Getting Better: Why Global Development Is Succeeding—And How We Can Improve the World Even More, published 
this month, is an exercise in ‘framing’ – trying to shift the way we feel, as well as think, about development and aid. It does it rather well. Two big frames:
1. Lives are getting better everywhere, including in Africa. People are healthier, live longer, lose fewer children, learn to read and write, and have more rights. The negative discourse of crisis epitomised by Tony Blair’s disastrous ‘Africa is a scar on the conscience of the world’ soundbite is factually wrong, as well as patronising and counter-productive in making aid seem like a waste of money.
2. The best way to spend aid is on areas where we know it works. That means encouraging the spread of relevant technologies and ideas. Interestingly, Kenny accepts that we don’t know how to create growth and so advises against it being a focal point for aid. Stick to vaccines and education, much of it delivered by the public sector. It’s a seductive message which reminds me of the speech by Mr and Mrs Gates in London last year, which had me sorely tempted to say ‘forget all that politics and power stuff, let’s just get the vaccines out there.’
Sample quote: ‘Abandoning an excess focus on income as a catch-all of development progress might, in the end, be the best way to achieve more rapid growth in the incomes of the poor.’ Not only that but he’s one of those economists who delights in ridiculing the excesses of his profession, from the ‘conga-line of formulae [required before a paper] is worthy of publication in the American Economic Review’ to their abiding belief that worldwide incomes will converge, despite all the evidence to the contrary. Wonder what his colleagues at the World Bank make of him 
downgrading the role of growth? Kenny’s a fellow at CGD, on sabbatical from the Bank – hope his job’s still there when he gets back.
As an unabashed polemic, he goes over the top in places (at one point I thought ‘Dr Pangloss, I presume?’ might be a better title), ignoring or dismissing evidence that runs against his views, and skating over holes in the argument. The biggest sleight of hand is on resource constraints (no mention of water scarcity, for example) and climate change, where he dismisses concerns as just another bit of misguided ‘neo-Malthusianism’. On the contrary, there is a pretty overwhelming scientific consensus that they represent a real game-changer – development is going to have to happen differently, North and South, in a resource-constrained world.
I’m caricaturing a bit here – Kenny stresses that the issue is consumption, not population: ‘A doubling of the incomes of the World’s poorest 650 million people would take the same resources as adding a little under one percent to the incomes of the World’s richest 650 million’. Hence his recipe for population control: ‘Sterilize the world’s billionaires first, then move on to a one-child policy for Switzerland, Luxembourg and the US’. But joking aside, he doesn’t pursue the issue.
[Malthus’ writing style is a revelation by the way – I wish development people wrote this well. Check this out:
‘The vices of mankind are active and able ministers of depopulation. They are the precursors in the great army of destruction; and often finish the dreadful work themselves. But should they fail in this war of extermination, sickly seasons, epidemics, pestilence, and plague, advance in terrific array, and sweep off their thousands and tens of thousands. Should success be still incomplete, gigantic inevitable famine stalks in the rear, and with one mighty blow levels the population with the food of the world.’]
And of course, there’s not much in the way of power and politics, which probably falls into both the ‘too messy and unpredictable’ and ‘too hard to measure’ baskets. That matters when it gets to recommendations for what health ministries and others should/shouldn’t do, as there is no discussion of which they might adopt/reject, and what to do about that.
His writing is good ‘pop economics’ – chatty, humorous and at times elegant, praising ‘the beautiful banality of health, learning and security’. He’s also an ace killer fact merchant and a voracious trawler of research and stats – definitely a gold mine for time-starved development advocates.
In passing, ‘Getting Better’ even provides an excellent run-through of the shifting (and frequently circular) tides of received wisdom on growth and development. The resulting picture reminds me strongly of the complexity literature – growth as an emergent property of a complex, tightly interconnected system, which means that it is essentially impossible to predict when and how it will occur (so similar policies in different countries at different times will have completely different outcomes). Sounds about right. Needless to say, Keynes got there first:
“We are faced at every turn with the problems of organic unity, of discreteness, of discontinuity—the whole is not equal to the sum of the parts, comparisons of quantity fail us, small changes produce large effects, and the assumptions of a uniform and homogeneous continuum are not satisfied.”
That was written in 1933 – does that make JMK the unwitting father of complexity theory? (Although there’s usually an Adam Smith quote to trump him.)
On technologies (broadly defined), he stresses the simple stuff: ‘vaccines, boiling water, civic organization, basic education’, and is damning about internet kiosks and other examples of excessive techno-whizzery. He points out that because of the spread of these, a better quality of life can be achieved at a lower level of economic output than in the past, and growth is not the main story in the improvements that do occur: ‘a country that saw absolutely no income growth over the entire century would still have experienced a near two thirds decline in infant mortality over [the last] hundred years.’
Getting Better distinguishes between process and product technologies: ‘Process technologies—institutions—are central to increasing GDP per capita. But the second set of technologies—ideas and inventions—have played the central role in improving health, education and security in developing countries to date.’ And process technologies are much harder to export and transplant, whereas ideas and simple products flow like water around the globe.
The result is that whereas growth is country specific, improvements in human development are largely accounted for by global ‘tides in the affairs of men’ – ideas and inventions etc. ‘All country-specific factors added together can account for only about one seventh of the average change in infant mortality across 68 countries for which we have data between 1950 and 2000. The other six sevenths of mortality change in these countries can be better accounted for by the global pattern of decline.’ In economist-speak, growth is largely endogenous, whereas human development exogenous.
This is not to say that nothing needs to be done – that influx of exogenous ideas and technologies has been propelled by an increased state role in health and education (of which Kenny approves) and legions of healthworkers and social entrepreneurs.
On health he goes further: the evidence suggests that primary care, health education and the spread of ideas (give babies with diarrhoea more to drink, not less) has far greater impact than building hospitals. Kenny thinks the key is boosting public demand for healthcare and education, not just building stuff. Despite record growth, health in China has deteriorated because the country has moved from ‘a system that once provided near-universal access to basic care to one that now provides limited coverage which extends to expensive, often unnecessary, medical techniques—all at seven times the price.’ Sounds a bit like the US…….
That spread of ideas and inventions can be accelerated by social marketing: ‘social marketing programs have shown strong results over the last thirty years in promoting the use of sugar-salt solutions to treat diarrhea, breastfeeding over bottle feeding and the use of contraceptives. A diarrheal disease control program which focused on social marketing in Egypt in the early 1980s saw the number of targeted mothers which recognized the danger of dehydration rising from 32 percent to 90 percent. In addition, within the first year of the marketing campaign, the number of mothers who used oral rehydration solution correctly increased from 25 to 60 percent.’
Finally, he has some neat ideas for how to speed up that flow of appropriate technologies and ideas that drives improvements in human welfare. Why not take the CGIAR global network of public agricultural research institutes and do the same for child mortality, or innovative forms of social marketing? What about a Global Innovation Bank, which uses advance market commitments, prizes etc (as well as more traditional research funding) to push pro-poor R&D – sounds like an argument for taking the Gates Foundation into (global) public ownership – globalization rather than nationalization?……]]>