James Hereford: ‘You write, Tony Blair came to America to beseech George Bush for $25 billion over ten years in aid to the impoverished nations of Africa, he got not quite 3% of it – $674 million. ‘I was hungry and you gave me nothing; I was thirsty and you gave me nothing; I was a stranger and you did not invite me in.” We have now reached the point that $674 million dollars is ‘nothing’? Have we completely lost perspective? We have dumped untold billions of dollars into Africa over many years and to what end? Is there a success story we can point to that shows money was the answer? We have made a few individuals very rich (along with some American and French arms dealers), but the average African is in the same boat he was in 30 years ago. Americans are always so quick to throw money at problems (especially other people’s money), thinking that money is always the solution.’
☞ I think this states the view of a great many Americans. Which is why I think the following interview with one of the world’s leading hands-on economists is so important.
Because it’s long, I’ve highlighted parts to save you time. (Or listen to it here, though it takes a while to load.)
Telephone Press Briefing for Journalists with Economist Jeffrey Sachs Discussing the Upcoming G-8 Summit
June 15, 2005
Dr. Jeffrey Sachs, director of the UN Millennium Project and Dr. Joanne Carter, legislative director of RESULTS International in Washington, DC.
Operator: Excuse me, everyone, we will now begin the conference. All lines will be muted during the broadcast. If you should need operator assistance during the call, you may press star zero, and an operator will come by to assist you. There will be a question and answer session following the presentation. Instructions for asking questions will be given at that time.
At this time, I would like to turn the call over to Joanne Carter. You may begin.
Joanne Carter: Thanks very much, Operator, and thank you to everyone for joining us for this conference call briefing with the economist Jeffrey Sachs, at this extraordinarily important time in advance of the G-8 Summit in Gleneagles, Scotland, in early July. My name is Joanne Carter, I am the legislative director of RESULTS, which is the organization sponsoring this call. RESULTS is an international advocacy organization that works to influence the U.S. and other donor country policies and priorities to ensure access to health care, education, and other basic needs for people in the world.
We set up this call to provide you with background to the upcoming G-8, the issues at stake related to poverty in Africa, the opportunities, and a realistic assessment of where the U.S. stands right now. In a moment I will introduce Jeff Sachs, and he will make some opening comments and then take your questions. But I would just say that it is really becoming clear that this year, and specifically, this year and this year’s G-8 may be the most important and most opportune moment we’ve ever seen to address poverty – the poverty that has over 1 billion people surviving on less than $1 a day, with a particular opportunity to address the severe poverty in sub-Saharan Africa. Jeff Sachs is going to put U.S. efforts to date in context by looking at some of the scale-up that we have seen in USAID’s efforts and the recent agreement on debt. But also, be clear that the U.S. is still far behind in providing its fair share by any standards. I would just point out that when we look at some specific critical areas like the Global Fund to Fight AIDS, TB and Malaria, we are so in danger of under-funding it from the U.S. side that the fund won’t even potentially have money to assist in grants, never mind funding new projects to be approved this fall, if the U.S. doesn’t do its fair share. Certainly the world and the U.S. have made very little progress to date on access even to primary education for all children in Africa, which has an especially detrimental effect on girls and AIDS orphans who are often kept out by school fees. So I would just say, whatever the United States chooses to do or not do at this G-8, whether or not we step up to the plate, is going to have a huge impact on the global momentum and successive global efforts.
I want to turn this over now to Jeff Sachs. For those of you who do not know him, Jeff Sachs is currently the director of the Earth Institute at Columbia University. He is the special advisor to UN Secretary-General Kofi Annan on the Millennium Development Goals. He is the director of the Millennium Project, which in January released a very important report that’s maybe the most detailed blueprint we have ever had for cutting severe poverty in half in the next decade. Jeff is also the author of the recently released The End of Poverty: Economic Possibilities for Our Time. So Jeff, if you go ahead with your comments and then we will take questions from journalists. Thanks very much.
Jeffrey Sachs: Thank you, Joanne, and thanks everybody for the opportunity to have a discussion. As Joanne Carter has just said, this is an extremely important year and a very important moment in our nation’s decision making. It is an important year because 2005 is in many ways a make-or-break year for achieving the Millennium Development Goals. These are international goals that were agreed [upon] by the world’s governments in September 2000, at the time of the Millennium Assembly at the United Nations. They call for very significant progress in cutting all aspects of extreme poverty by the year 2015, and they have the advantage that they’re quantified. They are specific goals in the relevant areas of life and death for the world’s poorest people: income, poverty, hunger, child survival, maternal survival, AIDS, tuberculosis, malaria, access to safe drinking water, and so on.
We know that for dozens of the world’s poorest people[s], we’re not on track to meet the goals, although happily for hundreds of millions of people, especially in Asia, indeed for billions of people, there’s been a lot of progress. It’s the progress that gives us the realistic hope that that kind of progress can be achieved everywhere, including the places where it is not being achieved right now. The epicenter of disaster is certainly sub-Saharan Africa, although places in our own hemisphere, in the Andean region, which we know is in turmoil again, and in central Asia around Afghanistan, but including places like Kyrgyzstan and Uzbekistan and other landlocked parts of central Asia, are also trapped in an extreme poverty trap.
