t goes into the fundamentals. >> i am so totally in agreement with you. one of my frustrations almost seems if we're going to fun things which have been successful we almost 'are going to say are going to fund things we previously funned as opost officed to funding things we never had before bus we'll never get to the point where we're successful. so that gives me an opportunity to push for the brain initiative? ...

couldn't get the full accounting accounting. >> the 300 billion doesn't include come under budget how much is going into that basic research to find the basis for the major mental illness? >> roughly 50% spirit what is your total budget? >> 1.45. >> 12% are going to hiv. by the way, my state has ever had per capita incidence of hiv and my patient population a disproportionate number of hiv. i am absolutely where of the nature of the issue of hiv but it does seem, if we have too few dollars going to the brain initiative and you've got roughly $800 million going to something that basic research or something which is costing us at least 300 billion, probably far

more, as important as the it seems like we should be throwing everything we have an understanding that basic sort of science regarding that. the 12% where does that come from? i mean i guess my priority, when i go back and look and we are spending $19,000 per death on hiv, ma i've a sense we probably spending probably $2000 her death on major mental illness. ballpark. >> let me give you some help. they are 41000 suicides each year in this country. that's most reasonable we have. 90% are due to mental illness. so the mortality here is extraordinary. it's higher than most forms of cancer,-traffic fatalities almost triple the rate of homicide that. >> 75% begin between ages 15 and 25 or something? >> that's right.

>> happened in the death rate even if it is not suicides among those with major mental villas, their average launch activities in the mid '50s as opposed to die from trauma, getting beat up. up. >> those are the ones who don't die from suicide. >> i'll make a point. dr. collins, you've got a tough job. as a guy with an average lasting, congratulations for being irish all -- hall of fame. but when they hear about this and again i'm guessing we've only spent $500 per death if you want to talk about dying before the age of what someone should ordinarily die. i would just hope that rebalancing would invest their dollars into basic science and we can say with some success amanita continue to find that success well. i don't mean to slight any of the condition except to say the policymaker, everyone of us knows somebody with a major mental illness. and the fact that the funding for that seems to be so woefully less and document it objectively

relative to other diseases puts the onus upon us is in the address of that to all for your work. we all stand in the shadow of the. i yield back. >> thank you. a couple of things. doctor gibbons, the budget request talks but a new program to less expensively identified recruiting animal patients in clinical trials. how does that impact your work? help with the work and how does it impact your work in heart, blood, lung research? >> thank you, senator, for that question. as you point out and dr. collins responded earlier, as public servants is our intention to be accountable to us for the taxpayers money. we are always vigilant for opportunities to be more efficient, effective and economical at the we did in making these investments. as dr. collins -- >> we will be this discussion at this point and go live now to the cato institute for foreign look at the future of south

africa. panelists talked about the political and economic development in the country. as a transition from apartheid to majority rule. >> instead, frans will talk a little longer than we originally assumed, for roughly 35-40 minutes. after which we will have a q&a and we expect to finish perhaps a little earlier, maybe at 1:15 or so. with that, let me to introduce the subject of today's forum. it has been 21 years since south africa since south africa's transition to a multiracial democracy. for much of that time the country enjoyed a largely positive media coverage and goodwill on the part of both domestic and international business community, and ordinary people around the world.

yet as the time passed, the baking some south africa became more difficult to ignore. first there was -- [inaudible] denial of the link between hiv/aids and support for the zimbabwe dictator robert mugabe, prompting michael gersten of the "washington post" to refer to south africa as a rogue democracy. then came the zuma presidency with its seemingly endless corruption scandals, widespread electricity outages and plunging business confidence. i sensed to muzzle the media and walsh the independence of the judiciary. groaned this order culminate in the massacre in 2012 during which the police gunned down 44 protesters.

for years the agency is trying to dismiss criticism of its miserable as an attack on south africa as a whole. that i believe says more about the agency and about its critics. the ruling party has tried to bring all institutions of of the state, not to mention perhaps part of the civil society under its thumb. as far as the agency is concerned, agency is the state. perhaps most shameless with those defenders who argued the criticism of the anc amounted to a criticism of the majority rule by disaffected whites. well times change. this is now a multiracial phenomenon as it has always been. to get a flavor of the political scene in south africa today please join me in watching a very short video from parliamentary proceedings in the

south african parliament earlier this year. >> we have indeed allowed one powerful man to get away with too much for far too long. members, this honorable man is in our presence here today. honorable president come in these very chambers, just five days ago you broke parliament. please understand, honorable president come when i use of the term honorable am i do it out of respect for the traditions and

conventions but please don't take it literally. for you, honorable president, are not an honorable man. you are a broken man presiding over a broken society. so you willing to break every democratic institution to try and fix the legal predicament you find yourself in. you are willing to break this parliament if it means escaping accountability for the wrong wrong you have done. you see, on thursday afternoon outside this area house commenced the parliament were arrested and assaulted by your riot police. a few hours later inside this house, our freedom to communicate was violated by an order to jam the telecommunications network your not long after that armed

police officers in plain shirts stormed into this sacred chamber and physically attacked members of this house. this was more than an assault on members of parliament. it was an assault on the very foundations of our democracy, honorable members. [applause] parliaments constitutional obligations to carefully scrutinize and oversee the executive lost all meaning on thursday night. in fact, the brute force of the state one and the hearts of our nation was broken. [speaking in native tongue] we knew at that very moment that our democratic order was in grave danger. but here's the question. what did you do, mr. president? you laughed.

you laughed when the people of south africa cried for their beloved country. you laughed while trampling the legacy in a very weak that we celebrated 25 years of his release. honorable president, we will never ever forgive you for what you did on that day. >> to our presence here today speak we've seen that already. >> good, so that's done then. frans cronje is the ceo of a south african institute of race relations. the institute was established in 1929 and is a research and policy organization, oldest in south africa. the institute is not only the oldest think tank in south africa, it is also the oldest

liberal institution in south africa. it tries to be independent of government and of all political parties. it sees its role as are the its members and the country at large to reach political and economic success on the continent by promoting liberal democratic values. or as we've got it classical liberalism. frans was educated at saint john's college and university of -- and holds a ph.d in planning from northwest university. he joins the institute of race relations in 2004 and established its center for race -- risk analysis which specializes in injured consumers to business and government leaders make decisions about investment and policy in south africa. he is also an associate of the center for innovative leadership, a leading south africa base center consultancy and also, the author for time

travel guide to our next 10 years. is work has been widely cited in the media. he writes columns for reports newspaper and is a regular contributor to classic business on classic fm. with that, help me welcome frans cronje. [applause] >> marian, thank you. good afternoon, ladies and gentlemen. it's a great pleasure to come and talk to you. the economist newspaper says that south africa is headed downhill. are they right, is the question i'm going to try to answer for you in the next 40 minutes or so. i'm going to do that via a scenario exercise called a time travel is similar. a time traveler scenario try and

describe the steps and the trends and the processes that will take south africa to its 2024 election. and if we pull pull this off that all you this afternoon, i leave you in 40 minutes with a reasonably clear description of south africa, the way it looks when it wakes up, opened the curtain looks out of the world the morning after the election about 10 years down the line. the story as we wrote start work on the possibly could come in the south african economy. 1994 was a the year of our democratic transition. nelson mandela comes to power as south africa's first democratically elected leader. and in a subsequent 20 years with average levels of gdp growth of just over 3%. there's a measure of success in that number but it's a bit of a roller coaster ride. what you are seeing over both my

shoulders here is gdp growth performance in south africa from the year 2000 projected by the institute into the year 2019. the 3% growth that we've averaged over the whole period to today we started relatively slowly coming out of the transition years as the african national congress grew up the debt with a very high interest rate inherited by the early 2000s things were looking very positive. indeed, between the years 2004-2007, south africa will exceed growth rates of just over 5% of gdp. that's something you must keep in mind. to represent again on a few occasions this afternoon. you convince the coming out of 2007 very obviously a global

financial crisis. the south african economy contracts by 1.5% in 2009. it bounces out of the crisis again to recover into 2010 and 2011 and 10 the recovery stalls. gdp growth in south africa now a threat and the damage went 1.5-2% of gdp, about a third i will show you later at the rate that south africa needs to get out of political trouble. that i many things happening in this graphic. you see the financial crisis. what you don't see and explained the difficulties south africa has been recovering economically out of the crisis is that the same 2007 and 2008 period coincide with a significant political shift in the country. nelson mandela has been dadaab those and come back same south africa and its party should dump the afro socialism in which it was a heavy invested during the liberation years.

