A Defeat for International Tax Cooperation 
NEW YORK – Most of the world’s governments – eager to mobilize more tax revenues to finance development and curb pervasive tax-avoidance schemes, such as those revealed in the so-called Luxembourg Leaks scandal last year – have an interest in collaborating on taxation matters. Yet at the Third International Conference on Financing for Development, held in Addis Ababa last month, the momentum toward strengthening international tax cooperation came to an abrupt halt. 
Developed countries blocked a proposal at the conference to establish an intergovernmental tax body within the United Nations to replace the current UN Committee of Experts. These countries insist that tax cooperation should take place exclusively under the leadership of the OECD, a body that they control. 
The rest of the world should hope this will prove to be a pause rather than an end to progress on international tax cooperation, which began 13 years ago, at the first International Conference on Financing for Development in Monterrey, Mexico. Two years later, in 2004, the United Nations Economic and Social Council (ECOSOC) upgraded its “ad hoc group” of tax experts to a regular committee. 
Four years later, at the Second Conference on Financing for Development, in Doha, Qatar, policymakers acknowledged that more needed to be done in tax matters, and asked ECOSOC to consider strengthening institutional arrangements. And then, in the year leading up to the Addis Ababa conference, the UN Secretary-General endorsed the need for “an intergovernmental committee on tax cooperation, under the auspices of the United Nations.” 
His endorsement, along with strong support from nongovernmental organizations and the Independent Commission for the Reform of International Corporate Taxation, gave greater force to the demand by developing countries, organized around the Group of 77 and China, for an equal voice in setting global tax norms. Up until the 11th hour of negotiations in Addis Ababa, they stood firm in calling for an intergovernmental body with the mandate and resources to create a coherent global framework for international tax cooperation. 
But to no avail: Developed countries, led by the United States and the United Kingdom –home to many of the multinational corporations implicated in the “Lux Leaks” – succeeded in blocking this much-needed advance in global governance. In the end, the Addis Ababa Action Agenda provides that the current Committee of Experts will continue to function according to its 2004 mandate, with three additional meeting days per year, all funded through voluntary contributions. 
The OECD, whose members are essentially the world’s 34 richest countries, certainly has the capacity to set international standards on taxation. Yet the domination of a select group of countries over tax norms has meant that, in reality, the global governance architecture for taxation has not kept pace with globalization. 
The Monterrey Consensus reached in 2002 included a call to enhance “the voice and participation of developing countries in international economic decision-making and norms-setting.” But although the OECD invites some developing countries to participate in its discussions to establish norms, it offers them no decision-making power. 
Such a body must operate under the auspices of the United Nations, which bears the institutional legitimacy necessary to respond effectively to the challenges of globalization with coherent global standards to combat abusive tax practices and ensure fair taxation of corporate profits worldwide. 
Despite the disappointment in Addis Ababa, the call for reform of the international tax system is not likely to be silenced. Instead, it will grow louder on all sides, as the developed countries’ counter-productive resistance to any give and take on international cooperation results in a tsunami of unilateral tax measures beyond OECD control. 

The Development Costs of Homophobia 
LONDON – As a gay man living in Nigeria, my biggest challenge was choosing between my sexuality and my job. 
I had just left university, and I was featured in “Roses and Thorns,” a prime-time soap opera on Galaxy Television, one of Nigeria’s most popular TV stations. I was playing the role of “Richard,” the only son of a rich family who was having an affair with the house maid. 
Whispers were making the rounds about my private life, and I decided it was time to come out. So I agreed to go on Nigeria’s most-watched television talk show to discuss my sexuality. 
And when my job disappeared, so did my financial security. Like many gay men and lesbians in Africa, my choice was between economic freedom and mental imprisonment. 
This year, Nigeria and Uganda put in place draconian anti-gay laws, sparking a worldwide debate about human rights. This debate has also started at the World Bank, whose president, Jim Yong Kim, recently declared that “institutionalized discrimination is bad for people and for societies.” 
But this assumes that homosexuality is “un-African.” And, despite the absence of evidence that any given country or continent does not have LGBT people (and ample evidence to the contrary), it is an assumption that an increasing number of African leaders have embraced. 
Uganda’s President Yoweri Museveni followed suit when signing the anti-gay bill into law in 2014. Other leaders, from Gambia’s President Yahya Jammeh to Zimbabwe’s Robert Mugabe, have spoken in the same vein. 
These official attitudes have caused significant suffering for Africa’s gays and lesbians. Indeed, the price of homophobia for gay people in many African countries is painfully clear: legal penalties, social ostracism, and mob justice. 
But here is what Africa’s anti-gay leaders miss: legal protections are not only a human-rights issue, but also an economic issue. Kim is exactly right, and research has started measuring the economic costs of homophobia by exploring links between anti-gay sentiment and poverty in countries where laws and social attitudes proscribe same-sex relationships. 
M.V. Lee Badgett, an economist at the University of Massachusetts-Amherst, presented the initial findings of a study of the economic implications of homophobia in India at a World Bank meeting in March 2014. Badgett estimated that the Indian economy may have lost up to $23.1 billion in 2012 in direct health costs alone, owing to depression, suicide, and HIV treatment disparities caused by anti-gay stigma and discrimination. 
In addition to such concrete costs, being gay can bring violence, job loss, family rejection, harassment in schools, and pressure to marry. As a result, many gay people have less education, lower productivity, lower earnings, poorer health, and a shorter life expectancy. 
In Nigeria, I started the Independent Project for Equal Rights (TIERs) in 2005 to respond to the increasing number of people who were losing their jobs because of suspicions about their sexuality. During our first year, we provided support for dozens of people. 
Across Africa, the economic costs of discrimination are increasing, in line with growing pressure on employers, landlords, health-care providers, educational institutions, and others to exclude LGBT people. 
Today, the World Bank and other development agencies are mapping out the global development priorities that will follow the Millennium Development Goals (MDGs), which officially end in 2015 and included specific targets for promoting gender equality and empowering women as a strategy for economic growth. Looking ahead, the Bank should take the same approach to LGBT rights and make legal protections for sexual orientation and gender identity a condition for countries receiving loans. 
Building recognition of women’s rights into the MDGs did not corrupt African cultures by imposing “Western” values; in fact, it strengthened many African countries, which now lead the world in the representation of women in government. By pursuing similar protections for LGBT people, international investment and aid can improve economic performance and strengthen respect for basic human rights. 
The World Bank, always wary of entangling itself in “political” questions, emphasizes that it is not a global human-rights enforcer. But it also increasingly recognizes its own role as a facilitator in helping Bank members realize their human-rights obligations. 
Aid to governments that permit specific social groups to be ostracized can carry very real economic costs. As new loans are considered, steps should be taken to ensure that the benefits are as inclusive as possible. 
If the Bank – which currently lends Nigeria almost $5.5 billion and expects to commit an additional $2 billion in each of the next four years – moved in this direction, other funders might follow. Africa’s LGBT people desperately need such powerful allies in their struggle for human and economic rights. 

Europe’s Airpocalypse 
Indeed, it sometimes seems as if no major environmental conference is complete without a presentation by European policymakers on their continent’s supposed “best practices,” which the rest of the world should emulate. When it comes to air pollution, however, Europe might consider doing less talking and more listening. 
The World Health Organization has called it the continent’s “single largest environmental health risk,” estimating that 90% of Europe’s citizens are exposed to outdoor pollution that exceeds WHO air-quality guidelines. In 2010, some 600,000 European citizens died prematurely because of outdoor and indoor air pollution, and the economic costs have been put at $1.6 trillion, roughly 9% of the European Union’s GDP. 
In the United Kingdom, air pollution kills some 29,000 people a year, putting it second only to smoking as a cause of premature death. Paris may be even worse off; in March, after air-pollution levels surpassed Shanghai’s, the city imposed a partial driving ban and introduced free public transportation. 
George Osborne, the UK’s chancellor of the exchequer, has argued against British leadership in the fight against climate change. “We are not going to save the planet by shutting down our steel mills, aluminum smelters, and paper manufacturers,” he declared in 2011. 
With European politicians arguing that introducing environmental safeguards will hurt the EU’s already-weakened economy, it comes as little surprise that measures to limit air pollution fall far short of the mark. The EU’s proposed standards regulating toxic emissions from coal plants are even less strict than China’s, Greenpeace reports. 
The continent is home to nine of the world’s ten most polluted countries, according to Yale University’s 2014 Air Quality Ranking. New Delhi is ranked as the most polluted city on earth, with air pollution exceeding safe levels by a factor of 60. 
China, for example, has declared a “war on pollution.” By 2017, Beijing – once dubbed “Greyjing” by the international media – will spend some CN¥760 billion ($121 billion) to combat air pollution. 
At the heart of China’s measures are improved public transportation, green trade, and a revision of the energy mix. The government has decided to install bus stops every 500 meters in city centers, reduce tariffs to 5% or less for a list of 54 environmental goods, and decommission many outdated and inefficient coal plants. 
Meanwhile, in India, the state governments in Gujarat, Maharashtra, and Tamil Nadu are about to launch the world’s first cap-and-trade schemes for particulates. India’s Supreme Court even suggested an extra charge on privately owned diesel vehicles in New Delhi. 
Bangkok, which has been tackling air pollution since the 1990s, has planted 400,000 trees. And Japan is offering subsidies for hydrogen cars and creating new pedestrian-only areas. 
Europe, as one of the world’s wealthiest regions, ought to be at the forefront of the effort to promote environmental sustainability. When it comes to air pollution, however, Europe’s policymakers should stop preaching to others and focus on fixing their own problems. 


A Fair Fight Against Antimicrobial Resistance 
BRIGHTON – Existing anti-microbial drugs are becoming ineffective. If current trends continue, we could end up reliving conditions before the discovery of antibiotics, when infectious diseases were major killers. 
It will require not only major investments in research and development of new anti-microbial drugs, but also a system to control and restrict new treatments, in order to preserve their efficacy. As with the response to climate change, an effective strategy will require international coordination. 
Crowded housing, poor sanitation, and compromised immune systems, whether owing to malnutrition or chronic infections such as HIV, provide fertile ground for contagion. Antibiotics are often misused or low-quality, providing bacteria the opportunity to develop resistance. 
A recent study in Bangladesh, for example, concluded that antibiotics provided by so-called “village doctors,” often operating from market stalls, contributed to declines in mortality from post-natal sepsis and childhood pneumonia. But there is also considerable evidence that the drugs being provided are of varying quality and are frequently taken unnecessarily. 
However, this could end up severely limiting poor people’s access to antibiotics, leading to higher death rates from infections, making it politically unacceptable and thus difficult to enforce. A better alternative would be to develop new strategies to improve antibiotic treatments that are provided through informal channels. 
For starters, investment is needed to generate reliable surveillance data on the drugs that are effective against common infections. Treatment guidelines must incorporate this information and be given to all providers of antibiotics. 
Counterfeit products must be identified and removed from the marketplace, and a regulatory partnership between governments, the pharmaceutical sector, and citizens’ groups must be developed to control for quality. Prices must be kept low through bulk procurement; in some cases, public subsidies may be necessary. 
Innovations in packaging, perhaps providing full courses of appropriate combinations of drugs, could simplify treatment decisions. Likewise, development of low-cost diagnostic technologies could help diminish the need to provide treatment on the basis of symptoms alone. 
This will require measures such as accreditation, modification of payment mechanisms, and the involvement of intermediary organizations to give technical support and monitor performance. These organizations could include NGOs, religious organizations, social entrepreneurs, and companies that distribute drugs. 
In the meantime, the public must receive reliable information and advice on the proper use of antibiotics. This is particularly important where citizens rely largely on their own resources to cope with health problems. 
One core aim must be to establish basic standards of conduct for health workers and drug companies that reflect the needs of patients and communities. Governments will need to build their capacity to play an effective role in this process, and companies that develop, produce, and distribute drugs and diagnostic technologies will have to contribute actively to the search for collaborative solutions. 

The Social Science of Medicine 
But I took my medicine, and I got better. The experience wasn’t pleasant, but thanks to cheap, effective malaria drugs I was never in very much danger. 
Even at the time I was taking them, the parasite that causes malaria had already become resistant to chloroquine in many parts of the world; Papua New Guinea was one of the last places where the pills continued to be effective, and even there they were losing their potency. 
The growing capacity of pathogens to resist antibiotics and other antimicrobial drugs is turning into the greatest emerging crisis in contemporary health care – and it is a crisis that cannot be solved by science alone. 
Superbugs, like methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, are proliferating. In India, antibiotic-resistant infections killed more than 58,000 newborns in 2013. 
Today, malaria is often treated with a combination of artemisinin – a drug derived from a Chinese herb – and other antimalarial drugs. But these revolutionary medicines are now in danger of following chloroquine into obsolescence; resistant strains of malaria have been documented in Southeast Asia. 
This is more than a medical problem; it is a potential economic disaster. Research commissioned by the Review on Antimicrobial Resistance, headed by the economist Jim O’Neill, has calculated that if current trends continue, drug-resistant infections will kill ten million people a year by 2050 and cost the global economy some $100 trillion over the next 35 years. 
Cancer patients receiving chemotherapy take them to suppress bacteria that would otherwise overwhelm their weakened immune systems. Many surgical operations now considered routine, including joint replacements and Caesarean sections, can be performed safely only when antibiotics prevent opportunistic infections. 
If pathogens are exposed to the selective pressure of toxic drugs, eventually they will adapt. The Wellcome Trust, which I lead, has invested hundreds of millions of dollars into researching these mechanisms, improving diagnoses, and creating new drugs. 
The key to combating resistance is to delay the rate at which the pathogens can adapt. But, by overprescribing antibiotics and failing to complete the required courses of treatment, we are exposing germs to just enough medicine to encourage resistance. 
Even the most informed patients misuse these wonder drugs. Research in the United Kingdom has found that even people who understand how resistance develops often contribute to the problem by taking antibiotics without a prescription or giving their drugs to members of their family. 
Changing such destructive behavior will require that we better understand the social and cultural factors that drive it. Disciplines like history, psychology, sociology, anthropology, economics, market research, and social marketing can help. 
Combating the virus requires knowledge about its biology, the epidemiology of its transmission, and the drugs and vaccines that could potentially be deployed against it. But it also requires an understanding of the behaviors that have allowed infection to spread in Liberia, Sierra Leone, and Guinea. 
Explaining what made these societies so vulnerable requires learning about the region’s recent history and understanding why people there are deeply distrustful of public authorities. Isolation of patients and safe burial of the dead are crucial to containing Ebola, but both need to be introduced with cultural sensitivity – not just explanations of the science behind them. 
Today’s great public-health threats have profound economic consequences. Minimizing the risks they pose requires recognizing that they are intertwined with the social, behavioral, and cultural landscape. 

Asian Growth in Turbulent Times 
In recent decades, many of Asia’s economies have boomed. The region today accounts for about 40% of the world’s GDP – up from 25% in 1990 – and contributes about two-thirds of global economic growth. 
Asia has made unprecedented strides in reducing poverty and improving broad development indicators. The poverty rate fell from 55% in 1990 to 21% in 2010, while education and health outcomes have improved significantly. 
But today, the region is facing challenging new economic conditions. With growth in advanced economies tepid, risk aversion increasing in global financial markets, and the commodity super-cycle coming to an end, the world economy is providing little impetus to Asian growth. 
Indeed, China is now the top trading partner of most major regional economies, particularly in East Asia and ASEAN. New research by the International Monetary Fund, to be published in next month’s Regional Economic Outlook for Asia and the Pacific, suggests that the median Asian country’s economic sensitivity to China’s GDP has doubled in the last couple of decades. 
Asia’s achievements in recent decades attest to the hard work of the region’s people, as well as to the soundness of the policies that many Asian governments have adopted since the late 1990s, including improved monetary-policy and exchange-rate frameworks, increased international reserve buffers, and stronger financial sector regulation and supervision. Against this backdrop, the region attracted vast amounts of foreign direct investment. 
As trade links expanded, a sophisticated network of integrated supply chains emerged, creating the conditions for Asia to become a manufacturing powerhouse and, increasingly, an exporter of services as well. More recently, thanks to strong policies and ample reserves, the region quickly recovered from the global financial crisis. 
Amid this new testing reality now dawning in Asia, we must not lose sight of the deep, and long term, structural challenges facing the region. Populations are rapidly aging and even declining in countries like Japan, Korea, Singapore, and Thailand, dragging down potential growth and putting pressure on fiscal balances. 
While inequality has remained stable or declined in Malaysia, Thailand, and the Philippines, it is rising in many parts of the region, most notably in India and China (as well as other parts of East Asia). In many emerging markets and developing countries, widespread infrastructure gaps persist, notably in power and transport. 
This shifting landscape calls for bold action on several fronts. While the response will certainly need to be tailored to each country’s specific circumstances, some recommendations could be helpful for most countries: 
· Because inflation remains low across most of the region, monetary policy should remain supportive of growth in case downside risks materialize. 
· Exchange-rate flexibility and targeted macroprudential policies should be part of the risk-management toolkit. 
· Countries need to deepen their financial systems to channel the large pool of domestic and regional savings toward financing their development needs; closing the region’s infrastructure gaps, for example, remains critical. 
· Structural reforms, aided by fiscal policy, should support the economic transitions and rebalancing, while boosting potential growth and alleviating poverty. 
The good news is that Asia, as demonstrated by its strong performance in recent years, can meet these challenges and continue to build upon the significant achievements of the past two decades. It has the resources and the people; it has the buffers and resilience; and it has ample opportunities for further trade and financial integration. 
To discuss these challenges, the government of India and the IMF are organizing the Advancing Asia conference in New Delhi on March 11-13, bringing together regional policymakers and thinkers. 
India, a bright spot among emerging markets in these difficult times – indeed, the world’s fastest growing major economy – is an auspicious place to hold this gathering. 
Our mutual aim in convening with Asian policymakers is clear and critical, for Asia and for the global economy: to ensure that growth in Asia continues to be robust, sustainable, and inclusive, so that the region remains a powerful locomotive for global growth. 

What Water’s Worth 
SINGAPORE/ATLANTA – In the early nineteenth century, Lord Byron wrote in Don Juan that “Till taught by pain, men really know not what good water’s worth.” Nearly 200 years later, humanity still does not seem to understand water’s value, exemplified in decades of poor water management and governance practically everywhere. 
To be sure, some improvements in water management have been made in recent years. But they have come incrementally, at far too slow a pace to address the problem effectively. 
To help kick-start progress, major multinational companies like Nestlé, Coca-Cola, SABMiller, and Unilever – which have long emphasized to their investors the challenge that water scarcity poses for their businesses, not to mention the communities in which they operate – are working to improve water availability, quality, and sustainability. Their success will require an innovative strategy that upends entrenched assumptions about – and approaches to – water-related problems. 
For example, the prevailing view that the world needs good water management, though accurate, is too narrow. Water management should not be regarded as an end in itself – a single-variant solution for a single-variant problem – but as a means to several ends, including environmental conservation and social and economic development. 
Viewed in this broader context, many of the paradigms, practices, and processes that are currently being used to manage communities’ water resources must change. Given that competition for water resources cannot be disentangled from competition for, say, food and energy, it cannot be addressed independently. 
Complicating matters further, these problems’ backdrop is likely to change considerably over the next few decades, owing to demographic shifts, population growth, urbanization, migration within and among countries, globalization, trade liberalization, and rapid expansion of middle classes in the developing world. These shifts will accompany rapid industrialization and advances in science and technology (especially information and communications technology), and will transform dietary habits and consumption patterns. 
Indeed, these linkages are already evident in many parts of the world. For example, in many Asian countries – including India, China, and Pakistan – groundwater levels are declining at an alarming rate, owing to over-extraction and energy subsidies. 
For India, the problem began in the 1970s, when major donors encouraged the government to provide farmers with free electricity for irrigation. The subsidies were manageable at first, and achieved their goal of boosting food production in states like Punjab, Haryana, Rajasthan, Gujarat, and Maharashtra. 
But the policy removed the incentive for farmers to limit the amount of water they pumped. They had to invest only in installing the actual pumps – and they did so willingly, resulting in a total of 23 million water pumps today. 
This profligacy has taken a serious toll on groundwater levels, forcing the tube-wells from which the water is pumped to be installed ever more deeply. According to the Third World Center for Water Management, the amount of electricity required to pump water in India has doubled – and, in some cases, even tripled – in the last decade alone, as tube-wells have moved from 10-15 meters (32-50 feet) to 200-400 meters (650-1300 feet) deep. 
Under these conditions, state water ministries have few options for making groundwater irrigation sustainable. With the relentless increase in electricity subsidies, which are squeezing the energy sector, it is difficult to devise effective policies to stem over-pumping. 
The water sector will have to react to developments in the energy and other sectors, over which, despite close ties, it has very limited control. Coordinating the various sectors’ policies effectively will be difficult, to say the least. 
We already have the needed technology, know-how, experience, and even financing. With strong political will, sustained pressure from an informed public, and a “can do” attitude from water professionals and institutions pursuing intersectoral cooperation, the world’s water-management problems can be addressed effectively. 
But we must act now. Time – and water – is running out. 

India’s Homemade Food Crisis 
SINGAPORE – According to current estimates, India’s total population will reach 1.45 billion by 2028, similar to China’s, and 1.7 billion by 2050, equivalent to nearly the combined population of China and the United States today. Given that India is already struggling to feed its population, its current food crisis could worsen significantly in the coming decades. 
According to the 2013 Global Hunger Index (GHI), India ranks 63rd, out of the 78 hungriest countries, significantly worse than neighboring Sri Lanka (43rd), Nepal (49th), Pakistan (57th), and Bangladesh (58th). Despite India’s considerable improvement over the past quarter-century – its GHI rating has risen from 32.6 in 1990 to 21.3 in 2013 – the United Nations Food and Agricultural Organization believes that 17% of Indians are still too undernourished to lead a productive life. 
According to UNICEF, 47% of Indian children are underweight and 46% of those under three years old are too small for their age. Indeed, almost half of all childhood deaths can be attributed to malnutrition – a state of affairs that former Prime Minister Manmohan Singh called a “national shame.” 
Farm output has been setting new records in recent years, having increased output from 208 million tons in 2005-2006 to an estimated 263 million tons in 2013-2014. India needs 225-230 million tons of food per year; so, even accounting for recent population growth, food production is clearly not the main issue. 
The most significant factor – one that policymakers have long ignored – is that a high proportion of the food that India produces never reaches consumers. Sharad Pawar, a former agriculture minister, has noted that food worth $8.3 billion, or nearly 40% of the total value of annual production, is wasted. 
This does not capture the full picture: for example, meat accounts for about 4% of food wastage but 20% of the costs, while 70% of fruit and vegetable output is wasted, accounting for 40% of the total cost. India may be the world’s largest milk producer and grow the second largest quantity of fruits and vegetables (after China), but it is also the world’s biggest waster of food. 
An estimated 21 million tons of wheat – equivalent to Australia’s entire annual crop – rots or is eaten by insects, owing to inadequate storage and poor management at the government-run Food Corporation of India (FCI). Food-price inflation since 2008-2009 has been consistently above 10%, (except for 2010-2011, when it was “only” 6.2%); the poor, whose grocery bills typically account for 31% of the household budget, have suffered the most. 
There are several reasons why so much perishable food is lost, including the absence of modern food distribution chains, too few cold-storage centers and refrigerated trucks, poor transportation facilities, erratic electricity supply, and the lack of incentives to invest in the sector. The Indian Institute of Management in Kolkata estimates that cold-storage facilities are available for only 10% of perishable food products, leaving around 370 million tons of perishable products at risk. 
The FCI was established in 1964 primarily to implement price-support systems, facilitate nationwide distribution, and maintain buffer stocks of staples like wheat and rice. But mismanagement, poor oversight, and rampant corruption means that the FCI, which gobbles up 1% of GDP, is now part of the problem. 
India will not have enough arable land, irrigation, or energy to provide enough nutritious food to India’s future 1.7 billion people if 35-40% of food output is left to rot. The new Modi government should therefore consider alternative ways to solve India’s food crisis. 

No Agnostics in the Climate Foxhole 
SYDNEY – On a recent 14.5-hour flight from Los Angeles to Sydney, I had time to read the columnist Charles Krauthammer’s collection of essays, Things that Matter. It made for a disturbing flight. 
I have enjoyed Krauthammer’s writing over the years, but there was something in his book that I found deeply troubling: his description of himself as an “agnostic” on climate change. He “believes instinctively that it can’t be very good to pump lots of carbon dioxide into the atmosphere,” and yet he “is equally convinced that those who presume to know exactly where that leads are talking through their hats.” 
The word that I found most galling was “agnostic” – not only because Krauthammer is a trained scientist, but also because the word was used repeatedly by former Australian Prime Minister John Howard when he addressed a group of climate-change deniers in London in late 2013. “Part of the problem with this debate,” Howard told the assembled skeptics, “is that to some of the zealots involved their cause has become a substitute religion.” 
According to a 2013 survey of peer-reviewed publications on the subject, some 97% of scientists endorse the position that humans are causing global warming. Anyone familiar with the scientific process is aware that researchers are trained to disagree, to contest one another’s hypotheses and conclusions. 
But I also understand the potential usefulness of regulatory measures like targets for renewable energy, bans on incandescent light bulbs, and mandates for the use of biofuels. What I cannot accept is for somebody who offers no solutions to claim that those of us who do are “talking through our hats.” 
To be sure, there are still holdouts, like Australian Prime Minister Tony Abbott, who replaced a carbon tax with a plan to tax the country’s citizens in order to pay polluters to cut emissions. As a policy, this is inequitable, inefficient, and unlikely to lower emissions at a pace that is sufficient to meet the conditions of the global climate-change agreement expected to be reached in Paris in December. 
A sure sign of a shift in mentality is the growing recognition by financial institutions that loans and investments may be overexposed to the risks of climate change. These risks include natural disasters, more extreme weather, efforts by governments to reduce greenhouse-gas emissions, and the knock-on effect of a technological revolution in renewables, energy efficiency, and alternative technologies. 
As a result, there is a risk that their investments and holdings will become “stranded,” as changes in policy or market conditions cut the value of infrastructure, other property, and fossil-fuel reserves. As Hank Paulson, Secretary of the US Treasury when the global financial crisis erupted in 2008, once warned, the risks of a climate-induced financial crisis would dwarf those of the sub-prime crisis. 
Consequently, shares in coal companies have fallen by as much as 90%, leaving asset owners scrambling to divest. By contrast, investing in a company like Tesla Motors – which has now developed a rechargeable battery for home use, which could lead to a sharp increase in the number of households switching to solar power – looks far more attractive. 
As this realization percolates through the market, asset owners are hedging their bets by increasing their investments in low-carbon industries and companies like Tesla. Over time, this will have a significant effect on the allocation of global investment funds. 

New Hope for Haiti 
NEW YORK – During a recent visit to the rural community of Los Palmas, Haiti, I had the opportunity to talk with families directly affected by the cholera epidemic that has been afflicting the country since the 2010 earthquake. One man explained that not only had the disease killed his sister, but his mother-in-law had also perished as she undertook the hours-long walk to the nearest hospital. 
In Haiti today, stories like this are not uncommon. Indeed, thousands of people across the country have endured similar trials and tragedies. 
Increased community engagement and changes in hygiene practices have freed the women, men, and children of Los Palmas and the neighboring village of Jacob of cholera – a dramatic reversal from the last few years – and reduced their risk of contracting other water-borne diseases. One family I met, for example, proudly showed me a new water filter. 
This community-led approach will be critical to the success of the “total sanitation campaign,” which Haitian Prime Minister Laurent Lamothe and I launched in Los Palmas during my visit. By encouraging household investment in durable, hygienic latrines, providing improved sanitation products and services at affordable prices, and ensuring that schools and health centers have adequate water and sanitation infrastructures, the initiative will improve health conditions for three million people in high-risk areas over the next five years. 
The campaign is the latest step in a comprehensive United Nations-supported operation to eliminate cholera from Haiti. The UN and the Haitian government recently created a high-level committee tasked with implementing a comprehensive strategy that covers all aspects of cholera prevention and response, including scaled-up assistance for families and communities. 
Moreover, Haiti’s Ministry of Health and the Pan-American Health Organization/World Health Organization are beginning the second phase of a UN-financed vaccination initiative that is targeting 600,000 people in areas where cholera persists; 200,000 people are set to be vaccinated in the next couple of months, with another 300,000 to follow by the end of this year. During the first phase last year, 100,000 people were vaccinated. 
These efforts have already reduced the toll of the epidemic significantly. During the first few months of this year, the number of cholera cases and deaths declined by some 75% compared to the same period of 2013, reaching the lowest level since the outbreak began. 
To be sure, Haiti still hosts the largest number of suspected cholera cases in the Western hemisphere – unacceptable in a world of such vast knowledge and wealth. But the country is on a trajectory toward success. 
Haiti’s prospects are improving in other areas as well, owing partly to the UN’s commitment to the country. Since 2004, the UN’s Stabilization Mission in Haiti (MINUSTAH) has been working to improve the security environment, support the political process, strengthen government institutions, and protect human rights. 
As a result of MINUSTAH’s efforts – and those of other UN agencies – the security situation has improved considerably, underpinned by a stronger judiciary and a more effective national police force. Meanwhile, primary-school enrollments rates have soared, from 47% in 1993 to nearly 90% today. 
In order to improve its chances of achieving its development goals, Haiti must follow through on its plans to hold long-overdue legislative and local elections later this year, followed by a presidential election next year. Haitian leaders across the political spectrum must rise above their differences to ensure that the electoral process is conducted fairly, thereby advancing the rule of law, safeguarding human rights, and consolidating the country’s democratic foundations. 
Most urgent, Haiti needs help funding its $2.2 billion ten-year National Cholera Elimination Plan. So far, just 40% of the $448 million that will be needed in the first two years for investments in early warning, rapid response, water, sanitation, and vaccines has been mobilized, and only 10% of the total has been pledged. 
The Haitian people possess all of the compassion and determination needed to overcome the cholera epidemic and achieve inclusive economic development. But the international community – in particular, international financial institutions working in the region – must step up and support them. 
But I also understand that Haitians expect their government and the UN to deliver on the promises made that day. If everyone does their part, we can give Haitians the healthier, more prosperous future that they deserve. 

Reimagining China’s Urban Future 
The overwhelming majority of China’s poor live in rural areas, and, for most, hope for a better life lies in the cities, where better-paying jobs are easier to find. Indeed, over the past three and a half decades, a staggering half-billion Chinese have already made the move, raising the urban share of the country’s population from less than 20% in 1980 to one-half today. 
By 2030, 70% of all Chinese are expected to live in cities. 
China’s urbanization has undoubtedly supported the country’s impressive growth and rapid economic transformation. Its cities have provided cheap land and abundant labor, while local governments have been eager to attract investment and create jobs. 
China’s growth model, driven by investment and exports, is running out of steam. Urban sprawl and congestion are spreading, fueling unrest among farmers who feel undercompensated for the loss of their land – a vital source of collateral for local-government debt (which now amounts to 30% of GDP). 
Stark inequalities also exist within cities, mainly between those with a hukou (a record in China’s official household-registration system) and migrants without one. Although migrant wages have now caught up, inequality in public services (access to which requires an urban hukou) ensures that this divide persists, risking migrant children’s lifetime prospects and welfare, and deterring future migration. 
Environmental pressures are also worsening. Although some measures of urban pollution are improving, urbanization exposes many more people to bad air, increasing the total human and economic cost. 
The authorities are aware of these issues and have announced plans for a new, “people-oriented” urbanization model that would be more efficient, inclusive, and environmentally sustainable. A joint report by the World Bank and the Development Research Center of China’s State Council recently outlined how to make this plan a reality. 
Under China’s constitution, urban land is owned by the state, and rural land by collectives. Though land reforms over the last three decades have recognized property rights for individuals and enterprises, rural land rights remain weak relative to legal conditions in urban areas. 
By strengthening farmers’ property rights, and restricting local governments’ power to expropriate land for urban growth, cities would become more compact and efficient, especially in terms of energy use. Reform would also help to consolidate farmland, facilitating better agricultural techniques. 
According to one estimate, the total compensation that farmers received for their land over the last 20 years was ¥2 trillion ($322 billion) below market value, equivalent to 4% of China’s 2013 GDP. If invested at rates in line with China’s GDP growth, that unpaid compensation would now be worth some ¥5 trillion, or almost 10% of GDP. 
Despite the high level of rural-urban migration so far, it is still below what could be expected, given China’s size and income level. Preventing the one-third of city dwellers who lack an urban hukou from accessing public services ultimately means that too many people who would have left rural areas remain tied to the land. 
As the World Bank-DRC report points out, China can do the same by linking public services to place of residency rather than to place of origin. Moreover, when migrant children are able to join their parents in the cities and get a good education, the next generation will have a better chance to escape poverty, too. 
Making migration easier would not only open up opportunities in the cities; it would also accelerate agricultural transformation, as the fewer remaining agricultural workers would need to acquire new skills to raise productivity and wages. 
However, in order to implement land and hukou reforms, China’s fiscal system must be overhauled. Stronger land rights for farmers will deprive city authorities of the land-conversion revenues needed to provide public services to new urban migrants. 
A property tax or a local surcharge on personal income taxes would target those who most benefit from urban living. Environmental charges and levies – such as higher registration fees for motor vehicles, pollution charges, and improved cost recovery on utilities – might also help, while simultaneously addressing urban environmental problems. 
China’s cities are forecast to spend around $5.3 trillion on infrastructure over the next 15 years; but denser, more efficient cities would save around $1.4 trillion (15% of 2013 GDP) of these costs. This money could then help to finance the additional health care, education, and low-income housing required by new migrants. 
China’s citizens, especially its poor, would benefit from a shift in government policy from the physical expansion of cities and infrastructure to the delivery of better, more fairly distributed public services. Achieving this would truly represent the people-oriented urbanization that the authorities seek to achieve. 

Infrastructure Unbound 
Every month in the developing world, more than five million people migrate to urban areas, where jobs, schools, and opportunities of all kinds are often easier to find. But when people migrate, the need for basic services – water, power, and transport – goes with them, highlighting the boom in infrastructure demand. 
The reality is evident from Kenya to Kiribati – everywhere where rapid urbanization, the need to support trade and entrepreneurship, and efforts to confront the challenges of climate change have exposed a wide infrastructure deficit. And it is a deficit that confronts advanced economies as well. 
Simply put, infrastructure construction and modernization worldwide needs to be part of a strategy for long-term global growth. That is why G-20 finance ministers, meeting recently for the first time this year in Sydney, Australia, singled out investment in infrastructure as one of the elements vital to ensuring a strong, sustainable, and balanced recovery. 
But, with G-20 finance ministers preparing to meet again in Washington, DC, next month, a note of caution is in order: Simply increasing infrastructure investment is not enough to foster growth and job creation. 
At the start of the financial crisis, both advanced and emerging-market economies pumped money into “shovel-ready” infrastructure projects to boost short-term economic growth and create jobs. Now, in the wake of the crisis, the infrastructure challenge has become more difficult to address. 
Indeed, a key challenge in financing infrastructure investment in emerging economies is that many of the commercial banks (mainly European) that had a significant presence in the past have withdrawn – and are unlikely to return until they repair their crisis-hit balance sheets and build capital to meet strengthened regulatory standards. 
In emerging and developing economies, it is estimated that an additional $1-1.5 trillion in annual investment will be required through 2020 to meet growth targets. Factoring in additional spending for reducing greenhouse-gas emissions or adapting to climate change could add $170-220 billion each year to the cost of these countries’ infrastructure needs. 
Obviously, the G-20 is right to emphasize how important meeting these needs is to how many people. For example, more than 69% of Sub-Saharan Africa’s population lack access to electricity; 65% of people in South Asia lack access to a simple pit latrine; and 40% of rural people in Latin America and the Caribbean lack access to all-weather roads. 
Some countries generate massive growth benefits from their infrastructure spending, while others hardly see a return. As a background note prepared by the World Bank Group for the G-20 explains, governments should pay more attention to the selection, quality, and management of infrastructure projects, as well as to the quality of the underlying investment climate. 
Prioritizing investments, good planning, and sound project design can significantly boost the impact of new and modernized infrastructure on growth and job creation, as well as raise returns on scarce resources. Better investment planning can also help to avoid locking infrastructure into inefficient and less “green” technologies. 
As I heard in Sydney, many developing countries face real difficulties in identifying, preparing, and implementing projects. The price tag for technical, financial, economic, and environmental feasibility studies and long-term plans can be high, running into the millions of dollars. 
The World Bank Group has been helping developing countries build up their capacity in these areas. But more must be done to enable countries to develop a robust project pipeline that supports a stronger public-investment program, which is critical to any strategy to attract substantial resources from the private sector. 
And, in today’s economic climate, attracting private financing is essential, because there is simply no way that public funding alone can close the infrastructure gap. Doing so will also require ensuring appropriate governance, predictable pricing structures, and a credible regulatory environment. 
Countries have no time to waste. The unique role of infrastructure in helping to provide basic services for poor people, creating jobs and opportunity, facilitating access to markets, and ensuring sustainable growth in our ever-growing cities requires policymakers to act quickly and decisively. 


Food in the Age of Biofuels 
For some, a renewable energy source produced from organic matter amounts to a magic wand in the fight against climate change. But others view biofuels as an existential threat, because the plants used to create them compete for agricultural land and water that would otherwise be used to grow food. 
We can make good use of both. Given the right conditions, biofuels can be an effective means to increase food security by providing poor farmers with a sustainable and affordable energy source. 
In some land-locked African countries, gasoline costs three times the global average, making fuel prices one of the main barriers to agricultural growth. Extending the use of biofuels in these regions could boost productivity and create new employment opportunities, especially in rural areas. 
In 2013, biofuels accounted for 3% of the total transport fuel used around the world, according to a report by the Food and Agricultural Organization and the OECD. While this percentage is expected to remain steady, we can nonetheless expect the production of biofuels to grow in absolute terms as the global market for transport fuels also expands. 
If that prediction is borne out, biofuels will consume 12% of the world’s coarse grain, 28% of its sugar cane, and 14% of its vegetable oil. As production of these fuels grows, we will require policies, programs, and capacities that ensure that they are used sustainably, without distorting food markets or compromising food security, which will always be the first priority. 
Rudolf Diesel’s first engine, designed in the late 1800s, ran on fuel derived from peanut oil. Henry Ford once scouted Florida in hopes of buying tracts of land to plant sugar cane, convinced that the United States would not tolerate the pollution from burning fossil fuels or the dependency implicit in importing oil to produce gasoline. 
Only in recent decades have biofuels regained their original appeal, owing to efforts to secure affordable energy, generate income, and mitigate the dependency of which Ford warned. More recently, concerns about pollution, climate change, and the finite nature of fossil fuels has driven a spike in demand – one that must now be managed. 
Flexibility is key to efforts to leverage the world’s growing reliance on biofuels to boost agricultural productivity, accelerate rural development, and increase food security. For example, policymakers must defuse the competitive pressures between food and fuel by designing schemes to counter price volatility for basic foodstuffs. 
National targets could also be made more flexible. If mandates for biofuel use were applied over several years, instead of only one, policymakers could influence demand in order to minimize pressure on food prices. 
Finally, at the individual level, greater flexibility could also be built in at the pump, through the promotion of flex-fuel vehicles of the type already in use in Brazil. If cars are equipped with engines that can run on conventional fossil fuels or blends with high percentages of biofuels, consumers can adapt to changes in prices by switching between one or the other. 
Finding the right balance will not be easy. But if we harness our collective knowledge, include developing countries’ smallholder farmers in this effort, and maintain our focus on reducing poverty and protecting the vulnerable, we can have more fuel, more food, and greater prosperity for all. 

Revolution and Reaction in Biopharming 
Aspirin was first isolated from the bark of the willow tree in the eighteenth century. And many other common pharmaceuticals, including morphine, codeine, and the fiber supplement Metamucil, are purified from the world’s flora. 
More recently, scientists have developed techniques that take this process a step further, using genetic engineering to induce agricultural crops to synthesize high-value pharmaceuticals. Known as “biopharming,” the great promise of this technology emerged about 15 years ago, with clinical trials of vaccines and drugs produced in bananas, tomatoes, and tobacco. 
One early example of biopharming was the production by the biotech company Ventria Bioscience of rice that contained two human proteins, lactoferrin and lysozyme. Once grown and harvested, the rice kernel is processed to extract and purify the proteins for use in oral rehydration solution for treating diarrhea, which is surpassed only by respiratory diseases as the leading infectious killer of children under the age of five in developing countries. 
The proteins have the same structure and functional properties as those found in natural breast milk, and the process for extracting them is analogous to that used routinely for the production of therapeutic proteins from organisms like bacteria and yeast. Research in Peru showed that fortifying an oral-rehydration solution with the proteins extracted from Ventria’s rice substantially lessens the duration of diarrhea and reduces the rate of recurrence – a near-miraculous advance for people in the developing world. 
When Ventria approached the US Food and Drug Administration in 2010 for recognition that these proteins are “generally recognized as safe” (a regulatory term of art), it received no response. Without an endorsement by the FDA, the company was unwilling to market the product, and so it remains unavailable, tragically depriving children in developing countries of a life-saving therapy. 
In 2003, the US Department of Agriculture announced onerous new rules for testing crops engineered to produce pharmaceuticals. The ostensible objective of the regulation is to avoid contaminating food supplies with drugs, especially when edible crops are used to produce them. 
In fact, even if biopharmed plants were to contaminate food crops, the likelihood that consumers would end up with harmful amounts of prescription drugs in their corn flakes, pasta, or tofu is very small. Gene flow is an age-old process that is well understood by farmers, who grow hundreds of crops, virtually all of which have been genetically improved in some way with a variety of techniques. 
Even if some crops were to become contaminated, the chances that active drug substances would be present in the final food product at sufficient levels to have an adverse effect on human health would remain very small. The biopharmed plant would be pooled into a large harvest, where its pharmaceuticals would be heavily diluted. 
But, with a combination of factors – including natural selection, farmers’ pursuit of their commercial self-interest, and liability concerns – militating against such a possibility, the odds are very long, and the impact would almost certainly be very low. When you weigh this against the possibility of the development of the drug industry’s Next Big Thing or, at the very least, a new method to produce high-value compounds at low cost, regulators’ preoccupation with such unlikely events appears to be misplaced. 
If we are to reap what we can sow, however, we will need reasonable, science-based policies from regulators worldwide. Sadly, to borrow a phrase from the late Nobel laureate economist Milton Friedman, that is like wishing that our cats could bark. 

The Creditworthy Poor? 
WASHINGTON, DC – Over the last five years, several low-income countries, such as Rwanda and Honduras, have issued their first-ever bonds to private foreign investors in London and New York. Until recently, that might have been unthinkable, so the new borrowers’ initial bond issue should be viewed as a sign of great investor confidence. 
Some 20 “debut issues” have raised around $12 billion at interest rates that, on average, are just 4.5 percentage points above what the United States government pays at maturities of five or more years. This is small change in the grand scheme of global finance; but, given that many of these borrowers were in distress or default just a decade ago, and needed debt forgiveness, theirs is an especially impressive turnaround. 
But low-income countries’ access to private lenders comes with risks that should be highlighted at the outset, before they grow into imminent threats. 
The bonds have to be repaid in a foreign currency, usually US dollars, in a single “bullet” payment. These bullets can be big, especially when compared with past debt obligations or future export earnings. 
World Bank data tracking the evolution of developing-country debt since the 1970s show that the probability of a country falling into debt distress increases nine-fold (to a one-in-five chance) if its repayments are equivalent to more than one-tenth of its exports – a situation that one in three of today’s new issuers could face when their bonds come due. 
Another is whether they invest the money prudently, thereby enabling prompt repayment. And it will also depend on whether countries with volatile incomes, especially those reliant on natural resources, put money aside when earnings are high. 
Lenders’ appetite for low-income-country bonds has been fueled in large part by a combination of abundant liquidity and near-zero interest rates in developed economies since the 2008-2009 global financial crisis. With only paltry yields on offer at home, investors have looked to riskier, “frontier” markets for higher returns. 
Sooner or later, however, developed economies will revert to tighter monetary policy, which will make developing-country bonds less attractive. Those borrowers with sound macroeconomic policies will probably retain some appeal for global financial markets; but less prudent governments might suddenly find themselves cut off. 
Unfortunately, the quality of debt-management practices among the new bond issuers is uneven. Sensible debt strategies, a professional and independent debt office, and a clear legal framework for public borrowing have become more important than ever. 
But more can and should be done before this new borrowing wave becomes too large to manage, or spreads to state and municipal governments that suffer from weaker administrative capacity. It is worth noting the strong negative correlation between the quality of a country’s debt-management practices and its risk of debt distress, with 90% of low-risk countries demonstrating good practices. 
Traditionally, low-income countries’ creditors were rich-world governments and multilateral organizations that found it politically unfeasible to call in debts if this meant that borrowers had to cut vital public services such as education or health. In a process that has already taken 15 years – and remains unfinished – the debts of 35 highly indebted poor countries (HIPCs) have been forgiven, at a cost of more than $100 billion. 
Now, however, many former HIPCs are selling bonds in the global market to private investors, which has become significantly riskier in recent months, in the wake of court rulings in the United States that permit bondholders to reject debt workouts and sue for full payment. One must hope that the funds raised will be put to good use, and that repayments will not require major sacrifices, as there is currently no agreed mechanism to restructure, let alone cancel, the new debts. 
One might ask why anyone but the private global investors taking the risk should care about roll-overs, reversals, debt management, and workouts. The reason is that public-debt distress most harms a country’s poorest citizens, who have little knowledge, and no choice, about issuing bonds. 
Sound debt management is, in effect, sound social policy – a lesson that borrowers and lenders alike should heed as they enter into debts that, if not properly managed, can turn out to be more complicated than first assumed and more troublesome than anyone expected. 

Bottled Risk 
BERLIN – Over the last 15 years, the bottled-water industry has experienced explosive growth, which shows no sign of slowing. In fact, bottled water – including everything from “purified spring water” to flavored water and water enriched with vitamins, minerals, or electrolytes – is the largest growth area in the beverage industry, even in cities where tap water is safe and highly regulated. 
The environmental problems begin early on, with the way the water is sourced. The bulk of bottled water sold worldwide is drawn from the subterranean water reserves of aquifers and springs, many of which feed rivers and lakes. 
But bottling the runoff from glaciers in the Alps, the Andes, the Arctic, the Cascades, the Himalayas, Patagonia, the Rockies, and elsewhere is not much better, as it diverts that water from ecosystem services like recharging wetlands and sustaining biodiversity. This has not stopped big bottlers and other investors from aggressively seeking to buy glacier-water rights. 
Much of today’s bottled water, however, is not glacier or natural spring water but processed water, which is municipal water or, more often, directly extracted groundwater that has been subjected to reverse osmosis or other purification treatments. Not surprisingly, bottlers have been embroiled in disputes with local authorities and citizens’ groups in many places over their role in water depletion, and even pollution. 
Worse, processing, bottling, and shipping the water is highly resource-intensive. It takes 1.6 liters of water, on average, to package one liter of bottled water, making the industry a major water consumer and wastewater generator. 
The industry depends mainly on single-serve bottles made from polyethylene terephthalate (PET), the raw materials for which are derived from crude oil and natural gas. In the 1990s, it was PET that turned water into a portable, lightweight convenience product. 
As a result, bottled water is now the single biggest source of plastic waste, with tens of billions of bottles ending up as garbage every year. In the United States, where the volume of bottled water sold last year increased by 7% from 2013, 80% of all plastic water bottles become litter, choking landfills. 
Of course, higher rates of recycling could improve this situation substantially. For example, Germany has successfully promoted recycling with a combination of smart regulations and incentives, such as machines at supermarkets that return deposits in exchange for bottles (often brought in by the poor). 
Although tap water in the West occasionally has quality problems, so does bottled water. The industry’s own production process sometimes causes contamination and forces major recalls. 
Indeed, tap water is often healthier than bottled water. Chemical treatment means that processed bottled water may lack fluoride, which is naturally present in most groundwater or is added in tiny amounts to municipal water supplies to promote dental health. 
There are also health concerns over the potential leaching of chemical compounds from PET bottles, as well as from the large reusable polycarbonate containers in which bottlers deliver water to homes and offices. Suboptimal storage conditions – which include, for example, prolonged exposure to sunlight and heat – can cause potent estrogenic activity in bottled water, exposing consumers to chemicals that alter the function of the endocrine system by mimicking the role of the body’s natural hormones. 
To be sure, these consequences are not going unnoticed. In the US, environmental concerns have prompted some university campuses and at least 18 national parks to ban the sale of bottled water. 
The bottled-water industry sees the danger as well – and is doing everything possible to keep public opinion on its side. To that end, big water bottlers like Nestlé, PepsiCo, and Coca-Cola Company have taken a page out of the playbook of energy behemoths like ExxonMobil, BP, and Shell, by pursuing “green” initiatives. 
It delivers no health benefits over clean tap water. And it does not even taste better; indeed, blind taste tests reveal that people cannot tell the difference between bottled and tap water. 
Unfortunately, it lacks the marketing muscle and advertising budgets that have powered the dramatic growth of the bottled-water industry. When a product that is cheaper and better does not prevail, that is bad news for consumers. 

India’s Shinzo Abe 
NEW DELHI – After a prolonged period of political drift and paralysis, India’s new government will be led by a man known for his decisiveness. Just as Japanese Prime Minister Shinzo Abe’s return to power in late 2012, after six years of political instability, reflected Japan’s determination to reinvent itself as a more competitive and confident country, Narendra Modi’s election victory reflects Indians’ desire for a dynamic, assertive leader to help revitalize their country’s economy and security. 
Like Abe, Modi is expected to focus on reviving India’s economic fortunes while simultaneously bolstering its defenses and strengthening its strategic partnerships with likeminded states, thereby promoting regional stability and blocking the rise of a Sino-centric Asia. The charismatic Modi – a darling of business leaders at home and abroad – has promised to restore rapid economic growth, saying there should be “no red tape, only red carpet” for investors. 
The 63-year-old Modi mirrors Abe’s soft nationalism, market-oriented economics, and new Asianism, seeking close ties with Asian democracies to create a web of interlocking strategic partnerships. 
In a country where the gap between the average age of political leaders and citizens is one of the world’s widest, Modi will be the first prime minister born after India gained independence in 1947. This constitutes another parallel with Abe, who is Japan’s first prime minister born after World War II. 
There is, however, an important difference in terms of the two leaders’ upbringing: While Modi rose from humble beginnings to lead the world’s largest democracy, Abe – the grandson and grandnephew of two former Japanese prime ministers and the son of a former foreign minister – boasts a distinguished political lineage. In fact, Modi rode to victory by crushing the dynastic aspirations of Rahul Gandhi, whose failure to articulate clear views or demonstrate leadership ran counter to the Indian electorate’s yearning for an era of decisive government. 
India is home to more than one-sixth of the world’s population, yet it punches far below its weight. A 2013 essay in the journal Foreign Affairs, titled “India’s Feeble Foreign Policy,” focused on how the country is resisting its own rise, as if the political miasma in New Delhi had turned the country into its own worst enemy. 
Many Indians want Modi to give a new direction to foreign relations at a time when the gap between India and China in terms of international stature has grown significantly. India’s influence in its own backyard – including Nepal, Sri Lanka, and the Maldives – has shrunk. 
India also confronts the strengthening nexus between its two nuclear-armed regional adversaries, China and Pakistan, both of which have staked claims to substantial swaths of Indian territory and continue to collaborate on weapons of mass destruction. In dealing with these countries, Modi will face the same dilemma that has haunted previous Indian governments: the Chinese and Pakistani foreign ministries are weak actors. 
Restoring momentum to the relationship with the United States – damaged recently by grating diplomatic tensions and trade disputes – is another pressing challenge. But Modi’s commitment to pro-market economic policies and defense modernization is likely to yield new opportunities for US businesses and lift the bilateral relationship to a new level of engagement. 
America’s strategic interests will be advanced by likely new defense cooperation and trade that boosts US arms sales and creates avenues for joint military coordination. The US already conducts more military exercises with India than with any other country. 
In 2005, the US government revoked his visa over unproven allegations that he connived in Hindu-Muslim riots in 2002, when he was Chief Minister of Gujarat. Even after India’s Supreme Court found no evidence to link Modi to the violence, the US continued to ostracize him, reaching out to him only on the eve of the recent election. 
With the US having expressed no regret for its revocation of his visa, Modi is unlikely to go out of his way to befriend the US by seeking a White House visit. Instead, he is expected to wait for US officials to come calling. 
By contrast, Modi is likely to remember states, such as Japan and Israel, that courted him even as the US targeted him. Modi’s 2007 and 2012 visits to Japan opened new avenues for Japanese investment in business-friendly Gujarat. 
Moreover, Modi has forged a special relationship with Japan and built personal rapport with Abe. When Abe returned to power, Modi congratulated him with a telephone call. 
Modi’s victory is likely to turn Indo-Japanese ties – Asia’s fastest-developing bilateral relationship – into the main driver of India’s “Look East” strategy, which, with America’s blessing, seeks to strengthen economic and strategic cooperation with US allies and partners in East and Southeast Asia. Abe, who has sought to build security options for Japan beyond the current US-centric framework, has argued that his country’s ties with India hold “the greatest potential of any bilateral relationship anywhere in the world.” 
A deeper Japan-India entente under Abe and Modi could potentially reshape the Asian strategic landscape. It is no surprise that Abe rooted for a Modi victory. 

Breaking Free from Fossil Fuels 
BERN – There has never been a better time to break free from fossil fuels. Record-breaking global temperatures, plummeting fossil-fuel prices, historic investments in renewable energy, and global pressure to honor climate pledges are all coming together to create the ideal setting for this world-changing shift. 
The United Nations climate agreement forged in Paris last December reconfirmed the level of 2°C above pre-industrial levels as a hard upper limit for global warming, beyond which the consequences for the planet become catastrophic. But it also included commitments to “pursue efforts” to limit warming to 1.5°C. Judging by the latest data published by NASA, achieving that lower limit should be viewed as an imperative. 
The new data confirm that 2015 was the hottest year on record, and show that the global run of record-breaking temperatures continued through the first two months of this year. According to NASA, global temperatures in February were 1.35°C above average, based on a 1951-1980 baseline. 
Fortunately, the privileged position of fossil fuels already seems to be weakening. In fact, according to the International Energy Agency (IEA), global greenhouse-gas emissions and economic growth have already decoupled, with global energy-related CO2 (the largest source of human greenhouse-gas emissions) having remained at the same level for the second year in a row. 
It seems that the precipitous decline in oil prices – by two-thirds over the last 18 months – has not, as many feared, encouraged increased consumption. What it has done is deal a major blow to the profits of fossil-fuel giants like Shell, BP, and Statoil. 
Coal is not faring any better. Following China’s announced moratorium on new coal-fired power plants at the end of last year, Peabody, the world’s largest coal company, recently filed for bankruptcy protection in the US, after it could no longer make its debt payments, partly because of waning demand for coal. 
Meanwhile, renewable energy sources are receiving record amounts of investment – some $329.3 billion last year, according to research from Bloomberg New Energy Finance. As a result, a cleaner, fairer, and more sustainable future, powered entirely by renewables, is starting to become a real option. 
Yet there is still a long way to go. Most governments are still clinging, to varying degrees, to destructive fossil fuels, with their volatile prices and devastating environmental impact, even as this dependence destabilizes their economies. 
Those committed to addressing climate change – from international organizations to local communities to individual citizens – must urgently build on the momentum acquired over the last year, by maintaining strong pressure on governments and companies to pursue the policies and investments needed to complete the break from fossil fuels. Just as a warming planet puts us all at risk, scaling up action early benefits everyone. 
Global movements such as Break Free have been exemplary in this regard. By backing campaigns and mass actions aimed at stopping the world’s most dangerous fossil-fuel projects – from coal plants in Turkey and the Philippines, to mines in Germany and Australia, to fracking in Brazil, and oil wells in Nigeria – Break Free hopes to eliminate the power and pollution of the fossil-fuel industry, and propel the world toward a sustainable future. 
Recognizing the scale and urgency of the challenge ahead, Break Free is prepared to intensify its peaceful resistance against new and existing fossil-fuel projects. The key will be the strength and bravery of communities demanding that we keep fossil fuels in the ground and instead build a healthier and more just world, in which everyone has access to sustainable energy. 
To accelerate progress, we must confront those who are profiting from climate change and defend the interests of ordinary people. Next month’s mobilizations against fossil-fuel projects are an important step in the right direction. 

Cancer Care for the Developing World 
BOSTON – More than four decades ago, US President Richard Nixon, inspired by early and encouraging results that showed that chemotherapy could cure diseases such as acute lymphoblastic leukemia and Hodgkin’s lymphoma, declared “war on cancer.” Since then, steady progress has been made using chemotherapy, surgery, and radiation to treat and cure an increasing number of cancer patients. 
In the United States, more than 80% of patients with breast cancer are long-term survivors, and more than 80% of cancer-stricken children survive. In my nearly 40 years as an oncologist at Harvard University, I have cared for thousands of patients who would have had little chance of survival were it not for chemotherapy. 
Stepping into the pediatric cancer ward at the central public referral hospital in Kigali was like traveling back in time. Outcomes among Rwandan children with Wilms’ tumor, a form of kidney cancer that rarely afflicts adults, mirrored those in the US 80 years ago, before the availability of drugs that today enable more than 90% of diagnosed American children to survive. 
According to Rwanda’s health minister, Agnes Binagwaho, the cancer ward in Kigali resembled the HIV/AIDS unit when she was a pediatrician at the hospital, a decade earlier. With no antiretroviral therapy, the prescription for HIV/AIDS was food and rest – meaning that infection essentially amounted to a death sentence. 
At the time, some were caught, if only briefly, on the wrong side of history. In 2001, a senior US official claimed that it would be impossible to treat HIV/AIDS in Africa, owing to its “complexity” and high cost. 
Today, rates of treatment adherence in Africa among HIV-positive patients with access to drugs have long exceeded those in the US. Indeed, Rwanda was one of the first countries to achieve universal access to AIDS treatment. 
True, cancer therapy is complex. It requires a broad range of diagnostic and therapeutic capacities – pathology, surgery, radiation, chemotherapy, and targeted medicines – together with the knowledge and skill to safely administer these life-saving treatments. 
But the Butaro Cancer Center of Excellence and others like it have proved that it is possible to treat cancer patients safely and effectively, even in poor, rural settings. Thanks to the Rwandan Ministry of Health, Partners In Health, and the Boston-based Dana-Farber Cancer Institute, the Butaro Center has treated more than 3,000 cancer patients, most of whom are referred from outside the region, since its dedication in July 2012 by former President Bill Clinton and Binagwaho. 
Fortunately, some major institutions are already stepping up to bolster this effort. The World Health Organization, together with the International Union for Cancer Control, is re-examining the WHO Model List of Essential Medicines for Cancer to identify more accurately which cancers are most responsive to treatment, and which place the heaviest burdens on populations. 
The most efficient approach to reducing global cancer mortality rates would be to bring existing therapies to cancer patients in developing countries. Add to that international funding for cancer treatment, like that which was mobilized for HIV/AIDS through the US President’s Emergency Plan for AIDS Relief and The Global Fund, and cancer mortality rates in developing countries could decline considerably – and quickly. 
More than a decade ago, the international community decided that it would no longer accept certain death for HIV patients. We must make the same commitment today to bring life-saving cancer treatment to patients everywhere. 

