written by Lant Pritchett
Nina Munk’s new book The Idealist: Jeffrey Sachs and the Quest to End Poverty is a great read. The book itself has been reviewed by development luminaries Bill Easterly, Angus Deaton, and Duncan Green and is on various “Best Book of 2013” lists.
One of my children required extremely complicated heart surgery as a young child and has had regular care since. This has exposed me to the difference among doctors between heart surgeons and cardiologists. Both are doctors, but the nature of their activity makes everything else about them different. Heart surgeons focus on discrete and dramatic interventions (surgery) in which the outcome is under their exclusive control (the patient is anesthetized) and the time of their engagement is measured in hours (the procedure) or at most days (discharge from the hospital). Cardiologists in contrast focus on sustained interventions (medication, cardiovascular conditioning, weight loss, blood pressure) in which the outcomes are primarily under patient control (e.g. compliance, exercise, diet) and the relevant time span of impact is decades not years. In my experience this leads heart surgeons and cardiologists, by self-selection and training, to have very different personalities and approaches. In considering surgeons to operate on our child, we were told that one surgeon had the best hands in the world (he had constructed a four chambered heart from a two-chambered heart) but was insufferably arrogant and impossible to deal with and universally disliked. We chose him.
There is a similar analogy among economists. While all economists might share some commonalities from selection and training there are huge differences across the sub-specialties of the discipline. The clan called “open-economy macro-economists” deal with crises in which interventions are dramatic, dependent on decisions of few people, and in which outcomes are measured in days and weeks and two quarters is a long horizon. In contrast the clan called “development economists” typically deal with chronic problems which rarely have discrete interventions, societies (not outsiders) are primarily determinative of outcomes, and in which a decade is the short-run, not the long-run.
There are two main points.
The most obvious that emerges from The Idealist is that Jeff Sachs’ professional training and early policy engagements were entirely as an open-economy macro-economist, which perhaps was practiced in developing country settings (e.g. Bolivia), but was not itself development economics. He has attempted to remake himself late in professional life (in his forties) from open-economy macro-economist to development economist. But Nina Munk’s book could have easily been subtitled: “Tales (and Tells) of a Development Amateur.” Some poker players have obvious “tells” that reveal them as new to (or just bad at) the game. Similarly, an obvious “tell” of a development amateur is saying any of the following:
- “It’s easy.”
- “We can do this quickly.”
- “We have a solution for every problem.”
The broader—and vastly more important—point than anything about Jeff Sachs is that this book reveals that many development debates and plans and practices have suffered from an inadequate analytical basis. Sometimes heart surgery is necessary: once a country is in hyper-inflation (like Bolivia in 1986) then a discrete, rapid, technocratic intervention like an orthodox shock really can fix the specific problem of runaway inflation—and perhaps there really is no other way. There cannot be a debate about whether “shock therapy” is good or bad any more than there could be a useful debate about whether using penicillin was good or bad: for the right conditions and in the right dosages: good, and for the wrong conditions and wrong dosages: bad. The sophistication needed is a correct diagnosis of what are the analytical types of problems in the world that are “surgery-like” and which are “exercise-diet-weight loss like.”
In our work on building state capability we have developed an analytical typology of tasks/activities based on four characteristics of the underlying nature of the task that produces five types of activities. This is not about “sectors” as traditionally understood (like “education” or “infrastructure”) as activities of each of our analytical types exist in most sectors.
An overly broad-brush characterization of development, but which I feel still gives some insight, is that where problems really were “policy” or “logistics” then “development” succeeded (and perhaps even development assistance helped in that success). As Charles Kenny puts it, things really are Getting Better. There has been an amazing improvement in health status (firstly and particularly–but not exclusively–in infectious disease conditions amenable to logistical interventions like immunizations), there has been amazing expansion in years of schooling, there has been a widespread defeat of chronic inflation and exchange rate disequilibria.
In contrast, where the problems faced are “implementation intensive” or “wicked hard” there has been much less progress. Ambulatory curative care in the public sector is often (though not always) extremely weak. While kids are in school they are often (though not always) learning very little. While inflation has been stabilized, sustained inclusive growth has often (though not always) been weak.
This is in part, we argue, because the expansion of “the solution” treated all problems as either “policy” or “logistics”, both of which led to “Seeing Like a State” and/or a “Tyranny of Experts”. The Idealist is a good account of what happens when a “logistical” approach—which may work for bed nets—is stretched in Procrustean fashion to fit “implementation intensive” tasks which require organizational capability and “wicked hard” problems like income generation. If interested in learning more, read Folk and the Formula: Fact and Fiction in Development.