1. Disease Control, Demographic Change and Institutional Development in Africa Margaret S. McMillan Department of Economics, Tufts University http://margaretsmcmillan.com/ William A. Masters Department of Food and Nutrition Policy, Tufts University http://sites.tufts.edu/willmasters Harounan Kazianga Department of Economics, Oklahoma State University http://www.hkazianga.org/ Revised version of NBER Working Paper No. 17718, entitled Rural Demography, Public Services and Land Rights in Africa: A Village-Level Analysis in Burkina Faso

2. Abstract: Our paper in 150 words This paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions. Disease, Demography and Institutional Development Motivation | Data | Method | Results

3. Abstract: Our paper in 150 words This paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions. Disease, Demography and Institutional Development Motivation | Data | Method | Results

4. Abstract: Our paper in 150 words This paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions. Disease, Demography and Institutional Development Motivation | Data | Method | Results

5. Abstract: Our paper in 150 words This paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions. Disease, Demography and Institutional Development Motivation | Data | Method | Results

6. Abstract: Our paper in 150 words This paper addresses the role of tropical disease in rural demography, land use rights and public amenities, using data from Onchocerciasis (river blindness) control in Burkina Faso. We combine a new survey of village elders with historical census data for 1975-2006 and geocoded maps of treatment under the regional Onchocerciasis Control Program (OCP). The OCP ran from 1975 to 2002, first spraying rivers to stop transmission and then distributing medicine to help those already infected. Controlling for time and village fixed effects, we find that villages in treated areas acquired larger populations and also had more cropland transactions, fewer permits required for cropland transactions, and more regulation of common property pasture and forest. Treated villages also acquired closer access to electricity and telephone service, markets, wells and primary schools, with no difference in several other variables. These results are consistent with both changes in productivity and effects of population size on public institutions. Disease, Demography and Institutional Development Motivation | Data | Method | Results

7. What are the deep determinants of global poverty? Why are some still so poor, long after others got so rich? The most visible variation is explained by social choices especially institutional rules and government policies Those differences can in turn be traced to physical geography especially tropical climate and landlocked isolation Do geographic factors still matter today? Do yesterdays obstacles still limit peoples choices? We might look where a new technology has helped overcome an old geographic obstacle, and see how people respond… Disease, Demography and Institutional Development Motivation | Data | Method | Results

8. Tropical disease control as natural experiment Tropical diseases are location-specific, often endemic in a particular place In the 20 th century, especially after World War II, there were many breakthroughs against tropical disease… The particular tropical disease control we study was unusual: Big enough to matter, but varied enough to measure (All across Africa, including about 60% of Burkina Faso) Suddenly brought under control in recent decades (From 1975 to 2002, between census years) Clearly exogenous to Burkina Fasos own choices (Same treatment across almost all of West Africa) Disease, Demography and Institutional Development Motivation | Data | Method | Results

9. The details of Onchocerciasis A species of blackfly (Simulium damnosum) breed in rivers, bite people and pick up Onchocerca larva transmit the Onchocerca to its next victim A species of worm (Onchocerca volvulus) grow in nodules under your skin, live for about 14 years release millions of microfilarial larva that live or up to 2 years in the human host, who they maim and blind, and viable for 6-8 days in the blackfly during transmission to next victim = > Endemic in hot, tropical places near to rivers (up to 40 km?), with low population density (under 35-50 people/km2) Disease, Demography and Institutional Development Motivation | Data | Method | Results

10. Disease, Demography and Institutional Development Motivation | Data | Method | Results Source: Carter Center (2010), River Blindness Programs. http://www.cartercenter.org/health/river_blindness.http://www.cartercenter.org/health/river_blindness

11. Disease, Demography and Institutional Development Motivation | Data | Method | Results The West Africa Onchocerciasis Control Program (OCP) Step 1: Spray larvacide in rivers, to stop blackfly reproduction In the late 1950s, French researchers mapped the blackfly larva and showed that killing them would stop transmission From 1975, World Bank and other donors paid for helicopters to spray larvacide over rivers in Oncho areas across Africa Source: IRD (2010), Onchocerciasis. http://en.ird.fr/all- the-current-events/news/onchocerciasis-an-exemplary- control-programme.http://en.ird.fr/all- the-current-events/news/onchocerciasis-an-exemplary- control-programme Source: WHO (n.d.), African Programme for Onchocerciasis Control. http://www.who.int/apoc/onchocerciasis/control/en.http://www.who.int/apoc/onchocerciasis/control/en

12. Disease, Demography and Institutional Development Motivation | Data | Method | Results The West Africa Onchocerciasis Control Program (OCP) Step 1: Spray larvacide in rivers, to stop blackfly reproduction Step 2: Distribute deworming meds, to kill microfilaria Source: Merck (2012), www.mectizan.orgwww.mectizan.org In the 1980s, a veterinary deworming drug called ivermectin (Mectizan) was found to control Onchocerciasis symptoms in people Since 1987, Merck has given the drug freely for distribution by aid agencies in affected areas

13. Disease, Demography and Institutional Development Motivation | Data | Method | Results The West Africa Onchocerciasis Control Program (OCP) spraying stopped in 1989, after 14 years (no new transmission) ivermectin distribution stopped in 2002 (and continues elsewhere)

14. Disease, Demography and Institutional Development Motivation | Data | Method | Results OCP Results in West Africa Burkina Faso Estimated Onchocerciasis Prevalence in West Africa Prior to control (1974)After control (2002) Source: WHO, Onchocerciasis Control Programme ( www.who.int/apoc/onchocerciasis/ocp). www.who.int/apoc/onchocerciasis/ocp How did people respond?

