We can banish extreme poverty in our generation--yet 8
million people die each year because they are too poor
to survive. The trag edy is that with a little help,
they could even thrive. In a bold new book, Jeffrey D.
Sachs shows how we can make it happen

It is still midmorning in Malawi when we arrive at a
small village, Nthandire, about an hour outside of
Lilongwe, the capital. We have come over dirt roads,
passing women and children walking barefoot with water
jugs, wood for fuel, and other bundles. The midmorning
temperature is sweltering. In this subsistence
maize-growing region of a poor, landlocked country in
southern Africa, families cling to life on an
unforgiving terrain. This year has been a lot more
difficult than usual because the rains have failed.
The crops are withering in the fields that we pass.

If the village were filled with able-bodied men, who
could have built rainwater-collecting units on
rooftops and in the fields, the situation would not be
so dire. But as we arrive in the village, we see no
able-bodied young men at all. In fact, older women and
dozens of children greet us, but there is not a young
man or woman in sight. Where, we ask, are the workers?
Out in the fields? The aid worker who has led us to
the village shakes his head sadly and says no. Nearly
all are dead. The village has been devastated by AIDS.

The presence of death in Nthandire has been
overwhelming in recent years. The grandmothers whom we
meet are guardians for their orphaned grandchildren.
The margin of survival is extraordinarily narrow;
sometimes it closes entirely. One woman we meet in
front of her mud hut has 15 orphaned grandchildren.
Her small farm plot, a little more than an acre in
all, would be too small to feed her family even if the
rains had been plentiful. The soil nutrients have been
depleted so significantly in this part of Malawi that
crop yields reach only about a half-ton per acre,
about one-third of normal. This year, because of the
drought, she will get almost nothing. She reaches into
her apron and pulls out a handful of semi-rotten,
bug-infested millet, which will be the basis for the
gruel she will prepare for the meal that evening. It
will be the one meal the children have that day.

I ask her about the health of the children. She points
to a child of about 4 and says that the girl
contracted malaria the week before. The woman had
carried her grandchild on her back for the six miles
to the local hospital. When they got there, there was

no quinine, the antimalarial medicine, available that
day. With the child in high fever, the two were sent
home and told to return the next day. In a small
miracle, when they returned after another six-mile
trek, the quinine had come in, and the child responded
to treatment and survived. It was a close call though.
More than 1 million African children, and perhaps as
many as 3 million, succumb to malaria each year.

As we proceed through the village, I stoop down to ask
one of the young girls her name and age. She looks
about 7 or 8 but is actually 12, stunted from years of
undernutrition. When I ask her what her dreams are for
her own life, she says that she wants to be a teacher
and that she is prepared to study and work hard to
achieve that. I know that her chances of surviving to
go on to secondary school and a teachers college are
slim under the circumstances.

The plight of Malawi has been rightly described by
Carol Bellamy, head of UNICEF, as the perfect storm of
human deprivation, one that brings together climatic
disaster, impoverishment, the AIDS pandemic and the
long-standing burdens of malaria, schistosomiasis and
other diseases. In the face of this horrific
maelstrom, the world community has so far displayed a
fair bit of hand-wringing and even some high-minded
rhetoric, but precious little action. It is no good to
lecture the dying that they should have done better
with their lot in life. Rather it is our task to help
them onto the ladder of development, to give them at
least a foothold on the bottom rung, from which they

can then proceed to climb on their own.

This is a story about ending poverty in our time. It
is not a forecast. I am not predicting what will
happen, only explaining what can happen. Currently,
more than 8 million people around the world die each
year because they are too poor to stay alive. Every
morning our newspapers could report, "More than 20,000
people perished yesterday of extreme poverty." How?
The poor die in hospital wards that lack drugs, in
villages that lack antimalarial bed nets, in houses
that lack safe drinking water. They die namelessly,
without public comment. Sadly, such stories rarely get
written.

