Jeffrey Sachs - April 21, 2005
ADDRESS TO THE CLUB
Jeffrey Sachs
Director, The Earth Institute at Columbia University; Special Advisor to Kofi Annan on the Millennium Development Goals; Author, The End of Poverty
The particular challenge that I'm going to talk about is the challenge of a world divided between the rich and the poorest of the poor as never before in history, a time when we have wealth beyond imagining in many ways, and yet millions of people are dying because they are too poor to stay alive. Twenty thousand today, 20,000 tomorrow - 8 million a year - who can't afford to live on a planet with so much to offer. We know that extreme poverty challenges us profoundly - in our souls, in our spirit, in our foreign policy, in many ways that threaten our national security. It's important for us to grapple with that challenge, to understand what we can do about this horrendous plague that continues to live in a world where it no longer belongs, in the 21st century, where we have so much power and ability to do better.
More generally, I want to talk about America and how it relates to all of the world, not just the poorest of the poor, because in our country we need to do better in thinking about the world: in taking it seriously, in working with, and not only feeling threatened by, the world. In understanding that, we have to put a lot more energy into peacefully shaping the world than we are today, because military approaches to our problems are never going to provide us with the security that we so desperately seek. We're going to have to find a way to live in a complicated and diverse world, including with people unimaginably poor compared to our standards, and people living in many other conditions that, because of how we've tended to view these challenges, we're not even aware of.
Thomas Friedman has a very fascinating new book with a lot of important insights called The World Is Flat; I'm going to talk about the bumps in the world. The world is not flat - Tom knows that. His metaphor that we're all on a level playing field is actually not right for many parts of the world, particularly places I'm going to talk about: places at 12,000 feet above sea level, like the Andes, where poverty grips countries like Bolivia and Peru and Ecuador, Colombia. Or the Himalayan landlocked countries of central Asia - Nepal, with its insurgencies, or Afghanistan, a disaster of violence and disarray for decades now, that we know did so much to harm us in this country. Or the highlands of East Africa, where people are struggling every day to stay alive and failing in horrendous numbers in that challenge - where millions and millions of people are every day threatened by disease, chronic undernutrition, and where children by the thousands die because they lack access to the most basic needs of human life: safe drinking water, adequate nutrition, emergency health care in the face of utterly preventable and treatable diseases. So the world, alas, is not flat; the world is filled with contours, with ups and downs and highlands, and pockets of extreme poverty. And it's a very diverse and complex set of circumstances that we find in this increasingly interconnected and globalized society.
There is no way to generalize about the complexities of the world; we must learn about them in their detail. All extremes of the debate about our world - that we have a clash of civilizations, or that we have a process of globalization that will lift all ships, or that we have a process in which the rich get richer and the poor get poorer - all such simple generalizations are utterly false, easily disproved by one counter-example after another. I compare it to as if our doctors had one-page handbooks of physiology or pathology, where they knew there was one cause of disease or one explanation - instead of the complex 32-chapter, 1,500-page volumes that in fact modern science has given us. And yet, when we turn to the issues of globalization, we seem to go for those slogans, for simplicities, rather than complexities. The fact of the matter is, on both sides of the debate about globalization - those against it because they see extreme poverty and exploitation, those for it because they see massive economic development taking place - they're both right and they're both wrong. And the reason, in essence, is because the world is not flat.
Not "Crisis" but "End"
We can potentially have a breathtakingly optimistic outcome in the complex challenges that we face in trying to spread prosperity in the world. Our generation can, if we think hard about it and care enough about it, bring about the end of extreme poverty on the planet. This is not a forecast, only a description of what is possible, not inevitable. On the one side, lots of the powerful forces of globalization are showing remarkable power to do good. Indeed, prosperity is spreading to China, to India, to billions of people around the planet, because technologies are being adopted, market forces are being used to empower the reduction of material deprivation among hundreds of millions of people, particularly in Asia. This is hugely good news. The fact that the kind of poverty that we, for long periods of history, associated with India, or came to associate with China, seems to be ending now is wonderful news for our security and for a chance for a world of peace and prosperity in the 21st century. Globalization can be an extraordinarily powerful force for the good.