by 1996 the south african government in terms of growth implement and register vision policy has adopted what is actually a fairly conservative economic model. it argues the need to finance social spending, for example, for growth and borrowing. that would be controversial in parts of the west. that take south africa up to the relatively high growth rates. in 2007 through the policy conference of the ruling party. leftist with the south african government ribs and cells of the communist party had been the engine of ideas, seize power i voting out south africa's then party leader also head of state was forced to resign two years later. subsequently left is within the south african government had seize control of the policy formulation function. the economist newspaper again and year ago i did absolutely

right when they quoted us all this talk about the ominous train to emerge from 2007 and 40 phone institute report as follows, that common thread through both, and i will introduce in 2710 is that we can property rights threatens business with draconian penalties, undermine investor confidence. that assessment is spot on. getting out of this growth track over my shoulder acquires dealing with two problems. the first one is not the international economic environment is coming together in a way that will make a south african recovery more difficult. the second thing that needs to be overcome is very bad domestic economic and other policies. i'm going to deal with both of those and struggle argument on the growth of the economy.

these numbers will be familiar to you. global economic growth is expected to pick up 2012-2017 to about 3% make possible by recovery and high income, europe and the united states but in terms of growth it is a story of developing economies that should be exceeding growth rates of 5% of gdp by 2017. those developing economies and purchasing power are now 51% of global gdp. advanced economies 49 to give you a sense of scale, asia is at 25% to world gdp. the european union and united states both at levels of 16, 17, 18%. china and purchasing power overtook the u.s. last year of course in absolute dollar terms. the united states is somewhat ahead. india is 6% the world economic.

japanese also. sub-saharan africa 2.5%. south africa 0.7%. a very great extent what happens in the south african economy will be determined by how we are swept along by the tide and current that shapes local economic performance. distort the growth is predicted to unfold is therefore a story largely of developing economies but it is the growth that is spread equally across the developing regions. essentially a story of the and south asia china and india predicted this year by exceeding growth rates of 6% of gdp. developing europe sitting at about three not much going on in latin america. note is that 2.5. sub-saharan africa 4.5% but on as long as you leave south africa. it becomes the third region of the world together with east and

south asia did not be exceeding growth rates of just over 6% of gdp. of course, before we take further steps, rv confident at all that we see in the growth numbers and projection is accurate? one of the concerns we ran across immediately is the that borne out by the price of copper. the numbers, the years about access 2001-2015, you're looking at the copper price in dollars per ton to get pics up from 2001 into the financial crisis. it appears to pick up again and it's been stepping down for five years just now at over 6300 hours thousand $300 a ton, a number that was accurate on the london exchange. yesterday, on top of the cover price, you can see why we like copper. copper is one of the base leading indicators for the

global economy is headed much better than oil and coal that can influence by decisions and risk appetite. what you see therefore, is a folding cover price at the same time the little orange groves line appears to tick upwards. when we dealt with the challenge we thought it relates to that the fact of global growth forecast with mr. off but what we see and what we know you all know happening. and china 2012 growing 8%. 2013 the same. stepping down in 22014 and the chinese will a genetic growth rate of about 7%. this year the real figure might well be somewhat below that. that's the problem for south africa. because that means one of our great commodity export markets is one of one manufactured product now in south africa's top 10 export. right now is starting to slow. demand is slowing faster than

chinese, driving the economy through internally driven consumption. the euro area is taking a recovery but their sisters questions marks over that there that's -- serious. that's another problem because what you're saying on the right hand side. major export markets. china 200 billion a year including the hong kong and little bit of japan is our biggest export market. that is wonderful and commodity demand will slow faster to our second biggest export market is european union and we put question marks over his assist in the the growth, what happens in eventin the event of a great exit. united states around to face the export market. south african out records and this is remarkable thing, trade deficits with every major economy and region of the world except for non-energy africa and

the united states of america. africa isn't export market considerable and will continue to remain one the rest of the world as well. the trouble for us is that as south africa needs desperate to stage a growth recovery a serious question hanging over them. our outlook on the current account therefore, is as follows. the little yellow bar that you see his 1982 and i chose it because that's the last time a south african currently traded at one to the u.s. dollar. i 1994 it was 3.5. 10 years later in 2004 it is six. it is but a decade later to the last blue bar 2015. we think you'll average 1225 this year. in the current context we think it is on its way to trade at about 20 to the us dollar over to the story on the rand can get

lost about half two-thirds of is the every decade since 1980 and there's nothing in the current climate that we think is going to change it. you see that same rand number again. i put you on the left side of which are about to see to remind you of the rand weakening trajectory. there's a very serious relationship between currency weakness and structure of south africa's gdp. figures are looking at our 1994-2015 for the whole democratic era. despite what rand weakness would've given agriculture exporters, agriculture contribution to gdp is down from five to about 3%. it would've been 15% in the 1950s. the same is true of the mining sector. despite local commodity boom that we seem in the late 2000 the weakening rand over that period my contribution to gdp is largely flat. the one that concerns is the

most grey gray like a manufacturing contribution to gdp. averaged about 25% from 1950 right through to the democratic transition in 1994. subsequent 20 years it's fallen by half to about 12% of those three lines, you see the hostile impact that government policy in south africa's has had on three critical areas of the south african economy. the extent of that hostility is such that the fact the huge benefit exports would've gained with the weakening rand, the economy is slipping. allows the line i will show here is something the entire economy to one of% but i left out some sectors that are not critical to my argument. it's high skilled services sector, 19 finance, insurance and information technology. now almost three times as important to south africa economy with mining and agricultural combined. are emerging evolving naturally over time. to become a high-tech, high

skilled postconcussion emerging market economy. when i showed the skills you will see why that presents opportunity. position south africa to africa's hong kong as to china. a skills-based means that we are likely to make much headway there. in the absence of a growth recovery don't think the revenue base of the government can improve quickly. this is the start of the south african taxpayer. the population in south africa's the about 55 million people. 33 million are adults over the age of 20. about half of those or 50 million or so have a job concluding in the informal sector. receiving monthly cash drawn from the state more people now than people in employment. registered taxpayers, the number looks healthy but that's an illusion because you have to register your employees now for income taxed at only 5 million people will submit income tax

returns in and just 10% of that number, 500,000, are earning the equivalent of $100,000 a year. that is the income tax base. without a tournament in that tax base, south africa's government runs into a number of fiscal constraints. 2005-2015 south africa's projected budget deficit is around negative four, negative 5%. you cannot bar its way out of trouble because of dislike, the orange one, that's the countries debt-to-gdp ratio. on the last -- that figure was 40% in one of the great successes the african national congress government brings debt levels down in the 20% i'll. 2009 as you can see subsequently they accelerate. this year those levels will end

they came at exactly the number they were on the eve of south africa's democratic transition. south african government cannot grow its way out of trouble. it cannot borrow its way out of trouble. i will show you in a moment that it cannot spend is either meaning this fiscal deficit is now the most powerful force acting on on the government to determine where it goes next. in terms of staging a growth recovery there is some formidable infrastructure constraints standing in the way. the most prominent of which is electricity supply constraint. 1994-2024 we measuring megawatts. what i'm showing you is that graybar is available capacity. coming megawatts are available to consumers to turn on the switch and draw electricity. it's a number that currently sits at about 30,000 will pick

up to 40,000 over the next decade. is it going to be enough? the first problem we get to is the relationship between is available capacity that we are calling stalin capacity. the difference between the two is electricity generating capacity that is out of action for maintenance reasons plant maintenance but more often than not i'm plan. we are assuming a differential gear up 20% between what's in store and was able to use. the worst david shear has been 30%, and plant maintenance, in other words, breakdowns cause significant blackouts across the country. if demand increases at 1% per annum, the gray line i showed you over there and indeed we do have enough surplus capacity of about 5000 megawatts by 2024. 1% demand growth for electricity correspond with 2% economic growth.

