Giving to charity (part 2)

If we just consider the poorest developing countries, what is the best kind of assistance we could give them? Malaria nets? Drinking water? Measles vaccines? Antibiotics? Food? Or birth control?

The problems faced in developing countries are quite different from most of the western world. More than half of the people born in the poorest countries will die before the age of 5. The root cause of most of these deaths is poverty. Most people do not even have clean water to drink or adequate shelter, never mind things like vaccinations, antibiotics and medical care. Malnutrition is a huge problem, with the WHO pinpointing it as the single gravest threat to public health. Malnutrition is the biggest contributing factor to child mortality.

There are many charities working on various health problems faced in developing countries: providing measles vaccinations, malaria nets, cheap antibiotics and anti-retrovirals. Other groups try to provide clean water and sewerage systems to try and reduce water-borne infectious diseases, or to provide medical clinics with trained doctors and nurses to try to improve public heath. Other charities take an education approach, particularly health education. With low literacy rates impeding the transmission of information, many segments of the population in developing countries don’t know basic useful information like mosquitoes cause malaria, or washing hands before handling food cuts down on food-borne illnesses, or that HIV is sexually transmitted.

But what if these groups succeed? What if we vaccinate against all the infectious diseases, eliminate malaria, get HIV under control and reduce the incidence of water-borne diseases? What if most of those children who currently die before the age of 5 survive until adulthood? If malnutrition is currently such a big problem, how much worse will it get if we find solutions to all the other causes of death? How will we feed everyone?

There is an oft-repeated statistic about how the world’s annual food production is sufficient to feed the entire world. However, the world has not solved the systemic logistical problem of distributing that food so that everyone gets it. If we solve (or even partially solve) the other health issues without making enough progress on the hunger front, things are just going to get worse rather than better.

Solving the hunger problem helps the other health issues as well, since malnutrition makes people more susceptible to diseases. But there are two ways to solve the hunger problem. One is to improve the quantity/distribution of food. The other is to reduce the number of people.

Now, I’m not talking about killing people, or even letting people die. But what about preventing so many people being born in the first place. For instance, in the Democratic Republic of the Congo, the average woman has more than 6 children, and 3 of them die before the age of five. There is a 10% HIV rate in the Congo, with HIV now being one of the leading causes of death of people who reach adulthood. I’m sure that at least some of the women, if they had the knowledge and access to them, would choose to use condoms both to prevent HIV infections and to prevent pregnancy. If you can’t even feed the children you currently have, wouldn’t you choose to not get pregnant again, given that the chances are high that the result of the pregnancy will be that you have to watch your child die?

To follow this line of thought to its conclusion, the two best forms of charity we can give to developing countries are:

1. Supporting the distribution of condoms and education people about their use
2. Supporting the systematic improvement in food production and distribution (rather than one-off transfers of food aid)