The activist-physician president of the World Bank, Jim Yong Kim, was in Seattle today to talk with folks at the Bill & Melinda Gates Foundation about their mutual interests in fighting poverty, reducing inequity and generally trying to make the world a better place. I wasn’t able to attend, but I did chat with Kim prior to the meeting.
Kim, before becoming an anti-poverty banker, was best known as the other half of the leadership at the health advocacy organization run by Paul Farmer, Partners in Health. Kim and Farmer showed, among many things, that complex TB and HIV treatments could be successfully done in poor communities. Both have been outspoken about the need to view health and poverty within a human rights context. Kim’s appointment by President Barack Obama to take the helm of the World Bank was highly controversial, to some extent because he was a physician rather than a policymaker, finance guy or economist. We asked him if things have calmed down, and when we can declare an end to poverty.
Irony note: Twenty years ago, Kim was outside on the street protesting against the World Bank. Now, he’s running it.
Q So how does it feel to be a banker trying to cure economic ills rather than a doctor fighting epidemics?
JK: The World Bank is really an extraordinary organization. The thing that surprised me is that this place is just full of extremely talented people who are passionate about fighting poverty. These are people who could have worked in other places, in finance, and made a lot more money but they are here to fight poverty. This is a bank with the mission of fighting poverty…. One of the things I’ve learned in taking this job is how critical it is to understand these complicated development problems within the context of economics and finance.
Q Are you guys holding any mortgage-backed derivatives? 🙂
JK: We are very highly regulated and closely watched. (So I guess that means no….)
Q When you were nominated, some said your concept of development – as a physician, focused on people – was not a good fit with the World Bank because it is an organization focused on “national development.” One expert and critic called your appointment an “intrusion of humane development into national development.” Response?
JK: Most of those commentators had, or still have, little knowledge about the work I’ve actually done and my ideas. I think the criticism has died down because people are now talking about what I have done rather than my credentials. That’s the way it should be. What I’m trying to do now at the World Bank is to set some bold goals like ending extreme poverty in 30 years. We’ve never before set a target like that for ourselves before.
The other goal is boosting shared prosperity. Inclusive growth. The evidence is strong that overall economic growth is really important but it’s also clear that economic growth that doesn’t include young people, or that doesn’t include women, or that doesn’t include the poorest, ends up creating instability into your society. The story of the Arab Spring is in many ways a story about economic growth without inclusion.
Q But is it meaningful to end ‘extreme’ poverty? If we move everyone off of $1.25 per day to everyone making at least $3 a day, does that really count as ending extreme poverty?
JK: That’s not what we’re saying. As I said, we have two related goals: One goal is ending extreme poverty. Today, more than a billion people still live on $1.25 or or less per day. That’s just obscene and we’ve got to do something about that right now. And the best way to lift people out of poverty is to encourage sustainable and inclusive economic growth and focus on creating jobs especially for women and young people. Ending extreme poverty is not the end of this process; it’s the beginning.
Q We’ve seen all over the world that economic growth and development can happen without improving human rights or democratic freedoms. Some believe equity, justice and respect for human rights follows on economic development. What do you think?
JK: According to our bylaws, the World Bank is not a political organization. But fortunately, there’s a nice division of labor in the multilateral development community. The United Nations is charged with dealing with the most difficult political issues, not the bank. But I do recognize that development and politics go hand-in-glove. For that reason, I’ve been working with United Nations Secretary General in a much closer partnership that, frankly, is unprecedented. I recently traveled to the Great Lakes region Africa with him (UN Secretary General Ban Ki-moon). We were focused on improving human rights in the region because that is critical to both human and economic develoment.
One thing that’s really struck me in all this is how much the world has already changed, largely because of social media. Grassroots social movements are erupting everywhere and you can’t prevent this. Look at Brazil and its middle-class uprising. It’s not just about poor people. Leaders are being forced to pay attention to issues they used to be able to duck. Today, leaders are called to account when you have economic growth that’s not inclusive.
Q The World Bank was launched to reduce poverty through loans or other finance strategies. The bank’s structural adjustment and loans program was one favored approach that many experts now criticize as actually having made poor countries poorer and weaker. Is the WB set up to address the key drivers of poverty or does it need to change?
There’s no question that we are structured to deal with those issues. But we’re not organized as effectively as we need to be. We have a broken system and we have to fix it. That’s why we’ve launched a major reform to change the bank’s structure for the first time in 17 years. Again, our focus is on promoting what we mean about inclusive growth, sustainable growth.
You can do all sorts of cute things like nationalizing industries and attempt to insulate your country or businesses from market forces. But these forces are simply reality. Today, there are only a handful of countries who see themselves as operating outside of the market and it doesn’t work very well. If ever there was a time where you could say yes or no to market forces, that time is over. We at the bank don’t pull the controlling levers here; we have to work with what’s reality.
Q That sounds like you’re making the case that poverty is best addressed not through traditional aid but by market-based strategies. Yet haven’t you and Paul Farmer long made the case that poverty is created by many of these same market forces — which tend to ignore people without money and also reward those who can best exploit for profit. Is the market the cause of or solution to poverty?
JK: Look, the market is just reality. Again, I see our job as helping countries function in the market in a way that maximizes their growth while at the same time maximizing inclusiveness of that growth. It’s true that in the past the World Bank used to operate according to the assumption that if you got the macro-economics right you can just forget about the rest. We don’t think that anymore.
Twenty years ago, I was on the outside protesting against the World Bank. I’d have to say the World Bank has evolved and improved tremendously over the last 20 years. The insistence on getting the macro-economics right in countries was a good thing; it helped them weather the recent economic crisis very well. More than half of global growth during the crisis was in emerging economies. But you have to invest in human beings, in health and education. These are not distractions; they are critical to success.
Q You recently got a lot of the experts in aid and development all riled up by proposing we work on the ‘science of delivery.’ What are you talking about? Is this at all related to when you got folks at the Gates Foundation (many years ago, after a lecture Kim gave in Seattle) all riled up by saying we didn’t need more new technologies so much as we need to get the existing tools – drugs, vaccines, health workers – we already have out to the poor?
JK: First of all, I never said we don’t need science. We should all be thankful to Bill and Melinda Gates for their interest and investments in building needed new tools. I’m a TB doc, for goodness sake. We definitely need new tools to battle TB, especially drug-resistant TB. The problem is we don’t really invest as much time and energy into thinking about how to deliver these tools to the poor. We’re creating a stockpile of tools that never get to the poorest people.
All I’m saying is that this is just as complicated as developing new tools and we should take it just as seriously. I didn’t say we have a science of delivery. I’m saying we need a science of delivery. Read what Paul, Michael Porter and I wrote for The Lancet (here’s a summary) about what we are proposing. It’s pretty simple really. I’m just asking that we bring the same kind of rigorous approach and scientific thinking to actually delivering these tools for health that we bring to creating them.