Q&A with Jeffrey Sachs: Why is everyone so mad at this guy?

Jeffrey Sachs, outside Paramount Theatre on recent visit to Seattle

Well, maybe not everyone.

But the world-renowned economist and director of Columbia University’s Earth Institute certainly has his fair share of angry critics.

Jeffrey Sachs draws fire like few others within the aid and development community. Yet it’s also fair to say he has done as much as anyone to promote the fight against global poverty and injustice.

Before he became known as an anti-poverty warrior, Sachs advised countries in Latin America and Eastern Europe on transitioning to market economies, an experience which led him to a focus on international development in general.

He’s become a vocal advocate of the power we have to end extreme poverty and a critic of the indifference of the rich world to the plight of the poor — or of policy makers who don’t take up the cause.

Sachs is perhaps mostly closely associated with the initiative known as the Millennium Development Goals, an ambitious scheme launched by the United Nations and international community in 2000 that set out eight goals aimed at reducing extreme poverty and global inequity.

To both prove the value of and learn how best to achieve these goals, Sachs launched the Millennium Villages Project (MVP) — a 10-year project based in 14 communities across Africa, involving some 500,000 people given funding to make strategic improvements in certain aspects of health, infrastructure, education and business.

Millennium Villages

It’s an investment of tens of millions of dollars over ten years that tallies out at $120 per person per year – aimed at demonstrating that key changes in health, agriculture, water, roads, education and business development can lift communities out of poverty.

And it is Sachs’ Millennium Villages Project that seems to get people hopping mad.

Sachs keeps saying the project is working, making progress, and his critics keep saying he’s got no evidence to back him up. A recent paper in The Lancet claiming child mortality had declined in the MVP villages sparked an uproar when it appeared the decline in child deaths in Sachs Millennium Villages was no more pronounced than the decline seen in the country or region overall.

That seemed like a good thing to me, fewer kids dying. Why are people so angry at this good news? Is it Metrics Mania? Or is it a legitimate beef? Sachs was in Seattle recently so I asked him.

Q People are saying you’re taking credit in the MVP for progress being made overall. Are you conflating?

JS: Well, that’s one of the criticisms, that in the first three years we didn’t outpace other areas — specifically that child mortality declined at the same pace.  My first response is to say that’s wonderful because the overall progress we’re seeing is happening for the same reasons. It’s hard to measure actually, but what’s happening in the villages right now is pretty dramatic.

Q But how do you know if this is due to the strategies of the MVP or just the region’s improvement overall?

JS: That’s why I need outside eyes on this and why I’ve asked for an international group of experts to come in and evaluate this, so when we cross the finish line in 2015 people won’t just argue that we’ve moved the finish line.

Look, the whole issue of measurement in aid has become almost a religious dispute. We can measure some things and we need to measure what we can. The Millennium Villages Project has had fierce critics from the start. Initially, the critics said it would fail because it was a “planner’s dream” bringing in targeted interventions rather than letting market forces work and emphasizing good governance. Now that our approach of integrated development is more accepted, the critics say we have no evidence.

Q Well, do you have evidence the approach is working?

JS: It depends what you mean by evidence. Some of my critics say we need to do these ‘randomized controlled trials’ (aka RCTs) as if what we’re doing is testing a red pill against a blue pill. What we’re doing has nothing to do with anything like that. It cannot be reduced down to such a simple and narrow test. We have been working with these communities for years to figure out how best to improve food production, get more kids in school, deliver clean drinking water, build infrastructure and encourage business development. This is not a randomized controlled trial; it’s a learning process.

Q So what have you learned so far?

JS: We set goals for these communities to reach by 2015 aimed at significantly reducing poverty by focusing on key areas. I’m pretty confident we’re going to achieve these goals, even though we’ve really got to run now.  It’s true that we didn’t make a lot of progress for three or four years. And we learned that these kind of things take time. They are complex. But now we’re seeing things come together. We finally have community health workers, farmers cooperatives and other transformative changes across the community. It’s really thrilling to see.

Q Given that you say many aspects of the MVP are hard to measure, are you concerned that metrics is trumping common sense?