A Carbon Price-and-Rebate Plan 
PARIS – So far, international climate talks have failed to find a mechanism that will successfully reduce global greenhouse-gas emissions. The 1997 Kyoto Protocol attempted to use a system of tradable quotas to establish a price on carbon-dioxide emissions, but foundered after the United States and several emerging countries refused to join. 
The 2009 Copenhagen Climate Change Conference introduced a pledge-and-review process, in which countries unilaterally decided how much they would cut. As a result, the US and several emerging economies made commitments to reduce emissions for the first time. 
As world leaders meet in Paris from November 30 to December 11 for the United Nations Conference on Climate Change, they will have a new opportunity to forge an effective agreement. To encourage governments to act in concert, it is essential to work toward a system of carbon pricing that is both straightforward and transparent. 
They also highlight the knock-on benefits that taking quick action on climate change could have, including reduction of local pollution, greater energy and food security, and faster innovation. To accelerate the move toward a low-carbon economy, an international agreement must be applicable to all countries; include a common and consistent system for monitoring, reporting, and verification; and provide strong economic incentives at a global scale. 
Our price-and-rebate mechanism is inspired by the “bonus/malus” scheme in France, in which buyers of new cars are taxed or given a bonus depending on the vehicle’s CO2 emissions. In our system, a country exceeding the worldwide average for per capita emissions would pay a specified amount on every ton of CO2 (or its equivalent) above a set threshold. 
This system would initially benefit countries with the lowest per capita emissions, meaning that most of the funds would flow towards the least-developed countries. Once it is fully operational, the price-and-rebate mechanism would encourage all countries to reduce their per capita emissions, thereby reducing the gap between payments and rebates. 
A price of $1-2 per ton would generate $14-28 billion, enough to fund the deployment of the monitoring, review, and verification process in developing countries. The Copenhagen Accord included a commitment by rich countries to spend $100 billion a year after 2020 to help underdeveloped countries mitigate and adapt to climate change. 
Of that $100 billion, a little over $60 billion would come from Western countries and Japan, and just under $20 billion would come from hydrocarbon-exporting countries (Russia and Saudi Arabia in particular) and high-growth Asian economies (including China and Korea). The introduction of a price-and-rebate system would thus redistribute funds among countries in conformity with the principle of “common but differentiated responsibilities and respective capabilities.” 
A price-and-rebate system would be both efficient and fair. Every citizen in the world would have the same right to emit greenhouse gas, and every country would face the same incentives at the margin to reduce emissions. 
The main obstacle to be overcome in establishing such a system will be to convince donor countries’ governments to pay for their carbon emissions. This cost will be modest relative to the size of their economies, and any successful climate-change agreement will require similar commitments. 

Stopping Women’s Next Biggest Killer 
GENEVA – For women, the act of bringing life into this world has historically meant risking their own lives, with the real prospect of death during childbirth. But, though great strides are being made in reducing maternal deaths in poor countries, those gains could be undone by a growing threat to women’s health. 
Even as better standards of care continue to cut maternal mortality, cervical cancer deaths are expected to rise further. By 2035, the disease is expected to cause 416,000 women to die slowly and painfully every year – virtually all of them in developing countries (mostly Sub-Saharan Africa and South Asia). 
Human papillomavirus (HPV) vaccines, coupled with screening and treatment, could prevent the vast majority of cervical cancer cases. But almost 90% of the women who die from cervical cancer are in developing countries, where, for too many of them, screening services are unavailable, and treatment even less so. 
As former Additional Secretary at the Ministry of Health and Family Welfare in India, the country with the largest number of cervical cancer deaths in the world, I have seen the impact of the disease with my own eyes. What is particularly devastating is how it also quashes hope. 
In 2010, the total global cost of cervical cancer was estimated to be around $2.7 billion per year. By 2030, this is expected to increase to $4.7 billion, unless we do something about it now. 
Vaccines, fortunately, are becoming increasingly available. Safe and effective HPV vaccines have been on the market since 2006, protecting against HPV types 16 and 18, which cause 70% of all cervical cancer cases. 
Recently, we secured a record-low price for HPV vaccines of $4.50 a dose, opening the door for millions of the poorest girls to be vaccinated in 27 countries. By 2020, we estimate that Gavi will have helped over 30 million girls in more than 40 developing countries receive vaccinations against HPV. 
And, given that even high-income countries struggle to meet the cost of cancer treatments, prevention is clearly a far more efficient option. Moreover, cervical cancer strikes women during their most economically productive years, when their contribution to society and the economy is greatest. 
A recommendation last year by the World Health Organization’s Strategic Advisory Group of Experts on Immunization promises to boost vaccines’ cost-effectiveness further, by calling for just two doses of the HPV vaccine, rather than the three doses previously thought to be required. This will not only reduce the overall cost of vaccine procurement and delivery; it will also make it easier for health-care workers and the girls themselves. 
A study published by WHO and the London School of Hygiene and Tropical Medicine in June predicts that vaccinating 58 million girls in 179 countries would prevent 690,000 cases of cervical cancer and 420,000 deaths from the disease. Unfortunately, the study also found that of the 33 countries where HPV vaccines are most likely to have the greatest effect in preventing cancer, 26 had not yet introduced the vaccine. 
But we must keep the threat of cervical cancer firmly in our sights. It is imperative to act now to ensure that every girl has access to HPV vaccines and a healthy future free from cervical cancer, no matter where she lives. 

The Poverty Line’s Battle Lines 
WASHINGTON, DC – For a long time, as a college professor and then as the chief economic adviser to the Indian government, I was a happy user of the World Bank’s data on global poverty, tracking trends and analyzing cross-country patterns. I seldom paused to think about how those numbers were computed. 
Being in the business of measuring poverty is a challenge for the World Bank. If poverty declines, critics accuse us of trying to showcase our success. 
Fortunately, there is something liberating in knowing that you will be criticized for any outcome. Still, as our team set about defining the global poverty line this year (and thus the incidence of poverty), I was acutely aware of the note of caution from Angus Deaton, this year’s Nobel laureate in economics: “I am not sure it is wise for the World Bank to commit itself so much to this project.” 
In 2011, new purchasing power parities (or PPPs, which essentially estimate how much $1 dollar buys in different countries) had been computed, and the data became available in 2014. This was one reason to take stock of how we would adjust the global poverty line, estimate new poverty numbers, and publish them in our Global Monitoring Report, which was released in October. 
A second reason is that the UN has included the eradication of chronic poverty in its new Sustainable Development Goals. This means that our decision on where to draw the poverty line probably will influence not just the World Bank’s mission but also the development agenda of the UN and all countries around the world. 
Our first task was to see how the global poverty line had been determined earlier. In 2005, when the previous round of purchasing power parities was estimated, the method used was to take the national poverty lines of the 15 poorest countries, compute their average, and treat that as the global line. 
But where the line is drawn in the initial year is in some sense not that important. Because there is no unique definition of poverty, what matters is to draw a line at some reasonable place and then hold the line constant in real (inflation-adjusted) terms so that we can track the performance of the world and individual countries over time. 
But what should alarm them is that in 2011, some 14.5% of the world’s population – one in every seven people – lived below it. Given that we are already committed to the goal of ending extreme, chronic poverty by 2030, our first decision was to hold the yardstick for measuring poverty constant. 
Since there had been inflation between the two rounds of the PPP computation, in 2005 and 2011, we would obviously have to raise the nominal poverty line to keep the real line constant. However, doing this for the world as a whole is far from easy. 
We ran two experiments: one was to inflate the poverty lines of the 15 countries used in 2005, using their respective inflation rates and then taking an average; the other was to do the same for 101 countries for which we had the necessary data. These two methods raised the line to $1.88 and $1.90, respectively. 
However, a third approach was possible: to raise the poverty line with the new PPP indices so that the incidence of global poverty remained unchanged (because PPP arguably tells us about parity across countries and should not change the absolute level of global poverty). This exercise – and it was beginning to look like a strange alignment of the stars – resulted in a poverty line just above $1.90. 
Furthermore, poverty can and should be measured by many metrics other than money: life expectancy, educational attainment, health, and various other measures of human “functionings and capabilities” (as Amartya Sen calls them) are all important. To tackle these problems in the future and broaden the World Bank’s poverty research, we have established the 24-member Commission on Global Poverty – chaired by Sir Tony Atkinson of the London School of Economics and Nuffield College, Oxford – which will submit its report next spring. 
Measuring poverty attracts attention from both politicians and academic researchers – and we had an ample amount of both. We were attentive to the politics of poverty, but we resisted political lobbying. 

The Chennai Warning 
THIRUVANANTHAPURAM, INDIA – Even as world leaders were meeting in Paris to address climate change, the city of Chennai (formerly Madras), the capital of the southern Indian state of Tamil Nadu, reeled under the onslaught of the heaviest rainfall in 104 years. The city, home to five million people, has virtually shut down, with roads flooded and nearly 5,000 homes under water. 
And yet global automakers such as Ford, Daimler, BMW, and Renault took the unprecedented decision to halt production at their local factories. The venerable Chennai newspaper The Hindu failed for the first time in 178 years to bring out a print edition, because its employees couldn’t get to work (though it gamely produced an online issue). 
More such disasters, they suggested, are inescapable unless world leaders in Paris take decisive action to limit global climate change. “We are feeling climate change’s fast-growing impact now,” said India’s Prime Minister Narendra Modi, pointing to Chennai and calling upon industrialized countries to do more to mitigate global warming. 
Indeed, scientists predict that India will become significantly hotter over the next few decades, and therefore more prone to a range of weather-related calamities such as droughts, floods, crop failures, and cyclones. Chennai, they say, is just a warning. 
It is normal for India’s east coast around Chennai to suffer heavy monsoon rains at this time of year. And, although this is the most severe precipitation to hit the region since 1911, the flooding was also the result of human error: the irresponsible and unplanned urbanization that has transformed India in recent decades. 
In virtually every affected area, the flooding can be linked to ill-planned construction, which has taken place without regard to hydrology or Chennai’s natural ecosystems. Norms set by the Environment Department of Tamil Nadu have largely been ignored, because politicians make common cause with builders in the name of development. 
As a result, airports and bus terminals have been built on floodplains; warehouses and factories on wetlands and marshlands; and housing projects on former lakes. Drainage courses and catchments have been fair game for developers. 
Because construction has occurred with scant regard for the provision of adequate waste disposal and sewage systems, the city’s rivers and canals have become garbage dumps, so choked that they can no longer serve as effective conduits to channel rainwater to the sea. Likewise, the destruction of crucial wetlands and inadequate infrastructure to contain flooding means that rainwater runoff has nowhere to go. 
Urbanization is inevitable: an economy of 1.2 billion people cannot employ two-thirds of them in agriculture and hope to grow; rural people will inevitably move to cities to seek work and better lives. India’s urban population has risen from 10% at independence, less than seven decades ago, to almost 40% today. 
Many Indian cities have a higher population density than Chennai, and a similar catastrophe in Kochi or Thiruvananthapuram could lead to much higher casualties. We need to rethink our city drainage systems, rework our disaster-management institutions, and ensure that monsoon rainwater can drain out of our cities in the shortest possible time. 
The disaster could have been avoided if strict measures had been taken to preserve water bodies and respect environmental imperatives. If we get our priorities right, we will heed the lessons of this horror and create urban space only in environmentally sustainable ways. 
But India’s cities must be smart in a low-tech sense, too. The lesson of Chennai is that we cannot let more construction, urbanization, and manufacturing erode our natural resilience to familiar monsoon weather events. 

China’s Brittle Development Model 
NEW DELHI – After gaining independence from Britain in 1947, India was something of a poster child for the virtues of democracy – in stark contrast with China, which became a Communist dictatorship in 1949. Until the 1970s, it was widely argued that, while both countries suffered from extreme poverty, underdevelopment, and disease, India’s model was superior, because its people were free to choose their own rulers. 
With China’s economic boom, however, the counterargument – that a repressive political system is more conducive to development – has gained currency. But while China’s recent performance has been spectacular, India’s model may well stand up better in the long run. 
The conversation changed after 1978, when China surged ahead of India economically, causing many to conclude that India’s chaotic democracy was holding back its people. After all, if China’s leaders want to build a new six-lane expressway, they can bulldoze any number of villages. 
That old debate has now taken a new twist with the publication of a new book by Daniel A. Bell, a professor at Beijing’s Tsinghua University. Bell argues that Chinese authoritarianism – specifically, its “political meritocracy” – is a viable model of governance, possibly even superior to the democracy of India and the West. 
The economist and philosopher Amartya Sen famously demonstrated that famines do not occur in democracies with a free press, because their governments cannot ignore the suffering. Bell points out that China has also avoided famine, at least since the Great Leap Forward, and has done better than India on malnutrition. 
In fact, Bell argues, China’s merit-based system for selecting and evaluating officials guarantees better leadership than democratic elections, which often lead to victory for ignorance and prejudice. Despite some weaknesses (notably complacency and corruption), China’s system ensures orderly governance and development. 
India debated this question 40 years ago, when then-Prime Minister Indira Gandhi declared a state of emergency. She suspended civil liberties, locked up opposition leaders, and censored the press, based on the belief that democracy had impeded India’s development. 
But the “bread versus freedom” dilemma remains: Can governments deliver economic growth and prosperity while respecting their citizens’ rights and freedoms? The dysfunction of Indian politics in recent years, with its fractious coalitions and disrupted parliament sessions, has made that question seem more relevant than ever. 
Rapid industrialization and development have lifted millions of Chinese out of poverty, but often at the cost of great human suffering. China may have grown at breakneck speed, but it has broken a lot of necks in the process. 
One might like to contrast India’s sclerotic bureaucracy with China’s efficient one, India’s red tape with China’s red carpet for foreign investors, and India’s partisan politics with China’s Party hierarchy. But there is no doubt that India’s pluralist democracy has enabled it to manage its diversity superbly, giving all citizens the sense that they have a strong stake in their country – and a real influence over how it is run. 
When they are frustrated with their government, they vote against its leaders in the next election, rather than launching revolts or insurrections. When violent movements do arise, the democratic process often defuses them through accommodation: Yesterday’s militants become today’s chief ministers – and tomorrow’s opposition leaders. 
By contrast, if China’s system faces a fundamental challenge, its only response is repression. That may have worked so far, but every autocratic state in history has reached a point where repression was no longer enough to ensure order and progress. 
Given that the Chinese system is rigidly bureaucratic, permitting only gradual ascent up the career ladder, it is impossible for a young and relatively inexperienced but dynamic and inspiring leader – like, say, US President Barack Obama – to emerge. China would not choose gifted leaders who were failures in their youth, like US Presidents Franklin D. Roosevelt or Abraham Lincoln. 
But these countries probably would have been at least as successful without authoritarianism. The methods they used to promote growth and development are consistent with democratic principles, to the point that many formerly authoritarian states in East Asia managed to carry out successful transitions to democracy, without derailing their development. 
Finally, Bell’s view can be refuted by a simple observation: No population that has gained democratic rights has clamored for a return to dictatorship. That alone should be enough to prove that democracy is a strength, not a weakness. 
China’s system may have enabled its rapid economic rise, but its dependence on a top-to-bottom consensus means that it functions well only in a predictable environment. India’s system, by contrast, requires consensus on only one point: that everyone does not always need to agree, so long as they agree on how to disagree. 

China’s Green-Energy Revolution 
SYDNEY – China generates most of its electricity by burning fossil fuels, just as every rising economic power has done since the Industrial Revolution. But to focus on this single fact risks overlooking a notable trend. 
According to data released by the China Electricity Council, the amount of power that China generated from fossil fuels in 2014 decreased by 0.7% year on year, the first drop in recent memory. Meanwhile, power generation from non-fossil-fuel sources increased by 19%. 
Electricity generated by strictly green sources – water, wind, and solar – increased by 20%, with the most dramatic growth occurring in solar power generation, which rose a staggering 175%. Solar power also surpassed nuclear in terms of new energy produced, providing an extra 17.43 terawatt-hours last year, compared to 14.70 terawatt-hours from nuclear sources. 
The second area in which the green trend has become apparent is China’s total electricity-generating capacity. The country’s power system is now the world’s largest, capable of producing 1.36 terawatts, compared to the United States’ one terawatt. 
Direct comparisons of different power sources are difficult, because the use of wind, solar, nuclear, and fossil-fuel plants varies according to the time of day. But a look at annual data can offer insights into how the entire system is changing. 
China increased its ability to generate electricity from fossil fuels by 45 gigawatts, to reach a total of 916 gigawatts. At the same time, it increased its capacity to produce electricity from non-fossil-fuel sources by 56 gigawatts, achieving a total of 444 gigawatts. 
As a result, wind, water, and solar power accounts for 31% of China’s total electricity-generation capacity, up from 21% in 2007, while nuclear power accounts for another 2%. These results exceed the goal established by China’s 12th Five-Year Plan, which projected that power generating capacity based on non-fossil-fuel sources would account for approximately 30% of the country’s electricity system by 2015. 
Finally, the trend toward green energy can be seen in China’s investment patterns. The evidence is plain: The country is putting more money toward green sources of electric power than toward those reliant on fossil fuels. 
Investment in facilities producing energy from fossil fuels has consistently declined, from CN¥167 billion (roughly $24 billion) in 2008 to CN¥95 billion in 2014 ($15.3 billion), while investment in non-fossil-fuel sources has increased, from CN¥118 billion in 2008 to at least CN¥252 billion in 2014. The share of energy investment going into renewable electric generation has increased steadily, reaching 50% in 2011, up from 32% just four years before. 
Much depends on the success of China’s energy reforms, and in particular on its efforts to build the world’s largest renewable power system – an ambition far larger than anything imagined, much less attempted, in the West. This makes it all the more important to report accurately on the system as it evolves, in order to comprehend the overall direction of change. 
China’s power system remains heavily based on coal, and much more will be burned before the system can accurately be described as more green than black. But the direction of change is clear. 

China’s Thirst Threat 
For years, the People’s Republic has been engaged in frenzied damming of rivers and unbridled exploitation of mineral wealth on the resource-rich Tibetan Plateau. Now it is ramping up efforts to spur its bottled-water industry – the world’s largest and fastest-growing – to siphon off glacier water in the region. 
Nearly three-quarters of the 18,000 high-altitude glaciers in the Great Himalayas are in Tibet, with the rest in India and its immediate neighborhood. The Tibetan glaciers, along with numerous mountain springs and lakes, supply water to Asia’s great rivers, from the Mekong and the Yangtze to the Indus and the Yellow. 
By annexing Tibet, China thus changed Asia’s water map. And it is aiming to change it further, as it builds dams that redirect trans-boundary riparian flows, thereby acquiring significant leverage over downriver countries. 
With much of the water in its rivers, lakes, and aquifers unfit for human consumption, pristine water has become the new oil for China – a precious and vital resource, the overexploitation of which risks wrecking the natural environment. By encouraging its companies to tap Himalayan glaciers for premium drinking water that can satisfy a public skeptical about the safety of tap water, China is raising the environmental stakes throughout Asia. 
Though much of the bottled water currently sold in China comes from other sources – chemically treated tap water or mineral water from other provinces – China seems to think that the bottling of Himalayan glacier water can serve as a new engine of growth, powered by government subsidies. As part of the official “Share Tibet’s Good Water with the World” campaign, China is offering bottlers incentives like tax breaks, low-interest loans, and a tiny extraction fee of just CN¥3 ($0.45) per cubic meter (or 1,000 liters). 
Two popular brands in China are Qomolangma Glacier, sourced from a supposedly protected reserve linked to Mount Everest, on the border with Nepal, and 9000 Years, named after the assumed age of its glacial source. A third, Tibet 5100, is so named because it is bottled at a 5,100-meter-high glacial spring in the Nyenchen Tanglha range that feeds the Yarlung Tsangpo (or Brahmaputra River) – the lifeblood of northeastern India and Bangladesh. 
Ominously, the Chinese bottled-water industry is sourcing its glacier water mainly from the eastern Himalayas, where accelerated melting of snow and ice fields is already raising concerns in the international scientific community. Glaciers in the western Himalayas, by contrast, are more stable and could be growing. 
One of the world’s most bio-diverse but ecologically fragile regions, the Tibetan Plateau is now warming at more than twice the average global rate. Beyond undermining the pivotal role Tibet plays in Asian hydrology and climate, this trend endangers the Tibetan Plateau’s unique bird, mammal, amphibian, reptile, fish, and medicinal-plant species. 
Nonetheless, China is not reconsidering its unbridled extraction of Tibet’s resources. On the contrary, since building railways to Tibet – the first was completed in 2006, with an extension opened in 2014 – China’s efforts have gone into overdrive. 
Beyond water, Tibet is the world’s top lithium producer; home to China’s largest reserves of several metals, including copper and chromite (used in steel production); and an important source of diamonds, gold, and uranium. In recent years, Chinese-controlled companies have launched a mining frenzy on the plateau that not only damages landscapes sacred to Tibetans, but also is eroding Tibet’s ecology further – including by polluting its precious water. 
These are precisely the kinds of actions that caused China’s water crisis in the first place. Instead of learning the lessons of its past mistakes, China is compounding them, forcing a growing number of people and ecosystems to pay the price for its imprudent approach to economic growth. 
Bottled water is being sourced even from protected reserves where glaciers are already in retreat. Meanwhile, the glacier-siphoning boom is attracting highly polluting ancillary industries, including manufacturers of plastic water bottles. 
Make no mistake: Glacier-water mining has major environmental costs in terms of biodiversity loss, impairment of some ecosystem services due to insufficient runoff water, and potential depletion or degradation of glacial springs. Moreover, the process of sourcing, processing, bottling, and transporting glacial water from the Himalayas to Chinese cities thousands of miles away has a very large carbon footprint. 
A better alternative, both environmentally and economically, would be to boost investment in treatment facilities to make tap water safe in cities. Unfortunately, China seems determined to remain on its current course – an approach that could do irreparable and severe damage to Asia’s environment, economy, and political stability. 

A Silk Glove for China’s Iron Fist 
NEW DELHI – For years, China has sought to encircle South Asia with a “string of pearls": a network of ports connecting its eastern coast to the Middle East that would boost its strategic clout and maritime access. Not surprisingly, India and others have regarded this process with serious concern. 
Now, however, China is attempting to disguise its strategy, claiming that it wants to create a twenty-first-century maritime Silk Road to improve trade and cultural exchange. But friendly rhetoric can scarcely allay concern in Asia and beyond that China's strategic goal is to dominate the region. 
Simply put, the Silk Road initiative is designed to make China the hub of a new order in Asia and the Indian Ocean region. Indeed, by working to establish its dominance along major trade arteries, while instigating territorial and maritime disputes with several neighbors, China is attempting to redraw Asia's geopolitical map. 
The strategic dimension of the maritime Silk Road is underscored by the fact that the People's Liberation Army has led the debate on the subject. The PLA National Defense University's Major General Ji Mingkui argues that the initiative can help China to craft a “new image" and “win influence," especially as the US “pivot" to Asia “loses momentum." 
Instead, they compare it to the fifteenth-century expeditions of Zheng He, a Chinese eunuch admiral who led a fleet of treasure ships to Africa. According to Central Military Commission member Sun Sijing, Zheng used the ancient Silk Road without seizing “one inch of land" or seeking “maritime hegemony" (though history attests to his use of military force – for example, executing local rulers – to control maritime chokepoints). 
Though China is employing ostensibly peaceful tactics to advance the initiative, its primary goal is not mutually beneficial cooperation; it is strategic supremacy. Indeed, the Silk Road is integral to President Xi Jinping's “China dream" ambitions, which entail restoring China's past glory and status. 
China, especially under Xi, has often used aid, investment, and other economic leverage to compel its neighbors to deepen their economic dependence on – and expand their security cooperation with – the People's Republic. Xi's use of a $40 billion Silk Road Fund and the new China-sponsored Asian Infrastructure Investment Bank to develop the maritime Silk Road reflects this approach. 
Already, China is constructing ports, railroads, highways, and pipelines in the region's littoral states, not only to facilitate mineral-resource imports and exports of Chinese manufactured goods, but also to advance its strategic military goals. For example, China concluded a multi-billion dollar deal with Pakistan to develop the port at Gwadar, owing to its strategic location at the mouth of the Strait of Hormuz, which more than offsets the port's limited commercial potential. 
Twice last autumn, Chinese attack submarines docked at Sri Lanka's newly opened, $500 million container terminal at Colombo Harbor – built and majority-owned by Chinese state companies. China has now embarked on a $1.4-billion project to build a sprawling complex roughly the size of Monaco on reclaimed land in Colombo – a “port city" that will become a major stop on China's nautical “road." 
Zhou Bo, an honorary fellow with the PLA Academy of Military Science, admits that China's mega-projects “will fundamentally change the political and economic landscape of the Indian Ocean," while presenting China as a “strong yet benign" power. This is important, because the new Asian order will be determined less by developments in East Asia, where Japan is determined to block China's rise, than by events in the Indian Ocean, where China is chipping away at India's longstanding dominance. 
But China is treading carefully enough that it can continue to advance its goals, without spooking its intended quarry. The American academic John Garver depicted it best using a Chinese fable: “A frog in a pot of lukewarm water feels quite comfortable and safe. 
Seen in this light, it is not surprising that China has invited India to join the maritime Silk Road initiative. The aim is not only to help calm a suspicious neighbor, but also to slow the development of India's strategic ties with the US and Japan. 
China's plans for the Silk Road combine economic, diplomatic, energy, and security objectives in an effort to create an expansive network of linked facilities to boost trade, aid strategic penetration, and permit an increasingly potent and active submarine force to play an expanded role. In the process, China aims to fashion an Asian order based not on a balance of power with the US, but on its own hegemony. 

Development Finance with Chinese Characteristics? 
GENEVA – After a late flurry of additions to the founding membership of the Asian Infrastructure Investment Bank, attention now turns to setting the China-led AIIB’s rules and regulations. But important questions remain – most important, whether the AIIB is a potential rival or a welcome complement to existing multilateral financial institutions like the World Bank. 
Since China and 20 mostly Asian countries signed the AIIB’s initial memorandum of understanding last October, 36 other countries – including Australia, Brazil, Egypt, Finland, France, Germany, Indonesia, Iran, Israel, Italy, Norway, Russia, Saudi Arabia, South Africa, South Korea, Sweden, Switzerland, Turkey, and the United Kingdom – have joined as founding members. 
According to China’s finance ministry, the AIIB’s founding members are to complete negotiations on the Articles of Agreement before July, with operations to begin by the end of the year. China will serve as the standing chairman of the negotiators’ meetings, which will be co-chaired by the member country hosting the talks. 
While GDP will be the basic criterion for share allocation among the founding members, the finance ministry suggested in October that China does not necessarily need the 50% stake that its GDP would imply. Moreover, although the AIIB will be based in Beijing, the ministry has said that regional offices and senior management appointments will be subject to further consultation and negotiation. 
Like the $50 billion New Development Bank announced by the BRICS countries (Brazil, Russia, India, China, and South Africa) last summer, the AIIB has faced considerable scrutiny, with some Western leaders questioning its governance, transparency, and motives. Indeed, many in the West have portrayed their establishment as part of an effort to displace existing multilateral lenders. 
But the new development banks seem less interested in supplanting current institutions than in improving upon them – an objective shared by those institutions themselves. As Deputy Finance Minister Shi Yaobin pointed out recently, by recognizing the need to reform their governance, existing multilateral lenders have shown that there are, in fact, no “best practices” – only “better practices.” 
In fact, given its experimental approach to development, China is well-suited – and, as some top officials have hinted, more than willing – to contribute to this process. If China can help find a way to balance the need for high standards and safeguards in project lending with the imperative of rapid loan dispersion, global economic governance would benefit significantly. 
The SRF and the AIIB will serve as the key financial instruments of China’s “One Belt, One Road” strategy, centered on the creation of two modern-day Silk Roads – the (overland) “Silk Road Economic Belt” and the “Twenty-First Century Maritime Silk Road” – stretching across Asia toward Europe. The initiative will aim to promote economic cooperation and integration in the Asia-Pacific region, mainly by providing financing for infrastructure like roads, railways, airports, seaports, and power plants. 
Yet the SRF has received scant attention from Western media. This is unfortunate, because what little is known about it suggests that it could play an important role in transforming development finance. 
The State Administration of Foreign Exchange will hold a 65% stake; the China Investment Corporation (CIC, the country’s sovereign-wealth fund) and the China Export-Import Bank (China Exim) will each have a 15% stake; and the China Development Bank (CDB) will hold the remaining 5%. The Fund was officially registered in December 2014, and held its first Board of Directors meeting the following month. 
In a sense, the SRF can be considered China’s latest sovereign-wealth-fund initiative, and some media have even referred to it as the “second CIC.” But, whereas the CIC is under the managerial control of the finance ministry, the SRF’s operations appear to reflect the influence of the People’s Bank of China. 
In a recent interview, the PBOC’s governor, Zhou Xiaochuan, suggested that the SRF would concentrate more on “cooperation projects,” particularly direct equity investment, before hinting at the Fund’s “just right” financing features. For example, Zhou indicated that the SRF will adopt at least a 15-year time horizon for investments, rather than the 7-10-year horizon adopted by many private equity firms, to account for the slower return on infrastructure investment in developing countries. 
China Exim and the CDB could subsequently disburse loans for debt financing, with the CIC providing further equity financing. When the AIIB is up and running, it, too, could support this process, by arranging debt financing alongside SRF’s initial equity investment. 
Of course, there is still much to digest in these new financing initiatives. But one can see the emerging contours of a South-South development-finance landscape – one with the potential to transform multilateral lending more broadly. 

The High Cost of Cheap Meat 
BERLIN – Factory-style livestock production is a critical driver of agricultural industrialization. Its remorseless expansion is contributing to climate change, deforestation, biodiversity loss, and human-rights violations – all to satisfy Western societies’ unhealthy appetite for cheap meat. 
Europe and the United States were the largest meat consumers in the twentieth century, with the average person eating 60-90 kilograms (132-198 pounds) annually – far more than is required to meet humans’ nutritional needs. Though Western consumption rates are now stagnating and even declining in some regions, they remain far higher than in most other regions in the world. 
Meanwhile, in emerging economies – especially the so-called BRICS (Brazil, Russia, India, China, and South Africa) – members of the burgeoning middle class are changing their diets to resemble those of their rich-country counterparts. In the coming decades, as incomes continue to rise, so will demand for meat and dairy products. 
To meet this demand, the world’s agribusiness firms will attempt to boost their annual meat output from 300 million tons today to 480 million tons by 2050, generating serious social challenges and ecological pressures at virtually every stage of the value chain (feed supply, production, processing, and retail). 
One major problem with factory-style livestock production is that it leads to considerable greenhouse-gas emissions – and not just because the digestive processes of ruminant animals produce methane. The waste from the animals, together with the fertilizers and pesticides used to produce feed, generate large quantities of nitrogen oxides. 
Indeed, the factory model implies significant land-use change and deforestation, beginning with the production of feed. As it stands, about one-third of existing agricultural land is used for feed production, with the total share used for livestock production, including grazing, amounting to about 70%. 
With expanded meat consumption, soybean production alone would nearly double, implying a proportional increase in the use of inputs like land, fertilizer, pesticides, and water. Increased crop diversion to feed livestock will put upward pressure on food and land prices, making it increasingly difficult for the world’s poor to meet their basic nutritional needs. 
Making matters worse, the shift from mixed-use or indigenous systems of raising livestock to large-scale operations jeopardizes rural livelihoods, particularly in developing countries. Pastoralists, small producers, and independent farmers simply cannot compete with low retail prices that fail to account for the industry’s true environmental and health costs. 
Moreover, keeping large concentrations of animals in confined spaces facilitates the proliferation of infectious diseases that can spread to humans, such as avian flu. And measures used to mitigate that risk, such as the administration of low doses of antibiotics to prevent disease (and promote growth), are creating a public-health crisis by strengthening resistance to antimicrobial drugs. 
Add to this the horrific conditions suffered by the animals themselves, owing to the industry’s resistance to applying reasonable animal-welfare standards, and one might wonder how the industry could have been allowed to grow so large. The answer lies in its oligopolistic power, which enables industrial livestock producers to externalize their true social and environmental costs, which must then be covered by workers and taxpayers. 
In the European Union, only two key elements of the Common Agricultural Policy (CAP) would have to be changed to reduce drastically the distortions in the production system. Implementing these changes would send a clear signal that European policymakers take consumers’ wishes seriously. 
The first change would be to prohibit imports of genetically modified feed, and require that farmers produce at least half of their animal feed on their own farms. A clear set of rules on feed procurement would eliminate international imbalances in nutrients, and diminish the power of multinational agricultural biotechnology corporations like Monsanto. 
Second, the unnecessary administration of antibiotics in feed and watering systems should be prohibited. This would force farmers to treat animals individually for illnesses, based on veterinary diagnosis. 
In the United States, the Food and Drug Administration could ban the non-therapeutic use of antibiotics. And the US Department of Agriculture’s farm bill programs could provide increased support for free-range livestock operations, in order to encourage more sustainable approaches to meat production. 
As emerging-economy middle classes grow, it is vital to recognize that existing Western models of meat production and consumption do not provide a sound blueprint for the future. It is time to create a system that adheres to our ecological, social, and ethical boundaries. 

A Bright Future for Clean Technology 
In Europe, solar power took a hit after the European Commission decided to phase out subsidies for renewable energy by 2017. The installation of solar panels fell by nearly 60% in Germany in 2013, and by 70% in Italy. 
The convulsions in the clean-tech sector are simply symptoms of a cycle that characterizes emerging technologies: excitement, inflated expectations, and consolidation – ultimately followed by stability and the resumption of growth. Indeed, underlying recent developments are signs of a much more significant transformation: clean tech is becoming commercially viable. 
Confidence in the clean-tech sector's future is rooted in the need for sustainable solutions for a planet that is supporting an ever-wealthier population. Over the next 20 years, the number of middle-class consumers is expected to rise to some three billion, from 1.8 billion today. 
Over the last 12 years, for example, the average real construction cost of an oil well has doubled, and in recent years new mining discoveries have been few, despite the industry's best (and often expensive) efforts. But clean-energy costs are trending in the opposite direction, ripening these solutions at a time when need – particularly in some of the world's largest developing cities – is becoming acute. 
But, even as Germany and Italy lost their first- and second-place rankings in terms of new solar-power installations, China and Japan took their place. Globally, the solar-power industry has grown at an average annual rate of 57% since 2006. 
One lesson from the German experience is that sudden changes in regulation can create peaks and valleys in demand that are not helpful to an industry that is still emerging. The biggest risk in many markets is not that subsidies and other supports will be withdrawn, but that the regulatory structure will not adapt as the sector develops. 
As industries mature, the case for policy support weakens. And, indeed, solar power increasingly appears to be able to survive without regulatory help. 
More than one-quarter of cumulative global solar photovoltaic capacity was installed just in the past year. The International Energy Agency, which has been conservative regarding solar energy's prospects, now expects it to be the world's largest power source by 2050. 
Third-party ownership, in which a company installs and maintains solar panels, in exchange for either a set monthly rate or a fixed price per unit of power, has driven up adoption rates in California, financing more than two-thirds of new installations in 2012 and 2013. Similarly, new partnerships with large industry incumbents – such as the tie-up between Daimler and Tesla and the controlling stake that Total took in SunPower – are reducing the cost of finance for smaller firms. 
An entire new industry has been created around the use of information technology to reduce energy consumption. Some companies, such as C3 Energy, offer electric utilities software that can analyze their electrical networks to improve grid operations and asset utilization, thereby increasing profits. 
Smart-grid hardware has been deployed widely in the past decade, and as companies figure out how to use big data and analytic tools, it will become much more important. Google's acquisition of Nest Labs for $3.2 billion is a good example of the value that companies are placing on this kind of data. 
All of this adds up to an industry that Bloomberg calculates reached $310 billion in investment last year. This is not a “niche" segment, but an asset-intensive industry on its way to commoditization. 
Clean tech is maturing and adopting proven management practices in operations, marketing, sales, and distribution. Increasingly, the industry is implementing approaches that have ensured success in other sectors, such as reducing procurement costs and deploying lean principles in manufacturing. 
The shakeout in the clean-tech industry has been tough; but it has also been typical of emerging technologies, and, by weeding out the weaker players, it has made the sector more robust. This is a global segment meeting a growing global need. 

Fifty Years of Climate Dithering 
SYDNEY – In November 1965, US President Lyndon B. Johnson was presented with the first-ever government report warning of the dangers that could result from burning large amounts of fossil fuels. Fifty years is a long time in politics, so it is remarkable how little has been done since then to address the threat posed by carrying on with business as usual. 
“Man is unwittingly conducting a vast geophysical experiment,” warned the scientists. “Within a few generations he is burning the fossil fuels that slowly accumulated in the earth over the past 500 million years…The climatic changes that may be produced by the increased CO2 content could be deleterious from the point of view of human beings.” 
The committee’s foresight is not surprising; the existence of the greenhouse effect had been known to science since the French physicist Joseph Fourier suggested in 1824 that the earth’s atmosphere was acting as an insulator, trapping heat that would otherwise escape. And in 1859, the Irish physicist John Tyndall carried out laboratory experiments that demonstrated the warming power of CO2, leading the Swedish physicist and Nobel Laureate Svante Arrhenius to predict that burning coal would warm the earth – which he saw as a potentially positive development. 
Their report accurately predicted that the amount of CO2 in the atmosphere would increase by close to 25% over the course of the twentieth century (the actual number was 26%). Today, the atmospheric concentration of CO2 is 40% higher than it was at the beginning of the Industrial Revolution – by far the highest it has been during the past one million years, as we know from drilling into the Antarctic ice. 
Furthermore, Johnson’s scientific committee rebutted objections that continue to be used today by those who deny the dangers of climate change, including the claim that natural processes might be behind the rise in CO2 levels. By showing that only about half of the CO2 produced by burning fossil fuels remains in the atmosphere, the committee proved that the earth acts not as a source of greenhouse gases, but as a sink, soaking up half of our emissions. 
What Johnson’s advisers could not do was offer specific predictions for how much the rise in atmospheric CO2 would affect global temperature; they said they would first need better models and more powerful computers. Those calculations formed the basis of the next landmark report, the 1979 “Carbon Dioxide and Climate: A Scientific Assessment,” prepared by the US National Academy of Sciences. 
“We have tried but have been unable to find any overlooked or underestimated physical effects that could reduce the currently estimated global warming … to negligible proportions,” the report concluded. Since then, the scientific evidence has only gotten stronger; today, the basic findings laid out in these two early reports are supported by more than 97% of climate scientists. 
Meanwhile, geopolitics has impeded the development of an effective global response. The international climate negotiations that are expected to culminate in an agreement at the United Nations Climate Change Conference in Paris in November and December have been hampered by the requirement of consensus among the 195 countries participating. 
Eventually, rising sea levels will flood large coastal cities and destroy entire island states. The hottest years since record-keeping began in the nineteenth century were 2005, 2010, and 2014, and last year’s record will almost certainly be broken again this year. 
It is time that world leaders put an end to 50 years of dithering. They must seize the opportunity in Paris, set aside their short-term interests, and finally act decisively to avert a looming planetary catastrophe. 

The Health Benefits of Fighting Climate Change 
In fact, it is too costly to ignore. That is why the World Health Organization (WHO), for example, has linked the prevention of disastrous climate change to “immediate health benefits and health cost savings” from the reduction of air pollution. 
The statistics are grim. Air pollution caused more than seven million premature deaths – one in eight globally – in 2012, compared to nearly six million premature deaths from tobacco. 
One of the biggest causes of harm are the fine particles called PM2.5, with a diameter of less than 2.5 micrometers. They wreak havoc by traveling deep into the lungs, contributing to inflammation, cancer, and respiratory infection, or by passing into the bloodstream, where they can trigger changes in blood vessels that cause heart attacks and strokes. 
Motorized transport now accounts for half of premature deaths from ambient particulate matter in the 34 OECD countries. Coal-fired power is also the main source of carbon dioxide, the main greenhouse gas responsible for climate change, which causes about 150,000 premature deaths annually and threatens pervasive risks this century and beyond. 
But human health is at greater risk in countries that burn more coal. Research for the Global Commission on the Economy and Climate last year calculated that particulate matter alone caused 1.23 million premature deaths in China – the world’s top coal-consuming economy – in 2010. 
Estimates for 2012 suggest that 88% of air-pollution-related deaths occur in low- to middle-income countries, representing 82% of the world’s population. The Western Pacific and Southeast Asian regions bear the burden of 1.67 million and 936,000 deaths, respectively. 
For example, PM2.5 reduces life expectancy across the European Union by eight months and, together with ozone, was responsible for 430,000 premature deaths in the EU’s 28 member states in 2011. In Britain, more than six decades after the Great Smog of 1952, PM2.5 pollution levels still persistently exceed WHO guidelines. 
The WHO recently carried out a review of the evidence on the health effects of air pollution, and found that the range of such effects is broader and occur at lower concentrations than previously thought. In addition to the well-known effects of air pollution on the lungs and heart, new evidence points to its detrimental impact on children’s development, including in utero. 
Despite the overwhelming evidence of health risks, many countries routinely ignore air-quality standards – as well as the emissions monitoring needed for effective regional cooperation – mainly owing to governments’ fear of their economic impact. Economic models used by advisers to shape development strategy – and touted by lobbyists to influence decisions on major infrastructure projects – exclude the human cost of air pollution and the long-term benefits of measures to reduce it. 
Any solutions to the problems posed by air pollution will require not only new economic models, but also integrated measures by local, national, and international governments. Cutting emissions from urban transport, for example, will involve city mayors, local planners, and national policymakers working together to induce compact development. 
Air pollution is at the top of China’s domestic agenda, following the choking smog dubbed “airpocalypse” that engulfed its major cities in January 2013 and Chai Jing’s recent documentary (and social-media phenomenon) “Under the Dome,” which exposed the catastrophic health impacts of air pollution. Indeed, China’s government has closed some of the country’s dirtiest power plants, resulting in a drop in coal consumption last year for the first time since 1998. 
A recent draft resolution on air pollution and health for the World Health Assembly (the WHO’s governing body) suggests that countries should “underscore” a link between air pollution and climate change. Countries should adopt the WHO air-quality guidelines and highlight additional opportunities for greener urban planning, cleaner energy, more efficient buildings, and safer walking and cycling. 
A formal acknowledgement by governments of the immediate health-related benefits of cutting carbon-dioxide emissions can tip the scales toward greater progress on climate change, air pollution, and human health simultaneously. Policymakers everywhere should recognize the economic opportunities – and the political benefits – that such an outcome promises to deliver. 

Climate Change and the Catholic Church 
The pope should stick to morality, they say, and not venture into science. But, as the climate debate unfolds this year, most of humanity will find Francis’s message compelling: we need both science and morality to reduce the risk to our planet. 
Unfortunately, their views are not represented in the US Congress, which defends Big Coal and Big Oil, not the American people. The fossil-fuel industry spends heavily on lobbying and the campaigns of congressmen such as Senators Mitch McConnell and James Inhofe. 
In a survey of Americans conducted in January 2015, an overwhelming majority of respondents (78%) said that, “if nothing is done to reduce global warming,” the future consequences for the US would be “somewhat serious” or “very serious.” Roughly the same proportion (74%) said that if nothing is done to reduce global warming, future generations would be hurt “a moderate amount,” “a lot,” or “a great deal.” 
These groups’ attitudes mirror those of Americans more generally: 69% of Catholics and 62% of mainline Protestants responded that climate change is happening, with a smaller majority of Evangelicals (51%) agreeing. Majorities in each group also agreed that global warming will harm the natural environment and future generations, and that reducing global warming would help the environment and future generations. 
The first are free-market conservatives, who seem to fear government intervention more than climate change. Some have followed their ideology to the point of denying well-established science: because government intervention is bad, they tell themselves that the science simply cannot be true. 
The second group comprises religious fundamentalists. They deny climate change because they reject earth science entirely, believing the world to be newly created, contrary to the overwhelming evidence of physics, chemistry, and geology. 
But it is the third group that is by far the most powerful politically: oil and coal interests, which contributed hundreds of millions of dollars to the 2014 campaign. David and Charles Koch, America’s biggest campaign financiers, are simply oilmen out to multiply their gargantuan wealth, despite the costs to the rest of humanity. 
When the Pontifical Academies of Sciences and Social Sciences and some of the world’s top earth and social scientists met at the Vatican in April, the libertarian Heartland Institute, supported over the years by the Koch brothers, mounted a fruitless protest outside of St. Peter’s Square. The scientists at the Vatican meeting took extra care to emphasize that climate science and policy reflect fundamental principles of physics, chemistry, geology, astronomy, engineering, economics, and sociology, key parts of which have been well understood for more than 100 years. 
The Church champions the marriage of faith and reason. At least since the publication of Thomas Aquinas’s Summa Theologica (1265-74), natural law and the Golden Rule have been viewed as the fundamental pillars of the Church’s teachings. 
But many are unaware of the Church’s support for modern science, including many important contributions to biology, chemistry, and physics by world-leading Catholic clerics. Indeed, the founding of the Pontifical Academy of Sciences traces its origins back more than 400 years, to the Academy of Lynxes (Accademia dei Lincei), which inducted Galileo in 1611. 
Our hard-won scientific knowledge should be used to promote human wellbeing, protect the vulnerable and the poor, preserve Earth’s fragile ecosystems, and keep faith with future generations. Science can reveal the environmental dangers caused by humanity; engineering can create the tools to protect the planet; and faith and moral reasoning can provide the practical wisdom (as Aristotle and Aquinas would have said) to choose virtuously for the common good. 
The Vatican gathering in April included not only world-leading climate scientists and Nobel laureates, but also senior representatives of the Protestant, Hindu, Jewish, Buddhist, and Muslim faiths. Like Francis, religious leaders of all the world’s major religions are urging us to take wisdom from faith and climate science in order to fulfill our moral responsibilities to humanity and to the future of Earth. 

The Climate Categorical Imperative 
CAPE TOWN – Nowadays, people are too often forced to choose between doing what is morally right and doing what is economically beneficial. Indeed, their options sometimes appear to be mutually exclusive, making the decision of which path to take exceedingly challenging. 
The moral imperative is indisputable, as the effects of climate change – including extreme weather, temperature changes, and rising sea levels – are felt most keenly by the global poor, who have also benefited the least from the economic activities that cause it. Moreover, climate change could accelerate poverty and inequality in the future, meaning that, unless we address it in a timely manner, it will diminish – or even eliminate – future generations’ chances to achieve their development goals. 
After all, climate change carries significant economic costs – for example, those associated with more frequent and extreme weather events. Moreover, building a “green” economy, based on continued technological innovation, is the smartest and most efficient way to create new engines of sustainable growth and job creation for the next generation. 
The most important tool the world has for doing the right thing – and reaping vast economic benefits – is a universal climate-change agreement. That is why world leaders must take the opportunity presented by the United Nations Climate Change Conference in Paris this December to develop a single global framework for action. 
In fact, world leaders already pledged to do so. The UN Climate Change Conference in 2011 – initiated and hosted by South Africa – produced an agreement to adopt a universal legal agreement on climate change as soon as possible, no later than this year. 
Last month, more than 30 countries – including the European Union’s members, Gabon, Mexico, Norway, Russia, Switzerland, and the United States – submitted their post-2020 plans to reduce greenhouse-gas emissions. In the coming weeks and months, this momentum will continue to build, as other countries – including, it is expected, major emerging economies like Brazil, China, and India – submit their commitments as well. 
But if the Paris meeting is to be successful – in terms of both fulfilling the moral imperative and capturing the economic benefits of confronting climate change – every participating country must submit its national contributions for the period beginning in 2020 as soon as possible. Furthermore, the final agreement must include an effective and ambitious plan for de-carbonization over the next 50 years. 
The fact is that short- and medium-term commitments alone are simply inadequate to fulfill the pledge, made by the world’s governments in 2009 and reiterated in 2010, to cap the rise in global temperatures at 2° Celsius relative to the pre-industrial era. It is crucial to create – and adhere to – a progressive long-term emissions-reduction strategy that sends a clear signal to capital markets that governments are serious about confronting climate change. 
Such a strategy could include, for example, incentives for investment in low-carbon solutions. With some $90 trillion dollars set to be invested in infrastructure globally over the next 15 years, the impact of such an approach could be considerable – if not decisive. 
Although the road ahead will be difficult, with new and unexpected challenges arising along the way, we can find inspiration in Nelson Mandela’s famous dictum: “It always seems impossible until it’s done.” We face an unprecedented opportunity to achieve a more sustainable, prosperous, and socially just future. 

Building Climate Trust 
WASHINGTON, DC – In less than 80 days, world leaders will have the opportunity to strike a once-in-a-generation agreement in the fight against climate change. The United Nations Climate Change Conference in Paris in December could mark a turning point in world history: unanimous recognition of the need to act to prevent the most harmful consequences of global warming. 
But if a deal is to be secured, participants in the conference will have to overcome the mistrust that has led to polarization and inaction during past negotiations. Implementing an agreement with robust limits on greenhouse-gas emissions will first require honoring the commitments that have already been made, including promises by developed countries to spend $100 billion a year by 2020 to help the developing world mitigate its contribution to climate change and adapt to a warming world. 
Given the scale of the challenge and the costs that inaction imposes on the world’s most vulnerable people, development financial institutions and other interested parties must demonstrate their commitment to preventing the most harmful effects of climate change. Doing so requires a renewed – and transparent – dedication to the effort. 
That is why the World Bank Group is examining what more can be done to help put economies on a sustainable path. Keeping a keen eye on the national plans being submitted ahead of the Paris summit, we are surveying the full spectrum of our work in order to find opportunities to help countries in the areas of energy, transport, agriculture, forests, urban management, and much more. 
Indeed, the fight against climate change must be carried out across a wide variety of fronts. Rising global temperatures and an increasingly unstable climate will influence all aspects of development and jeopardize existing investments unless adequate mitigation and adaptation strategies – which are also central to the new Sustainable Development Goals that the United Nations will adopt later this month – are put in place. 
Part of this effort to fight climate change must involve addressing sources of economic inefficiency, such as fossil-fuel subsidies and inadequate accounting of the cost of pollution. And there is a growing recognition that development funds and climate finance can be used to spur and catalyze investment from public and private sources. 
But, above all, a successful climate deal will have to include proper measures for the management of the trillions of dollars that will need to be invested in low-carbon infrastructure and increased resilience to the harmful effects of rising global temperatures. This must be carried out in as public and transparent a fashion as possible. 
In order to accomplish this, the six large multilateral development banks and the International Development Finance Club – a network of national, regional, and international development institutions – have been painstakingly working on developing common principles for tracking climate finance. These principles should apply to all projects intended to help countries adapt to or mitigate the impact of climate change. 
In a report released in June, the six banks described how they have provided more than $100 billion in climate finance in the four years since joint reporting began. The World Bank Group finances can also be tracked under its access to information policy. 
The conference in Paris offers the opportunity to establish a clear path toward averting the most harmful effects of climate change; world leaders attending the meeting must not allow it to slip through their fingers. By credibly and transparently honoring their promises, rich countries can demonstrate their commitment to the effort and increase the likelihood of an effective agreement. 
Our emissions are already having devastating effects around the world. As climate-related volatility and uncertainty mounts, the cost of inaction will only continue to rise. 

Nature’s Answer to Climate Risk 
As climate change exacerbates the effects of storms, flooding, and erosion, the lives and livelihoods of hundreds of millions of those people will be at risk. In fact, the latest edition of the World Economic Forum’s World Risk Assessment Report names failure to adapt to the effects of climate change as the single greatest risk, in terms of impact, to societies and economies around the world. 
Beyond endangering lives, more frequent and stronger storms could cost many billions of dollars, owing to infrastructure damage and lost revenues from farming, fisheries, and tourism. And, as the Harvard Business Review recently noted, the projected cost rises with each new study. 
When it comes to climate risk, an ounce of prevention is worth a pound of cure. As Rebecca Scheurer, Director of the Red Cross Global Disaster Preparedness Center, put it, “We spend millions of dollars on the response side, and were we to invest more of those resources on the front end we’d save more people. 
With the human and the financial costs of climate change attracting more attention than ever, now is the time to shift resources toward risk reduction. Doing so will require national governments, industry, aid organizations, and other NGOs to make the most of their investments. 
Coastal and marine ecosystems have considerable potential to mitigate the effects of storms and other risks, especially when combined with traditional built infrastructure. A 100-meter belt of mangroves, for example, can reduce wave height by up to 66% and lower peak water levels during floods. 
But leaders increasingly recognize their importance, and are beginning to take action, including on the international level. The Paris climate agreement, reached last December and signed last month, not only established a consensus on the importance of addressing climate change, but also explicitly affirmed that ecosystems play a role in capturing greenhouse gases and helping communities adapt to the effects of climate change. 
For example, last year, the Seychelles announced a first-of-its-kind “debt for nature” swap with its Paris Club creditors and The Nature Conservancy. The swap will allow the country to redirect $21.6 million of its debt toward investment in a comprehensive approach to ocean conservation that will bolster its resilience to climate change. 
Private-sector leaders, too, are starting to look toward natural tools. Engineering firms like CH2M are working with coastal communities in the Gulf of Mexico and beyond to find hybrid solutions that combine traditional and nature-based approaches. 
Over the last decade, insurers have paid out some $300 billion for climate-related damage, often to rebuild the same vulnerable structures. It is not surprising, then, that the reinsurer Swiss Re has conducted studies on mitigating the costly risks of hurricanes to coastal communities. 
But every dollar spent to protect mangroves and coral reefs saved $20 in future hurricane losses. Given such findings, it is no longer inconceivable that insurance companies might one day write coverage for wetlands and other natural infrastructure that offers protection for coastal communities and economies. 
A Red Cross-led mangrove restoration project in Vietnam not only reduced damage to dykes and other built infrastructure, but also resulted in higher aquaculture yields and thus more income for the local communities. A mangrove and coral restoration project in Grenada – a joint effort of the Red Cross, the Nature Conservancy, and the fishers of Grenada’s Grenville community – has also shown great potential to increase resilience. 
The World Bank, the Nature Conservancy, and partner researchers (including ecologists, economists, and engineers) have recently published a report offering guidelines for such cooperation. Specifically, the report recommends calculating the value of coastal ecosystems in terms of protected capital and infrastructure, based on approaches commonly used by the insurance and engineering industries. 
In the face of rising climate and disaster risk, investments in nature-based solutions can protect lives and safeguard prosperity in a cost-effective manner – all while preserving imperiled natural ecosystems around the world. It is time for governments, business, and NGOs alike to recognize that when it comes to fighting the effects of climate change and protecting coastal communities, preserving and restoring nature may be the smartest investment we can make. 

Common Sense on Conflict Minerals 
“Thou’lt torture me,” responds the villainous Iachimo, “to leave unspoken that which, to be spoke, would torture thee.” The story behind certain parts of the global trade in natural resources today, whether spoken or not, is no less a source of anguish. 
In many of these countries, the trade in natural resources motivates, funds, and prolongs conflict and egregious human-rights abuses. Resources such as diamonds, gold, tungsten, tantalum, and tin are mined, smuggled, and illegally taxed by violent armed groups, and provide off-budget funding to abusive militaries and security services. 
Consider just four African countries: Sudan, South Sudan, the Central African Republic, and the Democratic Republic of Congo. Together, these resource-rich countries account for just over 13% of the population of Sub-Saharan Africa, but some 55% of the region’s internally displaced persons (and one in five worldwide) due to conflict. 
The deadly trade in conflict resources is facilitated by supply chains that feed major consumer markets, such as the European Union and the United States, with cash flowing back the other way. Natural resources, such as tin, tantalum, tungsten, and gold – all minerals that have been linked in some parts of the world to conflict and human-rights abuses – are found in our jewelry, cars, mobile phones, games consoles, medical equipment, and countless other everyday products. 
But the responsibility to reconcile global commerce with the protection of basic human rights does not fall first and foremost on consumers. Conflict prevention and human-rights protection are primarily the responsibility of states, and it is increasingly recognized that businesses must play their part as well. 
The OECD offers guidance on how to source minerals responsibly. Developed in close collaboration with the industry, it offers “detailed recommendations to help companies respect human rights and avoid contributing to conflict through their mineral purchasing decisions and practices.” 
The United Nations has also endorsed similar requirements. In 2011, the UN published a set of Guiding Principles on Business and Human Rights, according to which companies whose “operating contexts pose risks of severe human rights impacts should report formally on how they address them.” 
More than 80% made no mention on their Web sites of what they had done to avoid funding conflict or human rights abuses. Similarly, the European Commission’s Directorate General for Trade found that only 7% of 153 EU companies refer to a due-diligence policy for conflict minerals in their annual reports or on their Web sites. 
The Securities and Exchange Commission requires companies that use tantalum, tin, gold or tungsten in their products to investigate these raw materials’ origin, and to mitigate risks in their supply chains in line with the OECD Guidance if they are found to originate in certain conflict-affected or high-risk areas. The 12 member countries of Africa’s International Conference on the Great Lakes Region have committed to similar mandatory due-diligence requirements. 
In March, the European Commission proposed a plan under which disclosure would continue to be voluntary, meaning that the minerals that enter the EU would not be subject to mandatory checks. The proposal, furthermore, focuses exclusively on raw ores and metals, and excludes products that contain the relevant minerals, such as mobile phones, vehicles, and medical equipment. 
It is crucial that both institutions seize this opportunity to strengthen the EU’s response by making disclosure and compliance mandatory and extending coverage to include finished and semi-finished products. Better regulating the trade in these resources will not itself bring peace to conflict-affected areas. 

