Sunday, Mar. 06, 2005
The End Of Poverty
In a world of plenty,
1 billion people are so poor, their lives are in danger.
How to change that for good
By JEFFERY D. SACHS
It is still midmorning in Malawi when we
arrive at a small village, Thandire, about an hour outside of
Lilongwe, the capital. We have come over dirt roads, passing
women and children walking barefoot with water jugs, wood for
fuel, and other bundles. The midmorning temperature is sweltering.
In this subsistence maize-growing region of a poor, landlocked
country in southern Africa, families cling to life on an unforgiving
terrain. This year has been a lot more difficult than usual because
the rains have failed. The crops are withering in the fields
that we pass.
If the village were filled with able-bodied men, who could have
built rainwater-collecting units on rooftops and in the fields,
the situation would not be so dire. But as we arrive in the village,
we see no able-bodied young men at all. In fact, older women
and dozens of children greet us, but there is not a young man
or woman in sight.
Where, we ask, are the workers? Out in the fields? The aid worker
who has led us to the village shakes his head sadly and says
no. Nearly all are dead. The village has been devastated by AIDS.
The presence of death in Thandire has been overwhelming in recent
years. The grandmothers whom we meet are guardians for their
orphaned grandchildren. The margin of survival is extraordinarily
narrow; sometimes it closes entirely. One woman we meet in front
of her mud hut has 15 orphaned grandchildren. Her small farm
plot, a little more than an acre in all, would be too small to
feed her family even if the rains had been plentiful. The soil
nutrients have been depleted so significantly in this part of
Malawi that crop yields reach only about a half-ton per acre,
about one-third of normal. This year, because of the drought,
she will get almost nothing. She reaches into her apron and pulls
out a handful of semi-rotten, bug-infested millet, which will
be the basis for the gruel she will prepare for the meal that
evening. It will be the one meal the children have that day.
I ask her about the health of the children. She points to a child
of about 4 and says that the girl contracted malaria the week
The woman had carried her grandchild on her back for the six
miles to the local hospital. When they got there, there was no
quinine, the antimalarial medicine, available that day. With
the child in high fever, the two were sent home and told to return
the next day. In a small miracle, when they returned after another
six-mile trek, the quinine had come in, and the child responded
to treatment and survived. It was a close call though. More than
1 million African children, and perhaps as many as 3 million,
succumb to malaria each year.
As we proceed through the village, I stoop down to ask one of
the young girls her name and age. She looks about 7 or 8 but
is actually 12, stunted from years of undernutrition. When I
ask her what her dreams are for her own life, she says that she
wants to be a teacher and that she is prepared to study and work
hard to achieve that. I know that her chances of surviving to
go on to secondary school and a teachers college are slim under
The plight of Malawi has been rightly described by Carol Bellamy,
head of UNICEF, as the perfect storm of human deprivation, one
that brings together climatic disaster, impoverishment, the AIDS
pandemic and the long-standing burdens of malaria, schistosomiasis
and other diseases. In the face of this horrific maelstrom, the
world community has so far displayed a fair bit of hand-wringing
and even some high-minded rhetoric, but precious little action.
It is no good to lecture the dying that they should have done
better with their lot in life. Rather it is our task to help
them onto the ladder of development, to give them at least a
foothold on the bottom rung, from which they can then proceed
to climb on their own.
This is a story about ending poverty in our time. It is not a
forecast. I am not predicting what will happen, only explaining
what can happen. Currently, more than 8 million people around
the world die each year because they are too poor to stay alive.
Every morning our newspapers could report, "More than 20,000
people perished yesterday of extreme poverty." How? The
poor die in hospital wards that lack drugs, in villages that
lack antimalarial bed nets, in houses that lack safe drinking
water. They die namelessly, without public comment. Sadly, such
stories rarely get written.
Since Sept. 11, 2001, the U.S. has launched a war on terrorism,
but it has neglected the deeper causes of global instability.
