How We Die

Originally published in the Informanté newspaper on Thursday, 15 November, 2018.

Death can be a very philosophical subject, but for today, we’re going to take a look at the statistics behind death in Namibia. Specifically, we’re taking a look at the data collected by the World Health Organization’s Department of Information, Evidence and Research, and published in April 2018. This reveals the age-standardized death rates by cause of morbidity per 100 000 population. 

It reveals that the all-cause death rate for Namibia is 1 237 per 100 000 population, or to put it another way, that 1 in 81 people in Namibia will die each year. Subdivided further, it shows that non-communicable diseases are the biggest killer in the population, which will kill 1 in 149 persons, then communicable conditions that kill 1 in 209 people, followed by injuries, that kill 1 in 1 131 people.

If we dig even deeper into non-communicable diseases, we find that the biggest killer in that category is cardiovascular diseases, which kills 1 in 317 people. In particular, the biggest killers are Ischaemic heart disease (where the blood supply to the heart is reduced) which kills 1 in 723 people annually, strokes which kill 1 in 935 people annually, and hypertensive heart disease (caused by high blood pressure) which kills 1 in 2 941 people annually. 

The second biggest killer in the category is malignant neoplasms (or cancers), which kill 1 in 1 332 people annually, but the cancers with the highest death rate are prostate cancer (1 in 10034), breast cancer (1 in 14982), cervix cancer (1 in 21 645), mouth cancer (1 in 21822), colon cancer (1 in 22685) and lung cancer (1 in 25803). 

The third biggest killer is diabetes mellitus, which kills 1 in 1359 people annually, with respiratory diseases fourth, killing 1 in 1492. Fifth is digestive diseases, with a death rate of 1 in 2667, with cirrhosis of the liver the biggest killer there, killing 1 in 8166 annually. Neurological diseases kill 1 in 2128 annually, with Alzheimer’s disease and other dementia’s claiming 1 in 2927 of Namibians each year. 

Let’s then dig deeper into communicable conditions. The number one killer in this category is infectious and parasitic diseases, which kill 1 in 300 people annually. It should therefore be no surprise to find out that in its subcategories, HIV/AIDS is the biggest killer, which deaths amounting to 1 in every 447 people in Namibia annually. Tuberculosis is a distant second, with deaths of 1 in 1937 people, and diarrhoeal diseases killing 1 in 2514 people annually. 

The second biggest killer here is respiratory infections, claiming 1 in 1039 people yearly, with almost 99% of those being lower respiratory infections. Third would be neonatal conditions, claiming 1 in 3386, with 1 in 7420 dying due to preterm birth complications. Next is maternal conditions, which kill 1 in 10868 annually. Finally, nutritional deficiencies result in the death of 1 in 11 064 annually, which 1 in 12763 being due to protein-energy malnutrition. 

Finally, we can take a look at injuries. Unintentional injuries kill 1 in 1732 people annually, with 1 in 3365 dying from road injuries suffered. Intentional injuries kill 1 in 3261, with interpersonal violence accounting for 1 in 5223 deaths, while self-harm accounts for 1 in 8685 death annually. 

So what other interesting statistics can we see when we take an overview of the data? Well, besides those causes which no Namibian dies from, the lowest causes of death are Thassaemias (where the blood does not produce haemogoblin) which kills 1 in 19 876 764, and eating disorders, which kill only 1 in 17 865 438. Also interesting is the fact that alcohol use disorders kill more people ( 1 in 42 128) and drug use disorders (1 in 45 820). 

When we take an overall view of the country, however, a clear picture emerges of the biggest killers in our nation. HIV/AIDS is the cause of 18% of deaths, with heart disease a close second at 14%. Strokes claim 9% of lives, with respiratory infections claiming 8% and diabetes 6%. Together, these diseases and conditions account for more than 50% of deaths in the country yearly. 

These are the numbers the life insurance companies use to calculate premiums, but more importantly, these are numbers that every citizen should be aware of. The old saying goes that being forewarned is forearmed. Ask your doctor about your risk factors for the biggest killers in Namibia, and you might be able to save your life, or the life of your child, or your parents. Every avoidable death is a tragedy.

The Ultimate Penalty

Originally published in the Informanté newspaper on Thursday, 1 November, 2018.

With violence once again the rage in our nation, social media has been in uproar every time a new incident gets reported. Time and time again, the same refrain is repeated, “bring back the death penalty”, or “let him hang”, or “if I get my hands on him”. If you browse the comment section of every gruesome incident reported on by the Informante, you know this song, sung by supposedly moral and upstanding citizens of our nation. 