There are ways out of this. In fact, all the recent studies that have been done, whether by the UN Millennium Project, which I had the honor to direct, or by Tony Blair’s Africa Commission, or by the Global Monitoring Report of the International Monetary Fund and the World Bank, have all come to the same conclusion: extreme poverty can be reduced, indeed eliminated by our generation. The Millennium Development Goals can be achieved, but they require a greatly increased level of investment. That’s the core: increased investment in people themselves and their health, their education, their nutrition, in the environments in which they live, the soils, the water, the habitats and in the infrastructure: roads, power, Internet connectivity, and telecommunications. With these investments, the poorest of the poor, who suffer from an extremely low level of productivity can have their productivity enhanced tremendously and they can become productive members of the world economy.
But all of these studies agree on the point that for the poorest of the poor, they can’t afford the vital investments that are needed, even when these are at very low cost. An example is something as simple as an anti-malaria bed net which is $7, it lasts for five years, and yet it is financially out of reach of hundreds of millions of people living in the extreme poverty of endemic malaria regions. If we help the poorest of the poor make the investments, not simply send over emergency food aid, but actually help them to grow more food, and help them to fight diseases like malaria, as we’re doing with AIDS, if we step up this effort, this kind of extreme poverty can be ended.
Now all of these studies found the same thing; that aid needs to be doubled in the next few years in order to meet these goals. Our project did the most detailed costing ever done. The Africa Commission came up with very similar numbers; so did the IMF and the World Bank in fact in their report. We do need to double overall aid in the next few years, in particular to Africa, as Prime Minister Tony Blair has said. We need to raise aid from about $25 billion a year now to about $50 billion a year within the next few years, and direct that aid towards high-priority investments: controlling malaria, helping farmers grow more food, building basic infrastructure, assuring the children are in school, providing school meals, replenishing soil nutrients, helping with micro-irrigation and many other very practical things. If that’s done, extreme poverty can be ended.
Now, unfortunately, we are not on track, and the United States is not following through on commitments that the Bush administration made in Monterrey, Mexico in March 2002 when it, together with other governments in the world, signed the Monterrey Consensus. That consensus says in paragraph 42 – I’ll quote it exactly – ‘We urge developed countries that have not done so to make concrete efforts towards the target of 0.7 percent of gross national product as official development assistance to developing countries.’ Now that goal of 0.7 percent, where we have committed to make concrete efforts, has become now the commitment of the European Union as of last month, with a specific timetable to reach 0.7 [percent] in steps by the year 2015 and to reach 0.5 percent of gross national product by the year 2010. This was the message that Prime Minister Tony Blair brought to Washington last week. The Bush administration has not agreed to this target, even though it is part of our commitment, as it is the commitment of all the signatories of the Monterrey Consensus. It is also part of the need for Africa to be able to surmount the multiple crises of hunger, and disease, and despair, and economic isolation that Africa now faces.
Let me put this in human terms if I can. I was in a village last week in Mali, sitting around a circle on the ground with a number of the impoverished farmers in the village. I asked whether any children had died in the village recently and everybody was shocked. A man stood up and said, ‘But mister, so many children, so many children dying all the time’. I see those children dying on each visit to Africa because I go to the clinics. I see children in coma, in convulsions from malaria. I know that this is a disease which will kill up to three million children this year, even though it is largely preventable and 100 percent treatable, but it is neither being prevented nor treated. These places are too impoverished to be able to fight on their own. We have started with AIDS; we have not started with malaria in the same way. We have not helped farmers grow more food; [instead] we’ve been sending food aid. There are practical things that are part of Tony Blair’s call for a doubling of aid to Africa by the year 2010. All of the governments around the world are sharing in this. The European Union is speaking clearly. I very much hope – I urge in every possible way for the United States, for the sake of the spirit of America and the sake of American security, to join in this call of Prime Minister Blair so that the summit in July can be a success for the world and a success for America. And I believe that all hangs in the balance still, to this day. Thank you.
Joanne Carter: Thanks very much, Jeff. Why don’t we go ahead then, too, so we have plenty of time for questions, and then, perhaps, Jeff, in the context of that, you can give a few more details, and then we can provide in writing the background note that you put together about America’s current aid to Africa if that would be helpful. For now, Operator, will you please let folks know how they can ask questions, and we will get started with that.
Operator: Ok. We will now begin the question and answer segment of the conference. If you would like to ask a question at this time, please press star one on your touch-tone keypad. Again, to ask a question, please press star one.
And your first question comes from Lynne Varner with the Seattle Times. Go ahead, Ms. Varner.
Lynne Varner: I wanted to ask Jeff, what is the role of politics, of reforming government in many of the poor countries you are talking about, and are we doing that? Is the U.S. moving toward pushing those governments to reform?
Jeffrey Sachs: Well, there are many reform governments in Africa that are struggling to survive. In fact, President Bush met with a number of those leaders a few days ago, but we are not helping those places either. So it is not just a matter of us pushing, because Africa has democratized all throughout the continent, not every place, but in many many countries. And yet, those democracies which struggle for survival, with hungry populations, facing very desperate odds, facing massive disease, are not getting the kind of help that they need to break out of extreme poverty. So my suggestion – in fact the suggestion of everyone that looks at this, including the Bush administration – is to help those countries that are ready for that help, prepared, and there are many of them, but they are not getting the help. That’s the basic point. The level of our assistance right now is really so extraordinarily small compared to the need and compared to the possibilities of dramatic use of such aid, that all governments around the world are saying to the United States, it’s time. We can do a lot more. That’s why Tony Blair came last week, to say we can do a lot more. So it’s not just a matter of pushing for reform. Reforms have happened, but we are not backing up the reformers.
Lynne Varner: OK.
Operator: Thank you sir, your next question comes from Martin Crutsinger with the Associated Press.
