Malaria, miseria, and underpopulation in Sardinia: the "malaria blocks development" cultural model.
Until the late Nineteenth century, endemic malaria was a serious public health problem in Sardinia, as in much of Southern Italy. As the poorest region of the new Italian nation, Sardinia was characterized by poor health, very low population densities, low agricultural productivity, and weak state authority associated with banditry. In this context, however, malaria was singled out as a key underlying problem for the situation of "internal underdevelopment." This paper describes the Italian scholarly literature about the relationship of malaria and economic productivity as a cultural model that can be labeled as "malaria blocks development" (MBD). Anti-malaria programs, including the state control of the distribution of quinine as well as land reclamation projects, played a major role in the decrease of malaria mortality in the first part of this century. Based on the logic of the MBD model, the decrease in malaria was expected to decrease an obstacle to "natural processes" of economic development. During the Fascist era, scientifically based antimalaria efforts formed a key element in centralized attempts for agricultural intensification and encouragement of immigration from over-populated parts of the country. Immediately after W.W.II, Sardinia was the site of a successful American-sponsored eradication project that represented one of the first uses of DDT against an indigenous anopheles vector. Hypotheses based on the MBD model about the nature of economic change after the removal of malaria are not supported. Nevertheless, variations of the MBD cultural model continue to be used in the field of International Health to the present day.