The nearly $500 billion that the U.S. will spend this year on
the military will never buy lasting peace if the U.S. continues
to spend only one-thirtieth of that, around $16 billion, to address
the plight of the poorest of the poor, whose societies are destabilized
by extreme poverty. The $16 billion represents 0.15% of U.S.
income, just 15(cent) on every $100 of our national income. The
share devoted to helping the poor has declined for decades and
is a tiny fraction of what the U.S. has repeatedly promised,
and failed, to give.
Yet our generation, in the U.S. and abroad, can choose to end
extreme poverty by the year 2025. To do it, we need to adopt
a new method, which I call "clinical economics," to
underscore the similarities between good development economics
and good clinical medicine. In the past quarter-century, the
development economics imposed by rich countries on the poorest
countries has been too much like medicine in the 18th century,
when doctors used leeches to draw blood from their patients,
often killing them in the process. Development economics needs
an overhaul in order to be much more like modern medicine, a
profession of rigor, insight and practicality. The sources of
poverty are multidimensional. So are the solutions. In my view,
clean water, productive soils and a functioning health-care system
are just as relevant to development as foreign exchange rates.
The task of ending extreme poverty is a collective one-for you
as well as for me. The end of poverty will require a global network
of cooperation among people who have never met and who do not
necessarily trust one another.
One part of the puzzle is relatively easy. Most people in the
world, with a little bit of prodding, would accept the fact that
schools, clinics, roads, electricity, ports, soil nutrients,
clean water and sanitation are the basic necessities not only
for a life of dignity and health but also to make an economy
work. They would also accept the fact that the poor may need
help to meet their basic needs. But they might be skeptical that
the world could pull off any effective way to give that help.
If the poor are poor because they are lazy or their governments
are corrupt, how could global cooperation help?
Fortunately, these common beliefs are misconceptions-only a small
part of the explanation of why the poor are poor. In all corners
of the world, the poor face structural challenges that keep them
from getting even their first foot on the ladder of development.
Most societies with the right ingredients-good harbors, close
contacts with the rich world, favorable climates, adequate energy
sources and freedom from epidemic disease-have escaped extreme
poverty. The world's remaining challenge is not mainly to overcome
laziness and corruption, but rather to take on the solvable problems
of geographic isolation, disease and natural hazards, and to
do so with new arrangements of political responsibility that
can get the job done.
We need plans, systems, mutual accountability and financing mechanisms.
But even before we have all of that apparatus in place-what I
call the economic plumbing-we must first understand more concretely
what such a strategy means to the people who can be helped.
Nearly half the 6 billion people in the world are poor. As a
matter of definition, there are three degrees of poverty: extreme
(or absolute) poverty, moderate poverty and relative poverty.
Extreme poverty, defined by the World Bank as getting by on an
income of less than $1 a day, means that households cannot meet
basic needs for survival. They are chronically hungry, unable
to get health care, lack safe drinking water and sanitation,
cannot afford education for their children and perhaps lack rudimentary
shelter-a roof to keep rain out of the hut-and basic articles
of clothing, like shoes. We can describe extreme poverty as "the
poverty that kills." Unlike moderate or relative poverty,
extreme poverty now exists only in developing countries. Moderate
poverty, defined as living on $1 to $2 a day, refers to conditions
in which basic needs are met, but just barely. Being in relative
poverty, defined by a household income level below a given proportion
of the national average, means lacking things that the middle
class now takes for granted.
The total number of people living in extreme poverty, the World
Bank estimates, is 1.1 billion, down from 1.5 billion in 1981.
While that is progress, much of the one-sixth of humanity in
extreme poverty suffers the ravages of AIDS, drought, isolation
and civil wars, and is thereby trapped in a vicious cycle of
deprivation and death.
Moreover, while the economic boom in East Asia has helped reduce
the proportion of the extreme poor in that region from 58% in
1981 to 15% in 2001, and in South Asia from 52% to 31%, the situation
is deeply entrenched in Africa, where almost half of the continent's
population lives in extreme poverty-a proportion that has actually
grown worse over the past two decades as the rest of the world
has grown more prosperous.
A few centuries ago, vast divides in wealth and poverty around
the world did not exist. Just about everybody was poor, with
the exception of a very small minority of rulers and large landowners.