At the same time, we see places where the poorest of the poor are not only not achieving that kind of progress but are falling deeper and deeper into the most basic and urgent distress. Almost all of Africa is in extreme poverty, and almost all of Africa during the last generation has fallen deeper into crisis at the same time that China has had the fastest economic growth in the history of the world. That's the kind of complexity that we need to grapple with. It can't quite be right to say the rich get richer and the poor get poorer. But it similarly is absolutely not right to say that globalization or the rise in tide lifts all ships. It plainly has not.
The rising tide hasn't reached those highlands of Bolivia - not too much tide at 12,000 feet. Didn't reach Afghanistan before al-Qaida did. Hasn't reached Nepal. We have to understand not only the wonders and powers of the market but also the limits of the marketplace - and those left behind. In this case, we are talking about not mere inconvenience of small numbers of people, but extreme suffering of a billion people of the planet who are fighting every day for their survival. Why do we need to understand these things? Because we in the United States are only 5 percent of the world's population, and because we're living in a complicated world, and if we don't understand it, our ignorance is our peril, as we've all found out.
We're not understanding it very well. Because of that, we're not responding very effectively to these challenges. Unless we live and move beyond the slogans and clichés, we're going to find the world continuing to be awfully hard to interpret - and awfully dangerous. The particular danger to think about is the danger of those parts of the world which are not part of global progress. The fact of the matter is, in the United States we stopped talking about these problems a long time ago. We hear almost nothing about them except the occasional picture of the disaster in Darfur, or a picture of famine someplace, but the rest of the time, the poorest of the poor are not our concern - until the next disaster strikes. And strike it will. Because unless these problems are addressed, not only will massive suffering of a shocking dimension continue in the world, but that suffering will find its way back to our country and our society and will threaten our lives, our children's lives and our well-being.
A Family in Malawi
Let me introduce you to people living in the conditions of extreme poverty: a family in Malawi. It's not a full family. The woman is the grandmother of the children surrounding her. Her husband's dead, and her children are dead. She's raising 15 orphaned grandchildren because she's lost her sons and daughters to the AIDS pandemic.
We came to a village outside of Lilongwe, Malawi, in March 2002, in circumstances of extreme drought. As we drove to the village that morning, the corn in the fields was clearly dead, killed by drought. The drought, our scientists would tell us, was explained by events 10,000 miles away in the Western Pacific; this was an El Niño cycle, and when El Niño hits, Malawi and other parts of southern savannah Africa experience drought.
This is a hungry family - a grandmother raising orphaned grandchildren, living in an adobe hut, with almost nothing to eat as we arrived that day. The grandmother reached into her apron and pulled out a handful of millet and showed us what was going to become the gruel for the meal that day: a handful of grain, bug infested, to feed her grandchildren. AIDS, drought, chronic hunger, landlockedness, because this is a rural community in an overwhelmingly rural country, landlocked in the middle of southern Africa; no ports, no adequate transport to ports, essentially cut off from world markets and threatened every day by malaria and other tropical diseases, which are what the scientists call holoendemic in such regions: year-round, affecting everybody. Probably every child in that picture is carrying malaria parasites in their blood year-round. And it's not just their parasitemia which takes a long-term toll; the parasites are not cleared by proper treatment, so they develop long-term anemias, with devastating consequences. Several times each year, they'll experience clinical malaria that can threaten their lives.
On the particular day that we were there, the grandmother recounted how she had, a few days before, carried one of the children in an acute episode of malaria to the nearest clinic - three hours on a five-mile walk - to find, as is not unusual in impoverished places, that the drugs were not available. The grandmother was told to turn around, go home and come back the next day. That's the kind of delay that leads to an estimated 3 million children dying of malaria every year. Malaria, amazingly enough - a disease we don't know anything about in this country because it's largely a tropical disease - is a wholly treatable disease, and yet it will claim 3 million lives this year, because it is not treated.
The grandmother walked back the next morning. The quinine had arrived and the daughter was put on intravenous, and she survived. But I don't know how many of those children are still alive today that we were looking at, because no doubt other cases came, and other close calls.
