Flipping through television programs, lamenting over filing taxes, or mediating post-holiday-meal banter between family members, we all eventually end up on the topic. "Foreign Aid" inevitably weaves its way through many of our personal conversations about domestic affairs and national spending, because at the end of the day, it's our taxpayer dollars that are being sent overseas, and it is our business as Americans to make sure the investments are wise and productive. Whether you're watching Bono duke it out with G8 leaders in televised arenas, or calming granpda down as he criticizes 'those damn [Democrats/Republicans]', the issue of foreign aid is anything but foreign to Americans.
We are undisputably one of the richest nations in the world, fluctuating among the top ten highest GDP/capita nations. Only $2,200 in assets puts you in the top half of the world's wealthiest people, and with $61,000 in assets, you shoot up to joining the 2% of the world's wealthiest. CRAZY.
America is exponentially better off than the 53% who live on less than $2/day (yes even fathers and mothers with families to raise) and certainly luxurious living compared to the 20% of our global neighbors living on less than $1/day. Let that SOAK IN for a minute. That's reality.
As a non-isolationist nation we have a responsibility to attend to the needs of our fellow global citizens. Not only would neglect be inhumane, unjust, and heartless, but more pragmatically, it is foolish to discount the potential benefits one would reap from giving stability, security, and health to billions of our global neighbors. Productivity and innovation would increase, not to mention basic human dignity.
Few would realistically argue that the U.S. should not provide foreign aid. However, contentions abound when the discussion begins on how best to give foreign aid: to whom? for what programs? in what amounts? on what conditions?
In 2006, the U.S. gave 0.17% of her national budget to foreign aid. Fabulous folks like Bono and Jeff Sachs are pressuring for at least 1%, but how do we know that more is better? Is .17% a cowardly shame or a wise decision? What's our track record? Has our foreign aid in the past been effective at all in sparking economic growth in recipient nations?
Research on aid effectiveness to date has primarily analyzed the macroeconomic impacts of aid on recipient country economic growth, savings, and investment, and has consistently yielded inconclusive results. Aid-efficacy studies relate economic growth as a dependent variable to many causal independent variables including foreign aid - these other variables include everything from economic measures to human development indicators (infant mortality, primary school ratios, life expectancy). Researchers continue to try and find a relationship between aid and growth - what is is about some countries that aid is effective? Why has is been ineffective in so many places?
Among many significant contributions to the literature, one notable discovery of how aid can be effective was authored by Craig Burnside and David Dollar in 2000,(click here and scroll to bottom to download free from SSRN). They concluded contrary to common conclusions that aid actually could impact macroeconomic growth, but only when recipient nations endorse specific ‘good’ policies. They found that aid has a positive impact on growth in developing countries with good fiscal, monetary, and trade policies, but has no effect on growth in countries with poor policies. Most significantly, they introduced the idea that policies and institutions of the recipient nation matter if aid is to improve and not hamper development.
However the theory has been challenged, with particular efficacy by William Easterly et al (click and scroll again to DL) , who determined with the same model and expanded data (countries and years) that not even in countries with deemed ‘good policies’ could aid be proven to promote economic growth.
After all the running of regressions and number crunching and data analysis...the effects of foreign aid on a recipient country's economic growth presently remain inconclusive. But if we don't know how to give effectively, why should we keep dumping billions of our taxpayer dollars into the foreign aid system?
[As I have mentioned, my thesis falls out of the overarching foreign aid conundrum, focusing specifically on the relationship between AIDS-specific foreign aid and HIV rates (in parallel to general foreign aid and rates of economic growth). The same questions arise in this sub-section, as there is abundant speculation over the billions presently being spent on HIV/AIDS. Do we not give enough, or give too much? Are we spending it effectively?]