15. Disease, Demography and Institutional Development Motivation | Data | Method | Results How might people have responded to Oncho control? Move into and invest in previously Oncho-affected areas Improve institutions and public policies in those areas If we observe this in response to the OCP during 1975-2002… Then the presence of Oncho can help explain why these locations stayed poor …which in turn implies that OCP-type programs to overcome other geographic problems can help disadvantaged locations because their deep determinants of historical underdevelopment might still be operative today

16. Disease, Demography and Institutional Development Motivation | Data | Method | Results Villages Location, Population Growth 1975-85 and Oncho Status

17. Survey Method Universe is 747 villages in the national farm survey of the Office of Agricultural Statistics in Burkina Faso, minus 118 subject to AVV planning, and 14 missing from census data, for a sample of 615 villages Survey asks a focus group of elders to recall: – the status of the villages land rights and distance to various public amenities, – now and in the past, – recording the year of each change. Responses permit construction of 3-step time series – we use only the situation in 1975, 1985, 1996 and 2006 – some villages did not report some data, so samples vary Disease, Demography and Institutional Development Motivation | Data | Method | Results

18. Questionnaire design: land rights Disease, Demography and Institutional Development Motivation | Data | Method | Results N°QuestionsRéponse VIII.1 Type de droit appliquée pour les terres de culture (si la réponse est non, mettre des croix à année de début dapplication) Type de droit appliquée (1=Oui ; 0=Non) Année de début dapplication VIII.1.1 Propriété individuelle |____||____|____|____|____| VIII.1.2 Propriété collective-familiale |____||____|____|____|____| VIII.1.3 Propriété collective-communautaire |____||____|____|____|____| VIII.2 Location, vente et prêts de terres de culture (si la réponse est non, mettre des croix à année de début dapplication) Possibilité de transaction (1=Oui ; 0=Non) Année de début dapplication VIII.2.1 Est-ce que la terre peut-être louée ? |____||____|____|____|____| VIII.2.2 Est-ce que la terre peut-être vendue ? |____||____|____|____|____| VIII.2.3 Est-ce que la terre peut-être prêtée ? |____||____|____|____|____|

19. Questionnaire design: distance to services Disease, Demography and Institutional Development Motivation | Data | Method | Results N°QuestionsRéponse Distance (en km)Année détablissement V.1Distance entre le village et ladministration centrale (pour les registres des naissances) V.1.1 La situation actuelle|____|____|____||____|____|____|____| V.1.2 La situation précédente|____|____|____||____|____|____|____| V.1.3 La situation antécédente|____|____|____||____|____|____|____| V.2Distance entre le village et la route praticable par car ou camion toute lannée V.2.1 La situation actuelle|____|____|____||____|____|____|____| V.2.2 La situation précédente|____|____|____||____|____|____|____| V.2.3 La situation antécédente|____|____|____||____|____|____|____|

20. Our measures of property rights – Are (or were) land rights assigned to individuals? – Do (or did) cropland transactions occur? – Is (or was) pasture access regulated? – Is (or was) forest access regulated? – Do (or did) cropland transactions require a permit? Disease, Demography and Institutional Development Motivation | Data | Method | Results

21. Our measures of public amenities – Road – Bus Stop – Bank – Electricity – Telephone – Public Market – Livestock Market – Private Shop – Water Well – Borehole – Dam – Primary School – Secondary Sch. – Health Clinic – Church – Mosque – Temple Disease, Demography and Institutional Development Motivation | Data | Method | Results Distance (km) from village to nearest:

22. Descriptive statistics: property rights in census years Disease, Demography and Institutional Development Motivation | Data | Method | Results Source: Table 1: Mean, standard deviation, and sample size for all variables in each year

23. Descriptive statistics: distance to amenities Disease, Demography and Institutional Development Motivation | Data | Method | Results Source: Table 1: Mean, standard deviation, and sample size for all variables in each year

24. Descriptive statistics: distance to amenities (contd) Disease, Demography and Institutional Development Motivation | Data | Method | Results Source: Table 1: Mean, standard deviation, and sample size for all variables in each year

25. Do treated and control villages differ at baseline? Disease, Demography and Institutional Development Motivation | Data | Method | Results Population and land rights Table 2: Mean, standard deviation and difference between treated and control areas in 1975

