Title: Essays on Malaria, Environment and Society
Description: The body of work presented here seeks to illuminate the complex relationship between human society, development, and environment for the case of malaria. While malaria profoundly affects human society and prospects for prosperity, public health measures and anthropogenic environmental change alter the intensity of transmission differentially around the globe. Using global maps of malaria risk, the first chapter finds that the elimination of the disease during the course of the 20th century occurred in places where the strength of transmission was weaker due to suboptimal ecology, and that this result holds even after controlling for income levels. The next chapter employs GIS datasets on population, urbanization, malaria risk, and malaria endemicity to spatially estimate the cost of fully deploying ecology-appropriate anti-malaria interventions in Africa; the cost of curbing malaria is found to be small (around $4 per person at risk per year), especially given its high disease burden and subsequent social and economic costs.

I next construct a spatial month-to-month ecological index of malaria transmission strength, and use a climate change model to predict changes in ecological transmission strength of malaria and estimate the implied changes in incidence and mortality given current technology and public health efforts. The final chapter uses the malaria ecology index as an instrumental variable to estimate the effect of child mortality on fertility behavior. The large effect of child mortality indicates that malaria has an indirect effect on society beyond morbidity and mortality: high malaria burdens increase fertility rates, thus slowing the demographic transition. These chapters span the fields of epidemiology, public health systems, climate science, economics and demography in order to holistically model the relationship between malaria and human systems; such understanding of coupled human-natural systems will be vital to policy making for sustainable development.