not enough to solve south africa's problems. 2004-seven care when south africa hit 5% economic growth for the first time and that rate is electricity demand, the shortfall would be close to 10,000 megawatts, the equivalent of two very large coal-fired power stations. what you are seeing you, therefore, is that you cannot that talk just about south africa succeeding on a sustainable basis, growth rates at 3% of gdp. the risk is on the downside. if we see more breakdowns of infrastructure, which are happening at a rapid rate, we will have to push that growth ceiling of 3% down. that means that level of growth come you can do with the achilles' heel which is south africa's labor market. the population, the blue line of

2001 in the orange bar is last year, 2014. the population is increase from 45 to roughly 55 million people. the population of working age is increased by similar quantity. the population with jobs has increased by very much less than the population of working age. the population of unemployed has increased even less than the population that is employed. where are people going? they are becoming discouraged. young people not looking for work. the numbers are smaller 9 billion as the population rises on the street. 8 million people joining the working age population. only 3 million of the age could find a job including in the informal sector. 1 billion became formally unemployed meaning they were looking for work 4 million become young people not working. it is a crisis of young people. looking at south africa's official unemployment rates by

age group. this first bracket along the bottom line is people aged 15-24. the data is skewed but school age children. that unemployment rate is 50%. for young black people aged 60%. for young black women it is in the 70% number come astonishing number as people get older they appear to find work but that is not the case. these are people that always had jobs and simply have haunted them. that 50% unemployment figure becomes a bubble that will drift through other age groups as we move two decades. is a globally unique circumstance. spain and greece can compete with us on this. we are home today abu ghraib or the 0.7% of the world than people but almost 2% of the world's unemployed young people.

where does it turn? the answers are here. you will follow my voice is the 1996-2014 along the bottom axis. the blue line i'm showing you runs off the right have access because economic growth in south africa. the middle. you're familiar with already that's 2004-2007. and the orange line is the unemployment rate. the only time after 1994 at south africa's record a sustained decline in unemployment rate with correspond perfectly with south african economy that broke through 4% of solidarity from 5% economic growth if it doesn't do so again it cannot solve the unemployment problem but i also told infrastructure constraints alone mean that growth rates in excess of 3% gdp cannot be made. you can start to see the position that the south african government has banned its fish

that painted itself into. before that a window for you into a south africa's living standards for i'm showing you households here with home loans. the first figures relate to what we call black african black south african families. you are about 12 million of those families that you can send orange bar but only half a million, 459000 have a home loan. an excellent indicator of middle-class status mean they could access formal financial services. mixed-race south africans, asian, indian south africa's and white south africans, middle groups alone and white south africans about 1.3 million families of which about a third have an active home loan from a financial services institution. look at the expenditure level of households and you see the

picture emerge. in lieu are your 12 million black families. of those, 8 million orange are spending less than two and a half thousand rand as a direct conversion. only 660,000 are spending more than 10,000 rand possibly a thousand dollars. mixed race india and asia and whites south africans about two-thirds of those will spend in excess of 10000 rand a month. this is very small and very personal upper-middle-class. only 5.5.5% of black african families have experienced spending more than equivalent of a thousand dollars a month at south africa remains the poorest country and it is often able to protect itself as the rest of

the world. if you want to turn that around the need to be able to turn this around. the problem of the skills base and what's happening in south african schools. along the is very important. i start to 1955 and i will take you to 60 years to 2015 come and we will measures to the apartheid era into the democracy how many black children successfully completed high school. a number, there is a number since 1955. it is 555 children to complete high school. by the 1950s. in the 1970s there's something stirring. the '80s there's a bit of the paper. a real pickup is in the last decade of apartheid. in the first decade of the democracy the rates at which young black kids leave and graduate high school is looking. we expect that you the number to be 350,000 after a cohort of 800,000 children that should

have, as it when it comes graduate from high school and that is what makes a point about the changing structure of south africa gdp. we are becoming a post international emerging market. the skills stored is not a good one. even if you were to survive in the blue bar and get the 2015 and graduate high school, he nonetheless suffered from a crisis of quality of education and we're showing you the results of a study done on numerous rates in south africa schools by grade, look at grades one through six. job to great night and then jump to grade 12, figure out which -- [inaudible] attest ties between grades one and two, 60% of children in south africa are -- they graduate nonetheless. four at 62 have only been left behind. numeracy rates will crash by

2000. only 12% of the class is found to be numerous recorded in grade nine. it will not surprise you can only seven and 100 african show will graduate high school with passing their final math exam with the grade of 50% or above. and that in an emerging market hurts the economy. for that reason people remain unlikely, likely depend on south africa's welfare system that now pays grants to more people than the our people in employment. my colleagues have developed an excellent indicator. it will appear in a moment and it measures what proportion of the budget in south africa is spent on free or subsidized housing, health care education and electricity, welfare, actual cash grants to households and individuals and water services. it is 60% of government

expenditure in south africa, a massive redistribution that is happening to the tax system. defense police, transport and others. there is little room to expand the welfare system especially when you look at the fiscal constraint on the government, and this is the point on south africa's not being able to spend less. you're spending cuts or we wouldn't have to come out of this. the public reaction is want i don't think the government is able to survive. the extent of the dependency that this has brought out in this graphic it runs from 2001-2015 and measures the number of people in employment for every 100 people who receive welfare grant from the state. in 2001, 300 people have a job for every grant recipient of 2008, nine for the first time. that are more social welfare recipients and our people in

employment. are we becoming a safer society? people ask the question, and it's not critical to the scenario but give the answer. it's a complex answer. in 1994, 70 in every 100,000 south africans were murdered. a decade later the murder rate has fallen to 40 and a largely stabilized to where we are today. it's a positive story but australia's big 2014 was 0.8 and yours in the united states was five. so many respects we remain a violent society. the complexity to the ocean to argue safer? on top of that, 2005-2014 armed houston business robbers in south africa rising from 12 to 40,000 incidents. total number of criminal convictions in the country has been falling. the reason i show you this is to

make the point that many state institutions, criminal justice system be one of them they simply overwhelmed by the demand placed on the. in the difficult fiscal environment, we don't see our way out of some of these problems without begin a growth recovery. this is the context we are 20 years, 21 years into our democracy, what they south africans think about it? the answer comes from an opinion poll has been conducted over much of that period by the presence in south africa and one question, many questions and one which is the agree the government is performing well? into your 2072% agreed with the. the government popular because fallen almost 20 percentage points just 54 digit we think the number will fall below 50% into 2015. this is a collapse in the south african state. the collapse in confidence can

be seen and read into the indicators as well. riot policemen employed in south africa, very good measure of government see their own future. between 1995-2001 south africa employed a national federal policing system, 11000 riot policemen, about 10% of police members work in the country. between 2002-six the number of riot policemen were 7000 between six and 10 two and a half thousand. we are going to become a successful democracy come and you can see and i think it's a fantastic way of measuring fat. subsequently the figure is at least 4.5000 we think it is probably doubled that now as well. a government that starts to our more riot policemen again is responding to a perceived

threat. leader of the opposition in south africa, a leader to the role when he said to the great shock of in south africans invaded south africa's public, physically assaulted members and ejected after the takeover price in any state of the nation speech to avoid he had interrupted the speech to the government is responding to real threat as well. 971 violent protests larger directed at the government back in 2001. the number has more than doubled into 2014. you are seeing the beginning of a can be a participant in south africa. that collapse of political confidence and confidence in the government can be measured when you look at the formal political arena how south africans vote. what i'm showing here is voting patterns and numbers measured

not as a proportion of people who went to vote but a proportion of people who were entitled to vote. in other words, citizens on the age of 18 had actually gone out and voted. in 1994 to anc got 54% of the vote of all people entitled to vote, everyone had a. they got 63% of people who went to vote and to have the number 20 years later. so it appears if you measure the election results, the anc support is constant. if you measure eligible voters it is shedding support quickly. the official opposition has made its way from one and a half to 13% of the actual vote, all of the parties easy and great, the collapse of the national party government, but they expect the apartheid era and some others but the most important political player in south africa's not yet appeared on the graphic. it is represented, but are by this double-blind, the nonvoter.