Life was as difficult in much of Europe as it was in India or
Your great-great-grandparents were, with very few exceptions,
poor and living on a farm. The onset of the Industrial Revolution,
supported by a rise in agricultural productivity, unleashed an
explosive period of modern economic growth. Both population and
per-capita income came unstuck, rising at rates never before
imagined. The global population rose more than sixfold in just
two centuries, while the world's average per-capita income rose
even faster, increasing around ninefold between 1820 and 2000.
In today's rich countries, the economic growth was even more
astounding. The U.S. per-capita income increased almost 25-fold
during this period.
In beholding that success, many people embrace faulty social
theories of those differences. When a society is economically
dominant, it is easy for its members to assume that such dominance
reflects a deeper superiority-whether religious, racial, genetic,
ethnic, cultural or institutional-rather than an accident of
timing or geography.
Such theories justified brutal forms of exploitation of the poor
during colonial rule, and they persist even today among those
who lack an understanding of what happened and is still happening
in the Third World. In fact, the failure of the Third World to
grow as rapidly as the First World is the result of a complex
mix of factors, some geographical, some historical and some political.
Imperial rule often left the conquered regions bereft of education,
health care, indigenous political leadership and adequate physical
Often, newly independent countries in the post-World War II period
made disastrous political choices, such as socialist economic
models or a drive for self-sufficiency behind inefficient trade
But perhaps most pertinent today, many regions that got left
furthest behind have faced special obstacles and hardships: diseases
such as malaria, drought-prone climates in locations not suitable
for irrigation, extreme isolation in mountains and landlocked
regions, an absence of energy resources such as coal, gas and
oil, and other liabilities that have kept these areas outside
of the mainstream of global economic growth. Countries ranging
from Bolivia to Malawi to Afghanistan face challenges almost
unknown in the rich world, challenges that are at first harrowing
to contemplate, but on second thought encouraging in the sense
that they also lend themselves to practical solutions.
In the past quarter-century, when poor countries have pleaded
with the rich world for help, they have been sent to the world
money doctor, the International Monetary Fund. For a quarter-century,
and changing only very recently, the main IMF prescription has
been budgetary belt-tightening for patients much too poor to
IMF-led austerity has frequently resulted in riots, coups and
the collapse of public services. Finally, however, that approach
is beginning to change.
It has taken me 20 years to understand what good development
economics should be, and I am still learning. In my role as director
of the U.N. Millennium Project, which has the goal of helping
to cut the world's extreme poverty in half by 2015, I spent several
eye-opening days with colleagues last July in a group of eight
Kenyan villages known as the Sauri sublocation in the Siaya district
of Nyanza province. We visited farms, clinics, hospitals and
schools. We found a region beset by hunger, AIDS and malaria.
The situation is grim, but salvageable.
More than 200 members of the community came to meet with us one
afternoon. Hungry, thin and ill, they stayed for 31/2 hours,
speaking with dignity, eloquence and clarity about their predicament.
They are impoverished, but they are capable and resourceful.
Though struggling to survive, they are not dispirited but are
determined to improve their situation. They know well how they
could get back to high ground.
The meeting took place on the grounds of a school called the
Bar Sauri Primary School, where headmistress Anne Marcelline
Omolo shepherds hundreds of schoolchildren through primary education
and the travails of daily life. Despite disease, orphanhood and
hunger, all 33 of last year's eighth-grade class passed the Kenyan
national secondary-school exams. On a Sunday last July, we saw
why. On their "day off" from school, this year's class
of eighth-graders sat at their desks from 6:30 a.m. until 6 p.m.
Preparing months in advance for this year's national examinations
in November. Unfortunately, many who will pass the exams will
be unable to take a position in a secondary school because of
lack of money for tuition, uniforms and supplies. Nonetheless,
to boost the fortitude of the eighth-graders during the critical
examination year, the community provides them with a midday meal,
cooked with wood and water the students bring from home. Alas,
the community is currently unable to provide midday meals for
the younger children, who must fend for themselves.
