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What if we allocated aid $ based on how much damage something does, and whether we know how to fix it?

March 7, 2013
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I usually criticize development wonks who come up with yet another ‘if I ruled the world’ plan for reforming everything without thinking through the issues of politics, power and incentives that will determine which (if any) of their grand schemes gets adopted. But it’s been a hard week, and today I’m taking time out from the grind of political realism to rethink aid policy.

Call it a thought experiment. Suppose we started with a blank sheet of paper, and decided which issues to spend aid money on based on two criteria – a) how much death and destruction does a given issue cause in developing countries, and b) do the rich countries actually know how to reduce the damage? That second bit is important – remember Charles Kenny’s book ‘Getting Better‘, which argues powerfully that since we understand how to improve health and education much better than how to generate jobs and growth, aid should concentrate on the former.

If you followed this exercise, I think you would end up with a radically different aid agenda, with a whole bunch of Cinderella issues coming in from the cold (I’m also taking a break from not mixing metaphors).

Here’s the global death toll (from the new edition of FP2P, c/o indefatigable  number crunching from Richard King).

causes of death

These are global figures, and I don’t have a breakdown by developed/developing. That would be important on obesity, but on other issues, the majority of impact is clearly in poor countries – alcohol, tobacco and road traffic for example. And they are precisely the areas where the rich countries have lots of experience in reducing the damage. It’s certainly a lot more straightforward than inventing/discovering new vaccines. When researchers put signs in Kenyan minibuses (matatus) urging passengers to criticize reckless driving, injuries and deaths fell by a half (for paper see here).

So how come such subjects are so seldom seen as development issues? Where’s the campaign on booze and fag dumping by large corporations in developing countries? Or international seat belt conventions, backed by technical assistance to help governments ratify and implement? Your thoughts please. Presumably some kind of campaigns exist on all these issues – please send links – but they could be a lot more prominent.

And for the truly wonky/medically inclined here’s a more sophisticated version from the Guardian – Disability Adjusted Life Years, which Claire Melamed and John Appleby reckon could be usefully mainstreamed in development. It shows which causes of global death and disability are up/down from 1990-2010. And if you don’t know what Ischemic or COPD mean, look them up.

DALYS by cause 1990-2010

11 comments

  1. If we base aid allocation on medical causes of death, logically 100% of aid will go to medical sectors.

    What about natural, environmental, political, economical and other factors causing these deaths?

    1. Well no, actually – household smoke leads to focus on energy poverty, road traffic on road safety, alcohol and tobacco on regulation of TNCs selling lethal products. On your wider point, obviously there are a wide range of factors, but my question is, which ones do the rich countries actually have a relative advantage in being able to fix? Economy and politics not so much, judging by current state of Europe. Environment arguable more so.

  2. Interesting. Looks similar to Bjorn Lomborg’s Copenhagen Consensus stuff. http://www.copenhagenconsensus.com

    Seems weird that the second criterion is “do outsiders know how to fix the problems?” Doesn’t that reflect an outdated view of how development happens? A bit aid and outsider centric?

    Actually, the first one should also take more account of what people in developing countries regard as the priority issues too shouldn’t it.

    All in all, this is a bit outsiders looking in and making decisions isn’t it?!

    best,
    alan

    1. Fair criticism, Alan. I was just making the point that even with a very instrumental, outsiderish, old fashioned approach to aid as $ + technical assistance, the gap between a logical and actual agenda is huge. (And now you’ve raised the comparison with Lomborg, I’m really worried!)

  3. Can I fly the flag for donors ?
    What if we allocated aid money based on the criteria of what donors , tax-payers and individuals want it spent on ?
    Why is the list of what donors want to spend money on , different from what the aid industry believes is effective aid ? Are donors just mule-headed or have we done a bad job in explaining ourselves ?

  4. Surely these issues have to be considered from a perspective of power and incentives. It is because of the way ‘power’ is allocated that they are not being tackled. It must be a bad day, Duncan, if you are switching off the most important part of the debate. It is like Chavez saying ‘suppose market forces really work…’ More on power please, Duncan.

    1. Good challenge Joe! So let’s take road traffic – hard to see what vested interests would want to prevent aid donors and governments working together to reduce needless fatalities. So not interests, but what about the other ‘i’s’ – incentives and ideas. No incentives because not much money to be made out of it? Or a blockage on ideas because RTAs are seen as somehow northern/ don’t fit the development imaginary? But there are countervailing incentives – lots more powerful middle class people are affected than by, say diarrhoea or maybe even malaria, so there out to be a political constituency for work on road traffic.

      Cd do similar exercise on alcohol and tobacco (interests – booze and cig companies; incentives – tax revenue), migration (main incentives political rather than economic), disability (ideas – prejudice and denial).

      So who’s volunteering to do a matrix on drivers/blockers for work on different cinderella issues, against interests/incentives/ideas?

  5. On road traffic , can you see the Daily Mail headlines when UK aid is spent on building a roundabout ? , or an Oxfam campaign to encourage the overweight in developing countries to take more exercise ?
    Donors don’t want to fund it , that’s why these thing don’t get funding.

  6. I think part of the problem is that aid for health is primarily channeled through the health sector, but the problems you have identified are not things that ministries of health are very good at dealing at.

    If you think about some of the things that have been a priority for health aid – such as HIV and other infectious diseases, family planning, childhood health – a large proportion of the funding goes to biomedical interventions. Interestingly enough, I suspect this focus ends up limiting the impact of these programmes. More could be achieved if more attention was also paid to “structural” (non health sector) interventions that can help tackle these problems. While it is clear that there are more or less popular issues at any given point in time, I reckon a big part of the challenge here is about how public health is conceptualised.

    I think Duncan is right to list the second criterion – there’s no point in spending money on something that we have no idea how to fix. But I also agree with the comments that this should not just be about aid donors deciding; it should be about all relevant decision makers (in particular the governments responsible for looking after the health of their people).

  7. On the subject of funding and funders for road safety, this is a newer topic for funders than, say tobacco. However, there are now major corporates and philanthropists putting real funds towards well developed and proven road safety practices, The Global Road Safety Partnership works with governments, civil society and leading corporate entities to deliver road safety projects in low- and middle-income countries around the world: take a look http://www.grsproadsafety.org

  8. Deaths from armed conflict is a bit of a misnomer- it’s not conflict itself that kills people, but rather the secondary impact on health, education, lack of jobs etc. Conflict related deaths would be much higher.

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