Funny how we get ahead of ourselves, though it feels quite natural to want to act urgently when the allocation of resources and wealth in the world is disproportionate to the point of disorientation. There is an enormous desire to tip the scale just for dignity's sake. But compassion is rarely what tips the scale and approves the budget requests. Strategic interests and need for political concessions predominantly determines who receives aid. So naturally, when aid is received by leaders who have made bilateral deals and arrangements, leaders who run systems where accountability to the general public is neither practiced nor enforced, the aid spills into personal accounts, and rarely reaches the people in need.
The intersection of power and resources, without a traffic light of coordination, quickly becomes a scene of collisions, destruction, and chaos. Especially when the police aren't enforcing, and when the drivers speed through, feeling accountable to no one else on the road. It's no surprise to see the gridlock and people waiting. Accidents and people dying. Frustration and people fighting.
Some people conclude that ineffective aid means we should stop giving. But many people continue to demand governments like the US give more, because we can. Personally, I am infuriated to my core watching people wait for promised aid who know in their hearts they are waiting for nothing (a clinic with no doctor, a line with no food at the end, a well queue with no clean water at the bottom). To suggest stopping aid seems as unjust as continuing our current, corrupted system: a guarantee that the poor will always be waiting, suffering, bearing injustice.
Rather, a diligently monitored and sufficiently financed reform effort of foreign aid systems seems to be a worthy global agenda item. In a world as rich as ours there is absolutely no reason, beyond pure human greed and insecurity, that anyone should have to raise a family on less than $1/day. And I don't believe it's a matter of not caring...if it didn't somehow effect the safety and security of Bono or grandpa, they wouldn't be bickering about it.
Whether this issue tears at your heart, concerns your reputation, or simply matters to your wallet, I encourage you to learn more about US Foreign Aid in the many links within this article. The situation is far from hopeless, but like most major issues, is merely a matter of political will and coordination of actors. If we want to help poor people, we should not give money to national governments. But if we want national governments to become less corrupt and likely to steal foreign aid, we need to seriously reverse our current track record of supporting corruption.
At the risk of concluding on useless vaguery, an example of reform's potential for progress:
We are undisputably one of the richest nations in the world, fluctuating among the top ten highest GDP/capita nations. Only $2,200 in assets puts you in the top half of the world's wealthiest people, and with $61,000 in assets, you shoot up to joining the 2% of the world's wealthiest. CRAZY.
America is exponentially better off than the 53% who live on less than $2/day (yes even fathers and mothers with families to raise) and certainly luxurious living compared to the 20% of our global neighbors living on less than $1/day. Let that SOAK IN for a minute. That's reality.
As a non-isolationist nation we have a responsibility to attend to the needs of our fellow global citizens. Not only would neglect be inhumane, unjust, and heartless, but more pragmatically, it is foolish to discount the potential benefits one would reap from giving stability, security, and health to billions of our global neighbors. Productivity and innovation would increase, not to mention basic human dignity.
Few would realistically argue that the U.S. should not provide foreign aid. However, contentions abound when the discussion begins on how best to give foreign aid: to whom? for what programs? in what amounts? on what conditions?
In 2006, the U.S. gave 0.17% of her national budget to foreign aid. Fabulous folks like Bono and Jeff Sachs are pressuring for at least 1%, but how do we know that more is better? Is .17% a cowardly shame or a wise decision? What's our track record? Has our foreign aid in the past been effective at all in sparking economic growth in recipient nations?
Research on aid effectiveness to date has primarily analyzed the macroeconomic impacts of aid on recipient country economic growth, savings, and investment, and has consistently yielded inconclusive results. Aid-efficacy studies relate economic growth as a dependent variable to many causal independent variables including foreign aid - these other variables include everything from economic measures to human development indicators (infant mortality, primary school ratios, life expectancy). Researchers continue to try and find a relationship between aid and growth - what is is about some countries that aid is effective? Why has is been ineffective in so many places?
