Lester R. Brown
Chapter 11. Eradicating Poverty, Stabilizing Population, and Rescuing Failing States
In 1974, Miguel Sabido, a vice president of Televisa, Mexico’s national television network, ran a series of soap opera segments on illiteracy. The day after one of the characters visited a literacy office wanting to learn how to read and write, a quarter-million people showed up at these offices in Mexico City. Eventually 840,000 Mexicans enrolled in literacy courses after watching the series. 1
While many analysts focus on the role of formal education in social change, soap operas on radio and television can quickly change people’s attitudes about literacy, reproductive health, and family size. A well-written soap opera can have a profound near-term effect on population growth. It costs relatively little and can proceed while formal educational systems are being expanded.
Sabido, a pioneer in this exciting new option for raising awareness, dealt with contraception in a soap opera entitled Acompáñame, which translates as Come With Me. Over the span of a decade this drama series helped reduce Mexico’s birth rate by 34 percent. 2
Other groups outside Mexico quickly picked up his approach. The U.S.-based Population Media Center (PMC), headed by William Ryerson, has initiated projects in some 17 countries and plans to launch projects in several others. The PMC’s work in Ethiopia over the last several years provides a telling example. Its radio serial dramas broadcast in Amharic and Oromiffa have addressed issues of reproductive health and gender equity. 3
A survey two years after the broadcasts began in 2002 found that 63 percent of new clients seeking reproductive health care at Ethiopia’s 48 service centers had listened to a PMC drama. There was a 55-percent increase in family planning use among married women in the Amhara region of Ethiopia who listened to these dramas. The average number of children per woman in the region dropped from 5.4 to 4.3. This is an exciting result because reduction in family size makes it easier to eradicate poverty. And conversely, eradicating poverty accelerates the shift to smaller families. 4
Poverty has many faces, such as hunger, illiteracy, and low life expectancy. In 2005, nearly 1.4 billion people around the world were living on less than $1.25 a day, which the World Bank classifies as extreme poverty. The highest regional concentration of poverty is in sub-Saharan Africa, where extreme poverty afflicts over half the sub-continent’s 863 million people. Among the world’s failing or fragile states, poverty is pervasive, also affecting more than half the population. Yet unlike in sub-Saharan Africa, where some progress (albeit slow) has been made, the prospects for alleviating poverty in failing states look pretty grim without major state rehabilitation. 5
Since those living in poverty spend a large share of their income on food, it came as no surprise when the World Bank reported in early 2009 that between 2005 and 2008 the ranks of the poor expanded by at least 130 million people because of higher food prices. The Bank also observed that 44 million more children may suffer permanent cognitive and physical injury caused by the rise in malnutrition. The effect of rising food prices was then compounded by the global economic crisis, which dramatically expanded the number of unemployed and reduced the flow of remittances from family members working abroad. 6
Although as of 2010 the world economy is starting to recover, the recession’s setbacks to eradicating poverty are likely to persist for some years. Hunger and disease are on the march in many parts of the world, partly offsetting gains made in countries like China and Brazil. The late twentieth century’s decline in hunger and malnourishment was reversed in 1996—rising from 788 million to 833 million in 2001, passing 900 million in 2008, to over 1 billion in 2009. 7
Eradicating poverty is the key to stabilizing population, improving food security, and minimizing state failure. There are many success stories of people moving up the economic ladder, but none are as impressive as China’s. There, a fast-growing economy and a continued shift to small families dropped the number of Chinese living in extreme poverty from 683 million in 1990 to 208 million in 2005. The share of the population living in extreme poverty plummeted from 60 percent to 16 percent. 8
Brazil has also succeeded in sharply reducing poverty through its Bolsa Familia program, an effort initiated by President Luiz Inácio Lula da Silva in 2003. This program offers poor mothers up to $35 a month as long as they keep their children in school, have them vaccinated, and make sure they get regular physical checkups. Between 1990 and 2005, the share of the population living in extreme poverty dropped from 15 to 5 percent. Serving over 12 million households, nearly one fourth of the country’s population, the program raised incomes among the poor by 22 percent over a five-year span, while incomes among the rich rose by only 5 percent. The gap between rich and poor is itself a source of instability. Brazil’s success in reducing that gap is remarkable because, as Rosani Cunha, the program’s former director in Brasilia, observed, “There are very few countries that reduce inequality and poverty at the same time.” 9
Children without any formal education start life with a severe handicap, one that almost ensures they will remain in abject poverty and that the gap between the poor and the rich will continue to widen. So another key to eradicating poverty is to make sure that all children have at least a primary school education. Nobel Prize–winning economist Amartya Sen asserts that “illiteracy and innumeracy are a greater threat to humanity than terrorism.” 10
The world is at least making progress on the education front. The number of elementary-school-aged children who were not in school dropped encouragingly from 106 million in 1999 to 69 million in 2008. And by 2005, almost two thirds of developing countries had reached another basic educational goal: gender parity in elementary school enrollment. This is not only a landmark achievement in its own right, it is also a key to stabilizing population. As female educational levels rise, fertility falls. Economist Gene Sperling notes that a study of 72 countries found that “the expansion of female secondary education may be the single best lever for achieving substantial reductions in fertility.” 11
