Jeffrey Sachs 2: The man who made ending poverty not fantastic

It is probably not an exaggeration to say that Columbia University economist Jeff Sachs has done as much as anyone over the past few decades to draw public, and policy maker, attention to the plight of those who live in extreme poverty around the world. Sachs literally wrote the book on how to end poverty.It is also not a stretch to say that Sachs has become a target of fierce criticis.

This is a sequel, or maybe prequel, to yesterday’s post The man who failed to end global poverty. Humanosphere interviews the renowned and controversial economist Jeffrey Sachs, on his history of big ideas and why they seem to irritate so many people.

Editors note: By ‘fantastic,’ we intend the original meaning. The idea of ending extreme poverty is today no longer considered a fantasy – in part due to the big ideas of a controversial economist.

It is probably not an exaggeration to say that Columbia University economist Jeff Sachs has done as much as anyone over the past few decades to draw public, and policy maker, attention to the plight of those who live in extreme poverty around the world. Sachs literally wrote the book on how to end poverty. As a numbers guy, he helped transform the idea of ‘ending poverty’ from a dreamy notion sung by Bono and Geldof into a real strategic vision. It is also not a stretch to say that Sachs has become a target of fierce criticism. Some of his critics simply seem to dislike foreign aid; others say his approach is all wrong. What’s clear to Humanosphere is that Sachs has long been a proponent of foreign aid, of the rich world’s moral obligation (and potential benefits) to helping the global poor and of the power of specific interventions for reducing poverty and suffering. Humanosphere thinks ideas matter and wanted to explore the history of this besieged economist’s big ideas:

Q: Over the past 15 years or so, we’ve seen major reductions in poverty worldwide, in rates of some diseases like AIDS and malaria. Back in 2000, you chaired a study called the Commission on Macroeconomics and Health that made the case for the creation of a huge Global Health Fund (which became the Global Fund to Fight AIDS, TB and Malaria). A Lancet article from 2002 quoted a number of experts dubious this could ever work.

JeffSachsmugJS: Yes, it was not a very popular idea at the time. The health situation in Africa was especially dreadful and there had not yet been a determination to begin treating people with HIV. Millions were dying without access to treatment. Malaria was also running rampant. There was handwringing but no large-scale action or strategy … There was maybe $100 million for AIDS worldwide, a shocklingly small amount given the scope of the problem. We recommended the international community put something like $5 billion per year to address this. The purpose of the commission was to show that investing in health was very effective and should be scaled up significantly. Many responded to this proposal as totally infeasible, in part because of how weak the health systems were throughout much of Africa. The head of USAID at the time even said the poorest Africans couldn’t work with complex AIDS drugs because they can’t tell time (and properly space out drugs). Critics said the money would be wasted, basically be about as effective as running into a buzz saw.

Q: And yet the Global Fund did get launched to the tune of now more than $20 billion so far, getting millions of people on life-saving drugs, distributing 100s of millions of bed nets and financing other interventions that have significantly reduced the death and disability toll of AIDS, malaria and TB.

JS: Yes, it’s now viewed as a stunning success story. This was mostly thanks to the efforts of Kofi Annan, who was UN Secretary General at the time. Annan worked with leaders like Gro Brundtland, then director general at WHO (World Health Organization), Paul Farmer (the physician activist head of Partners in Health) and others to lobby governments and policy makers to support this initiative … Every argument you can think of, against foreign aid in general and against the capability of Africa to make best use of this aid, was made against this initiative. It was the eventual support of the Bush Administration for these efforts that really propelled them forward. The critics were proved wrong. The Global Fund is not perfect, of course, but few now question it’s worth.

Q: At the same time momentum was building to create this Global Fund, the international community had launched the Millennium Development Goals – a set of eight goals that overlapped to some extent with the health aims of the Global Fund but included other targets such as cutting child mortality in half, reducing hunger and some incredibly vague goals like improving global partnership for development or empowering women. You’ve been the UN Secretary General’s lead adviser on the MDGs and helped initiate many of the strategies. Why set such vague goals?

