The status of global poverty as an international foreign policy priority

Frank Humphreys, Program of African Studies, Northwestern University, First Draft: February 2003

 

Introduction

 

Never before has more been known about international poverty, and never have such resources been available to address it. Yet, the life and death of the majority of the world’s population generates comparatively little sustained media attention or government action. Overseas aid levels have fallen, despite the catastrophic effect of AIDS in developing countries, and warnings of pending famine in Ethiopia. Debt and trade barriers continue to disadvantage poorer countries.

 

Perhaps the single biggest task facing NGOs concerned about suffering and inequality in developing countries is to raise global poverty nearer the top of the policy agenda in the Western world. A second, complementary task is to direct greater international attention to uncontroversial approaches for alleviating the suffering of a great many people, such as investments in health: prevention, treatment, education and research. In this document, the problem of global poverty is discussed briefly. On both the problem, and possible approaches to reduce it, there is considerable agreement. The more fundamental task is to explain the lack of attention and action prompted by these issues and to provide ideas to the NGO community for altering the status quo. This document highlights a number of potential reasons for the priority normally given to poverty in developing countries by Western Governments. Further research is required to identify the most salient factors. This document is both a first step and a call for such research.

 

 

The problem of global poverty

 

The scale of global poverty is not in question. The relative urgency of different problems may cause some debate but it not in dispute that the daily deaths of thousands of men, women and children in developing countries could be prevented.[1] The 2015 international development goals express this optimism and outline a selected number of important targets, such as reducing infant/child and maternal mortality rates by two-thirds or more.[2] (Reasonable people might disagree about the appropriate means to achieve these ends but are unlikely to disagree about the importance of the goals.)

 

What if these targets are not reached? Will it be the fault of bad policy, bad faith or bad luck, perhaps? There is some consensus but considerable debate about the most effective approach to reducing poverty and unnecessary death and suffering. The same applies to the identification of possible causes and culprits.

 

 

The role of the West - why is global poverty a relatively low priority?

 

The West has frequently been labelled as a prime culprit, either due to its legacy of colonialism, the debt burden, trade barriers, its cold war politics and/or support of despots, its arms sales or, more recently (and not always rationally), globalisation. However, though related, there are perhaps more important questions for the West: why, given the enormous resources of the West, is global poverty of such little apparent interest?[3] Why do members of the media not provide more coverage or generate more pressure on their own governments?[4] Why do mainstream parties rarely mention global (or even domestic) poverty in their political campaigns and platforms?[5] One might also ask, why extreme poverty is ignored when doing so contradicts of the professed beliefs of a large proportion of Western Europe and the United States. If the development goals are missed, one reason may be that the West will not have cared enough.

 

There are countless possible interconnected reasons for the low priority of international development policy:

 

Many of these suggested reasons, if accurate, raise yet more questions.[11]

 

The 1998 OECD report, Public Attitudes and International Development Co-operation (Smillie and Helmich, 1998), addressed some of these questions and came to the following conclusions (Smillie, 1998, pp. 21-22):

·        there is no evidence of compassion fatigue in DAC Member countries;

·        there has been some public disenchantment with development (though not compassion fatigue) in some countries, as a result of government mismanagement of aid;

·        some may believe aid does not work because it has not prevented high–profile crises, such as natural disasters, war, and economic meltdown;

·        public support for development assistance is high and has been largely stable for 15 years. In some countries, there is greater support for emergency assistance than for longer term projects.

·        ‘Spending on public information about development and development assistance is almost scandalously low;’

·        It is therefore not surprising that public knowledge is shallow.