Martin Crutsinger: Yes, Jeff. Could you make a prediction on what is going to happen at Gleneagles? Do you think that the U.S. will come part of the way to meet Blair’s request, or is it likely that, that it will end up in some sort of an impasse?
Jeffrey Sachs: Let me go through a few of the numbers just to be clear where we are right now. Europe has committed on a timetable to reach 0.5 percent of GNP in overall official development assistance by 2010 and to reach 0.7 [percent] by 2015. The United States is second from bottom of the rankings of aid relative to GNP. (Last year Italy was lower.) The United States is at 0.16 percent, but even the fact that we are at 0.16 [percent] and Europe is at around 0.4 [percent] now, on its way to 0.5 [percent] by the end of the decade and 0.7 [percent] by 2015, really in a way understates the issue. The U.S. is at 0.16 [percent] without any timetable, without any set of clear policies on how it is going to meet the obligation under the Monterrey Consensus of making concrete efforts towards the target of 0.7 [percent]. So we don’t even have a clear U.S. policy on this of how we’re going to get to where we have promised to aim. This is what Europe is saying to the United States – are you going to participate in this process? And the answer is very unclear right now because basically, the answer so far has been no. The U.S. says we don’t accept artificial targets – ironically it signed up to making concrete efforts to 0.7 [percent] so it signed the Monterrey Consensus together with everybody else. And these are not arbitrary except to the United States. These are life and death targets for the poorest people in the world.
So, I think that it’s not possible to answer the question of what will happen right now, because we are in a situation that I believe is neither in America’s interests, nor is it a place where I believe we are likely to remain. But, it’s very unclear what the administration’s policy will be. It has not really explained any policy of how it’s going to respond to this clear international commitment and to the repeated findings from all over the world of what can be accomplished right now.
Martin Crutsinger: Thank you.
Speaker: Next question, sorry, go ahead.
Operator: Your next question comes from David Francis with the Christian Science Monitor.
David Francis: Jeff, in Africa there is still a rapid population growth in many of these countries which, I imagine, would make the problem of development much harder and more difficult. And the United States seems to have some restrictions on population control. Is there conflict here? Is this a serious issue that should be addressed in the efforts to improve Africa’s situation?
Jeffrey Sachs: I believe that sexual reproductive health is a vital part of economic development, and I believe that the opportunity for families to choose family planning is a vital part of that. What’s also true is that in the poorest places in the world the population growth tends to be highest, because impoverished people, seeing their children die in such large numbers, tend to choose to have very many children as a kind of insurance policy, so that there will be some surviving children in the old age of the parents. And what this means is that ironically, it’s in the poorest places in the world, often the places least able to support a growing population, where you find the most rapid population growth.
What it also means is that when economic development begins, starting with child survival itself, fertility rates tend to fall quite sharply, as do population growth rates. And so I think there’s a real prospect through a strong development policy of saving children, of creating more productive agriculture, of empowering women, of having literacy and girls in school and literate mothers, another huge contributor to lower population growth. THAT All of these things, in my view, good development policy, will turn the tide in what is right now an unsustainably rapid growth of population. And I always find people amazed, but it’s true, that saving children actually will slow population growth, not speed it, because of the response of parents choosing smaller families and investing more in the health, and the education and the nutrition of each of the children that they have.
So yes, it’s very important, but the main thing that is happening right now is that we don’t have a coherent development strategy in Africa at all, and I have not really explained it properly. Our total aid budget for Africa is right now about $3 billion, total. In other words it is less than a couple of days of the Pentagon budget, for example. Of that $3 billion about $1 billion is emergency food aid. About $1 billion is the AIDS program, and about $1 billion is for everything else. Of the ‘everything else’, almost all of that is American consultancy salaries, rather than actual investable funds. What this means is that the image that Americans have, that we push huge amounts of money into Africa and it somehow goes bad or goes missing, is simply wrong. It’s simply wrong. It is a misunderstanding – it’s one of America’s great myths. In fact, we give very small amounts of assistance, most of which are our own salaries or food aid. What we give to actually invest in clinics, and schools, and irrigation projects, and soil replenishment is so small, it’s less than $1 per African. No wonder we don’t find it, we don’t do it! And this is the biggest misunderstanding in America, because you can understand American feelings. They say ‘Well, we give so much aid, and we see so few results’. If they understood we give so little and we see so few results, and if we gave more, we’d see more results, there would be considerably more support. And that’s what I would hope the president would explain to the American people. The truth about how much more could be done if we would simply make the effort. We could control malaria. We could help to promote a Green Revolution for Africa. We could ensure that all Africa’s children have a midday meal at their schools. Which would do wonders for getting the girls and the boys in school. We could enable Africa to drop user fees for primary education and primary health. These are all practical steps that could be accomplished quickly, but we haven’t tried them. And I believe the American people would support such practical results-based assistance, especially if the president of the United States would explain this to the American people.
Operator: Your next question comes from Shihoko Goto with UPI.
Shihoko Goto: Mr. Sachs, I actually wanted to know about how the private sector might fit into the development precis that you have for Africa. It seems to me that right now the G-8 is more concerned about immediate relief and aid, food aid, health, sanitation. But, if Africa is to grow in the longer term there needs to be a lot of business investment, and specifically technological transfer. How do you see that sort of private/public partnership developing?
