On the Ground: Steve Radelet

Steve Radelet is a development expert who has lived for many years in Africa and Asia, taught at Harvard, and worked at the US Treasury. He is currently a Senior Fellow at the Center for Global Development in Washington and economic advisor for President Ellen Johnson Sirleaf of
Liberia.

Unicef announced this week that the world reached a remarkable milestone in 2006: for the first time since records have been kept, the number of deaths of children under five years old has fallen below 10 million a year, less than half of the 20 million that died in 1960. The percentage of young children dying has fallen even more dramatically, from about 184 per thousand in 1960 to about 72 per thousand today. That means that out of every 1,000 children around the world, an additional 112 who would have died in 1960 are now living beyond age five.

This terrific news is the latest indicator of the dramatic fall in world poverty over the past few decades. While the percentage of people in the world living with incomes less than $1/day has fallen steadily for several hundred years, world population has grown faster; so the absolute number of people in poverty continued to rise – until it reached around 1.4 billion in 1980. Then one of the most important changes in world history occurred: for the first time ever, the number of people living in absolute poverty started to fall. Actually it started to fall in the 1960s, then it spiked up again during the commodity price shocks of the 1970s, before falling permanently in the 1980s. Since then it has fallen very rapidly to less than 1 billion today.

That’s right: after rising steadily since the beginning of time, the number of people in the world living in absolute poverty has fallen by nearly one-third in less than three decades. Amazing.

Of course, much (but not all) of the reduction in poverty is centered in Asia. But one of the most remarkable things about the fall in child mortality rates reported by Unicef is the fact that it occurred in every region of the world. Even in sub-Saharan Africa, under-five mortality has fallen from 277 per thousand in 1960 to 160 per thousand today.

What is behind this dramatic fall? According to Unicef, “much of the progress is the result of the widespread adoption of basic health interventions, such as early and exclusive breast feeding, measles immunization, Vitamin A supplementation and the use of insecticide-treated bed nets to prevent malaria.” At least three forces are at work here:

– First, developments in science and technology have helped save millions of lives, including more effective vaccines, new medicines and simple solutions like oral rehydration therapy to fight diarrhea. Immunizations, for example, save up to 3 million lives every year.

– Second, low-income countries have developed greater capacity to prevent and treat disease because of higher incomes (in some countries), larger public health budgets, more trained health workers and greater technical expertise. There is still a long way to go, as Josh Ruxin pointed out in an earlier posting, but clear progress has been made over the years, often very slowly but surely.

– Third, foreign aid programs have been very successful both in supporting the development of new technologies and their dissemination around the world. It is quite fashionable to criticize foreign aid as a failure, and there is no doubt that some aid has been wasted and that aid programs can be strengthened considerably. And money alone won’t solve all the problems. But most of the strongest critics get it wrong because they insist on looking at only part of the evidence. There is little doubt that foreign assistance programs have helped saved millions of lives over the last several decades by supporting routine immunization and neonatal health programs, helping to eradicate small pox, nearly eradicating polio and strengthening the fight against river blindness, guinea worm, diarrheal diseases, HIV/AIDS and other deadly diseases.

As welcome is the news that child deaths are now less than 10 million per year, there is still a long way to go. Passing this milestone shows both the promise and the challenge ahead. With a renewed commitment to developing even better technologies to prevent and treat illness, strengthening capacities in low-income countries and providing larger amounts of more effective foreign assistance, there is hope of saving millions of more lives in the years ahead.