26. Do treated and control villages differ at baseline? Disease, Demography and Institutional Development Motivation | Data | Method | Results Transport and infrastructure Table 2: Mean, standard deviation and difference between treated and control areas in 1975

27. Do treated and control villages differ at baseline? Disease, Demography and Institutional Development Motivation | Data | Method | Results Markets and water sources Table 2: Mean, standard deviation and difference between treated and control areas in 1975

28. Do treated and control villages differ at baseline? Disease, Demography and Institutional Development Motivation | Data | Method | Results Schooling, health and religious services Table 2: Mean, standard deviation and difference between treated and control areas in 1975

29. Our regressions are: Where: I is the institutional outcome of interest for the village, Pop is population of the village, are fixed effects for all villages, and β is the difference-in-difference estimator of treatment effects. In Equation (3), Pop is endogenous so we instrument it with the predicted value from equation (1), using 2SLS. Disease, Demography and Institutional Development Motivation | Data | Method | Results Regression specification

30. Disease, Demography and Institutional Development Motivation | Data | Method | Results OLS estimates of equation (1) Dependent variable:Post-75Post-85Annual Data log of village population(1)(2)(3) Treated X Post-75 (1985-2006)0.33*** Treated X Post-85 (1996-2006)0.25*** Treated X 19850.24*** Treated X 19960.39*** Treated X 20060.39*** Post-75 (1985-2006)0.09 Post-85 (1996-2006)-0.09* Year = 19850.21*** Year = 19960.17** Year = 2006-0.11 Constant6.68***6.88***6.68*** R-squared0.470.450.48 Table 3: OLS results for village population on Onchocerciasis treatment status and time

31. Disease, Demography and Institutional Development Motivation | Data | Method | Results OLS estimates of equation (2) Dependent variable: Land rights assigned to individuals Land transactions occurred Pasture access is regulated Forest access is regulated Land transactions require permit (1)(2)(3)(4)(5) Panel A: Post-1975 Treated X Post-75 (1985-2006)0.020.04***0.020.03*-0.04*** Time = 1985-20060.02**0.000.11***0.04*** Constant0.39***0.84***0.23***0.08***0.34*** R-squared0.960.920.83 0.96 Panel B: Post-1985 Treated X Post-85 (1996-2006)0.02**0.04***0.05***0.02*-0.05*** Time = 1996-20060.02***0.00*0.09***0.05***0.04*** Constant0.39***0.85***0.26***0.09***0.34*** R-squared0.960.930.84 0.96 Panel C: Annual Data (reported in paper - not shown here) Main results for land rights only Table 4: OLS results for property rights on Onchocerciasis treatment status and time

32. Disease, Demography and Institutional Development Motivation | Data | Method | Results OLS estimates of equation (3) Dependent variable: Land rights assigned to individuals Land transactions occurred Pasture access is regulated Forest access is regulated Land transactions require permit (1)(2)(3)(4)(5) Panel A: Post-1975 Population (log)-0.000.02***-0.01-0.000.00 Time = 1985-20060.03*** 0.13***0.05***0.01** Constant0.39***0.74***0.29***0.10**0.34*** R-squared0.960.930.83 0.95 Panel B: Post-1985 Population (log)0.000.02***-0.000.00 Time = 1996-20060.03*** 0.12***0.06***0.02*** Constant0.38***0.74***0.27***0.09**0.34*** R-squared0.960.930.84 0.96 Panel C: Annual Data (reported in paper - not shown here) Main results for land rights only Table 5: OLS results for property rights on village population and time

33. Disease, Demography and Institutional Development Motivation | Data | Method | Results 2SLS estimates of equation (3) Dependent variable: Land rights assigned to individuals Land transactions occurred Pasture access is regulated Forest access is regulated Land transactions require permit (1)(2)(3)(4)(5) Panel A: Post-1975 Population (log)0.050.13***0.060.08*-0.13** Time = 1985-20060.01-0.010.11***0.03*0.05*** Panel B: Post-1985 Population (log)0.08*0.15***0.19**0.09-0.19*** Time = 1996-20060.03***0.02***0.11***0.06***0.03*** Panel C: Annual Data (reported in paper - not shown here) Main results for land rights only Table 6: 2SLS results for property rights on predicted village population and time

34. Conclusion Disease, Demography and Institutional Development Motivation | Data | Method | Results Oncho-affected villages had been smaller, with similar or less market-oriented institutions before 1975 After OCP treatment (after 1975-1985) treated villages: expanded population by 25-33% faster than other villages, became 4-5% more likely to assign property rights to individuals, and 4-5% less likely to require permit before transactions some of that may have been due to population growth alone, in addition to increased productivity for those already there treated villages also came to be more closely served by rural amenities, especially public markets and also primary schooling and telephone service (results not shown in slides)

35. So what? Disease, Demography and Institutional Development Motivation | Data | Method | Results We hope this paper will lead to: Methodological improvements Other papers using villagers recall data to measure social changes Replication of results Other papers testing whether disease (control) explains poor (better) social choices Policy change More evidence to guide those willing to help geographically impaired places get richer