south africa over the age of 18 and to devote is choosing not to. their numbers are not great than the number of people voting for the party and that is not for a moment i comment on voter apathy. these are highly activist young people very politically engaged to say i don't think this is for me. at half of the to vote again, and not to vote for the ruling african national congress, the african national congress was south africa's next election and that reality -- private within the party. if this is the predicament they are facing what is going to do x. that's the scenario. and we think the government and the ruling party as it is now position is to set of choices. on economic policy, understand, seeing the consequences of the

approaching fiscal cliff because it driven to reform? the single-minded institute of economic growth. indiana's 10th of that growth driven by domestic and foreign investment can create wealth to create the jobs to meet the unmet expectations and to cure -- security political teacher. or does it persist in the face of the evidence. image of the socialist development state can do a far better job of meeting popular expectation. while that battle plays itself out south africa's battle of ideas, he we remain a free and open society under the rule of law as we have largely been, or do the incidents that were referred to today the shooting he does become the norm come and south africa's democratic institutions are eroding. how the country addresses those two questions, definitive and fundamental importance to our future gives you the scenario.

where the state insists on paying the socialist development state, and later heads off the inevitable political defeat board of the inability made popular expectations by attacking democratic institutions and south africa's rocky was no. socialism amid crumbling institution, negative growth rates, capital flight, investor flight, horrific human rights abuses. the best case is the government under pressure to the surprise of many of its critics turns to the right. growth rates will have to start approaching 45% of gdp and it will win on the right and acts as a popular mandate that will continue to strengthen as it of reform are felt in households around the country, there are a handful of reformers within the government who we know would like to turn this way but they remain a minority. and intriguing case, one the south african government finds particularly interesting is what we call the narrow road scenario. again the understanding follows

on the context that we are in at the moment market-driven reforms are the only way to escape the inevitable clinical defeat of the africa national congress. let the state understand at the same time that winning a popular mandate for reform is unlikely with the ideas in south africa remains hostile to the idea of private enterprise. the fourth outcome and there is no fifth one is a toll road future. the socialist development prevails economic performance remain significant under the country's potential and we have clung to our democratic institutions and in the future we know that the african national congress will lose the 2024 election, most likely.

no clear winner would emerge in south africa will enter a new era of coalition politics. the most likely coalition is the radical marxist left together with the african national congress, and by the time the african national congress loses, we think the radical left will have approached 16, 17, 18% of the vote added to the 49% of the african national congress and will give it at constitutional majority. the most probable outcome on the current trend is some hybrid of the whole in the rocky road i think ending in coalition politics even if you to push that one year ahead, one cycle it into 2029 for the team. that is a defense which is a little consulting group to come to another conclusion of as the

scenario of great probability. we want to see passion such as these emerge. economic upsurge of our major economic partners and stand up to global economic demand. is that the likelihood? is the government by itself time? increased inform interest rates capital outflows out of south africa, south african economy. reckless of short-term borrowing on the part of the government, shore up political support inevitable rating downgrades will follow up african bonds with likelihood move to junk status. institutional investors pulled out. it's a rocky road future. oil prices that will put -- any gross recovery.

one that we are particularly interest in his fundamental reforms in the labor market policy, emerge from the successful defeat of the apartheid system. if the current government moves on labor market deregulation, it will tell us that they are truly interested in real reform. other areas of economic policy reform also follow, opening the door to either the wide or the narrow road upsizing area. if we continue to see the loss of autonomy of democratic institutions the downside big and but so does the narrow road. where the government will appropriate itself considerable power and use those to force significant and conservative stock of economic policy reform. south africa emerges as -- that

are such attempts at the moment that are not yet been successful. it will deter investment of course but more serious government will follow very quickly once you taken property rights, individual rights will follow. instability in the ruling party falls apart and but i don't think we'll see but this would turn argues, sustained sharp increase in violent anti-government protests means the government is likely to end up with our by some sort of leftist alliance and will then fall in with the alliance in a coalition government. we have little doubt that south africa's future as he read from you or experienced it and live in the country will fall broadly within the confines of one of the scenarios set out for you today. marian and i will gladly take your questions. thank you. [applause]

>> thank you france, for a very interesting presentation. i would like to point out the marxist group and south africa's waiting in the wings difficult economic freedom fighters and want to make sure there's no connection between them and economic freedom fighters here at the cato institute the stanford exact opposite. before turning over to the audience for questions could you explain in just really want or two sentences your beef with the employment regulations? for those people are watching on tv or in the audience what's the problem with informer relations and also private property rights? >> i think the institute as maintain right from the start of the transition in 1994 that unduly heavy regulation of the south african labor market in the absence of the skills revolution will by necessity conclude in the problem of structural unemployment.

and we have been proven right of course by the numbers that we see behind us. the fact of the matter, whether activists on the left in south africa like it or not, is not in the medium term -- medium-term come with a significant deregulation of south africa's labor markets we will not be able to ensure the competitiveness that is necessary to allow very large numbers of young south africans, at least a chance of a job. labor unions in south africa for the most part, and there are exceptions, have become organizations to protect the employed from the unemployed. the political consequence of the rising and unmet expectations are driving the rising left in the marxist left in south africa. it's not just a question of the regulated labor markets to achieve economic ends.

if you can of pledge more south africans a position to young people, mainly black people, the unemployment rate compares favorably. to take charge of their own lives, i think we'll see a continued input of radical leftist thinking that will take south africa deep into the rocky road future. on property rights we have -- is not just a question of agriculture. there's a series of proposed an active policies and regulations in the pipeline that undermine those rights. that stretches from policy thinking that would undermine intellectual property rights and, therefore, become a severe disadvantage to the country should in time -- [inaudible] >> should want to become the

services, as it stands it is very little chance that south africa will track the domestic or foreign capital investment, a new green fields expansion in mining operations or agriculture and the like but as long as the rhetoric and now policy is starting to place the state in a position where it can seize property rights virtually athletes will. and delay the payment of compensation should be paid in the longer-term at all. >> thank you very much. over to the audience. please wait for the mic going to get to you and then if you would please state your name your paymaster this and just keep your question in the form of a question. first question here. >> doug brooks with international civilian operation. great presentation frans. i wonder if you can just address the issue of foreign workers in

south africa a little bit and discuss how that has impact on the economy and are chasing about the impact the economy as well. >> absolutely, doug. if you follow the news of south africa people have seen in recent weeks attacks on black foreign workers out of africa. these are nothing new. we estimate that between 350-500 foreign workers have been killed in terrible circumstances, machete wielding over the past decade. it's a function of rhetoric directed out of parts of the south african government at times even come and people closely, people in the pay as many would say, of the south african government, in this case the summa royal household who portrayed borders as they are jobs, taking out opportunity and even in cases stealing our

women, which raises all manner of question. it's part of something broader though, doug. it's an attempt to divert attention away from the root causes of south africa's problems. to offer the seductive idea that someone else is stood in the way of you and a better life if you can take that someone else out of the picture in your life will improve. you delay the inevitable turn the focus on the south african government. it is a very same phenomenon although it is not done as brutally, as talking about the negative impact of western investors and companies in south africa. there's been a movement in south africa of students to remove any vestiges of social rose from university campuses. it is the same thing. the idea that someone else came

here and through their actions you our corporate entity do not remove that other, you will never have a laugh -- you'll never have the lifestyle you aspire to. ..

