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).
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.