What if we allocated aid $ based on how much damage something does, and whether we know how to fix it?

I usually criticize development wonks who come up with yet another ‘if I ruled the world’ plan for reforming everything without thinking through the issues of politics, power and incentives that will determine which (if any) of their grand schemes gets adopted. But it’s been a hard week, and today I’m taking time out from the grind of political realism to rethink aid policy.

Call it a thought experiment. Suppose we started with a blank sheet of paper, and decided which issues to spend aid money on based on two criteria – a) how much death and destruction does a given issue cause in developing countries, and b) do the rich countries actually know how to reduce the damage? That second bit is important – remember Charles Kenny’s book ‘Getting Better‘, which argues powerfully that since we understand how to improve health and education much better than how to generate jobs and growth, aid should concentrate on the former.

If you followed this exercise, I think you would end up with a radically different aid agenda, with a whole bunch of Cinderella issues coming in from the cold (I’m also taking a break from not mixing metaphors).

Here’s the global death toll (from the new edition of FP2P, c/o indefatigable  number crunching from Richard King).

causes of death

These are global figures, and I don’t have a breakdown by developed/developing. That would be important on obesity, but on other issues, the majority of impact is clearly in poor countries – alcohol, tobacco and road traffic for example. And they are precisely the areas where the rich countries have lots of experience in reducing the damage. It’s certainly a lot more straightforward than inventing/discovering new vaccines. When researchers put signs in Kenyan minibuses (matatus) urging passengers to criticize reckless driving, injuries and deaths fell by a half (for paper see here).

So how come such subjects are so seldom seen as development issues? Where’s the campaign on booze and fag dumping by large corporations in developing countries? Or international seat belt conventions, backed by technical assistance to help governments ratify and implement? Your thoughts please. Presumably some kind of campaigns exist on all these issues – please send links – but they could be a lot more prominent.

And for the truly wonky/medically inclined here’s a more sophisticated version from the Guardian – Disability Adjusted Life Years, which Claire Melamed and John Appleby reckon could be usefully mainstreamed in development. It shows which causes of global death and disability are up/down from 1990-2010. And if you don’t know what Ischemic or COPD mean, look them up.

DALYS by cause 1990-2010

March 7th, 2013 | 11 Comments

Are crazy drivers as big a development issue as malaria or tuberculosis? The case for a global road safety campaign

This was clearly meant to be. A couple of weeks ago, I was blearily discussing road traffic accidents with a couple of colleagues as we headed in a taxi to get an early morning flight home from the post-2015 discussion in Cairo, when the car went into a horrendous screeching skid, avoiding the car in front by inches. Andy Sumner, in the passenger seat, said it felt like being inside a rather scary computer game. When theory and practice collide like that, it’s time to start blogging.

Is traffic a development issue? You bet. Firstly, it’s a killer. According to Make Roads Safe, the impressive (but not well-known) global road safety 1campaign for road safety, somewhere in the world, a person dies every 6 seconds – 1.3 million road deaths each year, a fatality rate comparable to Malaria or Tuberculosis. Nine in ten road deaths and injuries are in developing countries. The economic cost to these countries is estimated by the World Bank at up to US$100 billion a year (equivalent to all annual overseas aid from OECD countries).

Research in India and Bangladesh has shown that at least half of families affected by a road death or serious injury fall below the poverty line. The poorest communities are the worst affected, in rich countries and developing countries alike. Pedestrians, cyclists and other vulnerable road users are the majority of those killed and injured.

It’s also a problem with ready-made solutions – no new vaccines to invent, or new technologies to develop. Just speed limits, enforcement, safety standards both for pedestrians and in public or private transport, traffic (and driver) calming measures, changing public norms on things like drinking and driving. And it doesn’t have to be expensive: when researchers put signs in Kenyan minibuses (matatus) urging passengers to criticize reckless driving, injuries and deaths fell by a half (for paper see here).

True, RTAs may take more lives among better off people (including not a few aid and NGO workers) than infectious disease, and so tackling the issue may not be so ‘pro-poor’, but that at least means you have a ready-made constituency with a powerful political voice.
As countries grow richer, they will probably embark on sorting out traffic safety anyway, but meanwhile, millions of people in developing countries are dying or being injured unnecessarily. A bit of public campaigning could speed things up and save a lot of suffering.

road safety 2The carnage on the developing world’s roads is just one of a number of issues that people in rich countries tend not to think of as ‘development issues’. Tobacco (annual global death toll estimated at 6 million), alcohol (2.5 million), obesity (2.8 million), diabetes, heart disease, cancer, respiratory problems from household smoke (1.6 million) and pollution, depression and other mental illness. The focus on infectious diseases is important, but an awful lot gets left out, some of it relatively simple to tackle.

2011 marks the start of a UN decade of action on road safety. Here’s a 5 minute video that explains what it’s all about, presented by none other than my predecessor at Oxfam, Kevin Watkins

November 9th, 2011 | 2 Comments

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