The OECD DAC is preparing an updated report for publication in 2003. Other reports and surveys have come to the same conclusion about the level of public awareness.[12] It should be remembered that decision makers are also members of the public and may be equally ill informed for the same reasons.[13] EU surveys have indicated that the public would like to be better informed about issues such as the causes of underdevelopment and initiatives by European countries and the developing countries themselves.[14] A natural course of action would be to redouble efforts to inform the public. However it is not clear to what extent increased information would change attitudes.[15]

 

A focus on public opinion, however, may be misplaced. ODA as a percentage of GNP does not appear to correlate well with the strength of public opinion in favour of development cooperation (DAC/OECD, 1997 in Box and Kruiter, 1997).[16] In particular, the high public support for development cooperation[17] did not prevent considerable declines in aid budgets in the 1990s. This begs an investigation of the agents and factors that do influence the determination of government priorities.[18]

 

According to Frederick Douglass, ‘power never concedes anything without a demand; it never has and it never will’ (Huffington, 2001, p. ix). However, it may not be public opinion that generates sufficient demand. Democracy in the United States is perceived to have undergone a mutation from the populism of the 19th century to ‘one in which only the strongest of organized interests can effectively shape policy decisions’ (Maidment, 1997, pp. 123, 133).[19] Traditional constituencies that advocate for development cooperation, such as unions and churches, may have declined in influence but new and more volatile groups could be emerging (Box and Kruiter, 1997). Even though interest groups may heavily influence them, politicians still believe in the importance of public opinion. At an OCED DAC High Level Meeting (Paris, May 2001), several ministers stressed that ‘awareness of and public support for international development co-operation are crucial.’[20] It should also be borne in mind that politicians themselves are capable of generating support where little existed previously.

 

Despite the low priority it is given, global poverty is not ignored. AIDS in Africa, in particular, has received considerable constructive attention (albeit in comparison to the complete disinterest in malaria[21]). The Bush Administration has set up the Millennium Challenge Account and recently earmarked another $15 billion for global AIDS. Meanwhile, EU development aid is larger still. Both have made significant new commitments to increase overseas aid to poor countries.[22] All western governments have a department for international development. So, like every other policy issue, development is on a list of priorities. The question is why is it not a higher priority (and why not lower). An answer would help those who seek to push international poverty further up the public policy agenda of developed countries. Further research is needed to narrow the long list of reasons above to a kernel of critical factors.

 

The primary stumbling block may be pessimism – by the public, politicians and/or the media – that the situation is hopeless, and that time (or economic growth) may be the only healer. However, it is unlikely that many are aware how much may be achieved with comparatively little investment. It was estimated by the World Bank in 1993 that $40 billion could provide an essential clinical package for all developing countries (World Bank, 1993).[23] That figure would need to be revised upwards today, given the rapidity of the spread of AIDS. More funds are also needed to research malaria and other developing world diseases. Nonetheless, millions could be saved if such an investment were targeted along the lines suggested by the World Bank - including pregnancy-related care (which could prevent hundreds of thousands of maternal deaths per year[24]), care for common childhood illnesses and treatment of adult tuberculosis (illnesses which cause 7 million[25] and 2 million deaths[26] per year respectively). Arguments about aid begetting dependence do not apply here.

 

Another problem may be that people have difficulty with large numbers (as has been reported elsewhere[27]). It did not seem as if it would have mattered much to the media commentary at the time whether or not the size of the Bush Administration’s tax cuts were in billions or trillions. The sum of $1.35 trillion – which was estimated as the size of the 10-year US tax cuts signed into law on June 7, 2001[28] – is equivalent to more than 13 times the total annual income of the poorest fifth of the world’s population.[29] Alternatively, by one estimate, it could provide immunization from six leading child-killing diseases for 10,000 children a day (the number that die daily from those diseases) for 700,000 years.[30] Numbers are impersonal, however. People (and/or the media) are less moved by raw figures, than by images or individual stories of hardship (such as that of the Cuban child, Elián González).[31], [32]

 

A deeper problem may be that the dominant focus on markets, efficiency and growth has not been matched by an equal interest on the problems that economic growth may not solve quickly, especially if (as so often) it fails to materialise. Health and education, for example, may be sidelined as either part of the debate on the determinants of growth or as expected outcomes of growth.[33] The common emphasis on market solutions diverts attention from these areas,[34] hence obvious measures, such as mass immunizations, can be grossly neglected. Although economic growth is of undisputed importance and can bring about vast reductions in poverty, the focus on growth as an apparent end, rather than a means, may dull the reaction one might otherwise expect to hundreds of millions of poverty-related deaths.[35] There is a shortage of vision, of the blunt rhetoric with which former U.S. Secretary of State, George C. Marshall ended his presentation of the Marshall Plan: ‘What are the sufferings? What is needed? What can best be done? What must be done?’