The goal of reducing illiteracy must extend beyond the elementary level. As the world becomes ever more integrated economically, its nearly 800 million illiterate adults are severely handicapped. We can overcome this deficit by launching adult literacy programs that rely heavily on volunteers. The international community can contribute by offering seed money to provide educational materials and outside advisors where needed. Bangladesh and Iran, both of which have successful adult literacy programs, can serve as models. An adult literacy program would add $4 billion per year to the budget to save civilization. 12
The World Bank has taken the lead in seeking universal primary education with its Education for All fast-track initiative, where any country with a well-designed plan to achieve universal primary education is eligible for Bank financial support. The three principal requirements are that the country submit a sensible plan to reach universal basic education, commit a meaningful share of its own resources to the plan, and have transparent budgeting and accounting practices. If fully implemented, all children in poor countries would get a primary school education by 2015, helping them to break out of poverty. An estimated $10 billion in external financing, beyond what is being spent today, is needed to achieve this. 13
Few incentives to get children into school are as effective as a school lunch program, especially in the poorest countries. Children who are ill or hungry miss many days of school. And even when they can attend, they do not learn as well. Economist Jeffrey Sachs notes, “Sick children often face a lifetime of diminished productivity because of interruptions in schooling together with cognitive and physical impairment.” But when school lunch programs are launched in low-income countries, school enrollment jumps, academic performance goes up, and children spend more years in school. 14
Girls, who are more often expected to work at home, especially benefit. Particularly where programs include take-home rations, school meals lead to girls staying in school longer, marrying later, and having fewer children. This is a win-win-win situation. Launching school lunch programs to reach the 66 million youngsters who currently go to school hungry would cost an estimated $3 billion per year beyond what the U.N. World Food Programme is now spending to reduce hunger. 15
If children are to benefit from school lunch programs, we must improve nutrition before children even get to school age. Former Senator George McGovern suggests that a WIC program (for women, infants, and children) that provides nutritious food to needy pregnant and nursing mothers, similar to a program he helped launch in the United States, should be available in poor countries. Based on 33 years of U.S. experience, it is clearly successful at improving the nutrition, health, and development of preschool children from low-income families. If the program were expanded to reach pregnant women, nursing mothers, and small children in the 44 poorest countries, it would help eradicate hunger among millions of small children. And it would require additional expenditures of only $4 billion per year. 16
Ensuring access to a safe and reliable supply of water for the estimated 884 million people who lack it is essential to better health for all and a key to reducing infant mortality. Since clean water reduces the incidence of diarrheal and parasitic diseases, it also curbs nutrient loss and malnutrition. A realistic option in many developing-world cities is to bypass efforts to build costly water-based sewage removal and treatment systems and to opt instead for water-free waste disposal systems, including the increasingly popular odorless dry-compost toilets that do not disperse disease pathogens. This switch would simultaneously help alleviate water scarcity, reduce the spread of disease agents in water systems, and help close the nutrient cycle—another win-win-win situation. 17
Additional investments can help the many countries that cannot afford vaccines for childhood diseases and are falling behind in their vaccination programs. Lacking the funds to invest today, these countries will pay a far higher price tomorrow. In an effort to fill this funding gap, the Bill and Melinda Gates Foundation announced in early 2010 that it would provide over $10 billion this decade “to help research, develop, and deliver vaccines to the world’s poorest countries.” 18
More broadly, a World Health Organization study analyzing the economics of health care in developing countries concluded that providing the most basic health care services, the sort that could be supplied by a village-level clinic, would yield enormous economic benefits. The authors estimate that providing basic universal health care in developing countries will require donor grants totaling on average $33 billion a year through 2015. This figure includes funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria and for universal childhood vaccinations. 19
When it comes to population growth, the United Nations has three primary projections. The medium projection, the one most commonly used, has world population reaching 9.2 billion by 2050. The high one reaches 10.5 billion. The low projection, which assumes that the world will quickly move below replacement-level fertility, has population peaking at 8 billion in 2042 and then declining. If the goal is to eradicate poverty, hunger, and illiteracy, then we have little choice but to strive for the lower projection. 20
Slowing world population growth means ensuring that all women who want to plan their families have access to family planning services. Unfortunately, this is currently not the case for 215 million women, 59 percent of whom live in sub-Saharan Africa and the Indian subcontinent. These women and their families represent roughly 1 billion of the earth’s poorest residents, for whom unintended pregnancies and unwanted births are an enormous burden. Former U.S. Agency for International Development (AID) official J. Joseph Speidel notes that “if you ask anthropologists who live and work with poor people at the village level...they often say that women live in fear of their next pregnancy. They just do not want to get pregnant.” 21
