The Vertical Flow of Primary Sector Exports and Deforestation in Less-Developed Countries: A Test of Ecologically Unequal Exchange Theory

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The Vertical Flow of Primary Sector Exports and Deforestation in Less-Developed Countries: A Test of Ecologically Unequal Exchange Theory
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  Throughout the majority of the twentieth century, global inequality in health out-comes declined as most of the world experienced substantial economic gains and the availability of medicine, sanitation, and health interventions spread, especially to less-developed nations (Madzumdar 2001; Riley 2005; Soares 2007). During this period, the largest improvements in life expectancy were evidenced in the poorest of nations, where life expectancy scores have historically been the lowest (Clark DISEASE, WAR, HUNGER, AND DEPRIVATION: A CROSS-NATIONAL INVESTIGATION OF THE DETERMINANTS OF LIFE EXPECTANCY IN LESS-DEVELOPED AND SUB-SAHARAN AFRICAN NATIONS KELLY F. AUSTIN Lehigh University LAURA A. MCKINNEY Tulane University ABSTRACT:  Researchers note a recent trend of increasing inequality in cross-national life expectancy rates, largely due to conditions in the  poorest of nations. Threats to life expectancy in less-developed nations include poverty, warfare, intense hunger, and disease, particularly AIDS/  HIV. This article utilizes structural equation models for a sample of less-developed nations and a subsample of Sub-Saharan African nations to test interrelationships among predictors. Findings indicate modernization to be the most robust predictor of life expectancy across less-developed nations and HIV to be the strongest determinant of life expectancy in Sub-Saharan  African nations. Somewhat surprisingly, warfare and hunger do not have direct impacts on life expectancy among less-developed nations; however, important linkages among warfare, hunger, and disease are evidenced in the Sub-Saharan African sample, along with a notable positive influence of modernization on HIV rates. The findings demonstrate the significance of HIV on cross-national life expectancy scores and illuminate unique dynamics in Sub-Saharan Africa. Keywords: cross-national, HIV, hunger Sociological Perspectives  ,   Vol. 55, Issue 3, pp. 421–447, ISSN 0731-1214, electronic ISSN 1533-8673. © 2012 by Pacific Sociological Association. All rights reserved. Please direct all requests for permission to photo-copy or reproduce article content through the University of California Press’s Rights and Permissions website, at http://www.ucpressjournals.com/reprintinfo.asp. DOI: 10.1525/sop.2012.55.3.421. Address correspondence to: Kelly F. Austin 681 Taylor Street, Bethlehem, PA 18015; e-mail : kellyaustin@lehigh.edu.  422 SOCIOLOGICAL PERSPECTIVES Volume 55, Number 3, 2012 2011; Goesling and Firebaugh 2004; Madzumdar 2001). More recently, sociological and demographic research documents a major turnaround in the mid-1990s, where inequality in life expectancy across nations began to increase (e.g., Cornia, Rosignol, and Tiberti 2009; Goesling and Firebaugh 2004; Neumayer 2004; Riley 2005; Soares 2007). There are four explanations that have consistently been linked to declines in life expectancy—poverty (Clark 2011; Soares 2007), deaths from war-fare (Li and Wen 2005), hunger (Plümper and Neumayer 2006), and the AIDS/HIV pandemic (Goesling and Firebaugh 2004; Neumayer 2004; Riley 2005; Scanlan 2010). Although these factors are known contributors to life expectancy scores (in direct and indirect ways), we are unaware of any cross-national, empirical exami-nation that simultaneously examines the effects of these variables or the interrela-tions among them. Thus, we offer a direct and indirect effects model of four likely predecessors to life expectancy (poverty, deaths from war, severity of hunger, and disease) that includes theoretically hypothesized relationships regarding moderni-zation and dependency gleaned from the cross-national literature on health and well-being (e.g., Brady, Kaya, and Beckfield 2007).Most of the existing research on life expectancy argues that growing health inequalities are largely due to adverse disease conditions in Sub-Saharan Africa, as nations from this region face heightened rates of AIDS/HIV prevalence and are among those that have experienced actual declines in national life expectancy scores in the most recent years (e.g., Goesling and Firebaugh 2004; Neumayer 2004). Indeed, AIDS is now a leading cause of death globally, and Sub-Saharan Africa accounts for around 70 percent of the world’s HIV infections and AIDS deaths (UNAIDS 2006). Although this infection is most prevalent in Sub-Saharan Africa, other regional patterns are also emerging, where less-developed nations in Central America and Southeast Asia also suffer from elevated AIDS/HIV rates (UNAIDS 2006). Besides the influence of deadly diseases such as AIDS/HIV, Sub-Saharan Africa stands out as a region likely to face deteriorating levels of physical well-being given the degree of poverty, hunger, and warfare that characterizes this region. Certainly, issues of disease, poverty, hunger, and war are not independent, but rather share complex linkages and interdependencies that influence one another. For example, hunger and warfare have been linked to increasing rates of HIV transmission in several case studies (a point that we will consider further in later sections), 1  and each of these factors is also likely to have their own unique effects on life expectancy scores. Furthermore, while these