JS: That can happen. The whole basis of this project is that we believe what it takes to escape from extreme poverty is not that big a mystery. If you have have clinics and schools, get kids to sleep under anti-malarial bed nets, bring in electricity and safe drinking water on a nice new functional road, you see progress. To the extent those things get done, I expect a lot of progress.

Let me give you an example. About 12 years ago, I proposed widespread distribution of free bed nets in Africa. I was harshly criticized by many like Bill Easterly for what he saw as a top-down ‘planners’ approach. Others said we needed to sell the nets not give them away. I said it would take too long to try to develop a market to sell bed nets to the poor. That would literally be deadly ineffective.

When we launched the first Millennium Villages project in Kenya, one of the first interventions we did was distribute free bed nets. Malaria declined sharply. The Kenyan minister of health asked me to help get funding to distribute nationwide, which they did. Malaria fell nationwide. Then, when I claimed we had reduced malaria in the Millennium Village, I was criticized because the decline was the same nationwide. Our project helped changed government policy but critics said I had no evidence because our rate of malaria was the same. That’s the way the measurement game gets played at times.

Q Are you concerned that too much emphasis on measurement — metrics mania — will impede progress?

JS: Not for us. The skeptics can yell all they want. We intend to succeed and also to be able to show how we succeeded, with data. Again, that’s why I’ve called in independent outside experts to review our project as we move forward.

But I do think that, in general, this measurement thing can go overboard. These are often not red pill-blue pill problems and we already know a lot of what needs to be done. My wife is a pediatrician with a lot of clinical knowledge. She doesn’t need to do a randomized trial before she decides what a patient needs.

If you want to do something broad and messy like figure out how to help communities achieve a number of goals aimed at reducing poverty, it won’t be one thing you can test. It could be 50 things. That’s the Millennium Villages Project. It’s messy because the problems facing these communities is complex. We are still learning but we’re also making great progress.

Q One more thing. What do you and your supposed arch-nemesis Bill Easterly agree on?

Bill and I both think a lot of aid is badly directed. We agree that a lot of aid is done for political or self-serving and non-productive reasons, like giving money to a friendly dictator or paying American contractors to build unneeded and unwanted facilities in other countries. I think we do agree on a lot of things, but there are real differences as well.

The reason we’ve been pitted against each other, and we have really gone at it over the years, is because I say aid can work and Bill said aid doesn’t work because it is so intrinsically bound up in politics and corporate agendas. I’m not sure we’re quite so far apart as people think. There’s some common ground there.



About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.

  • Interesting that during all the recent MVP controversy I haven’t seen what I would regard as one of the most important historical precedents mentioned, from nearly 30 years ago:

    Lancet. 1984 Oct 20;2(8408):912-4.
    Changes in maternal and child mortality rates in three isolated Gambian villages over ten years.
    Lamb WH, Foord FA, Lamb CM, Whitehead RG.
    an adjunct to the general nutrition research programme, the MRC Dunn
    Nutrition Unit has provided for the past 10 years a continuous medical
    service to three adjacent rural Gambian villages. There have been
    substantial reductions in annual childhood mortality rates. Perinatal
    mortality fell from 109.6 to 45.5 per 1000 births, infant mortality from
    148.5 to 24.5 per 1000 live births, and mortality in children aged 1-4
    years from 109.1 to 13.3 per 1000. There have been no pregnancy-related
    maternal deaths in the community for 8 years; 16 could have been
    expected given current estimates of maternal mortality elsewhere in
    rural Gambia. Of all the health and nutritional interventions introduced
    the single most important factor has apparently been the on-the-spot,
    24 h availability of a physician or qualified midwife.

    I was in The Gambia at the time and the effects reported here were very real and obvious. In fact they were so obvious that the “Health For All” movement at that time condemned them as unsustainable, etc.

  • Guest

    I’m not a specialist in development economics or quantitative research, but every time I read about the MVP controversy I can’t help but think of the common sense response; if the comparison you’re using is country or even regional averages, don’t those averages tend to be biased upward by urban/less disadvantaged areas (in the same way that income per capita is usually biased upward)?  So although reductions in a rural, marginalized village such that MVP presumably works in are the same for the country as a whole, they may be far greater than other rural, marginalized villages in that country.