Malnutrition should not be neglected as developed countries concentrate on global warming. Oxfam has warned that at least 4.5 million children could die and 8.6 million fewer people could have access to HIV/AIDS treatment if rich countries divert aid to help poor countries tackle climate change instead of malnutrition as part of an agreement to be negotiated in Copenhagen next month.
Oxfam argued that developed countries should both increase aid and spend more to pay off countries that will suffer the worst of global warming. But the harsh truth is that resources are limited. Money spent on global-warming policies is likely to reduce the funds available for food aid.
It is therefore immoral to focus resources on doing a small amount of good in the distant future. Six-year-old Garsum is lucky to have been rescued by his uncle and aunt. As his uncle told the Consensus researcher, "In the villages, there is nothing. He is 10 times better here." But Garsum is still facing a tough life. Only an immediate focus on malnutrition interventions and HIV treatment will provide him with a chance at a better life.
His argument resonates deeply with me and in a sea of need, certainly we should prioritize and help the most that we can in the most efficient way possible. Malnutrition, vaccinations, malaria bednets, and de-worming are just the tip of the iceberg of proven, effective, and super cheap interventions that make an immediate difference in the lives of millions of people. And the world should be doing more. But I worry that the real struggle with allocating scare resources defies such easy comparisons.
Treatment for HIV/AIDS has become much less expensive than five years ago, but still represents tremendous cost compared to HIV prevention, or any of the interventions previously mentioned - but it remains a compelling moral imperative. The same could be said about so many other global health, development, and human rights issues - including climate change, which has dramatic long-term consequences especially for the poor. I struggle to accept that it's immoral to devote resources to legitimate and important issues simply because it's not cost-effective (try saying that to an HIV+ person waiting to get on treatment).
We need to do a better job prioritizing, but I think the answer is more complicated than Mr. Lomborg implies. But he's right that this shouldn't be top-down and that local demand should be the real driver of programs, not ex-pat or donor interest. If the people of Akakey want a hospital, food security, and job creation, that's what they should get - not researchers looking for answers on climate change.
5 comments:
Do you still think projects should be determined by the communities if, for example, the people of Akakey want laptops for their schools rather than healthcare? How about if they want to build a football pitch rather than provide literacy? Or maybe they want literacy programs, but only want to allow adult males to participate? These aren't hypotheticals - this actually happens quite frequently...
Great question and I think it gets right down into the dirty details of what it means to engage communities on what they want/need - something I know you have a lot more knowledge about than I do. The generalizations we tend to speak in tend to mask the complexities of implementation.
If a community wants laptops for their school rather than healthcare, it's probably the broader goal that should be respected (we desire education more than healthcare), and the approach on how to get to that goal can be discussed with the community (laptops might not be the best way to get people educated).
If the expressed priority is a football pitch, maybe there's a good reason (kids need a place to play), and maybe there's a bad reason (the elders who are speaking for the community may not have the community's best interests at heart). I guess it's a difficult call in terms of "what the community wants" since the "community" may not speak with one voice - and the question is which voice is the authentic voice. Everybody has a different incentive, and it'll depend on the purpose of the assistance which one should be prioritized.
Working in a cultural context where discrimination is very ingrained would make this much more complex - and I'd love to hear your thoughts on how to approach an opportunity to engage a community and do something good, but in a way that perpetuates gender inequality. I'm hesitant to say what should be done without being a part of that community - maybe it makes sense to go forward with a literacy program because it will help those it reaches and it will build relationships and trust that will eventually allow you to bring women into the program. Or maybe it's not worth the compromise and it makes sense to reach out to a more progressive community.
I absolutely love this discussion though, and think that we (ex-pats) need to get into the weeds of what our generalizations mean, and what principles will guide us in specific contexts - which are ultimately what matter.
Two things . . .
1) You've dealt a lot with donors . . . have you encountered situations where their interest is in a particular cause and they'll only fund projects in this area, regardless of the priorities of the community? What do we do when the funding is expressly for a purpose other than what a community might itself prioritize?
2) Your point about the community not having a singular voice is important, and raises a broader challenge - how far do you devolve the mantra bottom-upness? To villages, defined geographically? To family units? To individuals? One challenge of Mills' mantra is that it's hard to register the preferences of each individual, and harder still to meet their specific preferences once they're been registered. How do you navigate the trade-off between bottom-upness and efficiency/cost-effectiveness?
Hey Jacob,
These are difficult questions. I've definitely worked with donors that have a more set agenda, often because they have specific assets or expertise that make a strategic focus sensible for greater impact. In that case, often it's more a question of which communities have the greatest need that matches with how the donor is planning to act rather than about forcing a fit with a certain community. This of course is based on a program which has a focus area (e.g., prevent and treat HIV/AIDS, alleviate malnutrition). A program which has a broader goal such as helping the poor in a certain geography should come in with a less prescriptive agenda and involve the community more. But I think the question of fit is tough when there's a donor expectation to do certain things and not others.
In terms of knowing what a community wants, I think that's the importance of being in relationship with the community. I have little actual experience here and so want to be cautious in answering, but I would surmise it's all a balance. You want to get feedback from representatives in the community, but you also want to go beyond that and survey more broadly at times to ensure that you're getting the full perspective. And you would want to make sure that you're catching the views of those who may be marginalized and have quieter voices (e.g., women, youth, outcasts, minorities, etc.).
These are the critical issues that determine whether or not programs succeed, and I'm hopeful to engage more at the ground level rather than in just strategy and evaluation soon. I've certainly recognized the importance of the high-level thinking, but the devil's in the details. In global health and development, I have the growing feeling that execution is the most important step.
Post a Comment