Jeffrey Sachs: I think that the clear sense of international business, and of Africans and the experience of development in Asia and elsewhere is that the reason that Africa does not get the investment that it needs for growth in the private sector is because there’s a lack of basic infrastructure. Electricity is irregular. The roads don’t exist or are unreliable. The port facilities are unreliable. The population is hungry, the people are sick and the labor force is without all of the skills needed. Now, that sounds like a pretty daunting set of challenges, except that one can see practical solutions for each of them. It comes back to investment. Investing in basic infrastructure, investing in health. Which is a series of straightforward investments right now, such as control of malaria, that are not done yet. Investing in schooling for children with techniques as simple as ending user fees and promoting midday meals, using locally-produced foodstuffs.
These steps are what makes a business environment attractive for the private sector. So with roads, ports, electricity, health and an increasingly literate labor force, Africa would have the same kind of development that Asia is having right now. And in fact, Asia and Africa were in a similar situation 50 years ago, but Asia started with a Green Revolution to grow more food, feed the population and thereby escape from the cycles of famine, disease and extreme poverty. Africa has not had that Green Revolution yet and that’s because the farmers in Africa lack the basic inputs of improved seed, fertilizer or soil nutrients and small-scale water management. And yet, now, the scientists have shown in repeated projects that this can be done. This is where practical investment – for example at the G-8 Summit – could enable Africa to have a Green Revolution. That would change the face of Africa, that would change the business climate, that would change possibility over the coming generation, for the private sector to invest in a significant way. It was the trigger for Asia’s development. It requires financing, right now, the financing which, so far, the White House has not agreed, but if it did agree would change the prospects. But the one thing that will not create a Green Revolution is sending American food aid to Africa. That will not create Africa’s Green Revolution.
Operator: OK. Just so you know, there are 10 questions in queue.
Jeffrey Sachs: Yup!
Operator: Next question comes from Dan Carpenter with the Indianapolis Star.
Dan Carpenter: Hello. When we speak of the private sector, again, shouldn’t we be holding their feet to the fire more? So much of the money that is necessary for this investment that you speak of is already being extracted in places like Nigeria, for example. By corporations that are not being required to pay taxes, to protect the environment, or to engage and contribute to local needs. Are we talking too much about reform of government and not enough about reform of the private sector?
Jeffrey Sachs: Well, again, let me first say that the first thing we should be talking about is investment and then the areas of priority again are health, education, nutrition, the productivity of agriculture, which is an investments in the environments such as soils and infrastructure.
The question then becomes how to mobilize those investments. The problem is that in most countries, there is simply not the domestic resource base of any sort in order to finance the basic level of investments that are needed. This is true, incidentally, even in oil countries like Nigeria, because the costs are simply beyond what Nigeria can afford. It is often thought Nigeria is a rich country, it’s not a rich country. It produces 2 million barrels of oil per day, but it has 120 million people that are dependent on that.
The point you make is a good one, though, because when you have resources like oil, even if it’s not that much per capita – and it isn’t in the case of Nigeria – it is still important to use properly. At times, the oil has just been stolen by dictatorships like Abacha, but it’s clear that there is a tremendous lack of transparency about how that oil is extracted by the international industry as well in these countries. And so there are initiatives for extractive industries transparency, or the EITI, the Extractive Industries Transparency Initiative, or the ‘Publish What You Pay’ initiative. And that is extremely important because I believe that those resources would be used much better if there were transparency on the international business side as well.
I also believe that the large oil companies have a much greater responsibility to help the communities in which they operate than they have met so far. Now there are differences among them, but I think as a general rule, they should be doing a considerable amount more. But I don’t want to pretend, and I think it’s a mistake and almost a cop-out for all the rest of us, to pretend that that can actually solve the problems, because most of sub-Saharan Africa, first of all, is not hydrocarbon exporting economy. Most of these economies are subsistence, impoverished, disease-ridden, agricultural economies and they need help. And the help is going to have to come from us, or the people will die. And they are dying in massive numbers right now – 6 to 8 million a year in Africa alone. I think reliably, one could say worldwide, that at least 8 million people a year die of their extreme poverty, 20,000 a day. One can say that 6 million of those can be located in sub-Saharan Africa, with the nearly 3 million dying of malaria, 2 million of AIDS, half a million of tuberculosis, and millions more, in fact, of other infectious diseases. Those places don’t have an easy way out from oil. They need our help, or their downward spiral will continue. Fortunately, we have promised, time and again, to help. Unfortunately, we haven’t yet followed through. And fortunately, the G-8 Summit is the opportunity when we can finally match our commitments and our actions.
Operator: Thank you. Your next question comes from Mark Bixler with the Atlanta Journal-Constitution.
Mark Bixler: Dr. Sachs, as you know, the G-8 finance ministers recently agreed to cancel the debt of 18 poor countries, mainly in Africa. Can you give us your sense of how significant that decision is, and also could you put that into context by talking about the contributions through the years of faith-based activists, such as the Jubilee campaign. How significant a player have they been in the campaign to have some of the African nations’ debts cancelled?
Jeffrey Sachs: Thank you very much. What happened with the G-7 finance ministers is a step forward, definitely, but it’s a very modest step forward. As you have all been reading, the cash flow saving that results from this is at most about $1.5 billion per year. The aid need in sub-Saharan Africa is in the order of $25 billion per year. Even the headline number of $1.5 billion per year saving exaggerates the real net gain for Africa, perhaps by quite a large amount, actually, for somewhat complicated reasons. What’s happening is that these 18 countries are now being told, ‘you don’t have to repay that debt. The donor governments like the United States and U.K. will do it for you.’ And so the U.S., the U.K. and others are sharing that $1.5 billion annual flow, roughly, to repay to the World Bank and to other creditor institutions, who are the holders of the debt of those 18 countries.