 

Have attitudes changed over time? The percentage of the public that consider it important to ‘help people in poor countries’ remains very high, despite considerable fluctuations (see Table 1). Although the figures for the EU in 1998 are low, there is no clear evidence of a downward trend.[36] Indeed, in UK surveys, there has been an increase from 17% in 1999 to 29% in 2002 of the number of respondents ‘very concerned’ about poverty in developing countries (Dawe, 2002). Regardless of the existence of a trend, there may be identifiable reasons as to why fluctuations may have occurred, which could provide clues as to how public opinion is influenced.

 

Table 1. Survey results for average of EU member states

 

Year

Survey question / issue

%

Source

1981

The importance Europeans attach to international cooperation

75

Box and Kruiter (1997)

1983

% responding: It is ‘very important’ or ‘important’ to ‘help poor countries in Africa, South America, Asia, etc…’

c.67[37]

ECAD (1984)

1987

The importance Europeans attach to international cooperation

78

Box and Kruiter (1997)

1990

The importance Europeans attach to international cooperation

83

Box and Kruiter (1997)

1995

The importance Europeans attach to international cooperation

80

Box and Kruiter (1997)

1996

% responding: It is ‘very important’ or ‘important’ to ‘help people in poor countries in Africa, South America, Asia, etc to develop.’

82

INRA (1999)

1997

‘Is it important to help the people in poor countries in Africa, South America, Asia, etc. to develop?’ % responding: ‘Yes.’

c.89[38]

INRA (1997)

1998

% responding: It is ‘very important’ or ‘important’ to ‘help people in poor countries in Africa, South America, Asia, etc to develop.’

76

INRA (1999)

 

Much effort has been put into identifying solutions to world poverty directly.[39] The aim here, instead, is to understand how to motivate pro-poor development policy. Paul Streeten (1995) has argued that political economists have neglected this topic:

 

‘…it is surprising how little thought has been given to the normative application of power constellations: how to build constituencies for an anti-poverty strategy, how to form coalitions and alliances in favour of improving the nutrition, education and health of the poor… A possible reason for the failure in the past, of the recommendations of human development and poverty eradication, is the neglect of heeding political constraints and the need to create a constituency for reform.’

 

Merilee Grindle (2001, p. 369) agrees with Streeten (2001, p.4) that the political economy of development policymaking has focussed on stabilization and structural adjustment. He also argues that, in several respects, current political economy approaches to policy and institutional change ‘begin and end’ in agreement with Machiavelli – essentially predicting failure. This contributes to the pervasive attitude of pessimism. Grindle argues that this pessimism is contradicted by the (albeit uneven) progress made by developing countries in the last 20 years. Grindle (2001) also argues for the importance of ideas and leadership in determining public policy.  Timothy Besley (2001, p. 387) concurs and points to the potential role of analysis in persuasion.[40]

 

Streeten’s analysis (1995) concentrates on how political naivety constrains the successful implementation of good policies. He also examines the politics of aid and the mobilization of international support. He remarks that eliminating hunger is a public good and ‘part of the enlightened self-interest of mankind.’ UNICEF is cited a highly successful pressure group that achieve results due ‘not only to the general appeal of improving children's health, but also to the low costs at which substantial improvements can be achieved, to external financial support for these measures, and to the fact that they included many children in the middle-income groups’ (Streeten, 1995, p. 22).

 

Understanding how to generate optimism may be the most critical task.

 

 

References

 

Adelman, I. (2001) ‘Fallacies in Development Theory,’ in Frontiers of Development Economics: The future in perspective, Eds. G.M. Meier and J.E. Stiglitz, World Bank and Oxford University Press, NY, pp. 103-134.

Basu, K. (2001) ‘On the Goals of Development,’ in Frontiers of Development Economics: The future in perspective, Eds. G.M. Meier and J.E. Stiglitz, World Bank and Oxford University Press, NY, pp. 61-86.

