Food prices and healthcare adding to unrest

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March 8, 2011 - 6:00pm

Laurie Garrett has been watching the events in the Middle East and North Africa with particular interest. Garrett is a writer and Senior Fellow on Global Health at the Council on Foreign Relations, and will speak on global health at the E.N. Thompson Forum on World Issues at the University of Nebraska Lincoln. Garrett tells NET News' Grant Gerlock that food prices and poor healthcare are two issues that have been at the center of the uprisings in Egypt and other countries in the region.

GERLOCK: Laurie Garrett, thanks very much for joining us.

GARRETT: Thank you.

GERLOCK: When we hear in the news about the events unfolding in Libya, Egypt, Tunisia, and Bahrain there's a lot of attention paid to the politics of those situations. But with your concern on health issues, do you see things different when it comes to what's happening in North Africa and the Middle East?

GARRETT: We've had a long standing set of problems in that region in terms both health and food and the basics of ensuring safe children and safe family life. Egypt for example has the world's second largest rate of hepatitis C. All due to doctors reusing syringes in their sparsely funded medical clinics and passing the virus from one patient to the next. And there's really nothing you can do for hepatitis C once it gets advanced unless you luck out with a liver transplant. And this is not a society that can handle large scale numbers of liver transplants. The other one that was interesting to me was, we all have our eyes on Benghazi now, which is the eastern part of Libya and was the first breakaway part of Libya that is leading the revolt against Moammar Gadhafi. Well, it's interest that just until maybe two years ago Benghazi was best known in the world of health for the Benghazi Six - five Bulgarian nurses and a Palestinian physician who Gadhafi claimed had spread HIV in Libya and deliberately infected children in Benghazi. All of it a huge lie. These people were imprisoned for 6 years, tortured, abused horribly and ultimately only released because of the direct intervention of President Sarkozy of France when he first took office. So we know it's a region that uses health for political reasons, administers health to those that are perhaps good loyal voters and that sort of thing and not to those who are in the general impoverished populations. It's also been very interesting to see that among the front line in rebellion in every single country - Tunisia, Bahrain, Libya, Egypt, all of them - have been the medical providers, the doctors and nurses, who have given full disclosure on their estimated numbers of people shot, murdered, killed, what have you, to international reporters and human rights organizations and have really been at the forefront I think. Anybody who paid attention recalls all the doctors that set up a sort of ad hoc medical clinic at the middle of El Tahrir square to mend those who were injured by the opponents that were supporting Mubarak.

GERLOCK: So in Egypt, for instance, with the government changing, is that a hopeful sign for greater health in that country or is that raising more delays to improving the health of Egyptians?

GARRETT: Well, nothing is going to happen very quickly because there really isn't an organized government yet. But we're already getting very excellent reporting from the Egyptian Ministry of Health. This would be from the civil servants who have been there all along, reporting disease outbreaks to WHO (World Health Organization), providing data on people with a variety of different health problems in the country. This is amazing given that they don't really have a government right at the moment. There was a showdown around health building for quite some time in Egypt because the Muslim Brotherhood figured out the government had done so poorly under Mubarak in provision of health and health services were so corrupt - you had to bribe to get sterile syringes and so on - that they set up rival primary healthcare clinics next to their mosques and overnight attracted the lion's share of the masses coming to the Muslim Brotherhood clinics. That impressed Mubarak in that he realized that this was a potential source of revolt so he hired the American MacKenzie Corporation to help redesign the existing government clinics to provide better services and a friendlier face to win people back to the government side away from the Muslim Brotherhood. So there was already a tradition of basic healthcare being a political football in the country. And I think now what we'll see is depending on the outcome of when the military hands over rule to a democratically elected government, how quickly they're able to rewrite the constitution and so on, I think we will see some pretty profound changes in the health sector. They have a lot of very skilled personnel. A lot of good doctors. A lot of good nurses. They just need appropriate supply of materiel, better clinics and funding that is really ensuring a commitment to health for the masses.

GERLOCK: One issues that may have helped push Egypt past the tipping point was food prices. Commodities have been on the rise - corn, wheat, other crops - and that's good news for farmers in Nebraska. But it's also been helping push up food prices worldwide. Who's feeling it the most when it comes to rising food prices?

GARRETT: We've been battling food inflation spikes since late 2007. It's been going up and down but the general trend overall is up and we're now at record levels for certain core grains. The only reason we're not hearing about the kinds of food riots that we heard about in 2008 is that rice so far, knock on wood, has not been part of this latest round of food inflation. But wheat has and corn has. And wheat is the core grain in the Middle Eastern diet. And whenever the core grain that is the culturally desired food around which the whole cuisine is built for a given people, whenever that core grain skyrockets in price the women get deeply distressed because now they have to make choices about what they feed their families. They can't decrease the amount of grain they purchase because their whole cuisine is built around it. So as wheat prices skyrocketed you had an elevated level of rage in Egypt, all across the region. Some countries dealt with it and are continuing to deal with it, like Saudi Arabia and most of the emirates, with food subsidies. So they're artificially holding down the prices by the government absorbing some of the added inflated costs. But you can only do that for so long. I mean, Saudi Arabia is rich enough so they could probably do it indefinitely, but most of the other countries in the region that have been hard hit - Jordan, Egypt, Libya, and so on - don't have the capacity to cap food prices indefinitely and subsidize the cost. So in Egypt you saw all the basic foodstuffs just skyrocket in cost. Not only was wheat suddenly so expensive that women couldn't make their couscous and their pita breads and so on, their falafels, but also the oils skyrocketed and it's very much a diet based on olive oil. And that just went through the roof. And alternative oils, usually cheaper things like palm oil also skyrocketed in cost. That definitely contributed to the level of rage. And it was interesting to me when interviews were done in El Tahrir square and all over Egypt and especially in Alexandria, not with young women who were kind of leading the revolt - the college aged and college graduates - but with average mothers. Every one of them cited food prices as their primary reason to say, now Mubarak must go.