The New Health-Care Continuum 
DAVOS – The health-care industry has changed dramatically over the past few decades. Research and development have given us astonishing new treatments, powerful diagnostics, and a rapidly growing wealth of knowledge. 
Growing and aging populations are putting increased pressure on health-care systems that are already buckling under the burden of chronic diseases like cancer and diabetes. The Institute of Medicine estimates that in the United States alone, some $750 billion a year – about 30% of total health-care spending – is “wasted on unnecessary services, excessive administrative costs, fraud, and other problems.” 
A new generation of consumer technology, such as wearable health sensors, could automatically alert doctors to potential medical problems before they become acute episodes. Though such innovations must confront challenges like system interoperability and the need to protect patients’ privacy, the Internet’s integration into the travel and banking industries shows what is possible. 
Philips, for example, has developed a technology that allows doctors to share medical data from a prostate cancer biopsy with colleagues around the world. In the past, the biopsy could be shared only physically, which made diagnosing the exact type of prostate cancer difficult. 
They can continue to track themselves as their treatments progress, and their data can be integrated with medical records to provide a long-term view of their health, rather than an episodic snapshot of the day they visit a doctor. With access to professional coaching and support around the clock, patients will feel more empowered to manage their own physical wellbeing. 
The data are analyzed by obstetricians and gynecologists elsewhere, allowing women at high risk of illness to be identified and treated early. In Uganda, midwives in village health centers send compressed ultrasound scans to remote specialists, nearly doubling the number of newborns that can be delivered by a skilled health worker. 
This will create a continuum that starts with a focus on healthy living and prevention, empowers consumers to take control of their own health, and enables countries to improve their citizens’ overall wellbeing. The continuum will then move on to definitive diagnostics and minimally invasive treatments, optimized for quality and cost, and, finally, to recovery and home care, shifting medical care as soon as possible to more comfortable and cost-effective non-hospital settings. 
Governments, insurers, medical professionals, patients, and caregivers need to work together to ensure that the transition to this health continuum is well managed, so that access can be expanded, outcomes can be improved, and productivity can be enhanced. Together, we have the opportunity to improve the lives of billions of people, create healthier societies, save costs, and boost economic growth. 

Taking the BRICS Seriously 
BEIJING – Sailing down the Moscow River on a cool evening earlier this month, I found myself in intense conversation with the chair of the Foreign Affairs Committee of the Chinese National People’s Congress (NPC). Meanwhile, South African and Brazilian parliamentarians were swaying to Russian music and a guide pointed out the sights. 
What on earth could India’s fractious and rumbustious Lok Sabha, with its impassioned debates and disruptions, have in common with China’s decorous NPC, a rigorously controlled echo chamber for Communist Party decisions? Membership in the new BRICS grouping, many believed, did not provide a strong enough basis for cooperation. 
Such skepticism has been leveled at the BRICS grouping itself from its inception, with some dismissing it as the only international organization invented by an investment bank. Specifically, the term BRIC was coined more than a decade ago by then-Goldman Sachs analyst Jim O’Neill, who did not initially count South Africa among the ranks of the major emerging economies. 
But Russian President Vladimir Putin liked the idea from the start, and suggested in 2006 that the four countries should meet regularly. The grouping was soon formalized, with annual summits planned. 
Given that Russia was, until recently, a member of the G-8 – the northern hemisphere’s most important economic grouping – it would seem to have little affinity with the other four BRICS members, which have traditionally been viewed as the leading developing-country voices in global forums. But, by seizing on the idea of the BRICS, Putin revealed his desire to build an alternative global platform – and advance an alternative worldview. 
In addition to their annual summits – which have produced joint declarations covering every major global issue, from questions of peace and security to United Nations reform – the BRICS have conducted foreign ministers’ meetings and engaged in think-tank consultations. Moreover, the BRICS have created the New Development Bank, headquartered in Shanghai and headed by one of India’s most respected private-sector bankers. 
Seen against this background, the recent parliamentary forum is just the newest in an expanding array of institutions and mechanisms that are establishing the BRICS as an international grouping that cannot be ignored. 
The BRICS are emerging at a time when the future of the international system that arose in the immediate aftermath of World War II is increasingly being called into question. After two world wars, numerous civil wars, colonial oppression, and the horrors of the Holocaust and Hiroshima, the far-sighted statesmen of the time decided that liberal internationalism, based on the UN charter and allied institutions, was the only way to prevent more carnage. 
It has broadly ensured global peace, although at the cost of shifting many conflicts to the periphery. And it did not benefit only the developed world; it also ensured decolonization, promoted development, and found ways to accommodate the voices of newly emerging countries. 
China and India are seeking global influence commensurate with their economic weight; Brazil and South Africa are emerging as continental powerhouses, and hydrocarbon-fueled Russia is chafing at its status on the margins of the Western system. 
But the G-20’s effort to create parity in these institutions between the advanced economies and the emerging and transition countries has ground to a halt. Indeed, although US leaders technically agreed to IMF voting reforms, the US Congress has so far refused to ratify them. 
All they want is a place at the high table. Barring that, they have little choice but to build their own – though India, Brazil, and South Africa have reason to wonder if a Chinese-led world order would be an improvement on the current one. 
As countries acquire economic and military power, they start exercising their geopolitical muscle, too. The challenge for advocates of world order is to accommodate emerging powers within a framework of universal, predictable rules and global structures that ensure everyone a fair deal, appropriate for their size, capabilities, and contributions to the international system. 
Today’s world leaders appear to lack the statesmanship, the breadth of vision, and the generosity of spirit of those who created the post-1945 world order. By clinging stubbornly to the system they dominate and barring the door to new entrants, they have left those outside little choice. 
What the BRICS countries have in common is their exclusion from the places they believe they deserve in the current world order. That may not look like enough of a basis for a credible new international system. 
The fact is that, if the BRICS are not allowed to help lead within the existing global system, they will inevitably create their own. What that might mean for the world order established in 1945 is anybody’s guess. 

Local Innovation for Local Problems 
BOSTON – As we learn more about the threat from substandard and counterfeit medicines, it is becoming clear that it is a far greater problem than previously thought. It is also a scourge that is most acutely felt in developing countries, where fake and low-quality pharmaceuticals kill more than 500,000 people a year and affect millions more by contributing to the emergence of diseases that are resistant to existing treatments. 
This shortsightedness is a grave mistake that impedes innovation and progress. When it comes to tackling high-impact health challenges like the proliferation of fake or inferior drugs, local solutions and local innovations are not only likely to be central to any successful effort; they have the potential to provide benefits that go far beyond the scope of the original problem. 
Its members are quick to share ideas and eager to collaborate. While this group has produced some innovative solutions – for example, the Ghanaian entrepreneur Bright Simmons is using mobile technology to address the counterfeit-drug problem – many more passionate local inventors and entrepreneurs must get involved. 
They, too, are deeply concerned about the scourge of low-quality and fake drugs, but they are reluctant to rely on local innovation. In their minds, the solutions already exist, in the form of high-end technology designed and developed in the world’s richest countries. 
For developing-country leaders, the effort needed to create an ecosystem that supports innovation simply appears too great, and the return on investment too little. At countless conferences and symposia, ministry officials and government personnel insist that funds must be found to import solutions, à la carte. 
There is mounting evidence that sustainable solutions must have local support and local partners. Raising funds to import solutions from abroad addresses just one part of the challenge. 
As misuse and neglect causes equipment to malfunction, more funds become required or the program simply dies. Not only does this approach fail to nurture local ecosystems of innovation, which is deeply frustrating; it also fails – repeatedly – to solve the problem at hand. 
While some solutions in the area of drug-quality testing have come from African entrepreneurs like Simmons, such examples are extremely rare, and many are developed in the diaspora with the support of organizations from outside the region. For the most part, such initiatives never engage local students. 
And yet local talent is critical for solutions that are both original and sustainable. Indeed, by nurturing an inclusive culture of research, local innovation has the potential to provide benefits that extend far beyond the specific problem that is being addressed. 
Nurturing the participation of underrepresented groups and creating opportunities for education and learning not only creates goodwill and promotes transparency and accountability. Building a stable foundation for future research also enables more productive public-private partnerships and stronger links between academia and domestic industry, thereby promoting economic growth. 
Foreign organizations, such as aid agencies or pharmaceutical companies, do have a role to play in boosting local innovation. They can support it financially, create new partnerships, and encourage policymakers to give it more credence. 
This year, the United Nations will adopt the Sustainable Development Goals, marking the start of the next phase of global efforts to eradicate poverty and improve health. As the example of developing countries’ ongoing fight against counterfeit and low-quality medicines shows, success will depend – far more often than not – on local innovation. 

Lifesaving Convictions 
GENEVA – The plight of more than 200 girls abducted in northern Nigeria is a brutal reminder of just how vulnerable children in Africa – particularly girls – can be. But it is equally important to recognize that this is not a true reflection of modern Africa, and that African leaders are strongly committed to protecting their countries’ children. 
That is because, though terrorism is an insidious threat, the biggest risk to Africa’s children is disease, which often can be prevented through routine immunization. Indeed, as the world debates the best way to recover the missing girls, another menace is resurfacing: the World Health Organization recently declared the spread of polio an international public-health emergency, with several African countries now posing an ongoing risk of exporting the disease. 
Moreover, African leaders recognize that the best way to provide children with long-term and sustainable protection is through routine immunization. Earlier this month, African leaders meeting in Nigeria’s capital, Abuja, endorsed the Immunize Africa 2020 declaration, committing themselves to invest in a healthy and sustainable future for all children in their countries. 
And change is indeed occurring. Since 2001, there have been no fewer than 140 new vaccine launches in Africa, thanks to local leadership and support from my organization, the GAVI Alliance, and its partners, UNICEF, the World Health Organization, the World Bank, and the Bill and Melinda Gates Foundation. 
As a result of this kind of work, immunization coverage in Africa has increased dramatically, from 10% in 1980 to 72% in 2012. 
And now, from 2016 to 2020, Africa’s 50-plus countries will commit more than $700 million directly toward the cost of childhood vaccines through GAVI and its partners. This will make Africa the fourth-largest investor in GAVI, behind only the United Kingdom, the Bill & Melinda Gates Foundation, and Norway. 
However, given that African countries already spend billions of dollars on health services, and that the continent has so many other competing needs, investing in vaccines may not always seem an obvious choice. 
At the time, there was strong opposition to the ban, and I was compared to the world’s worst dictators. But I knew that the move would save many lives for years to come, and I was convinced that if I did not act, I would not be doing my job properly. 
As the gains to individuals – and society – became clear, more than 100 other countries followed Norway and Ireland’s lead, and today the number of smokers in Norway has been halved, and nine out of ten people support the ban. With the benefit of hindsight, some solutions may seem obvious; but it took the power of conviction to make the solution apparent in the first place. 
These countries’ leaders have already seen what can be achieved with vaccines, and they see further benefits from immunization in the coming years. Indeed, since its launch in 2000, GAVI has already supported the vaccination of 440 million additional people, helping to save six million lives. 
But now, as GAVI Alliance partners and donors prepare to meet in Brussels this week to map out GAVI’s funding for the next five years, there is a very real opportunity to do more. With GAVI support, we have within our grasp the chance to double the number of children immunized by 2020, approaching one billion in total and averting the deaths of more than five million lives between now and then. 
African leaders have demonstrated their resolve; but, at a time when many donor countries are still struggling to consolidate a fragile economic recovery, it will take commitment and conviction on the part of their leaders, too. None of us can do it alone, but through partnership we really can help to protect the world’s most vulnerable children. 

Trouble Amid Plenty in Emerging Africa 
NEW YORK – Africa is changing dramatically – and so are outsiders’ attitudes toward it, with the US finally seeming determined to catch up with China, Europe, and India in their interest in the continent. US President Barack Obama’s recent summit with 40 African heads of state and more than 200 US and African business leaders suggests a new, more confident mood. 
Consumer spending per capita is close to Indian and Chinese levels. If foreign investment, in partnership with the continent’s vibrant private sector, can benefit key sectors – particularly education, health care, and infrastructure – Africa may gain the broad-based development boost that its people need. 
There is also the Africa that is struggling, with conflict and crisis afflicting much of the continent, especially the tens of millions of people living in a belt of countries running from Mali to Somalia. Even before the recent Ebola outbreak in Liberia and Sierra Leone, South Sudan, the Central African Republic (CAR), and Mali were at risk of joining a long list of fragile or failing states that already includes Somalia and the Democratic Republic of Congo. 
In South Sudan, the world’s newest country, political unity across ethnic lines was maintained during the fight for independence, but collapsed this year into violent conflict. Roughly 1.5 million people have now lost their homes, and 400,000 have fled to neighboring states. 
In April, my own organization lost two staff members working inside a United Nations compound with displaced people. And, in early August, seven locally hired aid workers were targeted and executed. 
In the CAR, attacks on Christians by Muslim ex-Séléka fighters have been superseded by Christian and animist Anti-balaka militias’ violence against fleeing Muslims. CAR’s Muslim population has dropped from an estimated 15% to less than 5%. 
The UN appeal for South Sudan, which faces famine after fighting prevented farmers from planting crops, has reached only half of its funding target. Donor fatigue – and the multitude of global crises now confronting policymakers – is taking its toll. 
But it is important to recognize that, just as political crises often lead to humanitarian crises, humanitarian need can cause political instability, with mass exodus from crisis-ridden neighboring countries destabilizing entire regions. Indeed, civil wars are rarely contained within the countries where they begin. 
Half of the world’s poor, for example, live in fragile and conflict-ridden states – 20% more than ten years ago – and 75% of refugees live among locals in urban areas. Crisis and under-development are closely interlinked. 
Community-based initiatives that build trust are better than centrally or externally administered projects. Empowering women to protect themselves from violence, or teaching displaced children how to cope with their trauma, are among the most effective paths to recovery. 
But that alone will not address the sources of violent conflict that still blight millions of lives. Humanitarian relief must stand alongside economic development and good governance as the pillars of Africa’s drive to achieve its true potential. 

An Advocacy of Dunces 
CONCORD, MASSACHUSETTS – Imagine that a group of advocates tried to alert the public to a danger that they perceived, only the evidence showed that the danger was not real, and that by spreading their fears, this group was causing people to behave in ways that put the wider public – and you – at risk. What would you do? 
The government of Australia has answered that question in a dramatic way. It has revoked the tax-exempt charity status of an anti-vaccination advocacy group, on the grounds that their fear-mongering misinformation about the danger of vaccines threatens public health, especially the health of children. 
The government has also required the group to change its name, from the Australian Vaccination Network to the Australian Vaccination-Skeptics Network, in order to make the advocate’s perspective clear. “We will continue to ensure that they present themselves as an anti-vaccination advocacy,” said New South Wales Fair Trading Minister Stuart Ayres. 
Though the evidence is clear that vaccination does not cause the harms that its opponents stubbornly claim it does, any effort by a government to restrict speech is worrying. No free society should permit its government to decide which advocacy groups can say what, based on what those advocates believe. 
But, in this case, the Australian officials’ action was an entirely appropriate, and essential, public service: protecting public health and safety, based on robust and consistent medical evidence. 
That evidence conclusively disproves the claims of anti-vaccination advocates that childhood vaccination causes autism and other long-term neurodevelopmental damage. Yet a small but vocal group of alarmists and self-serving profiteers continues to spread fear-mongering distortions and outright lies claiming that vaccines do more harm than good. 
As a result, vaccination rates are declining in some communities, especially those with high concentrations of anti-government libertarians or back-to-nature environmentalists. As a result, in some areas, community-wide “herd” immunity levels for diseases like measles and pertussis (whooping cough) have fallen below those necessary to keep them from spreading into the general population. 
Protecting us from threats from which we cannot protect ourselves as individuals is, after all, a central part of what we empower government to do. When the evidence is as clear as it is with vaccines (and the consequences as grave), the government has the well-established authority – indeed, obligation – to act in the name of public safety. 
The ideology-driven denial of human-induced global warming is impeding efforts to mitigate climate-altering emissions or prepare for the increasingly obvious – and dangerous – consequences of this enormous threat. Absolutist opposition to any regulation of gun ownership, particularly in the United States, is making it harder to keep deadly weapons out of the hands of those who pose a threat to society. 
Resistance to biotechnology, especially genetically modified (GM) foods, is another example. Some applications could bring enormous net benefits to human health, but society is not enjoying those benefits – and people are suffering and dying as a result – because opponents reject all GM applications, owing to a fundamental dislike of large companies, commercial agriculture, or modern technologies generally. 
Consider “golden rice,” a GM hybrid that carries the gene from carrots that makes vitamin A. A recent study found that, in India alone, had golden rice been approved when it was technically ready in 2002, it could have saved 1.4 million disability-adjusted life years for those who instead suffered blindness or death from vitamin A deficiency. 
Scientists must speak out, as they did recently in England, where researchers testing a new strain of wheat challenged anti-GM advocates to a public debate. The advocates refused, but went ahead with planned attacks on the field trials, causing public support for those activists to diminish. 
You and I and our fellow citizens must push back, by choosing which groups to join or to support financially. We need to push back at public hearings and in testimony about pending legislation, and not let the most passionate voices bully our politicians and policymakers into choices that placate the loudest few, but that deny the greater community the most good. 
We need the passion of advocates on all sides to move society forward. But when those passions fly in the face of the facts and put us at risk, it is entirely fair that in the name of public health and safety, you and I and our governments all say, “Enough is enough.” 

REDD+ Handed in Paris 
BERLIN – It’s been 30 years since the Food and Agriculture Organization of the United Nations launched the Tropical Forestry Action Plan, the first global intergovernmental initiative to halt forest loss. Since then, deforestation has continued unabated, and the latest international effort to stop it – an initiative known as Reducing Emissions from Deforestation and Forest Degradation (REDD+) – looks no more likely to be effective. 
REDD+ was created as part of the UN Framework Convention on Climate Change, and the agreement governing its implementation is expected to be finalized during the UN Conference on Climate Change in Paris. But if world leaders are serious about halting forest loss, they should instead abandon REDD+ and replace it with a mechanism that addresses the underlying drivers of large-scale deforestation. 
The vast majority of its projects treat forest peoples and peasant farmers as the main agents of deforestation. REDD project developers seem to be especially fond of projects that focus on restricting traditional farming practices, even as they shy away from efforts to tackle the true causes of deforestation: the expansion of industrial agriculture, massive infrastructure projects, large-scale logging, and out-of-control consumption. 
These shortcomings are exemplified in the Socio Bosque Program, a REDD+ initiative in Ecuador, in which efforts to control forest communities and peasant farming overlook the far larger potential damage caused by industrial activity. Under the program, forest-dependent communities sign five-year agreements with the Ministry of Environment, agreeing to restrict forest use in return for small cash payments. 
There is a disturbing rationale for this myopic focus on peasants and forest people and for the prominence of this approach on the agendas of international agencies and climate negotiators. REDD+, it turns out, has less to do with stopping forest loss than with allowing industrialized countries to continue to pollute. 
The approach underlying the initiative is part of a broader effort to create a market for emission credits, which would allow polluters to continue releasing greenhouse gases if they can produce a certificate attesting that they have contributed toward preventing a similar amount of emissions elsewhere. The forests being protected by REDD+ are important producers of these tradable certificates to pollute, known as carbon credits. 
If REDD credits are approved in Paris, countries and companies could pay peasant farmers in Ecuador or elsewhere to protect trees that programs like REDD+ claim they otherwise would have chopped down – thereby avoiding the need to make difficult structural changes to cut emissions at home. Under the rules governing these transactions, the fact that no emissions were actually cut does not matter; what is important is that the tradable permission to pollute has been obtained. 
For governments, programs like REDD+ offer an opportunity to avoid politically costly changes. And for international conservation groups like The Nature Conservancy, Conservation International, the World Wildlife Fund, and the Wildlife Conservation Society, the program provides access to international development and philanthropic funding. 
The biggest beneficiaries, of course, are the corporations whose hunger for land is driving most of the large-scale deforestation. In addition to allowing them to continue cutting down trees as long as they can produce the necessary carbon credits, REDD+ effectively shifts the blame for forest loss away from their actions and onto communities that have the greatest stake in forests’ long-term health. 
If the climate negotiators meeting in Paris are truly interested in halting forest loss and bringing climate change under control, they should pull the plug on REDD+ and address the underlying causes of these problems. Rather than attempting to control the lives and actions of forest peoples and peasant farmers, the effort in Paris should focus on ending large-scale deforestation and leaving fossil fuels in the ground. 

Reversing Africa’s Medical Brain Drain 
The plan reportedly includes four of Uganda’s 11 registered psychiatrists, 20 of its 28 radiologists, and 15 of its 92 pediatricians. In return, the Caribbean country (which has a doctor-to-patient ratio 12 times higher than Uganda’s) will help Uganda exploit its recently discovered oil fields. 
Uganda’s foreign ministry says the agreement is part of its mandate to promote the country’s interests abroad through the transfer of skills and technology, as well as an opportunity to earn foreign exchange by sourcing employment for its citizens. But Uganda’s international donors are not convinced; the United States has voiced strong concern, and Belgium has suspended development aid to Uganda’s health-care sector. 
But they often work in appalling conditions at great personal sacrifice. So it is not surprising that they become disheartened and seek professional opportunities elsewhere. 
In 2009, I was on track to become only the sixth neurosurgeon in Uganda, working at Mulago National Referral Hospital, the country’s main tertiary institution. We sometimes had to cancel major operations when the malfunctioning sewage system in our theatre regurgitated waste into what was supposed to be a sterile environment. 
The deal between Uganda and Trinidad and Tobago violates the World Health Organization’s global code on the International Recruitment of Health Personnel, which is aimed at discouraging the recruitment of personnel from countries that have a critical shortage of health-care workers. A Ugandan think tank, the Institute of Public Policy Research, has called the plan a “state-sanctioned brain drain.” 
If the plan is executed properly, it could benefit both the health-care sector and the country, by raising additional funds, strengthening medical workers’ skills and motivation, and creating a model for engaging with the diaspora. Other developing countries facing similar challenges with retaining health-care workers could learn from Uganda’s experience. 
But it also should be recognized that it is not sensible to chain health-care workers to a failing system. There has to be a way to encourage doctors to contribute to their country’s health-care system, while offering them an opportunity to achieve their personal and professional goals. 
In order to make it work, the recipient country would have to agree to recruit health-care professionals solely through the government. The country could then tax the foreign income of its workers and use the revenues to develop its health-care system. 
Moreover, any agreement should explicitly require the provision of education and professional-development opportunities for recruited health-care workers. The recipient country might open their medical schools and health-care training to new recruits, or help pay for health-care education and a scholarship fund back home. 
With so many qualified doctors emigrating to the United Kingdom and the US, the rest of the world, including developed countries, is also experiencing a tremendous medical brain drain. Roughly 35,000 Greek doctors have emigrated to Germany, while Bulgaria is “bleeding doctors,” losing up to 600 every year (equal to the country’s annual number of medical-school graduates). 
Eighty percent of countries where the density of skilled health workers is less than 22.8 per 10,000 people are in Africa, and another 13% are in Southeast Asia. The effects of such shortages were made clear during the recent Ebola crisis in West Africa. 
The ultimate solution is not to discourage professionals from working abroad; it is to ensure better training and more amenable working conditions. That way, we health-care professionals can focus on the task at hand: providing health care to our people. 

A New Direction for Global Health 
NEW YORK – It is easy to be discouraged about the state of international cooperation today, but global health remains an area in which the world has come together to do significant good. Over the last dozen years, international initiatives have delivered HIV/AIDS treatment to millions, expanded childhood immunization, and spurred a dramatic increase in global support for addressing other health challenges, from malaria to maternal health. 
International support for global health is an investment in developing countries’ future prosperity and the wellbeing of their people. It is an investment that the world’s richest countries can well afford. 
Millions who would have otherwise perished from HIV/AIDS are still alive. Countries that were aid recipients are increasingly self-sufficient – and have become better trade and strategic partners as a result. 
Dramatic changes in urbanization, global trade, and consumer markets – which occurred over decades in wealthy countries – are happening at a faster rate, and at a much larger scale, in still-poor countries. These trends have brought substantial health benefits, such as better sanitation and increased food production, but have given rise to significant challenges as well. 
Prior to this year, Ebola had killed fewer than 2,000 people, all in Central Africa, since it was first identified in 1976. The virus has killed more than three times that number in 2014, with enough cases spreading internationally to dominate nightly news broadcasts and spook voters in recent US state and local elections. 
Urbanization is increasing in West Africa at a rate of 3% per year (compared to 0.2% and 0.3%, respectively, in North America and Europe). The result has been the proliferation of settlements of a million people or fewer living with limited public-health infrastructure. 
These cramped cities are ideal incubators for outbreaks of emerging infectious diseases like Ebola. With greater trade and travel to the region, outbreaks are likely to spread before international containment can coalesce. 
Another example of changing global health needs is the stunningly fast increase of heart disease, cancers, and other noncommunicable diseases (NCDs) in low- and middle-income countries. Once thought to be challenges for affluent countries alone, these diseases have quickly become the leading cause of death and disability in developing regions, killing nearly eight million people before their 60th birthdays in 2013. 
In a recent report sponsored by the Council on Foreign Relations, we highlight the contrast between rising rates of heart disease, cancer, diabetes, and other NCDs in developing countries and the success of international efforts on HIV/AIDS and other infectious diseases. From 1990 to 2010, death and disability from NCDs in low-income countries increased 300% faster than the rate of decline in infectious diseases. 
Inhabitants of densely packed urban areas in emerging economies often face both indoor and outdoor pollution, and are less likely to have access to adequate nutrition. Most health systems in these countries are not built for chronic or preventive care and lack basic consumer protections. 
International investments have not yet adjusted to changing global health needs, especially with respect to NCDs. In 2010, $69.38 of international aid was spent for each year lost to death or disability from HIV/AIDS (as measured in disability-adjusted life years, or DALYs), $16.27 was spent per DALY lost to malaria, and $5.42 per DALY lost to poor maternal, newborn, and child health. 
Meanwhile, the emerging NCD epidemic is worsening. Indeed, the World Economic Forum is predicting $21.3 trillion in losses from these diseases in developing countries by 2030. 
They include low-cost drugs to reduce heart attacks, vaccines to prevent cervical cancer, and the same tobacco taxes and advertising rules that dramatically cut smoking rates throughout Europe and the US. Pilot programs have successfully integrated these tools and policies into donor-funded programs on HIV/AIDS and other infectious diseases in low- and middle-income countries. 
If, over the next decade, low- and middle-income countries could improve NCD prevention and treatment at the same rate as the average rich country from 2000 to 2013, they would avert more than five million deaths. That return is comparable to the most successful global health investments in HIV and childhood immunization, and it is an investment worth making for the same reason: a peaceful, inclusive global economy presupposes healthier, more productive lives. 

Why Economists Put Health First 
PALO ALTO – In an ideal world, everyone, everywhere, would access the health services they need without having to pay more than they could afford. But is “health for all” – also known as universal health coverage – really possible, not just in rich countries, but in the poorest countries, too? 
That’s why we joined hundreds of fellow economists in almost 50 countries to urge leaders to prioritize investments in universal health coverage. And the broader impetus behind this Economists’ Declaration, convened by The Rockefeller Foundation and now with more than 300 signatures, has placed global health and development at a historic crossroads. 
In September, the United Nations General Assembly adopted a new set of 15-year global goals to guide the world’s efforts to end poverty, foster inclusive prosperity, and secure a healthy planet by 2030. As world leaders prepare to enact the most ambitious global to-do list yet – the Sustainable Development Goals will be launched on January 1 – deciding where to begin may seem a daunting task. 
For economists, however, the answer is clear: The next chapter of development strategy should assign a high priority to better health – and must leave no one behind. 
Reaching everyone with high-quality, essential health services without the threat of financial ruin is, first and foremost, the right thing to do. Health and survival are basic values to virtually every individual. 
The fact that “preventable deaths” remain common in low- and middle-income countries is a symptom of broken or under-resourced health-care delivery systems, not a lack of medical know-how. If we increase investments in health now, by 2030 we can be that much closer to a world in which no parent loses a child – and no child loses a parent – to preventable causes. 
When people are healthy and financially stable, their economies are stronger and more prosperous. And, with benefits ten times greater than initial costs, investing in health first may ultimately pay for the rest of the new global development agenda. 
More than a hundred countries have taken steps down this path; in the process, they have revealed important opportunities and strategies to accelerate progress toward the goal of health for all. In particular, we believe that three areas – technology, incentives, and seemingly “non-health” investments – have the potential to advance universal health coverage dramatically. 
First, technology is fast becoming a game changer, especially in developing countries, where the gap in access to health care is the widest. In Kenya, which already leads the world in mobile money through “m-PESA,” an upsurge in telemedicine is enabling rural patients and health practitioners to interact, through video conferencing, with staff in Kenya’s main hospitals – thereby increasing quality of care at very little cost. 
The m-PESA Foundation, in partnership with the African Medical Research Foundation, has also begun implementing online training of community health volunteers and complementing these trainings with bulk SMS/WhatsApp group messages to keep the group connected and share important updates. Investments in high-value, low-cost technologies will help us achieve more with every dollar. 
For example, when the state pays the private sector based on outcomes (for example, the number or share of vaccinated children), both accountability and results have been known to improve. Voucher programs for reproductive health care in Uganda and Kenya are now providing access to quality services from the private sector. 
These include clean water and sanitation, and roads and infrastructure that enable emergency care and delivery of services. Health systems do not exist in a vacuum, and if we are serious about sustainable development, it is time to understand that investments in complementary systems are “trade-ons” not trade-offs. 
A natural progression of the status quo will not be enough to reach them. Instead, we must push public health systems beyond their usual boundaries by investing in and promoting new technologies, sharpening incentives, and recognizing that health systems do not exist in a vacuum. 
Universal health coverage is right, smart, and overdue. To achieve a world where everyone’s health needs are met and nobody is trapped in poverty, our leaders must heed this message and act on it. 

Making the Most of More Aid 
In 2014, for the second consecutive year, official development assistance (ODA) totaled a historic high of $135 billion, according to new OECD data. This indicates that advanced economies remain committed to promoting global development, despite their own recent problems. 
Add to this total the substantial spending by China, Arab states, and Latin American countries in the form of investments and loans, and it is clear that flows of ODA toward the developing world have reached unprecedented levels. And yet happiness about the headline numbers should not be allowed to obscure opportunities to channel these funds more effectively. 
Official aid from donor countries has helped to halve extreme poverty and child mortality, and it has driven progress on many other fronts as well. But it is becoming clear that sustained flows of development aid will not be enough to eradicate extreme poverty by 2030 and implement the new United Nations Sustainable Development Goals, which are to be agreed upon later this year. 
The money being spent on aid today could have a substantially greater impact if it were used to mobilize domestic tax flows and private investment in aid-dependent countries. This use of ODA can be better captured in the new indicator introduced on April 8 by the OECD: Total Official Support for Development. 
On average, developing countries raise 17% of their GDP in taxes, compared with 34% in OECD countries. Some collect as little as 10%. 
Africa, for example, loses around $50 billion a year in illicit flows, much more than it receives in development aid. Enabling developing countries to generate just 1% more of GDP in taxes would mobilize twice as much money as the total amount of ODA – and all of it could be channeled into education, health, security, or cash disbursement schemes. 
In Kenya, Tax Inspectors Without Borders, a project led by the OECD, found that every dollar spent working with authorities on cracking down on tax avoidance produced $1,290 in increased revenues. Similarly, in the Philippines, a half-million dollars provided to support tax reform generated well over $1 billion in additional tax receipts. 
Guarantees, soft loans, and equity investments backed by development aid can help attract investors, as has occurred with solar energy projects in Mali and manufacturing plants in Ethiopia. In 2014, then-EU Commissioner for Development Andris Piebalgs reported that grants worth €2.1 billion ($2.2 billion) had “achieved an estimated leverage of €40.7 billion in 226 projects since 2007.” 
Even as aid remained at record levels last year, funds provided to the world’s least-developed countries actually dropped. Long-standing programs in better-off countries received greater amounts of money, while a string of poorer candidates were once again overlooked. 
When world leaders meet in Addis Ababa in July for the Financing for Sustainable Development Summit, they must agree to channel aid to those countries with the least access to other sources of finance, the greatest difficulty in attracting investors, and the weakest tax systems. Vulnerable groups, such as ethnic and religious minorities and indigenous rural populations struggling to break out of poverty, should receive special attention. 
These donor countries have also pledged to meet a UN target of spending at least 0.15% of their gross national income on development assistance to the least-developed countries. Moreover, they have agreed on new rules that should channel more resources on softer terms to the poorest countries, and that implement new safeguards to ensure debt sustainability. 
We are the first generation in human history with the means to pull every person on the planet out of abject poverty. There is enough money in the world. 

Drones for Development 
In April, the United States Navy announced an experimental program called LOCUST (Low-Cost UAV Swarming Technology), which officials promise will “autonomously overwhelm an adversary” and thus “provide Sailors and Marines a decisive tactical advantage.” With a name and a mission like that – and given the spotty ethical track record of drone warfare – it is little wonder that many are queasy about the continued proliferation of flying robots. 
DJI, a Chinese UAV manufacturer, is seeking a $10 billion valuation. Cargo drones will grow into an even larger industry in the coming years, simply because, unencumbered by the weight of humans and their life-support systems, they will fly more cheaply but be just as fast and safe. 
Some 800 million people around the world have limited access to emergency services, and that will not change in the foreseeable future, because there will not be enough money to build roads to connect them. By flying medium-size loads middling distances to many of these isolated communities, cargo drones can save lives and create jobs. 
Cargo drones embody what Jim Yong Kim, the president of the World Bank, calls the “science of delivery.” We know what we need to deliver: the solutions to many of our most pressing problems already exist. 
Answering that question is why humanitarians, roboticists, architects, logisticians, and others have joined together in a new initiative called Red Line, a Swiss-based consortium to accelerate development of emergency cargo drones and build the world’s first droneports – in Africa. 
After all, the experience of the most successful development organizations suggests that we should be skeptical about advanced technology’s power to bring about meaningful change for the poor. Yes, the falling cost of processing power creates new efficiencies, particularly in smartphones and related sky-fi connectivity. 
That is why many development experts favor “frugal innovation” over technology. The Bangladesh-based BRAC, the world’s largest development NGO, has 1.3 million children enrolled in one-room schools – and hardly a laptop in sight. 
Silicon Valley speaks the bulldozer language of “disruption,” but one reason to favor cargo drones is precisely that they are not disruptive at all. Instead, they can augment existing distribution networks in remote regions of Africa, Asia, and Latin America where poverty and disease are pervasive, distances are great, and roads will never be built. 
Companies and organizations have shown that in hard-to-reach places in Africa and South Asia, women trained as micro-entrepreneurs are often best positioned to deliver essential goods and services to their villages, even if they have limited literacy and formal education. BRAC’s community health workers, for example, work entirely on a micro-franchising basis, making their money from margins on sales of basic commodities like de-worming medication, anti-malarial drugs, and contraceptives. 
Though cargo drones will never replace ground transport, they can ensure that vital goods and services get to where they are needed. Mobile phones took off in Africa because the technology was so much cheaper than investment in landline infrastructure. 

An Earth Year 
Never have those challenges been greater or more urgent than they are today. The combination of climate change, erosion of biodiversity, and depletion of natural resources is propelling the planet toward a tipping point, beyond which objectives like sustainable development and poverty reduction will be more difficult than ever to achieve. 
Since 1970, scientists have learned not only that human activity is the primary driver of environmental change on Earth, but also that it is pushing the planet beyond its natural limits. If we do not make big changes fast, the results could be devastating. 
Global leaders seemed to recognize this when they agreed five years ago to limit global warming during this century to 2º Celsius above pre-industrial levels – the threshold beyond which we risk triggering more devastating consequences of climate change. But strong action to reduce greenhouse-gas emissions has not been taken. 
The world is now on track to deplete its remaining “budget” for CO2 emissions, which now amounts to less than one trillion tons, in just 25 years. The result would be catastrophic changes like unmanageable sea-level rises, devastating heat waves, and persistent droughts that create unprecedented challenges in terms of food security, ecosystems, health, and infrastructure. 
This Earth Day should serve as a reminder – and, indeed, a catalyst – of what the world really needs: strong and sustained action. Fortunately, 2015 may mark the beginning of just such a change for the better. 
In July, they will meet in Addis Ababa, Ethiopia, for the Conference on Financing for Development. In September, they will convene to approve the Sustainable Development Goals, which will guide development efforts until 2030. 
The outcomes of these meetings will shape this generation’s legacy for both the natural environment and economic growth and development. By decarbonizing the global economy and limiting climate change, world leaders can unleash a wave of innovation, support the emergence of new industries and jobs, and generate vast economic opportunities. 
It is up to all of us to encourage political leaders to do what is needed to secure such an outcome. Just as we demand that our governments address risks associated with terrorism or epidemics, we should put concerted pressure on them to act now to preserve our natural environment and curb climate change. 
Here, the scientific community has a special responsibility to share their research and its potential implications. That is why I and the 16 other scientists of the Earth League – representing world-leading academic institutions like the Potsdam Institute on Climate Impact Research, the Earth Institute, Tsinghua University, and the Stockholm Resilience Centre – have released the “Earth Statement,” which sets out the eight essential elements of a successful global climate deal, to be reached in Paris in December. 
· First, the agreement must reinforce countries’ commitment to limit global warming to below 2°C. 
· Second, the agreement needs to recognize the remaining global budget for CO2 emissions. 
· Third, the agreement should lay the foundation for a fundamental transformation of the economy, with deep decarbonization beginning immediately, in order to create a zero-carbon society by around 2050. 
· Fourth, all 196 countries in the United Nations Climate Convention must formulate an emissions pathway consistent with deep decarbonization, with richer countries taking the lead. 
· Fifth, countries must promote innovation in clean technologies and ensure universal access to existing technological solutions. 
· Sixth, governments must agree to support adaptation to climate change and to address the loss and damage associated with it. 
· Seventh, the agreement must include provisions to safeguard carbon sinks and vital ecosystems. 
· Eighth, to help developing countries fight climate change, donors need to provide additional support at a level at least comparable to current global development aid. 
Last year, total CO2 emissions from the energy sector remained unchanged year on year for the first time (in the absence of an economic downturn). And recent reports show that emissions in China, the world’s largest emitter of greenhouse gases, also did not increase from 2013 to 2014. 
Decarbonization has already begun, and the appeal of a fossil-fuel-free world is growing – not only because it would limit climate change, but also because it would be more technologically advanced, democratic, resilient, healthy, and economically dynamic. This is the right time to move fully onto a more sustainable, zero-carbon path. 
With the right global deal, the world could finally do just that. For the sake of the planet, and the people who depend on it, let us make 2015 Earth Year. 


Dying to Live 
FREETOWN, SIERRA LEONE – I was a young medical officer working at the Emergency Unit of the Ola During Children’s Hospital in Sierra Leone when I advised the mother of a child with severe malaria to tell a blatant lie. Her daughter Mariama needed a life-saving blood transfusion. 
I knew this would provoke the sympathy of her relatives, and they would scrape together their meager resources to ensure a proper funeral. The mother agreed, and when she returned six hours later, she threw enough money on the table to cover all of Mariama’s care: a blood transfusion and treatment for malaria and worm infestation. 
Though Mariama’s illness did not move her relatives to action, her death did. The same thing happened, on a much larger scale, during the Ebola epidemic in West Africa. 
It is believed that the epidemic first took hold in the forested regions of Guinea in December 2013, then gradually spread into Sierra Leone and Liberia. The international community watched as the disease ravaged the three countries, decimating villages, wiping out entire families, and bringing economies to a standstill. 
For fear of catching the disease, schools were closed, with students and teachers staying at home. Indeed, many workers stayed home as well, causing restaurants, bars, and hotels to cease functioning and the economy to grind to a halt. 
A curfew was imposed in many districts, and long-distance travel was discouraged. In several towns, accepting a visitor into your home meant the risk of a heavy fine. 
Nonetheless, the disease spread into urban areas and, like a wildfire, engulfed the three countries and spilled into others. To date, more than 8,500 infections and 3,500 deaths have been reported just in Sierra Leone. 
As fear of Ebola mounted, many citizens stopped using health services, reflected in a 23% drop in births in hospitals or clinics, a 21% drop in children receiving basic immunization, and a 39% drop in children treated for malaria. As a result, these countries experienced a resurgence in vaccine-preventable diseases, malaria, maternal and child deaths, and acute malnutrition. 
The first priority is to get the number of Ebola cases to zero and keep it there. This means changing the conditions that allowed it to spread so rapidly in the first place. 
The plan demands the restoration of health-care services in 40 hospitals and 1,300 primary health-care facilities across the country, so that children and mothers can receive free essential care, vaccinations, and treatment for diseases like tuberculosis, HIV/AIDS, and malaria. Moreover, in order to bolster safety – and restore confidence – in the health-care system, the plan calls for better infection-control practices and training for a new cadre of skilled workers. 
In Sierra Leone alone, it is expected to cost $1.3 billion – $896.2 million of which has yet to be procured. To close that gap, we need help from our African partners and the broader international community. 
We need genuine engagement, open communication, and mutual accountability, at the local, national, regional, and global levels. We have already seen how a lack of essential health-care services can devastate a country, taking thousands of lives and shattering many more. 
We came together as a country to beat Ebola, and we are committed to prevent future epidemics. With ongoing international support, we will do just that. 

Fighting Ebola on All Fronts 
PARIS – Judging by the media coverage in the United States and Europe of the Ebola outbreak in West Africa, one might conclude that conditions in the affected countries are gradually improving. But, though the epidemic is no longer a front-page story, the virus is far from being contained. 
I recently traveled to Conakry, the capital of Guinea, together with French President François Hollande, and then visited Macenta, a rural district in the country’s forest region, close to where the outbreak began. In both places, I witnessed firsthand the virus’s devastating impact: suffering, fear, despair, and, ultimately, death. 
The truth is that the Ebola virus continues to spread – and quickly. Granted, it has been contained in Liberia, but only in Liberia, and even there, there is no way to ensure that another outbreak will not occur. 
The virus does not spread as rapidly as many others, such as influenza, which in the past limited the scale of epidemics, particularly because outbreaks were confined to rural areas. But this time, the virus has entered cities and towns, making it especially dangerous. 
More than 16,000 are reported to have been infected. These are ballpark figures, and while they provide important information about the trajectory of the epidemic and the effectiveness of response efforts, officials warn that the real numbers are probably far higher. 
In most countries, the right to health is enshrined in the constitution or legislation. The right, according to the World Health Organization (WHO), includes “access to timely, acceptable, and affordable health care of appropriate quality.” 
From a moral point of view, it is incumbent upon the international community, with its institutions, authorities, resourceful businesses, and individuals – as well as its knowledge and wealth – to deploy the necessary means to stop the spread of Ebola. The imperative is equally strong from a purely self-interested point of view. 
If we are to achieve this, however, the virus must be understood and diagnosed. Its spread must be prevented, and treatment must be offered. 
Since the outbreak of the virus in March, the Institut Pasteur, an independent, non-profit research organization, has worked to understand how the virus can be contained and what treatment can be offered. Our researchers are tracking the spread of the virus to understand how epidemics evolve, and we are working to empower local scientific and medical personnel. 
The Institut Pasteur’s Ebola Task Force is fighting the virus on the ground in West Africa and in the laboratory in France, studying the virus and how it spreads, and leaving no stone unturned to find a medical solution that will stop this outbreak and prevent new ones. Together with the WHO and non-governmental organizations including Médecins Sans Frontières and the Red Cross and Red Crescent, the Institut Pasteur is committed to fighting the virus and its causes. 
Many countries already contribute to research into the causes, spread, and treatment of the Ebola virus. An international “coalition of the willing” has been established, and we call on all states, relevant organizations, interested businesses, and qualified individuals to join it. 

Ebola and Beyond 
By violating basic scientific principles, they defy the fundamental ethical criterion for compulsory public-health action. And when it comes to protecting citizens from Ebola – not to mention preventing similar global health crises from emerging in the future – these responses may well be counterproductive. 
The most egregious examples of overreach have occurred in the US, where the initial response entailed enhanced screening of travelers from Guinea, Liberia, and Sierra Leone. More problematic, several states instituted mandatory 21-day quarantines for volunteer health workers returning to the US from Ebola-stricken countries. 
This requires, first and foremost, a sustained “surge response” to Ebola in the three most affected countries. Such a response must be underpinned by adequate (and considerable) funding; well-trained doctors, nurses, and community health workers; and improved local capacity for diagnosis, treatment, contact tracing, and the isolation of infected individuals. 
There is no time to waste. Indeed, the dearth of bold leadership has already delayed an effective international response to the current Ebola outbreak for far too long, drastically increasing the costs of the crisis. 
Beyond stemming the spread of Ebola, the international community must apply the lessons of the current crisis to future potential health hazards, by developing a credible response that emphasizes early, robust, and evidence-based action. To this end, three key initiatives should be launched. 
First, the World Health Organization should commit to an emergency contingency fund that it could deploy for surge capacity as soon as it declares a “public health emergency of international concern.” Had such funding been available to mount a robust initial response when Ebola emerged, the WHO would have had a strong incentive to declare an international emergency in a timely manner. 
Though that would have been eminently affordable, representing less than 0.5% of international health assistance, the WHO failed to establish it. The folly of this decision is now painfully obvious, as is the fact that the contingency fund should be significantly larger – up to $500 million. 
The second pillar of an effective crisis-response strategy is an emergency reserve workforce – established by the WHO, in cooperation with national governments – comprising well-trained health professionals who are prepared for rapid deployment in low-resource settings. This would provide countries with weak health-care systems – which are particularly susceptible to disease outbreaks – with the human resources they need to bring health crises quickly under control. 
That is why the last and most important step toward preventing future global health crises is the creation of an international health system fund to support national efforts to acquire the capacity both to respond effectively in emergencies and to deliver comprehensive health services in normal times. Such a fund would fit into the International Health Regulations framework that was agreed to in 2005, and advance the cause of universal health care, based on the principle that all people have a right to health. 
Governments would also be expected to allocate adequate domestic funds to achieve these goals, with, for example, African heads of state fulfilling the 2001 Abuja Declaration’s pledge to allocate at least 15% of national budgets to the health sector. But, for lower-income countries, significant progress toward establishing strong health-care systems would be virtually impossible without support from a sustainable international fund. 
Given that creating such a fund would entail a massive multi-billion dollar investment in lower-income countries, social mobilization is the key to generating the necessary political support. In this sense, the global response to AIDS – spurred by the US President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria – could serve as a useful model. 
Beyond establishing strong health-care infrastructure, national governments will need to develop systems of accountability to deliver health services to their populations. This includes fair and transparent stewardship of resources, anti-corruption safeguards, tools for monitoring progress, civil-society engagement, and accountability for failures. 
To advance these objectives, an international coalition is pushing for a Framework Convention on Global Health, aimed at fostering good governance for health at the local, national, and global levels. The treaty, based on the principle of a right to health, would provide clear guidelines for the allocation of funding and other responsibilities. 
The West African Ebola epidemic should inspire a course correction on international health policy, reinforcing the need for rapid-response tools and strong health-care infrastructure. Establishing frameworks to provide scalable, sustainable funding to achieve these goals is a wise and affordable investment – one that is in everyone’s interest. 

Development for the People 
In Liberia, 60% of markets are now closed; in Sierra Leone, only one-fifth of the 10,000 HIV patients who are on anti-retroviral treatments are still receiving them; and Guinea’s government is reporting a $220 million financing gap because of the crisis. If the outbreak is not contained soon, most of the economic and social gains achieved since peace was restored in Liberia and Sierra Leone, and since Guinea’s democratic transition began, could be reversed. 
All three countries remain fragile, divided, and, as the current crisis highlights, uniquely prone to shocks. More broadly, the region’s current crisis should inspire reflection about how the world supports and advances development. 
One important reason for these countries’ vulnerability is the consistent lack of investment in their populations, which has prevented ordinary citizens from reaping the benefits of economic growth. Indeed, while the economies of Guinea, Liberia, and Sierra Leone grew rapidly in the ten years prior to the Ebola outbreak – at average annual rates of 2.8%, 10%, and 8%, respectively – their populations have seen little improvement in their daily lives. 
When Ebola struck, Liberia had only 120 doctors for its four million citizens. Add to that sprawling urban slums – semi-governed, overcrowded, and poorly sanitized – and it is not surprising that these countries have struggled to contain the epidemic. 
Throughout the region, a history of conflict and a legacy of poor governance have fueled a deep distrust of governments and state institutions, as indicated in a 2012 Afrobarometer survey. Indeed, these countries’ lack of an established social contract has been the main obstacle to establishing political authority and effective governance. 
Moreover, this environment has created fertile conditions for the spread of wild theories including that the government and aid workers are conspiring to infect citizens. Many people deny that the Ebola virus exists at all, claiming that their governments have invented it to raise additional funds – which they will never see – from the international community. 
Such doubts and fears are leading families to hide their dead and conduct funerals at night, with some communities going so far as to attack health workers. All of this is making it extremely difficult to halt the spread of the disease. 
With a highly contagious and lethal virus devastating poor and fragmented societies that distrust their leaders, business as usual is not enough. The only way to halt the current Ebola outbreak, and prevent similar epidemics, is to address the fundamental social and political vulnerabilities that have allowed the virus to flourish. 
The key is to place people at the center of development efforts, by increasing investments in health care, education, and other public services. At the same time, a strong effort must be made to bolster job creation. 
Those at the forefront of the fight against Ebola – including the United Nations Development Program – have been mobilizing communities against the disease, supporting medical teams, and helping survivors and families of the infected cope with the tragedy. While these efforts could not be more important, they must be backed by a longer-term strategy to strengthen these fragile countries’ defenses. 
The development approach that dominates global thinking today emphasizes economic growth and state-building over social progress. But the only way to boost a society’s resilience and ability to trust impersonal institutions is to give the people who comprise it the tools – and confidence – they need to prosper. 

Three Global Health Threats 
SAN FRANCISCO – The tragic Ebola outbreak in West Africa has underscored the imperative of strengthening health systems at both the national and global level. But, though Ebola has focused the world’s attention on systemic shortcomings, the goal must be to combat the abiding epidemics that are quietly inflicting suffering and death on populations worldwide. 
In fact, smallpox is the deadliest disease known to humanity; until Edward Jenner developed the vaccine in 1796, it was the leading cause of death in Europe. Before its eradication in 1980, it killed an estimated 300-500 million people. 
The Bubonic plague of the fourteenth century killed 75-100 million people – more than half of Europe’s population. Nearly 75 million people, or 3-5% of the world’s population, died in just a few months during the 1918 influenza pandemic – more than twice the number of people killed in World War I. 
The world continues to grapple with HIV/AIDS, which has already caused more than 40 million deaths and infects a similar number of people today, with 95% of the epidemic’s victims living in developing countries. Only when HIV/AIDS began to gain traction in advanced countries were highly effective anti-retroviral therapies developed – therapy that most of the poor people suffering from the disease could not access or afford. 
Similarly, the failure of governments, multilateral organizations, and NGOs to respond quickly enough to the Ebola outbreak reflects the fact that the disease has ravaged poor countries. But, at a time of unprecedented global interconnectedness, everyone has a stake in ensuring that adequate health-care systems and structures are in place to address such a pandemic. 
The United Nations Mission for Ebola Emergency Response’s “70/70/60” plan – to isolate 70% of Ebola patients and ensure that 70% of burials are conducted safely within 60 days – has largely been implemented, reducing the number of new cases considerably. But people are still suffering and dying – often owing to a lack of access to credible information or adequate treatment. 
Of course, when it comes to safeguarding the health of populations, there is a fine line between protecting the public and impinging on individual rights. That is why all public-health interventions must focus first and foremost on scientific facts, and avoid emotional or panicked responses. 
In this context, the imposition of mandatory quarantines on travelers from Ebola-affected countries was an obvious policy failure – just as they were when authorities tried to contain the Black Death of 1350 in Europe or the Plague of London in 1665. Instead of wasting time on fear-based strategies, the international community must leverage human and financial resources to ensure fact-based, concerted, collective action. 
At the turn of the century, the establishment of institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the Bill and Melinda Gates Foundation, and GAVI, the Vaccine Alliance, coincided with a renewed effort to improve global health. The UN’s commitment to the Millennium Development Goals – which included four health-related targets, covering nutrition, maternal and child health, and infectious diseases – reflected a political consensus to improve health worldwide. 
In regions like Southeast Asia and Sub-Saharan Africa, maternal and child health and infectious diseases remain priorities. In fact, the ten countries with the highest child mortality rates are all located in Sub-Saharan Africa; a baby born in West Africa is 30 times likelier to die before the age of five than one born in Western Europe. 
Even within countries, massive inequalities remain. For example, there is a ten-fold difference in infant mortality between municipalities in the Mexican states of Guerrero and Nuevo León. 
Moreover, silent epidemics have taken hold, particularly in lower-income countries, as the combination of mega-trends like urbanization, population aging, obesity, sedentary lifestyles, smoking, and alcohol consumption has spurred the rise of chronic non-communicable diseases (NCDs). For adults in most countries, cancer, diabetes, and cardiovascular disease have become leading causes of disability and death. 
Emerging infectious diseases like Ebola may be more compelling, but the health impact of chronic NCDs, not to mention their high and growing social and economic costs, is substantially larger. There is no time to waste. 
The world is facing a three-prong health challenge: We must build sustainable national and global health systems that can respond quickly and effectively to crises like Ebola; eliminate or control infectious diseases; and address the quietly rising epidemic of chronic NCDs. To succeed on all three fronts, we need sustained investment in health infrastructure, management, and personnel. 
But it also means addressing the deeper social inequities that extend beyond the public-health agenda. In formulating the post-2015 development goals, world leaders must remember that health is a fundamental human right. 

Turning the Page on Ebola 
WASHINGTON, DC – The Ebola outbreak that began last year in Guinea, Sierra Leone, and Liberia, three of the four countries of the Mano River Union, is the most severe on record since the disease was first diagnosed in Central Africa in 1976. The impact of the epidemic has been devastating, calling into question our three countries’ significant socioeconomic progress in the aftermath of decades of conflict and instability. 
The region has so far registered a total of 25,791 cases and 10,689 deaths – almost ten times the number of deaths from all other Ebola epidemics combined. For 2014, the projected growth rates for our three countries were 4.5%-11.3%. 
The uncontrolled spread of the disease exposed the shortcomings of our national health care systems, as well as regional and global institutions’ weak capacity for coordination and effective response. Simply put, we were ill prepared to cope with, much less prevent, an outbreak on this scale. 
And, today, thanks to institutional improvement and adaptation, we are closer to winning the fight against Ebola. Although the disease has not been contained and eradicated throughout the region, its spread has slowed; now we have to start planning our recovery, which must include strengthening the national, regional, and international systems that protect our people’s lives and futures. 
We, the presidents of the three affected countries, met in Conakry, Guinea, in February, joined by Côte d’Ivoire, to adopt a common strategy to end the epidemic and guide post-Ebola socioeconomic recovery. This meeting was followed by a donors meeting in Brussels at the beginning of March, and a meeting in Freetown, Sierra Leone, two weeks later to coordinate our technical committees. 
We are determined to eradicate Ebola by exchanging information, sharing technical expertise, creating innovative and accessible community health systems, and intensifying public education strategies, including steps that can be shared in families, such as applied water, sanitation, and hygiene (WASH) standards. Only then can investment by the private sector – the engine of employment and stable livelihoods – begin to recover. 
The spread of the Ebola virus has been facilitated by our countries’ shared history and culture, which has enabled the disease to cross borders easily and move quickly from remote rural areas to urban centers. Unfortunately, the epidemic forced us to close some of our borders, preventing access to relatives and care. 
We want our infrastructure, health policies, and economic strengths to benefit people across borders through links – community support systems and development corridors – that encourage collaboration and job creation. And we ask our international partners to support a common economic stimulus plan, with an emphasis on practical solutions that can enhance growth and increase employment. 
The first component is the creation of resilient public health systems, which requires trained community health workers in order to expand coverage in rural areas. It also requires nationwide water and sanitation programs and well-equipped centers for the control of infectious diseases in each country. 
We ask the African Development Bank to take the initiative in creating an infrastructure fund, an extension of the Mano River Initiative, launched in 2013, with the objective of furthering regional integration. And we ask our partners to recognize that programs originally planned on a ten-year time horizon, must be implemented urgently. 
Third, we need to support economic recovery by encouraging confidence within the private sector, which has been hit by rising costs in the region. Specifically, the region would benefit from grants to local entrepreneurs, concessional financing and loans to foreign investors, and budgetary support from the government. 
Finally, in line with the recommendation of the Commission for Africa, the United Nations, and the African Union, we ask for a total cancellation of our foreign debt. This would allow us to recover the fiscal flexibility we need to enable us to co-finance the reconstruction of our health systems. 
We urge our international partners to support our economic recovery in the same spirit of cooperation, and with the same sense of urgency, that helped us fight the Ebola virus. Together, we can build health care systems, infrastructure, and regional institutions that will be stronger than before the start of the epidemic. 

The Future is Old 
More than three decades have been added to the lives of hundreds of millions of people over the last hundred years. This is an accomplishment well worth celebrating; but we must also bear in mind that with increased longevity come significant long-term economic consequences – and that many societies are aging at a record speed. 
OECD countries in particular will be hit by a double demographic shock. Not only will their societies be rapidly aging; diminishing income gaps between rich countries and emerging economies are likely to slow immigration flows, shrinking the workforce by 20% in the eurozone and 15% in the United States. 
Demographic researchers divide countries into four categories, according to the share of the over-65 population: young (less than 7% aged 65 or over), aging (7-13%), aged (14-20%), and super-aged (more than 21%). Today, just three countries – Germany (21%), Italy (22%), and Japan (26%) – qualify as super-aged societies. 
During this period, the challenges of rapid societal aging will confront mainly the developed world. But, by 2040 some 55 countries will be struggling to manage an older population, with the US, China, Singapore, Thailand, and Puerto Rico joining the ranks of the super-aged. 
What makes the phenomenon even more remarkable is the speed at which these transitions are taking place. When France went from being a young country to an aging one in 1850, slavery was still legal in the US, the light bulb had yet to be invented, and Germany had yet to become a unified country. 
It went from having the youngest population among G-7 countries in the early 1960s to being the world’s oldest country in 2008. But if current projections hold true, several countries will accomplish a similar transformation a decade faster. 
Indeed, today the world’s most rapidly aging country is South Korea, which became an aging society in 1999, is expected to become an aged one in 2017, and will be a super-aged one in 2027. In other words, South Korea will undergo in less than three decades a transformation that will have taken France nearly 175 years. 
The speed of the decline in fertility rates has been dramatic around the world; in Iran, it has been nothing less than astonishing, dropping from seven children per woman in 1984 to 1.9 in 2006. This will certainly have long-term consequences as the working-age population declines and the elderly population soars. 
Countries such as Sierra Leone, Lesotho, Central African Republic, and Zimbabwe have among the lowest life expectancies on the planet. They face many challenges – famine, corruption, conflict, lack of access to clean water and education, AIDS, and Ebola – but rapid societal aging is not one of them. 