-- the government -- it's driven by nothing other than self-interest, sees it future in the violent repression of the left and property rights are protected if for no other ron than -- no other reason than for the greed of a major family or two. >> i think elements of that built into what we call the narrow road, the top left scenario. the state in terms terms of economic policy eventually forced to right. has to maintain a vestige of property rights, otherwise we'll get nowhere and tolerates no dissent at all. are we already on the way -- that attack in parliament on members of parliament was on the marckist radical left. the move within the ruling party, i think undermined the effectiveness of trade unions by isolating the very charismatic leader of the congress of south africa's trade union may be a move in that direction. we certainly see reformers in

the government and the ruling party, people that would prize some of the critics who if push come to shove will move in that direction. the trouble is the climate of ideas is very hostile to the type of private sector led investor c. growth. the property rights. i therefore think the reformers are more likely to fall short. the scenarios that then emerge is continuing economic decline and adverse move to try to undermine democratic institutions in the country. there was a gentlemen to your left. you, sir. >> david cherry with the executive intelligence review. a simple question. the first is, -- >> is this mic on? >> here? >> like this. okay.

you projected what you thought might be the most likely coalition government which could come in 2024 but i didn't understand clearly who the participants were. >> there are essentially four players in the political space at the moment. there's the african national congress, which has about 40% of the vote of potential vote at 60% of the actual vote. that's number one. the second player is the largely liberal or classically liberal left. these things aren't always clear. and opposition in south africa, and they are sitting at about -- let's talk about the actual vote. about 60. the liberal opposition is

sitting at around 25 or so. and the mar marckist left is -- the likely coalition for me is that the anc loses its absolute majority. it loses another 10 or 11 percentage points, moves to just below 50. that is attrition both from the marxist left and from the liberal right of the party. if through that process of attrition the young marxists can gather another 10 percentage points then the likely coalition is former african national congress with former young marxists and that completes the circle. the young marxist left it the form youth wing of the african national congress that was expelled from the party in the hope that other like other splinters, it finds life in the wilderness difficult difficult.

it as thrived through marketing genius and exploitation of the unmet expectations of young people. i think the anc goes below 50. the likely partner is the radical left, together they have a constitutional majority, which is something that anc has not had since 2004. >> i see. the other question if i may. was a big one. namely what -- i was very surprised in your scenario you did not include the factor of the alliance of nations. what bricks means to me is vast increases in infrastructure development. now, if you factor in south africa not only being a member, but what the bank coming into effect in a matter of months, and africa being somewhat of a priority for brks as i

understand it, how does that affect this picture? >> in terms -- it looks like a brick in absolute terms somewhat insignificant. i do think that goes into it. i think a lot of what flows into south africa, moverring into the narrow road scenario, is diplomatic pressure of sorts out of china that skis the enormous advantage to themselves in changing what would otherwise be a formative precedent, shaping the evolution of high-growth economies across the continent. in that narrow road scenario, the foreign corrupt practices act here would be a headache for any firm wanting to do business in south africa or in the rest of the continent leaving the chinese with an unassailable advantage and i think of the

bricks -- unavailable advantage in the battle for a future africa. africa is starting to look i can princess of the 20-year projections, consumer markets alone before you get to anything else can drive a future recovery. the lady in front of you and then the very egg are gentleman i see your hand. i'll have you next. the lady in front of me, please. that's you madam yes. >> my name is -- i would like to know what economic development credited about public-private partnership, and work in the normal moral way it probably is okay but the problem now is there is capitalism in the world, it misleading, is terrible, and according to other development, there's tendency to public debt equivalent to a profit of the people. the people don't have water

people don't have -- even in america, welfare benefit usually a deprive. they don't really receive it. wonder if you can explain a little bit more how are they going to use the public private partnership or going to say forget it, we want to do what the best interests of the general public. >> i think one point you cannot escape from south africa is that in the absence of significantly high levels of investment must be c. out of the private sect drone sure a growth recovery. public private partnerships are popular. they very often simply open the door to a corrupt relationship between big business and big government and i think to a significant extent, if south africa is going to reach five percent growth rates it will be because the private sector had the door open to it and enabling investment environment was created.

the gentleman at the back, you sir. >> thank you. my name is -- you made it very, very good presentation of what a de facto -- the decline in the economic growth 0 in south africa but it is a collection of [inaudible] -- and specific economic factors worldwide. now, maybe i got you wrong but i got the impression it seems you are more concerned about anc being at fault and something else you take over. assuming that is right suppose the anc loses the election and a new government comes in the way you want it, what are the specific actions you will recommend to their new

government to reverse the growth of -- the declining economic growth. and particularly, what are three specific things they should do and what time frame would you advise such a government before they see any positive response in economic growth in south africa. >> my first point to you is that with a close to two-thirds electoral majorrivity for 20 years, think it's only right if there are shortcomings in south africa we take a very close look at the behavior of the government. i don't think it's accurate to suggest that we are pushing for the collapse of that government. if anything else we fear that if it only loses its majority by one or two percentage points, we end up in a worse situation with a marxists get back in again. that said, we will back any party in the broader sense that is willing to embrace the reforms necessary to turn south

africa around. specifically what needs to be done. first point -- i won't talk generally. i think that's pointless -- is introduce a model adapted to south africa with a charter school system. school vouchers. allow parents choice. there are governments that can run very good school systems. our government is not one of those. if you cannot break the skills dead lock, cannot exploit our natural strength as a services economy. the second step that the future government must follow significant labor market deregulation scrap offering the minimum wage and scrapping of the horizontallal application of bargaining council agreements. the third step is scrap all race-based affirmative action policies and black economic empowerment policies in the country. they're simply a breeding ground for corruption in and incompetence and an unnecessary

obstacle to progress. that's our advice. if they'll accept that, time will tell. let me move on -- i see a number of hands. so, excuse me, i'm going to try to deal with as many as i can. the gentleman right in front of me. >> tony carroll, johns hopkins and i'm also vice president of man chess chester trade. last week you spoke about trying to generate the attention and interest of those sectors win the south african government that are actually competent and who may be drawn to more persuasive argument got good governance, and last me let me say, i was in south africa before the end of apartheid and this government inherited a mess. a society that was exclusionary and highly ineffecter. maybe things haven't gotten any better but they certainly were very bad when they took over so

i'm not sure if you reflect upon that. i'm more concerned about the issue of trying to generate and enage elements of the government that offer coherence and willingness to engage. >> there are advantages in the fiscal deficit because it means that moderates within the government and reform-minded members are now more focused on getting out of trouble -- it focuses the collective imagination. the prospect of a young precisely -- of a young marxist party in red berets, your colors -- think you did it just for them if you get them to speak one day. the prospect of that is focusing -- we're seen as a think tank, an independently privately financed group more positive interaction with elements of the ruling party in south african government than we have at any point in the last 20

years. of course, it's true to say that south africa is a better place than it was at the end of apartheid. and we have made that point repeatedly to the point that we have drawn the ire of the official opposition. and i think in the mid-2000s it appeared that would be our trajectory. but the confluence of the global financial crisis and the effective -- of the left retaking -- taking back the policy forming function means we are a country that is now significantly underperforming in terms of our potential. the gentleman on the extreme -- my extreme left. yes, sir. >> pat span. just myself. i didn't -- i was hoping to see a chart that would show the -- both the capital and the human

capital, people, leaving the country. i get the sense that -- can you go back after talking like you just did? i'm wondering what is the reverse immigration? specially of skilled people and also taking their capital with them? >> we're aware of a significant skills outflow. you don't see that in official population statistics, but it becomes very clear when you look at the age structure of the middle class. obviously a very big gap in the middle and that our glass image is reflected again in south africans that would have been the children of middle class parents who are not being born in the country anymore. so unless -- these aren't just demographics. these are moving. and if -- unless the middle class stops halving children completely those children are born overseas. i think we have seen that.