GERLOCK: When you hear about the distress that's caused by food prices, How should someone regard that as a farmer in Nebraska, you know, a corn farmer or a wheat farmer. I can imagine a producer thinking, I grow my crop. I grow as much corn or wheat I can. I sell it for the best price I can find. And that's my livelihood. How should they regard stories about the women in Egypt dealing with high food prices?

GARRETT: Well, we have a number of distorting elements in the United States that drive farmers one direction or another. I'm sure especially all the corn farmers all over Nebraska feel like, you know, in one year they're getting pushed to grow for ethanol and another year everybody's saying no, no you should grow for this. Every farmer spends a lot of time trying to imagine what crop is going to draw the best commodity pricing down the road. Each year, each harvest is a gamble. That's farming. And I don't think that it's the duty of the farmer as an individual to try and figure out how to offset your own needs to make money and a decent living for your own family against families on the other side of the world. But I do think we have very clear evidence that the push for ethanol and the corn subsidies on the ethanol side have had a deleterious effect on the availability of corn worldwide, the U.S. being such an important producer. But the big issue for us right now is that the combination of the number of mouths that we're feeding as the world population has increased with the rise of the middle class, which is a good thing, in China and India in particular but generally in the world more and more of the world population has reached middle class status - means that the demand for a broader range for types of food and for meat in particular has skyrocketed and will only continue to do so. That means that we have very little leeway if anything goes wrong. And the fires in Russia and Ukraine that obliterated the wheat crop for much of the country, we didn't have the resilience to offset it. So wheat prices have skyrocketed. And similarly there isn't enough corn grown in the world to both supply everybody's automobiles and everybody's stomach. And we have to make some choices here. In the long run what I'm very excited about is that finally there's been a major breakthrough in the biology of the enzyme steps necessary to use switchgrass as an excellent source of biofuels. And since switchgrass is indigenous to the entire prairie of the United States, North America, all the way into Canada and was traditionally what our giant lawnmowers, bison, ate. And we had a whole ecology in the prairie states that was basically constant cycles of switchgrass growth mowed down by these herds of bison. It may be possible to rotate crops so that you grow a couple rounds of switchgrass for biofuel and then grow corn for food, not for biofuels and then grow corn for food not for biofuel. And this could dramatically affect the situation at least for the next decade or so, buy us a lot of time before the next crisis point.

GERLOCK: I want to ask you about the federal budget because there have been proposals in Congress to make some cuts to foreign aid. Does the U.S. contribute enough that that would possibly have a significant effect on global health programs?

GARRETT: What the U.S. contributes for all forms of foreign assistance combined and specifically for health is an absolutely trivial part of our federal budget. It is less than 1 percent. In fact, health constitutes about 0.8 percent of our federal budget. So we aren't going to retire the debt or the deficit by eliminating it. That's for sure. But it is hugely significant in terms of the global budget for health and foreign assistance, anti poverty programs, food support programs, women and child health programs and so on. Right now the United States government contributes 52 percent of all funds used internationally for all forms of global health. And as a private donor the Gates Foundation contributes 68 percent of all private giving. So if we walk away from this sense of generosity to the world we eliminate more than half of the entire budget worldwide for global health overnight.

GERLOCK: The argument is we have to cut somewhere, we can't afford everything. How do you respond to that?

GARRETT: Well, this is like saying if I pull a few hairs out of my head I'm going bald. It's such a trivial amount of money. It's nothing. It's absolutely nothing. And yet what it buys for us in good will around the world, what it buys for us in safety for our own people, because we lower the probability of pandemic diseases breaking out. We lower the probability that our own business people, our own folks doing business overseas can travel safely or acquire disease where they travel because diseases are so rampant in absence of our efforts to deal with child vaccination and so on. I mean, we are buying ourselves safety and by eliminating it we will be increasing danger for all. And I think moreover, ever single American who was watching those crucial days in El Tahrir square in Cairo and realized that it was happening because of Facebook and Twitter and U.S. smartphones and iPads and iPhones, you must have been weeping with a sense of pride at what American products, American designed goods did to bring freedom and democracy on the other side of the world. Why would we want to shut that down now? Why in the world would we want to say, you know what we gave you a lot of years of treating you for HIV but now we're going to take 4 million of you that are on medication for your HIV/AIDS infection and therefore able to stay alive to raise your children and work in the productive labor force, we're going to take those drugs away and let you die immediately. Four million people will be killed instantly if we withdraw their treatment. That's pretty much reversing all the good will we've created. You will see people in the streets. I have already seen it as they're nervous and anxious this is going to happen, of Kenya, Uganda, South Africa, all over sub-Saharan Africa saying "damn you America, you gave us and now you take away."

GERLOCK: Do you have a sense of the politics of it, whether that's a serious threat or whether it's mostly rhetoric?

GARRETT: It's a very serious threat on the House side. It's an absolute more than threat. It's a reality. The Senate side is another story. I think the whole battle is going to come down to what the Senate and House work out in conference committee, which of course is all behind closed doors. Very little is transparent or public until there's an end result. And all we can do is hold our breath and wait and see.

GERLOCK: Laurie Garrett, thanks for joining us on NET Radio.

GARRETT: Thank you.



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