Since Sept. 11, 2001, the U.S. has launched a war on
terrorism, but it has neglected the deeper causes of
global instability. The nearly $500 billion that the
U.S. will spend this year on the military will never
buy lasting peace if the U.S. continues to spend only
one-thirtieth of that, around $16 billion, to address
the plight of the poorest of the poor, whose societies
are destabilized by extreme poverty. The $16 billion
represents 0.15% of U.S. income, just 15¢ on every
$100 of our national income. The share devoted to
helping the poor has declined for decades and is a
tiny fraction of what the U.S. has repeatedly
promised, and failed, to give.

Yet our generation, in the U.S. and abroad, can choose
to end extreme poverty by the year 2025. To do it, we
need to adopt a new method, which I call "clinical
economics," to underscore the similarities between
good development economics and good clinical medicine.
In the past quarter-century, the development economics
imposed by rich countries on the poorest countries has
been too much like medicine in the 18th century, when
doctors used leeches to draw blood from their
patients, often killing them in the process.
Development economics needs an overhaul in order to be
much more like modern medicine, a profession of rigor,
insight and practicality. The sources of poverty are
multidimensional. So are the solutions. In my view,
clean water, productive soils and a functioning
health-care system are just as relevant to development
as foreign exchange rates. The task of ending extreme
poverty is a collective one--for you as well as for
me. The end of poverty will require a global network
of cooperation among people who have never met and who
do not necessarily trust one another.

One part of the puzzle is relatively easy. Most people
in the world, with a little bit of prodding, would
accept the fact that schools, clinics, roads,
electricity, ports, soil nutrients, clean water and

sanitation are the basic necessities not only for a
life of dignity and health but also to make an economy
work. They would also accept the fact that the poor
may need help to meet their basic needs. But they
might be skeptical that the world could pull off any
effective way to give that help. If the poor are poor
because they are lazy or their governments are
corrupt, how could global cooperation help?

Fortunately, these common beliefs are
misconceptions--only a small part of the explanation
of why the poor are poor. In all corners of the world,
the poor face structural challenges that keep them
from getting even their first foot on the ladder of
development. Most societies with the right
ingredients--good harbors, close contacts with the
rich world, favorable climates, adequate energy
sources and freedom from epidemic disease--have
escaped extreme poverty. The world's remaining
challenge is not mainly to overcome laziness and
corruption, but rather to take on the solvable
problems of geographic isolation, disease and natural
hazards, and to do so with new arrangements of
political responsibility that can get the job done. We
need plans, systems, mutual accountability and
financing mechanisms. But even before we have all of
that apparatus in place--what I call the economic
plumbing--we must first understand more concretely
what such a strategy means to the people who can be
helped.

Nearly half the 6 billion people in the world are
poor. As a matter of definition, there are three
degrees of poverty: extreme (or absolute) poverty,

moderate poverty and relative poverty. Extreme
poverty, defined by the World Bank as getting by on an
income of less than $1 a day, means that households
cannot meet basic needs for survival. They are
chronically hungry, unable to get health care, lack
safe drinking water and sanitation, cannot afford
education for their children and perhaps lack
rudimentary shelter--a roof to keep rain out of the
hut--and basic articles of clothing, like shoes. We
can describe extreme poverty as "the poverty that
kills." Unlike moderate or relative poverty, extreme
poverty now exists only in developing countries.
Moderate poverty, defined as living on $1 to $2 a day,
refers to conditions in which basic needs are met, but
just barely. Being in relative poverty, defined by a
household income level below a given proportion of the
national average, means lacking things that the middle
class now takes for granted.

The total number of people living in extreme poverty,
the World Bank estimates, is 1.1 billion, down from
1.5 billion in 1981. While that is progress, much of
the one-sixth of humanity in extreme poverty suffers
the ravages of AIDS, drought, isolation and civil
wars, and is thereby trapped in a vicious cycle of
deprivation and death. Moreover, while the economic
boom in East Asia has helped reduce the proportion of
the extreme poor in that region from 58% in 1981 to
15% in 2001, and in South Asia from 52% to 31%, the
situation is deeply entrenched in Africa, where almost
half of the continent's population lives in extreme
poverty--a proportion that has actually grown worse
over the past two decades as the rest of the world has
grown more prosperous.