BBC News (1998) ‘Special Report: Dying for a baby,’ Tuesday, April 7, http://news6.thdo.bbc.co.uk/hi/english/special_report/1998/04/98/who/newsid_73000/73483.stm.

Besley, T. (2001) ‘Comment,’ in Frontiers of Development Economics: The future in perspective, Eds. G.M. Meier and J.E. Stiglitz, World Bank and Oxford University Press, NY, pp. 384-388.

Bok, D. (2001) The Trouble with Government, Harvard University Press, Cambridge, MA.

Box, L. and A. Kruiter (1997) ‘Rebuilding support for international cooperation: New Constituencies in a Global Village,’ ECDPM, Maastricht.

Cullen, P. (2001) ‘Public “unaware” of £250m overseas aid,’ The Irish Times, Monday, June 25.

DAC/OECD (1997) Development Cooperation, Efforts and policies of the Members of the Development Assistance Committee, 1996 Report, Paris.

Dawe, F. (2002) Public Attitudes Towards Development, Office for National Statistics, London.

ECAD (1984) Europeans and Aid to Development, European Consortium for Agricultural Development.

The Economist (2000), ‘Lexington: The Age of Fiscal Socialism,’ The Economist, April 15th – 21st, p. 30.

Emmott, B.[41] (1999), ‘Free to be poor,’ in Freedom’s Journey: A survey of the 20th Century, a supplement to The Economist, September 11th – 17th, pp. 27-29.

Foreign Policy in Focus (2000) ‘Foreign Policy of the Major Presidential Candidates,’ November 14, http://www.foreignpolicy-infocus.org/.

Galbraith, J.K. (1992) The Culture of Contentment, Houghton Mifflin Co.

Grant, J. (1990) in A world to make: Development in perspective, ed. F.X. Sutton, Transaction publishers, New Brunswick and London.

Grindle, M.S. (2001) ‘In Quest of the Political: The Political Economy of Development Policymaking,’ in Frontiers of Development Economics: The future in perspective, Eds. G.M. Meier and J.E. Stiglitz, World Bank and Oxford University Press, NY, pp. 345-380.

Huffington, A. (2001) How to Overthrow the Government, Regan Books, New York.

INRA (1996) Eurobarometer 44.1, The Way Europeans Perceive Developing Countries in 1995, for the European Commission, INRA (Europe), 20 March.

INRA (1997) Eurobarometer 46.0, Development Aid: Building for the Future with Public Support, for the European Commission, INRA (Europe), 8 January.

INRA (1999) Eurobarometer 50.1, Europeans and Development Aid, for the European Commission, INRA (Europe), 8 February.

Kull, S. (2001) ‘Vox Americani’, Foreign Policy, Sep/Oct, pp28-38.

Le Rue, S. (1998) ‘Using the Internet to mobilise Europe,’ in The Courier ACP-EU, 170, July-August, pp. 75-78.

Maidment, R. (1997) ‘Democracy in the USA since 1945’ in Potter, D., Goldblatt, D., Kiloh, M. and Lewis, P. (eds) Democratization, The Open University, Polity Press, Cambridge, UK, pp. 118-138.

O’ Donnell, L.[42] (2002) ‘Third World aid should be hallmark of our civilisation,’ The Irish Times, Friday, March 22.

The Pew Research Center For The People & The Press (2002) What the World Thinks in 2002, Washington DC, 2002.

Picciotto, R.[43] (1999) ‘Global Poverty Reduction and Institutional Change,’ Inaugural Wolf Lecture for 1999, The Rand Graduate School, August 30, http://www.rgs.edu/experience/wolflecture.html.

Pogge, T.W. (2001) ‘Global Poverty: Explanation and Responsibilities,’ Responsibility in the Global Age, 5th Annual Charles T. & Louise H. Travers Conference on Ethics and Government Accountability, April 14, University of Berkeley, http://www.igs.berkeley.edu/events/travers/2001/index.html.

Randel, J. and T. German (1998) ‘The European Union,’ in Public Attitudes and International Development Co-operation, eds. I. Smillie and H. Helmich in collaboration with T. German and J. Randel, OECD Publications, France.

Sen, A. (1999) Development as Freedom, Alfred A. Knopf, New York.