But, there are several details in this. One is that the United States government, at least till now, has said that its share of those payments, which are on the order of $130 to $180 million a year, that’s all we’re talking about here, about 30 to 50 cents per American per year, that that amount is going to come out of the existing aid budget.
So if the U.S. pays that interest, it may cut aid of other kinds. This is extraordinarily worrisome, because it would say, if that’s really the case, it’s just a shell game. A certain kind of relief will be given, but it will be offset by cutting aid of other sorts. We haven’t seen the end of the story, but if that’s the case, it means that there’s no net change in what is being offered to the countries that need our help. There is even concern that when a country that otherwise would pay back to the World Bank, will not pay back, the World Bank will actually lend or give that country a lesser amount in response. This is another point that needs to be clarified. But I think the answer is unambiguous. This is a small step in the right direction, but it may even be smaller than the small amount that it looks like on paper, depending on how the deal is actually financed.
Now you asked a very important and interesting second question, which is, to the extent that we’re getting movement at all, what is the role of the faith-based community? I think it’s quite large. I’ve worked on these debt issues for 20 years, saying that these debts are unpayable. I have constantly been told, ‘oh no, they’re payable,’ only to see another part cancelled and another part cancelled. And twenty years ago this was all understandable, but it wasn’t understood. And by the way, when I was on the Meltzer commission in 2000, we voted unanimously, [that] the International Monetary Fund, the World Bank and the regional development banks should write off, in their entirety, all claims against heavily-indebted poor countries. We already had this five years ago; it took so long to do the obvious. And that is why it is fine, but what a lot of effort to accomplish so little when we have so much to accomplish.
Now on the faith groups, the Jubilee 2000 was definitely propelled and championed by faith groups. The turn to increased effort to provide anti-retroviral medicines has been championed by faith groups in this country. I know that an increasing number of faith-based groups are taking an interest, for the first time – but still, it’s great – in controlling malaria, which is a tremendous blight, a massive child killer that we could so easily control if the United States would simply step up to it, which it hasn’t yet. So I think the fact that it is a deep religious value to feed the hungry and help the poorest of the poor, to help the least among you, it is one of the powerful sources of movement in this country. But the biggest problem, in my view, is that people do not understand how little we’re doing compared to what we’ve committed, what’s needed, and what we could so readily afford. It’s those three criteria: what have we promised, what is actually needed, what can we afford, where there is massive confusion. Roughly a 30-fold overestimate by Americans of what we are actually doing. Unfortunately the White House and other political leaders not clarifying this at all, rather say how generous we are, rather than explaining the truth of what we should be doing and are not doing right now.
Operator: Thank you. Your next question comes from Penelope Purdy with the Denver Post.
Penelope Purdy: Dr. Sachs, we had talked a little bit about the 18 countries, the poorest countries involved in this debt cancellation. Of those, 3 are in this hemisphere. We have talked heavily about Africa, but given our region’s connections to the Latin Americas, I am very interested in what you can tell me about what’s going on in Latin America, and why are places like Nicaragua, Honduras, and Bolivia remain in such economic and political turmoil?
Jeffrey Sachs: Yeah. It is of course, of great pertinence to us. Generally these are societies that are bereft of basic infrastructure, often divided ethnically and racially in internal politics. In the case of Bolivia, notably suffering from a massive geographical problem, which is, as an Andean landlocked country, being in a position of extreme economic isolation, with some of the highest transport costs in the world. Now, because they are in our hemisphere, one might have thought that we would pay more attention to them. And, unfortunately we tend to view countries too often through the optic of our immediate interest rather than through the optic of their long term development as a way to also address our interests. An example of Bolivia is very stark- a country that I know very well. We pushed very hard over the last eight years for coca eradication, and I watched in the late 1990s as the United States insisted on eradication of the coca crop without alternatives being provided. And it was very clear at the time that this would create a social explosion because hundreds of thousands are dependent on farmers that grow coca leaf. And if you just say that this is a military action, and you provide a trickle of so-called alternative development funding, but it’s so tiny that it’s really a de minimus sum compared to what would need to be done, it’s not surprising that you get uprisings, that you get massive political backlash. And this is exactly what’s happened. And I am sorry to say that it is predictable, and it’s been predicted by Bolivia’s own political leaders who warned President Bush, warned the American leadership, without some help and some realism, we’re just going to have turmoil, and that’s, unfortunately, what we have right now.
Operator: OK, and your next question comes from Mark Green.
Mark Green: Hi. Near the end of your remarks you mentioned that you hoped the United States would step up to its commitment from the 2002 consensus, and you said, ‘for the sake of American security’. I wondered if you would talk more about that.
Jeffrey Sachs: Yes, the security experts in the Pentagon, the intelligence agencies and in foreign policy circles are absolutely clear that impoverished and disease-ridden states are those that are also most likely to become failed states. It is the result of that kind of chaos that can put us into a terrible security bind. Let me quote. ‘Poverty doesn’t cause terrorism, being poor doesn’t make you a murderer, most of the plotters of September 11 were raised in comfort, yet persistent poverty and oppression can lead to hopelessness and despair, and when governments fail to meet the most basic needs of their people, these failed states can become havens for terror. Poverty prevents governments from controlling their borders, policing their territory, enforcing their laws. Development provides the resources to build hope and prosperity and security.’
