Does Development Work? Observations on Gates’ Annual Letter
Infant mortality is down worldwide
Every year, Bill and Melinda Gates release a letter on the state of the Gates Foundation and the current situation of global development and health. This time Gates set out to dispel three common myths on development, namely that poor countries are doomed to be poor forever, foreign aid is a total waste and that development will just lead to overpopulation.
The first is the most cynical, but even for us development/public health folks, it’s easy to be discouraged. Pessimism aside, the data don’t bear out the assumption that developing countries are entrenched in poverty. Just about all Sub-Saharan African countries experience consistent economic growth throughout the 00’s and have seen rapid improvements in just about all of the common health indicators. People are living longer, fewer kids are dying and they’re making more money to pay for school and health care.
Over the past five years that I’ve been going to Sub-Saharan Africa I’ve seen this change on the ground. Cars are in better shape, there’s more goods on the shelves, kids are better nourished and security has vastly improved. Does this mean that all of the problems are magically going away? No, there are still vast challenges to infrastructure development, access to health care and affordable medications, educational quality, gender issues and basic business development. However, these improvements do signal that Sub-Saharan African countries are reaching a point where sustained development is possible.
I have a hard time disagreeing with Gates here, but I did find his “before” and “after” pictures of Nairobi a bit bizarre. Though Nairobi is currently going through a construction boom, I fail to see how it would look any different in 2014 than it did in 1969 after more than three decades of stagnation.
Gates second point and the hardest myth to dispel is that of the alleged ineffectiveness of aid. Bill Easterly has made a career out of aid bashing, and, unfortunately, given cynical politicians looking for policy scapegoats a point to scream to their angry constituents. In a broader sense, the screaming over aid is really a questioning of developmental policies themselves. Certainly, there are development failures. The neo-classically informed structural adjustment policies of the World Bank and the IMF during the 80’s and 90’s were, on the surface, colossal failures (Read Beyond the World Bank Agenda: An Institutional Approach to Development by Howard Stein for a great analysis). On a smaller scale, we can easily cherry pick misguided but well meaning development projects or plans that simply went awry for any number of unforeseen reasons. The recent takedown of Jeff Sachs (The Idealist: Jeffrey Sachs and the Quest to End Poverty) and the massive problems of the Millenium Village in North East Province in Kenya is a great example of the challenges a development project can face.
However, in ever insular post Iraq America, the question that is most often asked is why we should even care and does our presence merely serve to make things worse. The truth is, and the point most often overlooked, is that most development projects are international collaborations. Many projects are conducted with partners in target countries and, more often than not, projects often make up for shortfalls that hobbled governments are unable (or sometimes unwilling) to provide. Health care is one example.
Jeff Sachs wrote a nice article this morning on how effective free insecticide treated nets have been in reducing malaria incidence and mortality in Sub-Saharan Africa. Nearly half a billion free nets have been given out worldwide as of 2014 and a lot of kids are alive today who would have been dead had they been born ten years earlier. Malaria is 100% associated with poverty. Wealthy people do not get malaria, even in malaria endemic countries. Though some of the decline in malaria incidence has been due to increased affluence and urbanization of African countries, a major percentage of this decline has been due to aid programs which provide bed nets and have expanded access to life-saving malaria medications. Certainly, not all aid works, but nothing works 100% of the time, particularly when humans are involved.
Which brings us to the most cynical and offensive of Gates’ three myths. Some people truly believe that saving African kids is a bad thing. One day there will be too many of them and they will suck up the ability for the world to sustain life. Honestly, this view couldn’t be more wrong.
The poorest parts of the world are the areas which are seeing the most rapid population growth. The average Malawian woman has 8 children in her lifetime, often starting when she isn’t even yet 15 years old. It has been said that if Malawi continues on it’s current trajectory, that it will have a population equivalent to that of Japan’s by 2050. Women in water and food constrained pastoralist communities can have ten or more children. The most affluent areas of Africa are the places with the slowest population growth.
Even more incorrect is the assumption that poverty is less harmful to the environment than development. Malawi is almost entirely deforested due to extensive use of charcoal for heating and tobacco cultivation. Deforestation not only robs the earth of potential carbon sinks, but also reduces need biodiversity and directly impacts precious water resources. Africa burns unclean fuels such as charcoal and coal for heating, and the poor condition of vehicles make it a major potential source of greenhouse gases. The air in Nairobi on any given weekday is so filled with exhaust that one can become dizzy just walking around town. It is, of course, unreasonable (and stupid) to deny Africans transportation and cooking fuel, but well meaning though poorly informed armchair environmentalists in the United States would happily suggest doing just that.
