Jeffrey D Sachs. Time. New York: Mar 14, 2005.Vol.165, Iss. 11;  pg.
42, 11 pgs

IT IS STILL MIDMORNING IN MALAWI WHEN WE arrive at a small village,
Nthandire, about an hour outside of Lilongwe, the capital. We have
come over dirt roads, passing women and children walking barefoot
with water jugs, wood for fuel, and other bundles. The midmorning
temperature is sweltering. In this subsistence maize-growing region
of a poor, landlocked country in southern Africa, families cling to
life on an unforgiving terrain. This year has been a lot more
difficult than usual because the rains have failed. The crops are
withering in the fields that we pass.

If the village were filled with able-bodied men, who could have built
rainwater-collecting units on rooftops and in the fields, the
situation would not be so dire. But as we arrive in the village, we
see no able-bodied young men at all. In fact, older women and dozens
of children greet us, but there is not a young man or woman in sight.
Where, we ask, are the workers? Out in the fields? The aid worker who
has led us to the village shakes his head sadly and says no. Nearly
all are dead. The village has been devastated by AIDS.

The presence of death in Nthandire has been overwhelming in recent
years. The grandmothers whom we meet are guardians for their orphaned
grandchildren. The margin of survival is extraordinarily narrow;
sometimes it closes entirely. One woman we meet in front of her mud
hut has 15 orphaned grandchildren. Her small farm plot, a little more
than an acre in all, would be too small to feed her family even if
the rains had been plentiful. The soil nutrients have been depleted
so significantly in this part of Malawi that crop yields reach only
about a half-ton per acre, about one-third of normal. This year,
because of the drought, she will get almost nothing. She reaches into
her apron and pulls out a handful of semi-rotten, bug-infested
millet, which will be the basis for the gruel she will prepare for
the meal that evening. It will be the one meal the children have that

I ask her about the health of the children. She points to a child of
about 4 and says that the girl contracted malaria the week before.
The woman had carried her grandchild on her back for the six miles to
the local hospital. When they got there, there was no quinine, the
antimalarial medicine, available that day. With the child in high
fever, the two were sent home and told to return the next day. In a
small miracle, when they returned after another six-mile trek, the
quinine had come in, and the child responded to treatment and
survived. It was a close call though. More than 1 million African
children, and perhaps as many as 3 million, succumb to malaria each

As we proceed through the village, I stoop down to ask one of the
young girls her name and age. She looks about 7 or 8 but is actually
12, stunted from years of undernutrition. When I ask her what her
dreams are for her own life, she says that she wants to be a teacher
and that she is prepared to study and work hard to achieve that. I
know that her chances of surviving to go on to secondary school and a
teachers college are slim under the circumstances.

The plight of Malawi has been rightly described by Carol Bellamy,
head of UNICEF, as the perfect storm of human deprivation, one that
brings together climatic disaster, impoverishment, the AIDS pandemic
and the long-standing burdens of malaria, schistosomiasis and other
diseases. In the face of this horrific maelstrom, the world community
has so far displayed a fair bit of hand-wringing and even some high-
minded rhetoric, but precious little action. It is no good to lecture
the dying that they should have done better with their lot in life.
Rather it is our task to help them onto the ladder of development, to
give them at least a foothold on the bottom rung, from which they can
then proceed to climb on their own.

This is a story about ending poverty in our time. It is not a
forecast. I am not predicting what will happen, only explaining what
can happen. Currently, more than 8 million people around the world
die each year because they are too poor to stay alive. Every morning
our newspapers could report, "More than 20,000 people perished
yesterday of extreme poverty." How? The poor die in hospital wards
that lack drugs, in villages that lack antimalarial bed nets, in
houses that lack safe drinking water. They die namelessly, without
public comment. Sadly, such stories rarely get written.

