Prioritize the Poorest

Helping the Bottom Billion is Good -- and Good Business

Students display their work at the Anganwadi centre in
Jamsaut village in Bihar. (Gates Foundation/flickr)

The world of international development has long been divided between idealists and pragmatists. The idealists give more weight to addressing the needs of the world's most destitute. The pragmatists are driven more by impact at the aggregate level, such as increasing GDP per capita. A growing body of evidence, however, suggests that the interests of these groups coincide. In many cases, it is most cost-effective to focus on the poorest groups.

In part, the convergence is due to the fact that, although many development indicators have improved at the national level -- including an overall reduction in poverty and child mortality and increasing school enrollment -- there are growing disparities within many countries. That is, as broad indicators improve, the gulf between the best and worst off is widening. A recent UNICEF study found that, in 26 countries, the mortality rate for children under five has declined by ten percent or more since 1990. But in 18 of those countries, the gap between the child mortality rates for the richest and the poorest quintiles of the population remained unchanged or grew. A specific example: between 1990 and 2008, measles immunization rates increased by ten percent among the wealthiest quintile of the population in West and Central Africa. They only increased by around three percent among the poorest quintile.

Read more at at Foreign Affairs' Special Report: Global Public Health.

Across the developing world, children in the poorest income quintile are still less than half as likely as those in the wealthiest quintile to have benefited from prenatal care; nearly three times as likely to be underweight; twice as likely to die before their fifth birthday; and, among girls, are three times as likely to get married before the age of 18. In addition, the disadvantaged have suffered the most from rising food and fuel prices, too often leading the poorest families to sell off vital economic assets and withdraw their children

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