A few weeks ago, I saw what happens when you don't get to the clinic in time: a child in coma in a rural area of western Kenya, the white tongue depressor in the child's mouth because the child was having seizures from this cerebral malaria. I don't know whether the child survived, but millions will not survive this year. I've called malaria the silent tsunami of Africa, because every single month as many children die of malaria as died in the Indian Ocean tragedy.
You'll recall from President Bush's recent speech about malaria…no you won't. Strike that! That will be for a later speech. We never hear about it! We give a pittance, we pay no attention. Somehow, in our interconnected, CNN, 24/7 world, 3 million children will die, and it won't even be mentioned. If you can figure it out, please let me know. I'm 50 years old, I think about it every day; I can't figure that out. What has happened to our country that we never discuss this?
You turn the corner from where that child was having the seizures and you see in the pediatric ward three children to a bed. It's normal in the evenings that six people are lying in one bed in the pediatric ward: three mothers sleeping across the bed with their three children. So overcrowded and so disease-ridden are these communities in Africa - AIDS, TB, malaria, diarrheal disease, acute lower respiratory infection, measles - perhaps 800,000 children will die of measles this year, an immunization-preventable disease. It's just not reaching the poorest of the poor. And when you look at the adult ward, this was a light day: only two to a bed.
If you go to a hospital in Western Africa, the Yala Subdistrict Hospital, with malaria, you may well be put head to foot in a bed with someone with tuberculosis. This is a hospital without enough beds for its patients; this is a hospital without running water. Why? Because Kenyans don't care? Of course not. Kenyans know that they're fighting for their lives, but Kenyans can't afford more. Kenyan incomes are less than $1 a day. A country of $300 per capita income maybe can muster $45 per year, per person, in government revenues - 15 percent of the gross national product. Think about $45 - that's what you have for the president, the congress, the courts, the land title systems, roads, water, power, electricity, air traffic controllers, schools, nutrition programs, family planning programs and hospitals. It turns out $45 doesn't go very far.
When you're stuck in extreme poverty, you know that you're dying, but you also can't do anything about it. Kenya spends about $8 per person per year on health; we spend $6,000 per person per year on health. The difference is that we have a life expectancy of nearly 80, with all of the difficulties and problems of our health system, and inequities in it; Kenya and other countries in Africa have life expectancies often half or less. Some countries have life expectancies of 35, 37 years and 200 of every 1,000 children born will die before their fifth birthday. They'll die of malaria, respiratory infection, diarrheal disease, measles - essentially of extreme poverty, because every one of those conditions is utterly preventable, or treatable, or both.
Food and Water
A woman walking with the water bottles - the charming sight of West Africa, women walking so gracefully along the road… Talk to the women. This woman spends six hours every day doing what we do when we turn on the tap. She walks in the morning an hour to the water hole and an hour back. Midday, an hour to the water hole and an hour back; in the afternoon, an hour to the water hole, an hour back. Six hours for the water. And there's the fuel wood to be collected, there's the milling of the grain, the caring for the children with malaria, the cooking, the weeding in the fields. These are the backbreaking days of undernourished people fighting to stay alive with almost nothing. How much productivity can there be when one's whole day is taken up in the mere struggle to stay alive?
The evening cooking: Particulate pollution indoors from wood burning without chimneys claims about 1 million children's lives a year of acute lower respiratory infection. The abrasion on the lungs leads to pneumonia and to death, and this is characteristic of impoverished countries all over the world.
And a sight that I could not have imagined before seeing it with my own eyes. A couple of months ago in a village in Ethiopia, men digging a hole in the middle of a dry riverbed, to try to reach the water several feet below the surface now. The river was, until recent years, the perennial river of this village - year-round flow. But the rains have failed so consistently now, the water table has fallen so sharply, there's no river; there's only the chance to reach it through this extraordinary excavation of a dry riverbed. The men were out there early in the morning, digging to find the water below the riverbed surface, so that they could somehow cart it up to their fields and try to save their drought-struck crops.
