Investing in people

BY: Suleiman Mustapha
Students line up to wash their hands before eating at Kanda Estate Primary School in Accra

Investing in health and education can, as we know, promote economic growth.  Furthermore, social protection programmes have been shown to stimulate local economies, as well as shield the disadvantaged from falling back into poverty.

No matter the level or prospects for economic growth, the bank plans to increase its efforts to insure poor people against the risks and looming disasters of modern life.  Well-off people already benefit from various forms of insurance; but everyone should have a safety net.  Too many people are living just one illness or accident away from destitution, even in a rich country such as the United States.


“We also know that investing in people, especially in their health and education is one of the most critical actions countries can take to promote economic growth”, said Dr Kim.

One of the bank’s most cherished and broadly shared values is the notion of equality of opportunity. In its quest to achieve equality of opportunity for all, we will have to invest in healthcare that will lead to what summers has called a “grand convergence” in health outcomes.

Among the investments in people we need to make, the most important one starts when a woman becomes pregnant.  It’s the combination of health and education, of investment and insurance, known as early childhood development.

Twenty-six per cent of all children under five in developing countries are stunted, a condition in which children are not only malnourished and under-stimulated but risk a loss of cognitive abilities that lasts a lifetime. In sub-Saharan Africa, some 36 per cent of children are stunted. That’s nearly four in 10 of sub-Saharan Africa’s children with limited prospects in life.  This is a disgrace; a global scandal and, in my view, a medical emergency.

When an infant brain is not fully developed, whether from malnutrition, toxic stress or a lack of stimulation, the neural connections just don’t form. Once a child loses those neural connections, the damage is permanent to areas of the brain involved in learning, emotions and response to stress.  An impaired prefrontal cortex affects the emergence of a young child’s self-regulatory skills, cascading in a short time to serious problems for their executive function, working memory and adaptability to change.

What does this have to do with shared prosperity?

Everything: Children who are stunted by age five will not have an equal opportunity in life.  There can be no equality of opportunity without proper antenatal care for mothers; or the appropriate stimulation, nurturing, and nutrition for infants and young children. Conditions of poverty, toxic stress and conflict will have produced such damage that they may never be able to make the best of any future opportunities.  If your brain won’t let you learn and adapt in a fast changing world, you won’t prosper and, neither will society.  All of us lose.

At the World Bank Group, we are committed to effective action on early childhood development.  We have identified five packages of 25 services for families with young children all based on strong evidence.

From 2001 to 2013, the World Bank has invested US$3.3 billion dollars in early childhood development programmes around the world – in Haiti, Indonesia, Jamaica, Lesotho, Mozambique, Russia and Vietnam. More programmes in more countries are in the works.  But we must do even more. Every country has to invest.

What we need now is an ambitious goal that will help drive our work in early childhood development.  For childhood stunting, there is in fact a goal, set in 2012:  a global target to reduce stunting in children by 40 per cent by 2025.  But that would still leave 100 million stunted children, and that’s not ambitious enough.  With strong leadership from UNICEF, the World Health Organisation and from new partners such as the world’s No.1 men’s tennis player, Novak Djokovic, whose foundation is working with us and the Serbian government to improve early childhood development programmes, we must aim higher.

If equality of opportunity is a value that we indeed all share, and we are serious about boosting shared prosperity, we need to work together to set a target to end stunting for all children as quickly as possible and well before 2030.

But we shouldn’t stop there.  Even before primary school, all children should have access to preschool.  In New York last week, I met with President Santos of Colombia who had just signed a peace agreement that will bring an end to the last remaining conflict in Latin America.

Even in the face of conflict, President Santos has moved aggressively to increase access to preschool, knowing that it’s not a luxury. This is the kind of leadership we need. Preschool is another great investment:  every dollar spent closing the gap in pre-primary education between the well-off and the poor will return between US$6 and US$17.

For shared prosperity to endure so that people, once having lifted themselves from poverty aren’t plunged back into it, we have to rethink our role in an unstable world riven by conflict, crisis, pandemics and climate change.

Who is most at risk during times of crisis?  Poor people. Last year, Ebola struck three of the world’s poorest countries – Guinea, Liberia and Sierra Leone. The months of global inaction to fight the epidemic – and the deaths of more than 11,000 people – can be directly tied to the poverty of those countries.  Many of those who died were among the extreme poor, whereas the survival rate among Americans who contracted the virus was 100 per cent.  We must not do now as we’ve always done – panic while the crisis rages, neglect when the headlines fade. 

World Bank and Ebola

The World Bank Group will not forget the lessons of Ebola.  We are now working on a global pandemic facility that will effectively provide insurance to poor countries for whenever the next epidemic strikes. To prevent the outbreak from reaching pandemic proportions, the facility would rapidly release funds for trained personnel to respond immediately.

Disbursements of up to hundreds of millions of dollars will support first responders:  If they can stop the epidemic quickly, they will save many, many lives and prevent enormous economic losses. The facility will be a critical part of a larger pandemic response capacity we are current building that we hope will finally be equal to the challenge.

If a flu outbreak like the one that killed millions of people in 1918 happened today, it could claim tens of millions of lives and cost the world five to 10 percent of global GDP, roughly US$4 to US$8 trillion dollars.  But today, we’re not ready to stop such a pandemic. And as with all natural disasters, it’s the poor who will suffer the most.

In difficult times, when we are concerned about growing inequality, worried about the health of our planet and future pandemics, and outraged that one-quarter of all children in developing countries are stunted, we must tackle the biggest problems with only the highest aspirations. Only then will we be successful.

“I’ve said it many times: When you’re fighting extreme poverty, optimism is a moral choice.  Pessimism in the face of extreme poverty can become a self-fulfilling prophesy that is deadly for the poor”, Dr Kim said.

“Our goals of ending extreme poverty by 2030 and boosting shared prosperity are not just slogans. We’re serious about them”, he added. — GB