Foreign aid brings antibiotics, vaccines and more to the poor
From Prof Jeffrey D Sachs.
Sir, William Easterly's claim (" Western vanities that do little to help the world's poor ", January 25) that foreign aid makes little contribution to the health of the poor is an affront to the field of public health he so blithely criticises. For all of Mr Easterly's vaunted "entrepreneurs, inventors, traders, investors, activists", lifesaving tools such as vaccines, antibiotics, antiretrovirals, bed nets and oral rehydration solutions don't reach the poor without public health. And the poor are especially vulnerable to disease because of unsafe drinking water, smoke-filled homes, malnutrition and disease-transmitting vectors. Public health offers a life-saving rescue.
Mr Easterly argues that economic development rather than public health programmes makes the difference in improving health. He argues this claim by observing that Ghana's infant mortality rate in 2000 was comparable to the US infant mortality rate in 1940. This is a comparison that actually proves the opposite. In 1940, the vaccines, antibiotics, anti-malaria medicines, oral rehydration and much more that save children today (or in 2000) did not yet exist. By 1950, with the advent of antibiotics and other innovations, the US infant mortality rate was already down to 29 per 1,000, less than half of Ghana's in 2000, 64 per 1,000. The life-saving tools simply were not yet reaching the poor in Ghana.
Easterly claims that aid is a "drop in the ocean" of the receiving economies. Wrong again. External donor resources for health exceeded one quarter of total health outlays in more than 20 countries in sub-Saharan Africa in the year 2010. A decade of increased donor assistance after 2000 enabled sub-Saharan Africa to accelerate the rate of decline in children's mortality (under age five). In 1990, the under-five mortality rate was 177 per 1,000 births. This fell slightly to 155 per 1,000 in 2000, and then rapidly to 98 per 1,000 in 2010. The acceleration was dramatically assisted by the spread of malaria control, vaccines, prevention of mother-to-child transmission of Aids and other measures made possible by a large increase in donor assistance for health, against which Mr Easterly had argued at the time.
His claim that philanthropy for public health is the "vanity" of "gilded hands" is unacceptable. Development aid, in combination with other tools of economic development, is combating disease, saving lives, and helping Africa to accelerate disease control, economic growth and the reduction of extreme poverty.
Jeffrey D Sachs,
Quetelet Professor of Sustainable Development and Health Policy and Management,
Columbia University,
New York, NY, US