These cries are often done in the name of ‘justice’, yet they are in reality calling for vengeance. While the two terms may seem to overlap a bit, they do come from two entirely different places. Revenge is emotional, which is why the call of it seems so strong in the aftermath of a crime, but justice is primarily rational. Revenge is personal, while justice is impartial. Revenge is vindictive, while justice is vindication. 

Revenge fuels revenge, the classic cycle of violence as perpetrated by the mob; justice on the other hand, seeks to bring closure. Vengeance, ultimately, is about retaliation, expressing rage, hatred and spite, while justice concerns itself with restoring balance – restorative justice. Justice focuses on equity in punishment, in restoring the social balance that was upset by the crime. Revenge escalates, while justice seeks to redress an imbalance. 

It is clear why most humanists oppose the death penalty – if everyone only has one life to live, the loss of a single life, no matter how irredeemable, is seen as abhorrent, and lessens all of us with its loss. Yet we do not live in a country of humanists, for the majority identify as Christian. To those who support it, the words of Exodus 21:234 give them the right to vengeance, for it claims, “a life for a life, eye for eye, tooth for tooth, hand for hand, foot for foot.” They are too eager to forget the Sermon of the Mount, where the progenitor of their religion, a certain Jesus, said in Matthew 5:38, “You have heard that it was said, ‘Eye for eye, and tooth for tooth.’ But I tell you, do not resist an evil person. If anyone slaps you on the right cheek, turn to them the other cheek also.”

Once the fervour of vengeance and religious certainty has subsided, only then do the proponents of the death penalty attempt more conventional arguments. Only now is it argued that the imposition of the death penalty will serve as a deterrent to future crimes of the same kind. Yet the facts do not support this. 

Firstly, a deterrent only works if it is consistently and promptly employed. With a criminal justice system that is run by people, we cannot claim that no errors will be made, and thus no court would allow for a quick execution after a crime until it has been properly examined. As such, executions are usually done quite a while after the commission of a crime, and has used a lot of court time and cost that could have been used to resolve other crimes.

Secondly, a lot of these crimes that people call the death penalty for are not planned, but committed in the heat of the moment, under emotional stress, or under the influence of alcohol – when people are already unable to appreciate the consequences of their actions. When a crime is planned, part of that planning involves not getting caught, so the perpetrator has already considered the risk of being executed before committing the crime. Thirdly, if severe punishment can deter crime, permanent imprisonment is quite severe enough that it would deter any rational person from committing that crime. 

The data in jurisdictions that have the death penalty have been unable to show that it has deterred such crimes to any reasonable degree. It is simply not a solution to the problems we face. Yet there are many more reasons not to employ the death penalty. For one thing, it denies citizens the due process of law, as the death penalty is the ultimate penalty that cannot be revoked. It does not allow the accused the opportunity to benefit from new forensic techniques or collection of evidence which would allow for the reversal of a conviction. And it is quite barbaric. We don’t punish those convicted of assault by assaulting them, so why should we kill killers? If it is to be used as a deterrent, is it morally justifiable to use one citizen’s life to deter other crimes they did not themselves commit?

Due to these reasons some people seem to think that opposing the death penalty implies a lack of sympathy for the victims, but the opposite is true. Rarely do the families of murder victims feel that another murder would make them feel better. Murder demonstrates a lack of respect for human life. Life is precious, and death is irrevocable, which makes murder abhorrent, and which should make state-authorized killing even more abominable. 

It advocates that the brutality of violence as the solution to society’s difficult problems, rather than reason. This is a terrible example to set for citizens, or children! The benefits of capital punishment are quite vague, but the destruction of community decency it causes by glorifying vengeance is not. Luckily, we live in a country that recognises this. Article 6 of the Namibian constitution, as entrenched and protected against repeal by article 131, reads: “The right to life shall be respected and protected. No law may prescribe death as a competent sentence. No Court or Tribunal shall have the power to impose a sentence of death upon any person. No executions shall take place in Namibia.”

For as Gandalf said to Frodo, “Many that live deserve death. And some that die deserve life. Can you give it to them? Then do not be too eager to deal out death in judgment. For even the very wise cannot see all ends.

Death And Taxes

Originally published in the Informanté newspaper on Thursday, 11 October, 2018.

