Health and State Capacity

I hypothesize that states with relatively low levels of capacity, but governed well, can respond with reasonable efficacy to the epidemic and control its further spread. This has occurred in Thailand, which saw political elites use their power to mobilize civil society in a bid to reduce risky behavior.18 Both of those countries have seen their serop-revalence levels of HIV infection decline significantly over the past decade. However, countries with middling to low levels of capacity, combined with poor governance, have been ineffective at containing the spread of the contagion, and in mitigating its adverse economic and political effects (e.g., Zimbabwe).

In the context of the HIV/AIDS epidemic this is of utmost importance as it helps to explain differential outcomes in the ability of governments to respond to the epidemic and maintain economic and political stability. For example, Botswana has much better political leadership and higher empirical levels of state capacity than Zimbabwe,19 despite having a slightly higher HIV seroprevalence rate. It is probable that this combination of effective political leadership and higher endogenous capacity (due to revenues from mineral exports) has moderated the negative effects of the pandemic, whereas Zimbabwe is seeing significant socio-economic destabilization as a result of HIV/AIDS.

This chapter draws on the preliminary finding that there is a strong positive empirical association between population health and state capac-ity.20 Population health is measured through indicators of Life Expectancy and Infant Mortality. In an empirical cross-national study of 20 countries, utilizing 40 years of data, Price-Smith demonstrated that public health is a major driver of state capacity. That prior work also revealed the existence of a feedback loop between population health and state capacity, wherein a 15-year lagging of the variables demonstrated that health is a stronger driver of capacity than the obverse. Altogether this suggests that significant declines in population health (regardless of the source of decline) will therefore generate significant declines in downstream state capacity. Given adult seroprevalence rates of 20.1 percent, the HIV/AIDS epidemic has dramatically eroded life expectancy in Zimbabwe and significantly compromised the welfare of the population as a whole.

One might reasonably ask why Zimbabwe seems to be reeling under the epidemic while its neighbor Botswana (possessing a marginally higher adult HIV seroprevalence rate of 24.1 percent) remains generally stable. It seems reasonable to assume that state capacity is an intervening variable between the independent variable of political will on the one hand, and the dependent variable of political stability on the other. Botswana is an interesting case because it is a relatively prosperous rentier state with significant mineral wealth, high per capita income (US$3,100 per annum), and therefore relatively higher levels of state capacity than Zimbabwe. Moreover, Botswana possesses relatively effective political leadership in President Festus Mogae, an Oxford-trained economist who is engaged in efforts to blunt the negative effects of the epidemic on the people of Botswana. The Mogae administration has provided significant leadership in mobilizing communities to reduce endogenous transmission, and has promised that infected persons will receive free anti-retroviral therapy to prolong their lifespan and their productivity. Thus, Botswana possesses several critical advantages over Zimbabwe, higher capacity, better political leadership, and greater levels of legitimacy in the eyes of its people.

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