Summers in a Matrix

During the question and answer session of a recent Harvard School of Public Health seminar with University President Lawrence H. Summers entitled, “Public Health Crisis in Africa: How May Harvard Help,” one particular exchange provided telling insight into the mind of Harvard’s top policy-maker—and it was not encouraging.

I raised a seemingly obvious point in the forum: some of the largest problems facing world health, such as AIDS and malnutrition, could be combated if global trade policies and U.S. foreign policy were adapted in order to prevent further impoverishment of poor countries. I asked Summers what he thought Harvard’s role should be to educate people about the matter, to which he responded that, although he wouldn’t defend every aspect of trade policies, he didn’t “actually think it is a plausible position that U.S. trade policies are a primary reason why people have AIDS in Africa or why there’s poverty in the less developed world. Far and away the greatest barriers to trade in developing countries are the barriers that they impose in a variety of ways.”

Wasn’t the World Bank’s former chief economist aware of the protectionist U.S. trade policies, including tariffs reaching 21 percent on imports from developing countries and agricultural tariffs averaging 9 percent on processed goods. And wasn’t he aware that such policies help to deprive developing countries of much needed resources?

On a global scale, the total cost of all trade barriers imposed by rich countries actually cost developing countries $100 billion—more than twice all development aid. Simultaneously, rich countries including the U.S. subsidize their farmers on the order of $350 billion dollars a year—approximately 15 times the amount that the Food and Agriculture organization estimates is necessary to halve the world’s population of hungry people by 2015, and about 10 times what Jeffrey D. Sachs suggests is necessary to eliminate the extra burden of disease in the developing world.

Farm subsidies also prevent 70 percent of the world’s population, which depends on agriculture, from competing in the global market, stifling income generation that could be used for future investment and much-needed medical care. Rather than acknowledging these problems, Summers resorted to blaming the victims, saying that the developing countries themselves impose the very barriers to trade that impoverish them.

Later in the forum, a classmate asked what Harvard’s role should be in helping to create what Presley Professor of Social Medicine Paul E. Farmer calls an “equity plan” for the distribution of technological advances. Summers responded by implying that my colleague lacked hope and was ungrateful, saying “there’s a tendency in this to defeatism and not recognizing the enormous amount of what is good that is happening in the world.... People think the Marshall Plan was really very good. The Marshall Plan provided Europe with an amount of money that was equal to about 2-3 percent of Europe’s GNP each year for four years. Sub-Saharan Africa receives each year about 11 percent of its GNP and it has for the last 20 years. And so yes, there’s certainly a case for more foreign aid in a variety of ways. But a huge amount is happening that is positive, and the things that are not happening hugely require great efforts in the societies that are at issue and are very hard to do from the outside.”

Either Summers was ignorant of the facts or deliberately misrepresenting them. Less than 10 percent of the Marshall Plan involved loans. The rest was pure aid money. Contrast this fact with Africa over the past two decades: In the 1980s, African countries were actually a net supplier of capital to industrialized countries. As late as 1993, rich countries took three dollars back in the form of loan repayments for every dollar given to Africa in aid, according to the 1995 Oxfam Poverty Report.

Even today, African countries continue to repay interest on loans whose principal has already been paid, and this debt repayment constitutes an average of 15 percent of their budget—often equal to or more than that allocated for health. Rather than coming to terms with how international financial institutions have treated Africa differently from Europe after World War II, Summers once again resorted to blaming Africa for the largest part of the problem.

Summers did propose some important remedies—increasing financial aid for public health students and making changes in the undergraduate curriculum to focus on problems relevant to developing countries. But there is much more that can be done. Educating students and officials within institutions, such as the International Monetary Fund, the U.S. Government and the World Bank, about the ways in which global trade policies continue to rob the poor would be a fine start. Summers must wake up from the rosy matrix of optimism. He must confront the consequences of our selfish policies on the developing world—before the people he wishes to help die from poverty and infectious diseases.

Felipe A. Jain is a member of the Class of 2006 at Harvard Medical School.