Since Sept. 11, 2001, the U.S. has launched a war on terrorism, but
it has neglected the deeper causes of global instability. The nearly
$500 billion that the U.S. will spend this year on the military will
never buy lasting peace if the U.S. continues to spend only one-
thirtieth of that, around $16 billion, to address the plight of the
poorest of the poor, whose societies are destabilized by extreme
poverty. The $16 billion represents 0.15% of U.S. income, just 15¢
every $100 of our national income. The share devoted to helping the
poor has declined for decades and is a tiny fraction of what the U.S.
has repeatedly promised, and failed, to give.

Yet our generation, in the U.S. and abroad, can choose to end extreme
poverty by the year 2025. To do it, we need to adopt a new method,
which I call "clinical economics," to underscore the similarities
between good development economics and good clinical medicine. In the
past quarter-century, the development economics imposed by rich
countries on the poorest countries has been too much like medicine in
the 18th century, when doctors used leeches to draw blood from their
patients, often killing them in the process. Development economics
needs an overhaul in order to be much more like modern medicine, a
profession of rigor, insight and practicality. The sources of poverty
are multidimensional. So are the solutions. In my view, clean water,
productive soils and a functioning health-care system are just as
relevant to development as foreign exchange rates. The task of ending
extreme poverty is a collective one-for you as well as for me. The
end of poverty will require a global network of cooperation among
people who have never met and who do not necessarily trust one

One part of the puzzle is relatively easy. Most people in the world,
with a little bit of prodding, would accept the fact that schools,
clinics, roads, electricity, ports, soil nutrients, clean water and
sanitation are the basic necessities not only for a life of dignity
and health but also to make an economy work. They would also accept
the fact that the poor may need help to meet their basic needs. But
they might be skeptical that the world could pull off any effective
way to give that help. If the poor are poor because they are lazy or
their governments are corrupt, how could global cooperation help?

Fortunately, these common beliefs are misconceptions-only a small
part of the explanation of why the poor are poor. In all corners of
the world, the poor face structural challenges that keep them from
getting even their first foot on the ladder of development. Most
societies with the right ingredients-good harbors, close contacts
with the rich world, favorable climates, adequate energy sources and
freedom from epidemic disease-have escaped extreme poverty. The
world's remaining challenge is not mainly to overcome laziness and
corruption, but rather to take on the solvable problems of geographic
isolation, disease and natural hazards, and to do so with new
arrangements of political responsibility that can get the job done.
We need plans, systems, mutual accountability and financing
mechanisms. But even before we have all of that apparatus in place-
what I call the economic plumbing-we must first understand more
concretely what such a strategy means to the people who can be helped.

of definition, there are three degrees of poverty: extreme (or
absolute) poverty, moderate poverty and relative poverty. Extreme
poverty, defined by the World Bank as getting by on an income of less
than $1 a day, means that households cannot meet basic needs for
survival. They are chronically hungry, unable to get health care,
lack safe drinking water and sanitation, cannot afford education for
their children and perhaps lack rudimentary shelter-a roof to keep
rain out of the hut-and basic articles of clothing, like shoes. We
can describe extreme poverty as "the poverty that kills." Unlike
moderate or relative poverty, extreme poverty now exists only in
developing countries. Moderate poverty, defined as living on $1 to $2
a day, refers to conditions in which basic needs are met, but just
barely. Being in relative poverty, defined by a household income
level below a given proportion of the national average, means lacking
things that the middle class now takes for granted.

The total number of people living in extreme poverty, the World Bank
estimates, is 1.1 billion, down from 1.5 billion in 1981. While that
is progress, much of the one-sixth of humanity in extreme poverty
suffers the ravages of AIDS, drought, isolation and civil wars, and
is thereby trapped in a vicious cycle of deprivation and death.
Moreover, while the economic boom in East Asia has helped reduce the
proportion of the extreme poor in that region from 58% in 1981 to 15%
in 2001, and in South Asia from 52% to 31%, the situation is deeply
entrenched in Africa, where almost half of the continent's population
lives in extreme poverty-a proportion that has actually grown worse
over the past two decades as the rest of the world has grown more