Smillie, I. (1998) ‘Optical and Other Illusions: Trends and Issues in Public Thinking About Development Co-operation,’ in Public Attitudes and International Development Co-operation, eds. I. Smillie and H. Helmich in collaboration with T. German and J. Randel, OECD Publications, France.

Smillie, I. and H. Helmich, eds. (1998) Public Attitudes and International Development Co-operation, in collaboration with T. German and J. Randel, OECD Publications, France.

Streeten, P. (2001) ‘Comment,’ in Frontiers of Development Economics: The future in perspective, eds. G.M. Meier and J.E. Stiglitz, World Bank and Oxford University Press, NY, pp. 87-93.

United Nations (2002) Final Outcome of the International Conference on Financing for Development, United Nations, Monterey, March 18-22.

University of Berkeley (2001) ‘Global Poverty: The Gap Between the World’s Rich and Poor Is Growing, and the Dying Continues,’ Public Affairs Report, Vol. 42, No.2, Summer.

University of Southampton (2001) Moving beyond research to influence policy, workshop, 23-24 January, http://www.socstats.soton.ac.uk/choices/workshop/index.html.

Wallace, K. (2001) ‘$1.35 trillion tax cut becomes law,’ CNN.com, June 7, http://www.cnn.com/2001/ALLPOLITICS/06/07/bush.taxes/.

World Bank (1993) World Development Report 1993: Investing in Health.

World Health Organisation (2002) ‘What is Roll Back Malaria,’ RBM information sheet 2 of 11, March, http://www.who.int/inf-fs/en/InformationSheet02.pdf.

 



[1] ‘In the 13 years since the end of the Cold War, well over 200 million people, mostly children, have died from poverty-related causes’ (University of Berkeley, 2001, excerpted from Pogge, 2001).

[2] See http://www.developmentgoals.org/.

[3] Europeans spend about twice as much on alcohol as current spending on development cooperation ($55 billion in 1999). What’s more, ‘incremental annual cost to achieve basic education for all is less than the amounts Americans spend on cosmetics. Reproductive health for all women would cost the same amount as spent on perfumes in the United States and Europe’ (Picciotto 1999). 

[4] Bizarrely, the sexual misconduct of a President is now more scandalous and media-worthy than the effect of his administration’s action or inaction on matters of life and death.

[5] Although he has since increased aid commitments to Africa, prior to coming to office George Bush brought little attention to the issue. He did say he was in favour of free trade with the continent but for reasons of economic self-interest (Foreign Policy in Focus, 2000).

[6] Streeten (1995, p. 28) regards the belief that ‘compassionate concern for the poor, … can lead only to their pauperization’ as akin to opposition to civil and political liberties (he cites A. O. Hirschman, The rhetoric of reaction: Perversity, futility, jeopardy, Harvard University Press, Cambridge, Mass.  1991).

[7] Or is there the opposite problem – a focus on impersonal solutions that makes the problems of individuals seem remote (see footnote 34)? Some commentators have suggested that there has been too much focus on solutions rather than underlying problems, which may generate unrealistic expectations (Box and Kruiter, 1997).

[8] This perception is not without foundation but may have been encouraged by the regular replacing of theories of underdevelopment. However, some argue that much has now been learned and that there is considerable consensus, ‘The strategies to achieve poverty reduction are well known. The task ahead is immense and will need to be tackled both locally and globally. But, with appropriate leadership, a consensus for global reform can materialize and the world has ample resources to get the job done’ (Picciotto, 1999).

[9] Paul Streeten (2001, p. 92), commenting on Basu (2001), writes: ‘If hypocrisy is the compliment vice pays to virtue, the evocation of national self- interest by politicians is the compliment virtue pays to vice. Citizens are often more moral, even in international relations, than their politicians.’

[10] Kaushik Basu (2001) argues that recognising the conditional morality of decision-makers may facilitate the design of coordinated action.

[11] For example, is media coverage poor simply because that reflects our tastes (University of Berkeley, 2001, excerpted from Pogge, 2001), or is it more to do with the knowledge and interests of editors and journalists, or with the nature of news reporting?