A few centuries ago, vast divides in wealth and
poverty around the world did not exist. Just about
everybody was poor, with the exception of a very small
minority of rulers and large landowners. Life was as
difficult in much of Europe as it was in India or
China. Your great-great-grandparents were, with very
few exceptions, poor and living on a farm. The onset
of the Industrial Revolution, supported by a rise in
agricultural productivity, unleashed an explosive
period of modern economic growth. Both population and
per-capita income came unstuck, rising at rates never
before imagined. The global population rose more than
sixfold in just two centuries, while the world's
average per-capita income rose even faster, increasing
around ninefold between 1820 and 2000. In today's rich
countries, the economic growth was even more
astounding. The U.S. per-capita income increased

almost 25-fold during this period. In beholding that
success, many people embrace faulty social theories of
those differences. When a society is economically
dominant, it is easy for its members to assume that
such dominance reflects a deeper superiority--whether
religious, racial, genetic, ethnic, cultural or
institutional--rather than an accident of timing or
geography.

Such theories justified brutal forms of exploitation
of the poor during colonial rule, and they persist
even today among those who lack an understanding of
what happened and is still happening in the Third
World. In fact, the failure of the Third World to grow
as rapidly as the First World is the result of a
complex mix of factors, some geographical, some
historical and some political. Imperial rule often
left the conquered regions bereft of education, health
care, indigenous political leadership and adequate
physical infrastructure. Often, newly independent
countries in the post--World War II period made
disastrous political choices, such as socialist
economic models or a drive for self-sufficiency behind
inefficient trade barriers. But perhaps most pertinent
today, many regions that got left furthest behind have
faced special obstacles and hardships: diseases such
as malaria, drought-prone climates in locations not
suitable for irrigation, extreme isolation in
mountains and landlocked regions, an absence of energy
resources such as coal, gas and oil, and other
liabilities that have kept these areas outside of the
mainstream of global economic growth. Countries

ranging from Bolivia to Malawi to Afghanistan face
challenges almost unknown in the rich world,
challenges that are at first harrowing to contemplate,
but on second thought encouraging in the sense that
they also lend themselves to practical solutions.

In the past quarter-century, when poor countries have
pleaded with the rich world for help, they have been
sent to the world money doctor, the International
Monetary Fund. For a quarter-century, and changing
only very recently, the main IMF prescription has been
budgetary belt-tightening for patients much too poor
to own belts. IMF-led austerity has frequently
resulted in riots, coups and the collapse of public
services. Finally, however, that approach is beginning
to change.

It has taken me 20 years to understand what good
development economics should be, and I am still
learning. In my role as director of the U.N.
Millennium Project, which has the goal of helping to
cut the world's extreme poverty in half by 2015, I
spent several eye-opening days with colleagues last
July in a group of eight Kenyan villages known as the
Sauri sublocation in the Siaya district of Nyanza
province. We visited farms, clinics, hospitals and
schools. We found a region beset by hunger, AIDS and
malaria. The situation is grim, but salvageable.

More than 200 members of the community came to meet
with us one afternoon. Hungry, thin and ill, they
stayed for 3 1/2 hours, speaking with dignity,
eloquence and clarity about their predicament. They
are impoverished, but they are capable and
resourceful. Though struggling to survive, they are
not dispirited but are determined to improve their
situation. They know well how they could get back to
high ground.

The meeting took place on the grounds of a school
called the Bar Sauri Primary School, where
headmistress Anne Marcelline Omolo shepherds hundreds
of schoolchildren through primary education and the
travails of daily life. Despite disease, orphanhood
and hunger, all 33 of last year's eighth-grade class
passed the Kenyan national secondary-school exams. On
a Sunday last July, we saw why. On their "day off"
from school, this year's class of eighth-graders sat
at their desks from 6:30 a.m. until 6 p.m. preparing
months in advance for this year's national
examinations in November. Unfortunately, many who will
pass the exams will be unable to take a position in a
secondary school because of lack of money for tuition,
uniforms and supplies. Nonetheless, to boost the
fortitude of the eighth-graders during the critical
examination year, the community provides them with a

midday meal, cooked with wood and water the students
bring from home. Alas, the community is currently
unable to provide midday meals for the younger
children, who must fend for themselves.