Scientists suggest that this very likely - or at least with reasonable probability - is the result of manmade climate change, which has warmed the oceans - in particular the Indian Ocean. The warming of the Indian Ocean correlated with this significant drop of rainfall in the whole Sahel region of Africa, the region just south of the Sahara, during the last 25 years. This is the region of Darfur. Darfur is not first and foremost a political crisis or a humanitarian disaster, which it is. Darfur, first and foremost, is a disaster of ecology and extreme poverty. It's a disaster of failed rains, rising populations, extreme rainfall, people fighting for survival and people killing each other to do so. That's the kind of crisis that can and does arise with all too high a frequency when people don't have enough to eat. The crisis of chronic hunger, insufficient water, chronic drought, repeated drought and all of the disease and distress that comes with it is part of the lives of hundreds of millions of people around the planet.
We have to understand this in a much more serious way than we do. Maybe Washington will be the last to get it. But Washington doesn't get it at all, and we have to help Washington to understand it. When I go to Washington, I hear a one-word explanation for all of this, as if it's self-evident: It's corruption. You know, if people would just take care of themselves, if their leaders weren't stealing from them, these problems would go away. This is the simple and largely ignorant gloss that we have added to our discourse so that we can turn away from these problems as if there's no solution that can have anything to do with us. It's all their fault. It's part of a long tradition, unfortunately, of the rich blaming the poor for whatever crises they face. But today, the way we do it is we say, Too bad the poor just can't behave themselves. Too bad their leaders have kept them enthralled this way.
I do agree there is corruption everywhere - not just in the United States. There is corruption all over the world, including in Africa, in Asia. But as an explanatory diagnosis of this situation, it's almost worthless. There are countries far more corrupt than Ghana, Senegal, Tanzania, Kenya or Ethiopia - in Asia, growing very well, thank you. There are well-governed countries in Africa, even glorious free multi-party democracies, where people live in freedom and they die massively in freedom, because they're dying of extreme poverty. There are countries celebrating multi-party elections that have life expectancies of 40 or 45 years. The explanation is not simply to blame the poor; the explanations are much more complicated, not beyond our ken, but they require a basic understanding that the world is not flat.
How is the world in Africa? Why is it so different from other parts of the world? Africa faces certain challenges of geography and ecology of unique harshness in the world. There are three that I would point out briefly.
The first is in growing enough food. Africa's food yields are by far the lowest in the world, per hectare. Africa, unlike Asia, did not have a green revolution starting 40 years ago. Africa's yield of one ton per hectare in maize growing, for example, is roughly a third or a fourth of what you'd find in other parts of the world. Why? Many complicated reasons - corruption not being an important part of that explanation. If I had to pick one, I'd say the Himalayas. The Himalayas give Asia the Ganges, the Brahmaputra, the Mekong, the Yellow River and the Yangtze River. The Himalayas give Asia a grain-fed system of agriculture which, 40 years ago, when combined with science (importantly brought by the Rockefeller Foundation and many American scientists), made it possible to triple food yields. High-yield-variety seeds, irrigation and high inputs of fertilizer is the combination that enabled India and China finally to escape the seemingly endless cycles of famine and begin the process not only of food self-sufficiency, but industrialization, and now, dynamic economic growth. Africa doesn't have that: 96 percent of Africa's food production is rain fed. That means all of Africa's population is vulnerable to the chronic droughts, the repeated disruptions of rainfall that characterize this savannah climate of Africa.
Second factor: tropical disease. Africa has by far the highest burdens of vector-born tropical diseases in the world, malaria being by far the weightiest and most significant. That's not a matter of bad governance or corruption or lack of care; that's a matter of the kind of mosquito vectors, breeding sites, ambient temperatures that Africa has. Studies at the Earth Institute at Columbia, and studies by other scientists, have explained why it is that 90 percent of malaria in the world is centered on sub-Saharan Africa, why 90 percent of the deaths this year will come from there. And you didn't hear it from Washington: It's not because of the corruption, it's because Africa has Anopheles gambiae mosquitoes and India has Anopheles culicifacies. In one place, near elimination of malaria is feasible; in another place we need other techniques of malaria control.
A third factor for Africa: Where are the highest population densities of African citizens? Not on the coasts, as in so many other parts of the world, including our own country, but in the interior of the continent, in the highlands, where the rains are better, where subsistence food crops can be grown. In Ethiopia, Rwanda, Burundi, Uganda - 1,000 miles in the interior of the continent, with almost impossible costs of land transport given the lack of adequate road systems, and yet people live there because that's where the rain allowed them to grow food from time immemorial. If you consider these factors - hunger, vulnerability to drought, low food productivity, disease burden, economic isolation from living far from ports up in the highlands - you begin to understand why the fact that the world isn't flat is of such significance. Because these people are vulnerable to a trap of extreme poverty which has left them on the edge of survival every day of their lives.