A Fish Called Development 
GENEVA – The just-adopted Sustainable Development Goals (SDGs) are expected to herald the start of a new era in global development, one that promises to transform the world in the name of people, the planet, prosperity, peace, and partnership. But there is an ocean of difference between promising and doing. 
In fact, whether the SDGs succeed will depend to a significant degree on how they influence other international negotiations, particularly the most complex and contentious ones. And an early test concerns a goal for which the Global Ocean Commission actively campaigned: to “conserve and sustainably use the oceans, seas, and marine resources for sustainable development.” 
When political leaders meet at the tenth WTO Ministerial Conference in Nairobi in December, they will have an opportunity to move toward meeting one of that goal’s most important targets: prohibition of subsidies that contribute to overfishing and illegal, unreported, and unregulated fishing by no later than 2020. 
But, even today, countries spend $30 billion a year on fisheries subsidies, 60% of which directly encourages unsustainable, destructive, or even illegal practices. The resulting market distortion is a major factor behind the chronic mismanagement of the world’s fisheries, which the World Bank calculates to have cost the global economy $83 billion in 2012. 
Rich economies (in particular Japan, the United States, France, and Spain), along with China and South Korea, account for 70% of global fisheries subsidies. These transfers leave thousands of fishing-dependent communities struggling to compete with subsidized rivals and threaten the food security of millions of people as industrial fleets from distant lands deplete their oceanic stocks. 
West Africa, where fishing can be a matter of life and death, is being particularly hard hit. Since the 1990s, when foreign vessels, primarily from the EU and China, began to fish on an industrial scale off its shores, it has become impossible for many local fishers to make a living or feed their families. 
From 1994 to 2005, Senegal’s catch fell from 95,000 to 45,000 tons, according to government estimates, and the country lost half of its fleet of traditional wooden pirogues. As the fish stocks collapsed in 2005, 5,000 people decided to put their redundant fishing boats to a different use, by fleeing to the Spanish Canary Islands. 
According to fisheries economists, subsidies by some of the world’s richest countries are the only reason large-scale industrial fishing in areas beyond coastal countries’ 200-mile exclusive economic zones is profitable. But fish do not respect international boundaries, and it is estimated that 42% of the commercial fish being caught travel between countries’ exclusive zones and the high seas. 
Eliminating harmful fisheries subsidies by 2020 is not only crucial for conserving the ocean; it will also affect our ability to meet other goals, such as our promises to end hunger and achieve food security and to reduce inequality within and among countries. 
The Global Ocean Commission has put forward a clear three-step program to eliminate harmful fishing subsidies. All that is needed is for governments finally to agree to put an end to the injustice and waste that they cause. 
Among the initiatives being put forward in advance of the Nairobi meeting is the so-called “NZ +5 proposal.” Co-sponsored by New Zealand, Argentina, Iceland, Norway, Peru, and Uruguay, the plan would eliminate fisheries subsidies that affect overfished stocks and contribute to illegal, unreported, and unregulated fishing. 
The Global Ocean Commission urges the remaining 40% of the WTO’s members – and especially the biggest players currently blocking this process – to accept the relatively modest proposals on the table. A sustainable future for our planet and its oceans depend on it. 

What Energy Shortage? 
MARTIGNY, SWITZERLAND – If we were able to capture and use the energy from just two minutes of sunlight falling on the earth, it would be enough to fuel our cars, light and heat our buildings, and provide for all of our other electricity needs for an entire year. Simply put, we humans are not facing a shortage of energy. 
Many of the world’s problems today can be traced to energy use, from conflicts over oil supplies and concerns about greenhouse-gas emissions to lost productivity and output stemming from shortages and blackouts. In many of the poorest parts of the world, the lack of energy stifles economic development. 
During the run-up to the recent presidential election in Nigeria, for example, a woman was asked what she wanted the candidates to deliver. She replied with a one-word answer: “Light.” 
Unreliable or unavailable energy is a problem in much of Africa and the Indian sub-continent, as well as some other parts of Asia. According to a report by the International Energy Agency, improvements to the energy sector could provide the equivalent of a decade of growth in some of the poorest parts of the world. 
According to a study by the United States government’s Lawrence Livermore National Laboratory, more than 60% of the energy we use is lost between the time it is generated and the time it is consumed. This includes the inefficiency in converting fossil fuels to electricity, losses during transmission, wasteful consumer behavior, and the need to maintain a reserve to prevent blackouts. 
A new wave of innovation is required, one that can eliminate waste, reduce pollution, and broaden access to energy around the world. That means focusing on efficiency-boosting technologies such as wireless communication, machine-to-machine communication, smart metering, and better production management. 
Renewable energy sources, including solar and wind power, are well positioned to contribute to energy needs in both mature and emerging economies. But, because the sun does not always shine, and the wind does not always blow, energy from these sources is unstable and intermittent. 
Studies by the US Western Electricity Coordinating Council have found that finding better ways to store energy could cut total waste by about 18% and boost the efficiency of electricity use by up to 11%. Better energy-storage methods would also make it easier to deliver electricity to hard-to-reach areas that are currently underserved, as well as help make the best use of often-scarce sources of power. 
But this approach is practical only in mountainous areas, making it unsuitable as a mass-market solution. Promising areas of research include grid-scale batteries with the ability to charge and discharge tens of thousands of times and data analytics to optimize the use of the batteries and make the grid as efficient as possible. 
We must also use it efficiently, and the wide-scale adoption of state-of-the-art storage technology will be an essential part of the solution. Ensuring that the world’s energy supplies are stable, efficient, accessible, and affordable will take time. 

The Migration Opportunity 
LONDON – In the last year, more than 4,000 men, women, and children have lost their lives attempting to cross the Mediterranean Sea from Africa to Europe. Their tragic deaths have done nothing to slow the human tide, which is swelling by the week, as smugglers on the coast become increasingly brazen and cruel. 
Against this backdrop – and that of the fear sown by the terrorist attacks in Paris and Copenhagen – the European Union is set to develop a new – and critically important – agenda on migration. When EU commissioners gather to debate how to proceed, they must overcome the temptation to grasp at short-term, knee-jerk solutions, and instead develop a truly creative, comprehensive plan of action both at home and abroad. 
The last time Europe faced such a turning point on migration was in 2011, when the Arab Spring triggered a flood of new arrivals fleeing violence and chaos in North Africa. But the moment for bold actions – the creation of a Mediterranean Marshall Plan, for instance, or massive investments into immigrant integration – passed without being seized. 
In 2014, the EU's emergency funding for migration and asylum totaled a mere €25 million ($28 million) – a pathetic exercise in collective action, albeit one supplemented by funds from member states. Last fall, Italy's bold Mare Nostrum sea-rescue operation, which had saved thousands of lives, was replaced by a far feebler EU initiative that has struggled to carry out its mission. 
Adding to the problem is an imbalance of commitment and compassion within the EU itself. Sweden and Germany have taken in the majority of asylum seekers from Syria and elsewhere, while most other EU member states have admitted few or none. 
Greece, Italy, and Malta have borne the brunt of the impact of accommodating new arrivals, with all of the financial, social, and political costs this entails. As a result, the ongoing tragedy in the Mediterranean is placing EU solidarity under serious strain. 
“Cracking down on smugglers," the go-to solution for many in the EU, will take many years to have an impact, given the instability of many North African governments. Meanwhile, further destabilization of the Middle East – a very real prospect – could compromise the security of tens of millions of people who, under international law, would have a legitimate right to claim asylum. 
A better, more active approach is needed. The immediate necessary response is resource-intensive but operationally viable: a robust joint EU sea operation with an explicit rescue mandate. 
When asylum seekers reach European shores, the EU should take collective financial and administrative responsibility for processing and accommodating them, regardless of where they disembark. And it should take solidarity a step further when it comes to Syrians, equitably distributing the responsibility to host them across all member states. 
Meanwhile, in order to lighten smugglers' boats, the EU should commit to resettling many more than the 30,000 Syrian refugees it has pledged to accept thus far. A number closer to 250,000, at least, would seem fair – given the millions being sheltered by Lebanon, Turkey, and Jordan. 
This could entail extending humanitarian, labor, and family-reunification visas, with applications processed overseas. The EU should consider longer-term goals, like creating a common Mediterranean market to allow North African economies to grow, eventually transforming the region into a destination for migrants rather than a transit zone. 
The continent is in desperate need of a dramatically different approach to diversity. The countries of the EU have two options: They can either make a vain attempt to revert to outdated, mono-ethnic models of statehood, or they can accept diversity with the realization that their national cultures will not only survive, but flourish. 
Doing so would in no way entail compromising any core European values. But it would require a commitment to respect all who adopt those values, regardless of their race or religion. 

ExxonMobil’s Dangerous Business Strategy 
We were reminded of this once again in a report of the National Petroleum Council’s Arctic Committee, chaired by ExxonMobil CEO Rex Tillerson. The report calls on the US government to proceed with Arctic drilling for oil and gas – without mentioning the consequences for climate change. 
While other oil companies are starting to speak straightforwardly about climate change, ExxonMobil’s business model continues to deny reality. That approach is not only morally wrong; it is also doomed financially. 
The year 2014 was the hottest on instrument record, a grim reminder of the planetary stakes of this year’s global climate negotiations, which will culminate in Paris in December. The world’s governments have agreed to keep human-induced warming to below 2º Celsius (3.6º Fahrenheit). 
Companies like Total, ENI, Statoil, and Shell are advocating for a carbon price (such as a tax or permit system) to hasten the transition to low-carbon energy and are beginning to prepare internally for it. Shell has stepped up its investments in carbon capture and sequestration (CCS) technology, to test whether fossil-fuel use can be made safe by capturing the CO2 that would otherwise go into the atmosphere. 
This is not to say that all is agreed with these companies; they have promised to state their climate positions and policies in advance of this year’s climate summit. Yet at least they are talking about climate change and beginning to face up to the new long-term market conditions. 
The company’s management, blinded by its own vast political power, behaves with a willful disregard for changing global realities. It lives in a cocoon of Washington lobbyists and political advisers who have convinced the company’s leaders that because the US Senate is currently in Republican hands, the business risks of climate change have somehow been nullified, and that the world will not change without or despite them. 
According to a 2013 study, ExxonMobil ranks second among the world’s companies, just behind Chevron, in total contributions of CO2 emissions. Indeed, the study finds that this single company has contributed more than 3% of the world’s total emissions since the start of the fossil-fuel age! 
So what does ExxonMobil say about the new climate realities? How does it reconcile its corporate policies with planetary needs? 
When asked by independent analysts such as Carbon Tracker how it plans to square its relentless oil drilling with the planetary limits on fossil-fuel use necessary to stay below the 2º climate-change threshold, it ignores the limits. It blithely believes that the world’s governments simply will not honor their commitments (or that it can lobby its way out of fulfilling them). 
The development of the Arctic’s oil and gas resources would contribute to warming far above the 2º limit. The Arctic itself is warming far faster than the planetary average, potentially causing massive, global-scale climate disruptions – which may include the extreme weather patterns recently observed in the US mid-latitudes. 
For these reasons, the best recent science, including an important study published in Nature this year, provides a clear and unequivocal message: Keep the Arctic oil in the ground and beneath the deep seas; there is no safe place in the climate system for it. 
The world has more than enough oil and gas reserves already; we now need to shift to low-carbon energy, stranding much of the proven reserves, rather than developing them and further threatening the planet. As the Nature study puts it: “Development of resources in the Arctic and any increase in unconventional oil production are incommensurate with efforts to limit average global warming to 2º C.” 
This would have been a fitting topic for the National Petroleum Council’s Arctic study. But the report never takes up the issue of whether Arctic oil and gas resources are compatible with climate safety. 
The company’s management is planning to spend vast sums – perhaps tens of billions of dollars – to develop Arctic oil and gas reserves that cannot safely be used. Just as the global shift toward renewable energy has already contributed to a massive drop in oil prices, climate policies that will be adopted in future years will render new Arctic drilling a huge waste of resources. 
Pension funds, universities, insurance pools, and sovereign wealth funds worldwide are grappling with the increasing risks, both moral and financial, of owning shares in oil, gas, and coal companies. As Lisa Sachs and I recently explained, responsible investors must urgently query these companies about their business plans to comply with the 2º limit on warming. 
ExxonMobil’s investors must urgently query the company’s management on a business strategy that contradicts global needs and policy agreements. If ExxonMobil persists in its dangerous business strategy, the company’s investors should quickly conclude that the time has come to pull up stakes and move on. 

Big Oil, Big Tobacco, Big Lies 
BOSTON – Over the last few years, a growing number of people have been taking a hard look at what is happening to our planet – historic droughts, rising sea levels, massive floods – and acknowledging, finally, that human activity is propelling rapid climate change. But guess what? 
They not only understood the science behind climate change, but also recognized the company’s own outsize role in driving the phenomenon. Recognizing the potential effects as “catastrophic” for a significant portion of the population, they urged Exxon’s top executives to take action. 
There may be a silver lining to this infuriating story: the recent investigation that exposed Exxon’s deceit could end up catalyzing the action needed to address the looming climate crisis. After all, similar revelations about the tobacco industry – what the major cigarette companies knew and when they knew it – transformed the public-health landscape. 
In 1996, a series of lawsuits forced tobacco companies to release millions of internal documents, which confirmed what public-health advocates and policymakers had long suspected: as early as the 1950s, the industry knew that nicotine was addictive and that cigarettes caused cancer. But, to protect its own interests, Big Tobacco deliberately misled the public, doing everything possible to cast doubt on scientific findings that it knew to be accurate. 
After the revelations, however, it was clear that the tobacco industry was a malevolent force that did not belong in the policymaking process. With Big Tobacco out of the picture, and armed with evidence of the real effects of tobacco consumption, health advocates were finally able to compel their governments to act. 
In 2003, world leaders agreed to the Framework Convention on Tobacco Control (FCTC), negotiated under the auspices of the World Health Organization. Today, the treaty covers 90% of the world’s population and has contributed to a significant decline in sales for global tobacco corporations. 
Big Oil, it is now clear, has been following Big Tobacco’s playbook. In 1997, almost two decades after it began studying climate change, it quashed its research, claiming that climate science was “far from clear” and thus that it did not “support mandated cuts in energy use.” 
Beyond suppressing its own findings, ExxonMobil (and its peers) funded and promoted junk science and attacked scientists who warned of the impending climate disaster. The fossil-fuel companies’ approach was so effective that the media are only now beginning to recognize the leading role the industry played in creating – almost out of whole cloth – the so-called “climate debate.” 
But perhaps Big Oil’s biggest success was diminishing the political will to implement appropriate regulation. Even after the international community adopted the United Nations Framework Convention on Climate Change (UNFCCC) in 1992, the fossil-fuel industry managed to block meaningful progress – to the point that, if serious action is not taken soon, the entire process could unravel. 
In Europe, Royal Dutch Shell’s lobbying so diluted the European Union’s efforts that there are now no binding targets for renewables or energy efficiency for individual countries. The company even sent a letter to the European Commission’s president claiming that “gas is good for Europe.” 
Just as the tobacco files drove the tobacco industry out of policymaking processes, the Exxon investigation should compel world leaders to eliminate the fossil-fuel industry from efforts to solve the climate crisis. After all, no policy can succeed if those who shape it are betting on its failure. 
We cannot simply hope that the fossil-fuel industry will change its ways. As an alliance of human-rights groups, environmental activists, and corporate-accountability advocates already is demanding, we must kick the industry out of the policymaking process altogether. 
Exxon’s scientists were right: the effects of climate change on many communities are catastrophic. With so many lives at stake – and such clear evidence of the threat – Big Oil, like Big Tobacco before it, should be treated for what it is: Big Trouble. 

Who Will Suffer Most from Climate Change? 
SEATTLE – A few years ago, Melinda and I visited with a group of rice farmers in Bihar, India, one of the most flood-prone regions of the country. All of them were extremely poor and depended on the rice they grew to feed and support their families. 
They don’t have access to improved seeds, fertilizer, irrigation systems, and other beneficial technologies, as farmers in rich countries do – and no crop insurance, either, to protect themselves against losses. Just one stroke of bad fortune – a drought, a flood, or an illness – is enough for them to tumble deeper into poverty and hunger. 
Now, climate change is set to add a fresh layer of risk to their lives. Rising temperatures in the decades ahead will lead to major disruptions in agriculture, particularly in tropical zones. 
The world’s poorest farmers show up for work each day for the most part empty-handed. That’s why of all the people who will suffer from climate change, they are likely to suffer the most. 
By 2050, global food demand is expected to increase by 60%. Declining harvests would strain the global food system, increasing hunger and eroding the tremendous progress the world has made against poverty over the last half-century. 
There’s an urgent need for governments to invest in new clean-energy innovations that will dramatically reduce greenhouse-gas emissions and halt rising temperatures. At the same time, we need to recognize that it’s already too late to stop all of the impacts of hotter temperatures. 
Many of the tools they’ll need are quite basic – things that they need anyway to grow more food and earn more income: access to financing, better seeds, fertilizer, training, and markets where they can sell what they grow. 
The Gates Foundation and its partners have worked together to develop new varieties of seeds that grow even during times of drought or flooding. The rice farmers I met in Bihar, for instance, are now growing a new variety of flood-tolerant rice – nicknamed “scuba” rice – that can survive two weeks underwater. 
It’s quite common to see these farmers double or triple their harvests and their incomes when they have access to the advances farmers in the rich world take for granted. This new prosperity allows them to improve their diets, invest in their farms, and send their children to school. 
One of the most exciting innovations to help farmers is satellite technology. In Africa, researchers are using satellite images to create detailed soil maps, which can inform farmers about what varieties will thrive on their land. 
A number of organizations, including a non-profit group called One Acre Fund, are finding ways to ensure that farmers take advantage of these solutions. One Acre Fund works closely with more than 200,000 African farmers, providing access to financing, tools, and training. 
In this year’s Annual Letter, Melinda and I made a bet that Africa will be able to feed itself in the next 15 years. Even with the risks of climate change, that’s a bet I stand by. 
Their lives are puzzles with so many pieces to get right – from planting the right seeds and using the correct fertilizer to getting training and having a place to sell their harvest. If just one piece falls out of place, their lives can fall apart. 
I know the world has what it takes to help put those pieces in place for both the challenges they face today and the ones they’ll face tomorrow. Most importantly, I know the farmers do, too. 

A Banker’s Revolution 
But in the developing world, that reputation is being turned upside down. In some of the world’s poorest countries, central bankers have proved willing to make bold decisions – embracing innovative approaches in their quest to broaden participation in the formal financial system, increase financial stability, and put their countries on the path to inclusive, sustainable economic growth. 
In Malaysia, the central bank took a lead role in raising the public’s level of financial literacy. And in the Philippines, the Bangko Sentral ng Pilipinas helped double the number of access points where consumers could obtain financial services, supporting the opening of 517 micro-banking offices, many of them in municipalities with no traditional bank branches. 
Likewise, in 2011, the Bank of Tanzania made a specific commitment to increase financial inclusion under the Alliance for Financial Inclusion’s Maya Declaration, a commitment by policymakers in the developing world to unlock the social and economic potential of the poor. The result was dramatic and vastly exceeded expectations. 
While not technically banks, these institutions are able to accept customer deposits and payments electronically through mobile phones or at licensed locations like a post office. The effort is part of a larger national strategy, launched in 2014, to provide 76% of adults with financial access and 56% with active savings accounts by the end of 2016. 
And in the Pacific region, Fiji, Papua New Guinea, Samoa, Solomon Islands, Timor-Leste, Tonga, and Vanuatu have banded together to create the Pacific Islands Regional Initiative (PIRI), which will enable every Pacific Island state, even those without a central bank, to share knowledge on improving access, quality, and usage of financial services in geographically challenging environments. 
But the accumulation of experience is proving invaluable. As lessons are shared and successes provide inspiration for others, the impact is becoming exponential, with even the smallest countries demonstrating that they have a significant contribution to make. 
Meanwhile, as central banks change how they operate, retail banks are responding with new ways of doing business. Kenya’s Equity Bank has grown enormously by explicitly targeting the financially excluded; in just six years, it has expanded from a half-million customers to almost six million. 
As Stephen Kehoe, Head of Global Financial Inclusion at Visa, recently noted, “The last seven years provide absolutely no indication of what the next seven years will be.” What is clear, however, is that there still remains much to be done – and that the opportunities are nearly limitless. 
Bringing the world’s two billion unbanked people out of the shadows and into the mainstream financial system will require new partnerships among regulators, the private sector, non-profits, regional bodies, and international organizations. That may seem like a tall order, but filling it would help build a brighter future for everyone. 

Fossil Fuel Follies 
BERLIN – If the world is to avoid climate catastrophe, it will have to forego burning almost 90% of proven coal reserves, plus one-third of oil and half of natural-gas reserves. But instead of implementing policies aimed at realizing that objective, governments continue not only to subsidize the fossil-fuel industry, but also to use scarce public resources to find new reserves. 
In an effort to help spur that change, the Heinrich Böll Foundation and Friends of the Earth International have aggregated key data about the coal industry in the just-released Coal Atlas. The figures are striking. 
And a recent report by the Natural Resources Defense Council, Oil Change International, and the World Wide Fund for Nature revealed that from 2007 to 2014, governments channeled more than $73 billion – or over $9 billion per year – of public money toward coal projects. Leading the way were Japan ($20 billion), China (around $15 billion), South Korea ($7 billion), and Germany ($6.8 billion). 
In 2013, 92 leading banks provided at least €66 billion ($71 billion) – over four times more than in 2005. All of this has gone to buttress an industry that produces a massive share of global emissions – and seems dead set on continuing to do so. 
And yet coal and other fossil-fuel companies have refused to adjust their business models. Instead, they have actively worked to block efforts to mitigate climate change at the national and international levels, including by funding climate-change deniers and lobbying against renewable-energy targets and successful instruments like feed-in tariffs. 
Meanwhile, the coal industry argues that it plays an indispensable role in tackling “energy poverty” – that is, the lack of access to modern non-polluting forms of power, primarily electricity. It is true that energy poverty is a huge problem, affecting some 1.2 billion people worldwide. 
In 2013, Coal workers pneumoconiosis (“black lung disease”) resulted in more than 25,000 deaths globally. In the European Union, coal combustion is responsible for 18,200 premature deaths and 8,500 new cases of chronic bronchitis per year. 
The physical toll carries large economic costs as well, from lost working days to pressure on health-care systems. Climate change, too, will impose enormous costs, even if strong mitigation and adaptation measures are taken. 
Far from receiving subsidies, the fossil-fuel industry should be paying for climate change. After all, just last year, the top two fossil-fuel companies – Chevron and ExxonMobil – together pulled in more than $50 billion in profits. 
If the world is to have any chance of capping the increase in global surface temperature at 2° Celsius above pre-industrial levels, without being forced to employ dangerous and risky technologies like Carbon Dioxide Capture and Storage or geo-engineering, its energy system must be transformed. 
First and foremost, world leaders must commit to phasing out fossil fuels, with the explicit goal of leaving 90% of proven coal reserves, one-third of oil reserves, and half of gas reserves in the ground. They must also end public subsidies for coal as soon as possible, within the next few years, while ensuring that poor and vulnerable communities do not suffer from an increase in energy prices. 
Moreover, governments worldwide must hold coal and other fossil-fuel producers accountable for the damage their products have caused, including through a levy on fossil-fuel extraction to fund the Warsaw Mechanism on Loss and Damage under the United Nations Framework Convention on Climate Change. Existing international law – in particular, the “polluter pays” principle, the “no-harm” rule, and the right to compensation – supports such a system. 
Finally, to address energy poverty, world leaders must scale up funding for decentralized renewable-energy projects, including through a globally funded feed-in tariff for renewable energy mini-grids in developing countries. 
The fossil-fuel industry’s success in safeguarding its own interests has come at the expense of the health of our planet and its people. It is time to reform our perverse global energy system – beginning by resolving to leave coal and other fossil fuels where they are. 

Good Crop, Bad Crop 
NAIROBI – Kenya’s ban on imports of genetically modified (GM) crops reflects a troubling trend in a country traditionally seen as an agricultural innovator. The move also represents a giant leap backward for a continent that often struggles to ensure its own food security. 
GM crops (also called genetically engineered or biotechnology crops) have repeatedly been proven to be safe, and are used successfully to boost agricultural productivity worldwide. But bureaucracy, propaganda, and misinformation are preventing millions of African farmers, including in Kenya, from accessing a technology that can improve livelihoods and help to redress food shortages. 
The country’s Famine Early Warning Systems Network notes that already-high maize prices will continue to rise until the end of the year, further straining food security and economic performance. As Kenya struggles to feed its people and stabilize its economy, GM technology should be a welcome means to increase yields and incomes, benefiting farmers, consumers, and the environment. 
The introduction of GM maize, soybean, and cotton in South Africa, for example, helped raise farmers’ incomes by more than $1 billion from 1998 to 2012. This was largely the result of GM maize varieties, which increased annual yields by 32%, and now represent nearly 90% of the country’s maize crop. 
Similarly, Burkina Faso’s farmers now grow a GM cotton variety that naturally resists a destructive insect, and thus requires less expensive pesticides. The switch from traditional cotton to the GM variety has helped increase yields by more than 18%, earning farmers $61 more per hectare and raising $1.2 billion in agricultural revenues in 2013 alone. 
Three-quarters of Kenya’s food is grown by small-scale farmers – the type that produce more than 90% of the world’s GM crops. Kenyans are already expected to benefit enormously from new GM varieties, such as insect-resistant maize, that are being developed by local scientists. 
Yet, despite early advances in the field, Kenya’s battle for GM crops has been unnecessarily political. In 2012, the cabinet banned GM crop imports without even consulting the NBA, a decision based on a widely denounced, and since-retracted, study that falsely linked GM foods with cancer. 
More recently, Kenya’s government appointed a special taskforce to investigate biotechnology. Its findings have not yet been made public, but anti-GM comments by the taskforce’s chair suggest further confusion on the issue, threatening to leave farmers, scientists, and the public in limbo at a time when GM crops are most needed. 
A clear opportunity to feed the population is being squandered as a result of politics and bureaucracy, and Kenya, unfortunately, is not alone in Africa in this regard. Badly needed biosafety legislation in Nigeria and Uganda, for example, has already been delayed. 
They typically claim that GM crops are unsafe – a view flatly rejected by the scientific community over the last two decades. The World Health Organization has also confirmed that “no effects on human health have been shown as a result of the consumption of such foods.” 
Although perhaps well intentioned, these activists, together with a few misinformed policymakers, are setting back agricultural technology and productivity across Africa. To be sure, GM crops are no panacea, but they are an important tool in achieving food security and economic prosperity. 
That is why decisions about the health and safety of new crop varieties should be based on scientific evidence, not driven by political wrangling and baseless “moral” arguments. By taking an evidence-based approach to policymaking, Kenya’s authorities can improve millions of lives at home and set an invaluable precedent for the whole continent. 

Global Capital Heads for the Frontier 
Though these low-income countries – including Bangladesh and Vietnam in Asia, Honduras and Bolivia in Latin America, and Kenya and Ghana in Africa – have small, undeveloped financial markets, they are growing rapidly and are expected to become the emerging economies of the future. In the last four years, inflows of private capital into frontier economies have been nearly 50% higher (relative to GDP) than flows into emerging market economies. 
By and large, the surge in capital inflows has boosted consumption rather than investment in recipient countries, exacerbating economic volatility and making painful financial crises more frequent. Rather than exerting discipline, global financial markets have increased the availability of debt, thereby weakening profligate governments' budget constraints and over-extended banks' balance sheets. 
The best argument for free capital mobility remains the one made nearly two decades ago by Stanley Fischer, then the International Monetary Fund's number two official and now Vice Chair of the US Federal Reserve. Though Fischer recognized the perils of free-flowing capital, he argued that the solution was not to maintain capital controls, but to undertake the reforms required to mitigate the dangers. 
Fischer made this argument at a time when the IMF was actively seeking to enshrine capital-account liberalization in its charter. But then the world witnessed financial crises in Asia, Brazil, Argentina, Russia, Turkey, and eventually Europe and America. 
Nonetheless, at the IMF and in advanced countries, the prevailing view remains that capital controls are a last resort – to be used only after conventional macroeconomic and financial policies have been exhausted. Free capital mobility continues to be the ultimate goal, even if some countries may have to take their time getting there. 
First, as advocates of capital mobility tirelessly point out, countries must fulfill a long list of prerequisites before they can benefit from financial globalization. These include the protection of property rights, effective contract enforcement, eradication of corruption, enhanced transparency and financial information, sound corporate governance, monetary and fiscal stability, debt sustainability, market-determined exchange rates, high-quality financial regulation, and prudential supervision. 
As the advanced countries' experience with the global financial crisis has demonstrated, even the most sophisticated regulatory and supervisory systems are far from being failsafe. Thus, demanding that developing countries build the kind of institutions that will render capital flows safe not only puts the cart before the horse; it is also a fool's errand. 
The second problem concerns the possibility that capital inflows may be harmful to growth, even if we leave aside concerns about financial fragility. Advocates of capital mobility assume that poor economies have lots of profitable investment opportunities that are not being exploited because of a shortage of investible funds. 
But many developing countries are constrained by a lack of investment demand, not a shortage of domestic saving. The social return on investment may be high, but private returns are low, owing to externalities, high taxes, poor institutions, or any of a wide array of other factors. 
They also fuel exchange-rate appreciation, which aggravates the investment shortage. The profitability of tradable industries – those most likely to suffer from appropriability problems – takes a hit, and investment demand falls further. 
In principle, frontier market economies can learn much from this experience. As the Johns Hopkins University economist Olivier Jeanne pointed out at a recent IMF conference organized to spur such learning, the capital-flow measures that have become fashionable of late do not work very well. 
As Brazil, Colombia, South Korea, and others have learned, limited controls that target specific markets such as bonds or short-term bank lending do not have a significant impact on key outcomes – the exchange rate, monetary independence, or domestic financial stability. The implication is that capital controls may need to be blunt and comprehensive, rather than surgical and targeted, to be truly effective. 
But this is no different from any other area of government action. We live in a second-best world where policy action is almost always partial (and partially effective), and well-intentioned reforms in one area may backfire in the presence of distortions elsewhere in the system. 
In such a world, treating capital controls as the last resort, always and everywhere, has little rationale; indeed, it merely fetishizes financial globalization. The world needs case-by-case, hardheaded pragmatism, recognizing that capital controls sometimes deserve a prominent place. 

The Age of Megaprojects 
WASHINGTON, DC – We seem to be entering a new age of megaprojects, as countries, in particular those of the G-20, mobilize the private sector to invest heavily in multi-million (if not multi-billion or multi-trillion) dollar infrastructure initiatives, such as pipelines, dams, water and electricity systems, and road networks. 
And geopolitics, the pursuit of economic growth, the quest for new markets, and the search for natural resources is driving even more funding into large-scale infrastructure projects. On the cusp of this potentially unprecedented explosion in such projects, world leaders and lenders appear relatively oblivious to the costly lessons of the past. 
But, unless the explosion in megaprojects is carefully redirected and managed, the effort is likely to be counterproductive and unsustainable. Without democratic controls, investors may privatize gains and socialize losses, while locking in carbon-intensive and other environmentally and socially damaging approaches. 
To begin with, there is the issue of cost effectiveness. Rather than adopting a “small is beautiful” or a “bigger is better” philosophy, countries must build “appropriate scale” infrastructure suited to its purposes. 
Bent Flyvbjerg, a professor at the University of Oxford specialized in program management and planning, studied 70 years of data to conclude that there is an “iron law of megaprojects”: they are almost invariably “over budget, over time, over and over again.” They are also, he adds, subject to the “survival of the unfittest,” with the worst projects getting built, instead of the best. 
As the international arena adjusts to this rebalancing, the United States has begun to worry that its hegemony will be challenged by new players and institutions, such as the China-led Asian Infrastructure Investment Bank. In reaction, the Western-led institutions, such as the World Bank and the Asian Development Bank, are aggressively expanding their infrastructure investment operations, and are openly calling for a paradigm shift. 
The G-20, too, is accelerating the launch of megaprojects, in the hope of boosting global growth rates by at least 2% by 2018. The OECD estimates that an additional $70 trillion in infrastructure will be needed by 2030 – an average expenditure of a little more than $4.5 trillion per year. 
In a March 2015 letter to the G-20, a group of scientists, environmentalists, and opinion leaders warned that ramping up investment in megaprojects risks irreversible and catastrophic damage to the environment. “Each year, we are already consuming about one-and-a-half planets’ worth of resources,” the authors explained. 
Similarly, the Intergovernmental Panel on Climate Change cautions that “infrastructure developments and long-lived products that lock societies into greenhouse-gas-intensive emissions pathways may be difficult or very costly to change.” And, indeed, the G-20 has put in place few social, environmental, or climate-related criteria for the “wish list” of mega-projects that each member country will submit to its summit in Turkey in November. 
As part of the renewed focus on large-scale investments, the World Bank, the International Monetary Fund, and other multilateral lenders have launched an effort to reengineer development finance by, among other things, creating new asset classes of social and economic infrastructure to attract private investment. “We need to tap into the trillions of dollars held by institutional investors… and direct those assets into projects,” said World Bank Group President Jim Yong Kim. 
By using public money to offset risk, the institutions hope to attract long-term institutional investors – including mutual funds, insurance companies, pension funds, and sovereign-wealth funds – who together control an estimated $93 trillion in assets. Their hope is that tapping this huge pool of capital will enable them to scale-up infrastructure and transform development finance in ways that would have been previously unimaginable. 
As result, according to researchers at the London School of Economics, they “are not regarded as an appropriate instrument for [information technology] projects, or where social concerns place a constraint on the user charges that might make a project interesting for the private sector.” Private investors seek to sustain the rate of return on their investments through guaranteed revenue streams and by ensuring that laws and regulations (including environmental and social requirements) do not cut into their profits. 
Finally, the rules governing long-term investment do not effectively incorporate long-term environmental and social related risks, as emphasized by trade unions and the United Nations Environment Program. Pooling infrastructure investments in portfolios or turning development sectors into asset classes could privatize gains and socialize losses on a massive scale. 
Left unexamined, the push toward megaprojects risks – in the words of the authors of the letter to the G-20 – “doubling down on a dangerous vision.” It is critical that we ensure that any transformation of development finance be crafted in a way that upholds human rights and protects the earth. 

The Grand Global Health Convergence 
By making today’s medicines, vaccines, and other health tools universally available – and by stepping up research efforts to develop tomorrow’s health tools – we could close the health gap between wealthy and poor countries within a generation. By 2035, we could achieve a “grand convergence” in global health, reducing preventable maternal and child deaths, including those caused by infectious diseases, to unprecedentedly low levels worldwide. 
A group of 25 global health and economics experts (including us) recently came together to develop such a strategy. In a year-long process, the group identified the tools, systems, and financing that would be needed to achieve global health convergence, and produced Global Health 2035 – an ambitious investment blueprint that would save millions of lives and bolster human welfare, productivity, and economic growth. 
With aggressively scaled-up health investments, ten million lives could be saved annually, beginning in 2035. And the economic payoff would be enormous: every dollar invested in low- and middle-income countries (LMICs) to achieve this grand convergence would return $9-20. 
Success will require a global commitment to ensuring that everyone can access today’s powerful health technologies and services, like childhood vaccines, treatment for HIV/AIDS and tuberculosis, and prenatal care for pregnant women. It will also require increased funding for the development and delivery of new health tools to redress the conditions that disproportionately kill women and children in LMICs. 
To this end, one of the central features of the convergence strategy is family planning. As it stands, more than 220 million women worldwide lack access to modern contraception – an inexcusable situation, given that scaling up family planning would be remarkably simple and inexpensive. 
For starters, improved access to contraception would prevent an estimated one-third of all maternal deaths, and would have a particularly large impact among those facing the highest risk. These include 15-19-year-old women in poor countries, who currently have the least access to contraception, and women who have multiple pregnancies in quick succession, by allowing them to space out their pregnancies. 
Reducing high-risk pregnancies, curbing unwanted pregnancies, and spacing out births have been shown to decrease newborn and child death rates. The Guttmacher Institute estimates that fully meeting women’s need for contraception would prevent 600,000 newborn deaths and 500,000 child deaths annually. 
At the same time, it would facilitate social change that fuels increased productivity and output. According to a study coordinated by the World Health Organization, the economic return from scaling up contraception in 27 countries with very high birth rates, such as Afghanistan and Chad, would exceed 8% of GDP from now until 2035. 
So, how much would it cost to ensure universal access to modern medicine and health services? Global Health 2035 puts the total at an additional $70 billion dollars annually, with $1 billion of this increase allocated to family planning alone. 
In fact, the total bill for global health convergence amounts to less than 1% of the additional GDP that these countries are expected to generate in the next two decades. In other words, public investment of less than 1% of GDP could avert a massive ten million deaths each year. 
Innovative partnerships aimed at reducing costs can diminish this burden even more. A group of donor governments, foundations, the United Nations, and private-sector actors recently came together to reduce the price of a long-lasting contraceptive implant (Levonorgestrel) from $18 to $8.50 per unit in more than 50 LMICs. 
Specifically, it must increase investment in research and development for the diseases that affect the poor, like childhood pneumonia and diarrhea, which kill around two million children every year. And direct financial assistance to LMICs – for example, to fund family-planning programs and combat malaria and HIV/AIDS – will be required for years to come. 
The opportunity to achieve a grand convergence in global health outcomes is within reach. We need only to convince ourselves to grasp it. 

Gender Equality and Earth's Future 
NEW YORK – Twenty years ago, the adoption by 189 governments of the Beijing Declaration and Platform for Action marked a turning point in the history of women's rights. This progressive blueprint remains a powerful source of inspiration in the effort to realize equal opportunities for women and girls. 
But while much progress has been made in the intervening decades, much more remains to be done to ensure that women and children are guaranteed healthy lives, education, and full social inclusion. In just 42 countries do women hold more than 30% of seats in the national legislature, and girls still do not have the same educational opportunities as boys in Sub-Saharan Africa, Oceania, and western Asia. 
Gender equality is not just the concern of half of the world's population; it is a human right, a concern for us all, because no society can develop – economically, politically, or socially – when half of its population is marginalized. We must leave no one behind. 
Governments will adopt a new set of Sustainable Development Goals, work together to draft a meaningful climate agreement, and craft a framework to provide the financial resources needed to deliver on a global sustainable development agenda. Those participating would be wise to remember that inclusive sustainable development can be realized only when all human rights – including gender equality – are protected, respected, and fulfilled. 
The three of us – each from different continents – support these international processes. We share a common motivation for our work: protecting our planet for our children and grandchildren, and ensuring the development of a world where all people – regardless of their gender, race, religion, age, disability, or sexual orientation – have an equal opportunity to achieve their aspirations. 
It is critical that we continue to engage men and boys actively in the fight against gender-based discrimination and violence. We have an opportunity to secure a better future and raise a new generation of girls and boys who respect one another and work together to protect the rights of all people. 
The implications of not providing girls with equal voices, choices, and opportunities affect not just their lives, but the future of the planet. Efforts to promote inclusive sustainable development and fight climate change are inextricably linked. 
Left unchecked, climate change – along with other unsustainable patterns of development – could wipe out the gains of recent decades. All countries – developed and developing – have a role to play in ensuring a stable world for our children. 
And when the usual sources of these resources are disrupted, women are forced to travel farther and spend more time working for less return. Scarcity requires them to make difficult choices like pulling children out of school or deciding which family member can afford to skip a meal. 
In many homes around the world, women are at the heart of the household's nexus of water, food, and energy – and thus often know firsthand about the challenges and potential solutions in these areas. In our conversations with women around the world, we hear about their struggles, but also their ideas, many of which, if applied, could facilitate change. 
Over the coming weeks, during the 59th session of the Commission on the Status of Women in New York, the international community will take stock of the progress that has been made toward achieving what was pledged 20 years ago in Beijing and assess where more efforts are needed. 
This year will be crucial. With the Financing for Development conference in July, the Special Summit on Sustainable Development Goals in September, and the UN Climate Change Conference in December, we have the opportunity to integrate gender equality and women's empowerment fully into the effort to promote sustainable development and fight climate change. 
Everyone should. We call on all women and men to join us in making their voices heard loudly and in seizing this opportunity for a just and equitable future for all. 

Europe’s Ukrainian Lifeline 
NEW YORK – Last weekend’s European Parliament election and presidential election in Ukraine produced sharply contrasting results. Europe’s voters expressed their dissatisfaction with the way that the European Union currently functions, while Ukraine’s people demonstrated their desire for association with the EU. 
The EU was originally conceived to be an ever-closer association of sovereign states willing to pool a gradually increasing share of their sovereignty for the common good. It was a bold experiment in international governance and the rule of law, aimed at replacing nationalism and the use of force. 
Unfortunately the euro crisis transformed the EU into something radically different: a relationship of creditors and debtors in which the creditor countries impose conditions that perpetuate their dominance. Given low turnout for the European Parliament election, and if support for Italian Prime Minister Matteo Renzi were added to the anti-EU vote on the left and the right, it could be argued that the majority of citizens are opposed to current conditions. 
Indeed, speaking on the Russian radio program Direct Line last month, he extolled the genetic virtues of the Russian people. The annexation of Crimea has made him popular at home, and his effort to weaken America’s global dominance, in part by seeking an alliance with China, has resonated favorably in the rest of the world. 
The Russian economy is weakening, despite the high price of oil, owing to the flight of capital and talent. Using violence in Kyiv’s Maidan has led to the birth of a new Ukraine that is determined not to become part of a new Russian empire. 
The success of the new Ukraine would constitute an existential threat to Putin’s rule in Russia. That is why he has tried so hard to destabilize Ukraine by fostering self-declared separatist republics in eastern Ukraine. 
With the Donbas region’s largest employer mobilizing protests against the separatists, Putin’s plan may not work, and he is now likely to accept the results of the presidential election, thereby avoiding additional sanctions. But Russia is likely to seek other avenues to destabilize the new Ukraine, which should not be too difficult, given that the security forces, having served the corrupt regime of former President Viktor Yanukovych, are demoralized and not necessarily loyal to the new leadership. 
All of this has happened very fast and very recently. Both the EU and the US are preoccupied with their internal problems and remain largely unaware of the geopolitical and ideological threat that Putin’s Russia poses. 
This would keep the economy running, despite the political turmoil, and it would signal to Ukrainians that the EU and the US – governments and private investors alike – are committed to them. Businesses would flock to a newly open and promising market if they were fully compensated for losses caused by political events beyond their control. 
Private insurers and reinsurers like Germany’s Euler Hermes have offered it for years. So have government institutions, like the World Bank’s Multilateral Investment Guarantee Agency and the US government’s Overseas Private Investment Corporation. 
Faced with high premiums, most businesses would simply opt to wait on the sidelines until the storm passed. That is why the governments concerned must take over the reinsurance function and use their agencies only to administer the insurance policies. 
They could guarantee the losses in the same way as they underwrite the World Bank: each government would provide a modest pro-rata capital infusion and commit the rest in the form of callable capital that would be available if and when losses are actually paid out. The EU would have to modify the fiscal compact to exempt the callable capital and allow actual losses to be amortized over a number of years. 
As long as there are so many productive resources lying idle, it would make sense to exempt from the fiscal compact investments that would eventually pay for themselves. Renzi, for one, is advocating precisely this course of action. 
With European support, Ukraine could compare favorably. And, if such an initiative marks the beginning of a growth policy that Europe so badly needs, by saving Ukraine Europe would also be saving itself. 

An Economic Roadmap for India 
NEW DELHI – India’s incoming prime minister, Narendra Modi, has promised to turn his country’s sluggish economy around. When asked recently about his reform plans, Modi responded that his roadmap was simply that “Our GDP should grow.” 
What will it take to return the Indian economy to sustainable growth? We believe that the following five simple facts about the Indian economy hold the key. 
A country’s output depends on its inputs, namely its labor force and capital stock, and on the efficiency with which it uses them. When the capital stock – including infrastructure – is deficient, investing in it is one of the quickest ways to generate growth (as long as finance is available). 
This is anachronistic for a country at India’s level of development. The fact that India has moved from an agricultural economy to a service-driven economy with almost no growth in industry is not a virtue; it is an outcome of policies that have hampered manufacturing and mining. 
With production costs rising in China, international buyers are looking for alternative sourcing destinations for manufactured products. If India, with its large labor force, is to seize this opportunity, it must nurture its industrial sector. 
The new government needs to reverse this trend and improve the environment for doing business. There is a large constituency of domestic and international investors who will respond positively and rapidly to any steady improvement in India’s institutional environment, which should be an ongoing process. 
Significant improvement could be achieved by rule changes to accelerate approval of business permits and environmental clearances, simplify labor regulations, and fill judicial vacancies. All of this is well known; what is needed now is the will to undertake such reforms and a mechanism for oversight and accountability to ensure that the bureaucracy implements them quickly and effectively. 
Fourth, in recent years the lack of fiscal discipline has been costly for the Indian economy, as excessive demand arising from large deficits translated into stubbornly high inflation and was partly responsible for large current-account deficits. Fiscal discipline should be a priority, not an afterthought. 
Lastly, improving the quantity and quality of education and healthcare through partnerships with the private and non-profit sector and researchers is essential to sustain growth beyond the next five years. The new government should promote researcher-policymaker partnerships to design and evaluate innovative programs to solve knotty policy challenges like improving learning outcomes and boosting preventive health care. 
India is fortunate to have thought leaders in almost every sector who could help unleash such innovation in partnership with the civil service. Just as there is a chief economic adviser in the finance ministry, why not have a technocratic chief education adviser or a chief health adviser to work with the education and health secretaries? 
Modi has certainly championed economic growth, and he constantly points to his success in building roads and ensuring power supply as Chief Minister in his home state of Gujarat. The BJP manifesto proposes to pursue “minimal government and maximum governance.” 
But replicating Modi’s success in Gujarat at the national level and confronting other development challenges will require cooperation from state governments, which is uncertain at best. After all, any attempt to change rules and laws (such as labor legislation) that benefit established interest groups invites opposition. 

Putting Public Health on the Map 
SEATTLE – Twenty-five years ago, the state of public health for large populations was like that of a doctor trying to treat a patient without a proper diagnosis. The diseases and injuries that cut lives short and caused widespread suffering were not rigorously tracked. 
Back then, well-meaning advocates for different diseases published death tolls that helped them make the case for funding and attention. But when all the claims were added up, the total was many times greater than the number of people who actually died in a given year. 
To address this problem, Alan Lopez and I launched the Global Burden of Disease project (GBD) in 1990. Decision-makers need information about the world’s biggest health threats and how they have changed over time, across age groups, and by sex, so they can ensure that everyone has the opportunity to live the longest, healthiest life possible. 
By ensuring that each death is counted just once, and by providing comprehensive statistics on the causes of ill health, the GBD can compare the impact of cancer to that of lower back pain or depression. It also enables comparison of health-care performance among countries. 
It also opened the international development community’s eyes to the importance of overlooked afflictions, such as mental illness and road injuries. Donors such as the World Bank and the Bill & Melinda Gates Foundation use GBD data to guide their investments, and more than 30 countries have conducted their own burden-of-disease studies. 
In China, the results of the GBD project, launched at a policy summit in 2013, raised awareness about the deadly impact of air pollution on the country’s population. Those findings helped shape the Chinese government’s efforts to curb the negative effects of pollution on health, and Chinese researchers are now key members of the global collaborative effort. 
In Rwanda, when the GBD study revealed that indoor air pollution from cooking with solid fuel was a leading cause of death, the government launched a program to distribute one million clean stoves to the most vulnerable households. Rwandan scientists and officials from the Ministry of Health – including the minister herself – are important contributors to the GBD. 
These collaborators improve the models on which the project is built, vet the study results, contribute new data sets, and communicate the results to media outlets, educational institutions, and decision-makers. The latest GBD study revealed that another disease seldom discussed in international development circles, lower back and neck pain, is the fourth largest cause of health loss globally. 
Policymakers are accountable, first and foremost, to their constituents, whose unique needs they must meet. Estimates of local disease burdens will be essential for combating afflictions like Ebola, checking the rising toll of non-communicable diseases in middle-income countries, and meeting the Sustainable Development Goals relating to maternal and child health in Sub-Saharan Africa. 
To help decision-makers make better use of their data, the Institute for Health Metrics and Evaluation, which I head, is creating geospatial maps of disease burdens with a groundbreaking level of resolution. Creating these maps is possible thanks to methods developed by the Malaria Atlas Project, which has produced a better spatial understanding of malaria than we have for any pathogen. 
These case studies can empower communities to replicate one another’s successes. One example is Cali, Colombia, which drove down homicide rates in the 1990s after the city’s mayor, Rodrigo Guerrero, tightened alcohol restrictions, introduced community-development programs in the most impoverished neighborhoods, and imposed temporary gun bans in public places. 
The mayor of Colombia’s capital, Bogota, learned about the program in Cali and implemented similar measures, which have helped reduce homicides steadily in the city. Since then, Guerrero has worked with the Inter-American Development Bank to develop programs that help other Latin American countries reduce violence in their communities. 
As the international community comes together to agree on the tools needed to finance and monitor progress toward the MDGs’ successor framework, the Sustainable Development Goals, geospatial mapping will be critical for tracking progress and indicating where course corrections might be needed. We are far beyond where we were in 1990 in terms of health measurement. 

Global Finance and Global Warming 
NEW DELHI/LONDON – Since 2008, when the global financial crisis nearly brought down the world economy, financial reform has been among the top items on policymakers’ agendas. But, as leaders move from fixing the problems of the past to positioning the financial system for the future, they must also grapple with new threats to its stability, particularly those stemming from climate change. 
In Brazil, the central bank views the integration of environmental and social factors into risk management as a way to strengthen resilience. And in countries like Singapore and South Africa, companies listed on the stock market are obligated to disclose their environmental and social performance, a requirement that investors and regulators increasingly view as essential to the efficient functioning of financial markets. 
In Bangladesh, the central bank’s efforts to support economic development include low-cost refinancing for banks lending to projects that meet goals for renewables, energy efficiency, or waste management. In the United Kingdom, the Bank of England is currently evaluating the implications of climate change for the insurance sector as part of its core mandate to oversee the safety and soundness of financial institutions. 
In China, annual investment in green industry could reach $320 billion in the next five years, with the government able to provide only 10-15% of the total. In order to prevent a funding shortfall, the People’s Bank of China has recently produced a report with the United Nations Environment Programme (UNEP) setting out a comprehensive set of recommendations for establishing China’s “green financial system.” 
In India, the Federation of Indian Chambers of Commerce and Industry has established a new “green bond” working group to explore how the country’s debt markets can respond to the challenge of financing smart infrastructure. And recent regulatory changes hold out considerable potential for listed investment trusts to deploy capital for clean energy. 
So far, such measures affect only a small fraction of the $305 trillion in assets held by banks, investors, financial institutions, and individuals in the global financial system. But they are set to be applied more broadly as financiers and regulators alike recognize the full consequences of environmental dislocation. 
The human and economic costs of continued high-carbon growth include severe health impacts, growing disruption to infrastructure, and water and food security, as well as increasing market volatility, most notably in developing countries. This damage will become worse, with risks becoming unmanageable if emissions of greenhouse gases are not reduced to net zero levels between 2055 and 2070. 
As the threat from climate change becomes more evident, financing the response to its impact will become increasingly important. Developed countries have committed to mobilize $100 billion in annual financial flows to developing countries by 2020, but much more is needed. 
The task for those charged with governing the financial system is to enable the orderly transition from high- to low-carbon investments and from vulnerable to resilient assets. According to the New Climate Economy initiative, $89 trillion will be spent on global infrastructure investment by 2030 – with an additional $4.1 trillion needed to make it low-carbon and resilient. 
To mobilize the required capital, policymakers will need to harness the power of the financial system. The scope of risk management will need to be expanded, so that long-term sustainability and risks from climate change are included in prudential rules for banking, insurance, and investment. 
For example, the G-20 finance ministers and central bank governors have just asked the Financial Stability Board to explore how the financial sector could address climate issues. Actions such as these will not only strengthen climate security; they will also contribute to a more efficient, effective, and resilient financial system. 

Rethinking Robin Hood 
MADRID – International development aid is based on the Robin Hood principle: take from the rich and give to the poor. National development agencies, multilateral organizations, and NGOs currently transfer more than $135 billion a year from rich countries to poor countries with this idea in mind. 
A more formal term for the Robin Hood principle is “cosmopolitan prioritarianism,” an ethical rule that says we should think of everyone in the world in the same way, no matter where they live, and then focus help where it helps the most. Those who have less have priority over those who have more. 
People in poor countries have needs that are more pressing, and price levels are much lower in poor countries, so that a dollar or euro goes twice or three times further than it does at home. Spending at home is not only more expensive, but it also goes to those who are already well off (at least relatively, judged by global standards), and so does less good. 
I have thought about and tried to measure global poverty for many years, and this guide has always seemed broadly right. But I currently find myself feeling increasingly unsure about it. 
Huge strides have undoubtedly been made in reducing global poverty, more through growth and globalization than through aid from abroad. The number of poor people has fallen in the past 40 years from more than two billion to just under one billion – a remarkable feat, given the increase in world population and the long-term slowing of global economic growth, especially since 2008. 
The globalization that has rescued so many in poor countries has harmed some people in rich countries, as factories and jobs migrated to where labor is cheaper. This seemed to be an ethically acceptable price to pay, because those who were losing were already so much wealthier (and healthier) than those who were gaining. 
A long-standing cause of discomfort is that those of us who make these judgments are not exactly well placed to assess the costs. Like many in academia and in the development industry, I am among globalization’s greatest beneficiaries – those who are able to sell our services in markets that are larger and richer than our parents could have dreamed of. 
Globalization is less splendid for those who not only don’t reap its benefits, but suffer from its impact. We have long known that less-educated and lower-income Americans, for example, have seen little economic gain for four decades, and that the bottom end of the US labor market can be a brutal environment. 
But several million Americans – black, white, and Hispanic – now live in households with per capita income of less than $2 a day, essentially the same standard that the World Bank uses to define destitution-level poverty in India or Africa. Finding shelter in the United States on that income is so difficult that $2-a-day poverty is almost certainly much worse in the US than $2-a-day poverty in India or Africa. 
Towns and cities that have lost their factories to globalization have also lost their tax base and find it hard to maintain quality schools – the escape route for the next generation. Elite schools recruit the wealthy to pay their bills, and court minorities to redress centuries of discrimination; but this no doubt fosters resentment among the white working class, whose kids find no place in this brave new world. 
We have documented a rising tide of “deaths of despair” among white non-Hispanics – from suicide, alcohol abuse, and accidental overdoses of prescription and illegal drugs. Overall death rates in the US were higher in 2015 than 2014, and life expectancy has fallen. 
We can argue about the measurement of material living standards, whether inflation is overstated and the rise in living standards understated, or whether schools are really that bad everywhere. But deaths are hard to explain away. 
Citizenship comes with a set of rights and responsibilities that we do not share with those in other countries. Yet the “cosmopolitan” part of the ethical guideline ignores any special obligations we have toward our fellow citizens. 
We can think about these rights and obligations as a kind of mutual insurance contract: We refuse to tolerate certain kinds of inequality for our fellow citizens, and each of us has a responsibility to help – and a right to expect help – in the face of collective threats. These responsibilities do not invalidate or override our responsibilities to those who are suffering elsewhere in the world, but they do mean that if we judge only by material need, we risk leaving out important considerations. 
When citizens believe that the elite care more about those across the ocean than those across the train tracks, insurance has broken down, we divide into factions, and those who are left behind become angry and disillusioned with a politics that no longer serves them. We may not agree with the remedies that they seek, but we ignore their real grievances at their peril and ours. 

A Global Marshall Plan 
ROME – Despite ongoing efforts to catalyze global development cooperation, there have been significant obstacles to progress in recent years. Fortunately, with major international meetings set for the second half of 2015, world leaders have an important opportunity to overcome them. 
The Seattle ministerial of the World Trade Organization ended without decision, and after two decades of the Washington Consensus, developing countries were frustrated at the US-led international financial institutions. Negotiations for the inaugural United Nations Financing for Development (FfD) conference in Monterrey, Mexico, seemed to be headed nowhere. 
World leaders agreed to begin the Doha Development Round to ensure that trade negotiations would serve developing countries’ development aspirations. And the 2002 Monterrey FfD conference produced major breakthroughs on foreign and domestic investment, foreign debt, international cooperation, trade, and systemic governance issues. 
This year’s major global meetings – the Conference on Financing for Development in July, the meeting at the United Nations to adopt Sustainable Development Goals in September, and the UN Climate Change Conference in Paris in December – should be sufficient. And the efforts that have gone into preparing for these meetings suggest that there is a will to move forward. 
The world needs a well-designed and far-reaching strategy to stimulate industrialization, modeled after the European Recovery Program – the American initiative that enabled Europe to rebuild after World War II. The Marshall Plan, as it is better known, entailed a massive infusion of US aid to support national development efforts in Europe, and is still viewed by many Europeans as America’s finest hour. 
The Marshall Plan’s impact was felt far beyond Europe’s borders, developing over the following decade into what is probably the most successful economic-development assistance project in human history. Similar policies were introduced in Northeast Asia following the establishment of the People’s Republic of China and the Korean War. 
Of course, there was a political motivation behind the Marshall Plan’s expansion. By creating a cordon sanitaire of wealthy countries from Western Europe to Northeast Asia, the US hoped to contain the spread of communism at the start of the Cold War. 
Crucially, it represented a complete reversal of its predecessor, the Morgenthau Plan, which focused on de-industrialization – with poor results. The plan’s aim – articulated by Treasury Secretary Henry Morgenthau, Jr., in his 1945 book Germany is Our Problem – was to convert Germany into a “principally agricultural and pastoral” country, in order to prevent its involvement in any new wars. 
By late 1946, however, economic hardship and unemployment in Germany spurred former US President Herbert Hoover to visit the country on a fact-finding mission. Hoover’s third report of March 18, 1947, called the notion that Germany could be reduced to a pastoral state an “illusion,” which could not be achieved without exterminating or moving 25,000,000 people out of the country. 
Less than three months later, Secretary of State George Marshall made his landmark speech at Harvard University announcing the policy reversal. Germany and the rest of Europe were to be re-industrialized, he stated, including through heavy-handed state interventions, such as high duties, quotas, and import prohibitions. 
First, in noting the role that the breakdown of trade between urban and rural areas played in Germany’s economic slowdown, he recalled a centuries-old European economic insight: all wealthy countries have cities with a manufacturing sector. “The remedy,” Marshall explained, “lies in…restoring the confidence of the European people,” so that “the manufacturer and the farmer” would be “able and willing to exchange their products for currencies, the continuing value of which is not open to question.” 
Second, Marshall argued that participatory institutions emerge from economic progress, not the other way around – the opposite of today’s conventional wisdom. As he put it, the policy’s “purpose should be the revival of a working economy in the world, so as to permit the emergence of political and social conditions in which free institutions can exist.” 
Third, Marshall emphasized that aid should be comprehensive and strategic, in order to foster real progress and development. “Such assistance,” he declared, “must not be on a piecemeal basis as various crises develop. 
Marshall’s vision offers important lessons for world leaders seeking to accelerate development today, beginning with the need to reverse the effects of the Washington Consensus on developing and transition economies – effects that resemble those of the Morgenthau Plan. Some countries – including large economies like China and India, which have long protected domestic industry – have been in a better position to benefit from economic globalization. 
It is time to increase poor economies’ productive capacity and purchasing power, as occurred in Europe in the decade after Marshall’s speech. Marshall’s insight that such shared economic development is the only way to create a lasting peace remains as true as ever. 