social problems are heightened in the region of Sub-Saharan Africa, disease, intense warfare, and hunger are not endemic to Africa;  but more accurately, we see elevated levels of these social ills across impoverished nations, particularly those in Latin America and Southeast Asia as well. This article contributes to the growing comparative literature on physical well-being by empirically examining the extent to which world-system position, modernization, deaths from war, intense hunger, and the AIDS/HIV virus con-tribute to life expectancy rates cross-nationally. Additionally, we consider plau-sible associations among the identified indicators, as these factors influence one another and thus are likely to have both direct and indirect effects on life expec-tancy scores. The inclusion of development and dependency predictors facilitates  Disease, War, Hunger, and Deprivation 423 our goal to reach a comprehensive explanation of the major determinants of life expectancy from a global perspective, for both less-developed nations and Sub-Saharan African nations. In so doing, we offer conclusions regarding the precur-sors of premature death—one of the most important elements of development in the world-system. THE EFFECTS OF DEVELOPMENT AND DEPENDENCY ON LIFE EXPECTANCY Comparative research routinely finds that economic development, typically mea-sured as increases in per capita GDP, is one of the strongest factors improving life expectancy and other physical quality of life outcomes in less-developed nations (e.g., Elo 2009; Firebaugh and Beck 1994; Lorentzen, McMillan, and Wacziarg 2008; Pritchett and Summers 1996). Additionally, this body of research also finds that other indicators of development such as expanding education, urbanization, and sanitation are also positively correlated with national health measures, including life expectancy (e.g., Burroway 2010; El-Ghannam 2002; Elo 2009; Pritchett and Summers 1996; Riley 2005; Shircliff and Shandra 2011; Soares 2007). These find-ings are consistent with the modernization perspective in global sociology, which posits that all nations are moving from primitive to advanced states, which is marked by increasingly complex and productive economies and improvements in social and economic well-being (Durkheim 1893/1997; Friedman 2005; Rostow 1960/1990; Smelser 1964).According to modernization perspectives, increases in national income spur a trickle-down effect, where individual incomes also grow and lead to an enhanced quality of life (Durkheim 1893; Rostow 1960/1990). Concomitantly, gains in educa-tion, urbanization, and sanitation are often associated with the adoption of health-ful behaviors and increased availability of health resources, both of which improve physical well-being (El-Ghannam 2002; Pritchett and Summers 1996; Soares 2007). Indeed, many studies demonstrate that despite the obvious connection between GDP growth and life expectancy gains, education, urbanization, and improvements in health infrastructure, such as access to clean water or sanitation, are often more robust predictors of life expectancy and other measures of well-being in less-devel-oped nations (e.g., Brady et al. 2007; Riley 2005; Soares 2007). Despite this, many proponents of modernization argue that increasing national GDP is the best way to increase life expectancy, and that poor nations could benefit from technology transfers, higher levels of foreign investment, attracting foreign businesses, increas-ing exports, specializing in comparative advantages, and utilizing Western models for development (e.g., Firebaugh and Beck 1994; Friedman 2005; Goesling and Firebaugh 2004; Rostow 1960/1990; Smith 1776). Notably, these prescriptions for modernizing parallel those advocated to less-developed nations by international organizations such as the World Trade Organization (WTO), the World Bank, and the International Monetary Fund (IMF) that view economic globalization as a means to achieving development (McMichael 2004; Stiglitz 2007). Regrettably, the lack of success of these strategies for inciting development has  been noted by economic practitioners (e.g., Stiglitz 2007) and world-system and  424 SOCIOLOGICAL PERSPECTIVES Volume 55, Number 3, 2012  dependency scholars alike (e.g., Dixon and Boswell 1996; Kentor and Boswell 2003; McMichael 2004; Wimberley and Bello 1992). 2  In contrast to modernization approaches, these theorists postulate that the structure of wealth and power in the world-system reinforces and reproduces states of dependency in peripheral and semi-peripheral locales, with attendant adverse impacts on measures of well-being (e.g., Amin 1976; Bradshaw and Huang 1991; Clark 2008; Ragin and Bradshaw 1992; Wallerstein 1974; Wimberley and Bello 1992). According to this perspective, the maintenance of core nations at the top of the global hierarchy is achieved via the installation of neo-liberal economic policies, patterns of international trade includ-ing narrow trading partners and commodity export profiles in less-developed nations, disproportionate political influence and representation, and domination in military power, all of which truncate economic and social development in semi-peripheral and peripheral regions (Amin 1976; Chase-Dunn 1998; Clark 2008; Frank 1978; McMichael 2004; Snyder and Kick 1979; Wallerstein 1974). World-systems and dependency theorists emphasize that despite overall economic gains worldwide, the developmental gap—including inequalities in health—between more- and less-developed nations has widened during the last several decades (e.g., Alderson and