A few centuries ago, vast divides in wealth and poverty around the
world did not exist. Just about everybody was poor, with the
exception of a very small minority of rulers and large landowners.
Life was as difficult in much of Europe as it was in India or China.
Your great-great-grandparents were, with very few exceptions, poor
and living on a farm. The onset of the Industrial Revolution,
supported by a rise in agricultural productivity, unleashed an
explosive period of modern economic growth. Both population and per-
capita income came unstuck, rising at rates never before imagined.
The global population rose more than sixfold in just two centuries,
while the world's average per-capita income rose even faster,
increasing around ninefold between 1820 and 2000. In today's rich
countries, the economic growth was even more astounding. The U.S. per-
capita income increased almost 25-fold during this period. In
beholding that success, many people embrace faulty social theories of
those differences. When a society is economically dominant, it is
easy for its members to assume that such dominance reflects a deeper
superiority-whether religious, racial, genetic, ethnic, cultural or
institutional-rather than an accident of timing or geography.

Such theories justified brutal forms of exploitation of the poor
during colonial rule, and they persist even today among those who
lack an understanding of what happened and is still happening in the
Third World. In fact, the failure of the Third World to grow as
rapidly as the First World is the result of a complex mix of factors,
some geographical, some historical and some political. Imperial rule
often left the conquered regions bereft of education, health care,
indigenous political leadership and adequate physical infrastructure.
Often, newly independent countries in the post-World War II period
made disastrous political choices, such as socialist economic models
or a drive for self-sufficiency behind inefficient trade barriers.
But perhaps most pertinent today, many regions that got left furthest
behind have faced special obstacles and hardships: diseases such as
malaria, drought-prone climates in locations not suitable for
irrigation, extreme isolation in mountains and landlocked regions, an
absence of energy resources such as coal, gas and oil, and other
liabilities that have kept these areas outside of the mainstream of
global economic growth. Countries ranging from Bolivia to Malawi to
Afghanistan face challenges almost unknown in the rich world,
challenges that are at first harrowing to contemplate, but on second
thought encouraging in the sense that they also lend themselves to
practical solutions.

IN THE PAST QUARTER-CENTURY, when poor countries have pleaded with
the rich world for help, they have been sent to the world money
doctor, the International Monetary Fund. For a quarter-century, and
changing only very recently, the main IMF prescription has been
budgetary belt-tightening for patients much too poor to own belts.
IMF-led austerity has frequently resulted in riots, coups and the
collapse of public services. Finally, however, that approach is
beginning to change.

It has taken me 20 years to understand what good development
economics should be, and I am still learning. In my role as director
of the U.N. Millennium Project, which has the goal of helping to cut
the world's extreme poverty in half by 2015, I spent several eye-
opening days with colleagues last July in a group of eight Kenyan
villages known as the Sauri sublocation in the Siaya district of
Nyanza province. We visited farms, clinics, hospitals and schools. We
found a region beset by hunger, AIDS and malaria. The situation is
grim, but salvageable.

More than 200 members of the community came to meet with us one
afternoon. Hungry, thin and ill, they stayed for 3 ½ hours,
with dignity, eloquence and clarity about their predicament. They are
impoverished, but they are capable and resourceful. Though struggling
to survive, they are not dispirited but are determined to improve
their situation. They know well how they could get back to high

The meeting took place on the grounds of a school called the Bar
Sauri Primary School, where headmistress Anne Marcelline Omolo
shepherds hundreds of schoolchildren through primary education and
the travails of daily life. Despite disease, orphanhood and hunger,
all 33 of last year's eighth-grade class passed the Kenyan national
secondary-school exams. On a Sunday last July, we saw why. On
their "day off" from school, this year's class of eighth-graders sat
at their desks from 6:30 a.m. until 6 p.m.. preparing months in
advance for this year's national examinations in November.
Unfortunately, many who will pass the exams will be unable to take a
position in a secondary school because of lack of money for tuition,
uniforms and supplies. Nonetheless, to boost the fortitude of the
eighth-graders during the critical examination year, the community
provides them with a midday meal, cooked with wood and water the
students bring from home. Alas, the community is currently unable to
provide midday meals for the younger children, who must fend for

When our village meeting got under way, I canvassed the group and got
very perceptive accounts of the grim situation. Only two of the 200
farmers at the meeting reported using fertilizer at present. Around
25% are using improved fallows with nitrogen-fixing trees, a
scientific farming approach developed and introduced into Sauri by
the World Agroforestry Center. With this novel technique, villagers
grow trees that naturally return nitrogen to the soil by converting
it from the atmosphere, thus dramatically improving yields. The new
method could be used throughout the village if more money were
available for planting the trees alongside their maize crops.