GMOs and Junk Science 
STANFORD – In today’s media landscape, where unfounded opinions, hype, and rumors are rife, the scientific method – the means by which we determine, based on empirical and measurable evidence, what is true – should serve as a touchstone of reality. Science enables us to gauge what we think we know and to identify what we do not. 
But scientists occasionally “go rogue,” forsaking the scientific method – often for notoriety or economic gain – to produce propaganda and to sow fear in a public that lacks expertise but is hungry for information. This abuse of scientific authority is especially widespread in the “organic” and “natural” food industries, which capitalize on people’s fear of synthetic or “unnatural” products. 
Systems Biology May Provide Answers.” (“GMOs” are “genetically modified organisms,” itself a misleading and often unfairly stigmatized non-category, circumscribing a universe of organisms modified with the most modern and precise techniques of genetic engineering.) 
Although the article supposedly passed the peer-review process, a key component of legitimate science, it appeared in a low-impact “pay-for-play” journal, Agricultural Sciences, which is produced by a “predatory” publisher. Within days of publication, anti-biotechnology organizations like the Organic Consumers Association and GMO Inside were reporting on Ayyadurai’s “findings” with frightening headlines – “Formaldehyde in GMO Soy?” and “New Study Shows GMO Soy Accumulates Cancer Causing Chemical Formaldehyde” – accompanied by scary graphics. 
If you think that GMOs might “accumulate formaldehyde” – a chemical that is probably carcinogenic at high levels but is present in most living cells and found widely in our environment – the obvious response would be to measure its levels in the organisms. Ayyadurai, however, chose to make guesses based on modeling via “systems biology.” 
Rather than actually testing the levels of any chemicals in plants, Ayyadurai plugged data into a computer algorithm to predict the levels of two chemicals, formaldehyde and glutathione. This is akin to a meteorologist predicting from his models that it will be sunny all day, instead of looking out the window to see whether rain is falling. 
To be sure, as Kevin Folta, the head of the horticultural sciences department at the University of Florida, explained, systems biology can be a useful approach if employed properly. As he put it, systems biology “is a way to make predictions based on integrating existing data, and then statistically deriving a likelihood that the predictions may be correct.” 
Like all predictive studies based on computer modeling, the validity of the results depends on the integrity of the data and the algorithm. If the data are cherry-picked to support the modeler’s desired conclusions, or if the algorithm is flawed, the results will be inaccurate. 
“If you developed a computer program that integrated Internet data to predict the location of Munich, and the program told you it was squarely in the Gulf of Mexico, right off Florida, it does not mean that Munich is in the Gulf of Mexico, right off of Florida.” Instead, it means that you have made a mistake, in your program, assumptions, or input data – all of which are testable. 
To decide not to challenge those data, Folta continues, and instead to “publish a map showing that Munich is squarely in the Gulf of Mexico, opposing all other data and the claims of millions of rather dry Germans, does not mean that you are brilliant. It means you have absolutely no clue, or more likely, have some reason you want a major German metropolis to be a two-hour boat ride from Tampa.” 
Folta also has something to say about Ayyadurai’s publisher. If you print the deceptive map showing the location of Munich, “what does that say about your integrity as a reliable information source?” 
In the spirit of scientific cooperation, Folta offered to collaborate with Ayyadurai on university-based testing of genetically engineered corn and soy samples (along with appropriate controls), with analysis by an independent lab. Ayyadurai declined, so Folta will proceed himself. 
The experimental data is forthcoming. In the meantime, if you get a hankering for sauerbraten and spaetzle, head for Central Europe, not the Gulf of Mexico. 

Educating Everyone 
With children in Gaza, Syria, Iraq, and Nigeria literally in the firing line in recent months, the immense scale of the challenge could not be more apparent. After all, fulfilling the promise of universal education demands that even those in the most difficult circumstances, such as child refugees and children in combat zones, can safely acquire a basic education. 
Academic research suggests that no country can enjoy sustained prosperity – and none can avoid the middle-income trap – without large-scale investment in high-quality education. This is particularly true for today’s knowledge-based economy, in which companies value themselves according to their human, not just physical, assets, and stock exchanges assess intellectual, in addition to physical, capital. 
Education has long been viewed as the number one guarantor of income, wealth, status, and security. Yet millions of people have consistently been left out or left behind, with nearly half of the world’s children still lacking access to basic education. 
To be sure, for the first five years after the MDGs were introduced, significant progress was made, with enrollment in primary and lower-secondary schools increasing by 1.5% annually. On that trajectory, the enrollment rate would have reached 97% worldwide by 2022, with Sub-Saharan Africa reaching that level by 2026. 
As a result, only 36% of children in the world’s poorest countries complete lower-secondary schooling. By 2030, that rate will have increased, but only to 54%. 
And, whereas boys in Sub-Saharan Africa will have to wait until 2069 for universal access to primary education, girls will have to wait until 2086. As for lower-secondary education, it will take almost a century, if current trends persist, to ensure access for all girls in Sub-Saharan Africa. 
A recent study indicates that Africa is so far behind in terms of educational opportunity that in 2025 just 2% of young adults in their early thirties in Rwanda, Chad, Liberia, and Malawi – and only 3% in Tanzania and Benin – will have a college or university education. Such low levels of tertiary education make it impossible not only to hire qualified teachers for the next generation, but also to staff medical centers and clinics with fully trained health professionals – failures that perpetuate the seemingly endless cycle of poor education, bad health, unemployment, and poverty. 
Of course, a few African countries – such as Algeria, Nigeria, and Egypt – might manage to buck the trend. But even in South Africa – currently Africa’s most advanced country – 10% of young adults, at most, will have college or university degrees by 2045. 
Meanwhile, in Pakistan, a bold education campaign led by Malala Yousafzai is helping to increase the share of young adults with a tertiary education, which stood at a measly 7% in 2010. But the gains are slight; even by 2045, the share is unlikely to exceed 15%. 
Even a major emerging economy like India will progress by only 11% from 2010 to 2045, reaching just 23% – far below the level suggested by the global reputation of its institutions of higher education. Meanwhile, in Singapore, South Korea, and Japan, the share of young adults with college or university degrees will reach 80-90%. 
The assumption that economic development and technological progress will inevitably expand opportunities for all is little more than wishful thinking. In reality, unless a concerted effort is made, the distribution of educational – and thus economic – opportunity will become increasingly unequal in the coming years. 
These long-neglected people will continue pressing governments and international organizations until every person’s fundamental right to education is respected. And the next stop in their campaign is the United Nations General Assembly in New York, with hundreds of young people, representing all countries, gathering to demand change from world leaders. 
As school doors reopen around the world, the international community should renew its commitment to ensuring that every child, everywhere, has a chance to walk through them. 

The Good-Governance Trap 
ROME – Development and improved governance have tended to go hand in hand. But, contrary to popular belief, there is little evidence that success in implementing governance reforms leads to more rapid and inclusive economic and social development. 
Instead of reassessing the prevailing economic-policy approach, international development institutions took aim at the easy targets: developing-country governments. Advising those governments on how to do their jobs became a new vocation for these institutions, which quickly developed new “technical” approaches to governance reform. 
The World Bank, using well over 100 indicators, introduced a composite index of good governance, based on perceptions of voice and accountability, political stability and the absence of violence, government effectiveness, regulatory quality, the rule of law, and levels of corruption. By claiming that it had found a strong correlation between its governance indicators and economic performance, the Bank fueled hope that the key to economic progress had been found. 
The indicators used were ahistorical and failed to account for country-specific challenges and conditions, with cross-country statistical analyses suffering from selection bias and ignoring the interlinkages among a wide array of variables. As a result, the World Bank badly overestimated the impact of governance reform on economic growth. 
To be sure, governance that is effective, legitimate, and responsive provides untold benefits, especially when compared to the alternative: inefficient governance, cronyism, and corruption. But the focus on governance reform has not proved nearly as effective as promised in fostering development. 
In fact, this governance-focused approach may have actually undermined development efforts. For starters, it has allowed international institutions to avoid acknowledging the shortcomings of the new development orthodoxy of the last two decades of the twentieth century, when Latin America lost over a decade, and Sub-Saharan Africa a quarter-century, of economic and social progress. 
With good-governance reforms now a condition for international aid, developing-country governments often end up mimicking donor expectations, instead of addressing the issues that are most pressing for their own citizens. Indeed, such reforms can even undermine traditional rights and customary obligations worked out among communities over many generations. 
Moreover, the required reforms are so wide-ranging that they are beyond the means of most developing countries to implement. As a result, good-governance solutions tend to distract from more effective development efforts. 
Another problem with governance reforms is that, although they are formally neutral, they often favor particular vested interests, with grossly unfair consequences. Reforms aimed at decentralization and devolution have, in some cases, enabled the rise of powerful local political patrons. 
The conclusion is clear: the development agenda should not be overloaded with governance reform. As Harvard’s Merilee Grindle has put it, we should be aiming for “good enough” governance, selecting a few imperatives from a long list of possibilities. 
But selecting the most important measures will not be easy. Indeed, advocates of governance reform have rarely been right about the most effective approach. 
Consider the unrelenting promotion of efforts to strengthen property rights. Absent alienable individual ownership of productive resources, it is asserted, there will be insufficient means and incentives to pursue development initiatives, and shared resources (the “commons”) will be over-exploited and used inefficiently. 
In reality, the so-called “tragedy of the commons” is neither ubiquitous nor inevitable, and individual property rights are not always the best – and never the only – institutional solution for dealing with social dilemmas. The late Elinor Ostrom, a Nobel laureate in economics, showed that human societies have built myriad creative and lasting solutions to resolve a wide range of dilemmas involving the use of common resources. 
The theme of good governance has special appeal to large bureaucratic organizations like multilateral development banks and UN agencies, which favor apolitical solutions to what are essentially political problems. In other words, good governance is an ostensibly technocratic answer to what donors and other well-meaning international groups consider bad policies and, especially, bad politics. 
Herein lies the real problem with the good-governance agenda: it supposes that the solution to most policy and political dilemmas lies in compliance with a set of formal process-oriented indicators. But experience over two decades shows that such directives provide little practical guidance for solving the technically, socially, and politically complex real-world problems of economic development. 
Recognizing that governance improves with development, the international community would be better served by pursuing reforms that directly advance development, instead of a broad agenda that may have, at best, a small indirect impact. Such a pragmatic approach to improving governance would be neither dogmatic nor pretend to universality. 
Many of the good-governance agenda’s key goals – empowerment, inclusion, participation, integrity, transparency, and accountability – can be built into workable solutions, not because outsiders demand them, but because effective solutions require them. Such solutions should draw from relevant experiences, with the understanding that they do not amount to “best practices.” 
The blind pursuit of good governance has guided development efforts for too long. It is time to acknowledge what works – and disregard what does not. 

A State-Powered Green Revolution 
Better mechanisms for storing and releasing that energy – when the sun isn’t shining, the wind isn’t blowing, or when electric cars are on the move – are also critical. And, contrary to popular belief, it is the public sector that is leading the way toward effective solutions. 
Since the commercial development of lithium-ion batteries – the rechargeable batteries common in consumer electronics – in the early 1990s, the challenge of storing and releasing power effectively enough to make sustainable energy sources viable alternatives to fossil fuels has been a vexing one. And efforts by entrepreneurial billionaires like Bill Gates and Elon Musk to overcome this challenge have been the focus of much excited media speculation. 
This week, Ellen Williams, Director of the Advanced Research Projects Agency-Energy, part of the US Department of Energy, announced that her agency had beaten the billionaires to it. ARPA-E, she declared, had attained “some holy grails in batteries,” which will enable us to “create a totally new approach to battery technology, make it work, make it commercially viable.” 
ARPA-E, by contrast, has been pursuing technological innovation in the purest sense: “creating new ways of doing” things. And they “are pretty well convinced” that some of their technologies “have the potential to be significantly better.” 
To many people, this development may seem surprising. After all, the private sector has long been regarded as an economy’s most important source of innovation. 
The late Apple founder and CEO Steve Jobs was a smart businessman, but every technology that makes the iPhone “smart” was developed with state funding. That is why Gates has declared that only the state, in the form of public institutions like ARPA-E, can lead the way to an energy breakthrough. 
It is critical to note here that it is not the state as administrator fulfilling this role; rather, it is the entrepreneurial state in action, creating markets, instead of just fixing them. With a mission-oriented approach and the freedom to experiment – with failure understood to be an unavoidable, and even welcome, feature of the learning process – the state is better able to attract top talent and pursue radical innovation. 
But, of course, leading a green revolution will be no easy feat. To succeed, public agencies will have to overcome significant challenges. 
Though still in its infancy, the agency – based on the model of the long-established Defense Advanced Research Projects Agency (DARPA) – has already shown major promise. And, following the commitment, made by Obama and 19 other world leaders at last December’s climate change conference in Paris, to double public investment in green-energy research, ARPA-E seems set to receive a welcome boost in funding. 
Though the development of wind- and solar-power technologies received a big push in the 1970s, both are still marked by market and technological uncertainty. The embedded energy infrastructure retains strong incumbency advantages, and markets do not value sustainability adequately or price waste and pollution fairly. 
In the face of such uncertainty, the business sector will not enter the market until the riskiest and most capital-intensive investments have been made, or until coherent and systematic political signals have been communicated. Governments must therefore act decisively to make the needed investments and provide the right signals. 
(At that time, the highest marginal tax rate was 91%.) Indeed, thanks to the lobbying of Silicon Valley venture capitalists, capital gains tax fell by 50% in five years at the end of the 1970s. 
As they assume a greater role in the commercialization and deployment of battery-storage technology, they will earn their fair share of rewards. But shouldn’t the ARPA-E (or its angel investors – US taxpayers) also get some return, for its early – and risky – investment? 
In some countries, such as Israel (with its Yozma program) and Finland (with its Sitra fund), the government has retained a stake in state-funded innovation. This enables the entrepreneurial state to continue to invest, catalyzing the next wave of innovations. 

New Life in Old Age 
In 2012, more than 2.4 million Americans over the age of 65 were treated in emergency rooms for injuries from falls alone. With populations worldwide aging fast, the scale of such challenges is growing exponentially, affecting not only health-care systems, but also economies, government policies, and, of course, families. 
The United Nations estimates that, by the middle of this century, the number of people older than 60 will double, with people over the age of 65 outnumbering – for the first time in history – children under the age of five. The explanation for this demographic trend is straightforward: global fertility rates have plummeted, from five children per woman, on average, in 1950-1955, to 2.5 children per woman in 2010-2015. 
In fact, they can play a positive role as active consumers – a potential that many industries have already recognized and begun to tap. According to Bank of America Merrill Lynch, people over 50 are responsible for almost 60% of consumer spending in the United States. 
But that does not ameliorate the seemingly intractable underlying challenge: a shrinking pool of taxpayers to support a growing number of retirees. This imbalance has already driven some governments to raise their retirement ages and change their pension policies to delay or reduce benefits and keep people in the workforce. 
That is why the health-care industry must play a significant role in efforts to address the challenges of population aging. Old age must be viewed not simply as an inevitable stage of life, but as an opportunity for health-care companies and systems to help people thrive. 
To this end, health-care companies should shift the focus of their research-and-development efforts toward conditions that are prevalent among older patients, including chronic diseases like diabetes, heart disease, glaucoma, rheumatoid arthritis, and cancer. Such efforts are also vital to find ways to stem more effectively the deterioration of people’s productivity and independence, by preserving their physical strength, mental acuity, and senses like hearing and vision. 
One particularly promising area is regenerative medicine, which has many potential applications – including for preventing or reversing hearing loss. As it stands, one-third of people aged 65-70 (and half of those over 75) experience significant hearing loss, often caused by damage to or loss of inner-ear hair cells, which sense and transform sound waves into signals that register in the brain. 
To address this issue, my company, Novartis, is testing a compound called CGF166, which targets certain healthy cells in the inner ear in order to “turn on” a specific gene that stimulates hair-cell development. We have already entered the clinical-trial phase of our research, during which we will assess the tolerability and efficacy of CGF166 in treating patients with severe hearing loss. 
And the current trajectory, with the burden of rising health-care costs increasingly being shifted onto patients themselves, is not encouraging. To reverse this trend, the health-care industry must work with all stakeholders to support the financial sustainability of health-care systems, so that they can better handle the growing demand for care. 
For example, the health-care industry could work with governments to offer health-enhancing services – such as remote patient monitoring, health apps, and patient-engagement tools – in addition to medications. Ensuring the availability of trained health workers or counselors to answer patients’ questions about their treatment or related issues like insurance could also help. 
For their part, payers – both governments and private insurers – should create a mechanism for rewarding health-care companies based on the real-world benefits of their products and services. Beyond the annual payment per patient, the health-care company could receive a bonus or penalty, depending on the outcomes achieved. 
A successful model will lower health-care costs, increase life expectancy, and improve elderly people’s quality of life. And, by providing a more comprehensive understanding of the aging process, it could also guide us toward treatments and cures for other diseases – including those affecting the young. 
Ensuring that every person lives as healthy a life as possible, for as long as possible, is in everyone’s interest. That is why it makes sense now to focus on the most senior among us. 

More Crop for the Drop 
STANFORD – The United Nations has called drought the “world’s costliest natural disaster,” both financially, imposing an annual cost of $6-8 billion, and in human terms; since 1900, it has affected two billion people, leading to more than 11 million deaths. That is because so much of the world is vulnerable; currently affected areas include Australia, Sub-Saharan Africa, South Asia, North and South America, and the Middle East. 
Given that agriculture accounts for 70% of water consumption, on average, worldwide, it seems logical that this sector should be the focus of conservation measures. And, in fact, a proven technology exists that could go a long way toward reducing the impact of drought: genetic engineering (GE). 
Sometimes called “genetic modification,” GE enables plant breeders to make existing crop plants do new things – such as conserve water. Even with research and development hampered by resistance from activists and excessive government regulation, drought-resistant GE crop varieties are emerging from the development pipeline in many parts of the world. 
Over the last two decades, such crop varieties have been cultivated on more than 1.5 billion hectares by more than 17 million farmers in some 30 countries – without disrupting a single ecosystem or causing so much as a stomachache. Worldwide, these new varieties have provided “very significant net economic benefits at the farm level, amounting to $18.8 billion in 2012 and $116.6 billion” from 1996 to 2012, according to a recent report by Landes Bioscience. 
Most of these new crop varieties are designed to resist herbicides, so that farmers can adopt more environmentally friendly, no-till cultivation practices, and many have also been engineered to resist pests and diseases that ravage crops. Others have higher nutritional value, making them ideally suited for developing-country populations that struggle to acquire the nutrients they need to lead healthy, productive lives. 
But, in the long term, the greatest boon of all, for both food security and the environment, will likely be the ability of new crop varieties to tolerate periods of drought and other water-related stresses. Even a small reduction in the amount of water used for irrigation could have huge benefits, especially in drought conditions. 
To develop such varieties, plant biologists identified genes that regulate water use and transferred them into important crop plants, enabling them to grow with less or lower-quality water, such as water that has been recycled or is high in natural mineral salts. Egyptian researchers have shown that by transferring a single gene from barley to wheat, the plants can tolerate reduced watering for a longer period of time. 
Other types of GE crop varieties, such as those that are disease- and pest-resistant, indirectly improve the efficiency of water use. Because much of the loss to diseases and pests occurs after the plants are fully grown – that is, after most of the water required for their growth has already been supplied – resistance to them means more agricultural output per unit of water invested. 
One-third of irrigated land worldwide is not suitable for growing crops because of the presence of salt – the result of repeated fertilization. To regain the more than 200,000 hectares of irrigated land that is lost to cultivation annually, scientists have enhanced the salt tolerance of crops as diverse as tomatoes and canola. 
India has approved insect-resistant cotton but has failed to sanction any food crops. Even where GE crops are being cultivated, unscientific, excessively burdensome regulation has raised the cost of producing new plant varieties significantly, keeping many potentially important ones from the market. 
These measures are irrational, because they are inversely related to risk. They permit the largely unregulated use of new varieties of plants and microorganisms that have been crafted with less precise and predictable techniques, under the pretense that they are somehow more “natural,” while stringently regulating – or even banning – those based on the most advanced knowledge and methods. 
As water scarcity increases, drought-stricken crops wither, and food prices rise, the need for resilient agriculture will become more obvious – and more urgent. With more rational public policy, we can meet that need now. 

How Safe Substances Become Dangerous 
PALO ALTO – Since the development of the science of toxicology in the sixteenth century, its guiding principle has been that “the dose makes the poison.” It is a rule that applies to the medicines used by patients worldwide many billions of times a day. 
The risk that a substance poses broadly depends on two factors: its inherent capacity to cause harm and one’s exposure to it. It is a simple idea, but even some presumptive professionals seem unable to grasp it – as evidenced by the decision by the International Agency for Research on Cancer (IARC), a component of the World Health Organization, to classify the commonly used herbicide 2,4-D as “possibly carcinogenic to humans.” 
When it comes to herbicides, the IARC seems to be on a losing streak. The organization recently classified glyphosate, another popular herbicide, as “probably” carcinogenic, a conclusion at odds with those of regulatory agencies around the world. 
Earlier this year, the United States Environmental Protection Agency (EPA) concluded that “based on weight of evidence consideration of the available data, 2,4-D would be classified as ‘Not Likely to be Carcinogenic to Humans.’” The European Food Safety Authority also recently concluded that “2,4-D, as currently manufactured, is unlikely to have a genotoxic potential or pose a carcinogenic risk to humans.” 
The decision by the IARC to classify substances like 2,4-D and glyphosate as potentially harmful is likely to cause alarm among farmers and consumers, who will wonder about the appropriateness of its continued use in commercial agriculture or gardening. This would be a shame, because these are highly effective and widely used herbicides, and when the IARC makes its decisions, it does not consider whether the substance in question is actually likely to cause cancer in the real world. 
As a result, the IARC has in the past classified aloe vera, acrylamide (a substance created by frying foods, such as French fries and potato chips), cell phones, working night shifts, Asian pickled vegetables, and coffee as “probable” or “possible” carcinogens. This is because it ignores the dosage, failing to consider the likelihood of coming into contact with enough of the substance to cause actual harm. 
Classifying 2,4-D as a cancer risk to humans ignores extensive research and analysis conducted by health authorities worldwide, including the United Nations WHO/FAO Joint Meeting on Pesticide Residue (JMPR). This body evaluates the risks of substances like 2,4-D, considering real-world variables such as the amounts in soil and nearby water, exposure to animals passing through treated fields, and the potential for direct human contact. 
In reviews beginning in 1970, the JMPR has always found that when 2,4-D is applied correctly, it does not pose a health threat to anyone or anything on land or water. This finding has been affirmed by numerous government agencies, including the European Food Safety Authority, the EPA, the US Department of Agriculture, and Health Canada. 
When the IARC, which restricts its panels to consider only a narrow spectrum of selected publications, makes a mistaken decision, the effects are harmful. Its rulings give credibility to chemophobic activists looking for headlines and raise the likelihood that substances wrongly labeled as harmful will be replaced by other products that could pose greater risks or provide fewer benefits. 
If products such as glyphosate and 2,4-D were to become unavailable, farmers would be forced to resort to other methods to control weeds – none of them as efficient. Indeed, many of the alternatives would be more toxic or require more tillage, resulting in damaging soil erosion, increased CO2 emissions, decreased crop yields, greater production costs, and higher consumer prices. 
There are more than 100 prescribed uses for 2,4-D, including the control of invasive weeds on lawns, in forestry, and to enhance safety along highways, power line corridors, and rail lines. The process the IARC uses in coming to conclusions is not only scientifically wrong; it is harmful. 

The Way Ahead in Hong Kong 
They would be, of course, if people in mainland China were allowed to know what is happening in their country’s most successful city. But China’s government has tried to block any news about the Hong Kong democracy demonstrations from reaching the rest of the country – not exactly a sign of confidence on the part of China’s rulers in their system of authoritarian government. 
First, it is a slur on the integrity and principles of Hong Kong’s citizens to assert, as the Chinese government’s propaganda machine does, that they are being manipulated by outside forces. What motivates Hong Kong’s tens of thousands of demonstrators is a passionate belief that they should be able to run their affairs as they were promised, choosing those who govern them in free and fair elections. 
Hong Kong is a great international center, whose freedoms and autonomy were guaranteed in a treaty registered at the United Nations. In particular, the United Kingdom, the other party to this Sino-British Joint Declaration, sought and received guarantees that the survival of Hong Kong’s autonomy and liberties would be guaranteed for 50 years. 
So it is ridiculous to suggest that British ministers and parliamentarians should keep their noses out of Hong Kong’s affairs. In fact, they have a right and a moral obligation to continue to check on whether China is keeping its side of the bargain – as, to be fair, it has mostly done so far. 
No one told Hong Kongers when they were assured of universal suffrage that it would not mean being able to choose for whom they could vote. No one said that Iran was the democratic model that China’s Communist bureaucracy had in mind, with the Chinese government authorized to exercise an effective veto over candidates. 
As early as 1993, China’s chief negotiator on Hong Kong, Lu Ping, told the newspaper People’s Daily, “The [method of universal suffrage] should be reported to [China’s Parliament] for the record, whereas the central government’s agreement is not necessary. How Hong Kong develops its democracy in the future is completely within the sphere of the autonomy of Hong Kong. 
The British Parliament summarized what had been said and promised in a report on Hong Kong in 2000. “The Chinese government has therefore formally accepted that it is for the Hong Kong government to determine the extent and nature of democracy in Hong Kong.” 
So, what next? 
The peaceful demonstrators in Hong Kong, with their umbrellas and refuse-collection bags, will not themselves be swept off the streets like garbage or bullied into submission by tear gas and pepper spray. Any attempt to do so would present a terrible and damaging picture of Hong Kong and China to the world, and would be an affront to all that China should aspire to be. 
The Hong Kong authorities have gravely miscalculated the views of their citizens. Like the bad courtiers against whom Confucius warned, they went to Beijing and told the emperor what they thought he wanted to hear, not what the situation really was in the city. 
Under the existing plans, there is supposed to be a second phase of consultations on democratic development to follow what turned out to be a counterfeit start to the process. Hong Kong’s government should now offer its people a proper second round of consultation, one that is open and honest. 
The demonstrators in Hong Kong, young and old, represent the city’s future. Their hopes are for a peaceful and prosperous life in which they can enjoy the freedoms and rule of law that they were promised. 


Breaking Down India’s Internal Barriers 
NEW DELHI – Of the many economic reforms crying out for immediate implementation in India, the most obvious is the long-pending Goods and Services Tax. So why have India’s politicians failed to enact it? 
As the billionaire Steve Forbes recently wrote in his eponymous magazine, “Outsiders are amazed that much of India resembles pre-revolutionary France, with many internal barriers standing in the way of economic efficiency and growth.” He then pointed out that a GST is critical to enabling India, like the United States, to reap the benefits of its continent-size domestic market, as it would replace the “stifling hodgepodge of local taxes” that amount to “internal tariffs on the movement of goods.” 
Sales taxes vary, and are augmented by “octroi” taxes on cross-border shipments of goods destined for local consumption. Whereas the European Union is 28 sovereign countries with one common market, the Indian Union is one sovereign country with 29 separate markets. 
For businesses, particularly those that have to transport goods across the country, the GST would be a boon. It is estimated that the GST’s passage would add 1-2% to India’s GDP instantly. 
So what is holding up the GST’s implementation? In short, politics. 
The GST was first introduced seven years ago by the Congress-led government in power at the time. But it was delayed because of the fierce opposition of Narendra Modi, then-Chief Minister of the western state of Gujarat. 
When Modi became Prime Minister last year, he and his Bharatiya Janata Party (BJP) suddenly recognized the virtues of a GST, embracing the bill with great fanfare, but also with important amendments. Pandering to BJP governments in Gujarat and Maharashtra, which claimed that, as “producer” states, they would lose out from a GST, Modi revised the bill to grant states the right to levy an additional 1% tax on outgoing goods. 
The change – a breathtaking act of petty politics – controverts the very spirit and intent of the GST. If states were levying individual taxes on top of the GST, the national market would again be divided and distorted, with checkpoints returning on state frontiers to assess the value of the goods on their way out. 
In another act of political appeasement, the BJP government has introduced a number of exemptions. By omitting alcohol, tobacco, petroleum products, and electricity – which together account for more than a quarter of all tax receipts – the government is significantly diluting the GST’s potential impact on the national economy. 
Moreover, the BJP government has increased so many other taxes (which it simply should have eliminated) that the National Institute of Public Finance and Policy estimates that the GST would have to amount to as much as 27% to prevent revenue loss. Far from reviving the economy, such a rate would cripple it. 
In order to reduce incentives for avoidance and thus augment revenues, Congress also wants to cap the GST at 18%. And, to ensure fairness, it seeks the restoration of the GST Disputes Settlement Authority provided for in the original bill, so that the GST council administering the tax would not rule on its own decisions. 
Instead of addressing these legitimate problems, Modi is accusing Congress of unconstructive opposition by thwarting reforms that it had once advocated. But Congress will not back down, insisting that it will not allow the bill to pass through the upper house of parliament, where the BJP does not have a majority, until the government accepts the key amendments. 
After all, it was democracy – specifically, the pressure to maintain adequate support – that led the Modi government to hollow out the GST concept. And it is democracy – that is, the need to secure adequate support for the bill in parliament – that is enabling Congress to block any further progress until Modi relents. 
Nonetheless, India is right to organize itself this way. Its system of governance rests on the belief that an integrated process of bargaining, disagreement, reflection, and compromise – not top-down unchallenged decision-making – is the most effective route to wise, fair, and successful policymaking. 
The GST bill that eventually emerges from this standoff will be better for having gone through these detailed, if time-consuming, debates. When it is finally adopted, the chances that it will transform the Indian economy for the better are high. 

The Modi Government Turns One 
NEW DELHI – India’s Bharatiya Janata Party (BJP) government, led by Prime Minister Narendra Modi, will mark its first anniversary in office this month. While it is too early to assess its overall performance, the overwhelming sentiment across India so far is one of disappointment. 
The BJP rode to power on a wave of expectations after a decade in opposition to the United Progressive Alliance government, led by Prime Minister Manmohan Singh of the Congress party. (Full disclosure: I was a member of that government.) 
Early enthusiasm for the BJP government was based on the perceived contrast with its predecessor. Here, at last, was a strong single-party government led by a decisive “man of action,” rather than a fractious coalition led by a reticent octogenarian, who was often unfairly caricatured as uncertain and vacillating. 
Modi was marketed to voters through a clever (and lavishly financed) campaign that portrayed him as the business-savvy leader who had transformed the state of Gujarat into a lodestar of development – and who would do the same for the country as a whole. Attracting young people with the promise of jobs, and older voters with the prospect of reform and growth, Modi won a mandate that stunned the country’s pollsters. 
Since the election, Modi has energetically strutted the global stage, touting his government as more hospitable to investors and urging foreign manufacturers to “Make in India.” Yet his foreign travels have achieved little, beyond improving his personal standing, which had suffered considerably following accusations that, as Chief Minister of Gujarat, he had been at least negligent as more than a thousand people were killed in a 2002 anti-Muslim pogrom. 
Modi’s domestic performance has also been underwhelming. Although his speeches and sound bites continue to impress fans of his Hindi oratory, the gap between rhetoric and reality widens by the week. 
Indeed, despite speaking eloquently of tolerance and accommodation, Modi has remained largely silent in the face of hate speech by BJP ministers and MPs that is alienating India’s non-Hindu minorities. The BJP may preach development, but it is practicing bigotry – a contradiction that Modi could resolve only by repudiating the forces that helped ensure his electoral victory. 
Likewise, Modi has not kept his vow of “minimal government, maximum governance”; on the contrary, he has created the most centralized, top-down, bureaucracy-driven, personality-cult-dominated central government since Indira Gandhi’s emergency rule in the mid-1970s. Those who decried the alleged “paralysis of decision-making” under Modi’s excessively democratic, consultative, and consensual predecessor are now faced with a different kind of paralysis, as files pile up in Modi’s office, the only place where decisions are made. 
Senior positions – including two on the indispensible three-member independent election commission – stand vacant, leaving vital institutions unable to function effectively. Despite his talk about transparency and accountability, Modi has failed to appoint a central information commissioner, vigilance commissioner, or lokpal (the ombudsman who has jurisdiction over all corruption cases involving MPs and central-government employees). 
With Modi too busy to keep up with all of the decisions he – and only he – can make, the government is adrift. In some cases, it is pursuing blatantly contradictory approaches. 
Although Modi has declared that “the government has no business to be in business,” he has failed to question his government’s ownership and control of airlines and hotels. Indeed, privatization of major public-sector behemoths is no longer mentioned. 
Furthermore, labor-market liberalization, once considered indispensable to attract investors and promote industrial growth, is on the back burner. Optimistic talk of reform has been replaced by officially articulated respect for “graduated incrementalism.” 
Likewise, Finance Minister Arun Jaitley, who once derided “tax terrorism,” has unleashed the taxman on entirely new categories of victims, including the foreign institutional investors Modi is trying to attract. Unsurprisingly, investor sentiment, which perked up during Modi’s campaign, has dampened considerably. 
Modi’s government has also revealed a fine talent for announcing grandiose schemes and failing to finance them. Worse, budgets for health, education, sanitation, and women’s security – all major talking points of the BJP’s election campaign – have been cut. 
None of this has been lost on the public. India’s farmers, for example, are up in arms, because the land-acquisition law passed by the previous government has been gutted through a series of amendments imposed by fiat (which are now, however, running into legislative resistance). 
More generally, voters are not impressed by Modi’s transformation from the chai-wallah (tea-seller) of the election campaign, who had sacrificed domestic bliss to serve the nation, into an omnipresent, gaudily attired celebrity hobnobbing with other bold-face names. The nadir was reached in January, when Modi received US President Barack Obama – “my friend Barack” – in a pinstripe suit with his own name embossed in gold on every stripe. 
In a sense, Modi is fortunate that his government’s failings have become so starkly apparent so early in his tenure; he now has time to address them. He showed that he is capable of learning the right lessons when he quickly auctioned the pinstripe suit for charity. 

India’s Deadly Cities 
SINGAPORE – China and India are driving Asia’s population and urbanization trends. According to a 2010 McKinsey study, the two countries are expected to account for 62% of the growth in the continent’s urban population between 2005 and 2025, and a staggering 40% of such growth worldwide. 
But it is equally important to acknowledge the critical differences between the two countries. Variations in their urban growth paths, as well as differences in their approaches to environmental policy, are likely to make India’s population challenges far more difficult to address. 
China may be home to 20% of humanity, but for more than two decades its fertility rate has been lower than the “replacement” level (that required to maintain the current population), with population growth expected to turn negative within the next two decades. As a result, India, where population growth is projected to remain positive for the foreseeable future, is poised to become the world’s most populous country. 
Indeed, over the next 35 years, India is expected to add more than 400 million urban residents (more than the entire population of the United States), while China will add just 292 million. For the first time, the majority of Indians will be living in cities – a significant transformation for a country whose rural population currently constitutes two-thirds of the total. 
India’s two largest urban centers – Delhi and Mumbai – are often described as emerging global megacities. Delhi is already the world’s second most populous city, and it is expected to close the gap with Tokyo, the world’s largest city, almost entirely by 2030. 
When population growth on this scale is combined with rapid urbanization, the associated environmental and social impacts become a formidable policy challenge. In 2014, the World Health Organization (WHO) determined that Delhi has the world’s worst air quality (based on concentration of fine particulate matter), with Indian cities occupying the top four spots and 13 of the top 18. 
But, according to McKinsey, China has been more proactive than India in planning for rapid urbanization, demonstrating that it has the capacity and the resources to address environmental challenges. In new cities across the country, urban plans already take into account such concerns, with riparian greenways and urban nature reserves complementing infrastructure projects that have environmental benefits (for example, extensive mass-transit networks). 
Large swaths of informal settlements have emerged in vacant inner-city districts and suburban peripheries, compromising environmental conditions, public health, and personal safety. Land-use patterns interweave industrial and residential districts, exposing vulnerable (and growing) populations to a host of negative spillover effects. 
China’s leaders are placing heavy emphasis on pollution control. In advance of the 2022 Winter Olympics in Beijing, the authorities are pushing for a regionally integrated plan to balance economic growth with environmental management, including the greening of manufacturing processes and the elimination of “excess capacity” in energy production. 
In India, by contrast, the central government has no role in managing air pollution, which is a state-level responsibility. Whatever Prime Minister Narendra Modi’s administration decides to do, state governments under the control of different parties are likely to oppose his policies, or fail to devote adequate attention and resources to them. 
The resulting addition of more than two billion “life years” represents a significant amount of human productivity, creativity, and uncompensated contributions to families and society. By failing to address the impacts of rapid urbanization adequately, India is leaving these benefits unclaimed. 
A good-faith, well-publicized official declaration would signal to India’s citizens and the world that the country intends to save its growing population from the life-shortening effects of urban environmental degradation. It would also provide a roadmap for improving the quality of life in India’s cities, benefiting local residents both directly and indirectly (by inducing foreign investment). 
India’s competitive advantages in the new global economy are well known. But transformative social progress will be possible only if the country launches a more comprehensive effort to address pathologies long brushed off as the unavoidable collateral damage of economic growth. 

Railroading India’s Railways 
NEW DELHI – Every February, the Indian Parliament performs a curious and unique ritual. The railway minister (a portfolio that exists in few democracies nowadays) presents the “railway budget" to the lower house for its approval. 
Of course, railway revenues today, at $23 billion, no longer dwarf the country's budget, which now stands at some $268 billion. But India's railways still produce other mind-boggling figures: 23 million passengers are transported daily (over eight billion per year, more than the world's entire population) on 12,617 trains connecting 7,172 stations across a 65,000-kilometer (40,000-mile) network. 
In short, the railways are the lifeblood of India's economy, touching the lives of every segment of society and playing a key role in moving people, freight, and dreams across a congested landscape. Yet much needs fixing. 
India's trains carry four times the number of passengers as China's, despite covering only half as many kilometers, but still lose about $7 billion annually. The problem is that a succession of railway ministers, viewing the trains as poor people's only affordable means of transport, have refused to raise passenger fares, squeezing freight instead. 
Though freight transport still accounts for 67% of railway revenues, with 2.65 million tons carried every day, the higher fares needed to subsidize passengers have deterred shippers. As a result, the share of freight carried across India by rail has declined from 89% in 1950-1951 to 31% today. 
Instead, an increasing volume of goods is shipped by road, choking India's narrow highways and spewing toxic pollutants into the country's increasingly unbreathable air. By contrast, China's railways carry five times as much freight as India's, even though China has a far better road network. 
As a result, several lines are operating beyond their capacity, creating long delays. Exacerbating this inefficiency are slow train speeds, which rarely exceed 50 kilometers per hours (and 30 kilometers per hour for freight), partly owing to the need to stop at an ever-rising number of stations to appease political interests. 
But perhaps the biggest problem is how dangerous the railways are. Aging rails, tired coaches, old-fashioned signals, and level crossings dating back to the nineteenth century combine with human error to take dozens of lives every year. 
As a result, the railways run out of money before running out of plans. In the last 30 years, only 317 of 676 projects sanctioned by Parliament have been completed, and it is difficult to imagine how the railways will acquire the estimated $30 billion needed to complete the remaining 359 projects. 
In a country where rail passengers cannot even expect a clean toilet, let alone an on-time arrival, Prime Minister Narendra Modi has spoken of introducing bullet trains – the latest in a string of irrationally grandiose aspirations. A technocratic new railway minister, Suresh Prabhu, has once again left passenger fares untouched and raised freight rates. 
Prabhu's pledges include improving and expanding rail lines, introducing wireless Internet at railway stations, eliminating unmanned level crossings, creating a 24-hour toll-free number for users to phone in complaints, and installing security cameras to protect women passengers. These improvements seem to his critics to be marginal, at best, and have left his fellow MPs underwhelmed. 
Prabhu's most impressive promise – to raise $140 billion from market lenders – is also his most problematic, as he has failed to clarify how exactly the railways would repay the loans. Given how high interest rates would have to be to attract investors, this will be no easy feat, especially because the railways currently have an operating surplus of just 6%, or about $100 million annually – barely 1% of the amount needed to upgrade and modernize the network. 
It is far from clear how Prabhu's grand vision of a safer, cleaner, and speedier Indian railway system will be achieved in practice. The railway minister has created a dream budget –though “pipe dream" might be a more accurate description. 
In fact, this is in line with the Modi government's approach thus far: lofty aspirations, soaring rhetoric, and quotable sound-bites have been accompanied by few specifics, no implementation plan, and no improvements in execution capacity. India's overburdened trains cannot run on hot air, but that seems to be what they are being offered for now. 

New Battlegrounds in Development Finance 
The United Nations hopes that infrastructure PPPs will provide the means to realize its post-2015 global development agenda. PPPs’ new appeal may redefine not just development economics, but also the overall relationship between rich and poor countries – though not necessarily for the better. 
The PPP bandwagon has three essential components: an explosion in infrastructure finance (backed by pension and other large funds); the creation of “pipelines” of lucrative mega-PPP projects to exploit countries’ raw materials; and the dismantling of environmental and social safeguards. Each must be carefully monitored as the use of PPPs expands. 
The World Bank is already seeking to double its lending within a decade by expanding infrastructure projects. Its new Global Infrastructure Facility (GIF) will mobilize global pension and sovereign wealth funds to invest in infrastructure as a specific asset class. 
The BRICS recently announced plans for a New Development Bank (NDB) for infrastructure and sustainable development. Its first Regional Center for Africa will be based in South Africa. 
Indeed, these new development-finance institutions are seen as a reaction against the Bretton Woods institutions, whose pursuit of neoliberal austerity policies and failure to reform their governance structures to share power with emerging economies, has been blamed for strangling public spending, de-industrialization, and the dismantling of national development banks. 
In response to this criticism, the Bank is revising its safeguards and enforcement mechanisms. But weaker oversight by the World Bank would leave loan recipients to monitor and enforce environmental and social standards themselves – regardless of their resources or political will to do so –thus jeopardizing efforts to defend the rights of indigenous peoples, resettle displaced people, mitigate environmental damage, or protect forests and biodiversity. 
The weakening of World Bank safeguards might also trigger a “race to the bottom,” pitting private or state investors, new financing institutions, and a deregulated World Bank against one another, while provoking a popular backlash. That is why it is important to have citizens’ groups that can step in to ensure that investments operate fairly. 
PIDA gives priority to energy (especially hydropower) projects to support mining operations and oil and gas pipelines, while sidelining renewable energy technologies, such as solar, wind, and geothermal. Similar concerns surround the project “pipelines” of the Initiative for the Integration of Regional Infrastructure in South America and the ASEAN Infrastructure Fund in Asia. 
Though some PPP projects offer high returns, they also demand hefty additional guarantees from the host government to offset private-sector risk. In this way, fundamental tensions are created both in the way these deals are put together and in the overall conduct of North-South and South-South integration. 
For example, powerful groups and transnational corporations (such as the World Economic Forum, General Electric, and Rio Tinto) are gaining influence within the G-20, the G-7, and the BRICS, whose members compete among themselves for access to resources and markets. That competition now features new Infrastructure Project Preparation Facilities (IPPFs) to accelerate and replicate large PPPs with a disturbing reliance on big dams and fossil-fuel infrastructure, such as Nigeria’s gas-supply pipeline to the European Union – a top priority of PIDA that implies slow progress toward a low-carbon future. 
That is a difficult challenge, because civil society organizations with the greatest interest in learning how to cope with the new pressures tend to specialize in specific development areas, such as the Millennium Development Goals, or sectoral issues, rather than having a broader view of how development finance institutions and their big shareholders operate. A revived World Social Forum might take on the task, by reverting to its original intention of being a counterweight to the WEF. 
In Africa, pan-African bodies charged with coordinated oversight and agenda-setting authority should be judged by whether mega-PPPs in infrastructure reinforce a colonial-style extraction and consumption economy, or create a healthy and sustainable economy for generations to come. 

The Western Roots of Anti-Western Terror 
BERLIN – The Islamic State’s horrific attacks in Paris provide a stark reminder that Western powers cannot contain – let alone insulate themselves from – the unintended consequences of their interventions in the Middle East. The unraveling of Syria, Iraq, and Libya, together with the civil war that is tearing Yemen apart, have created vast killing fields, generated waves of refugees, and spawned Islamist militants who will remain a threat to international security for years to come. 
With the exceptions of Iran, Egypt, and Turkey, every major power in the Middle East is a modern construct created largely by the British and the French. The United States-led interventions in Afghanistan and Iraq since 2001 represent only the most recent effort by Western powers to shape the region’s geopolitics. 
But these powers have always preferred intervention by proxy, and it is this strategy – training, funding, and arming jihadists who are deemed “moderate” to fight against the “radicals” – that is backfiring today. Despite repeated proof to the contrary, Western powers have remained wedded to an approach that endangers their own internal security. 
It should be obvious that those waging violent jihad can never be moderate. Yet, even after acknowledging that a majority of the Free Syrian Army’s CIA-trained members have defected to the Islamic State, the US recently pledged nearly $100 million in fresh aid for Syrian rebels. 
According to witnesses, the attackers at Paris’s Bataclan concert hall – where most of the night’s victims were killed – declared that their actions were President François Hollande’s fault. “He didn’t have to intervene in Syria,” they shouted. 
But after Nicolas Sarkozy became President in 2007, France aligned its policies more firmly with the US and NATO, and participated actively in toppling Libyan leader Muammar el-Qaddafi in 2011. And after Hollande succeeded Sarkozy in 2012, France emerged as one of the world’s most interventionist countries, undertaking military operations in the Central African Republic, the Ivory Coast, Mali, the Sahel, and Somalia before launching its airstrikes in Syria. 
Such interventions neglect the lessons of history. Simply put, nearly every Western intervention this century has had unforeseen consequences, which have spilled over borders and ultimately prompted another intervention. 
The result was Al Qaeda, whose actions ultimately prompted President George W. Bush’s invasion of Afghanistan and provided a pretext for invading Iraq. As then-Secretary of State Hillary Clinton admitted in 2010, “We trained them, we equipped them, we funded them, including somebody named Osama bin Laden….And it didn’t work out so well for us.” 
And yet, disregarding this lesson, Western powers intervened in Libya to topple Qaddafi, effectively creating a jihadist citadel at Europe’s southern doorstep, while opening the way for arms and militants to flow to other countries. It was this fallout that spurred the French counter-terrorist interventions in Mali and the Sahel. 
Having barely stopped to catch their breath, the US, France, and Britain – with the support of Wahhabi states like Saudi Arabia and Qatar – then moved to bring down Syrian President Bashar al-Assad, fueling a civil war that enabled the Islamic State to seize territory and flourish. With the group rapidly gaining control over vast areas extending into Iraq, the US – along with Bahrain, Jordan, Qatar, Saudi Arabia, and the United Arab Emirates – began launching airstrikes inside Syria last year. 
Though Russia is pursuing its military campaign independently of the Western powers (reflecting its support for Assad), it, too, has apparently become a target, with US and European officials increasingly convinced that the Islamic State was behind October’s crash of a Russian airliner in the Sinai Peninsula. That incident, together with the Paris attacks, may spur even greater outside military involvement in Syria and Iraq, thereby accelerating the destructive cycle of intervention. 
For starters, Western leaders should avoid playing into the terrorists’ hands, as Hollande is doing by calling the Paris attacks “an act of war” and implementing unprecedented measures at home. Instead, they should heed Margaret Thatcher’s advice and starve terrorists of “the oxygen of publicity on which they depend.” 
More important, they should recognize that the war on terror cannot credibly be fought with unsavory allies, such as Islamist fighters or fundamentalist-financing sheikhdoms. The risk of adverse unintended consequences – whether terrorist blowback, as in Paris, or military spillovers, as in Syria – is unjustifiably high. 
It is not too late for Western powers to consider the lessons of past mistakes and recalibrate their counterterrorism policies accordingly. Unfortunately, this appears to be the least likely response to the Islamic State’s recent attacks. 

Militant Islamism and Vaccine Skepticism 
Since the 1980s, an international vaccination effort led by the World Health Organization has driven the virus to the cusp of extinction. A disease that killed or paralyzed a half-million people annually now infects only a few hundred. 
Indeed, the few areas where the virus continues to hold out share worrying similarities. Since 2012, 95% of polio cases have occurred in five countries – Afghanistan, Pakistan, Nigeria, Somalia, and Syria – all of which are affected by Islamist insurgencies. 
But it is important to note that jihadists in Syria and Afghanistan have been largely supportive of polio vaccination campaigns. If the virus is to be defeated, we will have to move beyond caricatures of Islamists as violent zealots opposed to Western science and look closely at the specific political contexts in which the eradication effort has so far been unsuccessful. 
In Nigeria, for example, the extremist group Boko Haram’s animosity toward vaccination campaigns stems from an intra-Muslim conflict rooted in the colonial era, when the United Kingdom ruled northern Nigeria indirectly through a pro-British indigenous elite. The descendants of the colonial elite continue to dominate the region’s state governments, which are responsible for implementing the vaccination programs. 
Since the early 1990s, interventions by the United Nations and the African Union in Somalia have included troops from the United States and from the country’s predominantly Christian neighbors, Kenya and Ethiopia. This has resulted in widespread discontent and has fueled support for Islamist militants, whom many Somalis view as the main bulwark against foreign interference. 
Broadly speaking, the Pakistani Taliban is a Pashtun movement, concentrated in the semi-autonomous Federally Administered Tribal Areas in the northwest of the country. This mountainous region was never ruled directly by the British, and the Pashtun have fiercely resisted attempts by the Pakistani state to expand its power. 
The Pakistani Taliban’s hostility has been further hardened by US interventions in the country, including the use of a fake hepatitis vaccination campaign to gather DNA from Osama bin Laden’s relatives prior to his assassination. For Islamist militants, this confirmed that polio immunization efforts are a cover for gathering intelligence to identify targets for drone attacks. 
In Afghanistan, the Taliban is also a largely Pashtun movement, but its attitude toward the polio eradication effort could not be more different. When the Taliban ruled Afghanistan, from 1996 to 2001, it supported the vaccination effort, and indeed it continues to do so; a recent Taliban statement urged its Mujahedeen to provide polio workers with “all necessary support.” 
This difference reflects the political position of Pashtuns in the two countries. In Afghanistan, Pashtun are the majority; as a result, they have a much stronger influence in national politics than their counterparts in Pakistan – and thus view the state with less suspicion. 
Moderate opposition groups like the Free Syrian Army, with the help of the Turkish authorities and local non-governmental organizations, have organized their own vaccination program in areas outside Syrian government control. Islamist militants, including the Islamic State and the al-Nusra Front, have allowed these immunization programs to operate in areas under their control as well, as they are not associated with the Assad regime. 
The stance Islamist insurgents take toward polio vaccination campaigns has less to do with anti-Western zealotry than with the specific dynamics of the conflict in which they are involved. This has important implications for public-health policy. 

Climate Change at Ground Zero 
OUAGADOUGOU – Burkina Faso is located in the heart of the Sahel, which means that it is one of the world’s most vulnerable countries when it comes to climate change. Its farmers may know little of the physical causes of global warming, but they know about its effects – not least the huge variability in rainfall patterns, from droughts to flooding, which lead to lost harvests, the erosion of pastureland, and food crises. 
As a result, the concept of sustainable agriculture has been gaining ground for several years, both internationally and in Burkina Faso. The term features in political discourse and has become a key approach to global agricultural development. 
The concept of sustainable agriculture is inextricably linked to that of sustainable development, first defined in 1987 as a model of economic growth “that meets the needs of the present without compromising the ability of future generations to meet their own needs.” 
Sustainable agriculture is defined as a type of farming that ensures that internal and external resources are used and conserved as efficiently as possible; is ecologically sound (it improves, rather than damages, the natural environment); and is economically viable, offering reasonable returns on agricultural investments. 
Close scrutiny of both definitions leads us to conclude that there can be no sustainable development without sustainable agriculture. Indeed, in Burkina Faso, sustainable agriculture features prominently – as it must – in the country’s development policies and strategies. 
In 2012, Burkina Faso adopted the National Policy of Sustainable Development, which has become a key tool for realizing the vision set out in the Strategy for Accelerated Growth and Sustainable Development. That vision describes “a productive economy which accelerates growth, increases living standards, improves and preserves the living environment and living conditions through wise and efficient governance.” 
The national conference of the General Assembly for Agriculture and Food Security, held in November 2011, embraced the following objective: “By 2025, farming in Burkina Faso will be modern, competitive, sustainable, and driving growth. It will be founded on family-owned farms and efficient agricultural businesses, and will guarantee [that] all citizens have access to the food they need to lead healthy, active lives.” 
The goal is to improve smallholders’ productivity in a sustainable way, equipping them with the knowledge and understanding needed to operate efficiently while respecting human health and the environment. This policy has prompted behavioral changes regarding the management of natural resources and the use of agricultural inputs like pesticides. 
Here and elsewhere, it is the key to our ability to confront climate change and build resilience against food and nutritional insecurity, because it respects the land and is far more effective in the long term than industrial farming. Moreover, sustainable practices reassert the value of small, family-run holdings, which, in countries like Burkina Faso, produce nearly all of the domestic food supply. 
We are victims of a phenomenon caused mainly by developed countries – a phenomenon that is holding back our own development. If we are to take the definition of sustainable development seriously, those responsible for this outcome must also help, particularly by contributing to the adaptation costs that countries like Burkina Faso now face. 

Reassurance and Resolve in East Asia 
WASHINGTON, DC – As territorial frictions involving China and many of its neighbors persist in the East and South China Seas, the United States needs a clearer regional strategy. America must simultaneously uphold its interests and alliance commitments and avoid counterproductive confrontation, or even conflict. 
At the same time, the US must modernize its armed forces in response to new challenges – particularly China’s rise. As China develops advanced precision weapons to create a so-called anti-access/area-denial capability, the US must consider how to respond to the growing vulnerability of its bases and naval forces in the region. 
There is no easy answer to these challenges. What is needed is a nuanced approach, which is what we develop in our new book Strategic Reassurance and Resolve. 
Our approach is an adaptation of America’s longstanding “engage but hedge” strategy, through which the US and its allies have used economic, diplomatic, and sometimes military instruments to give China incentives to rise peacefully, while maintaining robust military capabilities in case engagement proves unsuccessful. 
But China’s development and acquisition of advanced weapons, including precision anti-ship missiles, makes it implausible that the US can maintain its forces’ decades-long invulnerability in the region, including the ability to operate with impunity near China’s shores. Given China’s own history of vulnerability to foreign intervention, unilateral US efforts to maintain overwhelming offensive superiority would only trigger an increasingly destabilizing arms race. 
Some American strategists advocate a largely technological solution to this dilemma. Their approach, a concept called “Air-Sea Battle,” implies a mix of defensive and offensive tools to address the new challenges posed by the proliferation of precision-strike weaponry. 
Officially, the Pentagon does not direct the concept of “Air-Sea Battle” against any particular country. For example, Iran’s possession of precision-strike capabilities – and a much more hostile relationship with America – would warrant new US initiatives to cope with growing security vulnerabilities. 
Some Air-Sea Battle proponents propose tactical preemptive strikes on missile launchers, radars, command centers, and perhaps also air bases and submarine ports. Moreover, many of these attacks would be carried out with long-range weapons based on US territory, rather than at sea or on the territory of regional allies, because these assets would be less vulnerable to preemptive attacks themselves. 
Air-Sea Battle is, obviously, a concept for battle. Though the US clearly needs war plans, it also needs to be wary of sending China and regional partners the message that its hottest new military ideas base deterrence primarily on the ability to win a war quickly and decisively through large-scale escalation early in a conflict. 
Air-Sea Battle recalls the AirLand Battle idea that NATO adopted in the late 1970s and early 1980s to counter the growing Soviet threat to Europe. But China is not the Soviet Union, and America’s relationship with it needs to avoid Cold War echoes. 
“Air-Sea Operations” would be a much more appropriate name for a more effective approach. Such a doctrine could include classified war plans; but it should center on a much broader range of twenty-first-century maritime activities, some of which should include China (such as the ongoing counter-piracy patrols in the Gulf of Aden and some military exercises in the Pacific). 
If a skirmish erupts over a disputed island or waterway, the US needs to have a strategy that enables a favorable resolution short of all-out war. Indeed, in the broader context of Sino-American relations, even “victory” in such an encounter might be costly, because it could trigger a Chinese military buildup designed to ensure a different outcome in any subsequent skirmish. 
Instead, the US and its partners need a broader range of responses that would enable them to adopt effective measures that are proportionate to the stakes involved – measures that demonstrate a willingness to impose meaningful costs without triggering counterproductive escalation. 
Responding to the threat that China’s growing arsenal of advanced weapons poses to many of its assets does not require greatly expanding America’s long-range strike platforms. In fact, doing so would inevitably create incentives for US war planners to emphasize preemptive options in contingency plans and deemphasize American forces’ day-to-day presence in forward areas near China, where they contribute significantly to maintaining deterrence. 
Economic and political measures, as well as a sustained US military presence, would be more effective than reliance solely on offensive escalation should the US need to counter Chinese actions that threatened important American interests. Indeed, relying on the capacity to attack the Chinese mainland to defend freedom of navigation and alliance commitments in East Asia could tempt China’s leaders to test America’s willingness to risk Los Angeles to defend the Senkaku Islands. 
A more balanced US strategy to increase regional stability requires a judicious combination of resolve and reassurance, and a military posture that reflects this mix. This approach would give the US the best chance to induce China’s leaders to adopt a more cooperative approach to the region’s territorial disputes. 