Those are comments of President Bush, March 2002. I think he had it exactly right. If we want to face the security challenges in Africa, which are very real right now, and known to be real, sending military advisors to train armies in the Sahel, in my view, is the wrong approach for hungry, disease-ridden, impoverished countries. If we want to help those countries, we should help them get out of the cycle of massive disease, despair, and extreme hunger. And we could do this through practical development approaches. Unfortunately, we have taken an approach based on the military. We have not followed through on development. We’re pretty good on the development rhetoric, once in a while, but not on real development programs. Those are what are missing, and that is where you have to separate the rhetoric from the ground reality. The ground reality, which I see all the time, is that we do not have development programs in place. I am told repeatedly by our own ambassadors in private, there is nothing we can do; we have no aid budgets. This happens all over Africa, I know it. I see more and more American security officials around. They are concerned about the instability, but they cannot solve the problem. It’s development, people getting enough to eat, children surviving, children in school, societies with hope, that will solve the security challenge for us.
But we have to make investments. Of all our spending right now, other than the AIDS program, which I like and think the president has done a good job on, the emergency food aid, which is not a development program at all. If all the rest comes to $1 billion dollars, roughly, and most of that is American consultant salaries (and what you’re talking about In real investments of the sort that I’ve been discussing: of helping farmers grow more food; providing safe drinking water and sanitation; helping to connect the villages with markets, with telecom, with Internet connectivity; helping children have school meals; helping there to be the war against malaria, which could be won) if all of that comes to a few hundred million dollars, it’s shocking, because what we have effectively done is leave hundreds of millions of impoverished people to die and then we worry about security and then we send military advisors and we wonder why it’s not working. It cannot work this way, until we step up to actual development assistance.
Operator: Your next question comes from Richard Knox with NPR.
Richard Knox: Yes, hi, thanks. You mentioned that you like what the president has been doing on AIDS, and there has been encouraging progress in providing anti-retroviral treatment. It is sort of the spear point of a lot of other issues. I am hearing growing worry, though, about meeting the targets that have been set. A large part of that worry revolves around personnel on the ground to deliver care. I wonder what – you know that’s not something that’s easily and quickly remedied- and I wondered what ideas you may have about that. If I could also ask a second question that maybe too complicated, but I am hearing conflicting things about policies by IMF and World Bank concerning requiring countries to cut back some of their spending in areas like health care in order to offset new aid, in order to avoid inflation and currency devaluation. IMF tells me that that’s not the policy. Other people say that countries think it is. I wondered from your perspective what the reality is.
Jeffrey Sachs: Well, two important questions. First, on health personnel, there actually are, believe it or not, it is amazingly sad but true, there are large numbers of unemployed or underemployed, trained health personnel that are not being hired now because these governments, the local communities, the hospitals, cannot afford to bring them on a payroll. Often a payroll, by the way, where there is a budget ceiling put on in the context of an IMF program. And Kenya is a case in point where there are thousands of unemployed nurses – one of the most profound nursing shortages I have ever seen with my own eyes for years. And I have been saying this to U.S. officials, to European officials, to the IMF, to the World Bank, and it would cost some tens of millions of dollars of donor financing to bring several thousand trained health workers, nurses and doctors, into desperately understaffed hospitals – and it could be done basically overnight. And it’s a matter of donor assistance, exactly what we are talking about. It’s all ready to go and yet the donors have not come through. And we will not be able to achieve targets for anti-retrovirals and for malaria control and others if we don’t have these personnel, all hands mobilized – this is a matter of donor assistance. We are not talking about billions, in that case in Kenya, we’re talking about millions, but it hasn’t been done. The United States has actually helped with some of what needs to be done, perhaps about a tenth of what needs to be done, but we haven’t gotten anywhere close to the minimum practical scale to be able to achieve the kinds of goals that we have set.
Now, the IMF and the World Bank basically don’t block increases in health spending, if donors come forward. But, I don’t believe they also realize the urgency, and they don’t speak up and say in public what they say in private. In private they know that there is a silent tsunami, silent holocaust underway in rural Africa with mass death. They know that there is not enough budgetary support to hire doctors and nurses and to keep proper provisioning of the health system. But, they don’t say in public that the United States and other donor countries should therefore do more to save the millions of lives that could be saved. What they say is to the governments, ‘Well, so sorry you have what you have; now live and in fact die, within your meager means.’
This is the great fallacy of these IMF programs. Not that they stand in the way, so much, of increased spending, but that they watch unblinkingly as millions are dying without saying, country by country, back to the rich governments, ‘Come on now, you could save these lives. And you could save them now. And this is a matter of dollars and cents so help this country.‘ That’s what they say in private, not to the U.S. and to others, that’s what they wring their hands to me. But they don’t say it in public, and they don’t put pressure on the donors to actually come through and save the lives. That is why IMF, World Bank programs often have health systems that have four or five dollars per person per year as the total spending. That is what you get in an impoverished country if you don’t get help. You get a few dollars per person per year in the health sector. Compared with our country with more than $5,000 per person per year. In Africa, it’s a few dollars. It is one of the most shocking facts on our planet, because in effect it is a mass death sentence and the IMF and the World Bank should be standing up country by country and declaring this.
Now, they have stood up last month and said that they need an overall doubling of aid. That’s what was brushed aside by the White House last week. Bush just casually said, no we’re not going to do that, as if millions of lives are not lost as a direct result of such an attitude. But we need that country by country to make absolutely clear that it is pure mythology that there’s nothing that can be done. There is so much that can be done, and can be done quickly with a little bit of financial help, but the kind of help that so far has been refused by the U.S. government.
Operator: Thank you. Your next question comes from Nina Tandon with the Austin American-Statesman.
Nina Tandon: Good afternoon Mr. Sachs.
Jeffrey Sachs: Hi.