Which bring me to my final point. The case against development is one that assumes that the status quo is somehow preferable to anything that might come after. The assumption is that Africans were just fine without Europeans and their planet destroying ways. There is, of course, little data on what Africa was like before Europeans started extracting resources from the continent. We do, however, know a lot about underdeveloped areas of Africa. There is evidence to suggest that some do fine. There is however, much evidence to suggest that other simply do not. The worst parts of Africa are the parts which are the least developed. They are the areas where the market doesn’t function. The areas where there is little education, no access to health care, no roads, no economy, kids regularly die, where old people are a venerated since they are so rare, where there’s violence and instability and people are entirely marginalized from any level of political participation. While development likely will never solve the worst problems (like those in Somalia), there is no case to be made that the current state of the ultra poor is acceptable on any measure, even to the poor themselves!
Alright, off to bed.
What I’m Reading Now
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Bad Samaritans: The Myth of Free Trade and the Secret History of Capitalism
I have no problem with the basic premise of the book. Many of the reforms suggested by the WB/IMF were wholly inappropriate for the level of the development of poor countries at the time. For example, it doesn’t really make much sense to privatize a health system before it has the structural means to support itself but that’s exactly what was recommended to a number of countries during the 1980’s. I do, however, become annoyed at the creation of monolithic enemies (“Bad Samaritans”), though I suspect that Chang’s view is much more nuanced than this popular work would suggest.
Worse yet is Chang’s unwillingness to present information on the situations which predicated some of the reforms, such as Zambia’s failed experiment with the nationalization of private firms and over-reliance on copper revenues. I’m willing to accept that the structural adjustment reforms were ill-conceived (because they were), but would like to see more information on why the reforms were suggested. Chang, Stiglitz and Stein (all heroes of mine, btw) fall too often into the trap of blaming ideology at the expense of history and overestimate the capacity of the WB/IMF, who were often grabbing at straws in the face of massive organizational adversity.
The Price of Civilization: Reawakening American Virtue and Prosperity
Jeff Sachs of the Earth Institute at Colombia University in NYC is a macroeconomist. As a macroeconomist, he worries about the big picture. How does the overall economy function and what are the macro level factors which insure or compromise the economic health of a country or region? Here he takes on issues of American politics. He’s worried that American politics has become hijacked by corporate interests for their own short term benefit. We need to worry about growing inequality, environmental destruction, climate change and stop fighting useless wars. In short, Sachs, in a cookie cutter sense, represents the views of liberal America.
Now, I like Sachs. I share his view that the market economy is a good thing and an efficient means of distributing scarce goods, but that government is required to effectively insure fairness in the market, reduce the impact of economic shocks and provide or regulate public goods for which the market is unsuited (health care, education, etc). Government and the private sector should complement one another.
I feel that though sometimes Sachs’ works are so broad as to sound naive, his critics, particularly Bill Easterly and Dambisa Moyo, are unfair, particularly regarding matters of the role of foreign aid in development. I had the pleasure of meeting him a couple of years back. It was an experience I will never forget.
As before, I have no problem with the premise of the book. The US is facing a set of challenges that will be difficult to overcome. Health care, economic inequality, political impasses, failure to adequately tax its citizens to insure a health set of public services, etc. etc. As the world’s biggest and one of the most vibrant economies, the US has a special responsibility to keep its house in order.
However, Sachs’ book, as a polemic, is often overly broad and somewhat annoying to me. For example, in his attempt to pit politics against the American people, he fails to adequately deal with the problem of the behavior of individual Americans. He views the current set of problems as stemming from some nefarious clique of ambiguous groups which manipulate the world for their own evil ends (like the Koch Brothers), concluding that Americans are hapless in the face of these powerful forces. It’s easy to think that Randian ideas are an abomination, but I think that Sachs needs to get out into the country-side a bit more. Libertarian ideas resonate strong with a lot of voting America. The reason that Tea Party groups are successful is because they speak to the gut of a wide swath of Americans.
In the end, Sachs appeals to the Millenials as the last great hope of America. I think, however, he is assuming that they are far more liberal than they might appear. Though I have no data to back it up, I suspect that the current younger generation is quite conservative in more ways than Sachs cares to recognize.
More annoying are his calls for a wide cultural shift in America. A task easier written about than implemented. In the end, he sounds like a rocking chair curmudgeon bemoaning the state of the world and calling for a return to the more idyllic days of the past. I have little tolerance for this kind of writing, honestly.
There are some small gems, though. Sachs vents his frustration with his own camp. Notably, how even environmentalists have stymied development of renewable energy sources (BANANA: Build Absolutely Nothing Anytime Near Anything) and how well meaning folks calling for a return to pre-industrial styles of agriculture are failing to deal with the reality that such a strategy would be disastrous for humanity and the environment.
An interesting book, though not a rigorous analysis of costs and benefits of potential implementable policies to mitigate the problems he addresses. The book is what it is.
Hidden Horrors: Japanese War Crimes In World War II (Transitions–Asia and Asian America)
by Yuki Tanaka (1998) This is one of the most depressing books I’ve ever read. Tanaka has written a detailed account of the wide range of atrocities committed by the Japanese military during World War II. Cannibalism, rape, mass killings, prisoner abuse, it’s all here and it’s gut wrenching.
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