Why Japan Should Rearm 
But it has received relatively little attention, because observers have preferred to focus on the country’s prolonged economic woes. Those woes are real, but Japan’s ongoing national-security reforms and participation in the new 12-country Trans-Pacific Partnership have placed it firmly on the path to reinventing itself as a more secure, competitive, and internationally engaged country. 
It went on to defeat Manchu-ruled China and Czarist Russia in two separate wars, making it Asia’s first modern global military power. Even after its crushing World War II defeat and occupation by the United States, Japan managed major economic successes, becoming by the 1980s a global industrial powerhouse, the likes of which Asia had never seen. 
But, while it is true that the economy has stagnated for more than two decades, real per capita income has increased faster than in the US and the United Kingdom so far this century. Moreover, the unemployment rate has long been among the lowest of the wealthy economies, income inequality is the lowest in Asia, and life expectancy is the longest in the world. 
In fact, it is Japan’s security, not its economy, that merits the most concern today – and Japan knows it. After decades of contentedly relying on the US for protection, Japan is being shaken out of its complacency by fast-changing security and power dynamics in Asia, especially the rise of an increasingly muscular and revisionist China vying for regional hegemony. 
In the strategically vital South China Sea, the People’s Republic has built artificial islands and military outposts, and it has captured the disputed Scarborough Shoal from the Philippines. In the East China Sea, it has unilaterally declared an air-defense identification zone covering territories that it claims but does not control. 
Recognizing the inadequacy of Japan’s existing national-security policies and laws to protect the country in this new context, the government has established a national security council and moved to “normalize” its security posture. By easing Japan’s longstanding, self-imposed ban on arms exports, boosting defense spending, and asserting its right to exercise “collective self-defense,” the government has opened the path for Japan to collaborate more actively with friendly countries and to pursue broader overseas peacekeeping missions. 
To be sure, Japan’s security-enhancing efforts have so far been limited in scope, and do not open the way for the country to become a militaristic power. Restrictions on deployment of offensive weapons, for example, remain in place. 
A recent survey by the Pew Research Center found that only 23% of Japanese want their country to play a more active role in Asian security. Another survey last year revealed that only 15.3% of Japanese – the lowest proportion in the world – were willing to defend their country, compared to 75% of Chinese. 
But the reality is that ensuring long-term peace in Asia demands a stronger defense posture for Japan. Indeed, reforms that enable Japan to defend itself better, including by building mutually beneficial regional partnerships, would enhance its capacity to forestall the emergence of a destabilizing power imbalance in East Asia. 
It is now up to Japan’s government to win over its own citizens, by highlighting the difference between pacifism and passivity. Japan would not encourage or support aggression; it would simply take a more proactive role in securing peace at the regional and global levels. 
A more confident and secure Japan would certainly serve the interests of the US, which could then depend on its close ally to take more responsibility for both its own security and regional peace. Americans increasingly seem to recognize this, with 47% of respondents in the Pew survey supporting a more active role for Japan in Asian security. 
But there remain questions about precisely how self-sufficient Japan would have to be to carry out this “proactive pacifism” – a term popularized by Prime Minister Shinzo Abe – consistently and effectively. Would Japan need to become a truly independent military power, with formidable deterrent capabilities like those of the UK or France? 
The short answer is yes. While Japan should not abandon its security treaty with the US, it can and should rearm, with an exclusive focus on defense. 
But it can build robust conventional capabilities, including information systems to cope with the risk of cyber warfare. Beyond bolstering Japanese security and regional stability, such an effort would likely boost Japan’s GDP and yield major profits for American defense firms. 
Defense is, after all, easier than offense. Still, the rise of a militarily independent Japan would constitute a game-changing – and highly beneficial – development for Asia and the rest of the world. 

Why Bill Gates Gets It Wrong 
NEW YORK – In his review of Nina Munk’s error-filled and out-of-date book, Bill Gates oddly abandons the rigorous approach to measurement and evaluation that defines his foundation’s invaluable work. He simply accepts Munk’s assertion that the Millennium Villages Project – an ongoing development project across more than 20 African countries – has failed. 
Munk spent an average of around six days per year – around 36 days over six years – actually visiting the villages, and usually at a stretch of 2-3 days. Moreover, she came to the story as a reporter for the magazine Vanity Fair, with no training or experience in public health, agronomy, economics, or African development. 
Does Bill Gates really believe that I advocated specific crops without worrying about whether there was a market for them, or that I failed to consider national taxation in my ongoing advice to government leaders? Moreover, the agricultural strategies and choices in the MVP have been led by African agronomists, some of the very best in Africa – often working hand in hand with Bill’s own agricultural staff in the Alliance for a Green Revolution in Africa (AGRA). 
Bill will be happy to know that the MVP will be properly and professionally evaluated next year – on time at its conclusion (and at the end of the Millennium Development Goals in 2015). The assessment will be based on the very considerable data that have been collected over the past decade, and on extensive new survey data that will be collected in 2015. 
Mortality rates are down sharply in the Millennium Villages. In fact, the current evidence, to be examined in greater detail next year, suggests that the bold goal of reducing under-five mortality rates to below 30 deaths per 1,000 births has been achieved or is within reach by 2015, and at a remarkably low cost to the health system. 
Recently, one of the Gates Foundation’s senior staff members visited the Millennium Village site in northern Nigeria. Afterwards, he confirmed to me personally that he and his team were deeply impressed by what they saw of the Millennium Village health system in operation. 
So let me take this opportunity to reiterate a challenge that I have posed to Bill. He can pick any district in rural Africa, and our team will work with the local communities using the Millennium Village health approach to reduce the under-five mortality rate to below 30/1,000 – a rate characteristic of many middle-income countries – at an annual health-sector cost of just $60 per person. 
Finally, given concerns, shared by Bill, about the MVP’s sustainability and scalability, it is no small matter that host governments are strong advocates of the approach. These governments’ leaders have seen the Millennium Villages day in and day out over almost a decade. 
Around a dozen countries are now starting or have approached the Millennium Village Project to help them start their own Millennium Villages. And the Pan African Youth Leadership Network, Africa’s own young people, recently visited the Millennium Village in Senegal, and requested the support of the MVP to expand the Millennium Village Project’s techniques and strategies in their home countries and regions. 
This spread of the Millennium Village approach throughout Africa shows that African political and community leaders consider the MVP’s methods, strategies, and systems to be highly useful in combating poverty in rural Africa. Nina Munk’s book is out of date and misses the mark. 

Responding to Ebola 
NEW YORK – The horrific Ebola epidemic in at least four West African countries (Guinea, Liberia, Sierra Leone, and Nigeria) demands not only an emergency response to halt the outbreak; it also calls for re-thinking some basic assumptions of global public health. We live in an age of emerging and re-emerging infectious diseases that can spread quickly through global networks. 
Ebola is the latest of many recent epidemics, also including AIDS, SARS, H1N1 flu, H7N9 flu, and others. AIDS is the deadliest of these killers, claiming nearly 36 million lives since 1981. 
Of course, even larger and more sudden epidemics are possible, such as the 1918 influenza during World War I, which claimed 50-100 million lives (far more than the war itself). And, though the 2003 SARS outbreak was contained, causing fewer than 1,000 deaths, the disease was on the verge of deeply disrupting several East Asian economies including China’s. 
SARS most likely came from civets traded in animal markets in southern China; and influenza strains such as H1N1 and H7N9 arose from genetic re-combinations of viruses among wild and farm animals. New zoonotic diseases are inevitable as humanity pushes into new ecosystems (such as formerly remote forest regions); the food industry creates more conditions for genetic recombination; and climate change scrambles natural habitats and species interactions. 
Second, once a new infectious disease appears, its spread through airlines, ships, megacities, and trade in animal products is likely to be extremely rapid. These epidemic diseases are new markers of globalization, revealing through their chain of death how vulnerable the world has become from the pervasive movement of people and goods. 
Moreover, given poor nutrition and lack of access to basic health services, their weakened immune systems are easily overcome by infections that better nourished and treated individuals can survive. And “de-medicalized” conditions – with few if any professional health workers to ensure an appropriate public-health response to an epidemic (such as isolation of infected individuals, tracing of contacts, surveillance, and so forth) – make initial outbreaks more severe. 
In any event, such tools must be continually replenished. This requires cutting-edge biotechnology, immunology, and ultimately bioengineering to create large-scale industrial responses (such as millions of doses of vaccines or medicines in the case of large epidemics). 
The AIDS crisis, for example, called forth tens of billions of dollars for research and development – and similarly substantial commitments by the pharmaceutical industry – to produce lifesaving antiretroviral drugs at global scale. Yet each breakthrough inevitably leads to the pathogen’s mutation, rendering previous treatments less effective. 
So, is the world ready for Ebola, a newly lethal influenza, a mutation of HIV that could speed the transfer of the disease, or the development of new multi-drug-resistant strains of malaria or other pathogens? The answer is no. 
Though investment in public health increased significantly after 2000, leading to notable successes in the fights against AIDS, tuberculosis, and malaria, there has recently been a marked shortfall in global spending on public health relative to need. Donor countries, failing to anticipate and respond adequately to new and ongoing challenges, have subjected the World Health Organization to a debilitating budget squeeze, while funding for the Global Fund to Fight AIDS, Tuberculosis, and Malaria has fallen far short of the sums needed to win the war against these diseases. 
First, the United States, the European Union, the Gulf countries, and East Asian states should establish a flexible fund under WHO leadership to combat the current Ebola epidemic, probably at an initial level of $50-$100 million, pending further developments. This would allow a rapid public-health response that is commensurate to the immediate challenge. 
The main goal would be to help the poorest countries establish basic health systems in every slum and rural community, a concept known as Universal Health Coverage (UHC). The greatest urgency lies in Sub-Saharan Africa and South Asia, where health conditions and extreme poverty are worst, and preventable and controllable infectious diseases continue to rage. 
In particular, these regions should train and deploy a new cadre of community health workers, trained to recognize disease symptoms, provide surveillance, and administer diagnoses and appropriate treatments. At a cost of just $5 billion per year, it would be possible to ensure that well-trained health workers are present in every African community to provide lifesaving interventions and respond effectively to health emergencies like Ebola. 
Finally, high-income countries must continue to invest adequately in global disease surveillance, the WHO’s outreach capacities, and life-saving biomedical research, which has consistently delivered massive benefits for humanity during the past century. Despite tight national budgets, it would be reckless to put our very survival on the fiscal chopping block. 


From War to Work 
OXFORD – There is no denying that conflict has far-reaching negative effects, including on employment. But the prevailing understanding of the relationship between conflict and employment does not fully recognize the complexity of this relationship – a shortcoming that undermines effective employment policies in fragile states. 
Moreover, because unemployment can spur more conflict, as unemployed young people find validation and economic rewards in violent movements, job creation should be a central part of post-conflict policy. But, while this certainly sounds logical, these assumptions, as I detailed in a 2015 paper, are not necessarily entirely accurate. 
The first assumption – that violent conflicts destroy jobs – ignores the fact that every conflict is unique. Some, like the 2008-2009 Sri Lankan civil war, are concentrated in a relatively small area, leaving much of the country – and thus the economy – unaffected. 
Even endemic conflicts, like the recurrent conflicts in the Congo, might not have a major impact on net employment. After all, the jobs that are lost in, say, the public sector or among commodity exporters may be largely offset by new jobs in government and rebel armed forces, informal production substituting for imports, and illegal activities like drug production and smuggling. 
For starters, the formal sector accounts for just a fraction of total employment in most conflict-affected countries. The majority of working people are in the informal sector, often engaged in low-status, low-productivity, and low-incomes activities that can, just like unemployment, generate dissatisfaction and potentially motivate young people to join violent movements. 
Given this, simply expanding formal-sector employment is not enough, unless it also improves the situation of young people in low-income informal-sector jobs. Yet post-conflict employment policies almost invariably neglect the informal sector. 
But even a focus on the informal sector is insufficient, as research has shown that poverty and marginalization are not, on their own, enough to cause conflict. If they were, most poor countries would be in conflict most of the time. 
That motivation can stem from a variety of sources, among the most common being exclusion from power. In that case, leaders will appeal to a common identity – for example, religion in the case of contemporary conflicts in the Middle East, or ethnicity in many African conflicts – to mobilize followers. 
People will generally respond only if they already have grievances – in particular, if they feel that their group faces discrimination in access to resources and jobs. In this sense, employment is relevant, but what matters is not the absolute level of employment so much as the distribution of good jobs among religious or ethnic groups. 
Yet post-conflict employment policies almost always neglect so-called “horizontal inequalities.” For example, employment policies did little to reduce the strong regional imbalances and discrimination within regions that persisted in Bosnia and Herzegovina after the war there in the 1990s. 
Given these failings, it is not surprising that employment policies’ net effects are often very small relative to the size of the problem. In both Kosovo and Bosnia and Herzegovina, job creation was thought to be central to post-conflict peacekeeping efforts. 
There is one example of a successful post-crisis employment policy. Nepal’s government sought to expand opportunities in the informal sector after the country’s civil war, implementing programs focused on building infrastructure, issuing micro-credit, and providing technology assistance, targeting the most deprived regions and castes. 
Recognizing the role that caste and ethnic tensions and discrimination played in fueling the conflict, the government designed employment schemes specifically for rural areas, along the same lines as India’s employment scheme, with 100 days of work per household guaranteed. The programs were supported by the Nepalese government and external donors, and focused on poorer regions and villages (and, within them, on the poorest castes). 
Leaders must make the most of that time, ensuring that every policy they pursue is as effective as possible. When it comes to employment, that means designing programs that reflect how people actually spend their working lives, as well as addressing the real grievances generating tensions. 

The Mosquito Menace 
Dengue fever is a leading cause of illness and death in the tropics and subtropics, with as many as 100 million people infected each year. And there are an estimated 200,000 cases of yellow fever annually, leading to 30,000 deaths worldwide. 
It takes only one bite from a disease-carrying mosquito to transmit a debilitating or deadly infection – and mosquitoes breed and multiply with astonishing speed. Given that there are no vaccines or drug treatments for illnesses like dengue fever and West Nile virus, and that treatments for diseases like malaria are difficult to access in many at-risk areas, more effective mechanisms for controlling mosquito populations are desperately needed. 
The good news is that a promising new technology is ready for field-testing. It is now up to government agencies to facilitate its development. 
Today, the dominant method for reducing insect populations – the so-called “sterile insect technique” (SIT) – relies on radiation to sterilize males, which are then released into infested areas to mate. But this approach, which has been used since the middle of the last century, has not been effective with mosquitoes, owing to their fragility. 
Advances in molecular biology offer analogous – but far more sophisticated – solutions. Using molecular genetic-engineering techniques, the British company Oxitec has created a new way to control the mosquito species that transmits dengue fever. 
As a result, their offspring produce high levels of a protein that prevents their cells from functioning normally, causing them to die before reaching maturity. Male mosquitoes do not bite, so their release presents no health risk, and, because their progeny die, no genetically engineered mosquitoes persist in the environment. 
If the males are released over a period of several months, this would, in theory, result in a marked reduction in the mosquito population. All that is needed now is to determine whether it works in practice. 
Scientific research to develop products like irradiated sterile insects or the Oxitec mosquitoes proceeds progressively from more to less contained conditions – from the laboratory to confined trials to limited field trials. Now that Oxitec has conducted promising field trials in the Cayman Islands, Malaysia, and Brazil, it is preparing to conduct trials in other countries, including the United States. 
Such trials are always appropriately controlled and monitored to ensure that they are safe and effective, with government regulation providing an extra safeguard. In order to determine the appropriate level of oversight, government bodies would presumably conduct a science-based risk analysis. 
But, while SIT remains unregulated in most places, the regulatory reviews of genetically engineered living organisms have tended to be drawn out and excessive worldwide, with politics delaying – and sometimes even preventing – approvals. As a result, research and development in genetic engineering is more expensive, discouraging investment and hampering innovation. 
The World Health Organization’s Special Program for Research and Training in Tropical Diseases has called upon regulatory agencies to emphasize “science-based, case-by-case targeted requirements with a degree of practical parsimony,” instead of relying on “a precautionary approach that can require data to address all theoretical risks.” In other words, regulators should consider these innovations’ public-health costs and benefits, and expedite their review. 
Given the degree of suffering caused by mosquito-borne diseases, government leaders must not subject genetic-engineering solutions for controlling them to the same kinds of political and populist headwinds that have impeded the approval of genetically engineered agricultural products. Only with pragmatic, fact-based regulation can the world realize genetic engineering’s full disease-fighting potential. 

The Case for Burning Ivory 
More than 100 metric tons of “white gold” – both illegally harvested (confiscated from poachers or traders) and naturally accruing (from natural mortality) – will go up in smoke this weekend. In China – where the majority of the world’s ivory is consumed or stockpiled – the recently reported price is $1,100 per kilogram, putting the total value of the material to be burned at roughly $110 million. 
To most economists, the idea of destroying something with so much value is anathema. But there are good reasons for a country – even one as poor as Kenya – to surrender its ivory wealth to the flames. 
For starters, stockpile destruction fortifies the credibility of demand-reduction campaigns in East Asia, without which the poaching problem will never be solved. Demand reduction aims to weaken the market for the product by changing consumer tastes. 
When countries keep their stockpiles, however, they signal that they anticipate being able to sell ivory in the future. This undermines the credibility of demand-reduction efforts; if the trade is likely to be legalized one day, any stigma associated with ivory consumption will be eroded. 
Proponents of a regulated, legal international ivory trade argue that demand-reduction efforts can coexist with a limited legitimate supply. But this line of reasoning has a dangerous weakness: It assumes that a legal cartel – one proposed model for regulating supply – would crowd out illegal suppliers by providing ivory to the market at a lower cost. 
The quantities traded through a legal mechanism would be insufficient to flood the market and suppress the price. Indeed, with legalized trade undermining demand-reduction efforts, the price of ivory is likely to remain high, ensuring that poaching continues. 
Some southern African countries argue that they should be allowed to sell their ivory in CITES-permitted, one-off sales to fund conservation efforts aimed at maintaining healthy elephant populations. But, aside from the low probability in some countries that the revenue would be directed to that end, it is not clear that much money would be made. 
But what other governments are willing to pay may be as low as one-tenth of the illicit value. And even then, governments can sell only naturally accrued ivory, not what was confiscated from poachers or illicit dealers. 
Vietnam and Laos are likely candidates, but they are also part of the infamous “golden triangle,” where illegal trade in wildlife and wildlife products continues to thrive. The possibility of the legal ivory trade shifting to poorly regulated markets calls for a concerted international response, spearheaded by African governments through coalitions like the Elephant Protection Initiative, together with countries such as China. 
Inventory management is labor-intensive and technologically demanding. The ivory also must be air-conditioned to prevent the tusks from cracking or becoming brittle (important factors for attracting higher prices). 
Given the low probability of being able to sell ivory in the future, the cost of storing and protecting it is unlikely to be recouped. Meanwhile, criminal syndicates need only corrupt a handful of local officials to make off with the goods. 
Then there are the high opportunity costs of investment in maintaining stockpiles. The scarce human and financial resources allocated toward stockpile management could be more efficiently directed toward landscape preservation efforts (which can become self-sustaining over time through payment for ecosystem services). 
Finally, burning ivory worth millions of dollars has an undeniable symbolic impact. It sends a clear message: Ivory belongs to elephants and to no one else. 
Elephants are a keystone species for preserving important ecosystems. And yet rampant poaching is destroying elephant populations across Africa, killing, on average, 30,000 a year. 
Recent research has shown that community conservancies (areas set aside for wildlife conservation) in northern Kenya are highly effective forms of landscape (and therefore elephant) preservation, provided the right incentives are in place. This is important because in countries like Kenya and Tanzania, the majority of wildlife exists outside formally protected areas. 
Ideally, all range-state countries should destroy their stockpiles to overcome the regional collective action problem. Doing so would send an unmistakable signal to the global market: Ivory is not for sale, not now and not in the future. 

Good Fences Make Safe Species 
Observers often cite loss of habitat in the face of population growth, land degradation, and industrialization. And then there is the most frequent charge of all: that an increase in poaching is endangering species such as elephants and rhinos. 
In Kenya, however, an innovative and extensive conservation project is underway. Begun in the Aberdare mountains in central Kenya, “Rhino Ark,” originally conceived to protect the highly endangered black rhino from the ravages of poachers, is supported by the very people who might have resisted it: the local communities in some of the country’s most productive farming areas. 
But it also protected the farmers, whose crops were regularly being destroyed by marauding elephant and other wildlife. Local farmers welcomed the initiative, which influenced the decision to expand the fence to surround the perimeter of the entire Aberdare range. 
The Aberdare Mountains, encompassing 2,000 square kilometers of indigenous forest and vital water catchment areas, as well as a national park, are vital to Kenya. Four of the country’s largest rivers, flowing north, west, east and south, begin there, providing water and power to seven major towns, including the capital, Nairobi. 
For 21 years, the fence around the Aberdares was painstakingly built, supported mainly by Kenya’s corporate sector, individual donors, and innovative fundraising exercises such as the Rhino Charge, an off-road motor event that has captured the Kenyan public’s imagination and annually raises more than $1 million. But, by the time the fully electrified fence was completed, in 2009, the government, under then-President Mwai Kibaki, had become an essential partner, with the Kenya Wildlife Service (KWS) and the Kenya Forest Service (KFS) deeply involved in the project. 
With Kenyan government backing, Rhino Ark has been able to turn its attention to other forested but degraded areas – such as Mount Eburu in the Mau Forests Complex, overlooking Lake Naivasha, and Mount Kenya, a World Heritage Site that has been heavily affected by human-wildlife conflicts. The 45-kilometer Mount Eburu fence was completed last year. 
Fences must be managed and maintained (some of the original fence posts in the Aberdares, for example, have had to be replaced), wildlife corridors must be developed, and local communities require support. All areas are kept under surveillance by air and foot patrols along the fence line – a constant monitoring process with considerable cost implications. 
The benefits, however, are significant. The fences keep the authorities fully alert to any incidents of poaching – particularly of elephant, rhino, and exceptionally rare species such as the Mountain Bongo antelope, which now exist only in the Aberdares, Mount Kenya, and the Mau Forests Complex, including Mount Eburu. 
Local communities are involved in all areas of fence and forest maintenance. In effect, they are the guardians of the fences, keeping them clear of vegetation and repairing damage caused by wildlife and other factors – and learning new skills in the process. 
To achieve this, endowment funds are being established as public-private partnerships, bringing together the Rhino Ark, the KWS and the KFS, and representatives from local communities. So-called trust deeds, set up locally, will manage these funds, which will eventually pay for the fences’ maintenance. 
Since the completion of the Aberdares fence, the value of local farmers’ land has quadrupled. They can work their fields in peace for the first time in more than a century, their children can walk to and from school without fear of being attacked by wild animals, and conservation is now part of the curriculum. 

West Africa’s Misguided War on Drugs 
ACCRA – A recent estimate by the United Kingdom’s Office for National Statistics that the market for illegal drugs adds £4.4 billion ($7.6 billion) annually to the country’s economy gives a sense of the astonishing scale of the illicit narcotics trade. For regions such as West Africa, with economies that are neither as large nor as developed as the UK’s, the impact of such activity can be even more corrosive. 
West Africa finds itself increasingly enmeshed in the global drug trade. Its location makes it vulnerable to being exploited as a transit point between the Latin American and Asian production centers and consumer markets in Europe and the United States. 
Illegal drugs and the money that surround them invade and destabilize their societies. This disturbing development – a byproduct of the failed “global war on drugs” – threatens to reverse recent economic and social gains in our region. 
So far, West Africa has avoided the worst of the endemic and routine violence that accompanies the passage of drugs through Central America. But, with the stakes so high, there is no room for complacency. 
We already know that the narcotics trade has played a direct or indirect role in political upheaval in countries such as Guinea-Bissau and Mali. National and international action against the traffickers must be stepped up, and it should include targeting those who run the networks, rather than expending scarce law-enforcement resources to pursue their foot soldiers. 
But it is not only the trade in illegal drugs that is destabilizing countries in the region; narcotics consumption is becoming a major problem as well. The West Africa Commission on Drugs, which I convened and former Nigerian President Olusegun Obasanjo chairs, points out in a new report that cocaine, heroin, and locally produced methamphetamines have become increasingly available across the region. 
But pushing them to the fringes of society or locking them up in ever increasing numbers will not solve the problem. On the contrary, it worsens health problems and puts enormous pressure on West Africa’s already over-stretched criminal justice systems. 
The Commission’s report instead calls for a new approach to drug abuse, one that treats it not as a criminal-justice issue, but rather as a public-health problem. That means tackling the near total absence of drug-treatment facilities and programs and the lack of personnel qualified to manage and monitor drug abuse. 
The Commission accepts that there are many urgent demands on strapped health-care budgets. But such is the importance of this challenge – and so dire are the consequences of failure to overcome it – that the Commission strongly recommends the adoption of a drug-treatment policy with minimum standards across the region. 
This includes the establishment of drug treatment and related health services and facilities, and the implementation of harm-reduction approaches, such as needle-exchange programs, which have been proven to reduce the spread of HIV and the incidence of drug-related deaths. To date, Senegal is alone in West Africa in implementing some form of government-run harm-reduction initiative. 
Tackling the impact of drugs through informed, humane, and coordinated policy will require leadership and a concerted effort by countries across the region. The Commission calls for a shared commitment from governments, civil-society groups, and regional organizations. 
The report also urges increased support for these efforts from the international community. Governments in those West African countries that are the principal producers and consumers of illegal drugs should fund prevention, treatment, and harm-reduction initiatives, rather than only investing in interdiction and law enforcement. 
Without a change of direction, drug trafficking, production, and consumption in West Africa will continue to undermine institutions, threaten public health, and damage development progress. But reforming drug laws, offering chronic users proper treatment, and vigorously pursuing high-level drug traffickers will reduce the damaging impact of illegal drugs on communities, families, and individuals. 

India’s Deadly Entrance Exams 
NEW DELHI – In late April, a 17-year-old girl named Kriti Tripathi leaped to her death in Kota, India, shortly after passing the country’s examination for admission to the prestigious Indian Institutes of Technology (IIT). A week later, another Kota student, Preeti Singh, hanged herself, succumbing to her injuries after a few days. 
Tripathi implored the Human Resource Development Ministry to shut down such institutes, which force their students to endure unbearable stress and depression. The story is all too common, but should the blame really be laid on the coaching institutes? 
In fact, Kota’s coaching institutes are a symptom of a larger problem, hinted at by the city’s senior administrator, District Collector Ravi Kumar Surpur, in an emotional letter he wrote in response to the latest deaths. Addressing parents directly, Surpur pleaded with them not to subject their children to excessive stress in an attempt to live vicariously through them. 
They know that a professional degree in the right field is a passport to social and economic advancement, so they push hard to ensure that their children get one – something that India’s higher-education system does not make easy. Given this deeply entrenched culture of academic ambition, the planned administrative inquiry into conditions at the Kota coaching institutes is unlikely to result in remedial action. 
Students are forced to pass brutally difficult examinations – only about 10,000 of the 500,000 who take the IIT-JEE each year score high enough to be admitted – in subjects they often detest. And Indian students are far more likely to push themselves until they crack than to drop out. 
But, in a throwback to the mid-twentieth century, Indian parents view engineering as the gateway to modernity, and continue pressing their children to study it. Students who do not make it to an IIT end up in institutions of varying quality, many of which do not equip their graduates for today’s labor market. 
But at least there are enough engineering colleges in India to meet demand. Medicine, by contrast, is a frustratingly crowded field – and for no good reason. 
India’s medical profession is controlled by the Medical Council of India, an opaque and self-serving cabal that has intentionally limited the supply of available medical college seats. Medical colleges must be recognized by the MCI, which has seen fit to permit only 381 to exist. 
As if that were not bad enough, some of the seats are awarded against “donations,” with the wealthy essentially purchasing positions that their marks do not merit. Meanwhile, high-achieving students who just barely missed the cutoff have to find alternatives – or pursue another field altogether. 
Some return after having attended obscure colleges in countries like Georgia or China, only to have the MCI refuse to recognize their degrees and block them from practicing. For those who cannot afford to go abroad – even bright students who barely missed the cutoff for a spot at an Indian university – studying medicine is no longer an option. 
In the United States and the United Kingdom – two countries to which Indian doctors often emigrate – the rate is 2.5 per 1,000 and 2.8 per 1,000, respectively. The crippling lack of capacity means that lives are lost every day – particularly in rural areas – for want of medical attention. 
India could be graduating four or five times as many capable doctors as it does each year. Yet the MCI has been allowed to pursue its restrictive approach, depriving poor Indians of adequate health care, while augmenting the already-huge pressure on students to gain a seat in a medical college. 
It is in this context – with a huge population competing for a tiny number of seats in professional colleges – that coaching institutes like those in Kota thrive. When succeeding in tough entrance examinations is the only way to fulfill one’s educational goals, test preparation becomes the be-all and end-all of schooling. 


Measuring Inclusive Growth 
WASHINGTON, DC – When the Millennium Development Goals (MDG) deadline expires next year, the world will be able to point to several important achievements since their launch in 2000. Extreme poverty has been halved during this period; an estimated 100 million slum-dwellers have gained access to safe drinking water, and millions to health care; and large numbers of girls are now receiving an education. 
The post-2015 development agenda will continue where the MDGs left off, while adding further objectives relating to inclusion, sustainability, jobs, growth, and governance. The success of the coming Sustainable Development Goals (SDGs) will depend on how new programs are developed, implemented, and measured. 
But such growth is often accompanied by environmental degradation, which diminishes human health and quality of life, threatens water supplies, and compromises ecosystems, impeding growth for future generations. Moreover, short-term growth that erodes natural capital is vulnerable to boom-and-bust cycles, and can cause people who live close to the poverty line to fall far below it. 
Discussion of the SDGs is now taking into consideration the need to incorporate food, water, and energy security, together with urban planning and biodiversity. But translating prospective goals into actions at the country level will not be feasible without measurable and meaningful indicators to guide policy and measure progress. 
A recent World Economic Forum report proposes a “dashboard” for inclusive and sustainable growth. This model brings together natural capital accounting, a human-opportunity index, a gender-gap index, measures of public investment as a percentage of GDP, a competitiveness index, indicators of shared prosperity, and disaggregated unemployment data. 
A World Bank-led partnership, Wealth Accounting and the Valuation of Ecosystem Services (WAVES), shows governments how certain behavior depletes natural assets, and how natural capital accounting can help to establish more sustainable development policies. Following a campaign at the 2012 Rio+20 Summit, 70 governments, including those representing 40 middle- and low-income countries, endorsed natural capital accounting. 
“Forest accounts,” for example, have revealed that Guatemala has the fastest deforestation rate in Central and South America, with most uncontrolled logging being carried by households for their cooking needs. This information has spurred the Guatemalan government to review the country’s forestry law, and to fund new strategies to control firewood use, prevent unauthorized logging, and encourage families to use alternative energy sources. 
Botswana’s attempts to diversify its economy are constrained by water shortages; but “water accounts” are helping the government to identify sectors – including agriculture, mining, and tourism – that can grow with minimal water consumption. 
“Ecosystem accounts” have become instrumental in determining how better to manage this resource. These accounts are also being used to improve forest management in the Indian state of Himachal Pradesh, where forests are a vital resource for two major growth sectors, tourism and hydropower generation. 
Incorporating sustainability forces governments and businesses to consider the environmental impact of their decisions. A UN report calls on all governments to adopt natural capital accounting so that their sustainability efforts can be consistent, accurate, and comparable over the long term. 
Only by shifting to a broader understanding of growth and development can the world address the pressing problems of inequality and sustainability. Placing that understanding at the heart of the SDGs will help to improve the health and wellbeing of all societies long into the future. 


Data and Development 
WASHINGTON, DC – Since the turn of the century, the international development community has rallied behind the Millennium Development Goals, which set specific targets in eight key areas, including poverty, child mortality, and disease, to be achieved by 2015. In formulating the post-2015 development agenda, measuring the MDGs’ successes – and identifying where progress has lagged – is critically important. 
To be sure, international institutions and many developing countries have invested significantly in improving data collection to track better their performance against MDG targets. In 2003, only four countries had two data points for 16 or more of the 22 principal MDG indicators; by last year, that figure had soared to 118 countries. 
A catalyst is needed to expand the production and use of development data. With this in mind, the high-level panel on the post-2015 development agenda is right to call for a global “data revolution.” 
The meteoric rise of digital technologies has changed the global landscape since 2000, when the MDGs were launched. Remote sensing, information gathered from online activity, and crowd-sourced data from mobile phones can complement traditional methods of gathering statistics. 
This technology-driven shift in the way people create, curate, share, and apply data should be reflected in development efforts for two reasons. First, policymakers are eager to attain more up-to-date data that can guide their efforts. 
However, there is a caveat. The size and complexity of these datasets require specialized analytical skills (which remain in short supply), as well as more research and experimentation. 
Increasing the quantity, quality, availability, and usability of data for development requires addressing the market failures that lead to gaps in data use and coverage in developing countries. This means that as technology, data, and data users and providers make rapid advances, cooperation among diverse actors – governments, national statistics offices, donor agencies, global and local NGOs, academic and research institutions, the private sector and others – will be needed. 
In this spirit of cooperation, the major multilateral development institutions – the African Development Bank, the Asian Development Bank, the Inter-American Development Bank, the International Monetary Fund, the Islamic Development Bank, the United Nations, and the World Bank – have already begun to strengthen their joint efforts in producing and sharing development data. And the effort has already borne fruit. 
But there is much more to be done. Through new forms of collaboration, developing-country statistical agencies should aim to improve data coverage and quality, while leveraging technology to make data easier to manage, use, and access. 
More (and more reliable) data could also improve decision-making by helping policymakers to understand specific social, economic, and environmental issues. Better gender statistics could provide a more detailed understanding of women’s access to justice, education, and finance; improved measures of poverty and inequality could reveal how the benefits of economic growth are distributed; and natural capital accounting could uncover the value of resource endowments, thereby helping to ensure that they are used in a rational and sustainable manner. 
Obviously, data related to issues that directly affect the wellbeing of people and the planet are essential for effective policymaking. Making such data open and accessible should be viewed as a basic condition of ensuring people’s ability to hold governments accountable and thus participate in decisions that affect their lives. 

The Infrastructure Solution 
TORONTO – “Infrastructure, by the nature of the word,” former US Secretary of State Madeleine Albright said in February 2013, “is basic to the functioning of societies.” And yet infrastructure has arguably been the forgotten economic issue of the twenty-first century. 
Though the debate about infrastructure tends to focus on the need for more money and more creative financing, the real problem is not insufficient investment. Rather, the built environment is deteriorating as a result of a fragmented approach to infrastructure planning, finance, delivery, and operation, which emphasizes cost, asset class, and geographical location. 
Developing a new approach – based on a broad, systemic perspective – should become a top priority of those with the capacity to deliver change, including CEOs and senior public officials. That is precisely what McKinsey’s Global Infrastructure Initiative, which held its second meeting in Rio de Janeiro last month, aims to do, by promoting practical global solutions aimed at raising the productivity and efficiency of every aspect of infrastructure. 
Without such solutions, an estimated $57 trillion of infrastructure investment would be needed in 2013-2030, just to keep pace with GDP growth. That is more than the value of the entire existing stock of infrastructure. 
More productive infrastructure could reduce the world’s infrastructure bill by 40%, or $1 trillion annually – savings that could boost economic growth by about 3%, or more than $3 trillion, by 2030. This would facilitate higher infrastructure investment, with an increase equivalent to 1% of GDP translating into an additional 3.4 million jobs in India, 1.5 million in the United States, 1.3 million in Brazil, and 700,000 in Indonesia. 
Increasing infrastructure’s productivity begins in the planning phase. A more pragmatic approach to selecting infrastructure projects in which to invest – including a systematic evaluation of costs and benefits, based on precise criteria that account for broader economic and social objectives – could save the world $200 billion annually. 
Some countries are already reaping the benefits of such an approach. South Korea’s Public and Private Infrastructure Investment Management Center has reduced infrastructure spending by 35%; today, officials reject 46% of the proposed projects they review, compared to 3% previously. 
Similarly, the United Kingdom established a cost-review program that identified 40 major projects for prioritization, reformed overall planning processes, and then created a cabinet sub-committee to ensure faster delivery of projects, thereby cutting infrastructure spending by 15%. And Chile’s National Public Investment System evaluates all proposed public projects using standard forms, procedures, and metrics – and rejects as many as 35%. 
Additional opportunities for savings – to the tune of $400 billion annually – lie in more streamlined delivery of infrastructure projects. There is massive scope to accelerate approvals and land acquisition, structure contracts to encourage innovation and savings, and improve collaboration with contractors. 
In Australia, the state of New South Wales cut approval times by 11% in just one year. And one Scandinavian road authority reduced overall spending by 15% by updating design standards, adopting lean construction techniques, and taking advantage of bundled and international sourcing. 
Governments could save $400 billion annually simply by increasing the efficiency and productivity of existing infrastructure. For example, smart grids could cut power infrastructure costs by $2-6 billion annually in the US, while reducing costly outages. 
Similarly, intelligent transportation systems for roads can double or triple the use of an asset – typically at a fraction of the cost of adding the equivalent in physical capacity. The UK’s intelligent transport system on the M42 motorway has reduced journey times by 25%, accidents by 50%, pollution by 10%, and fuel consumption by 4%. 
Congestion pricing can also reduce the need for new capacity, while providing significant savings in terms of fuel costs and time. Such a charge has enabled the City of London to cut congestion by 30%. 
None of these solutions is particularly earth-shattering. They simply require a less fragmented approach within government, and more cooperation between the public and private sectors. 
Switzerland’s Department of the Environment, Transport, Energy, and Communications, for example, incorporates national goals, set by the Federal Council, into a unified infrastructure strategy that accounts for the needs of specific sectors. Likewise, Rwanda’s Ministry of Infrastructure coordinates the activities of other ministries and public agencies – ensuring that infrastructure strategies align with the East African Community’s regional integration plans – and monitors downstream delivery and operations. 
Governments must recognize that the private sector can provide more than infrastructure financing; it can also offer know-how in the planning, construction, and operation phases. Chile, the Philippines, South Africa, South Korea, and Taiwan are all developing frameworks that expand the role of private players in planning projects. 
Infrastructure increases economies’ competitiveness, while providing the physical framework for people’s lives. Policymakers’ goal should be to ensure that infrastructure realizes its full potential, so that the people who depend on it can realize theirs. 

The Arab World’s Options 
AMMAN – When the Arab awakening began in 2011, its primary goal should have been to advance pluralism and democracy – causes that were neglected in the Arab world’s first, anti-colonial awakening in the twentieth century. But, after three years of struggle, the process has only just begun. 
The answer depends on which of three models Arab countries use to guide their transition: an inclusive, far-sighted model that aims to build consensus; a winner-take-all approach that excludes large segments of the population; or a stop-at-nothing approach focused on regime survival. These models reflect the vast differences among Arab countries’ current circumstances and prospects for the future. 
The strongest example of the inclusive model is Tunisia, where former opponents have formed a coalition government, without military interference. Of course, the process was not easy. 
In February, Tunisia adopted the Arab world’s most progressive constitution, which establishes equality between men and women, provides for peaceful alternation of government, and recognizes the right of citizens to be without religious belief – an unprecedented move in the region, supported by both Islamist and secular forces. Tunisia’s experience embodies the commitment to pluralism and democracy for which the second Arab awakening stands. 
Fortunately, Tunisia is not alone in following this path. Both Yemen and Morocco have undertaken a relatively inclusive political process, with Yemen pursuing a national dialogue and Morocco forming a coalition government. 
Consider Egypt, which has been pursuing the second, exclusionary approach, with all parties believing that they have a monopoly on the truth and thus can ignore or suppress their opponents. Egypt’s Islamists, led by the Muslim Brotherhood, adopted this philosophy while they were in power; the secular forces that ousted them in last July’s military coup are now taking the same approach. 
The country remains plagued by security threats, economic chaos, and political instability – problems of such a scale that neither camp can solve them alone. If leaders on both sides do not begin to work together, Egypt’s awakening will remain a distant dream, with ordinary citizens suffering the social and economic consequences. 
Meanwhile, the opposition remains fragmented, leaving a security vacuum that radical groups – made up largely of foreign fighters – have been exploiting. The result has been a horrific civil war, which has already led to at least 150,000 deaths and forced millions to flee their homes, with no end in sight. 
The stark differences between these three models and their outcomes offer a clear lesson: inclusiveness is the only route to stability. With the right approach, any country can succeed in building a better future. 
Specifically, the two forces that have long dominated the political scene – secular, often military or military-backed rulers, and the religious opposition – have lost their unassailable status; today, they are increasingly subject to the kind of criticism that characterizes democratic systems. In many Arab countries, it is even acceptable to be a liberal. 
But, while the rigid social systems that long impeded progress have broken down in many Arab countries over the last three years, with liberalism becoming a more acceptable worldview, the experiences of Egypt and Syria demonstrate that the goals of the second Arab awakening are not universally shared. Old rivalries, ideological preoccupations, and unproductive habits continue to block efforts to find real solutions to socioeconomic problems. 
Arab societies deserve better. As Tunisia has shown, if they embrace the politics of pluralism and inclusiveness, they will get it. 

Closing Africa’s Agricultural Gender Gap 
SEATTLE – Africa’s GDP is now growing faster than any other continent’s. When many people think about the engines driving that growth, they imagine commodities like oil, gold, and cocoa, or maybe industries like banking and telecommunications. 
When I met her in 2012, she had just harvested her first crop of maize grown from a seed specifically adapted for Tanzania’s climate. Even during a bad crop year that caused many of Joyce’s vegetables to wither and die, her maize crop flourished. 
They are the foundation of its economy, and the key to triggering its broader growth. Research shows that increasing agricultural productivity is the most effective way to reduce poverty in sub-Saharan Africa. 
In fact, agriculture offers the continent its best opportunity to turn a vicious cycle of poverty into a virtuous cycle of development. That is why leaders and policymakers from across the continent have declared 2014 Africa’s Year of Agriculture and Food Security. 
Joyce’s story is relevant for another reason, too. She is important to Africa’s future not only because she is a farmer, but also because she is a woman. 
At the Gates Foundation, I spend a lot of my time understanding the many ways that women and girls drive development forward: by investing in their children’s nutrition, basic health, and education – and also by providing farm labor. What I am now learning is that if Africa hopes to spark an agricultural transformation, countries will first need to remove one of the main barriers holding the sector back: a pervasive gender gap. 
The gap is one of productivity. Across the continent, farms controlled by women tend to produce less per hectare than farms controlled by men. 
The world has had evidence of this gender gap since at least 2011, but only limited data about its scope, shape, and causes. To help us better understand the problem, the World Bank and the ONE Campaign recently conducted an unprecedented analysis of the challenges facing women farmers. 
Their report highlights one stark fact from the start: The gender gap is real, and in some cases it is extreme. When we compare male and female farmers with similar land sizes across similar settings, the productivity gap can be as high as 66%, as it is in Niger. 
With the new data in hand, we can see that, surprisingly, the productivity gap persists even when women have equal access to inputs. The precise reasons vary from country to country – but many of them stem from entrenched cultural norms that prevent women from reaching their full potential. 
Women usually have more childcare and household responsibilities than men, which make it difficult for them to devote as much time to farm work, or even to supervise hired labor. The problem is compounded by the fact that women are also likely to have less income to hire laborers in the first place. 
Fortunately, the new data do not just map the complexity and depth of the problem; they also point to concrete opportunities to develop gender-responsive policies that will help unlock the promise of all of Africa’s farmers. 
In some places, that may mean teaching agricultural extension workers how to make their messages more relevant to female audiences, or encouraging them to visit when women are most likely to be at home. In other places, it may mean increasing women’s access to markets, or introducing labor-saving tools to help them get the highest yield from their land. 
It may also require establishing community childcare centers, so that women farmers have the option to spend more time farming. In every case, it will require African policymakers to start recognizing women farmers as the essential economic partners that they are. 
This June, leaders from all over Africa will meet in Malabo, Equatorial Guinea, to set the agenda for agricultural policy in the next decade. If Africa’s agricultural sector is to achieve its promise – and if Africa’s economic growth is to continue – policymakers should take into account the needs of farmers like Joyce. 

Combating Konzo 
EAST LANSING, MICHIGAN – Too many preventable diseases, from AIDS to yellow fever, have long afflicted Sub-Saharan Africa. But eradicating them requires an understanding of the disease in question, money, education, government support, planning, and, not least, an interest from the community and the wider world in solving the problem. 
Consider a preventable disease that most people have never heard of: konzo, a permanent, irreversible, upper-motor neuron disorder, common in rural areas of Sub-Saharan Africa that rely on the bitter varieties of the cassava plant as a staple crop. Konzo occurs when cassava tubers are not properly prepared before consumption, which usually requires soaking them until they ferment and then drying them in the sun to allow for the breakdown of cyanogenic compounds. 
Konzo is especially common in the Democratic Republic of the Congo, the Central African Republic, Mozambique, and Tanzania, and often follows droughts or conflicts, when food is scarce. Women and children are the worst affected, especially during times of economic hardship, when they have the least access to meat, beans, and other sources of sulfur amino acids necessary for the liver to detoxify cyanide in the body. 
The effects are not easy to miss. The World Health Organization defines konzo as a visible spastic abnormality of gait while walking or running; a history of onset within one week in a formerly healthy person, followed by a non-progressive course; and exaggerated jerking of the knees or ankles without signs of spinal disease. 
Konzo’s severity varies. According to the WHO’s 1996 classification, the disease is deemed mild when the victim does not need to use walking aids regularly; moderate when one or two sticks or crutches are used; and severe when he or she is bedridden or unable to walk without support. 
But electrophysiological evidence later emerged suggesting that higher-level brain functioning may be affected as well. In documenting neurocognitive impairments in children with konzo, my colleagues and I also noted sub-clinical symptoms even in konzo-free children living in konzo-affected households, a finding based on their performance on more specialized neurocognitive tests of memory and learning. 
These subtler symptoms may constitute a pre-konzo condition, providing a warning that a child is approaching the disease’s threshold. Thus, the neurocognitive effects documented for non-konzo children in konzo-affected households and communities make it all the more important to ensure food safety in regions dependent on bitter varieties of cassava with high levels of cyanogenic compounds. 
To this end, the Bill and Melinda Gates Foundation has supported research leading to the development of nontoxic, high-yield varieties of cassava. These genetically engineered strains can thrive even in degraded soil, so that people no longer have to turn to the more toxic varieties. 
Konzo-affected regions lack the agricultural, educational, and public-health capacity and infrastructure needed to implement the necessary changes. For the same reasons, these regions fail to diversify their food staples to include safer crops such as millet, maize, or beans. 
While that means continuing to demonstrate the benefits of new strains of cassava and other staples, the first priority must be to educate people, especially village women, about the hazards of eating unprocessed cassava, and to teach them how to prepare it safely. Using culturally appropriate social marketing, similar to those used in anti-HIV education, the message can be spread through social networks, mobile phones, radio, and television. 
But they may be unaware of why these practices are so important, and therefore of the consequences of not adhering to them. Especially during times of upheaval and increased food scarcity, soaking the peeled tubers for three days until fermentation, and then sun-drying them for a day, might seem like an unaffordable luxury. 
Millions are at risk of konzo, and outbreaks can occur at any time. The neurological injury can be debilitating, and it is permanent. 

Modi’s Mandate 
WASHINGTON, DC – In an impressive exercise in democracy, 550 million eligible voters participated in India’s 16th general election. The new prime minister will be Narendra Modi of the conservative Bharatiya Janata Party (BJP), who presided over rapid economic growth in his 13 years as Chief Minister of the state of Gujarat, on India’s northwest coast. 
The election once again demonstrated how different in political terms India is from its giant neighbor, autocratic China. Now, however, the new government must try to match the superior economic progress that China has achieved over the last three decades. 
The first ingredient is a robust industrial sector composed of manufacturing industries that use unskilled labor, which would offer a route out of poverty for India’s hundreds of millions of rural laborers and their families. It is the route that China, and other countries before it, has taken. 
Poor infrastructure constrains the industry that India does have. Factories need reliable supplies of power to operate effectively, good roads and railways to source inputs and distribute products, and, if they are to export those products, ports for cargo ships and airports for high-value items and business travel. 
Power outages are routine in India, nearly half the country’s households lack any electricity at all, and modern highways are scarce. While a trucker in the United States can haul a load a thousand miles in about 20 hours, in India the equivalent trip takes 4-5 days. 
In democracies, people are free to organize themselves, and often do so on the basis of common economic interests. Such groups work politically to bring benefits to their members, but the benefits can come at the expense of the general welfare – and in India they have blocked the development of low-skilled industries and high-quality infrastructure. 
While India abounds in workers with low (or no) skills, laws governing employment make it all but impossible for large firms to fire workers, discouraging them from hiring in the first place. The most efficient companies tend to avoid precisely the industries that could, if established on a large scale, lift millions of Indians out of poverty. 
It is a particular kind of interest group – trade unions – that promotes and defends the laws that discourage large firms from entering industries that employ unskilled workers. While these laws benefit union members, who make up a very small fraction of the total workforce, they penalize India as a whole. 
Political minorities also inhibit the construction of infrastructure and the development of the educational system that India needs by using the democratic process to divert resources to themselves, which then cannot be used to build roads or pay teachers. Subsidies of various kinds, all of them legislative achievements of interest groups, account for fully 2.4% of the country’s GDP. 
Its salaries consume resources that would be better devoted to more productive uses. Special-interest spending leads to budget deficits, while the borrowing needed to finance these deficits drains yet more money from infrastructure and education. 
With its various ethnic groups, religions, castes, and 30 languages used by more than a million native speakers each (and another 105 spoken by at least 10,000 people), India is more culturally diverse than the entire European Union – but with twice as many people. Without the emphasis on compromise, peaceful dispute resolution, and minority rights inherent to democracy, a united India could not exist. 
So Modi’s challenge is to overcome the obstacles to growth-promoting polices using democratic methods. Here, the election has brought good news: the growing strength of India’s growing middle class, a potent ally in the cause of pursuing the needed economic reforms. 
That middle class consists of propertied, salaried people, many of them young, who see government as an impersonal enforcer of the law and a neutral arbiter of disputes, rather than as a source of funds and favors. The votes of such people helped Modi win the election. 

The Unity of Water 
MOSCOW – In May, Vietnam became the 35th and decisive signatory of the 1997 United Nations Convention on the Law of the Non-Navigational Uses of International Watercourses. As a result, 90 days later, on August 17, the convention will enter into force. 
The fact that it took almost 50 years to draft and finally achieve the necessary ratification threshold demonstrates that something is very wrong with the modern system of multilateralism. Regardless of longstanding disagreements over how cross-border freshwater resources should be allocated and managed, and understandable preferences by governments and water professionals to rely on basin agreements rather than on international legal instruments, that half-century wait can be explained only by a lack of political leadership. 
Roughly 60% of all freshwater runs within cross-border basins; only an estimated 40% of those basins, however, are governed by some sort of basin agreement. In an increasingly water-stressed world, shared water resources are becoming an instrument of power, fostering competition within and between countries. 
But the really bad news is that water consumption is growing faster than population – indeed, in the twentieth century it grew at twice the rate. 
As a result, several UN agencies forecast that, by 2025, 1.8 billion people will be living in regions stricken with absolute water scarcity, implying a lack of access to adequate quantities for human and environmental uses. Moreover, two-thirds of the world’s population will face water-stress conditions, meaning a scarcity of renewable freshwater. 
Without resolute counter-measures, demand for water will overstretch many societies’ adaptive capacities. This could result in massive migration, economic stagnation, destabilization, and violence, posing a new threat to national and international security. 
In today’s context of climate change, rising demand, population growth, increasing pollution, and overexploited resources, everything must be done to consolidate the legal framework for managing the world’s watersheds. Our environmental security, economic development, and political stability directly depend on it. 
The convention will soon apply to all of the cross-border rivers of its signatories’ territories, not just the biggest basins. It will complement the gaps and shortcomings of existing agreements and provide legal coverage to the numerous cross-border rivers that are under increasing pressure. 
Worldwide, there are 276 cross-border freshwater basins and about as many cross-border aquifers. Backed by adequate financing, political will, and the engagement of stakeholders, the convention can help address the water challenges that we are all facing. 
An ambitious agenda should be adopted now, at a time when the international community is negotiating the contents of the Sustainable Development Goals (SDGs), the successor to the UN Millennium Development Goals, which will expire in 2015. We at Green Cross hope that the new goals, which are to be achieved by 2030, will include a stand-alone target that addresses water-resources management. 
Moreover, the international community will soon have to agree on a climate-change framework to replace the Kyoto Protocol. Climate change directly affects the hydrological cycle, which means that all of the efforts that are undertaken to contain greenhouse-gas emissions will help to stabilize rainfall patterns and mitigate the extreme water events that so many regions are already experiencing. 
How will countries apply its mandates within their borders and in relation to riparian neighbors? How will the American and Asian countries that have largely ignored ratification respond? 
Furthermore, how will the convention relate to the Convention on the Protection and Use of Transboundary Watercourses and International Lakes, which is already in force in most European and Central Asian countries and, since February 2013, has aimed to open its membership to the rest of the world? Similarly, how will the convention’s implementation affect existing regional and local cross-border freshwater agreements? 
The countries that ratified the UN Watercourses Convention are expected to engage in its implementation and to go further in their efforts to protect and sustainably use their cross-border waters. What instruments, including financial, will the convention provide to them? 
Several legal instruments can be implemented jointly and synergistically: the Ramsar Convention on Wetlands, the UN Convention to Combat Desertification, and the UN Framework Convention on Climate Change, to name just a few. The UN Watercourses Convention’s long-delayed enactment should be viewed as an opportunity for signatory states to encourage those that are not yet party to cooperative agreements to work seriously on these issues. 
Clearly, politicians and diplomats alone cannot respond effectively to the challenges that the world faces. What the world needs is the engagement of political, business, and civil-society leaders; effective implementation of the UN Watercourses Convention is impossible without it. 
This is too often overlooked, but it constitutes the key to the long-term success of cooperation that generates benefits for all. Inclusive participation by stakeholders (including the affected communities), and the development of the capacity to identify, value, and share the benefits of cross-border water resources, should be an integral part of any strategy to achieve effective multilateral collaboration. 

The Intellectual Battle Against ISIS 
DUBAI – The global financial crisis taught the world how profoundly interdependent our economies have become. In today’s crisis of extremism, we must recognize that we are just as interdependent for our security, as is clear in the current struggle to defeat ISIS. 
If we are to prevent ISIS from teaching us this lesson the hard way, we must acknowledge that we cannot extinguish the fires of fanaticism by force alone. The world must unite behind a holistic drive to discredit the ideology that gives extremists their power, and to restore hope and dignity to those whom they would recruit. 
But military containment is only a partial solution. Lasting peace requires three other ingredients: winning the battle of ideas; upgrading weak governance; and supporting grassroots human development. 
Such a solution must begin with concerted international political will. Not a single politician in North America, Europe, Africa, or Asia can afford to ignore events in the Middle East. 
Nonetheless, it has emerged, spread, and resisted those who oppose it. What we are fighting is not just a terrorist organization, but the embodiment of a malicious ideology that must be defeated intellectually. 
With its twisted religious overtones, this pre-packaged franchise of hate is available for any terrorist group to adopt. It carries the power to mobilize thousands of desperate, vindictive, or angry young people and use them to strike at the foundations of civilization. 
The ideology fueling ISIS has much in common with that of Al Qaeda and its affiliates in Nigeria, Pakistan, Afghanistan, Somalia, Yemen, North Africa, and the Arabian Peninsula. What most worries me is that a decade ago, such an ideology was all that Al Qaeda needed to destabilize the world, even from a primitive base in the caves of Afghanistan. 
The destruction of terrorist groups is not enough to bring lasting peace. We must also strike at the root to deprive their dangerous ideology of the power to rise again among people left vulnerable by an environment of hopelessness and desperation. 
The first is to counter malignant ideas with enlightened thinking, open minds, and an attitude of tolerance and acceptance. This approach arises from our Islamic religion, which calls for peace, honors life, values dignity, promotes human development, and directs us to do good to others. 
Only one thing can stop a suicidal youth who is ready to die for ISIS: a stronger ideology that guides him onto the right path and convinces him that God created us to improve our world, not to destroy it. We can look to our neighbors in Saudi Arabia for their great successes in de-radicalizing many young people through counseling centers and programs. 
It should be clear to everyone that the rapid growth of ISIS was fueled by the Syrian and Iraqi governments’ failings: the former made war on its own people, and the latter promoted sectarian division. When governments fail to address instability, legitimate grievances, and persistent serious challenges, they create an ideal environment for hateful ideologies to incubate – and for terrorist organizations to fill the vacuum of legitimacy. 
This is not only an Arab responsibility, but also an international responsibility, because providing grassroots opportunity and a better quality of life for the people of this region is guaranteed to ameliorate our shared problems of instability and conflict. We have a critical need for long-term projects and initiatives to eliminate poverty, improve education and health, build infrastructure, and create economic opportunities. 
We have the opportunity to inspire them with hope and to direct their energies toward improving their lives and the lives of those around them. If we fail, we will abandon them to emptiness, unemployment, and the malicious ideologies of terrorism. 
Every day that we take a step toward delivering economic development, creating jobs, and raising standards of living, we undermine the ideologies of fear and hate that feed on hopelessness. We starve terrorist organizations of their reason to exist. 
I am optimistic, because I know that the people of the Middle East possess a power of hope and a desire for stability and prosperity that are stronger and more enduring than opportunistic and destructive ideas. There is no power stronger than that of hope for a better life. 