Nina Tandon: Could you talk a little bit about past aid programs that have been successful in Africa, and how the U.S. could learn from them to come up with its own effective strategies?
Jeffrey Sachs: Yes, aid works when it is directed towards development, not towards politics, and when it is of measurable inputs and measurable outputs based around proven technology. In other words, when aid is specific, when it’s targeted, when it’s measurable, when it’s properly audited – when it’s really for development, not for Cold War purposes or to reward someone in the war against terror or something else, but actually for development, then aid works. Some examples: the eradication of smallpox, one of the great achievements of humankind. That wasn’t an eradication in the United States, that was an eradication in every country in the world, including the poorest of the poor in Africa; the control of African river blindness; the control of African Guinea worm which President Carter has championed. The control of polio – and it’s close to eradication – which Rotary International has championed; the rise of immunizations among children, which UNICEF in particular championed. All of these have the same characteristic. They are targeted towards specific outcomes, they are measurable, you can quantify them, you can measure how much goes in, how much comes out, you can track them and you can audit them. And they are development goals, they are not just waving one’s hands, they are specific targets.
Now another great goal like this was the Green Revolution itself, which was the spread of high-yield varieties of food crops throughout India and the rest of Asia in 1960s and 1970s. And the hero of that was the Rockefeller Foundation. I raise all of these examples because this is precisely the kind of program that we ought to have in Africa right now. We ought to be controlling malaria through targeted means by the year 2008, insuring that everybody in malaria regions is sleeping under a bed net, that everybody has access to the new generation of effective anti-malarial drugs, that every village has the capacity for local diagnostics and has trained community health workers to control malaria. This is absolutely achievable, but it requires U.S. government leadership together with other countries. We could help to promote a Green Revolution for Africa, which I believe is of fundamental importance for Africa to escape from this seemingly endless cycle of famine, disease and instability. Because we know what it would take to triple Africa’s food yields, which are a third of what other farmers in other parts of the world achieve. It requires improved seed, it requires fertilizer or other soil nutrient inputs, and it requires water management technologies. This is not high cost, but it is beyond the means of the poorest of the poor.
So these are the programs that work. When we put our mind to it, we achieve them. This is what is happening with anti-retrovirals also, although it started too late and it remains under-funded. It’s too small; we should be supporting the Global Fund to Fight AIDS, Tuberculosis and Malaria at a much larger level. But it’s why the president is having some success in that one area, which is the only aid initiative of this administration, the one on HIV/AIDS. Because it’s measurable, monitorable, targeted, and an actual development need. And so it’s working, and we should be doing that in many other areas as a practical approach that’s enabling Africa finally, once and for all, to escape from this seemingly endless cycle of extreme poverty. It could be accomplished if we would stop saying no, and roll up our sleeves and get to doing what we have committed to do.
Operator: Thank you. Your next question comes from Fran Quigley of the Indianapolis Recorder.
Fran Quigley: Hello, Professor Sachs.
Jeffrey Sachs: Hi.
Fran Quigley: You mentioned that the White House policies don’t really exist right now to put us in a position to ramp up to the 0.7 percent commitment. I know you have advised a lot of nations on economic policy, and then you realize this is currently a reflection of domestic concern. What kind of options do you think the Bush administration and Congress have domestically to quickly move up to meet the commitments we have made in the past years?
Jeffrey Sachs: I have been speaking all over the country in recent months, and also on a lot of talk shows, and [had] a lot of chance to sample opinion with Americans. I believe strongly that America is absolutely prepared, in many ways very eager, to help with these real life-saving and life-changing interventions right now. Americans tend to be very surprised to find out how little we do. It’s alarming to many, many Americans. And this is across the political spectrum, it is not a left-right division. It is religious groups, it’s groups across our society, ready to move. And then when Americans hear how practical it would be to control malaria; how practical it would be for Africa to have a Green Revolution; how readily children could have school meals; how readily we could enable impoverished African countries to drop user fees on schools and clinics, they’re ready to support it.
I said – at the White House during the first phase of the Bush administration, I advised on a $3 billion a year program on AIDS, and I remember for the first two years, I was told, well, that’s politically impossible. In the third year, in January 2003, the president announced a $3 billion AIDS program, and it’s turned out to be politically popular, as well as an effective program on the ground. It’s just a shame that it is the only thing the administration has done in this regard, and compared to our commitments and Africa’s needs, it’s a very small step. But it has not been a politically unpopular step, it’s been a politically popular step. So I don’t think that there is a great impasse. I wait to hear from the president. The speech about ending extreme poverty, about America’s lead in that, about our role in the world in fighting malaria, in promoting a Green Revolution and keeping children in school and promoting safe drinking water and using American technology. This is a winner politically. It’s a winner in foreign policy terms. It will increase our security markedly, and in the end it’s going to save, not only millions of lives, it’s going to save money for the United States because it’s going to save a lot of grief from insecurity in the planet and Americans would, I believe, rally to the president if he would lead.
Operator: Thank you. And your next question comes from Sara McGregor with the Embassy Newspaper in Canada.
Sara McGregor: Hi. Canada is one of the few countries that hasn’t yet committed to the timetable of 0.7 [percent], saying, you know, that we – the government can’t afford it. I’m just wondering, you were in Canada recently – what’s your sense if Canada actually doesn’t announce at the G-8 that it is going to commit to the 0.7 percent timetable, do you think there’s going to be a reputational problem or any sort of diplomatic rift because we’re not keeping up our part of the bargain?