Among many significant contributions to the literature, one notable discovery of how aid can be effective was authored by Craig Burnside and David Dollar in 2000,(click here and scroll to bottom to download free from SSRN). They concluded contrary to common conclusions that aid actually could impact macroeconomic growth, but only when recipient nations endorse specific ‘good’ policies. They found that aid has a positive impact on growth in developing countries with good fiscal, monetary, and trade policies, but has no effect on growth in countries with poor policies. Most significantly, they introduced the idea that policies and institutions of the recipient nation matter if aid is to improve and not hamper development.
However the theory has been challenged, with particular efficacy by William Easterly et al (click and scroll again to DL) , who determined with the same model and expanded data (countries and years) that not even in countries with deemed ‘good policies’ could aid be proven to promote economic growth.
After all the running of regressions and number crunching and data analysis...the effects of foreign aid on a recipient country's economic growth presently remain inconclusive. But if we don't know how to give effectively, why should we keep dumping billions of our taxpayer dollars into the foreign aid system?
[As I have mentioned, my thesis falls out of the overarching foreign aid conundrum, focusing specifically on the relationship between AIDS-specific foreign aid and HIV rates (in parallel to general foreign aid and rates of economic growth). The same questions arise in this sub-section, as there is abundant speculation over the billions presently being spent on HIV/AIDS. Do we not give enough, or give too much? Are we spending it effectively?]
Funny how we get ahead of ourselves, though it feels quite natural to want to act urgently when the allocation of resources and wealth in the world is disproportionate to the point of disorientation. There is an enormous desire to tip the scale just for dignity's sake. But compassion is rarely what tips the scale and approves the budget requests. Strategic interests and need for political concessions predominantly determines who receives aid. So naturally, when aid is received by leaders who have made bilateral deals and arrangements, leaders who run systems where accountability to the general public is neither practiced nor enforced, the aid spills into personal accounts, and rarely reaches the people in need.
The intersection of power and resources, without a traffic light of coordination, quickly becomes a scene of collisions, destruction, and chaos. Especially when the police aren't enforcing, and when the drivers speed through, feeling accountable to no one else on the road. It's no surprise to see the gridlock and people waiting. Accidents and people dying. Frustration and people fighting.
Some people conclude that ineffective aid means we should stop giving. But many people continue to demand governments like the US give more, because we can. Personally, I am infuriated to my core watching people wait for promised aid who know in their hearts they are waiting for nothing (a clinic with no doctor, a line with no food at the end, a well queue with no clean water at the bottom). To suggest stopping aid seems as unjust as continuing our current, corrupted system: a guarantee that the poor will always be waiting, suffering, bearing injustice.
Rather, a diligently monitored and sufficiently financed reform effort of foreign aid systems seems to be a worthy global agenda item. In a world as rich as ours there is absolutely no reason, beyond pure human greed and insecurity, that anyone should have to raise a family on less than $1/day. And I don't believe it's a matter of not caring...if it didn't somehow effect the safety and security of Bono or grandpa, they wouldn't be bickering about it.
Whether this issue tears at your heart, concerns your reputation, or simply matters to your wallet, I encourage you to learn more about US Foreign Aid in the many links within this article. The situation is far from hopeless, but like most major issues, is merely a matter of political will and coordination of actors. If we want to help poor people, we should not give money to national governments. But if we want national governments to become less corrupt and likely to steal foreign aid, we need to seriously reverse our current track record of supporting corruption.
At the risk of concluding on useless vaguery, an example of reform's potential for progress:
The antiretroviral drug Nevirapine has been clinically proven to half the chance of an infected mother passing HIV to her child during pregnancy, birth, or breastfeeding. Nevirapine is an incredibly hopeful advance in the prevention of new cases of HIV in resource poor settings, because it is so simple that even mothers in rural areas, where many women give birth with just a midwife and no doctor, can easily receive the pill. Nevirapine is certainly not without its controversies and imperfections, but widely agreed upon as the best option for prevention of mother-child transmission in resource poor settings.