When our village meeting got under way, I canvassed the group
and got very perceptive accounts of the grim situation. Only
two of the 200 farmers at the meeting reported using fertilizer
at present. Around 25% are using improved fallows with nitrogen-fixing
trees, a scientific farming approach developed and introduced
into Sauri by the World Agroforestry Center. With this novel
technique, villagers grow trees that naturally return nitrogen
to the soil by converting it from the atmosphere, thus dramatically
improving yields. The new method could be used throughout the
village if more money were available for planting the trees alongside
their maize crops.
The rest of the community is farming on tiny plots, sometimes
no more than one-quarter of an acre, with soils that are so depleted
of nutrients and organic matter that even if the rains are good,
the households still go hungry. If the rains fail, the households
face the risk of death from severe undernutrition. Stunting,
meaning low height for one's age, is widespread, a sign of pervasive
and chronic undernutrition of the children.
The real shocker came with my follow-up question. How many farmers
had used fertilizers in the past? Every hand in the room went
up. Farmer after farmer described how the price of fertilizer
was now out of reach, and how their current impoverishment left
them unable to purchase what they had used in the past.
As the afternoon unfolded, the gravity of the community's predicament
became more apparent. I asked how many households were home to
one or more orphaned children left behind by the AIDS pandemic.
Virtually every hand in the room shot up. I asked how many households
were receiving remittances from family members living in Nairobi
and other cities. The response was that the only things coming
back from the cities were coffins and orphans, not remittances.
I asked how many households had somebody currently suffering
from malaria. Around three-fourths of the hands shot up. How
many use antimalarial bed nets? Two out of 200 hands went up.
How many knew about bed nets? All hands. And how many would like
to use bed nets? All hands remained up. The problem, many of
the women explained, is that they cannot afford the bed nets,
which sell for a few dollars per net, and are too expensive even
when partially subsidized by international donor agencies.
A few years back, Sauri's residents cooked with locally collected
wood, but the decline in the number of trees has left the area
bereft of sufficient fuel. Villagers said that they now buy pieces
of fuel wood in Yala or Muhanda, a bundle of seven sticks costing
around 30(cent). Not only are seven sticks barely enough to cook
one meal, but for a lack of 30(cent), many villagers had in fact
reverted to cooking with cow dung or to eating uncooked meals.
The dying village's isolation is stunning. There are no cars
or trucks owned or used within Sauri, and only a handful of villagers
said they had ridden in any kind of motorized transport during
the past year. Around half of the individuals at the meeting
said that they had never made a phone call in their entire lives.
This village could be rescued, but not by itself. Survival depends
on addressing a series of specific challenges, all of which can
be met with known, proven, reliable and appropriate technologies
and interventions. (Thanks to a grant from the Lenfest Foundation
in the U.S., the Earth Institute at Columbia University will
put some novel ideas to work in Sauri.) Sauri's villages, and
impoverished villages like them all over the world, can be set
on a path of development at a cost that is tiny for the world
but too high for the villages themselves and for the Kenyan government
on its own. African safari guides speak of the Big Five animals
to watch for on the savannah. The world should speak of the Big
Five development interventions that would spell the difference
between life and death for the savannah's people. Sauri's Big
With fertilizers, cover crops, irrigation and improved seeds,
Sauri's farmers could triple their food yields and quickly end
chronic hunger. Grain could be protected in locally made storage
bins using leaves from the improved fallow species tephrosia,
which has insecticide properties.
Improving basic health
A village clinic with one doctor and nurse for the 5,000
residents would provide free antimalarial bed nets, effective
antimalarial medicines and treatments for HIV/ AIDS opportunistic
Investing in education
Meals for all the children at the primary school could improve
the health of the kids, the quality of education and the attendance
at school. Expanded vocational training for the students could
teach them the skills of modern farming, computer literacy, basic
infrastructure maintenance and carpentry. The village is ready
and eager to be empowered by increased information and technical
Electricity could be made available to the villages either via
a power line or an off-grid diesel generator. The electricity
would power lights and perhaps a computer for the school; pumps
for safe well water; power for milling grain, refrigeration and
other needs. The villagers emphasized that the students would
like to study after sunset but cannot do so without electric
Providing clean water and sanitation
With enough water points and latrines for the safety of the entire
village, women and children would save countless hours of toil
each day fetching water. The water could be provided through
a combination of protected springs, rainwater harvesting and
other basic technologies.
