Paper long abstract:

$10 billion goes to fight HIV/AIDS annually. This money has been accompanied by the introduction of quasi-governmental bodies, a mushrooming of civil society actors and high-level political commitments of states and international agencies. This paper argues that the multiplicity of actors involved in the HIV/AIDS response, their competing demands and desired outcomes has led to a re-modelling of the state in East Africa. This re-modelling has seen the establishment of donor-positioned governmental bodies at the height of the response; the introduction of civil society as key to the service economy; and an embedded dependency upon international aid. Crucially, the global context of decision-making implies that the reconfiguration of the state may not be limited to East Africa as global commitments have witnessed a significant increase in uptake by states throughout the world.

This paper does the following. First, it highlights the key elements of the global response to HIV/AIDS. Second, it demonstrates how these key factors have led to change within state governance and power within East Africa. Third, the paper shows how such change could be transposed to wider states and the implications this has upon understandings of the influence of international decision-making and global governance

Paper long abstract:

Historical data on Africa is often scarce and of limited reliability. Partly for this reason, economists prefer a short view analysis ignoring the important lessons that can be learned from a long term view of the development process. For eluminating what factors proved historically successful in reducing poverty, we first need to document how well-being changed, at the most disaggregated level possible. In this paper, I focus on two important dimensions of the quality of life: nutrition and health. Both dimensions can be quantified by height measurements – using new data and following a methodology which was hitherto not applied in studies of African economic history.

Body stature can serve as a gauge of nutritional status. The physical development of children is enhanced by a healthy environment, including high-quality nutrition in sufficient quantities. Deprivation, in contrast, stunts bodily growth. Because the ‘noise’ of individual genetics cancels when considering populations, population mean height can be taken as a measure of nutritional intake net of claims due to diseases. The anthropometric indicator has significant advantages. Heights measure outcomes, not inputs and they are applicable to the diverse social and economic systems that exist amongst Africans including hunters, pastoralists, subsistence farmers, cash-crop producers, and employees in the modern and informal sector. Kenya represents this diversity of social groups in one country. This and the historical background, particularly that of a settler economy with demonstrably exploitative policies, makes Kenya an extremely interesting case study.

Using height measurements of cohorts born in the 1880s, 1915s, 1960s and 2000s, I map changes in regional inequality over time finding significant spatial and temporal variations. The Central Region (north of Nairobi) underwent a remarkable transformation. The prevalence of chronic malnutrition was extremely widespread in the 1880s, but it decreased considerably by 1980. The neighbouring Kamba region, in contrast, stagnated, whereas the Nyanza and Western Region (in the west) could defend their favourable nutritional status until the 1980s. The mixed experience in Kenya provides interesting insights into the nature of the development process. Firstly, Kenya looked back on a relatively long period of improvements in well-being before it was hit by the devastating economic crisis of the 1980s. Secondly, dynamic and stagnation can be spatially very close. Thirdly, likely factors behind improvements in living standards were commercialisation of agriculture, trade, transfers of successful technologies.