the global financial crisis but the brakes on. we warrant at the time it is a pattern that will resume if domestic policy in the country remains hostile. much of the middle class as the graphics indicates white south africa. if the point of doug brooks, if the racial nationalist sentiment that attacks the foreign migrants that see job rhodes' statue removed, if that turns -- i don't think it will turn in a vow lent matter on the white middle class. be very clear on that. this isn't that -- not attributed to me. if it was i would have said so. i think that as pressure is brought to bear on that group they will increasingly seek to leave. our systems are that half of south africa's white middle class have foreign residents rights they choose to enter size the rights. you say why are we there? every individual has to talk for

themselves but certainly my colleagues and many others want it to be a success. and want to be an influence in allowing it to be successful, because while it's turning against us, those upside scenarios remain within reach for south africa, and we're not going to die wondering what would have hand had we as a think tank not committed every resource we had to reform. if it's going to go down, then it's going to go down in a fight, and unfortunately the trends are starting to turn against us. the gentleman on -- i'm pointing at. >> thank you. i am peter justin, a ceo of a company focused on growing economies, and we're cussing on south africa. as look at statistics on emerging growths economies in at

the world they mirror u.s. stacks, two-thirds net new job creation 50% of the gdp 68% employment, driven by entrepreneurship and small business. i wonder what your thoughts were how that would impact your growth curves. >> well, there's no doubt that if south africa is to beat its unemployment crisis, that job creation is not going to be out of large foreign or domestic investors or job creators. that burden is going to have to be born to a very great extent by communities themselves. now, south africa's statistics are something with halve levels of emerging entrepreneurship. someone is trying a startup that appear with the bricks. but our level of established entrepreneurship, compared with russian, former soviet union what is happening the? it's that the impetus is to get going, but when you run into the regulatory wall that the south

african government represents no small businessman can possibly hope to make it, and that to drive entrepreneurship, which might have been the fourth piece of advice i'd give to future south african government -- what we need to do is remove the dead hand of the south african state. we actually need to establish a ministry that is responsible for going to see other cabinet ministers and saying, are you aware that you have 200 laws on the statute books and which of those do you really need? if you aren't able -- and otherwise you repeal and scrap them. massive deregulation of the investments. we know that those foreign immigrants that are being attacked are young entrepreneurs. the advantage they have over the south african colleagues is not that they're better educated or come from more peaceful climbs or arrive with capital. the advantage is by the legal

status they're not subject to the many laws and regulations of the south african government, and we need to give that freedom to more poor south africaons as well. >> the last two questions. >> two more questions. i've seen two very persistent hands right at the back. the gentleman first on my left and then the one somewhat in from of me. >> i will be available here -- i'll try to be available here for half an hour after this meeting. >> okay. >> let me just take those two -- i will take one more from the right. >> i'm on my own pearl just to make that we're. since you pantoate very dismal picture of south africa, and keep saying with one or two person changes could get the leftists in, why not go pick the china model and start all over

again, get on mao and build through that and then have this xi jinping and all that come through china the miracle we see today. >> that's my narrow road scenario. >> that is your very narrow road -- >> narrow rode scenario. it would leave south africa economically better off but the basic rights and freedoms the country struggled for through the appar tight era would disappear with it. there was a question -- yes you, sir. >> i am kyle gibson with the u.s. chamber of commerce, the african affairs department and a former cato institute intern in the policy department. i want to go back to the broad-based economics empowerment code. you have the narrative of high unemployment rates dropping commodity prices, and you have many african governments

continually trying to diversify they economies. with that we see a rising trend in localization policies in the continent in south africa, this the empowerment codes. with the way this is trending not only in south africa but across the entire african continent, what is your opinion on future outlook for foreign investment especially from the u.s. and other western countries as well as national economic development if there's any influence. >> i'm -- we are not talking about countries each with their own sets of policies. as a short answer, most of africa is starting to look good. zimbabwe is an exception. there are other exceptions. considering where the continent was and where it's going we will

not again see the economy -- the hopeless continent front page. i like your question, though, because you're touching on something that i haven't seen many endless outside of south africa identify and that is the importance of ensuring that the formative precedent in south africa is the right one. it's an influential precedent for the rest of africa's development. it was the great democratic experience, and the precedent that shaped in south africa will be definitive to how other african economies not that we in south africa -- we can learn enormous amounts more from east africa in terms of attracting investment and they can learn from us how not to do it. but the danger is very much as wealth starts being created that the political elite will seek to distract that wealth for themselves through an

indigenousization policy, through what the south africans call an empowerment policy. it's simply this. a means to allow very big government and very big business to work together in a quasi-corrupt fashion to security short-term economic goals and personal economic goals for the government and its supporters. should other countries start to move towards that model i think it bodes ill for western investment particularly because of the implications of the foreign corrupt practices act. a criticism we often have of u.s. state department is that on the one hand you have the foreign corrupt practices act. on the other hand your investors in africa run the risk of being exposed to governments that increasingly become less democratic more authoritarian and there's not enough of an effort to create an environment that would be conducive to long-term western investment. the winner, all of us ultimately remains china's view on africa.

the last gentleman today you sir. >> my name is -- i am with united state of africa. a message for you and the south african people. tell zuma to stop interfering with creating the federation. that's the only way to survive as an economic entity. if you don't be part of this federation the status of south africa or nigeria oar ethiopia will obtain is that of mexico 40 years ago so you need to join the federation, take that message to the people and it's private sector driven. the federation is geared to what is done, limited interference of state, stupid governing class. >> thank you sir. >> thank you very much. [applause]

[inaudible conversations] [inaudible] conversation [inaudible conversations] [inaudible conversations] if you missed any offing this program it's available in the c-span video library. it will be shortly. go to c-span.org.

in congressional news, the senate will be back in session this afternoon at 3 eastern and will consider overriding a presidential veto of a measure dealing with regulations on union election rules. senators this week expect to continue work on the iran nuclear oversight bill and they are also expected to start consideration of the 2016 budget resolution that was negotiated by house and senate conferees last week. this house is out this week for a district work period. members will be back for legislative business on may 12th. you can watch the house when members return live on c-span and the senate right here when they gavel in this afternoon at 3:00 on c-span2. "the wall street journal's" washington wire today looks at the presidential candidacy announcement's carly fiorina and ben carson if the article says carly fiorina and ben carson chose different ways to launch their 2016 presidential campaigns. mr. carson retired neurosurgeon held a 30-minute concert including his wife

playing a violin at a detroit concert hall. there weren't many specifics in his remarks which were pepper width tea party friendly lines our it's time for people to rise up and take the government back. mrs. fiorina the former hewlett-packard ceo held a 43 minute conference call with reporters. she focused her attention on hillary clinton. and during the call she took questions from 16 different reporters on a variety of topics. we'll show you ben carson's announcement tonight starting at 8:00 eastern on c-span. and tomorrow, we are expecting the announcement of former arkansas governor mike huckabee. you can watch that live at 11:00 a.m. eastern on our companion network c-span. >> presidential candidates often release books to introduce themselves to voters. here's a look at some recent books written by declared and potential candidates for president. former secretary of state hillary clinton looks back on her time serving in the obama

administration in "hard choices. "an american dreams, floor florida marco rubio outlines his plan to restore economic opportunity. former arkansas governor mike huckabee gives his take on politics and culture in "god, guns and grits and gravy. "and in" blue collar conservative "rick santorum argues the republican party must focus on the working class in order to retake the white house in" a fighting chance "elizabeth warren recounsels events in her life. wisconsin governor scott walker argues republicans must offer bold solutions to fix the country, and have the courage to implement them in "unintimidated," and kentucky senator rand paul, who recently declared his candidacy, calls for smaller government and more bipartisanship in "taking a stand." more potential presidential candidates with recent books include former governor jeb

bush in "immigration wars. "he argued for new immigration policies. in "stand for something," ohio governor john kashich calls for a return to traditional american values. former virginia senator james webb looks back on his time serving in the military and in the senate in "i heard my country calling. "independent vermont senator bernie sanders recently announces his intention to seek the democratic nomination for president. his book "the speech" is a printing of hays eight-hour long filibuster against tack cuts. and in "promises to keep" vice president joe biden looks back on his career in politics and explains his guiding principles. neurosurgeon ben carson calls for greater individual responsibility to preserve america's future in "one nation. "in" fed up "former texas governor rick perry explains governments has become too

intrusive and must get out of the way. another politician who has expressed interest in running for president irformer rods governor lincoln chaffee in "against the tide." carly fiorina former ceo o hewlett-packard, shares lessons she learned from her difficulties and triumphs in "rising to the challenge. "louisiana governor bobby jindal criticizes the obama administration and complains why conservative solutions are needed in washington in" leadership and cries. "and finally in" a time for truth. "texas senator ted cruz recounts his journey from a cuban immigrant son to the u.s. senate. look for his book in june. >> last month the united states took over as chair of the arctic council and its ministerial meeting in canada. up next a discussion on the u.s. agent focusing on climate