The irony is that the cost of these services for Sauri's 5,000
residents would be very low. My Earth Institute colleagues and
I estimated that the combined cost of these improvements, even
including the cost of treatment for AIDS, would total only $70
per person per year, or around $350,000 for all of Sauri. The
benefits would be astounding. Sooner rather than later, these
investments would repay themselves not only in lives saved, children
educated and communities preserved, but also in direct commercial
returns to the villages and the chance for self-sustaining economic
growth. The international donor community should be thinking
round-the-clock of one question: How can the Big Five interventions
be done on a larger scale in rural areas similar to Sauri? With
a population of some 33 million people, of whom two-thirds are
in rural areas, Kenya would need annual investments on the order
of $1.5 billion for its Sauris, with donors filling most of that
financing gap, since the national government is already stretched
beyond its means. Instead, donor support for investment in rural
Kenya is perhaps $100 million, or a mere one-fifteenth of what
is needed. And Kenya's debt service to the rich world is several
hundred million dollars per year. Kenya's budget is still being
drained by the international community, not bolstered by it.
This is all the more remarkable since Kenya is a new and fragile
democracy that should be receiving considerable help.
The outside world has pat answers concerning extremely impoverished
countries, especially those in Africa. Everything comes back,
again and again, to corruption and misrule. Western officials
argue that Africa simply needs to behave itself better, to allow
market forces to operate without interference by corrupt rulers.
Yet the critics of African governance have it wrong. Politics
simply can't explain Africa's prolonged economic crisis. The
claim that Africa's corruption is the basic source of the problem
does not withstand serious scrutiny. During the past decade I
witnessed how relatively well-governed countries in Africa, such
as Ghana, Malawi, Mali and Senegal, failed to prosper, whereas
societies in Asia perceived to have extensive corruption, such
as Bangladesh, Indonesia and Pakistan, enjoyed rapid economic
What is the explanation? Every situation of extreme poverty around
the world contains some of its own unique causes, which need
to be diagnosed just as a doctor would a patient. For example,
Africa is burdened with malaria like no other part of the world,
simply because it is unlucky in providing the perfect conditions
for that disease: high temperatures, plenty of breeding sites
and particular species of malaria-transmitting mosquitoes that
prefer to bite humans rather than cattle.
Another myth is that the developed world already gives plenty
of aid to the world's poor. Former U.S. Secretary of the Treasury
Paul O'Neill expressed a common frustration when he remarked
about aid for Africa: "We've spent trillions of dollars
on these problems and we have damn near nothing to show for it."
O'Neill was no foe of foreign aid. Indeed, he wanted to fix the
system so that more U.S. aid could be justified. But he was wrong
to believe that vast flows of aid to Africa had been squandered.
President Bush said in a press conference in April 2004 that
as "the greatest power on the face of the earth, we have
an obligation to help the spread of freedom. We have an obligation
to feed the hungry." Yet how does the U.S. fulfill its obligation?
U.S. aid to farmers in poor countries to help them grow more
food runs at around $200 million per year, far less than $1 per
person per year for the hundreds of millions of people living
in subsistence farm households.
From the world as a whole, the amount of aid per African per
year is really very small, just $30 per sub-Saharan African in
2002. Of that modest amount, almost $5 was actually for consultants
from the donor countries, more than $3 was for emergency aid,
about $4 went for servicing Africa's debts and $5 was for debt-relief
operations. The rest, about $12, went to Africa. Since the "money
down the drain" argument is heard most frequently in the
U.S., it's worth looking at the same calculations for U.S. aid
alone. In 2002, the U.S. gave $3 per sub-Saharan African. Taking
out the parts for U.S. consultants and technical cooperation,
food and other emergency aid, administrative costs and debt relief,
the aid per African came to the grand total of perhaps 6(cent).
The U.S. has promised repeatedly over the decades, as a signatory
to global agreements like the Monterrey Consensus of 2002, to
give a much larger proportion of its annual output, specifically
up to 0.7% of GNP, to official development assistance. The U.S.'s
failure to follow through has no political fallout domestically,
of course, because not one in a million U.S. citizens even knows
of statements like the Monterrey Consensus. But we should not
underestimate the salience that it has abroad. Spin as we might
in the U.S. about our generosity, the poor countries are fully
aware of what we are not doing.