Well, what good is a diagnosis if it doesn't lead to treatment? The fact of the matter is that this diagnosis, far more accurate than blaming the poor for their problems, suggests ready solutions. This is the biggest irony of it all, because science and technology have given us practical approaches for every one of these challenges and more.
Difficulties of growing food? There are farm systems applicable to the savannah, seeds that are drought resistant, drip irrigation, water-harvesting techniques, planting strategies, intercropping with tree crops and other kinds of crops that are tolerant of drought conditions, that can make all the difference. But they require some investment, and when people are so poor that they are barely surviving day to day, it's precisely that investment that they're unable to make.
What about malaria? In Africa, malaria cannot be eliminated with current technologies, and until there's a sterilizing vaccine it probably won't be possible. But malaria can be decisively controlled, because every one of those cases can be treated - and a very large number of those cases can be prevented by something as simple as a bed net treated with insecticide to repel the mosquitoes that transmit the disease. A $7 bed net - which lasts five years, $1.40 per year, two children sleep under it, 70 cents per child per year - combined with effective medicines available at the village level could save millions of lives every year. How much would it cost? One cup of coffee at a pretty good price per year, from everybody in America and everybody else in a high-income country. About $3 per year from each of us - $3 per person from the billion people living in the rich world, $3 billion per year, could finance the bed nets, the medicines, the village-based diagnostics, the community health workers, to make it possible to dramatically control this disease. So how much do we spend? For the rich world, about 10 cents per person per year - about $100 million, perhaps a 30th of what's needed - and as people die, we say, Look at how corrupt they are.
The transport conditions? Every one of these villages can be easily connected to the Internet. Fiber optic cable could be laid between all of the major cities in Africa for an estimated $1 billion: $1 from each of us. Local loop wireless technologies could bring connectivity right down to the village level. All of a sudden there are referral services and ability to call a truck to bring a patient, to bring a mother dying in labor to a hospital, an ability to order fertilizer, an ability to know where to sell crops. Again, for almost nothing, if we cared to look. What are we doing in this country about all of this? You won't believe me, but we're doing essentially nothing.
The total aid that the United States government gives to Africa is about $2 billion a year - to the 49 countries of sub-Saharan Africa and 750 million people. It's a little less than $3 per African; it's a little less than two days of the Pentagon budget, which this year will cost us $500 billion. It is, as they say, a rounding error.
My math or economic friends, because I'm a macroeconomist, laugh; they don't even deal in such small numbers anymore. All my friends deal in trillions; I'm the last one dealing in billions. Two billion, by the way, doesn't even go for the kinds of investments that I'm talking about. Two billion is mainly American consultants' fees sponsored by USAID, Americans to fly over to lecture poor and dying people. We give food aid on top of that $2 billion, maybe another $500 million; we ship food in famines, rather than help farmers to grow food. We turn our heads. A quarter to a half of the children are chronically undernourished. We have let malaria claim up to 3 million lives every year, and somehow, we have found it natural that we spend $500 billion on the military and $2 billion for the 750 million people of Africa. And we think we have a foreign policy.
More and more, as I travel to Africa, I see very interesting people at the embassies and at receptions and meetings: the colonels, captains and military attaches - because the Pentagon has begun to realize we've got a security issue there. We've started a pan Sahel counter-insurgency initiative. We think we're somehow going to help stabilize these countries, prevent the terrorism and the instability of dying and hungry people by having Americans train armies abroad.
