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How Aid Can Work

In response to:

Aid: Can It Work? from the October 5, 2006 issue

In a review of William Easterly’s book The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good [“Aid: Can It Work?,”NYR, October 5], Nicholas Kristof discussed Professor Easterly’s references to the work of the economist Jeffrey D. Sachs. Professor Sachs has now sent the following comment.

—The Editors

In a very different era, President John Kennedy declared

to those peoples in the huts and villages across the globe struggling to break the bonds of mass misery, we pledge our best efforts to help them help themselves, for whatever period is required—not because the Communists may be doing it, not because we seek their votes, but because it is right. If a free society cannot help the many who are poor, it cannot save the few who are rich.

It is difficult to imagine President Bush making a similar pledge today, but he is far from alone in Washington. The idea that the US should commit its best efforts to help the world’s poor is an idea shared by Bill Gates, Warren Buffett, and Jimmy Carter, but it has been almost nowhere to be found in our capital. American philanthropists and nonprofit groups have stepped forward while our government has largely disappeared from the scene.

There are various reasons for this retreat. Most importantly, our policymakers in both parties simply have not attached much importance to this “soft” stuff, although their “hard” stuff is surely not working and the lack of aid is contributing to a cascade of instability and security threats in impoverished countries such as Somalia. We are spending $550 billion per year on the military, against just $4 billion for Africa. Our African aid, incredibly, is less than three days of Pentagon spending, a mere $13 per American per year, and the equivalent of just 3 cents per $100 of US national income! The neglect has been bipartisan. The Clinton administration allowed aid to Africa to languish at less than $2 billion per year throughout the 1990s.

A second reason for the retreat is the widespread belief that aid is simply wasted, money down the rat hole. That has surely been true of some aid, such as the “reconstruction” funding for Iraq and the cold war–era payouts to thugs such as Mobutu Sese Seko of Zaire. But these notorious cases obscure the critical fact that development assistance based on proven technologies and directed at measurable and practical needs—increased food production, disease control, safe water and sanitation, schoolrooms and clinics, roads, power grids, Internet connectivity, and the like—has a distinguished record of success.

The successful record of well-targeted aid is grudgingly acknowledged even by a prominent academic critic of aid, Professor Bill Easterly. Buried in his “Bah, Humbug” attack on foreign aid, The White Man’s Burden,* Mr. Easterly allows on page 176 that

foreign aid likely contributed to some notable successes on a global scale, such as dramatic improvement in health and education indicators in poor countries. Life expectancy in the typical poor country has risen from forty-eight years to sixty-eight years over the past four decades. Forty years ago, 131 out of every 1,000 babies born in poor countries died before reaching their first birthday. Today, 36 out of every 1,000 babies die before their first birthday.

Two hundred pages later Mr. Easterly writes that we should

put the focus back where it belongs: get the poorest people in the world such obvious goods as the vaccines, the antibiotics, the food supplements, the improved seeds, the fertilizer, the roads, the boreholes, the water pipes, the textbooks, and the nurses. This is not making the poor dependent on handouts; it is giving the poorest people the health, nutrition, education, and other inputs that raise the payoff to their own efforts to better their lives.

These things could indeed be done, if American officials weren’t so consistently neglectful of development issues and with many too cynical to learn about the constructive uses of development assistance. They would learn that just as American subsidies of fertilizers and high-yield seed varieties for India in the late 1960s helped create a “Green Revolution” that set that vast country on a path out of famine and on to long-term development, similar support for high-yield seeds, fertilizer, and small-scale water technologies for Africa could lift that continent out of its current hunger-disease-poverty trap. They would discover that the Gates and Rockefeller Foundations have put up $150 million in the new Alliance for a Green Revolution in Africa to support the development and uptake of high-yield seed varieties there, an effort that the US government should now join and help carry out throughout sub-Saharan Africa.

They would also discover that the American Red Cross has learned—and successfully demonstrated—how to mass-distribute antimalaria bed nets to impoverished rural populations in Africa, with such success and at such low cost that the prospect of protecting all of Africa’s children from that mass killer is now actually within reach. Yet they’d also learn that the Red Cross lacks the requisite funding to provide bed nets to all who need them. They would learn that a significant number of other crippling and killing diseases, including African river blindness, schistosomiasis, trauchoma, lymphatic filariasis, hookworm, ascariasis, and trichuriasis, could be brought under control for well under $2 per American citizen per year, and perhaps just $1 per American citizen!

They would note, moreover, that the number of HIV-infected Africans on donor-supported antiretroviral therapy has climbed from zero in 2000 to 800,000 at the end of 2005, and likely to well over one million today. They would learn that small amounts of funding to help countries send children to school have proved successful in a number of African countries, so much so that the continent-wide goal of universal attendance in primary education is utterly within reach if financial support is provided.

As chairman of the Commission on Macroeconomics and Health of the World Health Organization (2000– 2001) and director of the UN Millennium Project (2002–2006), I have led efforts that have canvassed the world’s leading practitioners in disease control, food production, infrastructure development, water and sanitation, Internet connectivity, and the like, to identify practical, proven, low-cost, and scalable strategies for the world’s poorest people such as those mentioned above.

Such life-saving and poverty-reducing measures raise the productivity of the poor so that they can earn and invest their way out of extreme poverty, and these measures do so at an amazingly low cost. To extend these proven technologies throughout the poorest parts of Africa would require around $75 billion per year from all donors, of which the US share would be around $30 billion per year, or roughly 25 cents per every $100 of US national income.

When we overlook the success that is possible, we become our own worst enemies. We stand by as millions die each year because they are too poor to stay alive. The inattention and neglect of our policy leaders lull us to believe casually that nothing more can be done. Meanwhile we spend hundreds of billions of dollars per year on military interventions doomed to fail, overlooking the fact that a small fraction of that money, if it were directed at development approaches, could save millions of lives and set entire regions on a path of economic growth. It is no wonder that global attitudes toward America have reached the lowest ebb in history. It is time for a new approach.

*Penguin, 2006.

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