When our village meeting got under way, I canvassed
the group and got very perceptive accounts of the grim
situation. Only two of the 200 farmers at the meeting
reported using fertilizer at present. Around 25% are
using improved fallows with nitrogen-fixing trees, a
scientific farming approach developed and introduced
into Sauri by the World Agroforestry Center. With this
novel technique, villagers grow trees that naturally
return nitrogen to the soil by converting it from the
atmosphere, thus dramatically improving yields. The
new method could be used throughout the village if
more money were available for planting the trees
alongside their maize crops.

The rest of the community is farming on tiny plots,
sometimes no more than one-quarter of an acre, with
soils that are so depleted of nutrients and organic
matter that even if the rains are good, the households
still go hungry. If the rains fail, the households
face the risk of death from severe undernutrition.
Stunting, meaning low height for one's age, is
widespread, a sign of pervasive and chronic
undernutrition of the children.

The real shocker came with my follow-up question. How
many farmers had used fertilizers in the past? Every
hand in the room went up. Farmer after farmer
described how the price of fertilizer was now out of
reach, and how their current impoverishment left them

unable to purchase what they had used in the past.

As the afternoon unfolded, the gravity of the
community's predicament became more apparent. I asked
how many households were home to one or more orphaned
children left behind by the AIDS pandemic. Virtually
every hand in the room shot up. I asked how many
households were receiving remittances from family
members living in Nairobi and other cities. The
response was that the only things coming back from the
cities were coffins and orphans, not remittances.

I asked how many households had somebody currently
suffering from malaria. Around three-fourths of the
hands shot up. How many use antimalarial bed nets? Two
out of 200 hands went up. How many knew about bed
nets? All hands. And how many would like to use bed
nets? All hands remained up. The problem, many of the
women explained, is that they cannot afford the bed
nets, which sell for a few dollars per net, and are
too expensive even when partially subsidized by
international donor agencies.

A few years back, Sauri's residents cooked with
locally collected wood, but the decline in the number
of trees has left the area bereft of sufficient fuel.
Villagers said that they now buy pieces of fuel wood
in Yala or Muhanda, a bundle of seven sticks costing
around 30¢. Not only are seven sticks barely enough to
cook one meal, but for a lack of 30¢, many villagers
had in fact reverted to cooking with cow dung or to
eating uncooked meals.

The dying village's isolation is stunning. There are
no cars or trucks owned or used within Sauri, and only
a handful of villagers said they had ridden in any
kind of motorized transport during the past year.
Around half of the individuals at the meeting said
that they had never made a phone call in their entire
lives.

This village could be rescued, but not by itself.
Survival depends on addressing a series of specific
challenges, all of which can be met with known,
proven, reliable and appropriate technologies and
interventions. (Thanks to a grant from the Lenfest
Foundation in the U.S., the Earth Institute at
Columbia University will put some novel ideas to work
in Sauri.) Sauri's villages, and impoverished villages
like them all over the world, can be set on a path of
development at a cost that is tiny for the world but
too high for the villages themselves and for the
Kenyan government on its own. African safari guides
speak of the Big Five animals to watch for on the
savannah. The world should speak of the Big Five
development interventions that would spell the
difference between life and death for the savannah's

people. Sauri's Big Five are:

BOOSTING AGRICULTURE With fertilizers, cover crops,
irrigation and improved seeds, Sauri's farmers could
triple their food yields and quickly end chronic
hunger. Grain could be protected in locally made
storage bins using leaves from the improved fallow
species tephrosia, which has insecticide properties.

IMPROVING BASIC HEALTH A village clinic with one
doctor and nurse for the 5,000 residents would provide
free antimalarial bed nets, effective antimalarial
medicines and treatments for HIV/ AIDS opportunistic
infections.

INVESTING IN EDUCATION Meals for all the children at
the primary school could improve the health of the
kids, the quality of education and the attendance at
school. Expanded vocational training for the students
could teach them the skills of modern farming,
computer literacy, basic infrastructure maintenance
and carpentry. The village is ready and eager to be
empowered by increased information and technical
knowledge.

BRINGING POWER Electricity could be made available to
the villages either via a power line or an off-grid
diesel generator. The electricity would power lights
and perhaps a computer for the school; pumps for safe
well water; power for milling grain, refrigeration and
other needs. The villagers emphasized that the
students would like to study after sunset but cannot
do so without electric lighting.