The United Nations Population Fund and the Guttmacher Institute estimate that meeting the needs of these 215 million women who lack reproductive health care and effective contraception could each year prevent 53 million unwanted pregnancies, 24 million induced abortions, and 1.6 million infant deaths. Along with the provision of additional condoms needed to prevent HIV and other sexually transmitted infections, a universal family planning and reproductive health program would cost an additional $21 billion in funding from industrial and developing countries. 22
The good news is that governments can help couples reduce family size very quickly when they commit to doing so. My colleague Janet Larsen writes that in just one decade Iran dropped its near-record population growth rate to one of the lowest in the developing world. 23
When Ayatollah Khomeini assumed leadership in Iran in 1979 and launched the Islamic revolution, he immediately dismantled the well-established family planning programs and instead advocated large families. At war with Iraq between 1980 and 1988, Khomeini wanted to increase the ranks of soldiers for Islam. His goal was an army of 20 million. 24
Fertility levels climbed in response to his pleas, pushing Iran’s annual population growth to a peak of 4.2 percent in the early 1980s, a level approaching the biological maximum. As this enormous growth began to burden the economy and the environment, the country’s leaders realized that overcrowding, environmental degradation, and unemployment were undermining Iran’s future. 25
In 1989 the government did an about-face and restored its family planning program. In May 1993, a national family planning law was passed. The resources of several government ministries, including education, culture, and health, were mobilized to encourage smaller families. Iran Broadcasting was given responsibility for raising awareness of population issues and of the availability of family planning services. Some 15,000 “health houses” or clinics were established to provide rural populations with health and family planning services. 26
Religious leaders were directly involved in what amounted to a crusade for smaller families. Iran introduced a full panoply of contraceptive measures, including the option of vasectomy—a first among Muslim countries. All forms of birth control, including the pill and sterilization, were free of charge. Iran even became the only country to require couples to take a course on modern contraception before receiving a marriage license. 27
In addition to the direct health care interventions, Iran also launched a broad-based effort to raise female literacy, boosting it from 25 percent in 1970 to more than 70 percent in 2000. Female school enrollment increased from 60 to 90 percent. Television was used to disseminate information on family planning throughout the country, taking advantage of the 70 percent of rural households with TV sets. As a result of this initiative, family size in Iran dropped from seven children to fewer than three. From 1987 to 1994, Iran cut its population growth rate by half, an impressive achievement that shows how a full-scale mobilization of society can accelerate the shift to smaller families. 28
The bad news is that in July 2010 Iranian President Mahmoud Ahmadinejad declared the country’s family planning program ungodly and announced a new pronatalist policy. The government would pay couples to have children, depositing money in each child’s bank account until age 18. The effect of this new program on Iran’s population growth remains to be seen. 29
Shifting to smaller families brings generous economic dividends. In Bangladesh, for example, analysts concluded that $62 spent by the government to prevent an unwanted birth saved $615 in expenditures on other social services. For donor countries, ensuring that men and women everywhere have access to the services they need would yield strong social returns in improved education and health care. Put simply, the costs to society of not filling the family planning gap may be greater than we can afford. 30
Many developing countries in Asia, Africa, and Latin America were successful in quickly reducing their fertility within a generation or so after public health and medical gains lowered their mortality rates. Among these were Brazil, Chile, China, South Korea, Thailand, and Turkey. But many others did not follow this path and have been caught in the demographic trap—including Afghanistan, Ethiopia, Iraq, Nigeria, Pakistan, and Yemen. 31
Slowing population growth brings with it what economists call the demographic bonus. When countries move quickly to smaller families, growth in the number of young dependents—those who need nurturing and educating—declines relative to the number of working adults. At the individual level, removing the financial burden of large families allows more people to escape from poverty. At the national level, the demographic bonus causes savings and investment to climb, productivity to surge, and economic growth to accelerate. 32
Japan, which cut its population growth in half between 1951 and 1958, was one of the first countries to benefit from the demographic bonus. South Korea and Taiwan followed, and more recently China, Thailand, and Viet Nam have been helped by earlier sharp reductions in birth rates. Although this effect lasts for only a few decades, it is usually enough to launch a country into the modern era. Indeed, except for a few oil-rich countries, no developing country has successfully modernized without slowing population growth. 33
Countries that do not succeed in reducing fertility early on face the compounding of 3 percent growth per year or 20-fold per century. Such rapid population growth can easily strain limited land and water resources. With large “youth bulges” outrunning job creation, the growing number of unemployed young men increases the risk of conflict. This also raises the odds of becoming a failing state. One of the leading challenges facing the international community is how to prevent that slide into chaos. Continuing with business as usual with international assistance programs is not working. The stakes could not be higher. Somehow we must turn the tide of state decline. 34