The rest of the community is farming on tiny plots, sometimes no more
than one-quarter of an acre, with soils that are so depleted of
nutrients and organic matter that even if the rains are good, the
households still go hungry. If the rains fail, the households face
the risk of death from severe undernutrition. Stunting, meaning low
height for one's age, is widespread, a sign of pervasive and chronic
undernutrition of the children.

The real shocker came with my follow-up question. How many farmers
had used fertilizers in the past? Every hand in the room went up.
Farmer after farmer described how the price of fertilizer was now out
of reach, and how their current impoverishment left them unable to
purchase what they had used in the past.

As the afternoon unfolded, the gravity of the community's predicament
became more apparent. I asked how many households were home to one or
more orphaned children left behind by the AIDS pandemic. Virtually
every hand in the room shot up. I asked how many households were
receiving remittances from family members living in Nairobi and other
cities. The response was that the only things coming back from the
cities were coffins and orphans, not remittances.

I asked how many households had somebody currently suffering from
malaria. Around three-fourths of the hands shot up. How many use
antimalarial bed nets? Two out of 200 hands went up. How many knew
about bed nets? All hands. And how many would like to use bed nets?
All hands remained up. The problem, many of the women explained, is
that they cannot afford the bed nets, which sell for a few dollars
per net, and are too expensive even when partially subsidized by
international donor agencies.

A few years back, Sauri's residents cooked with locally collected
wood, but the decline in the number of trees has left the area bereft
of sufficient fuel. Villagers said that they now buy pieces of fuel
wood in Yala or Muhanda, a bundle of seven sticks costing around
Not only are seven sticks barely enough to cook one meal, but for a
lack of 30¢, many villagers had in fact reverted to cooking with
dung or to eating uncooked meals.

The dying village's isolation is stunning. There are no cars or
trucks owned or used within Sauri, and only a handful of villagers
said they had ridden in any kind of motorized transport during the
past year. Around half of the individuals at the meeting said that
they had never made a phone call in their entire lives.

This village could be rescued, but not by itself. Survival depends on
addressing a series of specific challenges, all of which can be met
with known, proven, reliable and appropriate technologies and
interventions. (Thanks to a grant from the Lenfest Foundation in the
U.S., the Earth Institute at Columbia University will put some novel
ideas to work in Sauri.) Sauri's villages, and impoverished villages
like them all over the world, can be set on a path of development at
a cost that is tiny for the world but too high for the villages
themselves and for the Kenyan government on its own. African safari
guides speak of the Big Five animals to watch for on the savannah.
The world should speak of the Big Five development interventions that
would spell the difference between life and death for the savannah's
people. Sauri's Big Five are:

BOOSTING AGRICULTURE With fertilizers, cover crops, irrigation and
improved seeds, Sauri's farmers could triple their food yields and
quickly end chronic hunger. Grain could be protected in locally made
storage bins using leaves from the improved fallow species tephrosia,
which has insecticide properties.

IMPROVING BASIC HEALTH A village clinic with one doctor and nurse for
the 5,000 residents would provide free anti-malarial bed nets,
effective antimalarial medicines and treatments for HIV/AIDS
opportunistic infections.

INVESTING IN EDUCATION Meals for all the children at the primary
school could improve the health of the kids, the quality of education
and the attendance at school. Expanded vocational training for the
students could teach them the skills of modern farming, computer
literacy, basic infrastructure maintenance and carpentry. The village
is ready and eager to be empowered by increased information and
technical knowledge.