Nielsen 1999; Bergesen and Bata 2002; Clark 2011; Korzeniewicz and Moran 1997). Indeed, development in the world-system is seen as a zero-sum game, where the modernization of core states is enabled through the underdevelopment of periphery states, and depressed lev-els of physical well-being will therefore be persistent features of less-developed nations (Amin 1976; Frank 1978; Hornborg 2001; Wallerstein 1974). This is because the proliferation of neo-liberal economic doctrine allows affluent nations to use less-developed regions as sources of cheap labor and natural resources, which reinforces global inequalities over the long term (Bunker and Ciccantell 2005; Hornborg 2001; McMichael 2004). Thus, even when gains in national GDP are made among poorer nations, the extent to which this translates into improved well-being for the masses is questionable. As inequalities in health have risen over the last few decades (e.g., Clark 2011), it is necessary to look beyond conventional aspects of underdevelopment to consider how these dynamics also influence the proximate factors that would lower estimates of life expectancy—including disease, severe hunger, and deaths from warfare. We now turn to a discussion of the AIDS/HIV pandemic, as we predict this virus to be one of the most prominent determinants of cross-national life expectancy rates, especially in Sub-Saharan Africa. 3  Following this, we turn to discussions of hunger and warfare, as these factors are theorized to influence national life expectancy in direct and indirect ways. THE AIDS/HIV PANDEMIC There are about 33 million people globally living with HIV or AIDS, 95 percent of which are located in less-developed nations (UNAIDS 2006). Infection of the AIDS/HIV virus occurs during the transmission of human body fluids, most com-monly through blood, semen, vaginal secretions, and breast milk (Barnett 2004; Heimer 2007). In poor communities, the typical period from initial infection to  Disease, War, Hunger, and Deprivation 425 death is between five and eight years (Barnett 2004). Thus, this disease has impor-tant ramifications for national life expectancy scores. Life-prolonging therapies, such as anti-retroviral therapies (ARTs), are emerging, but these are very expen-sive and therefore are not used as widely in poor nations (Barnett 2004; Garnett, Grassly, and Gregson 2001; Heimer 2007). The spread of AIDS/HIV spurs increased pressure on medical resources, elevates the numbers of orphaned children, cre-ates prolonged absence from work, causes decreases in household incomes, and stimulates higher household expenses (Barnett 2004; Heimer 2007). In addition, AIDS/HIV is likely to have profound effects on national development, as the age group most likely to be affected by AIDS/HIV is working-age adults. The impair-ment of infected individuals’ labor power during what is otherwise considered the most productive stage in the life course undeniably impedes national trajectories of growth and development (e.g., Garnett et al. 2001; Ukpolo 2004).Globally, the HIV incidence rate (the number of new HIV-infected people as a proportion of previously uninfected persons) is believed to have peaked in the late 1990s and has subsequently stabilized (Bongaarts, Buettner, Heilig, and Pelletier 2008; UNAIDS 2006). Changes in incidence, rising AIDS mortality, and population growth have caused global AIDS/HIV prevalence rates to level off. However, the absolute number of people infected with AIDS/HIV continues to increase over time (UNAIDS 2006). The patterns in prevalence represent a sociological issue as this disease, like many others, follows traditional cleavages along the lines of race, class, and gender. Poor African women represent the group most likely to be infected with the virus cross-nationally (Heimer 2007; UNAIDS 2006). Their dis-advantaged position within their own society and across nations, generally, often means these women are the least likely to be able to seek treatment for this oth-erwise terminal illness (e.g., Scanlan 2010; Shircliff and Shandra 2011), an issue to which we now turn.One of the factors associated with the leveling off of AIDS/HIV incidence rates are external funds from large, well-established international agencies such as the World Health Organization (WHO) and the United Nations (UNAIDS). Programs such as these can account for around two-thirds of AIDS/HIV spending in poor nations, and the most common support comes in the form of ART drugs. These drugs are useless, however, without trained staff to administer them safely, which depends on the existence of other resources (Bates et al. 2004; Heimer 2007). Less-developed nations tend to have inadequate and underfinanced health care sys-tems, contributing to higher rates of prevalence and lower rates of treatment (e.g., Bates et al. 2004).The AIDS/HIV pandemic is most pronounced in less-developed nations not only because people in these regions are likely to have poor access to health care and treatments, but also because many live in unhealthy conditions (including limited use of disease-blocking contraceptives) and engage in work/migration patterns that facilitate increased rates of transmission (Heimer 2007; McIntosh and Thomas 2004; Shircliff and Shandra 2011). For example, many Sub-Saharan Afri-can men leave their isolated rural villages for temporary work in the cities or in other regions. Absence from home inflates opportunities to engage in unsafe sex practices, possibly resulting in the contraction of sexually transmitted infections,
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