We promised a few years ago - you didn't hear about it because it was in that malaria speech of President Bush's - together with the other rich countries, to give 0.7 percent of our gross national product in official development assistance - 70 cents out of every $100 of our income. We're giving 2 cents out of every $100 to Africa; we're giving, at least in the numbers, another 14 cents to other developing countries, although a lot of that is to Iraq, Afghanistan - it's the military kind. In total we're giving 16 cents out of every $100. But we promised - George Bush was there, in Monterrey, Mexico, with the International Conference on Financing for Development, in March 2002 - together with all of the other rich countries, to make concrete efforts towards the international target of 0.7 percent. That would be about $80 billion a year, about what we're spending this year in Iraq. We could afford it. Not only could we afford it; the difference would be we'd be saving, when combined with what other countries are doing, 8 million people a year. We would be setting these societies on a path of development, not charity, not continued dependence, but on a path where they could grow enough food, move to industrialization, follow the successes of Asia and elsewhere, where economic development works and has been proven to work. We would help them to slow population growth, because that's what economic success does. We would help to protect environments that are being destroyed by rapid population growth in Africa and other impoverished regions now. We would, in short, create precisely the kind of world that we so dearly want for our children.
Let me end with the good news: 70 cents out of $100 is enough to do it. We don't have to do anything more than what our country has promised. Think about it. We literally are the first generation in the history of the world that can say with rigor and honestly, We could bring an end to extreme poverty on the planet. In my view, the fact that we can say it honestly means that we will also choose to do it honestly.
Answers to Questions from the Audience
Q: How much of a lone voice are you in this effort, and what are the chances of this administration getting behind your recommendations?
A: This year, although you might not know it, is an important year for all of this, because in September 2005 there will be the largest gathering in world history of political leaders from around the world at the United Nations. Five years ago the Millennium Development Goals were adopted. These are goals to cut extreme poverty by half by the year 2015. I'm proposing to look 10 years beyond that, to bring an end to extreme poverty by 2025. When the goals were adopted in 2000, the 147 leaders that had assembled at the United Nations sensed that they better revisit this five years on and with 10 years to go; that's what they're doing in September.
The challenge of extreme poverty is very much in global political discussion right now (except in this country), and this is making a difference. Five countries have reached 0.7 percent as they long promised to do: Sweden, Norway, Denmark, the Netherlands and Luxembourg. But importantly, seven countries this year have set a timetable to achieve 0.7 before the year 2015. This is a political breakthrough: France, the United Kingdom, Belgium, Spain, Ireland, Finland and, last month, Germany. Something significant is happening. Much of the world is understanding we can't go on like this. Prime Minister Tony Blair has said that one of the two issues that will be central to the G-8 Summit in July will be Africa; the other will be this administration's other favorite issue, global climate change. So it should be a fun couple of days in Scotland for President Bush and his colleagues.
Tony Blair senses rightly that he better deliver. He's raised expectations in Africa and in other poor parts of the world, and it's time that he brings his friend George along. My feeling is, truly, the American people would be all for this. All over this country people are saying, We want to find a way to have a safer world. We don't believe the military alone can do the job. All over the world people are saying it can't quite be right that you have a $500 billion military budget and a $16 billion peaceful development budget - 30 times less. That can't be a foreign policy that can meet our needs. But most Americans don't yet know, because surveys show repeatedly that the public estimates what we are actually giving to be about 30 times larger than it is. So there's a lot of confusion. I don't blame the public - we haven't had a lot of clarity in our media explaining these things.
I did an interview on CNN with Aaron Brown when our advisory report to the secretary-general was released. I thought it was a pretty good interview, but you didn't see it because Aaron Brown decided, as he put it at a conference later, I just couldn't feed too much Brussels sprouts to the American public. We're not being treated like adults - we're being spun every day, but we're not being told basic truths. Is it any surprise that we can't quite sort our way out?
So why am I optimistic? Because I don't think anything that I'm saying is anything but basic standards that Americans have, basic standards of decency and basic standards of self-interest to do better.
Q: With the World Bank now to be led by Paul Wolfowitz, do you think that that relief, as you've urged, will be accepted?
A: I had a good talk with Paul Wolfowitz last week, and I realized quickly one very important thing: He's been at the Pentagon for a few years; he knows the $2 billion for Africa is chump change. When he starts in his new position as head of the World Bank, looking at the resources that he's supposed to solve global problems with, he's going to understand this very well. He's going to understand we need real resources, not symbolism, and I think that this is one piece of good news in this appointment.
Q: Why isn't the invisible hand working in these regions? Africa's been home to man for 4 million plus years, why hasn't the population reached equilibrium with the climatic and geographic limitations of the continent?