BRINING POWER Electricity could be made available to the villages
either via a power line or an off-grid diesel generator. The
electricity would power lights and perhaps a computer for the school;
pumps for safe well water; power for milling grain, refrigeration and
other needs. The villagers emphasized that the students would like to
study after sunset but cannot do so without electric lighting.

latrines for the safety of the entire village, women and children
would save countless hours of toil each day fetching water. The water
could be provided through a combination of protected springs,
rainwater harvesting and other basic technologies.

The irony is that the cost of these services for Sauri's 5,000
residents would be very low. My Earth Institute colleagues and I
estimated that the combined cost of these improvements, even
including the cost of treatment for AIDS, would total only $70 per
person per year, or around $350,000 for all of Sauri. The benefits
would be astounding. Sooner rather than later, these investments
would repay themselves not only in lives saved, children educated and
communities preserved, but also in direct commercial returns to the
villages and the chance for self-sustaining economic growth.

The international donor community should be thinking round-the-clock
of one question: How can the Big Five interventions be done on a
larger scale in rural areas similar to Sauri? With a population of
some 33 million people, of whom two-thirds are in rural areas, Kenya
would need annual investments on the order of $1.5 billion for its
Sauris, with donors filling most of that financing gap, since the
national government is already stretched beyond its means. Instead,
donor support for investment in rural Kenya is perhaps $100 million,
or a mere one-fifteenth of what is needed. And Kenya's debt service
to the rich world is several hundred million dollars per year.
Kenya's budget is still being drained by the international community,
not bolstered by it. This is all the more remarkable since Kenya is a
new and fragile democracy that should be receiving considerable help.

countries, especially those in Africa. Everything comes back, again
and again, to corruption and misrule. Western officials argue that
Africa simply needs to behave itself better, to allow market forces
to operate without interference by corrupt rulers. Yet the critics of
African governance have it wrong. Politics simply can't explain
Africa's prolonged economic crisis. The claim that Africa's
corruption is the basic source of the problem does not withstand
serious scrutiny. During the past decade I witnessed how relatively
well-governed countries in Africa, such as Ghana, Malawi, Mali and
Senegal, failed to prosper, whereas societies in Asia perceived to
have extensive corruption, such as Bangladesh, Indonesia and
Pakistan, enjoyed rapid economic growth.

What is the explanation? Every situation of extreme poverty around
the world contains some of its own unique causes, which need to be
diagnosed just as a doctor would a patient. For example, Africa is
burdened with malaria like no other part of the world, simply because
it is unlucky in providing the perfect conditions for that disease:
high temperatures, plenty of breeding sites and particular species of
malaria-transmitting mosquitoes that prefer to bite humans rather
than cattle.

Another myth is that the developed world already gives plenty of aid
to the world's poor. Former U.S. Secretary of the Treasury Paul
O'Neill expressed a common frustration when he remarked about aid for
Africa: "We've spent trillions of dollars on these problems and we
have damn near nothing to show for it." O'Neill was no foe of foreign
aid. Indeed, he wanted to fix the system so that more U.S. aid could
be justified. But he was wrong to believe that vast flows of aid to
Africa had been squandered. President Bush said in a press conference
in April 2004 that as "the greatest power on the face of the earth,
we have an obligation to help the spread of freedom. We have an
obligation to feed the hungry." Yet how does the U.S. fulfill its
obligation? U.S. aid to farmers in poor countries to help them grow
more food runs at around $200 million per year, far less than $1 per
person per year for the hundreds of millions of people living in
subsistence farm households.

From the world as a whole, the amount of aid per African per year is
really very small, just $30 per sub-Saharan African in 2002. Of that
modest amount, almost $5 was actually for consultants from the donor
countries, more than $3 was for emergency aid, about $4 went for
servicing Africa's debts and $5 was for debt-relief operations. The
rest, about $12, went to Africa. Since the "money down the drain"
argument is heard most frequently in the U.S., it's worth looking at
the same calculations for U.S. aid alone. In 2002, the U.S. gave $3
per sub-Saharan African. Taking out the parts for U.S. consultants
and technical cooperation, food and other emergency aid,
administrative costs and debt relief, the aid per African came to the
grand total of perhaps 6¢.

