research institute for compassionate economics

Is health small development?

Written by Dean Spears on April 19th, 2012

It’s been official since Monday: Jim Yong Kim will be the next president of the World Bank. President Obama’s nomination was controversial for many reasons — not least the mere fact that the U.S. president gets to pick the president of the World Bank.

One reason may be that the nomination made salient a difference in views about what “development” should be about: small programs targeted at the neediest, ofted implemented by non-profits, or large programs aiming for economic growth and systemic change, by necessity implemented by governments? As a founder of Partners in Health — an organization that got its start treating sick people in Haiti — Jim Kim is praised or criticised as an emblem of the “Small Development” approach.

This is the thesis of Michael Woolcock’s recent blog post: that we in the poor people industry are divided among those emphasizing Big Development and those advocating Small Development. Thinking back on my MPA classes and the cost-effectiveness estimates of J-PAL briefcases, Small Development doesn’t seem like an overly uncharitable caricature of how we sometimes talk these days.

What Development folks talk about has shifted from growth towards health, and part of the implication of all of this is that health is Small Development. Woolcock is careful not to make that claim, and mentions major public health investments as an important part of what Big Development can do. But Dr. Kim’s focus on treating infectious disease seems to be as open to a critique of missing the transformative forest for the charitable trees as anything could be.

So, is health Small Development? I don’t know, but there’s nothing small sanitation. As I have argued here before, safe excreta disposal saves babies and reduces illness, but it also builds human capital and makes children smarter — almost certainly making workers more productive. India has worse sanitation coverage today than poorer African countries had 20 years ago, which may explain much of why Indian children are so puzzlingly short.

Over the past few years, evidence has been mounting that investing in early life health is investing in adult productivity, in a big way. Maybe you like Small Development; maybe you think Big. But whether your heart bleeds for dying babies, or you worry about the pace of nations, sanitation in India may be one of the first steps to take.