A world of hurt

LATE last December, Time magazine put the face of Bono on its cover and declared him, along with Bill and Melinda Gates, a “person of the year.” The pick had nothing to do with the increasingly banal musical output of an aging rock legend. Instead, it was for having “persuaded the world’s leaders to take on global poverty,” as the magazine’s editors grandly put it. “We’ve been doing this for a few years -- pretending this is the one, this is the leap,” Bono told Time. “And in fact, this year was the one.”

Getting the world’s attention is one thing but, as William Easterly argues, getting results is an entirely different matter.

“It is great that rock stars donate their time for the needy and desperate,” he writes in “The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good.” “Unfortunately, the West already has a bad track record [with] previous beautiful goals.” Indeed, Bono seems to offer a prime example of what Easterly calls “the second tragedy” of the world’s poor. The first tragedy is that 3 billion people live on less than $2 a day, 800 million people do not have enough to eat, and 10 million children die from easily preventable diseases every year; the second is that so many well-intentioned schemes to help them have so utterly failed.

“This is the tragedy,” Easterly states, “in which the West spent $2.3 trillion on foreign aid over the last five decades ... and still had not managed to get four-dollar bed nets to poor families” to help combat malaria.

Although his combative, crackling prose might not suggest it, Easterly is a respected economist who spent almost 20 years working on development projects for the World Bank. In 2001, he published the book “The Elusive Quest for Growth,” an incisive analysis of why poor countries remain poor despite all the efforts by institutions like the World Bank, and wrote a newspaper op-ed on the same topic -- and was subsequently dismissed. According to bank officials, he had failed to follow the organization’s publishing guidelines. But most observers couldn’t help thinking that Easterly was being punished for his heresy.

“The White Man’s Burden” serves as a coda to that incident, and in the intervening years, something has happened (besides his getting fired) to make Easterly -- now affiliated with New York University and the Center for Global Development -- even angrier about the West’s approach to foreign aid.

After declining through the 1990s, aid to poor countries has made a comeback since 2000. With Bono among those leading the charge, rich countries have started to again talk about their “mission” and “responsibility” to rescue the world’s poor. Jeffrey Sachs, the Columbia University economist whom Bono calls “my professor,” has been traveling the world arguing that “success in ending the poverty trap will be much easier than it appears.” Less than $200 billion a year in aid from rich countries, he proclaims, would completely eradicate extreme poverty -- which afflicts the 1 billion people who get by on less than a dollar a day -- by 2025.

If it were so easy, Easterly shoots back, we would have done it long ago.

After all, scores of institutions have devoted themselves to the cause of economic development over the last 50 years. Countless heads of state have pledged to end poverty in 10 or 15 or 25 years. Africa has received some $600 billion in aid in the last four decades. Yet many of its inhabitants are worse off than they were in 1960.

The $4-bed-net problem, a hot topic in foreign-aid circles these days, is telling. Every year, a million people die of malaria, a preventable, treatable disease that has been eradicated from all but the world’s most destitute regions. Because malaria is transmitted by mosquitoes, aid advocates offer a simple solution: hand out insecticide-treated bed nets to the poor in sub-Saharan Africa. Easterly rushes to point out that it’s not that simple. “If bed nets are such an effective cure, why hadn’t [aid agencies] already gotten them to the poor?” he asks, noting that they “are often diverted to the black market, become out of stock in health clinics, or wind up being used as fishing nets or wedding veils.”

Easterly is not, however, opposed to foreign aid, despite the vitriol and occasional sarcasm of his critique. It’s not as if he thinks the developed world shouldn’t help the developing world; it’s that he sees the predominant approach to doing so as fundamentally flawed. Too much attention is paid to what he calls “big plans” instead of “piecemeal solutions.” Big plans -- the grandiose programs beloved by politicians and rock stars -- have sweeping missions like “ending poverty” that overlook the more specific needs of the poor. Piecemeal solutions are small scale and local, responsive to circumstances on the ground and devoted to narrow goals. In fact, Easterly suggests, “the right plan is to have no plan.”

The basic problem with big aid, as Easterly describes it, is that it is utopian -- of a piece with the high-minded hubris that has driven the United States to deliver democracy to others at the point of a gun (and that underpinned the original, more openly imperialist “white man’s burden” of a century ago). Poor countries, according to this vision, need just one “big push” from foreign donors to start down the path to prosperity and escape extreme poverty forever. Unfortunately, it is questionable whether there is any single country where aid has played a significant role in jump-starting economic growth: Most of the major success stories of the last half-century have come in countries that received relatively little aid and that, more important, followed paths that diverged from development orthodoxy in key ways. Ultimately, whether a country manages to grow has to do with conditions -- good government prominent among them -- over which outside actors have little control. The great anomaly of sub-Saharan Africa, for example, has been Botswana (though not with regard to AIDS). It has enjoyed some of the strongest economic growth in the world mostly because it has a more-or-less well-functioning democratic government that has shrewdly used natural-resource wealth to reduce poverty.

This is why giving foreign aid the mission of ending poverty is like having, as Easterly puts it, “the goal that your cow will win the Kentucky Derby.” Setting grand, impossible goals means that there is little accountability for results. The rich world’s desire to tell itself that “something is being done” ends up outweighing its interest in making sure that the “something” is actually making a difference.

Easterly does not exactly prove that foreign aid has caused “so much ill,” as his subtitle sneers. But he provides plenty of examples of grandly conceived, misguided pursuits sucking up resources that would have been better spent on smaller projects. One of his most provocative attacks is on a highly publicized sacred cow, AIDS programs. The self-importance of rich countries, he argues, has led them to direct their efforts in stupid ways: toward giving AIDS patients anti-retroviral drugs to alleviate “what the West considers the most dramatic kind of suffering” instead of supporting prevention programs like handing out condoms and educating prostitutes. “If money spent on treatment went instead to effective prevention,” he writes, “between three and seventy-five new HIV infections could be averted for every year of life given to an AIDS patient.”

The trade-off in this case is particularly acute because healthcare is one area (primary education is another) in which aid has helped tremendously, as Easterly acknowledges. A vaccination drive in southern Africa essentially eliminated measles (a major killer in poor countries), and an “oral rehydration therapy” campaign in Egypt reduced childhood deaths from diarrhea (also a major killer) by more than 80%. For Easterly, these are examples of what aid should be: narrowly focused, responsive to conditions on the ground and accountable for results. Thanks to such programs, the developing world has seen recent massive improvements in childhood mortality and average life spans even as incomes have stagnated.

Of course, the utopian advocates of a “big push to end poverty” cite many of the same programs as models for their proposals. Sachs’ book “The End of Poverty” -- which Easterly savaged in a review in the Washington Post last year -- touts some of the same projects “The White Man’s Burden” does, an irony unnoted by Easterly. The disagreement between their views has less to do with what effective projects look like than with how to create more -- how to motivate the wealthy to pay the bill and how to ensure that those carrying them out get results.

In the end, Easterly’s curmudgeonly realism and Bono’s earnest cheerleading may be more complementary than either side acknowledges. Easterly’s call for a more modest, results-oriented approach to aid is dead-on, but it would be a moot point without the enthusiasm and advocacy with which Bono and those like him raise interest in (and money for) aid in the first place. So it’s hardly fair to say that rock stars do nothing for the fight against poverty: Were it not for their preaching, Easterly’s important book would probably never have been written. *