruption is endemic, life-saving vaccines, drugs, and treatments too often fall beyond the reach of poor people who cannot make under-the-table payments. 

Foreign aid has come under criticism for not being effective, and most countries have very small foreign aid budgets. How do you make the case that foreign aid is a worthy investment?

Jeremy M. Weinstein: While foreign aid may be a small part of most countries’ national budgets, global development assistance has increased markedly in the past 50 years. Between 2000 and 2010, global aid increased from $78 billion to nearly $130 billion – and the U.S. continues to be the world’s leading donor.

The challenge in the next decade will be to sustain high aid volumes given the economic challenges that now confront developed countries. I am confident that we can and will sustain these volumes for three reasons.

First, a strong core of leading voices in both parties recognizes that promoting development serves our national interest. In this interconnected world, our security and prosperity depend in important ways on the security and prosperity of those who live beyond our borders.

Second, providing assistance is a reflection of our values – it is these humanitarian motives that drove the unprecedented U.S. commitment to fighting HIV/AIDS during the Bush Administration.

Perhaps most importantly, especially in tight budget times, development agencies are learning a great deal about what works in foreign assistance, and are putting taxpayers’ dollars to better use to reduce poverty, fight disease, increase productivity, and strengthen governance – with increasing evidence to show for it.

Some of the most dire situations in the developing world are found in conflict zones. How can philanthropists and nongovernmental organizations best work in places with unstable governments and public health crises? Is there a role for larger groups like the Gates Foundation to play in war-torn areas?

Paul H. Wise: As a pediatrician, the central challenge is this: The majority of preventable child deaths in Sub-Saharan Africa and in much of the world occur in areas of political instability and poor governance. 

This means that if we are to make real progress in improving child health we must be able to enhance the provision of critical, highly efficacious health interventions in areas that are characterized by complex political environments – often where corruption, civil conflict, and poor public management are the rule. 

Currently, most of the major global health funders tend to avoid working in such areas, as they would rather invest their efforts and resources in supportive, well-functioning locations.  This is understandable. However, given where the preventable deaths are occurring, it is not acceptable. 

Our efforts are directed at creating new strategies capable of bringing essential services to unstable regions of the world.  This will require new collaborations between health professionals, global security experts, political scientists, and management specialists in order to craft integrated child health strategies that respect both the technical requirements of critical health services and the political and management innovations that will ensure that these life-saving interventions reach all children in need.

Gates says innovation is essential to improving agricultural production for small farmers in the poorest places. What is the most-needed invention or idea that needs to be put into place to fight global hunger?

Walter P. Falcon: No single innovation will end hunger, but widespread use of cell phone technology could help.

Most poor agricultural communities receive few benefits from agricultural extension services, many of which were decimated during earlier periods of structural reform. But small farmers often have cell phones or live in villages where phones are present.

My priority innovation is for a  $10 smart phone, to be complemented with a series of very specific applications designed for transferring knowledge about new agricultural technologies to particular regions.  Using the wiki-like potential of these applications, it would also be possible for farmers from different villages to teach each other, share critical local knowledge, and also interact with crop and livestock specialists.

Language and visual qualities of the applications would be key, and literacy problems would be constraining.  But the potential payoff seems enormous.

While many of us here in the US wake up concerned about political, economic, and military unrest at home and abroad, billions still wake up with more basic, human security concerns, opened FSE director Rosamond L. Naylor in a plenary connecting climate, energy, food, water, and health.

Are we going to have enough to eat today? How am I going to feed my family or care for family members struggling with HIV/AIDS and other infectious diesease? Is there enough water to drink, bathe, and still water my crops?

Naylor emphasized the need to bring these human security issues back into the forefront of our global conscious. While these are 'humanitarian needs at the core', they are also related to national and international security.

"When people are desperate enough, and we've seen this particularly with the food price spike in recent years, they take to the streets, and sometimes when they take to the streets they realize they are disgruntled about a number of things in addition to food prices," said Naylor.

The Arab Spring and wave of rebellions throughout the Middle East last year demonstrate the connections between food security, unmet basic needs, and national security. It has been a chaotic time for world food markets, said Naylor.

Naylor's global statistics are discouraging. Over a billion people still suffer from chronic hunger and malnutrition, 1/5 don't have physical access to water, and roughly 1.6 billion are facing economic water constraints (do not have the economic resources to access available water). Food and water insecurity are exacerbating the incidence and transmission of infectious disease.

At a time when investment is sorely needed, the Hill has been making dramatic cutbacks in foreign assistance and foreign investment is falling short. Efforts made by the private sector, philanthropy, and civil society, while valuable, remain siloed. Opportunties are being missed by not addressing the interrelated nature of food and health issues.

Despite this dire outlook, Naylor offered solutions to help us rethink our development strategy.

