In the summer of 2003, at yet another symposium dedicated to struggling with the reality of the tenacious poverty and disease of the millennia, the Bellagio Study Group on Child Survival estimated that each year, 6 million children in 42 countries where 90% of child deaths occurred in 2000 could be saved; if only 23 proven health interventions for common ailments and diseases were deployed.
Yet this month, as pleas for more aid echo throughout the world, the UN reports that the basic development goals are still not being met:
"Slow economic growth, poor trade performance, continuing environmental degradation, debilitating HIV/AIDS pandemic, discouraging foreign direct investment and unmet ODA (overseas development assistance) commitments, compounded by a host of new challenges in a globalizing world make the development tasks of these countries extremely difficult," UN Under-Secretary-General Anwarul K. Chowdhury told a symposium on the global development agenda at UN Headquarters [June 1, 2005].
Meanwhile, a recent report: "Can the world afford to save the lives of 6 million children each year?", in the medical journal Lancet (subscription) follows-up the Bellagio study, and asks in the June 25th issue: What is the cost benefit analysis of meeting the challenge? The authors find that:
"US$5.1 billion in new resources is needed annually to save [the] 6 million child lives in the 42 countries [of the Bellagio Report]. This cost represents $1.23 per head in these countries, or an average cost per child life saved of $887. Sensitivity analyses for salary levels for community delivery agents, drug costs, and coverage rates for 2000 were used to develop uncertainty estimates around the US$5.1 billion annual price tag that range from about $3.1 billion to $8.0 billion."
The article assesses the Millenium Development Goals (MDG) of (among other things) reducing child mortality by two-thirds by 2015, and determines that "child survival is affordable for donors and developing countries". The hurdles will be the "lack of funds" and "scaling up health delivery".
In related news, The Ellison Medical Foundation has been announcing that they will bequeath $100 million dollars or so to Harvard University to start a global monitoring research center, purportedly to independently measure global health expenditures, delivery of services, and the impact on population health. The Ellison Foundation was dedicated to aging and global infectious diseases however they have dropped the global infectious diseases focus to target areas that are 'less well-funded'. [Headline philanthropy may be even more competitive than the software industry].
About development aid, there have always been debates, which oppose modernity or developmentalist ideals, argue for self-sufficiency, or oppose colonialist attitudes. Setting those aside, aid and global health initiatives are routinely justified via cost-benefit analyses, nationally and internationally. However notions that these are somehow conclusive are flawed. The models are sometimes necessarily limited. A vaccinated child does not only save himself, for instance, but the costs of care for those he may infect if unvaccinated.
Even more ponderous then methodological questions are the ethical considerations of this type of economics. For example, within the apparently burgeoning cost-benefit analysis industry, how are the cut offs discerned? At what point - perhaps not the $887 determined by the current study, but something more - $889? - or less? - where a certain life, to some, just isn't worth giving to? Despite proclamations about a culture of life? Or will we be consoled by ever more precisely balancing the cost of others lives- in order to ever so quietly bear with poverty and death on other continents? Do the goals behind the millions that will be spent for cost benefit analyses dare to propose to change anything?
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