JEFFREY SACHS *
was published in Project Syndicate,
an international not-for-profit association of 327 newspapers in 132
countries dedicated to hosting a global debate on the key issues shaping
In his exclusive Project Syndicate commentaries Jeffrey
Sachs - legendary adviser to the governments of Poland, Russia, and
other countries on three continents, as well as a leading critic of
today's international economic architecture - monitors and makes
comprehensible the social forces behind economic growth around the
expectancy in the world's high-income countries is now 78 years, while
it is only 51 years in the least-developed countries, and as low as 40
years in some AIDS-ridden African countries. For every 1,000 children
born in rich countries, seven die before their fifth birthday; for every
1,000 births in the poorest countries, 155 children die before their
These deaths are not only human tragedies, but also
calamities for economic development, systematically reducing economic
growth and helping to keep the poorest countries trapped in poverty. But
a growing number of programs around the world are proving that the death
and illness of the poor can be reduced sharply and rapidly with targeted
investments in public health programs.
Big victories in recent years have come through the
Global Fund to Fight AIDS, Tuberculosis, and Malaria. The Fund,
established six years ago, has provided financing to more than 130
countries to scale up their programs against these three killer
diseases. Since then, Global Fund programs have helped roughly one
million Africans to receive anti-retroviral medicines to treat AIDS,
financed the distribution of around 30 million bed nets to combat
malaria, and supported treatment of around two million people with TB.
Malaria can be brought under decisive control
through bed nets, indoor spraying of insecticides, and making medicines
freely available to poor people in malaria-prone villages. In just two
days last year, Kenya's government distributed more than two million bed
nets. Similar mass distribution programs have been implemented in
Ethiopia, Rwanda, Togo, Niger, Ghana, and other places. The results are
amazing. The poor use the bed nets effectively, and the burden of
malaria comes down rapidly.
Likewise, a campaign led by Rotary International
and several partners has nearly eradicated polio. The number of cases
worldwide each year is now in the hundreds, compared to many tens of
thousands when the campaign began. Success is being achieved in even the
most remote and difficult places, such as the poverty-stricken states of
Indeed, India is doing much more with its
remarkable National Rural Health Mission (NRHM), which is the single
largest mobilization of public health measures in the world. An
astounding half-million young women have recently been hired as health
workers to link impoverished households and public clinics and
hospitals, which are being improved, and to increase women's access to
emergency obstetrical care in order to avoid tragic and unnecessary
deaths in childbirth.
Another remarkable success in India is the safe
home-care of newborn infants in the first few days of life. Currently,
an alarming number of newborns die because of infection, mothers'
failure to breastfeed during the first days, or other preventable
By training community health workers, the NRHM has
achieved a marked reduction in newborn deaths in Indian villages. All
these programs refute three widely held myths.
The first is that the burden of disease among the
poor is somehow inevitable and unavoidable, as if the poor are bound to
get sick and die prematurely. In fact, the poor die of known and
identifiable causes that are largely preventable and treatable at very
low cost. There is no excuse for millions of deaths from malaria, AIDS,
TB, polio, measles, diarrhea, or respiratory infections, or for so many
women and infants to die in or after childbirth.
The second myth is that aid from rich countries is
inevitably wasted. This fallacy is repeated so often by ignorant leaders
in rich countries that it has become a major barrier to progress.
The rich like to blame the poor, partly because it
lets them off the hook, and partly because it gives them a feeling of
moral superiority. But poor countries are capable of establishing
effective public health programs rapidly when they are helped. Recent
success stories have been made possible through a combination of
increased spending from poor countries' budgets, supplemented by aid
from rich-country donors.
The third myth is that saving the poor will worsen
the population explosion. But households in the least-developed
countries have many children - an average of five per woman - partly
because fear of high childhood death rates leads them to overcompensate
with large families. When childhood death rates come down, fertility
rates tend to decline even more, since families are now confident that
their children will survive. The result is slower population growth.
It is time to make good on a basic global
commitment - that everybody, poor and rich alike - should have access to
basic health services.
If just 0.1% of rich-world income were devoted to
life-saving health care for the poor, it would be possible to raise life
expectancy, decrease child mortality, save mothers in childbirth, slow
population growth, and spur economic development throughout the poor
The success stories in public health for the poor
are multiplying. Given the low cost and the huge benefits of supporting
such efforts, there is no excuse for inaction.
Jeffrey Sachs is Professor of
Economics and Director of the Earth Institute at Columbia University.Professor of Economics and Director of the Earth
Institute at Columbia University. He is also a Special Adviser to
United Nations Secretary-General on the Millennium Development Goals.