Saving children around the world

It’s easy to get on the web and find knowing pronouncements that foreign aid “doesn’t work.” Of course, specific critiques of particular approaches and projects are often warranted. Yet the more sweeping critiques of global development assistance bear uncomfortable resemblance to top-1-percenters opposing greater social provision here at home. There’s just nothing more comforting to the comfortable than the claim: “There’s nothing we can do.” It’s very easy to point to a crummy public housing project or pathologies connected with AFDC while ignoring the larger and quieter benefits of the EITC and WIC. It’s even easier to find a World Bank-funded bridge-to-nowhere in arguing against the possibility of effective foreign aid.

Domestically and internationally, the right strategy is to aggressively pursue evidence-based interventions, rigorously evaluate the quality of implementation and the outcomes. We should unsentimentally reform or stop interventions that don’t work, while methodically committing serious resources to more effective interventions.

To an impressive extent, this is actually happening in global public health. PEPFAR, polio immunization, and so many other initiatives are saving millions of lives. If I could restart my career, I would be a development economist helping with these efforts. With all the bad news around the world, it’s worth noting that we are witnessing remarkable gains in global health. Improved governance and more broadly-shared economic growth are huge factors here. Yet global health assistance and coordination have made a huge difference, too.

Effective HIV medications now reach millions of patients who need them. That’s widely known. Fewer people realize the extent that maternal and child mortality are much reduced, and continue to decline, across the developing world. The Economist notes that twenty African countries now have strong data on child survival to age five. Twelve of the twenty countries are now achieving child mortality reductions exceeding four percent annually. The rise of China, India–not to mention Korea, Taiwan, and many other nations–is probably the greatest boon to humanity since the Industrial Revolution.

Obviously the world faces serious challenges, too. Billions of people endure grinding poverty, bad governance, and often profound violations of human rights. Recession and political backsliding in wealthy democracies threaten funding of global health efforts. We face the human consequences of environmental degradation, resource scarcity, and pending climate change.

Without denying these challenges, the range and quality of global health activity deserves note. If you want to see both the accomplishments and the challenges facing the best people doing this work, I highly recommend this week’s Journal of the American Medical Association, devoted to global health. There is no more important subject facing the world. And there is reason for optimism.

I’ll have another column regarding one specific intervention that JAMA special issue. It concerns strategies to reduce infant and child mortality in rural Bangladesh. So stay tuned. (HAP)

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