The progress made towards reducing poverty and improving global health over the last 15 years surpasses that made in the whole history of mankind, explains Joe Cerrell. He outlines the story so far, what drove some of the main achievements, and stresses the importance of Britain’s commitment to overseas development aid.
This article is an abridged version of an essay in Our Today, Their Tomorrow, a collection published by Save the Children, which sets out a vision for Britain’s post-Brexit role in the world.
A recent cover story in the Spectator highlighted something that we at the Bill & Melinda Gates Foundation have been certain of for some time now: life is better now than it has ever been. For many people this is pretty hard to believe, and I have to admit that it’s something I’ve struggled with myself at times.
But the truth is that over the last 15 years the world has made more progress in reducing poverty and improving the health of the poorest people than in the whole history of mankind. And by 2035, there will be almost no countries left that would be described, by today’s standards, as “poor”.
Proof of Progress
In the early 19th century, every country was pretty poor and pretty sick. But slowly, thanks to innovation, the industrial and agricultural revolutions, and the spread of capitalism and democracy, the world has started to get better. The initial downside was the growth of inequality between the rich world and the rest. But in the 1970s Asia started to catch up, and over the last 15 years Africa has moved as well. In fact, progress has been so fast that the percentage of people living in extreme poverty has dropped by half since 1990. But it has been in health where the results have been most striking.
In the last 15 years child mortality has been cut in half – and maternal mortality has also nearly halved. In Africa child death rates are dropping five times faster than they did in the 1990s. We’ve also made real progress in fighting disease. In the 20th century at least 300 million people died of smallpox. In 1979 the world eradicated it forever.
In 1988 there were 350,000 cases of polio. Now, thanks to development of a vaccine by Jonas Salk which helped end polio in the UK and the US, and thanks to a concerted global effort, we are on the brink of eradicating it forever.
And thanks to the infrastructure built to beat polio in Nigeria, when Ebola struck, that country beat Ebola. In three months. On its own. When it comes to malaria, a disease that has crippled an entire continent, killing over 500,000 people in Africa every year and costing the continent US$12 billion a year in direct costs as well as reducing GDP growth by 1.3% annually, we’ve halved the death toll since the turn of the century.
Investment in simple measures like insecticide-treated mosquito nets and preventative treatment for pregnant women has been so successful that we continue to shrink the map of areas afflicted by malaria. And with some exciting new tools to tackle the disease under development, we believe it will be possible to achieve complete eradication within a generation.
What’s behind these achievements?
There is no doubt that some of this progress is driven by the amazing growth that comes from exposure to capitalism. A great deal of that progress has been due to the ingenuity, generosity and skill of scientists and inventors, many of them British. And credit also goes to the expansion of free trade, improved tax collection and the removal of corrupt and ineffective leaders by African people themselves.
But progress like this happened not because the world just stood back and let the market get on with it. It occurred because we harnessed the creative power of capitalism, using deliberate, sped up, interventions, funded by international development and philanthropic capital, to work for the world’s poorest people.
The market couldn’t have provided a solution on its own for a problem like Ebola, polio, or malaria with little or no profitable solution. It took government support for R&D to jumpstart the creativity and commitment of the private sector to be entrepreneurial and take investment risks.
Return on Investment
We know for a fact that health improvements also spur economic growth. The Lancet Commission on Investing in Health found that between 2000 and 2011, reductions in mortality due to health improvements accounted for at least 11% of the economic growth in the world’s low- and middle-income countries. As impressive as that number is we get even better results if we look at some of the specific project areas the British Government invests in.
Both the UK and the Gates Foundation are big backers of childhood vaccination, and of GAVI, the vaccine alliance. GAVI is a unique public-private partnership which pools investment from international partners – including the Department for International Development – and works with the pharmaceuticals industry to focus on developing and distributing vaccines.
Since its establishment in 2000 GAVI has reached 500 million children and prevented more than 7 million deaths in the process. And that’s not the half of it.
To establish the economic impact that vaccination has The Johns Hopkins Bloomberg School of Public Health recently examined the projected return on investment of vaccinations between 2011 and 2020 in 94 low- and middle-income countries. When looking only at the direct costs associated with illness, such as treatment and lost productivity, they found that the return on every pound spent on vaccines was £16. When they expanded their analysis to look at the broader economic impact of illness they found that the return was £44 for every £1 spent, a return on investment way better than what you might get on the stock market.
Open for business
These returns aren’t just good for people overseas; they benefit us as well as they help spur science, innovation and businesses here in the UK. Great British companies like GSK, which employees 16,000 people on 18 sites across the UK, are an integral part of the international development ecosystem due to the drugs they produce for people in the developing world, drugs that are often paid for through the international aid system.
But it isn’t just big companies that benefit. Vaccines need to be kept cold at all times and for years doctors and vaccinators struggled with how to get vaccines into remote, hard-to-reach locations around the world when battery power didn’t last long enough. Ian Tansley and a small company from Wales came up with a solution. SureChill is a unique freezer that freezes water and then uses the melting ice to keep its contents at 4°C – the perfect temperature for vaccine storage – without the need for a constant power source or access to the grid. As simple as it sounds, this is now one of the most important innovations saving children’s lives around the world.
Keeping us safe through the 2.7% commitment
These investments are also vital to keeping us safe. Diseases like Ebola and Zika and health emergencies like anti-microbial resistance threaten all of us; there is a significant chance that a substantially more infectious epidemic will come along over the next 20 years.
We can’t build a wall to hold back the next Spanish Influenza epidemic. We need to help build the surveillance and response systems to detect it. We need to be able to quickly develop a test for it and start to produce a cure. And we need basic health infrastructure to be available so that when a poor country is hit by an epidemic it can be dealt with fast and at source before its starts to spread. All of this means that investing in global health isn’t just a nice-to-have. It doesn’t just make moral and financial sense. It’s also firmly in the national interest and vital for the future safety and security of all of us.
The 0.7% commitment to overseas development aid stands proudly alongside the 2% commitment to national defence as the two sides of the soft and hard power that will keep Britain safe in the 21st century. With all the rest of government spending going to domestic concerns, it’s that 2.7% that will underpin the Global Britain of tomorrow.
Our Today, Their Tomorrow, published by Save the Children, includes essays from political and business leaders, diplomats and academics setting out ideas for the future of Britain’s foreign policy and overseas aid.
Joe Cerrell is Managing Director for Global Policy and Advocacy at the Gates Foundation’s European Office in London.
Image credit: Public Domain