PROVIDING CLEAN WATER AND SANITATION With enough water
points and latrines for the safety of the entire
village, women and children would save countless hours

of toil each day fetching water. The water could be
provided through a combination of protected springs,
rainwater harvesting and other basic technologies.

The irony is that the cost of these services for
Sauri's 5,000 residents would be very low. My Earth
Institute colleagues and I estimated that the combined
cost of these improvements, even including the cost of
treatment for AIDS, would total only $70 per person
per year, or around $350,000 for all of Sauri. The
benefits would be astounding. Sooner rather than
later, these investments would repay themselves not
only in lives saved, children educated and communities
preserved, but also in direct commercial returns to
the villages and the chance for self-sustaining
economic growth.

The international donor community should be thinking
round-the-clock of one question: How can the Big Five
interventions be done on a larger scale in rural areas
similar to Sauri? With a population of some 33 million
people, of whom two-thirds are in rural areas, Kenya
would need annual investments on the order of $1.5
billion for its Sauris, with donors filling most of
that financing gap, since the national government is
already stretched beyond its means. Instead, donor
support for investment in rural Kenya is perhaps $100
million, or a mere one-fifteenth of what is needed.
And Kenya's debt service to the rich world is several
hundred million dollars per year. Kenya's budget is
still being drained by the international community,
not bolstered by it. This is all the more remarkable
since Kenya is a new and fragile democracy that should
be receiving considerable help.

The outside world has pat answers concerning extremely
impoverished countries, especially those in Africa.
Everything comes back, again and again, to corruption
and misrule. Western officials argue that Africa
simply needs to behave itself better, to allow market
forces to operate without interference by corrupt
rulers. Yet the critics of African governance have it
wrong. Politics simply can't explain Africa's
prolonged economic crisis. The claim that Africa's
corruption is the basic source of the problem does not
withstand serious scrutiny. During the past decade I
witnessed how relatively well-governed countries in
Africa, such as Ghana, Malawi, Mali and Senegal,
failed to prosper, whereas societies in Asia perceived
to have extensive corruption, such as Bangladesh,
Indonesia and Pakistan, enjoyed rapid economic growth.

What is the explanation? Every situation of extreme
poverty around the world contains some of its own

unique causes, which need to be diagnosed just as a
doctor would a patient. For example, Africa is
burdened with malaria like no other part of the world,
simply because it is unlucky in providing the perfect
conditions for that disease: high temperatures, plenty
of breeding sites and particular species of
malaria-transmitting mosquitoes that prefer to bite
humans rather than cattle.

Another myth is that the developed world already gives
plenty of aid to the world's poor. Former U.S.
Secretary of the Treasury Paul O'Neill expressed a
common frustration when he remarked about aid for
Africa: "We've spent trillions of dollars on these
problems and we have damn near nothing to show for
it." O'Neill was no foe of foreign aid. Indeed, he
wanted to fix the system so that more U.S. aid could
be justified. But he was wrong to believe that vast
flows of aid to Africa had been squandered. President
Bush said in a press conference in April 2004 that as
"the greatest power on the face of the earth, we have
an obligation to help the spread of freedom. We have
an obligation to feed the hungry." Yet how does the
U.S. fulfill its obligation? U.S. aid to farmers in
poor countries to help them grow more food runs at
around $200 million per year, far less than $1 per
person per year for the hundreds of millions of people
living in subsistence farm households.

From the world as a whole, the amount of aid per
African per year is really very small, just $30 per
sub-Saharan African in 2002. Of that modest amount,
almost $5 was actually for consultants from the donor

countries, more than $3 was for emergency aid, about
$4 went for servicing Africa's debts and $5 was for
debt-relief operations. The rest, about $12, went to
Africa. Since the "money down the drain" argument is
heard most frequently in the U.S., it's worth looking
at the same calculations for U.S. aid alone. In 2002,
the U.S. gave $3 per sub-Saharan African. Taking out
the parts for U.S. consultants and technical
cooperation, food and other emergency aid,
administrative costs and debt relief, the aid per
African came to the grand total of perhaps 6¢.