The U.S. has promised repeatedly over the decades, as a signatory to
global agreements like the Monterrey Consensus of 2002, to give a
much larger proportion of its annual output, specifically up to 0.7%
of GNP, to official development assistance. The U.S.'s failure to
follow through has no political fallout domestically, of course,
because not one in a million U.S. citizens even knows of statements
like the Monterrey Consensus. But we should not underestimate the
salience that it has abroad. Spin as we might in the U.S. about our
generosity, the poor countries are fully aware of what we are not

THE COSTS OF ACTION ARE a tiny fraction of the costs of inaction. And
yet we must carry out these tasks in a context of global inertia,
proclivities to war and prejudice, and understandable skepticism
around the world that this time can be different from the past. Here
are nine steps to the goal:

COMMIT TO THE TASK. Oxfam and many other leaders in civil society
have embraced the goal of Making Poverty History. The world as a
whole needs now to embrace the goal.

ADOPT A PLAN OF ACTION. The U.N.'s Millennium Development Goals,
approved by all of the world's governments at the start of the
millennium, are the down payment on ending poverty. The MDGS set out
specific targets for cutting poverty, hunger, disease and
environmental degradation by 2015 and thereby laid the foundation for
eliminating extreme poverty by 2025. The rich and poor countries have
solemnly agreed to work toward fulfilling the MDGS. The key is to
follow through.

RAISE THE VOICE OF THE POOR. Mahatma Gandhi and Martin Luther King
Jr. did not wait for the rich and powerful to come to their rescue.
They asserted their call to justice and made their stand in the face
of official arrogance and neglect. It is time for the democracies in
the poor world-Brazil, India, Nigeria, Senegal, South Africa and
dozens of others-to join together to issue the call to action.

REDEEM THE U.S. ROLE IN THE WORLD. The richest and most powerful
country, long the leader and inspiration in democratic ideals, is
barely participating in global efforts to end poverty and protect the
environment, thus undermining its own security. It's time to honor
the commitment to give 0.7% of our national income to these crucial

RESCUE THE IMF AND WORLD BANK. They have the experience and technical
sophistication to play an important role. They have the internal
motivation of a highly professional staff. Yet they have been used
like debt-collection agencies for the big creditor countries. It's
time to restore their role in helping all 182 of their member
countries, not just the rich ones, in the pursuit of enlightened

STRENGTHEN THE U.N. It is no use blaming the U.N. for the missteps of
recent years. Why are U.N. agencies less operational than they should
be? Not because of "U.N. bureaucracy," though that exists, but
because the powerful countries fear ceding more authority. Yet U.N.
specialized agencies have a core role to play in the ending of
poverty. It is time to empower the likes of the U.N. Children's Fund
(UNICEF), the World Health Organization (WHO), the Food and
Agricultural Organization (FAO), and many others to do the job-on the
ground, country by country.

HARNESS GLOBAL SCIENCE. New technology has led directly to improved
standards of living, yet science tends to follow market forces as
well as to lead them. It is not surprising that the rich get richer
in a continuing cycle of growth while the poorest are often left
behind. A special effort should be made by the powerhouses of world
science to address the unmet challenges of the poor.

PROMOTE SUSTAINABLE DEVELOPMENT. Ending extreme poverty can relieve
many of the pressures on the environment. When impoverished
households are more productive on their farms, for example, they face
less pressure to cut down neighboring forests in search of new
farmland. Still, even as extreme poverty ends, we must not fuel
prosperity with a lack of concern for industrial pollution and the
unchecked burning of fossil fuels.

MAKE A PERSONAL COMMITMENT. It all comes back to us. Individuals,
working in unison, form and shape societies. The final myth I will
debunk here is that politicians are punished by their constituents
for supporting actions to help the poor. There is plenty of
experience to show that the broad public will accept such measures,
especially if they see that the rich within their own societies are
asked to meet their fair share of the burden. Great social forces are
the mere accumulation of individual actions. Let the future say of
our generation that we sent forth mighty currents of hope, and that
we worked together to heal the world.