Some donor countries have recognized that failing states need special attention. Since state failure is, by its nature, systemic, a systemic response is called for—one that is responsive to the many interrelated sources of failure. Traditional, project-oriented development assistance is not likely to reverse state failure. Rather, it requires a much deeper, across-the-board engagement with the failing state. 35
Reversing the process of state failure is a much more challenging, demanding process than anything the international community has faced, including the rebuilding of war-torn states after World War II. And it requires a level of interagency cooperation that no donor country has yet achieved. Pauline H. Baker, President of the Fund for Peace, suggests that a major stumbling block is that industrial governments do not recognize state failure as an entirely new kind of problem and thus do not design a comprehensive, integrated strategy to combat it. 36
Within the U.S. government, efforts to deal with weak and failing states are fragmented. Several departments are involved, including State, Treasury, and Agriculture. And within the State Department, several different offices are concerned with this issue. This lack of focus was recognized by the Hart-Rudman U.S. Commission on National Security in the Twenty-first Century: “Responsibility today for crisis prevention and response is dispersed in multiple AID and State bureaus, and among State’s Under Secretaries and the AID Administrator. In practice, therefore, no one is in charge.” 37
What is needed now is a new cabinet-level agency—a Department of Global Security (DGS)—that would fashion a coherent policy toward each weak and failing state. This recommendation, initially set forth in a report of the Commission on Weak States and U.S. National Security, recognizes that the threats to security are now coming less from military power and more from the trends that undermine states, such as rapid population growth, poverty, deteriorating environmental support systems, and spreading water shortages. The new agency would incorporate AID (now part of the State Department) and all the various foreign assistance programs that are currently in other government departments, thereby assuming responsibility for U.S. development assistance across the board. The State Department would provide diplomatic support for this new agency, helping in the overall effort to reverse the process of state failure. 38
The DGS would be funded by shifting fiscal resources from the Department of Defense, which defines security almost exclusively in military terms. In effect, the DGS budget would become part of a new security budget. It would focus on the central sources of state failure by helping to stabilize population, restore environmental support systems, eradicate poverty, provide universal primary school education, and strengthen the rule of law through bolstering police forces, court systems, and, where needed, the military.
The DGS would make such issues as debt relief and market access an integral part of U.S. policy. It would also provide a forum to coordinate domestic and foreign policy, ensuring that domestic policies, such as cotton export subsidies or subsidies to convert grain into fuel for cars, do not weaken the economies of low-income countries or raise the price of food to unaffordable levels for the poor. A successful export-oriented farm sector often offers a path out of poverty for a poor country. The department would provide a focus for the United States to help lead a growing international effort to reverse the process of state failure. It would also encourage private investment in failing states by providing loan guarantees to spur development.
Thus far the process of state failure has largely been a one-way street, with hardly any countries reversing the process. Liberia is one of the few that have turned the tide. Following 14 years of cruel civil war that took 200,000 lives, Foreign Policy’s annual ranking of failing states showed Liberia ranking ninth in 2005. But things began to turn around that year with the election of Ellen Johnson-Sirleaf, a graduate of the Harvard Kennedy School and a former World Bank official, as president. A fierce effort to root out corruption along with a multinational U.N. Peacekeeping Force of up to 15,000 troops who maintain the peace, repair roads, schools, and hospitals, and train police have brought progress to this war-torn country. By 2010, Liberia had dropped to thirty-third on the list of failing states. 39
In Prism magazine, John W. Blaney, who served as U.S. Ambassador to Liberia from 2002 to 2005, describes how a dead state was gradually resuscitated and brought back to life. He writes about the exceptional role of a U.N. group that “led the way in developing and tailoring a disarmament, demobilization, reintegration, and rehabilitation program.” He further notes that “we plotted out what should be done sequentially and simultaneously once the fighting stopped.” Blaney concludes that there is no set formula for rebuilding a collapsed state—each situation is unique. 40
Collectively, the Plan B initiatives for education, health, and family planning discussed in this chapter are estimated to cost another $75 billion a year. These cornerstones of human capital development and population stabilization will also help prevent state failure by alleviating its root social causes. Meanwhile, more effective responses to fragile states can be paid for by redistributing donor countries’ existing security budgets to reflect the twenty-first century threats they must address. 41
As Jeffrey Sachs regularly reminds us, for the first time in history we have the technological and financial resources to eradicate poverty. Investments in education, health, family planning, and school lunches are in a sense a humanitarian response to the plight of the world’s poorest countries. But in the economically and politically integrated world of the twenty-first century, they are also an investment in our future. 42
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