[12] It marks a failure to inform the public by the international NGOs with a presence in the US – about a statistic of central relevance to their goals – that the public believes that 20% of the US budget goes to foreign aid, rather than less than 1%. Even so, the majority believe it should not be cut and, indeed, that foreign policy should not be tied closely to US national interests (source: Program on International Policy Attitudes, as presented in Kull, S., 2001; see also ‘Vox Populi - Are Americans willing to make sacrifices for altruistic reasons or to help the world as a whole, or do Americans want US foreign policy tied closely to a narrow concept of the national interest?’ http://www.vox-populi.org/digest/america_role2.html). Part of the problem may be that the US Congress prohibits the USAID from advocating of behalf of foreign assistance with public funds (‘United States Development Co-operation Review: Main Findings and Recommendations,’ downloaded 01/24/03, http://www.oecd.org/oecd/pages/document/print_template/0,3371,EN-document-notheme-2-no-3-36138-0---,00.html). In contrast to the United States, the Irish are unaware of the extent of their government’s aid programme (Cullen, 2001). Other surveys have suggested that Europeans in general are poorly informed with respect to their national and the EU development programmes but, nonetheless, would appear to support an increase in aid spending (e.g., INRA, 1997, p6).

[13] Jim Kolbe, Chair of the US House Appropriations Subcommittee on Foreign Operations, delivered a speech on ‘The Millenium Aid Iniative: New Idea or More of the Same?’ at Northwestern University, Chicago on May 10th, 2002. Despite the title, his senior responsibility for US development funding, and his apparently genuine interest in and concern about the topic, he did not appear to be aware that linking development assistance to conditions or performance was not a new idea. He also stated incorrectly that no European country spent 0.7% of its GNP on ODA.

[14] See Le Rue (1998); the author highlights the potential of the Internet in both helping citizens understand the issues and convincing the public of their importance.

[15] According to the 2002 PEW Global Attitudes Survey, 88% of US respondents answered that their government does too much (47%) or the right amount in helping solve world problems (5% did not respond). However, in response to the previous question, only 39% believed that United States policies lessen the gap between rich and poor countries (addendum to The Pew Research Center For The People & The Press, 2002). To reconcile these results, it would appear that the gap is not perceived to be the sort of serious problem the US should be helping to solve. It should be noted that the question related to inequality, not poverty, and that a question about (absolute) poverty might have received a different response.

[16] This apparent disconnect between public opinion and public policy has been noticed in other contexts. Despite the focus of the Bush Administration on tax cuts, according to The Economist, “In poll after poll, tax cuts come way down on the list of voters’ concerns, somewhere above the cost of Pokemon cards” (The Economist, 2000; the explanation offered in the article was that US voters did care about taxes but were more worried about Social Security and the national debt). D. Bok has examined a list of “goals and priorities that large majorities of citizens claim to share” (Bok, 2001, p42) and found that the US performed poorly relative to several other countries despite its greater wealth.

[17] The high support has to be taken with a pinch of salt because respondents often ranked many domestic issues to be of greater importance (e.g. Randel and German, 1998, p. 163).

[18] There is not enough information to conclude that public opinion is irrelevant (at least, for ‘ordinary’ members of the public) but clearly there are other factors at work. For public opinion to really matter on these issues, there have to be votes at stake. (The reality may be complex at present, whereby voters for whom it might be decisive can be targeted by focusing on ‘correlated’ issues, such as domestic poverty or social services.) 

[19] The strength of special interests may be determined by the sizes of their political donations, as much as by the size of their memberships. Senator John McCain has stated, ‘politics is increasingly becoming a battle of bucks rather than a battle of ideas, and … the national interest is too often subordinate to the care and feeding of special interest’ (Huffington, 2001, p. i).

[20] See ‘International Development Co-operation in OECD Countries: Public Debate, Public Support and Public Opinion - Background Note,’ OECD documents, downloaded 01/25/03, http://www.oecd.org/oecd/pages/document/print_template/0,3371,EN-document-278-7-no-20-9904-278---,00.html. The OCED DAC proposed that several issues require analysis, including trends in public opinion, and the nature and effectiveness of official efforts to raise awareness.  

