We study the effects of development and climate change on infectious diseases in Sub-Saharan Africa. Infant mortality and infectious disease are closely related, but there are better data for the former. In an international cross-section, per capita income, literacy, and absolute poverty significantly affect infant mortality. We use scenarios of these three determinants and of climate change to project the future incidence of malaria, assuming it to change proportionally to infant mortality. Malaria deaths will first increase, because of population growth and climate change, but then fall, because of development. This pattern is robust to the choice of scenario, parameters, and starting conditions; and it holds for diarrhoea, schistosomiasis, and dengue fever as well. However, the timing and level of the mortality peak is very sensitive to assumptions. Climate change is important in the medium term, but dominated in the long term by development. As climate can only be changed with a substantial delay, development is the preferred strategy to reduce infectious diseases even if they are exacerbated by climate change. Development can, in particular, support the needed strengthening of disease control programs in the short run and thereby increase the capacity to cope with projected increases in infectious diseases over the medium to long term. This conclusion must, however, be viewed with caution, because development, even of the sort envisioned in the underlying socio-economic scenarios, is by no means certain.

Poorer countries are generally believed to be more vulnerable to climate change than richer countries because poorer countries are more exposed and have less adaptive capacity. This suggests that, in principle, there are two ways of reducing vulnerability to climate change: economic growth and greenhouse gas emission reduction. Using a complex climate change impact model, in which development is an important determinant of vulnerability, the hypothesis is tested whether development aid is more effective in reducing impacts than is emission abatement. The hypothesis is barely rejected for Asia but strongly accepted for Latin America and, particularly, Africa. The explanation for the difference is that development (aid) reduces vulnerabilities in some sectors (infectious diseases, water resources, agriculture) but increases vulnerabilities in others (cardiovascular diseases, energy consumption). However, climate change impacts are much higher in Latin America and Africa than in Asia, so that money spent on emission reduction for the sake of avoiding impacts in developing countries is better spent on vulnerability reduction in those countries. His last big project in a long career, Jan Feenstra managed the Netherlands Climate Change Assistance Programme through which the Dutch Government sponsors climate change research in developing countries. He hated how climate change detracted from what he considered to be the real issues. This paper is dedicated to his memory.

The paper discusses valuation issues in the context of climate change impact estimation. Issues addressed are aggregation of damage costs over diverse regions (particularly equity-weighting), differentiation of per-unit values, willingness to pay versus willingness to accept compensation as a basis for valuation, and accountability for impacts. Numerical illustrations show that the damage cost estimates are quite sensitive to the assumptions made on these issues.