1. Invest in more diversified and nutritious crops that have more climate adaptation potential.
2. Consider new irrigation strategies, particularly in areas like Africa where 96% of the continent is still not irrigated. Not large dams, but small, distributed irrigation systems that rely on solar and wind.
3. Integrate food and health programs and the way we think about domestic and productive water uses.

Naylor was joined on the panel by Jeff Seabright (Vice President, The Coca-Cola Company), Daniel Gerstein (Deputy Under Secretary for Science and Technology, U.S. Department of Homeland Security), and Geoff Dabelko (Woodrow Wilson International Center for Scholars). The panel was moderated by Frank Sesno (George Washington University and Planet Forward). Video of the plenary can be found below:

Eight research projects led by multidisciplinary-faculty teams have jointly received $1.05 million in the first round of awards made by Stanford's new $3 million Presidential Fund for Innovation in International Studies.

Coit D. Blacker, director of the Freeman Spogli Institute for International Studies, said the fund is the first program launched by the university's International Initiative, which seeks to encourage collaborative, cross-disciplinary approaches to address the global challenges of pursuing peace and security, improving governance and advancing human well-being.

The multi-year projects, selected by the International Initiative's executive committee from 37 proposals, will bring together faculty from fields that traditionally do not collaborate to produce new courses, symposia, conferences and research papers. Blacker, who chairs the executive committee, said additional awards totaling about $2 million will be made in 2007 and 2008.

President John Hennessy said he supports the research projects. "The world does not come to us as neat disciplinary problems, but as complex interdisciplinary challenges," he said. "The collaborative proposals we have selected for this first round of funding offer great potential to help shed light on some of the most persistent and pressing political issues on the global agenda today."

Projects in the first round of funding include:

Governance under Authoritarian Rule. Stephen Haber and Beatriz Magaloni, political science; Ian Morris, classics, history; and Jennifer Trimble, classics. The researchers will examine the political economy of authoritarian systems and determine why some authoritarian governments are able to make the transition to democracy, stable growth and functioning institutions, while others prove predatory and unstable.

Addressing Institutional and Interest Conflicts: Project Governance Structures for Global Infrastructure Development. Raymond Levitt, civil and environmental engineering; Doug McAdam and W. Richard Scott, sociology. The project will analyze the challenges of creating efficient and effective public/private institutions for the provision of low-cost, distributed and durable infrastructure services in emerging economies.

Combating HIV/AIDS in Southern Africa: The Treatment Revolution and Its Impact on Health, Well-Being and Governance. David Katzenstein, infectious diseases; and Jeremy Weinstein, political science. Based on the 2005 Group of 8's commitment to put 10 million people infected with HIV/AIDS on treatment within five years, this project will research the impact of this treatment revolution on health, well-being and governance in sub-Saharan Africa.

Evaluating Institutional Responses to Market Liberalization: Why Latin America Was Left Behind. Judith Goldstein, political science; Avner Greif, economics; Steven Haber, political science; Herb Klein, history; H. Grant Miller, Freeman Spogli Institute (FSI)/medicine; and Barry Weingast, political science. The project will research the interaction between inequality and Latin American institutions in explaining the poor economic performance of countries in the region during the past two decades, examining why reforms such as trade liberalization have failed to yield expected results.

Feeding the World in the 21st Century: Exploring the Connections Between Food Production, Health, Environmental Resources and International Security. Rosamond L. Naylor, FSI/economics; Stephen J. Stedman, FSI/political science; Peter Vitousek, biological sciences; and Gary Schoolnik, medicine, microbiology and immunology. The group will launch a new research and teaching program, titled "Food Security and the Environment," with an initial priority on determining linkages between food security, health and international security, and globalization, agricultural trade and the environment.

The Political Economy of Cultural Diversity. James D. Fearon, political science; and Romain Wacziarg, Graduate School of Business. The researchers will assess the impact of ethnic, linguistic and religious diversity on economic growth, trade and capital flows, governance, development of democracy and political stability.

In addition, two grants to plan forthcoming research projects have received $25,000:

Global Health by Design. Geoffrey Gurtner, plastic and reconstructive surgery; David Kelley, mechanical engineering; Thomas Krummel, surgery; Julie Parsonnet, medicine, health research and policy; and Paul Yock, medicine, bioengineering. The group will design a project to examine how new technology can be used to develop effective, affordable and sustainable methods and devices to prevent disease in the world's poorest countries.

Ecological Sanitation in Rural Haiti: An Interdisciplinary Approach to Sanitation and Soil Fertility. Ralph Greco, surgery; and Rodolfo Dirzo, biological sciences. The researchers will develop a plan to test the efficacy of ecological sanitation in decreasing disease and enhancing soil fertility in rural Haiti.