[21] There are 300 million acute malaria cases – and over a million deaths - per year. It is not true to say that the problem has been completely ignored outside the affected countries. For example, 2001-10 has been declared by the UN as the decade to roll back malaria (RBM), with the aim of halving the malaria burden. However, the WHO RBM group needed to use gimmicks such as the world’s largest bed net to attract the attention of the world’s press (World Health Organisation, 2002).

[22] However, prior to the Conference on Financing and Development at Monterey, overseas aid from rich countries had halved from the early 1990s to 0.22% of GDP, while aid per capita to sub-Saharan Africa fell from over $30 to less than $20 (O’ Donnell, 2002).

[23] The Bank also recommended that $20 billion per year was needed for public health programs which cost as little as $25-$150 per disability-adjusted life year (DALY) saved, such as: “immunizations, school-based health services, information and selected services for family planning and nutrition, programs to reduce tobacco and alcohol consumption...(efforts) to improve the household environment, AIDS prevention.”

[24] BBC News, 1998.

[25] UNICEF web site, http://www.unicef.org/programme/health/child/imci.htm, downloaded September 2002.

[26] WHO web site, http://www.who.int/inf-fs/en/fact104.html, downloaded September 2002.

[27] Find references (e.g. the alleged difficulty investors have in assessing risks when large sums are involved – The Economist?).

[28] See Wallace, 2001.

[29] If $1.2 billion live on less than $1 PPP per day in 1993 money and fall on average 30% below it. Then the average annual income, when converted into US$ at 2000 market exchange rates (not PPP), is $82. 13.7 x 1.2billion x $82 = $1.348 trillion. The calculation of $82 is from University of Berkeley (2001), which is excerpted from Pogge (2001). 

[30] Immunization can be achieved for 50 cents per child (Grant, 1990, p. 15 in Streeten, 1995, p. 9). Oral rehydration costs 10 cents per child, yet diarrhoea may be ‘the biggest killer’ (Streeten, 1995, p. 9).

[31] The effect of US policy on Cuban children also fails to generate the same interest.

[32] Nonetheless, the Holocaust would seem to be an example where the scale of the suffering significantly affects its continuing impact.

[33] Investments in health, education and nutrition are important investments in human capital, that not only influence economic production but also, as Amartya Sen (1999, p. 296) has argued, directly affect well-being and freedom and indirectly influence social change. He also argues that freedom is often wrongly seen as a means to growth, rather than an end in itself.

[34] The 17-page ‘Final Outcome of the International Conference on Financing for Development’ (United Nations, 2002) devoted individual sections to several ‘Leading actions.’ These included foreign direct investment, international trade, financial and technical cooperation, and the coherence and consistency of the international monetary, financial and trading systems. Health, on the other hand, is mentioned three times: twice in lists with education, nutrition, etc., and once, where it received a whole clause. Children, mentioned once (only featuring in one of the lists that health was mentioned in), do not merit a full sentence either. One wonders how the people the conference was implicitly concerned about, and one of their primary problems, could come across as peripheral. In fact, they were mentioned prominently – just not by name – in the context of the international development goals (see footnote 2). It seems a strange way to ‘build a global alliance for development’ (United Nations, 2002, p. 15). Nonetheless, the conference appears to be have been highly successful.

[35] See footnote 1.

[36] An earlier report expressed concern that the drop between 1991 and 1995, resulted from ‘a “withdrawal into one’s self” in the population of the Member States’ (INRA, 1996). However, as was pointed out in Box and Kruiter (1997), the statistics at the time did not strongly support such a deduction.

[37] “Two thirds.” The exact amount was not evident in ECAD (1984).

[38] “Nearly 90.” The exact amount was not evident in INRA (1997).

[39] It is worth noting that many such efforts may have had limited success by focusing on a single cause of underdevelopment or a single criteria for measuring development performance (Adelman, 2001).

[40] ‘The study of political economy does not preclude using analytical tools to persuade policymakers that there are ways to improve the world’ (Besley, 2001, p. 387).

[41] Editor of The Economist.

[42] Minister of State at the Irish Dept. of Foreign Affairs.

[43] Director General, Operations Evaluation, The World Bank.