Jeffrey Sachs: I think Canada’s friends in the world are utterly perplexed at Canada’s inaction right now. We find it completely inexplicable. First the 0.7 percent goal came from Lester Pearson, no less, in 1969. Paul Martin is in many ways a political protégé of that era and of Lester Pearson, and we know that he’s an internationalist as well. I also know that in Parliament there’s extremely strong support, all-party support, for 0.7 [percent]. Canada has the budgetary means to announce the timetable to 0.7 [percent]. So I have to say that we are dismayed and perplexed by the inaction, but I’m believing that Prime Minister Martin is going to come, through because I think that it would be one of the great disappointments for Canada and for himself to look back and to have missed this historic opportunity. Canada seeks to lead in the so-called L20, or G20. It seeks to have its voice heard in the world, but if it’s ducking its most basic issue for absolutely no understandable reason (because this could be accommodated financially, and after all, your own finance minister signed up to this recommendation as part of the Africa Commission) I believe that this will be a blight on Canada’s politics for a long time to come, so much so that I’m looking forward to Canada making the announcement about 0.7 [percent] before the summit.
Operator: Thank you. Your last question comes from Nancy Alexander with Citizens’ Network [on Essential Services].
Nancy Alexander: Thank you. In 2002, at the World Bank – at the U.S.’ leading, the World Bank adopted a private sector development strategy that makes it the purpose of the World Bank Group, which leads most of the other donors and creditors, to privatize health care, water, and education, and this has really caused havoc so that people are out in the streets of all these countries that we would like to help, demonstrating against the aid programs that are tied to their privatizing assets. Whether it’s in Malawi where the National Seed Agency is being sold to Monsanto, or in Ghana where the donors and creditors withdrew their money for water until Ghana agreed to privatize its water and the IMF set the rates. Or in Ethiopia where right now, farmers are really suffering because subsidies or inputs are being withdrawn and no private sector response is expected, just as it didn’t come about in Tanzania. So in terms of privatizing these basic services and the actions on the street, how do you square going ahead and doubling aid?
Jeffrey Sachs: Oh, I think that public health is a public issue. Malaria is not going to be controlled by the private sector; it’s going to be controlled as a public health intervention. It’s going to be controlled through a free, mass distribution of bed nets, just as we ensure a mass access to vaccines. And many of the other areas: children’s education, school meals, basic infrastructure, absolutely depend on government provision of basic services and an assurance of universal access to life – vital life needs. So what happens every time there is a call to privatize water without explaining to the poorest of the poor how they’re going to be able to survive, you do get great instability. The idea that health could be achieved with the access of the poorest of the poor through a market basis is absolutely bizarre when that view is actually held. I know of no African governments that believe it. They want to ensure universal access of the poorest of the poor.
Now in the United States, in control of malaria for example, we’ve had a failed policy for many years of trying to sell bed nets to people that have no money, and it’s been, in my view, a disastrously wrongheaded policy. During this whole time, the malaria burden has gone up, not gone down. Millions of children are dying on this administration’s watch for absolutely tragically inappropriate reasons of our neglect and our misguided policies of trying to sell things to people that have absolutely no money, and I think we have to get this right. Now, most of the world agrees that for the most basic needs, these cannot be sold to people that have no resources or the result is massive debt and I think that this is the right position. We need to continue to insist on it. Ironically we end up wasting the aid that we could otherwise provide in the case of malaria because we try to sell the nets. Then people don’t buy them. Then instead of spending our aid on getting nets to people, we actually spend our aid on advertising bed nets, and this is what was described as in the New York Times and Congressional hearings last week. It’s a shocking mistake and so when these basic needs are addressed, they have to be addressed in the recognition that people that have nothing, that are dying of their poverty, need help. They cannot find their way through market purchases. They’re just being left to die if we pretend that they can.
Nancy Alexander: Thank you.
Operator: At this point there are no further questions.
Jeffrey Sachs: I wonder if I could add one thing, I don’t know if anyone else is on the line but I think it’s interesting and important that not a single question came up about the Millennium Challenge Corporation. This was to be the administration’s big initiative. It was announced in March 2002 at the time of the Monterrey Summit. It was supposed to disperse $10 billion over the following three years. I don’t know whether it’s dispersed a penny yet, but I know that the one program in the first four years of the existence will be a program for Madagascar where the first-year disbursements are budgeted at $27 million. So this was a program that was announced in March 2002 and we have essentially done nothing, and this I think shows how urgent it is for the United States to do more than just talk and to do more than just wave away the entreaties of the world for the U.S. to live up to its commitments. This demonstrates the U.S. has an urgent role to play that it has not yet played.
Joanne Carter: Thanks. Thanks very much, Jeff, and just to let folks know that we have available from Jeff a brief analysis on U.S. foreign investment in Africa and also some background information on the needs of the Global Fund that we put together on opportunities for eliminating school fees, and school meals and access for other economic opportunity, so if anyone is interested in that, they will be posted to our website at results.org, and a transcript of this call should be available within about 24 hours, again from our office or, as soon as it is ready it will be posted on our website. And I believe there’s going to be, you will be able hear an audio version on the Earth Institute website.
Thanks very much everyone for joining us and thanks Jeff as well for your time.
Jeffrey Sachs: Thank you very much.
Joanne Carter: OK. It’s really important, thank you all. Bye.
Operator: Thank you.
☞ Three thoughts:
- ‘There but for the grace of God go I.’
- ‘No man is an island. Ask not for whom the bell tolls; it tolls for thee.’
- What if the people of Africa were white?
Tomorrow (or soon): Barack Obama’s Commencement Speech
Quote of the Day
Doctors bury their mistakes. Brokers just take a second commission.~Unknown
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