change pollution, maritime safety and the health of arctic inhabitants. >> thank you all. we're beginning our last panel here today. we run until 1:00 p.m. focus is on health. and we have a great array of speakers here today. i want to first of all congratulate heather conly and carolyn roloff, colleague here for the production of this report, which i hope you have all had a chance to get and which is available electronically online. this is a terrific and very timely piece of work that brings together and so we'll hear from heather in one place, a lot of data a lot of analysis, a

lot -- situated in the context of what has been going on up to this time in engagement in the arctic on the health. what do we know and what are the possibilities here in terms of concrete additional action by the u.s. government in its chairmanship of the artic couple over the next two years which begins next week. and so we're delighted that we could partner and that heather and carolyn could produce this really excellent piece of work. thank you for doing that. congratulations. that's terrific. this morning the senator in her speech matted a very powerful point and that is that all action by the u.s. government and other government inside the arctic need to put the human reality, the individual and the community, at center stage in discussing the future and in discussing the approaches going to be taken and so with -- i think this gives us a wide open door for talking about these

issues and where we are going to go. the way we're going to do our business here today we're going to ask heather to give a quick synopsis of the report and then have pamela collins a psychiatrist and an m.d., director of the office for research on disparities in global mental health at the national institute of mental health. pamela came to us, we have known each other little built over the years. roger glass who is with us today, roger, thank you for joining us. roger kindly connected us and thank you pamela for coming and being with us. pamela will roll through eight or ten minutes of presentation on the work that nimh is leading in this area. we will then move to dr. michael bruce, epidemiology deem leader of the arctic investigations

prom for cdc based in anchorage. thank you for taking the team be with us today. he will walk through the cdc program in some detail as well. we're using this really as an occasion for getting these two lead u.s. agencies to tell us what they do, tell us what has -- what the major challenges and issue focus will be and what the future might look like in terms of continued work and intensified efforts in this area. dr. bruce is the epidemiology leader and has put predominant focus upon a wide range of research and studies across vaccine-preventible diseases, chronic diseases, health disparities, chronic disorders. so we're thrilled that michael is with us. our fourth speak iris dr. timothy palanac a research professor at george washington university and leading polar

expert. a migration expert and demographer who has been working on polar screography and polar environment for his career and is one of the contribute awe their to the newly issued arctic human development report which i hope you have had a chance to look at. it's a very comprehensive ten-year study built on the 2004 study, comes out it's full of enormous amount of insight and detail and we were very fortunate through heather's intervention to enlist timothy to come be with us. so thank you for making the journey to bee with that. once we roll thank you the presentations we'll have a conversation but we'll move to you all very rapidly to get your opinions and comments. so please be ready for that. and heather, the under is your.

>> thank you so much, steve. it's wonderful to be able to have such a great partner. steve and i -- our offices right beside this other. we were talking and i have gotten the nickname at the office the polar princess, the arctic queen. i said we should do something together. how can the global health program be part of this conversation? i said funny you should ask. halve is not an issue in in the policy space we focus on as much. we know the u.s. chairmanship, one of the major themes is the economic and the livelihoods of people in the north a focus on that and we need to pull this information together. that do we know? what is the united states doing about it? and then, of course, the timing is perfect because we know the arctic human development report, which first issued in 2004, so as it was issued -- a 2014

report issued in 2015, we had ten years to see what has changed, where is the focus we need to do. so all of these elements came together and really encouraged us to put this report together. so many thanks to the global health program for being part of that and of course, my colleague, carolyn rolloff is instrumental in developing this report. you're so sick of hearing from me today. i'll be extremely provide and i want to hear from our panelists. i'll be copious. i want to learn a lot here, too. i just want to do a couple of highlights in the report. i think the first thing that this strikes me -- i think it strikes anyone that doesn't know this topic and begins to read it -- is the huge challenge of mental health and suicide prevention. a recent -- this comes from our report. a recent study has found that every five degrees of increase evidence northern latitude,

suicide rates increase by 18%. now, just to bring this home for the state of alaska, in alaska natives the rate of suicide has increased a hundred% since 1960, with rates four times higher among ten to 19-year-old alaskan natives than nonnative peers. this is striking and it certainly is a huge crisis. there are contributing factors. substance abuse and violence and there's a whole issue of mental health challenges that are profound and if there's one thing we hope this study does is reinforce that urgency and bring new focus to it. there's other pressing issues that just require continued focus. the change in food habits, food security, we're seeing increased rates of obesity diabetes, also seeing heightened impact on the

food security of environmental contaminants and mercury and some of the things from the changes in the climate that also is the food cycle so dramatically changes. but the arctic picture is a complex one because there is no one model. you have a very different health spectrum -- where health indicators in northern europe, the nordic countries is far different from what we see in other communities so the challenge for the arctic council, as it is developing its thinking is how -- there's not one size fits all but how to meet the needs and bring the study the information to focus together. so there's a lot of information. i welcome you to read the report. i just wanted to conclude by highlight something recommendations, and two are particularly perhaps provocative to state department colleague. i am a proponent of rethinkingthinking

the arctic council's governance structure in light of to its birthday next year. it was design net 1996 for one purpose, but as we just talked about over the last three and a half hours so much has changed. do we have the right align independent our working groups? do we have the right alignment in how the arctic council meets challenges? so we very provocatively recommend that the arctic council should think about having a working group designated for arctic health and well-being. if people are at the center of this policy, which they are we have a flora and fauna working group. we have the protection for the arctic marine environment. i'd like to see a very focused working group on health. if we think it's important we put it out there and so as i said know that will -- that's a pretty provocative recommendation but we think it's the one thing that could perhaps

be a leg gay for the u.s. chairmanship and moving forward. the second linkage as you heard from our discussion on energy resource development what we really found in our report there is a link between economic development and growth and mental wellness and well-being. and maybe we should be a little bit more specific about that linkage, where people have livelihood their living standards are incareering. can we make that -- increasing. can we make that linkage. can the arctic economic council have a direct role in how the private sector, public-private partnerships are engaging in these pressing health issues for arctic communities. and of course, as part of all of this is how do we engage traditional knowledge in working towards an improved arctic health and well-being picture and i think again the working group -- a new working group

could bring that traditional knowledge in. we have some other recommendations, obviously it is our hope that the u.s. chairmanship focuses like a laser beam on these issues. we know mental health and suicide prevention is part of it. i know our colleagues are going to give us some great insights on what the work of the -- their agencies are doing but we want to raise this up. we want to highlight and it impress upon policymakers that this is a critical issue that demands our full attention. senator murkowski talked about the young people and their enthusiasm. we can't see arctic young people not see a promising future and committing suicide. thank you again. >> pamela? >> thank you. and thank you for the introduction. it's a pleasure to be here. the many opportunities and challenges we have herd discussed this morning ex-i'm going to focus on one of those suicide and suicide prevention. just to orient all of you this

graph -- oops -- this graph shows you some data on suicide rates in the united states over the last 20 years. the red line shows you homocide rates in the united states, which you can see have dropped substantially over the last 20 years. suicide rates have increased by 17% from 2002 to 2012. and in 2013 there were 41,000 suicides in the u.s. to give you a sense of when we're talking about these polar communities. the bottom arrow shows the u.s. suicide rate and the communities in the arctic, the top arrow is the suicide rate in afc. the main takeaway, the yell yellow bars represent nord rick

countries, green represents greenland at the very top. the blue represents russia and regions in russia, and the red is north america and regions. so the bottom red bar is the united states, suicide rate. the top the red bar bill the other red arrow is alaska. so clearly the rates in alaska are higher than the u.s. population in general. and if you -- what you can also note from slide is that as you go higher, the bars that are the higher rates often represent indigenous communes compared to the country totals. so there's considerable variation across regions and variation within countries with indigenous groups a higher risk for suicide. these are data from alaska specifically. and again because -- just to orient you to what the lines are. the bottom line in yellow shows nonnative alaskans and thesees