The costs of action are a tiny fraction of the costs of inaction.
And yet we must carry out these tasks in a context of global
inertia, proclivities to war and prejudice, and understandable
skepticism around the world that this time can be different from
the past. Here are nine steps to the goal:
Commit to the task.
Oxfam and many other leaders in civil society have embraced
the goal of Making Poverty History. The world as a whole needs
now to embrace the goal.
Adopt a plan of action.
The U.N.'s Millennium Development Goals, approved by all
of the world's governments at the start of the millennium, are
the down payment on ending poverty. The MDGS set out specific
targets for cutting poverty, hunger, disease and environmental
degradation by 2015 and thereby laid the foundation for eliminating
extreme poverty by 2025. The rich and poor countries have solemnly
agreed to work toward fulfilling the MDGS. The key is to follow
Raise the voice of the poor.
Mahatma Gandhi and Martin Luther King Jr. did not wait for
the rich and powerful to come to their rescue. They asserted
their call to justice and made their stand in the face of official
arrogance and neglect. It is time for the democracies in the
poor world-Brazil, India, Nigeria, Senegal, South Africa and
dozens of others-to join together to issue the call to action.
Redeem the U.S. role in the world.
The richest and most powerful country, long the leader and
inspiration in democratic ideals, is barely participating in
global efforts to end poverty and protect the environment, thus
undermining its own security. It's time to honor the commitment
to give 0.7% of our national income to these crucial goals.
Rescue the IMF and World Bank.
They have the experience and technical sophistication to
play an important role. They have the internal motivation of
a highly professional staff. Yet they have been used like debt-collection
agencies for the big creditor countries. It's time to restore
their role in helping all 182 of their member countries, not
just the rich ones, in the pursuit of enlightened globalization.
Strengthen the U.N.
It is no use blaming the U.N. for the missteps of recent
years. Why are U.N. agencies less operational than they should
be? Not because of "U.N. bureaucracy," though that
exists, but because the powerful countries fear ceding more authority.
Yet U.N. specialized agencies have a core role to play in the
ending of poverty. It is time to empower the likes of the U.N.
Children's Fund (UNICEF), the World Health Organization (who),
the Food and Agricultural Organization (fao), and many others
to do the job-on the ground, country by country.
Harness global science.
New technology has led directly to improved standards of
living, yet science tends to follow market forces as well as
to lead them. It is not surprising that the rich get richer in
a continuing cycle of growth while the poorest are often left
behind. A special effort should be made by the powerhouses of
world science to address the unmet challenges of the poor.
Promote sustainable development.
Ending extreme poverty can relieve many of the pressures
on the environment. When impoverished households are more productive
on their farms, for example, they face less pressure to cut down
neighboring forests in search of new farmland. Still, even as
extreme poverty ends, we must not fuel prosperity with a lack
of concern for industrial pollution and the unchecked burning
of fossil fuels.
Make a personal commitment.
It all comes back to us. Individuals, working in unison,
form and shape societies.
The final myth I will debunk here is that politicians are punished
by their constituents for supporting actions to help the poor.
There is plenty of experience to show that the broad public will
accept such measures, especially if they see that the rich within
their own societies are asked to meet their fair share of the
burden. Great social forces are the mere accumulation of individual
actions. Let the future say of our generation that we sent forth
mighty currents of hope, and that we worked together to heal
Copyright (copyright)2005 Jeffrey Sachs. Adapted from The
End of Poverty, to be published this month in the U.S. by Penguin
Time magazine's cover story excerpts
Jeffrey D. Sachs' new book
"The End of Poverty," which is due out on March 21.
( Link to: http://www.time.com/time/covers/1101050314/story.html
The End of Poverty - Economic Possibilities
for Our Time
by Jeffrey D. Sachs
( Link to: http://www.earthinstitute.columbia.edu/endofpoverty/
The Earth Institute at Columbia University
( Link to: http://www.earthinstitute.columbia.edu/ )