Imagine if we were able to prevent ALL mother to child transmission? No children born with AIDS! We wold need to responsibly 1. make the drug the safest it can be and 2. mass distribute. The simplicity of a single pill is easy enough to supply to doctors and midwives all over the world (or rather, simpler than complicated drug regimens that are difficult to adhere to or require refrigeration). Researching, perfecting, and producing the drug is possible. But the logistics of distribution are complicated. Dollars earmarked for HIV-prevention don't just transform into Nevirapine. In this example we need professional doctors to give the drug, hospitals and clinics at which woman can give birth and get the drug, clean water with which to take the drug. It's great to give a magic pill but it's cruel to give that if the surrounding necessities are not in place.
Nevirapine's potential to end the transmission from mother to child - a revolutionary advance - demonstrates the need for coordinated actors and shared responsibility. The pharmaceutical industry needs to recognize the emergency and the potential of the drug to respond, and invest more time and resources into AIDS drug research - make the drugs the best and easiest to take that they can be. Rich countries need to monitor massive aid to build hospitals and hire doctors in poor countries. Smaller organizations, social entrepreneurs, and innovative projects and programs can supplement this national-level reform that is not achievable by non-governmental actors. Effective, specific efforts would ensure and increase use of improved health systems: sponsoring patients at hospitals and clinics for their medication, providing cars to rural communities or district hospitals to allow drugs to be delivered (although the roads are often unnavigable!), or training community members to serve as health-care workers to do simple tasks like giving Nevirapine that don't require an M.D.
What emerges is a tier of primary and secondary concerns that we hate to admit exists, because it seems inhumane to categorize the provision of lifesaving drugs to be 'secondary'. But pragmatically, the drugs won't work without doctors and clinics and food and water. However we absolutely cannot wait until primary concerns are solved - they will never wholly be - before we attack the secondary. Rather we must agree internationally on who will conquer what, how, and when.
Imagine if we were able to prevent ALL mother to child transmission? No children born with AIDS! We wold need to responsibly 1. make the drug the safest it can be and 2. mass distribute. The simplicity of a single pill is easy enough to supply to doctors and midwives all over the world (or rather, simpler than complicated drug regimens that are difficult to adhere to or require refrigeration). Researching, perfecting, and producing the drug is possible. But the logistics of distribution are complicated. Dollars earmarked for HIV-prevention don't just transform into Nevirapine. In this example we need professional doctors to give the drug, hospitals and clinics at which woman can give birth and get the drug, clean water with which to take the drug. It's great to give a magic pill but it's cruel to give that if the surrounding necessities are not in place.
Nevirapine's potential to end the transmission from mother to child - a revolutionary advance - demonstrates the need for coordinated actors and shared responsibility. The pharmaceutical industry needs to recognize the emergency and the potential of the drug to respond, and invest more time and resources into AIDS drug research - make the drugs the best and easiest to take that they can be. Rich countries need to monitor massive aid to build hospitals and hire doctors in poor countries. Smaller organizations, social entrepreneurs, and innovative projects and programs can supplement this national-level reform that is not achievable by non-governmental actors. Effective, specific efforts would ensure and increase use of improved health systems: sponsoring patients at hospitals and clinics for their medication, providing cars to rural communities or district hospitals to allow drugs to be delivered (although the roads are often unnavigable!), or training community members to serve as health-care workers to do simple tasks like giving Nevirapine that don't require an M.D.
What emerges is a tier of primary and secondary concerns that we hate to admit exists, because it seems inhumane to categorize the provision of lifesaving drugs to be 'secondary'. But pragmatically, the drugs won't work without doctors and clinics and food and water. However we absolutely cannot wait until primary concerns are solved - they will never wholly be - before we attack the secondary. Rather we must agree internationally on who will conquer what, how, and when.
We need coordination - a much better traffic light - because even though our cars our bigger and safer and virtually indestructible, we are all driving on the same road. At the end of our American day, certainly our national security and economic stability are top concerns, and these are two major reasons that dictate who we give to and in what amounts. But the well-being and humane treatment of our global neighbors is not mutually exclusive. It's not one or the other. And if we can be innovative and visionary enough, we can design a system where each perpetuates the other.