The Brain Regain 
DUBAI – In 1968, while studying at the Mons Officer Cadet School in the United Kingdom, I needed to visit a hospital. There I met a doctor who, to my surprise, spoke fluent Arabic. 
That doctor’s words stayed with me for many years, because they underscored the contradiction between our idealized view of “home” and the harsh realities of life that push talented people to leave their homes. 
The doctor was a classic case of the “brain drain” phenomenon that has afflicted developing countries for decades. These countries spend scarce resources educating doctors, engineers, and scientists, in the hope that they will become engines of prosperity. 
It is, of course, everyone’s right to choose a better life, wherever in the world they wish. We understand why they go. 
For the countries left behind, however, it feels like an endless vicious cycle: they need talent to create opportunity; but without opportunity, talent gravitates to the bright lights of the West. Indeed, the United Nations and the OECD report that migration for work has risen by one-third since 2000. 
In some countries, the brain drain has reversed its flow. The causes are fascinating, and there is reason to be optimistic that the vicious cycle can be broken, transforming the balance of hope and opportunity between developing and developed economies. 
A new study by LinkedIn, the world’s largest online professional network and recruitment platform, has measured the net international movement of talent among its members. 
Topping the list as a destination for talent is my own country, the United Arab Emirates, with a net talent gain of 1.3% of the workforce in 2013. Other net “talent magnets” include Saudi Arabia, Nigeria, South Africa, India, and Brazil. 
In fact, the top talent exporters in this study are Spain, the UK, France, the United States, Italy, and Ireland. Rich countries that until recently had been tempting away our brightest minds are now sending us their own. 
Of course, this is only one study, and many poor countries still suffer from a chronic talent exodus. OECD data show that many countries in Africa and Latin America have migration rates for graduates above 50%. 
Part of the tragedy playing out in Middle Eastern countries beset by conflict and instability is that if only their most talented sons and daughters could apply their skills at home, they would become part of the solution: agents of peace through development. This makes it all the more important to examine how some developing countries succeeded in reversing the outward flow. 
Talent flows naturally to countries that create an environment for economic growth; that make life easy for enterprise; that attract and welcome investment; and that nurture a culture of achievement. Skills are attracted to challenge and possibility. 
Opportunity on this scale is becoming a scarce commodity in many parts of the West. But this is not the case in the developing world – at least among countries with the appetite and determination to deploy strong governance and continually raise their competitiveness. 
We have shown that the business of reversing brain drain is also the business of creating a better life for citizens and residents. Building happiness is, after all, the primary business of good government everywhere. 
Ours is a story of great hope for the Middle East in particular, where generations of conflict and despair have driven high levels of outward migration. I have always argued that, besides good governance, the best solutions to the divisions and strife of the Arab world lie in grassroots development and economic opportunity. 
Research shows that small countries suffer disproportionately from brain drain. But we have shown that even for a small country like the UAE, and even in a region divided by conflict, it is worth building an island of opportunity. 
It means turning a vicious cycle into a virtuous one. By attracting the best talent from around the world, we can create a vibrant and diverse society that fuels innovation and prosperity – which in turn attracts still more talent. 
Human beings – their ideas, innovations, dreams, and connections – are the capital of the future. In this sense, the “brain regain” is not so much an achievement in itself as it is a leading indicator of development, because where great minds go today, great things will happen tomorrow. 

The People’s Climate 
Two million activists demanded through an online petition that governments shift to 100% clean energy. For the first time since the fated 2009 Copenhagen Climate Change Conference, virtual climate activism moved into the real world. 
They have come to recognize that powerful interests are blocking the necessary shift to clean energy, and they simply no longer trust that their governments are doing enough to stand up for the future of the planet. This was reflected not only in the record number of people who participated, but also in the diversity of the marchers – urban activists, indigenous groups, adherents of different faiths and political viewpoints, and, most conspicuously, old and young. 
People today draw natural connections between climate change and daily life. Teachers stood for schools that run on renewable energy, women supported healthier agriculture, grandmothers demanded clean air for their grandchildren, unions want a green job transition, and city mayors want investments in energy-efficient buildings. 
The aim was to create favorable conditions for governments to negotiate a climate deal in Paris in 2015. And, though the UN cannot enforce the promises that leaders made, the summit catalyzed a popular demonstration that has moved the political spotlight back to the climate-change challenge, where it is likely to remain until governments take credible action. 
Climate records continue to be broken worldwide. In 2014 alone, ordinary people suffered from heat waves in Australia, floods in Pakistan, and droughts in Central America, while the collapse of the West Antarctic ice sheet has been shown to be irreversible. 
As a result, the global debate has shifted from the costs of action to the costs of inaction. And, though the costs of climate damage are staggering, scientific research indicates that mitigation costs are manageable. 
People want clean energy, the technologies are available and profitable, and, with millions of people lacking access to reliable power, the emergence of renewable sources is a lifesaver. Global wind and solar energy capacity has tripled since 2009, and renewable energy now provides more than one-fifth of the world’s electricity supply. 
Indeed, every second megawatt of new electricity that is added globally is green, implying that the share of renewable energy could reach 50% in 2030. Clean energy is a game changer, because it puts power over power back into the hands of citizens, posing a direct challenge to the fossil-fuel industry. 
This week’s UN climate summit may not affect the course of negotiations for an international climate agreement. But it has put the focus back where it should be: real people demanding real change from their governments. 

The End of Malaria? 
In 2013, the disease was responsible for 584,000 deaths, nearly 90% of them in Sub-Saharan Africa; some 78% of its victims are children under the age of five. In the 97 countries in which malaria is endemic, it ravages the economic productivity of those who can least afford it: poor people with limited access to treatment and care. 
In July, the European Medicines Agency approved RTS,S – a vaccine also known by its trade name, Mosquirix – for use in children from six weeks to 17 months old. The global health community has long appreciated the importance of a vaccine in reducing the disease’s burden, and the World Health Organization is expected to make an announcement in November about the use of Mosquirix in countries where malaria is endemic, some 30 excruciating years after researchers at the pharmaceutical company GlaxoSmithKline (GSK) began working on the vaccine. 
It is also a testament to the enduring power of social philanthropy, partnerships, and international collaborations. However, many questions about the vaccine’s deployment – and its integration into the health systems of some of the world’s poorest countries – remain to be answered. 
It remains to be seen whether “equity pricing” will be feasible, considering the millions of dollars invested into research and development. GSK has said that Mosquirix will be offered “not for profit”; but the pharmaceutical company still must break even. 
And who will actually pay? Many African governments have shown some willingness to invest in public health infrastructure in the past; but a political commitment to the vaccine could mean redirection of resources from other important tools, including rapid test kits, cheap drugs, safe insecticides, and long-lasting insecticidal bed nets. 
International non-governmental organizations and private foundations have collaborated with the public sector in the fight against malaria, providing funds and bringing attention to the issue. It might be asking too much to expect them to pay for the vaccine. 
There are also questions about some countries’ capacity to distribute the vaccine, as well as uncertainty about how it will hold up under real-world conditions. For example, the testing for Mosquirix did not account for the possibility that parents would neglect to use insecticide-treated nets for their children because of a false sense of safety and security provided by the vaccine. 
Moreover, in order to maintain the vaccine’s efficacy, a booster needs to be delivered after the initial three doses. Without it, effectiveness drops to non-protective levels. 
Finally, many parents in Sub-Saharan Africa currently do not immunize their children for a variety of reasons, including distrust of health officials and ignorance. The polio vaccine faced an uphill battle in Nigeria, and the new malaria vaccine could suffer a similar fate. 
To meet them, African countries must initiate, develop, and support homegrown research capacity and leaner models for delivering care. Research and investment in physical and social infrastructure must be a high priority as well. 
Ten years from now, that statistic could be no more than a bad memory, thanks to Mosquirix. At the very least, the world now has a new weapon in the fight to reduce the disease’s toll. 

Carbon Majors and Climate Justice 
BONN – A groundbreaking study published last November revealed that the activities of a mere 90 producers of coal, oil and gas, and cement – dubbed the “carbon majors” – have led to 63% of all CO2 emissions since the Industrial Revolution. 
The report was released just weeks after Typhoon Haiyan (or Yolanda as it was known locally) tore through the Tacloban region in the Philippines. With unprecedented wind speeds of 315 kilometers (196 miles) per hour, the storm killed 6,300 people, left four million homeless, and caused more than $2 billion of damage. 
Haiyan and its devastation became a rallying cry for delegates at the subsequent United Nations climate-change conference in Warsaw. In response, they agreed to establish an international mechanism to address climate-change-related “loss and damage,” to be applied in countries that are unable to adapt or protect themselves from the worst effects of global warming. 
Those most vulnerable to climate change are often least responsible for its causes, and have the fewest resources to deal with its consequences. Contrast this with the carbon majors, which have made huge fortunes from the fossil fuels that are largely responsible for climate change. 
It seems only fair and reasonable, therefore, that all fossil-fuel entities, but especially the carbon majors, pay a levy on each ton of coal, barrel of oil, or cubic meter of gas they produce to a new International Mechanism for Loss and Damage, which would help to fund efforts to address the worst effects of climate change. Furthermore, given that the effects of climate change today are the result of past emissions, the carbon majors should pay a historical levy, too. 
The revenues could support vulnerable countries’ efforts to develop long term plans to deal with climate change, as well as finance pilot projects aimed at minimizing loss and damage, sharing information, and replicating best practices. They could fund the monitoring and forecasting of slow-onset and extreme-weather events, enabling authorities and the public to prepare more effectively for an impending disaster. 
Governments would collect the levies from the carbon majors, perhaps when they collect royalties and other extraction-related fees, and deposit the money with the international mechanism. If the new levy were added to existing fees, it would strengthen the price signal driving a shift away from fossil fuels and toward renewables. 
This fossil-fuel levy would be entirely compatible with the norms established by the United Nations Framework Convention on Climate Change and with the “polluter pays” and “do no harm” principles of international law, according to which organizations are required to pay for the damage that they cause. Indeed, the arrangement would be similar to existing regimes, such as those covering oil-spill compensation or nuclear damage. 
When the world’s governments meet at the UN climate-change conference in Paris in 2015, they must agree on ways to phase out net greenhouse-gas emissions and stop burning fossil fuels by mid-century. According to Carbon Tracker, 80% of fossil-fuel reserves must remain in the ground if we are to avoid catastrophic climate change. 
Even at today’s “low” level of climate change, the devastation is already all too real. It is real for the Philippines citizens mourning relatives and trying to rebuild homes and lives; for the Pacific Islanders growing crops in containers, importing drinking water, and building sea walls to protect their islands from the encroaching ocean; and for hungry farmers in the Sahel. 
These people deserve the world’s support – not just moral support, but genuine help in the form of effective, properly funded mechanisms designed to prevent, or at least alleviate, the climate-related hardships inflicted upon them by past and present industrialization. For the carbon majors, the time to pay up has arrived. 

India’s Fiscal Fortune 
And now, after the Central Statistics Office revised its methodology for calculating GDP data, that task has become easier still. According to the CSO, as a result of the methodological change, annual output growth in the second quarter of 2014 stood at 8.2%, up sharply from the original estimate of 5.3%. 
Based on the revised GDP figures, India is expected to average 7.4% growth in the fiscal year ending March 2015. Moreover, the country is projected to grow at an 8-8.5% rate in the next fiscal year. 
Nonetheless, Finance Minister Arun Jaitley's budget succeeds on several fronts – not least in its alignment of vision and implementation. Specifically, it advances the government's vision of a pro-growth agenda that enhances the ease of doing business in India, while targeting better delivery mechanisms for welfare schemes. 
On the expenditure side, the budget is expansionary, scaling up investment spending dramatically, introducing new welfare programs, and increasing credit for various sectors. While there is no significant effort to cap spending on some of the largest fiscal programs, including the National Rural Employment Guarantee Act (which guarantees 100 days of wages to rural households) or the fertilizer subsidy, measures to improve implementation and reduce leakage are being put in place. 
With private investment remaining weak, owing to the corporate sector's heavy debt burden and banks' huge volume of bad assets, the government has clearly decided to jumpstart the process through infrastructure spending. But India's infrastructure needs far exceed what the government can spend. 
The budget's success will be determined by how these public-sector investments play out, which in turn will depend on other policies, especially the Land Acquisition Bill (designed to enable industrial development in rural areas), which has already run into trouble. Moreover, government investment and allocation of resources has long been tainted by corruption, and Modi's government has yet to show that it can implement the budget's promises in a transparent and sustainable manner. 
The implementation of the Goods and Services Tax – a form of value-added tax on which the government has made admirable progress – would be a major accomplishment and a huge boost for the economy. Despite raising expenditure substantially, however, the budget relies mainly on growth and improved tax collection to keep the country's fiscal deficit within reasonable limits. 
Of the budget's many proposed measures to boost inflows of foreign investment, one appears risky from a macro-prudential perspective. The government would “do away with the distinction between different types of foreign investments, especially between foreign portfolio investments and foreign direct investments, and replace them with composite caps." 
Portfolio investment, often called “hot money" because of its volatile nature, can increase the economy's vulnerability to the vagaries of international finance. Foreign direct investment, on the other hand, is far more stable and driven by domestic fundamentals. 
In general, the budget plan addresses the major issues facing India's economy. But translating good intentions into desired outcomes will depend crucially on the government's ability to push through complementary and urgently needed reforms on hot-button regulatory issues like land, labor, and the environment. 
In any case, the budget sends a clear signal about the Modi government's intentions. At least in the near term, it is shifting its practice of “minimal government and maximum governance" to one of “moderate government and maximum governance." 

Marginalized People’s Neglected Diseases 
WASHINGTON, DC – When Pope Francis visited the United States in September, he delivered historic addresses to the US Congress and the United Nations General Assembly. Building on the sentiments of his encyclical letter, Laudato Si’, Francis highlighted the international community’s responsibility to respond to human suffering, such as that faced by refugees and those living in extreme poverty, and called for global solidarity in order to overcome social exclusion and inequality. 
This group of parasitic and related infections – including lymphatic filariasis (or elephantiasis), intestinal worms, and schistosomiasis – is a scourge of poverty. These illnesses afflict approximately 1.4 billion people per year, including more than 500 million children, causing untold pain and suffering and, through lost productivity, contributing to the cycle of poverty. 
Over the past decade, the international community has made important progress against NTDs. For example, the generosity of major pharmaceutical companies, which provide medicines free of charge, has enabled treatment programs to be scaled up. 
But, unfortunately, despite encouraging signs of progress, barely 40% of people at risk for these preventable diseases receive the medicine they require. Well over a billion people still do not have access to treatments for potentially debilitating conditions that cost less than $0.50 per person to deliver. 
The reason for the international community’s failure to solve this problem is as simple as it is ugly: for the most part, NTDs afflict only the poorest and most overlooked people. As Francis put it in Laudato Si’ “There is little in the way of clear awareness of problems which especially affect the excluded.” 
Congress was finalizing spending bills for fiscal year 2016, and the UN was completing its work on the Sustainable Development Goals (SDGs), setting targets that will guide development policy for the next 15 years. Both organizations would do well to heed the pontiff’s words. 
It is critical that the US continue its strong leadership on NTDs by maintaining funding for treatment programs in the federal budget, this year and in the years to come. As Francis reminded members of Congress, “How much has been done in these first years of the third millennium to raise people out of extreme poverty! 
On the international level, we are encouraged that UN members were inspired to assign high priority to the fight against NTDs in the post-2015 development agenda. In particular, a global indicator for NTDs – the “number of people requiring interventions against neglected tropical diseases” – was included in the SDGs’ monitoring framework. 
One of the most basic steps we can take to overcome what Francis calls “the globalization of indifference” is to come together in support of decisive, measurable action against NTDs. Introducing a global metric to mark our progress on the path to controlling and eliminating them for good is a true demonstration of our solidarity with the poor. 
In his UN speech, Francis reminded us of a crucial point: “Above and beyond our plans and programs, we are dealing with real men and women who live, struggle and suffer, and are often forced to live in great poverty, deprived of all rights.” If, with all of our technological advances and unprecedented private-sector donations, we cannot change the predicament of the poorest people for mere pennies per person, how can we truly expect to overcome the more challenging, costlier health and development challenges we face? 

The Myth of Net-Zero Emissions 
BERLIN – The emissions from burning coal, oil, and gas are heating up our planet at such a rapid rate that increasingly volatile and dangerous climate conditions seem almost inevitable. Clearly, we have to reduce emissions fast, while developing alternative energy sources that allow us to leave fossil fuels in the ground. 
Yet climate change has been subject to so much political inertia, false information, and wishful thinking for the last few decades that we continue to see ineffective or impossible solutions, rather than an effort to address root causes. Often these “solutions” are based on non-existent or risky new technologies. 
This approach is highly expedient, for it threatens neither business as usual nor socioeconomic orthodoxy. But climate models that depend on elusive technologies weaken the imperative to enact the deep structural changes that are needed to avoid climate catastrophe. 
The latest such “solution” to emerge is “net-zero emissions,” which depends on so-called “carbon capture and storage.” Though the technology still faces more than a few shortcomings, Intergovernmental Panel on Climate Change (IPCC) Chairman Rajendar Pachauri issued a deeply problematic statement last month, saying that, “With CCS it is entirely possible for fossil fuels to continue to be used on a large scale.” 
To be fair, the IPCC’s latest assessment report highlights the imperative of cutting CO2 emissions drastically to avoid exceeding the world’s small – and still risky – carbon budget. But to shift from clear-cut goals like “zero emissions,” “full decarbonization,” and “100% renewable energy” to the far hazier objective of net-zero emissions is to adopt a dangerous stance. 
So, instead of embarking immediately on a radical emissions-reduction trajectory, we can continue to emit massive amounts of CO2 – and even establish new coal plants – while claiming to be taking climate action by “supporting” the development of CCS technology. It is apparently irrelevant that such technology might not work, is riddled with practical challenges, and carries the risk of future leakage, which would have major social and environmental consequences. 
Bioenergy with Carbon Capture and Storage is the poster child for the new “overshoot approach” of net-zero emissions. BECCS entails planting a huge amount of grass and trees, burning the biomass to generate electricity, capturing the CO2 that is emitted, and pumping it into geological reservoirs underground. 
BECCS would have enormous development implications, provoking large-scale land grabs, most likely from relatively poor people. This is not some farfetched scenario; rising demand for biofuels has spurred devastating land grabs in developing countries for many years. 
Indeed, an estimated 218-990 million hectares would have to be converted to switchgrass to sequester one billion tons of carbon using BECCS. That is 14-65 times the amount of land the United States uses to grow corn for ethanol. 
Nitrous-oxide emissions from the vast amount of fertilizer that would be required to grow the switchgrass could be enough to exacerbate climate change. Then there are the CO2 emissions from producing synthetic fertilizers; clearing trees, shrubs, and grass from hundreds of millions of hectares of land; destroying large reservoirs of soil carbon; and transporting and processing the switchgrass. 
Even more problematic is the revelation that CCS and BECCS would most likely be used for “enhanced oil recovery,” with compressed CO2 pumped into old oil wells for storage, thereby creating a financial incentive to recover more oil. The US Department of Energy estimates that such methods could make 67 billion barrels of oil – three times the volume of proven US oil reserves – economically recoverable. 
In any case, no form of CCS advances the goal of a structural shift toward full decarbonization, which is what social movements, academics, ordinary citizens, and even some politicians are increasingly demanding. They are prepared to accept the inconveniences and sacrifices that will arise during the transition; indeed, they view the challenge of creating a zero-carbon economy as an opportunity to renew and improve their societies and communities. 
A clear understanding of the climate crisis expands the range of potential solutions considerably. For example, by banning new coal plants and shifting fossil-fuel subsidies toward the financing of renewable energy through feed-in tariffs, sustainable energy could be brought to billions of people worldwide, while reducing fossil-fuel dependency. 
While such innovative and practical solutions are prevented from being scaled up, billions of dollars are pumped into subsidies that reinforce the status quo. The only way to reform the system and make real progress toward mitigating climate change is to work to eliminate fossil fuels completely. 

Getting Anxiety Right 
NEW YORK – When researchers want to evaluate the efficacy of new anxiety treatments, the traditional approach is to study how rats or mice behave in uncomfortable or stressful situations. Rodents shun brightly lit, open spaces, where, in the wild, they would become easy prey. 
Neither patients nor their therapists consider the available options – including benzodiazepines like Valium and selective serotonin reuptake inhibitors like Prozac or Zoloft – as adequate treatments for anxiety. After decades of research, some of the big pharmaceutical companies are raising the white flag and cutting back on efforts to develop new anti-anxiety drugs. 
But we cannot afford to give up on treatment for the so-called anxiety disorders, which encompass problems related to both fear and anxiety. Feelings of fear occur when a possible source of harm is nearby or likely to present itself, while feelings of anxiety usually involve the possibility of harm in the future. 
Counter-intuitively, the reason that the most frequently prescribed anxiety medications don’t address the underlying problem is that they are working exactly as they should – according to the criteria used to design them. Most treatments based on studies using mice or rats do make anxiety disorders easier to live with. 
The brain systems that control behavioral responses in threatening situations are similar in rodents and humans, and involve older areas deep in the brain that work nonconsciously (for example, the amygdala). On the other hand, the systems that produce conscious experiences, including feelings of fear and anxiety, involve evolutionarily new regions of the neocortex that are especially well developed in the human brain and poorly developed in rodents. 
Consequently, though animal studies are useful in predicting how a drug will affect nonconsciously controlled symptoms triggered by threatening stimuli, they are less effective when it comes to conscious feelings of fear or anxiety. The drugs we have can help patients who, in order to avoid situations that inspire fear or anxiety, such as crowded subways or being judged by their peers or superiors, have stopped going to work. 
This doesn’t necessarily mean better drugs. Nonconscious responses can also be treated with exposure therapy, in which repeated interaction with a threatening stimulus is orchestrated in order to dampen its psychological effects. 
Findings about how conscious and nonconscious brain systems work may enable us to make exposure therapy more effective. The basic idea is that the symptoms involving nonconscious processes should be targeted separately from those involving conscious processes. 
Once the nonconscious systems are under control, use conscious exposures to treat conscious symptoms. Finally, employ more traditional psychotherapies: Verbal interactions with the therapist aimed at helping patients work on changing beliefs, reevaluate memories, encourage acceptance of one’s circumstances, acquire coping strategies, and so on. 
There is also a place for drugs in this approach, but not as a long-term solution. Rather, drugs can be used to make the exposure treatment more effective (the pharmaceutical d-cycloserine has shown some promise in this regard). 
The effectiveness of an approach that recognizes that different brain systems control different symptoms has yet to be properly evaluated, but research suggests that it should work. It would also be noninvasive and would require only a repurposing of frequently used procedures. 

A Strategy to Unite and Safeguard Europe 
BRUSSELS – The purpose – and even the survival – of the European Union is being questioned as never before. In fact, Europe’s citizens and the world need a strong EU now more than ever. 
Europe’s wider region has become less stable and more insecure in recent years. Moreover, the crises within and beyond the EU’s borders are directly affecting the lives of all European citizens. 
In challenging times such as these, a strong EU is one that thinks strategically, shares a vision, and acts together. In the wake of the United Kingdom’s vote to “Brexit” the EU, we Europeans will indeed have to rethink how our Union works; but we know very well what we need to work for. 
None of the EU’s member states, acting alone, has the strength to address the threats that Europe faces. Nor can they seize the opportunities presented by today’s global economy alone. 
We are the top trading partner and foreign investor for almost every country in the world. Together, the EU’s member states invest more in development cooperation than the rest of the world combined. 
It is also clear, though, that we in Europe are not making full use of this potential, at least not yet. A vast majority of our citizens understands that we need to take collective responsibility for our role in the world. 
The EU can deliver on its citizens’ needs and make its partnerships work only if we all act together – EU institutions and national governments, at all levels, united. This is exactly the aim of the Global Strategy for European Foreign and Security Policy, which I recently presented to the leaders of the member states and to the European Commission and European Council. 
This Strategy, the EU’s first in over a decade, focuses on defense capabilities and anti-terrorism as much as on job opportunities, social inclusion, and human rights. It deals with peace building and the resilience of states and societies in and around Europe. 
For example, the EU currently conducts 17 military and civilian operations around the world. In places as far afield as Afghanistan and Congo, Georgia and the Sahel, Moldova, Somalia, and the Mediterranean, thousands of men and women serve under the European flag. 
The Strategy nurtures the ambition of strategic autonomy for the EU, which is necessary to promote our citizens’ common interests, as well as our principles and values. Yet we know that such priorities are best served when we are not alone, and in an international system based on multilateralism and rules, not on global policemen and lone warriors. 
This is why the EU will continue to deepen the transatlantic bond and our partnership with NATO, while also connecting to new players and exploring new formats to advance our Strategy. The EU will invest in regional institutions, and in cooperation within and among regions. 
As we do this, we will engage in a practical and principled way, sharing global responsibilities with our partners and contributing to their strengths. Two decades of spreading global uncertainties have taught us a clear lesson: my neighbor’s weaknesses and my partner’s weaknesses are my own weaknesses. 
But all the goals outlined here can be achieved only by a truly united and committed Europe. Joining all our cultures together to achieve our shared goals and serve our common interests is a daily challenge, but it is also our greatest strength: diversity is what makes us strong. 
Our interests are indeed common European interests, and the only way to serve them is by common means. That is why all Europeans, and all EU member states, have a collective responsibility to strengthen our Union. 
A fragile world calls for a more confident and responsible EU, equipped with an outward- and forward-looking foreign and security policy. The new Global Strategy will guide us as we work toward a Union that truly meets its citizens’ needs, hopes, and aspirations; a Union that builds on the success of 70 years of peace; and a Union strong enough to contribute to peace and security in our region and worldwide. 

Taking the Offensive Against Tuberculosis 
In 2013 alone, it accounted for 1.5 million deaths, including one-fifth of adult deaths in low-income countries. Although the estimated number of people contracting TB annually is decreasing, the decline has been very slow. 
Nonetheless, the world now has a narrow window of opportunity to eradicate TB. Taking advantage of it will require the rapid development and dissemination of effective diagnostic tools, novel drug treatments, and innovative vaccines, in conjunction with efforts to ensure that health-care systems are equipped to deliver the right care. 
The World Health Organization’s post-2015 Global TB Strategy, which was endorsed by the World Health Assembly in May 2014, aims to eradicate TB by 2035. The Sustainable Development Goals, which will be formally adopted in September by the United Nations’ 193 member states, foresee achieving that objective five years sooner. 
To stem the development and spread of drug-resistant TB requires a two-pronged global effort: ensuring early detection and adequate treatment of patients with drug-sensitive TB, and finding new ways to treat patients infected with drug-resistant strains. The problem is that existing tools for TB diagnosis, treatment, and prevention have severe limitations. 
In low-income countries, the dominant diagnostic method is sputum microscopy, an outdated approach that fails to detect TB in about half of all infected patients, with an even lower success rate for young children and patients co-infected with HIV. Indeed, no more than one in ten children with TB is diagnosed by sputum microscopy. 
Moreover, for patients infected with multi-drug-resistant TB, treatment with the currently available drugs is successful only half the time, even under the best conditions. And the therapeutic process is tough, lasting at least two years and involving up to 14,600 pills and hundreds of injections – with severe side effects. 
New TB drugs with novel mechanisms of action are badly needed, not only to treat multi-drug resistant TB, but also to shorten the treatment time for drug-sensitive TB. Here, there is some promising news: Bedaquiline recently became the first new TB drug to be approved by the US Food and Drug Administration in 40 years. 
The Bacille de Calmette et Guérin (BCG) vaccine – the only one available for the disease, and the main pillar of TB prevention – is only partly effective. Indeed, while it protects children from the worst forms of the disease, it does not protect anyone against the most common variant, pulmonary TB. 
The challenges are clearly formidable. But, with millions of lives at stake, backing down is not an option. 
But scaling up investment in diagnostic tools and treatments for TB costs more money than has been allocated. Of the estimated €1.73 billion ($2 billion) that is needed annually for research and development, only €589 million was invested in 2013. 
Making matters worse, critical donor funding – provided by a very limited number of actors, mostly government agencies and philanthropic groups in OECD countries – fell by nearly 10% last year. At present, a single philanthropic donor, the Bill & Melinda Gates Foundation, supports more than 25% of research on new tools to fight TB. 
As for the private sector, pharmaceutical companies have been withdrawing from TB research, as part of a general trend away from anti-infective drugs toward the development of new drugs for chronic illnesses. Pfizer exited TB research in 2012, followed by AstraZeneca in 2013 and Novartis last year. 
Closing the funding gap and ending the scourge of TB will require the involvement of more – and more diverse – donors. If the private sector is unwilling to do its part, it is up to governments to step in with a sustained commitment – manifested in direct contributions, as well as efforts to create the right incentives – to achieving the SDG target to which they have agreed. 
In short, eradicating the TB epidemic presupposes efforts to ensure that health-care systems are capable of delivering the right care. And the right care requires rapid development and dissemination of new tools, including quick point-of-care diagnostic tests, safe and fast-acting drugs, and an effective TB vaccine. 

Polio’s Last Stand 
The vast majority of the 276 schoolgirls abducted in Chibok last year are still missing. And yet, during this time, despite such horrors, Nigeria has quietly managed to achieve something truly remarkable: an entire year without a single new case of wild polio. 
Until now, there were only three countries where the virus was still considered endemic: Afghanistan, Pakistan, and Nigeria. Health officials wait three years before declaring a country polio-free, but the one-year milestone in Nigeria raises hopes that we may have already seen the last case of wild polio in the country – and the whole of Africa. 
In addition to the logistical challenge of reaching every child in Africa’s most populated country, the Nigerian polio-eradication campaign has had to overcome security issues, opposition by religious fundamentalists, and rampant corruption. The fact that a country as troubled as Nigeria could pull off such an important feat is cause for celebration and provides grounds for optimism, not only in the fight against polio, but for global health efforts in general. 
The children that had previously not been reached with polio vaccines live in communities with little or no access to routine immunization, maternal healthcare, nutritional supplements, deworming, or malaria prevention. They are the children who are most at risk of dying before they reach their fifth birthday. 
Nigeria’s success in reaching these children is the result of the efforts of thousands of dedicated local volunteers, some of whom lost their lives in the process. Since 2012, there has been nearly a fivefold increase in the number of volunteers involved in mobilizing communities during immunization campaigns. 
In early 2012, for example, Nigeria’s government established dedicated emergency operations centers to coordinate data flow, facilitate decision-making, and improve accountability within the program. With support from Gavi, the Vaccine Alliance, Nigeria also installed more than 1,600 solar-powered refrigerators, which are critical to ensuring that vaccines remain safe and effective during their long journey through the distribution chain. 
The infrastructure has helped introduce new vaccines – such as pneumococcal conjugate vaccines, which protect against pneumonia, the biggest killer of children under the age of five – and increased coverage of routine immunization against measles and rubella. Thanks to the emergency operations centers, this infrastructure even helped to stop the Ebola outbreak in Nigeria in 2014, by enabling contact tracing and surveillance. 
These efforts have the additional benefit of ensuring that Nigeria cements its polio-free status. The health infrastructure put in place during the eradication campaign has enabled the deployment of injectable polio vaccines, which will complement the oral vaccines in ensuring that the virus does not return. 
This was also the pattern in India, the most recent country to be declared officially free of polio, with no cases since 2010. The infrastructure put in place to deliver polio vaccines there is now being used to increase coverage of routine immunization, like the 5-in-1 pentavalent vaccine. 
To eradicate the disease, however, we will have to build on successes like Nigeria’s and strengthen routine immunization efforts. The end of polio should mark not just the defeat of a terrible disease, but also the beginning of a new phase in the effort to reduce childhood suffering and death, the benefits of which will be felt for generations to come. 

From Nuclear Safety to Nuclear Security 
WASHINGTON, DC/MOSCOW – Four years ago, a devastating tsunami crashed into the coast of Japan. Fifty-foot waves breached the seawall of the Fukushima Daiichi nuclear power plant, cutting off its emergency power supply and disabling its cooling systems. 
The nuclear accident was the worst since the meltdown of the Chernobyl power plant in 1986. Investigators concluded that one of the underlying causes was complacency: those in charge of the facility believed that their safety systems were robust, and there was no effective independent oversight. 
The disaster in Japan has spurred reforms in the field of nuclear safety. But when it comes to nuclear security, complacency remains a major problem. 
Some are poorly secured. Yet enough nuclear material to fill a small bag of sugar is all it takes to construct a device with the potential to kill hundreds of thousands of people and inflict billions of dollars in damage. 
Much has been done to improve security at nuclear facilities in recent years, but governments must do more to protect their citizens from the risks of catastrophic nuclear terrorism. The lessons from the Fukushima crisis can serve as a useful guide for reform. 
For starters, governments and industry must treat nuclear security as a process of continuous improvement and work to keep pace with evolving threats and challenges. A facility considered secure 20 years ago might now be vulnerable to a cyber attack that bypasses its security systems or confounds efforts to keep track of its nuclear material. 
Well-organized and well-financed non-state groups, like the Islamic State, may employ new tactics, technologies, and capabilities to steal nuclear materials. Governments must therefore consistently evaluate evolving technologies and threats so that security systems designed to protect nuclear materials stay ahead of the capabilities of those who would seek to steal them. 
Second, governments and industry should make sure that security culture, like safety culture, becomes an integral part of every nuclear facility’s operations. As General Eugene Habiger, a former commander-in-chief of the United States Strategic Command who was the US Department of Energy’s “security czar,” once put it: “Good security is 20% equipment and 80% people.” 
Governments and industry should work together to nurture a strong culture of security. Each and every employee at a nuclear facility – from guards to scientists to senior staff – must view the security of nuclear materials as an essential part of their jobs. 
Third, governments must regularly review security systems at nuclear facilities. It is not sufficient for nuclear operators to say that the state of security in their facilities is “good enough.” 
Fukushima exposed the need for regulators to perform regular stress tests, evaluating the ability of nuclear facilities to stand up to various contingencies affecting their safety. Regulators should conduct similar evaluations aimed specifically at assessing facilities’ ability to withstand security threats, including theft by knowledgeable insiders. 
Finally, world leaders should seek to establish closer forms of international cooperation on nuclear security. As Chernobyl and Fukushima demonstrated, nuclear safety vulnerabilities in one country can have profound consequences for the rest of the world. 
Countries should draw on the example of the Nunn-Lugar Cooperative Threat Reduction program, a successful program of collaboration on nuclear security among the United States, Russia, and ex-Soviet states. Countries with nuclear materials should exchange information on how best to bolster security, increase intelligence-sharing on common nuclear-security challenges, and explore the possibility of conducting peer reviews. 
Our friend and colleague Sam Nunn, co-chairman of the Nuclear Threat Initiative, often warns that we are in a race between cooperation and catastrophe. It is important that we learn the lessons of Fukushima and incorporate them into our strategy to combat nuclear terrorism. 

Obama Versus Obamacare 
NEW YORK – The US Patient Protection and Affordable Care Act, President Barack Obama’s signature 2010 health-care reform, has succeeded in extending insurance coverage to millions of Americans who would not otherwise have it. And, contrary to critics’ warnings, it has not pushed up health-care costs; in fact, there is some hope that the cost curve may finally be bending downward. 
That will depend on the Obama administration’s other policies, particularly in an area that might seem unrelated: the United States’ ongoing discussions with India over intellectual property. And here, Obama appears determined to undermine his own signature reform, owing to pressure from the powerful US pharmaceutical lobby. 
Lowering health-care costs thus requires greater competition in the pharmaceutical industry – and that means allowing the manufacture and distribution of generic drugs. Instead, the Obama administration is seeking a trade deal with India that would weaken competition from generics, thereby making lifesaving drugs unaffordable for billions of people – in India and elsewhere. 
But the multilateral approach, using the World Trade Organization, has proved less effective than they hoped, so now they are attempting to achieve this goal through bilateral and regional agreements. The latest negotiations with India – the leading source of generic drugs for developing countries – are a key part of this strategy. 
In the 1970s, India abolished pharmaceutical patents, creating an advanced and efficient generics industry capable of providing affordable medicines to people throughout the developing world. That changed in 2005, when the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) forced India to allow drug patents. 
But, in the view of America’s pharmaceutical industry, TRIPS did not go far enough. The Indian government’s desire to enhance its trade relations with the US thus provides the industry an ideal opportunity to pick up where TRIPS left off, by compelling India to make patents easier to obtain and to reduce the availability of low-cost generics. 
Last fall, during his visit to the US, Indian Prime Minister Narendra Modi agreed to establish a working group to reevaluate the country’s patent policy. The US participants in the group will be led by the Office of the US Trade Representative, which serves the pharmaceutical companies’ interests, rather than, say, the National Academy of Sciences, the National Science Foundation, or the National Institutes of Health. 
As it stands, India sets the bar quite high, resulting in its refusal to grant patents for new combinations of existing drugs. India could also stop issuing compulsory licenses to allow other companies to produce a patent holder’s drug, in exchange for a fee – an arrangement permitted under TRIPS, but anathema to the drug industry. 
Indian manufacturers are able to sell the generic version profitably for less than $1,000 per treatment. The generic price is still a huge expense for people living on a few dollars a day; but, unlike the US price, it is manageable for many governments and aid organizations. 
This is hardly an isolated example. Low-cost generics have made it possible to treat tens of millions of HIV/AIDS patients in the developing world. 
In fact, the threat of competition from Indian generics is partly responsible for major pharmaceutical companies’ decision to make some of their drugs available to the world’s poor at low prices. If the US compels India to tighten its patent rules substantially, so that they resemble US rules more closely, this outcome could be jeopardized. 
Of course, if America’s strong patent regime were, as its proponents claim, the best way to foster innovation in the pharmaceutical industry, the Obama administration’s policy toward India could perhaps be justified. But that is not the case. 
A patent that raises the price of a drug a hundred-fold has the same effect on the market as a 10,000% tariff. In such cases, drug companies gain a powerful incentive to mislead doctors and the public about their products’ safety and effectiveness, and even to promote their drugs for inappropriate uses, often using innovative side-payments to persuade doctors to prescribe them. 
Yet openness is crucial for efficient scientific progress. Many economists, including the authors, have suggested a variety of alternatives to patent-supported R&D and testing that avoid these problems. 
If the Obama administration succeeds in forcing India to strengthen its patent laws, the change would harm not only India and other developing countries; it would also enshrine a grossly corrupt and inefficient patent system in the US, in which companies increase their profits by driving out the competition – both at home and abroad. After all, generic drugs from India often provide the lowest-cost option in the US market once patent terms have expired. 
Obama was right to push for a health-care reform that would increase the sector’s efficiency and accessibility. In its dealings with India, the Obama administration is pursuing a policy that flouts these goals, with consequences not just for India and the US, but for the entire world. 


Sugar-Free Health Care 
LAGOS – While at dinner recently at a restaurant in Nigeria’s capital, Abuja, I observed a mismatched couple. The man appeared to be at least 60, but was dressed in skinny jeans and a skin-tight sleeveless top, with a large gold chain and dark sunglasses, though it was after eight in the evening. 
Few people are shocked to see a wealthy older man take up with a younger, poorer women, promising to finance her education, travel, or shopping in exchange for her company. What is surprising is when one of these relationships develops into something deep and lasting. 
The relationship between Africa and the West, especially when it comes to health care, strongly resembles this sugar-daddy dynamic. For decades, health-care innovations have been copied from developed countries, perhaps with slight variations, on the assumption that father knows best. 
The reality is that African countries’ needs, interests, and resources differ substantially from those of their Western counterparts. For example, in most European countries, there are roughly 30 doctors for every 1,000 patients; in Nigeria, that ratio is closer to 4:100,000. 
The problem is that it has been difficult to shake the conviction that innovation flows only one way: from North to South. But developing countries can help to improve Western countries’ health-care systems, which are far from perfect (even at home). 
Total health-care spending in the United States is expected to reach $4.8 trillion – nearly one-fifth of GDP – in 2021, up from $2.6 trillion in 2010 and $75 billion in 1970. Likewise, in Europe, public expenditure on health care could rise from 8% of GDP in 2000 to 14% in 2030. 
Advances in medical technology also contribute considerably – 38-65%, according to the Robert Wood Johnson Foundation – to the increase in health-care spending. Such technologies expand the range of treatments available to patients, but often by replacing lower-cost options with higher-cost services. 
Ever-increasing global connectivity has reshaped the innovation landscape, enabling anyone with a mobile phone or an Internet connection to access the ideas and resources they need to deliver game-changing systems. Add to that a level of need that developed countries do not share, and developing countries can not only revolutionize their own health-care systems; they can also help to find solutions to the developed world’s health-care predicament. 
The good news is that developing countries’ innovative potential is becoming increasingly apparent. In order to leapfrog the constraints imposed by their countries’ lack of modern infrastructure, Africans are increasingly taking advantage of mobile technologies and renewable-energy sources like solar. 
Using a basic mobile phone, people can instantly – and at no cost – verify if a particular medicine is authentic. Similarly, the Embrace infant warmer, developed in India, costs roughly $200 – compared to $2,000 for a conventional incubator in the US – giving millions of low-birth-weight and premature infants access to this life-saving resource. 
Hundreds of innovations like these are delivering high-quality health care to those who need it most, for as little as 1% of the cost in America, Europe, or Japan. This kind of innovation can improve the lives of millions of people in developing countries, while helping to reduce the crippling costs of health care in the West. 
But a partnership of equals has a fighting chance. It is time for world leaders and multilateral organizations to recognize and support Africa’s potential to innovate – for everyone’s sake. 

Knowledge for Progress 
In his Bill for the More General Diffusion of Knowledge, Thomas Jefferson called for “a system of general instruction” that would reach all citizens, “from the richest to poorest.” It was the first step in the creation of the American system of public education – an institution that helped to propel the country’s rise to global prominence. 
Investments in education provided a catalyst for economic growth, job creation, and increased social mobility. As Claudia Goldin and Lawrence Katz have shown, it was American “exceptionalism” in education that enabled the country to steal a march on European countries that were under-investing in human capital. 
In fact, with the global economy becoming increasingly knowledge-based, the education and skills of a country’s people are more important than ever in securing its future. Countries that fail to build inclusive education systems face the prospect of sluggish growth, rising inequality, and lost opportunities in world trade. 
In this context, some of today’s discussions on education sound curiously anachronistic. Harvard economist Ricardo Hausmann recently berated what he describes as the “education, education, education crowd” for advocating an “education-only” strategy for growth. 
Expanding education in countries where institutional failure, poor governance, and macro-economic mismanagement stymie investment is a prescription for low productivity and high unemployment. In North Africa, the disharmony between the education system and the job market left young, educated people without decent opportunities – a situation that contributed to the revolutions of the Arab Spring. 
Extensive research – from the work of Adam Smith to Robert Solow and Gary Becker and, most recently, Eric Hanushek – confirms the importance of learning in building productive human capital. One step up the standard deviation score on the OECD’s Program for International Student Assessment is associated with a 2% increase in a country’s long-run per capita growth rate. 
Education may not be a quick fix for slow growth. But try naming a country that has sustained an economic transformation without advances in education. 
Economists at the World Bank have contributed a few straw men of their own to the education debate. In one contribution, Shanta Devarajan criticizes the view that education is an essential public good that governments should finance and deliver, arguing that it should instead be considered a private good, delivered through markets to customers – that is, parents and children – seeking private returns. 
It is, however, a “merit” good, something that governments should offer for free, because of the wide-ranging private and social returns that might be lost if parents underinvest, or if the poor are excluded. For example, progress in education – especially girls’ education – is closely associated with improvements in child survival and nutrition, and maternal health, as well as higher wages. 
It is time to move beyond futile discussions based on flawed logic to focus on the real challenges in education – challenges that must be addressed, if we are to meet the Sustainable Development Goal of delivering high-quality primary and secondary education to all by 2030. The Oslo summit presents an important opportunity to lay the groundwork for success. 
One background paper for the summit highlights the failure of successive governments in Pakistan, which now has the world’s second-largest out-of-school population, to invest in education. At the heart of the problem are politicians who are more interested in facilitating tax evasion by the wealthy than improving learning opportunities for the poor. 
That is around five times current levels. Beyond closing the aid gap, United Nations Special Envoy on Education Gordon Brown has rightly called for financing mechanisms to deliver education to children affected by conflict and humanitarian emergencies. 
In Nigeria, for example, urban boys from the wealthiest 20% of households average ten years of schooling, while poor rural girls in northern areas can expect less than two years. Yet, as another Oslo summit background paper shows, education finance is skewed toward the wealthy in most countries. 
Finally, governments and aid agencies must abandon market-based experiments, and commit to genuine system-wide reform. One key priority area is teachers, who need strong incentives, effective training, and dependable support systems to deliver real learning. 
As world leaders gather in Oslo, millions of parents will be struggling to ensure that their children receive the education they deserve – one that will enable them to build better lives for themselves and their families. For these parents, schooling is a source of hope. 

Overcoming India’s Official Homophobia 
NEW DELHI – Sixty-six years after adopting one of the world’s most liberal constitutions, India is being convulsed by a searing debate over a colonial-era provision in its penal code, Section 377, which criminalizes “whoever voluntarily has carnal intercourse against the order of nature with any man, woman, or animal.” Though not widely used – there were 578 arrests under Section 377 last year – the law is a tool for the harassment, persecution, and blackmail of sexual minorities within India. 
Beyond forcing millions of gay men and women to live in fear and secrecy, Section 377 has undermined HIV-prevention efforts and contributed to depression and suicides. A 2014 study by the World Bank revealed that India suffers a loss of between 0.1% and 1.7% of GDP because of homophobia. 
By giving the state the authority to control what Indian adults do, consensually, in their bedrooms, Section 377 violates the constitutional rights to dignity, privacy, and equality enshrined in Articles 14, 15, and 21, respectively. As the Nobel laureate Amartya Sen has observed, “The criminalization of gay behavior goes not only against fundamental human rights, but it also works sharply against the enhancement of human freedoms in terms of which the progress of human civilization can be judged.” 
Indian society did not collapse. Yet bigots petitioned to reverse that decision, ultimately succeeding in turning back the clock for gay rights in India in 2013, when the Supreme Court overturned the High Court’s decision. 
Like many Indians, I found the Supreme Court’s 2013 ruling antithetical to India’s commitment to pluralism and democracy, which provides for the embrace of a multitude of identities, including those based on sexual orientation. So, last December, I sought to introduce a bill that would have amended Section 377 and decriminalized all consensual sex between adults, irrespective of their gender and sexuality. 
A vocal section of homophobes in the ruling Bharatiya Janata Party (BJP) voted overwhelmingly against the bill’s introduction, so that no pragmatic debate on the bill’s merits could take place. The same thing happened when I tried again in March. 
The Indian ethos toward sexual difference has historically been liberal, with neither mythology nor history revealing the persecution or prosecution of sexual heterodoxy. In fact, the Hindu epics are dotted with characters like Shikhandi in the Mahabharata, who was born female and became male; many Hindus venerate the half-man, half-woman Ardhanarishvara; and temple sculptures across India depict homosexual acts. 
Unfortunately, thanks to the prejudices of a few dozen vocal and motivated BJP members, parliament is not up to the task. Indeed, legislative recourse for the injustice of Section 377 may not be available as long as the BJP is in power. 
The Supreme Court has now agreed to undertake a “curative review” of its 2013 decision. Such a review could lead it to repeal Section 377 of the Indian Penal Code. 
While I have been unsuccessful in my efforts to amend Section 377 through legislative channels, I remain committed to human rights, to keeping the government out of our bedrooms, and to defending Indian pluralism. As we await the Supreme Court’s review, we can and must continue to seek justice for India’s minorities in the court of public opinion. 
But, in terms of real change in this area, my hopes rest with the judiciary, rather than the government. After all, whereas change via legislation would require political courage – a quality sorely lacking in the current Indian government – the judiciary is not hampered by such considerations. 
The good news is that India’s Supreme Court has an exemplary record of interpreting statutes in a way that expands human rights in the country. The curative review raises hope that it will do so again, creating an India in which the law embodies constitutional values of privacy, equality, dignity, and non-discrimination for all citizens. 
The alternative – allowing Indian law to continue to serve as an iron cage for some of our people – would directly undermine the freedom of identity and expression that constitutes the backbone of Indian democracy. What is more, it would leave India out of step with much of the rest of the international community, a country embarrassed before the world’s other democracies. 
We must demand that our Supreme Court – if not our lawmakers – affirm a pluralist India that accommodates all identities within our country. The time for change was many years ago. 

Toward a Viable Climate Target 
BERLIN – Last December in Paris, 195 governments reached a consensus on how to curb climate change over the coming decades. But, as usual when it comes to the United Nations, the deal that was struck was big on stated ambition, but far more modest when it comes to commitments to concrete action. 
The Paris climate agreement includes a pledge to keep warming “well below two degrees Celsius above pre-industrial levels.” Furthermore, at the request of the world’s most vulnerable countries, language was added promising “to pursue efforts to limit the temperature increase to 1.5º.” 
The trouble is that these aspirations are not matched by the commitments called for by the treaty. Instead, the agreement’s system of voluntary mitigation pledges will allow global emissions to rise until 2030, likely leading to a warming of 3-3.5º by 2100. 
They address the whole Earth system, not individual actors or governments. By failing to state explicitly what individual countries are required to deliver, it allows leaders to support targets that seem ambitious, while pursuing mitigation efforts that are in reality insignificant. 
No scientific formula can describe how to share the burden of global mitigation equitably among countries, leaving every government able to declare confidently that its policies are in line with any given temperature target. An evaluation of whether the goals are being attained can be carried out only on a global level, and thus no country can be held responsible if the target is missed. 
Diplomats and politicians treat talk, decisions, and actions independently, in order to satisfy the demands of a diverse set of stakeholders and to maximize external support for their organizations. In climate policy, most governments choose a progressive stance while talking and deciding, but a more cautious one when it comes time to act. 
The Paris agreement itself offers one possible approach. Hidden behind a vaguely defined formula, a third mitigation target has been introduced: reaching zero emissions in the second half of the century. 
This provides a transparent system to evaluate the actions not only of national governments, but also of cities, economic sectors, companies, and even individuals. Defection would be discouraged because it is easy to see – and more important, to explain to the public – whether emissions are going up or down. 
Such a target would put all new fossil-fuel-based infrastructure under intense scrutiny; if we need to drive emissions down, why build another coal plant or badly insulated building? A shared vision of zero emissions could even spark a race to cross the finish line first. 
But history proves that this does not automatically lead to action. Replacing temperature thresholds with an effort to reduce emissions to zero would ensure accountability and minimize political inconsistency. 
There is precedent for such an approach. The Montreal Protocol for protecting the ozone layer primarily addresses harmful substances, trying to accelerate their phase-out, rather than defining a stabilization target for the ozone layer. 
The gap between real-world emissions and what will be needed to keep warming below the agreed-upon limits is rapidly widening. The UN has tasked the Intergovernmental Panel on Climate Change to conduct a detailed investigation of how to meet the – already unrealistic – ceiling of 1.5°C. This implies a risk that the world will waste valuable time on yet another debate about lofty goals. 
Whatever our temperature target, global emissions have to peak soon and decrease afterwards – all the way to zero. The Paris climate agreement will be remembered as a success only if we manage to shift our focus from talk to effective action. 

The African Dream 
KIGALI – The dream that the twenty-first century will be the “African Century” is powerful and intoxicating. 
It is also becoming reality. As African officials gather in Washington, DC, on August 4-6 for the first US-Africa Leaders Summit, it is worth considering the basis – and the limits – of the continent’s progress. 
While conflict and poverty remain serious problems in many African regions, our continent is not only more stable than ever before; it is also experiencing some of the highest economic growth rates anywhere on the planet. Over the past decade, tens of millions of people across Africa have joined the middle class; our cities are expanding rapidly; and our population is the most youthful in the world. 
But Africans must not take it for granted that their time has come. Words are cheap, and, despite the continent’s positive momentum, we know that history is littered with squandered dreams – nowhere more so than in Africa. 
Building bigger, more integrated sub-regional markets that are deeply embedded in the global economy is one of the most urgent tasks that we are facing. After all, from the European Union to the Association of Southeast Asian Nations to the North American Free Trade Agreement, we see how geographic regions can create conditions for shared growth and prosperity by removing barriers to commerce, harmonizing regulatory norms, opening labor markets, and developing common infrastructure. 
That is precisely the vision that we are working to realize in our own part of Africa, under the banner of the Northern Corridor Integration Projects. In the past 18 months, Kenya, Rwanda, and Uganda, joined by South Sudan and more recently Ethiopia, have launched 14 joint projects that will integrate East Africa more closely and make our region a better, easier place to do business. 
We have established a single customs territory, slashing red tape and removing non-tariff trade barriers. A standard-gauge railway from Mombasa to Kigali and Juba via Kampala is being designed, and financing for the first segment has been secured from Chinese partners. 
Unfortunately, across Africa, national borders have tended to be chokepoints rather than enablers of intra-continental cooperation on trade, security, labor, and environmental issues. Too often, Africa’s economies exchange goods and coordinate policy among themselves less than they do with countries outside of the continent. 
We are determined to change this. Under the Northern Corridor initiative, for example, each of our governments has accepted responsibility for shepherding key projects. 
Uganda is securing investors for a new oil refinery and is spearheading the development of regional infrastructure for information and communications technology, which will lead to the elimination of cellular roaming charges among our countries. 
Kenya is tasked with developing a regional commodity exchange, improving human resources through education and consultancy services, and building both crude and refined oil pipelines. Kenya is also exploring ways to expand regionally focused power generation and transmission. 
Rwanda is charged with aligning immigration laws and promoting freedom of movement for both citizens and visitors. Other coordination duties include regional security (through the East African Standby Force), coordinated airspace management, as well as joint tourism marketing. 
And we know what needs to be done. Progress will be achieved not by building monuments for politicians or holding summits, but by lowering the costs of doing business and raising the incomes of our people. 
Bureaucracies move slowly, sometimes because they are institutionally programmed to subvert change. The framework of the Northern Corridor Integration Projects is designed to generate and sustain the political will necessary to get the project done. 
The United States has always been an important partner for our countries, but the path to solving our problems is not through handouts from American taxpayers. Only we, together with our business sector, can do the job. 
Africa has always had what it takes to rise. Together, we can make it happen. 


Megafunding Drug Research 
SEATTLE – As price-gouging practices by a handful of drug companies attract headlines, one troubling aspect of the story remains underplayed. Exorbitant increases in the prices of existing drugs, including generics, are motivated not just by crass profiteering but by a deep skepticism about the economic feasibility of developing new drugs. 
In the US and many other developed countries, the average cost of bringing a new drug to market has skyrocketed, even as patents on some of the industry’s most profitable drugs have expired. Venture capital has pulled back from early-stage life-sciences companies, and big pharmaceutical companies have seen fewer drugs reach the market per dollar spent on research and development. 
Indeed, on average, only one of every 10,000 compounds identified as potentially useful in early-stage research will ultimately win approval from regulators. The approval process can take as long as 15 years and errs on the side of caution. 
The price tag for these “slow fails” can be enormous. Pfizer, for example, spent a reported $800 million on its cholesterol-lowering drug, torcetrapib, before pulling it from phase III clinical trials in 2006. 
Spurred by these pressures, finance experts have proposed several funding alternatives that reduce the risk of biopharma investments while improving the efficiency and productivity of the R&D pipeline. Although industry incumbents may be slow to shift gears, developing countries creating next-generation biopharma hubs have a unique opportunity to adopt and benefit from alternative models. 
Two decades ago, a company called Royalty Pharma launched a diversified model, building a fund of ownership interests in multiple drug royalty streams. Royalty Pharma focused on approved drugs with blockbuster potential, creating stable revenue streams and impressive equity returns – even during periods of extreme stock-market volatility. 
But Royalty Pharma’s model will not bridge the funding gap between the basic research supported by government grants and the late-stage development of drugs that are in clinical trials. Because the candidate drugs in this R&D “valley of death” are riskier than anything in which Royalty Pharma invests, an even larger portfolio of compounds would be needed to yield levels of risk and rates of return that are acceptable to typical investors. 
How large would that portfolio have to be? One of us (Lo) has carried out simulations of diversified funds for early- and mid-stage cancer drugs, which show that a so-called megafund of $5-30 billion, comprising 100-200 compounds, could sufficiently de-risk the investment while generating returns of between 9-11%. 
That’s not exciting territory for venture capitalists and private-equity investors, but it is in keeping with the expectations of institutional investors, such as pension funds, endowments, and sovereign wealth funds. Moreover, the risk reduction from diversification would allow the megafund to issue large amounts of debt as well as equity, further broadening the pool of potential investors. 
To put these numbers in context, consider that the US National Institutes of Health funds just over $30 billion annually in basic medical research, and members of the Pharmaceutical Research and Manufacturers of America spent about $51 billion last year on R&D. A megafund approach would help to make both investments more productive by filling the funding gap between them. 
Moreover, this model may work on a smaller scale. Further simulations suggest that funds specializing in some drug classes, such as therapies for orphan diseases, could achieve double-digit rates of return with just $250-500 million dollars and fewer compounds in the portfolio. 
It won’t be easy to manage a large pool of candidate compounds and dozens of simultaneous drug trials. Simulations show that megafunds will not work for all classes of drugs in all therapeutic areas. 
But where they do work, megafunds could make drug development vastly more efficient, and therefore less costly. No single company possesses the scale or finances to deploy all the advances in science and technology since the genomics revolution, but a megafund-backed effort could. 
Researchers employed by the fund could share knowledge, facilities, and state-of-the-art equipment, data, and computing resources, spread over a wide array of projects. Failures would be faster – and much cheaper – because stakeholders would be less dependent on any one project. 
Most are chasing the pharmaceutical and biotechnology industries. China has established hundreds of life-sciences research parks and committed billions of dollars in national funds for drug development; comparable programs are under way in India, Singapore, and South Korea. 
A biopharma megafund would offer a competitive edge in the industry, with lower development costs, a higher success rate, and faster time to market. Regional economies would benefit from the same networks of high-paying research jobs, entrepreneurs, investors, and service providers that traditional life-sciences innovation hubs create. 
London’s mayor recently embraced this approach, proposing a $15 billion megafund to help the United Kingdom maintain a leadership role in drug development. In addition to direct investment, governments can also create incentives for the formation of these kinds of funds – for example, by guaranteeing bonds issued for biopharma research. 
That funding must pay off for both society and investors. Emerging countries can lead the world to better health and greater wealth by pioneering new ways to finance drug development. 