The U.S. has promised repeatedly over the decades, as
a signatory to global agreements like the Monterrey
Consensus of 2002, to give a much larger proportion of
its annual output, specifically up to 0.7% of GNP, to
official development assistance. The U.S.'s failure to
follow through has no political fallout domestically,
of course, because not one in a million U.S. citizens
even knows of statements like the Monterrey Consensus.
But we should not underestimate the salience that it
has abroad. Spin as we might in the U.S. about our
generosity, the poor countries are fully aware of what
we are not doing.

The costs of action are a tiny fraction of the costs
of inaction. And yet we must carry out these tasks in
a context of global inertia, proclivities to war and
prejudice, and understandable skepticism around the
world that this time can be different from the past.
Here are nine steps to the goal:

COMMIT TO THE TASK. Oxfam and many other leaders in
civil society have embraced the goal of Making Poverty
History. The world as a whole needs now to embrace the
goal.

ADOPT A PLAN OF ACTION. The U.N.'s Millennium
Development Goals, approved by all of the world's
governments at the start of the millennium, are the
down payment on ending poverty. The MDGs set out
specific targets for cutting poverty, hunger, disease
and environmental degradation by 2015 and thereby laid
the foundation for eliminating extreme poverty by
2025. The rich and poor countries have solemnly agreed
to work toward fulfilling the MDGs. The key is to
follow through.

RAISE THE VOICE OF THE POOR. Mahatma Gandhi and Martin
Luther King Jr. did not wait for the rich and powerful
to come to their rescue. They asserted their call to
justice and made their stand in the face of official
arrogance and neglect. It is time for the democracies
in the poor world--Brazil, India, Nigeria, Senegal,
South Africa and dozens of others--to join together to
issue the call to action.

REDEEM THE U.S. ROLE IN THE WORLD. The richest and

most powerful country, long the leader and inspiration
in democratic ideals, is barely participating in
global efforts to end poverty and protect the
environment, thus undermining its own security. It's
time to honor the commitment to give 0.7% of our
national income to these crucial goals.

RESCUE THE IMF AND WORLD BANK. They have the
experience and technical sophistication to play an
important role. They have the internal motivation of a
highly professional staff. Yet they have been used
like debt-collection agencies for the big creditor
countries. It's time to restore their role in helping
all 182 of their member countries, not just the rich
ones, in the pursuit of enlightened globalization.

STRENGTHEN THE U.N. It is no use blaming the U.N. for
the missteps of recent years. Why are U.N. agencies
less operational than they should be? Not because of
"U.N. bureaucracy," though that exists, but because
the powerful countries fear ceding more authority. Yet
U.N. specialized agencies have a core role to play in
the ending of poverty. It is time to empower the likes
of the U.N. Children's Fund (UNICEF), the World Health
Organization (WHO), the Food and Agricultural
Organization (FAO), and many others to do the job--on
the ground, country by country.

HARNESS GLOBAL SCIENCE. New technology has led
directly to improved standards of living, yet science
tends to follow market forces as well as to lead them.
It is not surprising that the rich get richer in a
continuing cycle of growth while the poorest are often

left behind. A special effort should be made by the
powerhouses of world science to address the unmet
challenges of the poor.

PROMOTE SUSTAINABLE DEVELOPMENT. Ending extreme
poverty can relieve many of the pressures on the
environment. When impoverished households are more
productive on their farms, for example, they face less
pressure to cut down neighboring forests in search of
new farmland. Still, even as extreme poverty ends, we
must not fuel prosperity with a lack of concern for
industrial pollution and the unchecked burning of
fossil fuels.

MAKE A PERSONAL COMMITMENT. It all comes back to us.
Individuals, working in unison, form and shape
societies. The final myth I will debunk here is that
politicians are punished by their constituents for
supporting actions to help the poor. There is plenty
of experience to show that the broad public will
accept such measures, especially if they see that the
rich within their own societies are asked to meet
their fair share of the burden. Great social forces
are the mere accumulation of individual actions. Let
the future say of our generation that we sent forth
mighty currents of hope, and that we worked together
to heal the world.

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