Imagine for a moment that you're a government minister in a poor or fairly poor country. You've got a limited budget and you've also got a lot of work to do -- children are undernourished, you need to increase the numbers of them that go to school, and maternal mortality is leaving behind ranks of young orphans. Let's also say that, like most countries in the world, yours is a bit unequal. So here's the question: If you want to cut poverty rates, who should you target? The lower middle class -- the "low-hanging fruit" that doesn't have far to go? Or the most destitute of the population?
For years, the answer has been the former. It seems logical: If you can only spend so much, why not help the category that is closest to overcoming poverty? Surely, the most destitute have too far to go to benefit from the limited aid available. This is the approach that countries such as Nigeria, Ghana, Pakistan, and Vietnam have taken in recent years. And they have made some progress.
But you'd be wrong, according to a new study released today by UNICEF. Based on rigorous data tests from 15 countries, the researchers found that the best way to reduce poverty is to start at the bottom, not in the middle. And the difference is a lot. For every $1 million spent on anti-poverty measures, you would "avert 60 percent more deaths" if you help the poorest first, according to the study. The reason for this is simple: if you're destitute, and you recieve a bit of aid, say a cash transfer of $100 a month, that will boost your income by a massively larger percentage than if you are middle-income. Put in another context, if you are a women with no access to healthcare during childbirth, a trained midwife will mean much more to you than it would to a woman with basic care already.
This isn't wonky. It's big -- really big -- not least because it is something of a rethink of the way that governments, including the United States, have been doing development. One of the biggest focuses of the Obama administration's $63 billion Global Health Initiative, for example, is to build up health "systems" -- training healthcare workers, improving facilities, etc. This study says, that kind of thing is great -- but it's also not the most efficient solution. Health systems are usually not accessible to the poorest of the poor because of cultural barriers, poor transportation, or a pure and simple lack of information. Healthcare has to come directly to the communities.
This is, by the way, useful for another another global problem that has arisen in recent years: massive inequality. The world has lifted millions out of poverty (thanks to China and India mostly, but they weren't alone.) But those who remained poor have gotten poorer, and those who were rich have gotten richer. How great would it be if the way to tackle absolute poverty (the numbers of poor) and relative poverty (the inequality factor) was actually the same? Pretty great. As UNICEF Exectuive Director Anthony Lake put it today, "We have an extraordinary opportunity to do not only the right thing but the most practical thing."
Now, to convince the politicians...
Editors note: I am in New York this week on a generous fellowship from the United Nations Foundation, covering the lead-up to the Millennium Development Goals Summit at the U.N. General Assembly starting on Sept. 20.