JS: Some of the MDGs are barely understandable. Even the one focused on HIV and malaria isn’t really clear if you think about it: “Have halted by 2015 and begun to reverse the spread of HIV, malaria and other major diseases.” What’s that even mean? I didn’t establish the MDGs. Rather, with our Millennium Villages Project, we’ve tried to turn some of the same goals set by the MDGs into more quantifiable indicators.

Q: The reason I bring up the MDGs is not to credit/blame you for them. What’s interesting is how so many people celebrate the MDGs as having helped focus the world on achieving specific targeted improvements despite maybe half of them not being at all clear or quantifiable. At the same time, you are lambasted for not making the MVP as precisely quantifiable as a clinical research study. Response?

JS: Our goal is not simply to run an experiment. Our goal in the MVP is to improve people’s lives and show that specific, evidence-based interventions in health, education and infrastructure can make a substantial difference.  Most would agree that the data show improvements in health improve all aspects of life. How much exactly do specific improvements in health improve a poor family’s economic standing? It’s a good question, but I doubt anyone could answer it very precisely. Did our success at reducing malaria in our Kenyan MVP prompt wider nationwide efforts that reduced malaria overall? I think it did, but others argue we can’t prove it and it was the other way around. Look, we are doing are best to incorporate serious metrics in the MVP. But to satisfy the critics, to not spoil the experiment they want, I would have had to try to convince the Kenyan minister of health to delay expanding our malaria prevention efforts nationwide until we could show scientifically success in just our village. It’s absurd.

Q: What’s another example of improvements you believe are happening in the MVPs that is difficult to measure?

JS: Macroeconomics is still pretty limited in terms of our tools. Two key variables that appear to have a strong impact on people’s overall well-being are life expectancy and total fertility. Higher life expectancy is good while higher fertility (rates) has a largely negative effect. In our villages, we’ve seen a huge uptake in contraception. There are a number of studies that indicate reducing child mortality also brings down fertility rates (because subsistance farming families don’t need to have 10 kids to ensure five survive to work the farm). High child mortality and high fertility rates impede poverty reduction. We fully believe that reducing child mortality and encouraging family planning will, in time, produce measurable economic benefits to these families. Do we have the data yet? No, but I think these trends are already underway and eventually we can show the benefits.

Q: We are now in the so-called post-2015 discussion – on what should be the next set of development goals for the international community after we reach the finish line for the first MDGs. While the original MDGs were somewhat arbitrarily selected by a handful of do-gooders mostly at the UN, now everyone wants a say. And the talk seems full of unquantifiable lingo like ‘sustainable’ or such. Any concerns that the next agenda will be even less precise?

JS: The MDGs are rightly getting praised for contributing to Africa’s turnaround, including its economic growth and improved health outcomes. They are just one part of this story but they have definitely played a role in this positive trend on the continent. Part of the post-2015 agenda includes a strong call for ending extreme poverty. This is, of course, not going to be easy. We have climate change disruptions and massive demographic pressures. That’s why we talk about setting goals that include aspects of ‘sustainable’ development.

Q: So you’re saying that big ideas, which are often messy and immeasurable, are just as needed and useful as establishing initiatives that can be tracked and evaluated?

JS: Yeah, in practice I think we’re moving from setting abstract and ethereal development goals to finding more quantifiable and practical efforts. That’s positive. We’re also more cognizant today of the complexity of these challenges, which is why it’s important and useful for the world to not shy away from big, ambitious goals. Some are concerned that we are diluting the fight against poverty by focusing on environmental issues, for example. But I believe that unless we get climate change under control, we won’t be able to make as much progress on extreme poverty. We need a more holistic agenda ….

Q: Holistic? That doesn’t sound like something you can measure. It actually sounds kind of granola head. Aren’t you just setting yourself up again for criticism by the metrics enforcement police within the aid/dev community?