And to give this our best most responsible effort, we need data, to be informed! Next time, further focus on HIV/AIDS: how is the disease progressing and has AIDS-specific foreign aid been effective?
All questions and comments are greatly appreciated!
And to give this our best most responsible effort, we need data, to be informed! Next time, further focus on HIV/AIDS: how is the disease progressing and has AIDS-specific foreign aid been effective?
All questions and comments are greatly appreciated!
3 comments:
siharitiria, rinaki.
well-organized set of questions, and i believe, to slap cliche a big high-five, you are asking the right ones.
i, myself, have grappled perhaps not with the issues of finance circulation as they pertain to the HIV/AIDS situation, but more conceptually, and more in the context of exchange from people to governments (e.g. TOURISM) as opposed to the other way around (e.g. FOREIGN AID). and naturally, as an anthropologist, my levels of analysis tend to be thick as a mrs. otto baklava, so excuse that the following thoughts sprawl languidly across those layers...
one thing i have consistently noticed as it applies to my own research, and i imagine in this case as well as others (AND, which isn't a new or original thought in the least), is the dichotomy of behavior in positions of real power. many enter politics because they want to effect real change - others enter it in order to prevent it. some enter the medical profession to perpetuate a sense of nurturing and specificity and small-scale compassion, while for others it is a widely recognized, highly professionalized field for which one is bound to be respected and well-paid. i don't mean to imply that all of these career decisions are black and white, that people don't have overlapping and complex reasons for choosing a profession. however, my point is to set the foreground for critiquing our own critiques:
one of the biggest difficulties i have had in my own research is with regards to 'the blame game.' who do we blame for the situation of the poor? conservation authorities? governments? multinationals? the tourists who so often CREATE THE MARKET FOR INEQUALITY? (and, in turn, is 'the blame game' a dangerous one? we must recognize the danger in pointing fingers [vis-a-vis laying out a situation as if it were a two-dimensional web of connections] just as much as we recognize its marketing value/efficacy in garnering moral and financial support. it's hard to generalize, as each situation has its own nuances, as well.)
just as a child that finds a perfectly legitimate reason to ask 'why?' after every answer, so seems to be the anthropologist's task in figuring out the true "root" of the problem. and it would truly be naive to say that there was, in fact, one straight answer. our daily schedules can get complicated enough, why should we assume that international health issues should be simply a matter of troubleshooting, finding the "link that doesn't connect"?
again, forgive me for bludgeoning through multiple layers of analysis simultaneously. there is absolutely no disagreement to anything you've pointed out, if anything my "softer" analyses aim simply to establish the peripheral web of of theory, philosophy, ethics, and human nature around the pragmatic center of PROBLEM NEEDS SOLUTION.
Though HIV/AIDS is a most appropriate application of the questions you are raising, I believe that your thoughts are legitimate as any could be in terms of structural inequalities in many other contexts.
Personally, I think the most interesting part of the whole issues is the telephone-game of money-passing...as I said before my research is more headed in the direction of Person gets money from job, person gives money to another government through tourism, other government [Gives money to its people???]... your interests involve a slight change in the middle slep...person gives money to OUR government through taxes, and then the additional step of allocation and proportions and implementation, before the question of the final step of [Government to people??]
forgive me that my thoughts were so disorganized - i enjoyed reading your account and the papers are very good at contextualizing broader arguments.
eager to hear your response.
i realize that the point about the career choice was not followed up appropriately- what i meant with that in relation to the blame game was that sometimes it feels pretentious to place blame on an institution, knowing that some people try to work through the system to change the system (i.e. some amazing doctors, politicians, etc...) and so placing blame on an institution feels SO RIGHT sometimes, yet somehow so weird, on the individual level
again, not that it doesn't have its own effective purposes, or that people need a target or a goal, but just that sometimes it's not as easy as yanking out a weed
I was thrilled to find your blog - PEPFAR and GFATM, and their effectiveness or lack thereof, are special interests of mine. I look forward to reading your future posts!
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