are females. suicide rate. the next line that little jagged one are alaska native females and then above them the brown line nonnative males in alaska, and that top line represents alaska natives young men and men. so again huge differences by ethnicity with -- and certainly regional variation within alaska too where are there certain communities in alaska that have higher suicide rates than others. so this is a complex problem. it's not the same everywhere. but clearly this group of men and young men in particular are the group that are at the highest risk among alaska natives. the conversations about suicide prevention in the united states are happening at an opportune time. the u.s. upublished a prioritized research agenda for

suicide prevention in 2014 with an ambitious goal of seeing that suicide could be reduced by 20% in the u.s. over the next five years, should the research and resultant policy and services interventions be implemented and an ambitious goal of seeing a 40% reduction over the next ten years given that we can implement we know needs to happen. at the same time the w.h.o. published in 2014 its world suicide report. also setting ambitious targets and looking at the regional differences around the world and what can we learn as a global community to address suicide. i just want to highlight a couple of cross-cutting things in the u.s. the u.s. research agenda that are reality to arctic countries. one is a positive approach. testing approaches that actually initiate and maintain healthy

behaviors that can lead to reduction in risk. testing interventions aim at reducing risk factors and using technology to figure out how to facilitate social connections and help seeking. using practical studies practical trials to determine the benefits of quality improvement in healthcare systems. recognizing that these interventions need to happen in the context of quality mental health service delivery and quality health care delivery, and finally recognizing these are interventions that need to take -- so testing components in other systems responsible for health, inclusion house justice, education et cetera. so i spent some days, a few weeks ago in alaska. the canadian institute of health research sponsored a meeting of -- on the mental wellness project that they did underneath the canadian chairmanship, and

it was a great discussion. the canadians sponsored a couple of teams to do an environmental scan of available interventions that are being implemented in communities, that communities find promising particularly looking to see what is it that indigoes communities in the polar arctic find most important and what is considered promising interventions. they also look to see the evidence-based interception some lessons that came from this conversation were that solutions need to be culturally grounded. they need to be community-base expected community-driven. there was a lot of discussion around the importance of intervention specificity for communities. this is important for communities to recognize that this is not a one-size-fits all. these solutions need to be adapted for context.

what is the importance of culturally appropriate shared inintervention across communities? how can one learn from simply implementing the mental health services needed, for example how can we learn from enter sexting cooperation that would benefit multiple communities. another takeaway the solution studies of the problems need to be solution focused instead of problem focused. how do we focus on health, strengthening health, even while we're trying to reduce risk and reduce the bad outcomes. communities, clean nikschs governments and others, need to know what works in order to know what to implement more widely, and a number of questions arose how do we make sure that communities -- how do we know how communities define what works. that's not always the same as the way researchers define what works. how do decisionmakers define what works and where do these different perspectives actually intersect. and finally they noted there were few studies of

interventions with the regular rouse evaluation -- rigorous evaluations. so thank you. s we see from the u.s. perspective for building on the canadian activities, first of all, acknowledging that these kinds of challenging problems need shared knowledge and tailored efforts but when we're tailoring interventions how can we be sure others are learning from those interventions? and if your interventions are successful, what is required for implementation? and once an intervention is implemented, how can one ensure that the intervention can be sustained? so how can the result of successful interventions be communicated to decisionmakers, to aide sustainability, and one answer may come in how we approach testing the efficacy of these interventions and that includes figuring out how can we harmonize outcome measures to provide a shared language to communicate to different

stakeholders. an important issue arose in the conversations and that is that if we want to think about wellness and health, there are many slices to the pie and so focusing on the health second at sector is not sufficient. one has to think.the economic sector and we talk about this today. economy, education physical environment, climate and also remembering social history and how that influences the way that people respond to current challenges. so the u.s. proposed project under the arctic council is called reducing the incidence of suicide in indigos -- indigenous groups and the context is remembering that, as i've shown you in the to first slides, they're an elevated risk of suicide in remote rural arctic communities.

we also are talking about communities with considerable cultural diversity and often very small populations. so the standard approaches that researcher tend to use to evaluate the efficacy and effectiveness of intervention is quite challenging. so what might be a way to get around some of those things? there are also some important assumptions and those are that efforts also have to continue, of course,on what is propose he would under the u.s. chairmanship and under the sustainable development working group specifically and that these proposed projects, like rising sun can move the agenda forward, but they have to happen in concert with broader ongoing efforts for service delivery, for research, and for these other intersectorral intersenses. so some of the questions that rising sun hopes to answer are can lessons been the impact of suicide prevention, interventions, be learn from information across more than one arctic community? would this be facilitate bid

identifying common measures to assess the outcomes of interventions and what are some of the underlying themes that are most frequently measured across these interventions? so what might this look like? we know that there's a big body of existing interventions out there, some of which were highlighted in canada a few weeks ago and those interventions targeted policies, some of them target health systems, some of them are clinics based some are more community level interventions focusing on bringing youth in particular back to -- back in touch with their cultural traditions and some of them are focused at individual levels. so what we hope to do is prepare a tool kit that takes into account these various levels of intervention and meaningful outcome measures. that can be used to harmonize ethe ago vacation across fights that can enable communities to measure what is relevant to their needs and would enable the sharing and comparing of data

across studies of effectiveness and this we hope will be able to be amenable for community use that will -- and will take into consideration what communities value in terms of outcomes, that will take into consideration the kinds of data that subnational governments are currently using and val knew terms of outcomes and that will also use the expertise of researchers who are working on methods appropriate for this kind of evaluation. thank you. [applause] >> thank you very much, pamela. dr. michael bruce. cdc. >> can we pull up the slides? there it is. okay. thanks very much for having me here to speak to you today about cdc's role and activities in

regardses to human health in the arctic and the subarctic. so i'm going to work off 0 a series of slides. so this is a slide that shows you sort of cdcs ates in the arctic and i work for the arctic investigations program, 33 people total. we also have a quarantine station there focused on infectious diseases. we have the national institute of occupational safety and health office there and also have an atfdr office. so our mission at arctic investigations program is to prevent infectious disease morbidity -- special emphasis on diseases with-among indigos people or-under priority areas are surveillance of infectious diseases emerging ineffecting she diseases, reducing health -- preparedness response and leader ship in circumpolar

health. one our activitieser is international surgicallance, and we're headquarters for a circumpolar network look can at different infectious diseases across the arctic. that map shows you in the darker color the countries that participate in the invasive back tier you're disease network and we add tb on so if it was a map showing tb, russia would be includes also. some of the thing that have come out of this network we have been age to identify outbreaks of infectious diveses across the different country and also been able to identify new dangerous emerging infections in these countries, and we have actually been work over the past decade to identify a new infection that has a case fatility rate of 10% in our children. and we have worked closely with the canadians in particular where the canadian have quite

high disease rates also to work on this issue. we also work with the international union for sir culp polar health. i'm a former president of the union and we work for the american societies for the circumpolar health and we work mainly through a variety of different infectious disease working groups, and these working groups fall within the union's purview. we also work with the u.s. interagency, arctic research policy committee. there's a cdc rep from our office that co-chairs that meeting, and dr. roger glass i believe also co-chairs fromly and he is here today. we also work with the arctic council, particularly we have a represent tim -- representative from our group that's mer member of -- allen park pinson but is no going to be dr. tom

hennessey, my boss, and advises the sustainable development working group of the arctic council. and then we have been working on a number of other health initiatives in alaska. one is the alaska water and viewer challenge -- sewer challenge and i'll tell you more about that in subsequent slides. one thing we're trying to do is take a local alaska specific initiative to improve water distribution and sewage -- sewer system availability to people and internationalizing and expand it to our international partners elm we also work within a group called the one halve working group in alaska that is led by the alaska nate till tribal health association and that's looking at the enter section of human animal, environmental health. so i'm going to speak ubriefly about water san nation and health in alaska -- sanitation and health in alaska inch alaska we're far behind at least in

terms of rural alaska in terms of the percentage of homes with complete plumbing and if you look at this graph you can see that on the x axis is dead cake, on the y axis is percentage of homes with complete plumbing inch the u.s. we went from 55% in 1940 up to 100% in lower 48 states. alaska is pretty high but when you look at rural alaska, as of 20 you draw a line across, we're where the u.s. was in 1959. ...