JS: (laughs) I get criticized no matter what.

 

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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.

  • Christopher Thomas

    Very insightful and testament to the remarkable power of ideas to change the world. In my humble opinion, the feud is internecine.

    Ariel Pablos-Mendez noted that “we are indeed in the midst of an accelerated economic transition, a success in part due to our efforts in international development. While rich economies faced a grand recession, the majority of countries labeled as low-income in the year 2000 will qualify for middle-income status in 2020. It is this economic transition of health that makes the Grand Convergence both possible and sustainable – though it is by no means automatic.”

    With less bitterness, add some salt, we can work better together to align our efforts, scale-up evidence-based strategies, reduce disparities, employ result based financing, and foster the use of innovative technologies so that women and children everywhere can survive and thrive.

  • oatmeal

    The words of Sachs are by no means sacrosanct (sachsrosanct? anyone?), but I can’t help finding myself identifying with his rationale. Very frequently, his harshest critics are those that, as he points out, want an experiment. To establish a control (and thus validate the experiment), that would mean intentionally denying some people access to vital services to keep them alive. And for what? To see if it’s Sachs strategies or a larger cycle or trend that is responsible for improvement (or lack thereof)? Not only is that absurd on the face of it (“sorry village A, you get nothing so we can have more specific data”), it’s flawed – there are larger forces at work that have profound influences on whether or not ANY interventions (not just Sachs’) would work. El Nino patterns, global climate change, globalization, instability in world markets, etc, all contribute to the problems. To call Sachs’ efforts a failure, amidst worldwide phenomena, the magnitude of which is unique in history (and the effects of which, consequently, are not knowable), is simply unreasonable. I would, however, like to see the effects of the Millennium Villages across the board. Certainly there are some that are more successful than others – then it’s just a matter of compare/contrast economics.

    Poverty is a complex issue. Does Sachs have the answer to every facet of every issue for every region experiencing extreme poverty? Of course not. There is something to be said about the cultural barriers that Nina Munk writes about – villages that hesitate to follow-through on techniques due to religious beliefs, for example. How to account for civil unrest that isn’t a direct result of poverty is a tall order for any economist. But this is where legitimacy tends to meander into speculation and projection. The whole messiah complex/big ego bit would be laughable if it wasn’t swallowed so readily. It’s a sophomoric and inappropriate practice. As far as I can see, it’s the same tired cynicism in brand new clothes. “He thinks he’s better than us because he’s trying to help as many people in dire circumstances as he possibly can – what a jerk.” It’s like the valedictorian being vilified as an overachiever because he’s making the casual student feel insecure. Spare me the superfluous lectures on hubris and ego jockeying unless there it is a definitive connection between that and poor decision-making. Until then, drop it and focus on what the man himself is focused on – helping people who need it most.

    Ultimately, if anyone carries the expectation that Sachs should have a 100% success rate at all times, they will have plenty of fodder for criticism. And that’s what I have accounted as the wellspring for a great deal of his critics. “Look! Here are examples of his plan not working. Gotcha!” What a shock – villages in the most challenging and dire of situations are presenting unforeseen obstacles. Ironically enough, detractors pointing to those examples are validating Sachs’ rationale. That is, many of the problems that cause or magnify poverty are solvable. Wells not working in a village and nobody knows how to fix it? More technical training needed. Villages resisting intervention processes? Sounds like something better education could help alleviate. I’m not saying Sachs has got it all figured out, or that his work is above criticism or inspection, but I do have a problem with taking isolated failures as a means to make broad, sweeping judgements, as well as the willingness of people to make ridiculous suggestions that would be detrimental to the real lives of people, just for the sake of proper experiment methodology. As we should all know, tackling the toughest problems in life is a process, and the fact that Jeff Sachs is so intimately and unrelentingly involved in that process is truly a remarkable and significant contribution to our collective humanity.