Earthquakes, Governance, and Health

By: Alanna Shaikh

Right now, estimates for the final death toll of Japan’s earthquake and the aftershocks and tsunamis that followed run between 10,000 and 20,000. That’s a hideous number; a tragedy and a catastrophe that will affect Japan for generations. But the estimates of Haitian deaths are at 230,000 – 250,000, and the earthquake in Japan was 100 times stronger than the earthquake in Haiti.

Both earthquakes hit populous island nations, and were followed by aftershocks, although Japan’s aftershocks have been much worse and there was also a tsunami. What made the difference? Why did Japan fare so much better? Building codes.

Well, not just building codes – although that is a big part of it – but also earthquake preparedness, prompt emergency response, and good infrastructure. In other words, government. Good government that was ready for an emergency and acted well when that emergency occurred.

We don’t normally think about building codes and health, but these two earthquakes demonstrate that the linkages are pretty powerful.

Government regulation isn’t just important for disaster response. It matters for all kinds of health, including infectious diseases like Neglected tropical Diseases (NTDs).

Take mass drug administrations. You can’t import your NTD medications if you don’t have ports to bring in the medicines and a fairly honest customs service to clear them. You can’t manufacture drugs without a government infrastructure to certify and approve their quality. And you can’t actually get those drugs out to people in rural areas unless you have roads and bridges you can use to get there. Every single one of these functions is a good governance function. You can work around it – bribe the customs officials, run your factories unlicensed, drive SUVs off-road. But it’s slower, more expensive, and vastly less efficient.

It’s the difference between losing twenty thousand people in a catastrophic earthquake and losing a quarter million.

The problem is that public health professionals are not governance experts. Some of us have a decent sense of health sector policy and how to improve it, and you can often to apply that to other social sector issues. And health NGOs are frequently the core of civil society, so we kind of get that too. But what do we know about roads, or building codes, or import taxes?

In other words, the impact of health projects is constantly affected by factors that health type people cannot control, and wouldn’t know what to do with if they could control them. One solution posited has been cash on delivery aid, where a donor identifies the outcome they want and then the government pushes the levers that are needed. If a government has that capacity, I can see the approach working. But what do we do when they don’t? Donors could try harder to bundle development aid projects – pairing health projects with governance projects – but even that approach may be too limited.

This is where we start running into jargon like holistic approaches to development, and we roll out in territory so vague it loses meaning. But the fact remains: good governments are an important element in good health, and we need to find a way to development good governments.

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not necessarily the views and opinions of the Global Network. All opinions expressed here are Alanna’s own and not those of any employer or the US government.

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