A: First, it's important to understand that in that village in Kenya there are no markets, there's no invisible hand, there's no income. People are living in subsistence, or in what I call sub-subsistence, because they're not even growing enough for basic nutrition. One ton per hectare when your farm size is maybe two-tenths of a hectare isn't enough to feed a family, much less to be able to bring grain to market.
There is a market out there, but you have no transport, no roads, there's not a truck in that village. When I asked the villagers in a town meeting, "How many of you have ridden in a bus, or a car, or any kind of motor transport in the last year?" about five hands in the room went up. There is no market reaching these people. You might ask, Why doesn't the market come to save them? There's no market failure at work here. Efficient markets can perfectly well leave impoverished people to die. Well-functioning markets are designed to service people that have income, not to service people that have nothing. The fact that no one comes to rescue them from market forces, that's not a surprise; they're trapped in extreme poverty. If I'm an investor in a company that says I'm going to go invest in this village, I'm selling my stock. I don't want my firm to go rescue these people, because markets can't rescue them right now. They need basic health care, adequate nutrition, basic farm inputs, basic infrastructure, at least to arrive at a level that's viable in the literal sense, and then there will be a little bit of income and then a little bit of that can be saved, and if the yields can be tripled in this village, then what farmers will do is they'll only grow half of the field to staple food and the other half can begin to be cash crops and they'll start to earn some income. And with a little bit of income they'll be able to buy some tools and diversify and start doing some woodworking, which is what a lot of the men in the village want to do but can't afford to do right now. And they'll start selling furniture, processed foods - honey, milk, cheese - other products, and that's how development works. But when you're stuck below survival level there is no market.
The point about help is not to be charitable - although that would be enough for many of us; the point is to help communities get to a point where they're earning an income. From there, the step-by-step process of economic development can go forward. What's happened is population growth has been extraordinarily rapid. Child survival rates did improve; it used to be 400 or 500 deaths for every 1,000 children born 50 or 75 years ago, but with immunization and antibiotics reaching part of the population, the child mortality rates fell by about half. Fertility rates did not fall.
If you're impoverished on a farm, children are economic assets. You don't know whether your children are going to survive. To ensure a surviving son, as many families would want, you might need to have five or six children. Children tend to the animals, tend to the crops, collect the fuel wood, collect the water. But when impoverished families have six children, they can't invest properly in the health and education and nutrition of the children - maybe in one, but not in six. Part of what economic development brings about is a dramatic voluntary reduction of fertility rates, once families understand that their children will survive. So if a community invests in child survival, has contraception and family planning available, economic opportunities for men and for women, fertility rates would come down even faster than the mortality rates and you'd move to a low population growth scenario and one that eventually would stabilize. That's part of what will give the possibility of economic development really taking hold. The irony is, the poorest places in the world are systematically the places with the fastest population growth, and that's part of this poverty trap. It's called the demographic trap: rapid population growth, reproducing poverty in the literal sense, generation to generation. But it can be changed dramatically, in a period of a few years, by appropriate investments in the village life.
Q: What can one person do? Give money? If so, where?
A: All of us are going to make the change. We need to. It's for our children as well as for the people who are struggling to survive. What we need to do first is to let our politicians know it's not dangerous to care about other people on the planet, it's only smart. Foreign assistance is not some terrible plague that a politician dare not approach if given the right to control malaria or AIDS or to help farmers grow more food. It's the American way. The first thing we all have to do is let Washington know: You're not making us safe by not addressing this crisis.
Second, we all need to understand this situation as best as possible, and I encourage people to go out of their way, because that's the way it has to be done: to learn, to read our project for the secretary-general, the UN Millennium Project has thousands of pages for your reading pleasure, at www.unmilleniumproject.org, and the Earth Institute also has a vast amount of material, at www.earth.columbia.edu. Then yes, please, through your favorite charities, through the Global Fund to Fight AIDS, Tuberculosis and Malaria, through a new foundation that we'll be launching, called Millennium Promise - in both its senses, the promise of what we can do and the promise that we've made - please do find ways to contribute. You'll be saving lives, you'll be saving our own spirit in this country as well.
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