‘Tis impossible to be sure of anything but Death and Taxes. So wrote Christopher Bullock in 1716, in The Cobbler of Preston. And it’s still as true today as it was then. Last month, Finance Minister Calle Schlettwein made public his proposed Income Tax Amendment Bill, reiterating this fact. Naturally, this bill contains some good portions, and some which are downright dangerous for a country in the midst of its longest recession in history.

Why tax at all, however? Well, the easiest answer would be to say that its funds the government. To put it into an economic context, there are some economic goods we expect from society that would not be provided otherwise if not provided for by government. Economic goods can be classified as either rivalrous or non-rivalrous, and either excludable or non-excludable. 

Rivalrous goods can only be consumed by one person at a time – think of a chair, in that if you’re sitting on it, no one else can. Non-rivalrous goods are like a movie – just because I’m watching it, doesn’t mean the person sitting next to me cannot. Excludable goods are those you can prevent others from using – think of a car, where if it’s locked, you cannot gain access to it without the key. Non-excludable goods are like the air – no one can stop you from breathing it.

Our society and our nation depends on several goods – marine and mineral resources, biodiversity, clean water, transport infrastructure, sanitation, defense, just to name a few. Unfortunately, while the free market economy is quite good at managing excludable, rivalrous goods, there is no incentive to provide services that could be consumed by anyone without excluding others. Yet we still depend on them. This is the ultimate reason we pay taxes – so that we all can contribute towards providing those resources we consume without a second thought. 

Of course, some services provided by the government are simply there because we wish our society to have them. As John Green so famously put it, “Let me explain why I like to pay taxes for schools even though I don’t personally have a kid in school: I don’t like living in a country with a bunch of stupid people.” 

So overall, the collection of taxes is done for a good cause. That is not to say, however, that taxes don’t have an economic impact. These impacts can be divided into one of two categories – it either has an income effect, or a substitution effect. If the tax is applied to individuals or legal entitites, taxes have an income effect – it reduces the purchasing power of taxpayers. The substitution effect occurs when taxes are placed on products – VAT for example. Those items that are VAT exempt will thus be cheaper in relation to those that are not, encouraging a shift in consumption towards those products. 

So let’s take a look at some of the changes proposed by Minister Schlettwein. In particular, some changes prepare the country for electronic tax submissions, which in my view are long overdue. Then there are several amendment to curb tax avoidance, which could be achieved with the existing tax structures. In addition, the penalties for tax evasion and tax fraud are amended to be more pertinent and scaling to the amount of tax payable, instead of a flat N$ 2000 fine. 

In addition, assessed losses can now only be carried forward for 5 years, limiting the ability to set off losses against future earnings and potentially accelerating tax payments of newly formed businesses still struggling to get off the ground. For investors in those businesses, they can expect the 10% withholding tax on dividends to be applied to them even if they are resident in Namibia. 

A welcome change is that religious, charitable and educational institutions will now be taxed on their commercial activities. However, this does not go far enough – we are a secular country, as per Article 1 of the constitution, and religious institutions have for far too long rode on the back of civil society, collecting their own forms of taxes without being required to invest that into their communities. Minister Schlettwein should consider having them register as charitable institutions, and tax all non-charitable activities they engage in. 

Finally, personal income tax is to be amended. The changes, however, provides minimal while increasing the taxes at the higher end of the spectrum. According to economic theory, income taxes would have an income effect and a substitution effect. The income effect is simply the reduction in purchasing power of everyone that’s taxed more harshly. Per theory, then, since there is less purchasing power available to these individuals, they should therefore compensate by working more.

However, in Namibia, the substitution effect would be negated by two factors. Firstly, the Labour law limits hours of work and overtime, preventing anyone from compensating the income effect by increasing their hours worked at a single employer. Secondly, with our unemployment rate being what it is, the feasibility of finding a second job would be almost nil. As such, the effect of increasing income taxes would only have an income effect, reducing consumption in the economy, and thus, as demand influences supply, also reducing economic growth. 

It is thus quite puzzling that Minister Schlettwein would seek to reduce the purchasing power of the Namibian consumer in this way, especially when the country has experienced nine consecutive quarters of negative growth. Perhaps he is gambling that the few dollars saved by the lower-end of taxpayers will be spent and outweigh the hundreds of dollars not spent by the higher end. Or, more worryingly, that he’s of the opinion that the financial condition of the Namibian government is of such a state that it can only be saved by further strangling the economy.