The Center for Global Development (CGD) is a nonprofit think tank based in Washington, D.C., and London that focuses on international development.
Kuznets predicts an economy’s return to low inequality once structural transformation has peaked. I explore some headwinds to falling inequality in developing countries given their thorough engagement in the globalized market Kuznets could not have foreseen. Headwinds include plutocrats’ abuse of open capital markets to elude taxation; populism in rich countries that prevents migration of labor from less to more productive economies; and climate damage. On structural transformation: growth and urbanization in some countries, though less dramatic than for the first industrializers, indicates it is occurring. But in countries including India and Nigeria, the services-based transformation today’s global market now requires depends on a dramatic upgrade in the quality of basic education.
Objectives Health systems in Latin America and the Caribbean face pressures from rising healthcare costs, inflation, and limited revenue growth. Rationalizing inappropriate or unnecessary uses of technologies can enhance efficiency and sustainability. Disinvesting in obsolete or ineffective technologies is a key part of that effort. This study aims at measuring and quantifying the potential savings from disinvesting in the use of 6 candidate health technologies in the contributory regimen of the Dominican Republic. The analysis focuses on evaluating these savings and estimating the opportunity cost of such disinvestment. Methods The methodology consists of 4 key steps. First, the necessary data for analysis are identified from the contributory regimen of the Dominican Republic. Second, the baseline case for evaluation is defined. Third, the level of waste for each prioritized technology is estimated, along with the potential savings generated through divestment. Finally, the opportunity cost of reallocating these savings to selected cost-effective alternatives (best buys) is quantified, providing a comprehensive assessment of the impact of divestment. Results Six candidate health technologies for disinvestment were evaluated. Disinvestment in the candidate technologies could yield potential savings ranging from $122 113 to $8.6 million US dollars in the Dominican Republic. We present results in terms of how much those potential savings could contribute to (1) reducing coverage gaps for cost-effective interventions and (2) lead to quality-adjusted life-years gained. Conclusions This study demonstrates the potential of disinvesting in specific use of technologies to enhance health efficiency in the Dominican Republic.
Lead poisoning affects one in three children globally, with large but neglected impacts on health and education. One important source of exposure is the use of lead as a pigment in the form of lead chromates, in paints, plastics, and even food. Lead chromates are toxic and safe alternatives exist: Its continued use is effectively prohibited in the European Union and the United Kingdom and is highly restricted in other high-income countries. In this paper, we present new data documenting the global trade in lead chromates. Exports are dominated by companies based in India, but we also show significant ongoing exports from high-income countries including the United States, Canada, and Spain, despite these countries placing bans or strong restrictions on use in their own territories. Many exports go to countries with low capacity to regulate its end use and prevent highly hazardous applications. While the harm posed by any particular shipment or actor depends on the end use of the exported lead chromates, which is not possible to determine, the volume of exports from rich to poor countries could be sufficient to poison hundreds of thousands of children. We conclude with recommendations to policymakers to end the detrimental and unnecessary use of lead chromates.
This study explores how, in the eastern Democratic Republic of the Congo, the introduction of ICT technology among cacao farmer cooperative members relates to farmer-to-farmer and extension-farmer communication networks, as well as farmer knowledge and collective action. Using a mixed-methods impact evaluation approach, 563 baseline surveys, 393 endline surveys, and 29 interviews were conducted in five communities in eastern Democratic Republic of the Congo. A quantitative Difference in Difference analysis coupled with qualitative analysis were conducted to evaluate changes in farmer-to-farmer and farmer-extension communication networks, knowledge, and collaboration. It is found that the capacity of smallholder farmers in post-conflict regions to leverage ICT to their advantage, despite infrastructural and governance challenges. The ICT technology improved communication of logistical and organizational information. Enhanced connectivity enabled farmer collective action, including organizing in response to crop theft and collectively lobbying for their rights as producers. Lack of reliable infrastructure presents an obstacle to the effectiveness of ICTs, a challenge that is compounded by the precarity of regions with persistent conflict. This study provides crucial insight into the agency and innovativeness of smallholder farmers in post-conflict fragile settings.
Background Lead is a well-recognized neurotoxic metal with demonstrated consistent detrimental effects on children’s intelligence quotient (IQ) in the postnatal period. However, there is no such consensus about the effects of prenatal exposures. Aim We aimed to examine the effect of prenatal lead exposure on children’s intelligence quotient. Methodology We conducted a systematic review with meta-analysis based on three databases: PubMed (MEDLINE), Web of Science, and Lilacs (Latin American and Caribbean Health Sciences Literature). We included studies where exposure involved biomarkers of lead exposure (e.g., blood, urine, etc.) during the prenatal period, and global IQ assessments were conducted in children aged 5 years or older. We standardized the estimates to linear point estimates. The Risk of Bias (RoB) in Non-randomized Studies of Exposures (ROBINS-E) tool was used to evaluate potential systematic errors. We analyzed the pooled estimates using random effects models, also considering fixed effects models. Pooled effects were examined separately by sex. To assess heterogeneity across studies, we employed the I2 statistic and Cochran’s Q test. Results Only 7 studies were included in analyses. In those studies evaluating blood lead levels, we found a modest negative association between prenatal Pb and standardized IQ scores, although the confidence interval included the null value (β: −0.06; 95%CI: −0.17, 0.05; I2: 24.1%). Conclusion Results from our study suggest that prenatal lead exposure may be associated with modestly lower intelligence quotient scores in children 5 years and older. However, research is sparse and more studies are needed to investigate confounding factors and whether the effect varies by sex.