Squashing the Superbugs 
LONDON – Current antibiotics are becoming increasingly ineffective, not only at fighting common illnesses like pneumonia and urinary tract infections, but also at treating a range of infections, such as tuberculosis and malaria, which now risk again becoming incurable. With the G-7 leaders having committed, in a recent joint declaration, to tackle “antimicrobial resistance” (AMR), it is time for the more inclusive G-20 – and China, as it chairs the group for the first time – to take the fight to the next level. 
Failure to address AMR will affect everyone, regardless of their nationality or their country’s level of development. Indeed, by 2050, ten million people could be dying as a result of AMR, up from around 700,000 today, with China and India each housing about one million sufferers. 
After all, if infections travel with the people who carry them, so does resistance, meaning that the only solution to AMR is a shared one. That is why members of the World Health Organization have agreed to implement a “global action plan on AMR,” and have called upon the United Nations to convene a high-level meeting of political leaders in 2016. 
In this effort, the emerging economies – with their large populations, rising wealth, and growing international clout – have a particularly important role to play, with China leading the way. We at the Review on Antimicrobial Resistance (which I chair) have already recommended such a role for China, including in discussions with some Chinese policymakers. 
Between now and 2016, the stage must be set for China to act. The G-7 countries should drive this effort forward by taking concrete steps to fulfill the commitments they made in their joint declaration. 
Some European governments have already made significant progress in regulating this practice. The United States has been slower to act, but has lately made some important policy moves. 
But perhaps the best way to change the way livestock are raised is by putting pressure on major food companies – a feat that consumers could achieve most effectively. Indeed, rising demand for healthier foods, including antibiotic-free meat, has already compelled major food-industry players like McDonald’s, Costco, and KFC to declare their intention to phase out antibiotic-laden meat. 
Governments should capitalize on this trend by implementing a major social-media campaign highlighting the smarter, healthier habits that all people should adopt – habits that would indirectly reduce demand for antimicrobials. The low cost and potentially high payoff of such a campaign makes it all the more appealing. 
A second commitment included in the joint declaration – to help ensure that medicines are used only when they are needed – may seem obvious, but in fact represents a major problem driving AMR. The key to addressing this problem is, as the declaration recognizes, to develop and improve access to rapid point-of-care diagnostic tools. 
But they will invest only if they are confident that health systems will use their innovations. If governments, say, mandated that particular diagnostic tests must be conducted before antibiotics could be prescribed, companies would have the necessary incentive. 
Such a requirement would face criticism, with some claiming that testing takes too long, and thus is not always possible before starting treatment. While this may be true in rare cases, there are many areas where fast and effective tests exist, but are not yet used widely – either in developing or developed countries. 
Consider one of the most common infections: sore throats. Though they are often viral, rather than bacterial, they are frequently treated with antibiotics – an approach that not only is ineffective, but also fuels AMR. 
In a trial by a British pharmacy chain (which, admittedly, used a small sample), the test reduced the number of antibiotics consumed by nearly 60%. Investment in the development and deployment of this technology could lead to a substantial decline in unnecessary antibiotic treatments for sore throats, not to mention ease pressure on health systems and save doctors’ time. 
A third imperative, recommended by the Review and recognized by the G-7, is improved surveillance of the spread of drug-resistant infections, particularly in developing countries, where such data is most sparse. On this front, our own government is leading the way, with Chancellor George Osborne pledging in March to allocate £195 million ($307 million) to help emerging countries finance the fight against AMR. 
The world faces many challenges and crises, virtually all of which will demand strong political commitment and significant investment to resolve. But the fact is that, when it comes to AMR, governments have a rare opportunity to preempt a major crisis, at a fraction of the cost of responding to the crisis once it has escalated. 
That is why the G-7 governments should intensify their efforts to address AMR. And it is why China and the other emerging economies should join the fight. 

Francis of the Forest 
WASHINGTON, DC – When Pope Francis visited Latin America in July, he made an impassioned plea for the protection of the Amazon rainforest and the people who live there. “Our common home is being pillaged, laid waste and harmed with impunity,” he told activists gathered in Bolivia for the World Meeting of Popular Movements. 
Heeding Francis’s call for action is not only a moral issue; it is a practical one. When world leaders meet at the United Nations Climate Change Conference in Paris later this year to craft a response to the challenges of global warming, they should put in place policies to protect tropical forests and the people who make them their home. 
Franciscan, Jesuit, and Dominican priests have been spreading the gospel in the region for centuries. What makes Francis’s appeal different is that his words were directed not so much at the local population, but at the residents of North America and Europe, where demand for timber, biofuels, and agricultural products drives the destruction of the rainforests and imperils the lives of indigenous populations. 
In September 2014, for example, Edwin Chota and three other leaders of the Asháninka communities in Peru, were brutally murdered, most likely by illegal loggers. Two months later, José Isidro Tendetza Antún, a leader of the Shuar people in Ecuador, was tortured and killed while headed to a protest against a mining project that threatened his people’s homeland. 
In addition to being an affront to human rights, deforestation and the accompanying assault on indigenous cultures is a serious threat to the fight against climate change. The links between the loss of forest cover and global warming has been well documented. 
The forests where indigenous people live often hold more carbon than those managed by any other owners, public or private. Indeed, indigenous reserves in the Brazilian Amazon have played a critical role in lowering deforestation rates – at a considerable cost. 
During the proceedings in Paris later this year, countries will be expected to present national plans – known as Intended Nationally Determined Contributions (INDCs) – outlining the specific steps they will take to reduce CO2 emissions. If Francis’s appeal is to be respected, these steps must include commitments to help indigenous people secure the right to their land and empower them to protect their forests against destruction. 
So far, only a little more than one-quarter of the world’s countries have submitted preliminary INDCs for review. Unfortunately, few countries with tropical forests have submitted their plans, and not one of the Amazon countries has done so. 
The government has used its INDC to set several ambitious goals, including commitments to zero deforestation by the year 2030 and to restoring forest ecosystems in the country’s watersheds. And yet, while Mexico has relatively strong formal land and property rights for indigenous peoples and local communities, those rights have yet to be integrated with other regulations – hindering any kind of economic development. 
Forest communities must be provided with assistance in managing their resources and maintaining their livelihoods. The Green Climate Fund, established by the United Nations to help developing countries mitigate CO2 emissions and adapt to climate change, should include provisions specifically for indigenous people, along the lines of the Climate Investment Fund’s Dedicated Grant Mechanism. 
Francis’s upcoming trips will include visits to Washington, DC and Paris, where he is expected to continue his advocacy on behalf of the environment. It is up to our leaders to answer his call and turn prayers into policy. 

The Inclusion Imperative 
But, unfortunately, many countries still remain far from achieving them, and, even in countries that have made substantial progress, some groups – including indigenous peoples, residents of slums or remote areas, religious or other minorities, and people with disabilities – are consistently left out. As a recent World Bank report emphasizes, understanding the causes of exclusion is critical to ensuring that future development efforts are more effective and inclusive. 
Social and economic exclusion is not only a moral problem; it is also extremely costly. 
A 2010 World Bank report on the exclusion of the Roma from educational and economic systems in Europe estimated annual productivity losses of at least $172 million in Serbia, $273 million in the Czech Republic, and $660 million in Romania (using April 2010 exchange rates). 
The World Health Organization and the World Bank found that children with disabilities are less likely to enter school than their non-disabled peers – and that they also stay in school at lower rates. In Indonesia, there is a 60% discrepancy between the share of disabled and non-disabled children attending primary school and a 58% discrepancy for secondary school. 
The emerging development agenda that will succeed the MDGs reflects a more acute awareness of the critical importance of inclusivity. 
In its report on the post-2015 agenda, the High-Level Panel of Eminent Persons emphasized inclusion, stating that “no person – regardless of ethnicity, gender, geography, disability, race, or other status – is denied universal human rights and basic economic opportunities.” The next development agenda, it asserts, must “end discrimination” and “tackle the causes of poverty, exclusion, and inequality.” 
Given this, it is not surprising that inclusion is a cornerstone of the ambitious new proposal for the MDGs successor, the Sustainable Development Goals (SDGs) – beginning with the goal-selection process, in which developing countries are playing a leading role. 
Targets must be clearly defined, measurable, and actionable, and they must be supported by effective monitoring, evaluation, and shared frameworks of accountability. Moreover, a system must be created to help countries transform the global goals agreed at the United Nations into concrete measures that suit their particular economic circumstances and social norms. 
To this end, Mexico’s government has hosted a series of workshops this year that have engaged representatives from governments, UN agencies, multilateral development banks, and academia to share visions, best practices, and methodologies to implement, measure, and monitor inclusive and sustainable goals. These discussions were informed by the international community’s commitment to tackling the structural causes of poverty, inequality, and environmental degradation. 
After all, these objectives cannot be achieved unless investment in development benefits everyone; ensuring this requires a focus on groups that have consistently been marginalized. That is why the World Bank Group established equality as a key theme of this year’s Annual Meetings of the World Bank and the International Monetary Fund. 
Policies and programs that seek to address social inclusion do not necessarily do more; rather, they do things differently. With such an approach, South Africa has made considerable progress from institutionalized segregation toward an ideal of a “rainbow nation” in just two decades. 
Similarly, Bangladesh has advanced inclusion by expanding participation in its once-exclusionary system of informal local justice, the shalish. Vietnam’s Northern Mountains Poverty Reduction Project, created to provide improved social services and sustainable infrastructure to the region’s poor villagers, demonstrated the vital role that ethnic minority community members can play in development initiatives. 
Finally, Mexico’s Inclusive Early Childhood Development Compensatory Education Project, focused on expanding access to early-childhood-development services and improving learning outcomes in the most marginalized municipalities, has engaged with excluded groups to identify their specific needs. For example, it provides bilingual education, as requested by indigenous parents. 
Of course, designing an inclusive post-2015 development agenda is only the first step. Its successful implementation will require bold policies and strengthened global cooperation that address both the impact of inclusion and its underlying causes. 
Moreover, world leaders must apply the key lessons of the MDGs: clear targets, adequate financing, and better data are essential to evidence-based policy and monitoring its effectiveness. With such an approach, the next development agenda can finally ensure that all groups gain in terms of economic opportunity and social progress. 

Health in a Time of Ebola 
But, as panic about the spread of Ebola grips Liberia – as well as Sierra Leone, Guinea, and Nigeria – people there are increasingly associating clinicians and health-care facilities with exposure to the disease. Ensuring that they continue to seek care when they need it requires improvements to frontline clinics and investment in locally hired community health workers (CHWs) to reach the vulnerable in their homes. 
To be sure, the shortcomings of Liberia’s health-care system long preceded the Ebola outbreak, with roughly 28% of the country’s four million citizens lacking access to adequate facilities. 
The 2003 Accra Comprehensive Peace Agreement may have ended years of civil war, but it left the country with only 51 doctors and decimated infrastructure. 
With very few qualified health-care professionals, repairing the health-care system demands more than building new hospitals and clinics across Liberia’s densely rain-forested countryside. Fortunately, the government, like others in Sub-Saharan Africa, recognizes the need to invest in training CHWs in rural counties to treat diarrhea, pneumonia, and malaria – the three major causes of death in children under five years old. 
By definition, CHWs have deep relationships with their communities, including traditional healers, which enables them to help the formal health-care system calibrate its approach. At the same time, mobile technologies facilitate quality control and supervision, while providing CHWs with expert clinical support. 
In March, Liberia’s health ministry, in collaboration with United Nations agencies, USAID, local and international NGOs, and private companies, created a comprehensive scale-up plan for the country’s community-health program. But Ebola struck soon after, shifting attention to clinics, quarantines, and reports of cures. 
The World Health Organization (WHO) has played a central role in coordinating the international response along with national governments, aid groups like Doctors Without Borders, and the US Centers for Disease Control and Prevention (CDC). With the epidemic still growing, the public-health community is attempting to mount an effective response, using a $100 million funding boost to deploy clinicians, epidemiologists, and other experts. 
To be sure, investments in CHWs should not come at the expense of critical public-health measures to slow the spread of Ebola or support for frontline clinics. But without continued investment in CHWs, whose costs are modest compared to those of traditional health-care systems, it will be difficult for the international community and national governments to stop the spread – and prevent the recurrence – of Ebola and other devastating epidemics. 
One has hospitals at the center and clinics radiating outward; the other is founded on social networks and mobilized by CHWs. If the first is too rigid, diseases and their social context evolve beyond its means. 
Doing so in the midst of an epidemic is even more complicated, owing to the social dimension of epidemics. In other words, how people respond when a child or family member falls ill is shaped by their friends’ and neighbors’ experiences, the availability of health-care services, and the community’s perception of those services; this response, in turn, determines how and to what degree the disease will spread. 
As a CDC expert explained, CHWs are the key to stopping Ebola, because anybody who shows symptoms of the disease becomes a “suspected patient,” all of whose contacts must be followed for another three weeks. “Every day, except Sunday, the workers report their findings to a supervisor.” 
One organization, Last Mile Health, has built a network of 300 CHWs that serves 30,000 patients, providing access to basic clinics even in places like hard-to-reach Konobo, Liberia. The organization’s hybrid structure is capable of addressing regular challenges, while retaining the flexibility to respond to extraordinary developments. 
As the rainy season approaches, threatening to facilitate the emergence of multiple epidemics that will overwhelm the health-care system’s capabilities, the need to mobilize, train, and equip citizens to respond has become even more urgent. This demands a combination of targeted development aid, domestic investment, expert support, and on-the-ground perspectives from Sub-Saharan countries that have successfully scaled up CHW networks. 
Indeed, buttressed by the organizations behind the One Million CHWs campaign, these countries are already working to scale up CHWs. But they need more support, and international agencies and development banks remain too focused on containing the Ebola epidemic to offer the needed backing. 
International organizations must recognize that they do not have to choose between supporting traditional health-care investments and emergency-response efforts. Long-term investment in credible health-care systems is the only way to head off future epidemics. 

A New World of Health Care 
In the OECD, costly hospitals and clinics dominate health services, and account for 97% of the United States’ health-care spending. These systems are struggling in the face of cost constraints, public demand for higher quality, and exaggerated expectations. 
We need both approaches; and we need them to work together. Indeed, the growing gap between the promise and the reality of health care has created room – in developed and developing countries alike – for new players who are concerned more with social behavior than with biology. 
In his seminal 1996 article in the Harvard Business Review, W. Brian Arthur identified the important distinctions between a health-care system defined by planning, hierarchy, and control and one characterized by observation, positioning, and flattened organizations. The first type of system, he argued, is concerned with materials, processing, and optimization. 
It can increase returns through its agile structure and ability to meet varied, locally determined, needs. It is not driven by the interests of any specific industry, and it complements, rather than competes with, high-cost health-care systems. 
The latter approach is particularly relevant to conditions such as heart disease, hypertension, and diabetes, which most closely reflect individual behavior, physical context, and socioeconomic factors. 
A few major pharmaceutical companies compete for a finite group of diabetics by offering new formulations, marginal improvements in blood-sugar control, competitive pricing, and strategic partnerships with insurers and health-care providers. These incumbents are primarily concerned with defending their market position. 
But the key to living well with diabetes is a nutritious diet, an active lifestyle, social support, and coaching that is tailored to each individual’s circumstances. This basic formula also forms the foundation of efforts to prevent diabetes, as well as most chronic diseases. 
Indeed, traditional medical care accounts for only a small share (perhaps 20%) of our quality of life and life expectancy, while the rest is determined by healthy behavior, social and economic factors, and the physical environment. Dealing with the global epidemic of chronic diseases requires us to address this 80%, and doing so cannot be left to traditional health-care organizations alone. 
Instead, many successful initiatives, built upon existing social infrastructure, solve known health problems and even uncover new issues. Examples of this new approach include technology companies such as Omada Health, which delivers customized online health coaching at home for people at risk of diabetes; social enterprises, such as the Grameen Bank, which is building low-cost primary care systems on the back of its microlending networks; and the One Million Community Health Worker Campaign, which teaches ordinary citizens how to provide care in their own communities, based on lessons learned from similar models in Ethiopia, Rwanda, and elsewhere in Sub-Saharan Africa. 
Moreover, these new entrants should have access to the costly data and financial infrastructure of traditional health-care systems. Physicians and nurses should be encouraged to work with new health practitioners to engage external stakeholders, such as schools, food companies, financial firms, and social services. 
Britain’s National Health Service in Wales, for example, is experimenting with community practices similar to those used in Brazil. New York City, inspired by African health networks, is expanding its community health networks to connect the city’s disjointed services. 
To be sure, the promise of traditional health care will always be compelling as long as technological progress continues to enhance health infrastructure and service delivery. Even so, there is much to learn from a new generation of health experts who understand how individuals make decisions, how collective action creates a healthier environment, and how good health is a means to a better life. 
Ultimately, the new world of health care has unlimited potential, because its frontier is where we live, work, and play, making all of us health-care experts and innovators. Ultimately, the battle against chronic disease will be won or lost at home. 

New Frontiers in Development Finance 
WASHINGTON, DC – When the Millennium Development Goals (MDGs) expire at the end of this year, the world will have made significant progress on poverty reduction, the provision of safe drinking water and sanitation, and other important objectives. In order to ensure that the next development agenda, underpinned by the Sustainable Development Goals (SDGs), produces even greater progress, world leaders must refine and optimize the MDG framework – particularly when it comes to financing. 
The MDGs brought together governments, multilateral organizations, and NGOs to support the implementation of key programs and policies, with global partnerships advocating for resources. In order to maximize efficiency, the MDGs were pursued and funded individually, rather than as a unit, with new initiatives being implemented when targets were not being met. 
This sectoral model must be reevaluated ahead of the next development agenda's launch to ensure that such imbalances do not persist. Doing so is particularly important, given that the proposed SDGs attempt to incorporate the social, economic, and environmental dimensions of sustainable development, making them more comprehensive and interdependent than the MDGs. 
In September, the UN General Assembly will convene to launch the SDGs. And in December, world leaders will attend the 21st Conference of the Parties (COP21) of the UN Framework Convention on Climate Change, where they are expected to adopt a binding global agreement on the long-term reduction of greenhouse-gas emissions. 
Given the vital importance of finance in supporting development initiatives, it should be among the first issues to be addressed. World leaders must avoid making the same mistake they made with the MDGs – the implementation of which was delayed for two years, until financing was agreed at the 2002 Monterrey Consensus – by developing an effective and traceable financing program at their earliest opportunity: the conference in Addis Ababa. 
Beyond funding for initiatives aimed at eradicating poverty and hunger, improving health and education, strengthening governance, and promoting gender equality, investments must be made in infrastructure, energy, and agriculture. The SDGs will also call for financing global public goods, including environmental protection and efforts to combat climate change and mitigate its impact. 
With governments and international donors unable to foot the bill alone, they must develop programs and policies that can channel a larger share of global savings, which now amount to roughly $22 trillion annually, toward the SDGs. Specifically, national and local governments and international financial institutions should leverage their resources by deploying tailored financing measures, including public-private partnerships, performance-based instruments, and a variety of credit and political risk guarantees. 
This will be especially pertinent for emerging middle-income economies. As these countries strengthen their creditworthiness and improve their capacity to manage debt and equity instruments, they will have at their disposal a larger toolkit of financing instruments with which to attract private-sector resources. 
By tapping private resources, emerging economies can free up much-needed official development assistance (ODA), which can then be channeled toward poverty-reduction efforts and to countries that international private financial flows largely bypass (and that thus have a lower capacity to raise resources domestically). Viable financing solutions should be considered on a case-by-case basis across countries and sectors. 
To ensure that the Addis Ababa conference produces the needed action, the World Bank, the International Monetary Fund, and several regional multilateral development banks (MDBs) are working on a joint approach that will leverage billions of dollars in grant and ODA funds into the trillions needed to finance the post-2015 agenda. 
MDBs already help, individually and collectively, to leverage scarce official assistance to attract enough capital to finance development projects. In fact, their financial leverage is built into their structure: they are fundamentally financial institutions, funded efficiently by small amounts of paid-in capital, which is backed by callable capital from shareholders. 
The MDBs also have significant operational leverage, stemming from their capacity to establish – through innovation, intermediation, and market creation – conditions that are attractive to the private sector, thereby producing sustainable solutions and investment opportunities. And they provide integrated, cross-sectoral inputs, by investing in the systems, institutions, and capacities that are needed to achieve development goals. 
To support this joint approach, the World Bank is providing an analysis, based on 11 case studies, of how countries in diverse circumstances can use a combination of public, private, domestic, and international sources of financing most effectively to fund the implementation of the SDGs. The analysis will also recommend a pragmatic approach to assessing the SDGs' financing needs at the country level. 
The MDBs will discuss their common approach at April's IMF-World Bank Group Spring Meetings. Their ability to identify tangible financing solutions will be crucial to set the stage for the Addis Ababa conference in July – and, indeed, for the successful implementation of the SDGs and the post-2015 development agenda. 

Death and Hope on the High Seas 
They survived the catastrophic mass extinction that finished off Tyrannosaurus Rex and all the rest, as well as the Permian-Triassic extinction that wiped out around 96% of marine species. Even the more recently evolved shark lineages, such as the hammerheads, have been around for more than 30 million years. 
Yet in just a few decades, a quarter of all sharks and rays have become threatened with extinction. This is our fault – and it is our responsibility to fix it. 
Many other components of marine biodiversity – especially corals, marine mammals, seabirds, and turtles – are also struggling to withstand human pressures. As a result, marine ecosystems are at risk of unraveling and becoming less stable and less productive. 
Given the broad range of threats facing marine life – including overfishing, climate change, pollution, and coastal development – it is easy, perhaps even rational, to be pessimistic. Yet this year could mark the beginning of a more robust approach to safeguarding ocean ecosystems, particularly with regard to overfishing, which is responsible for precipitous declines in many species. 
The challenge ahead should not be underestimated. Meeting it will require overcoming one of the most intractable obstacles to marine conservation: ensuring the sustainability of biodiversity in the roughly 60% of the world’s oceans that lie beyond the jurisdiction of individual states. 
Within the 200-nautical-mile limit that comprises their exclusive economic zones (EEZs), a few countries have used a combination of strong legislation, good management, and effective enforcement to preserve fish stocks and ecosystems. (There have also been far too many counter-examples.) 
Beyond the EEZs, however, a pernicious problem arises: most living resources are de facto open-access, leaving them vulnerable to overexploitation. While there have been numerous well-intentioned attempts to improve management of these resources, all rely on individual actors’ willingness to concede the short-term economic benefits of intensive resource use for the sake of the long-term common good. 
This is especially true for environmental issues, where the political capital required is high; the need for near-unanimous support is crucial; the issues can be contentious; and the benefits are disproportionately distributed and are realized over a long time horizon. A passing familiarity with the Realpolitik of climate change suggests that this is an intimidating – if not intractable – challenge, displaying elements of the most difficult political and social quandaries: the prisoner’s dilemma, the free-rider problem, and the tragedy of the commons. 
At present, a web of legislation – including the United Nations Convention on the Law of the Sea, Food and Agriculture Organization guidelines, and the Fish Stocks Agreement, as well as the Convention on Migratory Species of Wild Animals – governs activities that may affect biodiversity on the high seas. Yet the protection afforded to living resources remains limited – and riddled with loopholes. 
For example, because not all countries are signatories to these agreements, vessels can choose which flag to fly to avoid being bound by regulations (a “flag of convenience”). Some fisheries remain outside the jurisdiction of any of the regional bodies that play a role in resource management. 
One promising step, recommended by a UN working group in January, is the development of a new, legally binding agreement on high-seas biodiversity, to be ready for the UN General Assembly to review by September. 
Such a coordinated and harmonized framework may help to close regional gaps in governance; compel existing fisheries bodies to work to improve outcomes; and ultimately enable the development of new bodies that are focused on management and protection of ecosystems, not only fish stocks. That, in turn, may catalyze the cooperation needed to create high seas marine protected areas, which would enable damaged or depleted ecosystems to recover. 
A promising development has been the use of satellite technology to detect and address fisheries violations by individual vessels. This could bring about a profound change for the better in ocean management, particularly for countries with large EEZs and limited marine enforcement capacity. 
A coordinated system for responding to violations is also vital. Closing ports to vessels that break the rules could be achieved through the Port State Measures Agreement, currently awaiting ratification. 
Marine resources cannot be overexploited indefinitely. The forthcoming “biodiversity beyond national jurisdiction” agreement, underpinned by novel ways of monitoring compliance, could improve ocean management dramatically. 
The difficulty is that, in any scenario, better management assumes that we choose long-term sustainability over short-term profits. Whether we will overcome our inclination to choose otherwise remains to be seen. 

Publicly Funded Inequality 
WASHINGTON, DC – One of the factors driving the massive rise in global inequality and the concentration of wealth at the very top of the income distribution is the interplay between innovation and global markets. In the hands of a capable entrepreneur, a technological breakthrough can be worth billions of dollars, owing to regulatory protections and the winner-take-all nature of global markets. 
As the development economist Dani Rodrik recently pointed out, much of the basic investment in new technologies in the United States has been financed with public funds. The funding can be direct, through institutions like the Defense Department or the National Institutes of Health (NIH), or indirect, via tax breaks, procurement practices, and subsidies to academic labs or research centers. 
Once a new technology is established, private entrepreneurs, with the help of venture capital, adapt it to global market demand, build temporary or long-term monopoly positions, and thereby capture large profits. The government, which bore the burden of a large part of its development, sees little or no return. 
One example, flagged by the economist Jeffrey Sachs, is Sovaldi, a drug used to cure hepatitis C. As Sachs explains, the company that sells it, Gilead Sciences, holds a patent for the treatment that will not expire until 2028. As a result, Gilead can charge monopoly prices: $84,000 for a 12-week course of treatment, far more than the few hundred dollars it costs to produce the drug. 
Sachs estimates that the private sector spent less than $500 million on research and development to develop Sovaldi – an amount that Gilead was able to recoup in a few weeks of sales. The NIH and the US Department of Veterans Affairs, however, had heavily funded the start-up that developed the drug and was later acquired by Gilead. 
There can be no doubting that the imagination, marketing savvy, and management skills of private entrepreneurs are critical to the successful application of a new technology. And the lower prices, better products, and consumer surplus provided by the commercialization of many innovations clearly provide large societal gains. 
Adding indirect expenditures, like tax breaks, would bring this figure to at least 35%. Thanks to such public outlays, a few private players are often making huge returns, which are a major cause of excessive income concentration. 
Rodrik proposes the creation of public venture capital firms – sovereign wealth funds – that take equity positions in exchange for the intellectual advances created through public financing. Another solution would be to reform the tax code to reduce returns when an individual or firm is cashing in on publicly funded research. 
Sovereign wealth funds would have to be shielded from partisan politics, perhaps by giving them only non-voting shares. Raising taxes on the beneficiaries of publicly funded research would be a challenge, given that the link between an original breakthrough and the wealth it created might be hard to quantify. 
Other approaches are also possible: tightening up patent laws or imposing price controls for monopolistic industries, such as pharmaceuticals, as many market economies have done. What would not be a solution, however, would be to channel fewer public resources into research and innovation – key drivers of economic growth. 
Multiples of that amount, however, simply end up as gifts by the public to a few individuals. A combination of measures and international agreements must be found that would allow taxpayers to obtain decent returns on their investments, without removing the incentives for savvy entrepreneurs to commercialize innovative products. 
The amounts involved contribute to the creation of a new aristocracy that can pass on its wealth through inheritance. If huge sums can be spent to protect privilege by financing election campaigns (as is now the case in the US), the implications of this problem, for both democracy and long-term economic efficiency, could become systemic. 

Radical Goals for Sustainable Development 
Two billion people look forward to a life without poverty, hunger, and violence. Rather than paying lip service to climate change and resource scarcity, we start to respect and uphold the limits of our planet and its atmosphere. 
And it will be the aim next year, when the MDGs expire and the UN adopts a successor framework for environmental and development policy. The coming set of Sustainable Development Goals (SDGs) will seek to protect ecosystems, conserve resources, and, as with the MDGs, lift millions of people out of poverty. 
Combining environmental and developmental frameworks is a good idea – one that builds on the success of a host of legally binding international conventions and agreements crafted under the UN’s auspices to protect the climate, conserve biodiversity, uphold human rights, and reduce poverty. Though they may not be perfect – and, unfortunately, the countries that ratify them do not always achieve the targets – they have led to the creation of institutional processes that encourage countries to meet their promises and embolden citizens to hold governments accountable. 
For starters, global agreements and targets have not yet been put in place for major environmental challenges, including the destruction of fertile topsoil and global plastic production. Such agreements will be necessary to enable the SDGs to consider human rights, the environment, and development holistically. 
Researchers and civil-society organizations have been calling for a reversal of soil degradation by 2020, and are pressing for at least one international panel of experts to meet at the UN to address this central aspect of global food security. Every year, 12 million hectares of land – an area the size of Austria and Switzerland – are lost to overuse and excessive application of fertilizers. 
Every year, more than 280 million tons of plastic is produced, with vast quantities making their way into groundwater, rivers, and oceans – and onward up the food chain. Though plastic is not biodegradable, not a single country has pledged to prevent it from entering our environment. 
Globally, such subsidies, like those offered by the European Union’s Common Agricultural Policy, run into the hundreds of billions of dollars, draining budgets and often doing nothing for the poor. Cutting them would not only remove perverse incentives; it would also free up money for education, universal health care, and infrastructure in rural areas, where it is needed to create income opportunities. 
The SDG negotiations reflect what is currently possible in a multilateral framework: relatively little. No government is truly willing to tackle the causes of inequality and hunger, which would require making fair taxation and comprehensive welfare a top priority. 
The rules of the global economy also remain untouchable, making it nearly impossible to restructure financial and trade policies to ensure that they do not result in more poverty, unchecked climate change, and irreversible resource destruction. 
A timeworn commitment to economic growth at all cost is no answer to the question of how development can be balanced against the limits of our planet and the fact that billions of people live in poverty. In a finite world, infinite growth is impossible, and rising output will not put food on everyone’s table if the benefits of growth are not fairly distributed. 
It is not only the advanced countries that are impeding the creation of a bolder development agenda. Elites in emerging and developing countries are using the SDG negotiations primarily as a platform to call for international aid transfers. 
The UN is only as good as its members. We will know how good they are by the extent to which they view the SDGs as an opportunity to establish truly new priorities and truly universal goals for environmental and development policy in the twenty-first century. 


Africa’s Hidden Hunger 
DAR ES SALAAM – Just over 20 years ago, South African photographer Kevin Carter shocked the world with a controversial photograph of a famished young Sudanese child being watched by a vulture during a famine. Critics slammed the shot as “disaster porn,” calling it yet another example of how the international media sensationalize African problems. 
Rather, it is that two decades later, the conditions that the photograph depicts remain basically the same. Every year, 3.1 million children around the world still die of hunger. 
They are not always as manifest as they are in the protruding ribs of ghostly children hooked up to feeding tubes, like those I used to see in hospital wards in Tanzania. Chronic malnutrition, or “hidden hunger,” shows itself in other ways – but it can be just as devastating and deadly. 
In the last two decades, astounding success has been achieved in the fight against HIV, tuberculosis, and malaria. New HIV infections have dropped by as much as 50% in some countries in Africa, with AIDS-related deaths down by 30-48%; 
But the stunting of early childhood growth as a result of malnutrition remains high, dropping by only about 1% over the same period. In Africa, hunger remains the leading cause of death in children, accounting for half of all deaths of children under the age of five and killing more than AIDS, TB, and malaria combined. 
In fact, many scientific studies have shown that a malnourished child is much more likely to contract an infection, to suffer from other illnesses, and to suffer from them longer. Diarrhea, for example, is a deadly disease for severely underweight children, who are 12 times more likely to die from an ailment that should be easily treated. 
Indeed, childhood malnutrition is now confirmed to be the leading cause of the global disease burden, with the World Health Organization attributing to it 45% of all deaths under the age of five in 2011. Recent reports from the war-ravaged Central African Republic indicate that more children there are dying from hunger than from bullets. 
The lack of vitamin A alone results in blindness in a half-million children every year, with half of them dying within 12 months of losing their sight. Similarly, half of all women of childbearing age in developing countries suffer from weakened immune systems, owing to anemia caused by iron deficiency. 
The long-term damage caused by malnutrition has a domino effect, impeding educational achievement, and ultimately, hobbling national economies. Addressing this ongoing crisis requires money – an estimated $10 billion per year – and new and better strategies to bring life-saving solutions to the mothers and children who most need them. 
And this is not the whole story. Malnutrition costs an estimated $3.5 trillion every year to the global economy, owing to loss of productivity and higher health-care costs. 
To meet this challenge, save lives, and improve economies, Africa needs a comprehensive strategy and increased investment in agriculture. 
The Africa Union has declared 2014 the year of agriculture and food security in Africa, and the continent’s agriculture sector is expected to grow significantly. In theory, that should improve overall nutrition; but increased investment in agriculture is not a panacea. 
A big step would be to increase women’s control over land ownership and farming decisions, along with access to agricultural credits and subsidies designed to encourage domestic food production through home gardening and cattle and poultry husbandry. Studies show that women are much more likely than men to spend additional income on food and health. 
Moreover, agricultural policies, subsidies, and investments have traditionally benefited cereal farmers. But policymakers need to concentrate on increasing access to more nutritious foods, such as meat, fruit, and vegetables, which are too expensive for the poor. 
Malnutrition causes the greatest damage during the first thousand days of life, leading to grievous and irreversible changes in infant health. To make real inroads against hidden hunger, African governments, supported by global development partners, must act quickly. 

Rethinking Hunger 
Though great strides have been made toward the Millennium Development Goal of halving the proportion of undernourished people in developing countries, the problem remains persistent, pervasive, and complex. After all, the issue goes beyond merely providing more food; effective efforts to reduce undernourishment must ensure that people have access to enough of the right types of food – those that give them the nutrients they need to live healthy, productive lives. 
Since 1945, food production has tripled, and food availability has risen by 40%, on average, per person. Over the last decade alone, vegetable production in the Asia-Pacific region, where more than three-quarters of the world’s vegetables are grown, increased by one-quarter. 
But, despite these gains in expanding the food supply, at least 805 million people still go hungry every day, of whom some 791 million live in developing countries. Many more go hungry seasonally or intermittently. 
Hunger and undernourishment damage the health and productivity of adults, undermining their ability to learn and work. Moreover, they impede children’s physical and cognitive development, and leave them more susceptible to illness and premature death. 
Adequate nutrition is most vital during the first 1,000 days of life (from conception to a child’s second birthday). But, even after that, hunger and undernourishment continue to diminish children’s chances of surviving to adulthood, much less reaching their full potential. 
Ironically, in many parts of the world, pervasive hunger coexists with rising levels of obesity. 
More than 1.5 billion people are overweight, with one-third of them considered obese. These people are particularly vulnerable to non-communicable diseases like heart disease, stroke, and diabetes. 
Contrary to popular belief, obesity is often related less to an overabundance of food than to inadequate access to affordable, diverse, and balanced diets. The challenge facing the international community is thus to ensure adequate consumption of the right kinds of food. 
This means developing food systems that are more responsive to people’s needs, particularly those of the socially excluded and economically marginalized. Mothers, young children, the elderly, and the disabled are among the most vulnerable to the pitfalls of undernourishment, and should be given special attention in efforts to end food insecurity and undernourishment. 
In order to ensure that today’s efforts benefit future generations, strategies to improve global food systems must emphasize environmental sustainability. Specifically, world leaders must reassess prevailing food-production processes, which often put considerable stress on natural resources by exhausting freshwater supplies, encroaching on forests, degrading soils, depleting wild fish stocks, and reducing biodiversity. 
Consider livestock production, which accounts for many foods – including milk, eggs, and meat – that have enriched diets in developing countries and provide livelihoods for millions. Unsustainable production systems, combined with wasteful and excessive consumption in some regions of the world, have had serious consequences in terms of climate change, disease transmission, and nutritional balance. 
Likewise, food-related research and development should focus on facilitating the production of nutrient-rich foods and the diversification of farming systems. Finding ways to use water, land, fertilizer, and labor more efficiently, and with minimal adverse impact, is essential to ecological sustainability. 
Equally important will be interventions that empower local communities to improve their diets. This requires comprehensive public-health and education campaigns, social protection to enhance resilience, and initiatives to boost employment and income generation. 
Finally, producers and distributors need support and encouragement to transform their existing systems. After all, a shift toward sustainability cannot come at the expense of farmers’ livelihoods. 
Malnutrition in all of its forms reduces global economic welfare by about 5% annually, through foregone output and additional costs incurred. The economic gains of reducing micronutrient deficiencies are estimated to have a cost/benefit ratio of almost 1:13. 
The upcoming Second International Conference on Nutrition in Rome will provide a historic opportunity to galvanize political commitment to enhance nutrition for all through better policies and international solidarity. Failure to make the needed investments in food access, nutrition, and sustainability is morally – and economically – unjustifiable. 

India’s Antiquated Penal Code 
NEW DELHI – A number of seemingly unrelated controversies in India actually have one important element in common: They all relate to criminal offenses codified by India’s British imperial rulers in the mid-nineteenth century that India has proved unable or unwilling to outgrow. 
The problematic features of the British-drafted Indian Penal Code include the prohibition of “sedition,” defined loosely as speech or actions promoting “disaffection against the government established by law”; the criminalization of homosexual acts; and the uneven prosecution of adultery. The first two, in particular, have lately been the source of considerable public outrage – and rightly so. 
Consider sedition, against which a draconian law that was established in 1870 to suppress any criticism of British policies – even criticism that, as one Briton candidly put it, did not involve “an absolute breach of the peace.” The result was Section 124A of the penal code, under which any person who used “words, signs, or visible representation … to excite disaffection against the government” could be charged with sedition and potentially sentenced to life imprisonment. 
But even that was not sufficient for Britain’s leaders, who tightened the law further in 1898, making it even harsher than the sedition law in England. The British had concluded, in the words of the British lieutenant governor of Bengal, that “a sedition law which is adequate for a people ruled by a government of its own nationality and faith may be inadequate, or in some respects unsuited, for a country under foreign rule.” 
Sedition was thus explicitly intended as an instrument to terrorize Indian nationalists; indeed, Mahatma Gandhi was among its prominent victims, though far from its last. In fact, just last month, students at New Delhi’s Jawaharlal Nehru University were arrested on charges of sedition, for using “anti-Indian” slogans in their protests against the execution of the convicted terrorist Afzal Guru. 
My amendment would limit sedition charges to situations where an individual’s words or actions lead directly to the use of violence or incitement to violence, or where they constitute an offense – such as murder or rape – that, under the Indian Penal Code, is punishable by life imprisonment. By clarifying that simply criticizing the government’s actions does not constitute sedition, such an amendment would reinforce freedom of speech – fundamental to any democracy – while safeguarding against speech that actually incites violence. 
Then there is Section 377 of the penal code, which was enacted in 1860 and criminalizes “carnal intercourse against the order of nature” – wording so archaic that it would invite derision in most modern societies. Even in the past, there was no taboo against homosexuality in Indian culture and social practice; it was the British Victorians who introduced it. 
By criminalizing sexual acts in private between consenting adults, Section 377 violates the fundamental rights guaranteed under Article 21 (life and liberty, including privacy and dignity), Article 14 (equality before the law) and Article 15 (prohibition of discrimination) of India’s constitution. The real-world consequences of this are jarring: In the last two years, 58 Indians have been arrested under Section 377 for acts carried out in the privacy of their homes. 
Unfortunately, conservative members of the ruling Bharatiya Janata Party (BJP) voted against the bill’s introduction in parliament, citing a 2013 Supreme Court judgment upholding the law. But there is still some reason for hope: The Supreme Court has agreed to hear a curative review petition against its earlier judgment. 
The Indian Penal Code is not much easier on heterosexual women than it is on homosexuals. According to Section 497, a husband can prosecute his adulterous wife, and the man with whom she had sexual relations, but a woman cannot sue her adulterous husband, unless his partner is underage or married. 
It is time for India’s government to get out of its citizens’ bedrooms, and also to recognize that a pernicious sedition law has no place in a lively and contentious democracy. Indeed, the British, who created these problematic offenses, have since eliminated all of them at home – a reflection of the changing times. 
President Pranab Mukherjee, for one, feels it is time to take India’s penal code into the twenty-first century, underscoring last month, on the code’s 155th anniversary, the need to revise it thoroughly. India’s criminal law, he declared, was largely “enacted by the British to meet their colonial needs,” and must be revised to reflect our “contemporary social consciousness.” 
With that speech, Mukherjee threw down the gauntlet to the right-wing BJP government. One hopes that its leaders respond, though their fondness for autocratic measures and indulgence of illiberal and intolerant statements by their supporters – behavior that has spurred serious concern across the political spectrum – raises serious doubts that they will. 
In order to prevent this, and to create a liberal legal framework fit for a modern democratic country, homosexuality and adultery must be decriminalized, and sedition must be approached from a far more liberal perspective. As the recurring debates consuming the country indicate, it is manifestly time for a change. 

The Real Raw Material of Wealth 
Rich countries export – often to those same poor countries – more complex products such as chocolate, cars, and jewels. If poor countries want to get rich, they should stop exporting their resources in raw form and concentrate on adding value to them. 
Poor countries could follow the example of South Africa and Botswana and use their natural wealth to force industrialization by restricting the export of minerals in raw form (a policy known locally as “beneficiation”). But should they? 
Some ideas are worse than wrong: they are castrating, because they interpret the world in a way that emphasizes secondary issues – say, the availability of raw materials – and blinds societies to the more promising opportunities that may lie elsewhere. 
A classical economist would argue that, given this, the country should export wood, which Finland has done. By contrast, a traditional development economist would argue that it should not export wood; instead, it should add value by transforming the wood into paper or furniture – something that Finland also does. 
As the Finns were chopping wood, their axes and saws would become dull and break down, and they would have to be repaired or replaced. This eventually led them to become good at producing machines that chop and cut wood. 
Finnish businessmen soon realized that they could make machines that cut other materials, because not everything that can be cut is made out of wood. Next, they automated the machines that cut, because cutting everything by hand can become boring. 
After all, Switzerland has no cocoa, and China does not make advanced memory chips. That has not prevented these countries from taking a dominant position in the market for chocolate and computers, respectively. 
Having the raw material nearby is only an advantage if it is very costly to move that input around, which is more true of wood than it is of diamonds or even iron ore. Australia, despite its remoteness, is a major exporter of iron ore, but not of steel, while South Korea is an exporter of steel, though it must import iron ore. 
What the Finnish story indicates is that the more promising paths to development do not involve adding value to your raw materials – but adding capabilities to your capabilities. That means mixing new capabilities (for example, automation) with ones that you already have (say, cutting machines) to enter completely different markets. 
Proximity to which particular raw material makes a country competitive in producing cars, printers, antibiotics, or movies? Most products require many inputs, and, in most cases, one raw material will just not make a large enough difference. 
Beneficiation forces extractive industries to sell locally below their export price, thus operating as an implicit tax that serves to subsidize downstream activities. In principle, efficient taxation of extractive industries should enable societies to maximize the benefits of nature’s bounty. 
Arguably, the biggest economic impact of Britain’s coal industry in the late seventeenth century was that it encouraged the development of the steam engine as a way to pump water out of mines. But the steam engine went on to revolutionize manufacturing and transportation, changing world history and Britain’s place in it – and increasing the usefulness to Britain of having coal in the first place. 
By contrast, developing petrochemical or steel plants, or moving low-wage diamond-cutting jobs from India or Vietnam to Botswana – a country that is more than four times richer – is as unimaginative as it is constricting. Much greater creativity can be found in the UAE, which has used its oil revenues to invest in infrastructure and amenities, thus transforming Dubai into a successful tourism and business hub. 
There is a lesson here for the United States, which has had a major beneficiation policy since the 1973 oil embargo, when it restricted the export of crude oil and natural gas. As the US increasingly became an energy importer, its leaders never found any reason to abandon this policy. 
But is this the best use of the government’s capacity to tax or regulate trade? Would the US not be better off by using its capacity to tax natural gas to stimulate the development of the contemporary technological equivalent of the revolutionary engine? 


Piketty’s Missing Knowhow 
CAMBRIDGE – Theoretical frameworks are great because they allow us to understand fundamental aspects of a complex world in much simpler terms, just as maps do. But, like maps, they are useful only up to a point. 
A useful way to understand the world’s economy is the elegant framework presented by Thomas Piketty in his celebrated book Capital in the Twenty-First Century. Piketty splits the world into two fundamental substances – capital and labor. 
The main distinction between the two is that capital is something you can buy, own, sell, and, in principle, accumulate without limit, as the super-rich have done. Labor is the use of an individual capacity that can be remunerated but not owned by others, because slavery has ended. 
Otherwise, the owner of one parcel would sell it to buy the other. This no-arbitrage condition implies that, in equilibrium, all capital yields the same risk-adjusted return, which Piketty estimates historically at 4-5% per year. 
A person or country that saves 100 units of income should be able to have a yearly income, in perpetuity, of some 4-5 units. From here, it is easy to see that if capital were fully reinvested and the economy grew at less than 4-5%, capital and its share of income would become larger relative to the economy. 
Piketty argues that, because the world’s rich countries are growing at less than 4-5%, they are becoming more unequal. This can be discerned in the data, though in the United States a large part of the increase in inequality is due not to this logic but to the rise of what Piketty calls “super-managers,” who earn extremely high salaries (though he does not tell us why). 
In the 30 years from 1983 to 2013, the US borrowed from the rest of the world in net terms more than $13.3 trillion, or about 80% of one year’s GDP. Back in 1982, before this period started, it was earning some $36 billion from the rest of the world in net financial income, a product of the capital that it had previously invested abroad. 
If we assume that the return on this capital was 4%, this would be equivalent to owning $900 billion in foreign capital. So, if we do the accounting, the US today must owe the rest of the world roughly $12.4 trillion (13.3 minus 0.9). 
Assuming a 4% yield, this would be equivalent to owning $5.7 trillion in foreign capital. In fact, the difference between what the US “should” be paying if the Piketty calculation was right is about $710 billion in annual income, or $17.7 trillion in capital – the equivalent of its yearly GDP. 
The US is not the only exception in this miscalculation, and the gaps are systematic and large, as Federico Sturzenegger and I have shown. 
Chile has borrowed little in net terms for the past 30 years, but pays to the rest of the world as if it had borrowed 100% of its GDP. China has lent to the rest of the world, in net terms, over the last decade, about 30% of its annual GDP but gets pretty much nothing for it. 
The simple answer is that things are not made just with capital and labor, as Piketty argues. They are also made with knowhow. 
To see the effect of this omission, consider that America’s net borrowing of $13 trillion dramatically understates the extent of gross borrowing, which was more like $25 trillion in gross terms. The US used $13 trillion to cover its deficit and the rest to invest abroad. 
This money is mixed with knowhow as foreign direct investment, and the return to both is more like 9%, compared to the 4% or less paid to lenders. In fact, 9% on $12 trillion is more than 4% on $25 trillion, thus explaining the apparent puzzle. 
Chile and China put their savings abroad without mixing them with knowhow – they buy stocks and bonds – and as a consequence get just the 4-5% or less that Piketty assumes. By contrast, foreign investors in Chile and China bring in valuable knowhow; hence the gross capital that flows in yields more than the gross savings abroad. 
The point is that creating and deploying knowhow is an important source of wealth creation. After all, Apple, Google, and Facebook are jointly worth more than $1 trillion, even though the capital originally invested in them is a minuscule fraction of that. 
Everybody in the team is crucial, but outside the team each individual is worth much less. Shareholders may want to take the difference as profits, but they cannot do without the team. 
This is where the super-managers come in: they strive to pocket part of the value created by the team. Behind the growth of wealth and inequality lies not just capital, but also knowhow. 

Stop Taxing the Sick 
WASHINGTON, DC – The debate over access to affordable medicines in emerging and developing countries frequently overlooks a critical issue: Governments in these countries routinely slap tariffs and other taxes on vitally important drugs. While these measures tend to be modest revenue generators, they make the affected medicines more expensive, which can put them out of reach for many who need them most. 
With tariffs and other taxes increasing drug costs by as much as two-thirds in some areas, even the most basic generic drugs become unaffordable for the poorest people. As one research report on Delhi’s medicine market concluded, such levies are essentially a “tax on the sick” which the government could easily remove. 
The story is similar in many emerging markets. According to a 2012 study by the World Trade Organization, Argentina, Brazil, India, and Russia impose tariffs of around 10% on imported medicines, while Algeria and Rwanda, for example, maintain a 15% rate. 
Many countries also levy hefty sales taxes. Brazil imposes a 28% rate on prescription medicines, while medicines in India are subject to 5% value-added tax and a 3% education tax, on top of state taxes that range from 5% to 16%. 
But, in 2011, India raised more in drug taxes than the government spent on medicines for the public. India’s health-care crisis might ease if the government stopped artificially hiking the prices of medicines that people need. 
Moreover, fiscal pressures notwithstanding, it seems highly regressive, if not downright perverse, to place the greatest financial burden on those in the poorest health (and who presumably are the target of such social programs). It is also economically counterproductive. 
Several countries, including Colombia, Ethiopia, Malaysia, Nicaragua, Pakistan, Tanzania, and Uganda, have substantially reduced or eliminated tariffs and taxes on medicines. The results have been dramatic. 
India and China, as major pharmaceutical exporters themselves, have a clear interest in seeing lower medicine tariffs worldwide. India, hailed as “the pharmacy to the developing world,” is one of the largest exporters of finished drugs, while China produces 70-80% of these drugs’ active ingredients. 
Abolishing pharmaceutical tariffs would follow the example set by developed countries when they created the WTO two decades ago. As the World Health Organization declared: “governments should tax the things which make people ill, not the things which make them well.” 
To be sure, tax cuts would not address all of the many challenges surrounding access to healthcare in emerging and developing countries, such as the lack of hospitals, clinics, doctors, and public and private insurance. But removing tariffs is something that could be implemented quickly and that would benefit the neediest people immediately. 
As home to leading drug producers – and many of those most affected by these taxes – India and China should lead an international liberalization effort. The BRICS Summit, to be held on July 15-17 in Fortaleza, Brazil, might be a good place to start. 
Earlier this year, China joined 13 other WTO members calling for tariffs on environmental goods to be removed. China, India, and the other BRICS should form a similar coalition to press for the elimination of pharmaceutical tariffs, thereby broadening access to health care throughout the developing world. 

Bangladesh’s Fundamentalist Challenge 
NEW DELHI – In February, while returning from a book fair at Dhaka University, Avijit Roy, a Bangladeshi-American blogger known for his atheism, and his wife were dragged from their rickshaw and hacked with machetes. The book fair, held annually to commemorate the 1952 protests that culminated in the Pakistani military opening fire on students at the university, is a typically Bengali response to violence. 
But Roy’s brutal murder (his wife was maimed, but survived) – together with the fatal stabbing of another atheist blogger, Washiqur Rahman, barely a month later – exposes another force at work in Bangladesh, one that is subverting the country’s tradition of secularism and intellectual discourse. That force is Salafist Islamic fundamentalism. 
The irreverent secularism and thoughtful inquiry reflected in the works of Roy and Washiqur have long been a hallmark of Bengali writing. A generation ago, their views would have been considered perfectly acceptable, if not mainstream, in the vibrant intellectual culture of Bengal (the Western portion of which is the Indian state of West Bengal). 
Backed by lavish financing from abroad, Salafist fundamentalism – an intolerant version of Islam at odds with the more moderate Sufi-influenced variant that prevailed in India for centuries – has been spreading across Bangladesh in recent years. While Bengal’s long secular tradition, which drove its efforts to break away from Pakistan, is still alive and well, the corrosive impact of the radical Islamists – who use force to silence those with whom they disagree – is undeniable. 
Last year, the atheist blogger Ahmed Rajib Haider was, like Roy, hacked to death in Dhaka. Why engage in theoretical debates with your ideological opponents, the Islamists are saying, when one can simply shut them up for good? 
Many Bangladeshi intellectuals have seen the writing on the wall and fled the country, sacrificing daily contact with their rich cultural heritage for the sake of self-preservation. The novelist Taslima Nasrin went into exile in 1994 to escape death threats from Islamist radicals; she now lives in Delhi. 
Ordinary secular Muslims who turn to atheism are more vulnerable to charges of apostasy and, worse, blasphemy. In the old days, such charges might have attracted a fatwa or two and, at worst, social ostracism. 
Bangladesh has long faced the claim that, in accordance with the logic of the 1947 Partition of India, which produced what was then East Pakistan, it should be more Islamic. Others, opposing this claim, insist that the country must live up to the legacy of its 1971 secession from Pakistan, in a revolution that proclaimed Islam insufficient grounds for nationhood and asserted the primacy of Bangladesh’s secular culture and Bengali language over its allegiance to Islamabad. 
This conflict is also reflected in the country’s often bitterly divisive politics. Each camp has taken its turn controlling the government, under two formidable female leaders: the Awami League’s Sheikh Hasina Wazed, the current prime minister, and her two-term predecessor, the Bangladesh Nationalist Party’s Begum Khaleda Zia. 
Though the secularists are currently in power, Zia retains wide support, including among the Islamists. Her party boycotted the last election, and has provoked political violence that has claimed more than 100 lives this year and left hundreds more injured. 
The recent killings have inflamed public opinion, sparking mass demonstrations to demand justice for the victims and more effective government protection of secularist writers. HT Imam, a senior adviser to Hasina, squarely challenged the police for their inaction on Roy’s murder, telling top police officers to “identify the black sheep among the force and bring them under law and justice to uphold your image.” 
Though the government is seen as sympathetic to liberal intellectuals, it is also anxious to maintain law and order and avoid provoking the extremists. As a result, the government has not hesitated to try to curry favor with the Islamists by using legislation that prohibits “hurting religious sentiments” to harass and arrest atheists and liberals. 
Hasina – the daughter of Sheikh Mujibur Rahman, the “father” of independent Bangladesh who was assassinated in 1975 – knows that compromising with the Islamists will get her nowhere; she will never be acceptable to them. Her government must not succumb to the temptation to accommodate the extremists in the name of good governance (or in the cause of political survival). 
The principles for which Bangladesh bled when it won its independence from Pakistan must not be compromised. If Hasina gives in to the machete-wielding Islamists, she will sacrifice the Bangladesh that her father fought to free. 


Save our Soils 
BERLIN – The United Nations has declared 2015 to be the International Year of Soils, and April 19-23 marks this year’s Global Soil Week. Such events, though not exactly glamorous, do not receive nearly the amount of attention they deserve. 
Intact soils are an invaluable and irreplaceable resource, one that performs myriad functions in achieving the international community’s main development and environmental goals. And now they are in urgent need of protection. 
We rely on them not only for food production, but also to create new drinking water. They help to regulate Earth’s climate, storing more carbon than all of the world’s forests combined (only the oceans are a larger carbon sink), and are essential to maintaining biodiversity: a handful of fertile soil contains more microorganisms than there are humans on the planet. 
Inappropriate agricultural practices are also to blame: the liberal use of synthetic fertilizer, for example, decimates organisms inhabiting the soil and changes its structure. It takes millennia for fertile topsoil to form; in many places, a cloudburst is now all it takes to wash it away. 
At the same time, global demand for food, fodder, and biomass for fuels is growing, in turn driving up the value of land – a fact that has not escaped international investors’ attention. According to a World Bank estimate, 10-30% of arable land worldwide – land that would be used by millions of smallholders, pastoralists, and indigenous people – has been affected by large-scale investment. 
The struggle to secure land rights for individuals and communities has thus become a matter of survival in much of the world. Access to land is one of the key determinants of hunger, and it is even more unequally distributed than income. 
Just producing the fodder needed to cover the European Union’s meat consumption requires an area of agricultural land in Brazil the size of the United Kingdom. If every human ate as much meat as the average EU citizen, 80% of the world’s arable land would have to be dedicated to producing it, compared to 33% currently. 
Biofuels do not benefit the climate nearly as much as wind or solar energy systems, yielding only one-tenth the energy per square meter. As a result, the biofuel requirements contained in the EU’s 2030 Framework for Climate and Energy would need a further 70 million hectares of land – an area larger than France. 
On the contrary, sustainable soil-protection practices can actually boost agricultural yields – especially those of smallholders. Crop diversification, recycling, and soil cover can all contribute to living, fertile, and active soil capable of optimal water management. 
One approach, so-called agro-ecology, is based on small farmers’ traditional knowledge and experience, making it readily adaptable to local conditions. A study of agro-ecological farming practices by Jules Pretty in 2006 examined 286 sustainable agricultural projects in 57 countries and concluded that yields had increased an average of 79%. 
Despite the proven success of such methods, the use of synthetic fertilizers has increased by a factor of more than five over the past 50 years, and many African governments spend up to 60% of their agricultural budgets to subsidize them. Particularly in tropical environments, such products lead to the destruction of the topsoil and biodiversity loss (and the runoff is transported to the oceans, where it damages marine ecosystems). 
Policymakers must address the following question: How can poor people produce enough food to escape hunger and destitution in a manner that protects soils, mitigates climate change, and preserves biodiversity? 
Despite the issue’s urgency, approaches like agro-ecological production are not being promoted to any serious extent anywhere. Events like the International Year of Soils and Global Soil Week offer an opportunity to change that – from the ground up. 

The Data Revolution for Sustainable Development 
NEW YORK – There is growing recognition that the success of the Sustainable Development Goals (SDGs), which will be adopted on September 25 at a special United Nations summit, will depend on the ability of governments, businesses, and civil society to harness data for decision-making. The key, as I have highlighted before, is to invest in building innovative data systems that draw on new sources of real-time data for sustainable development. 
Advertisers, insurance companies, national security agencies, and political advisers have already learned to tap into big data, sometimes to our chagrin; so, too, have countless scientists and researchers, thereby accelerating progress on new discoveries. But the global development community has been slower to benefit – not least because too much development data are still being collected using cumbersome approaches that lag behind today’s technological capabilities. 
Every day, in remote villages of developing countries, community health workers help patients fight diseases (such as malaria), get to clinics for checkups, receive vital immunizations, obtain diagnoses (through telemedicine), and access emergency aid for their infants and young children (such as for chronic under-nutrition). But the information from such visits is usually not collected, and even if it is put on paper, it is never used again. 
That information can go directly onto public-health dashboards, which health managers can use to spot disease outbreaks, failures in supply chains, or the need to bolster technical staff. Such systems can provide a real-time log of vital events, including births and deaths, and even use so-called verbal autopsies to help identify causes of death. 
Currently, school enrollment rates tend to be calculated based on student registrations at the beginning of the school year, even though actual attendance may be far below the registration rate. Moreover, officials wishing to report higher enrollment rates sometimes manipulate registration data, so we never get an accurate picture of who is actually at school. 
With mobile apps, schools and community education workers can log student and teacher attendance on a transparent, real-time basis, and follow up more easily with students who drop out, especially for reasons that could be overcome through informed intervention by community education workers. This information can be fed automatically into dashboards that education administrators can use to track progress in key areas. 
But that is only the first step. The same techniques should also be used to collect some of the key indicators that measure progress on the SDGs. 
In fact, measuring progress at frequent intervals, and publicizing the successes and shortfalls, is vital to keeping the world on track to meet its ambitious long-term targets. Doing so would not only enable us to reward governments that are fostering progress; it would also keep laggard governments accountable for their weak performance and, one hopes, motivate them to redouble their efforts. 
The need for such real-time measurement became apparent over the last 15 years, when the world was pursuing the Millennium Development Goals. Given that many key indicators are not yet collected in real time, but only through laborious retrospective household surveys, the indicators for the key poverty-reduction goal are as much as five years out of date for many countries. 
Fortunately, the information and communications technology revolution and the spread of broadband coverage nearly everywhere can quickly make such time lags a thing of the past. As indicated in the report A World that Counts: Mobilizing the Data Revolution for Sustainable Development, we must modernize the practices used by statistical offices and other public agencies, while tapping into new sources of data in a thoughtful and creative way that complements traditional approaches. 
Through more effective use of smart data – collected during service delivery, economic transactions, and remote sensing – the fight against extreme poverty will be bolstered; the global energy system will be made much more efficient and less polluting; and vital services such as health and education will be made far more effective and accessible. 
With this breakthrough in sight, several governments, including that of the United States, as well as businesses and other partners, have announced plans to launch a new “Global Partnership for Sustainable Development Data” at the UN this month. The new partnership aims to strengthen data collection and monitoring efforts by raising more funds, encouraging knowledge-sharing, addressing key barriers to access and use of data, and identifying new big-data strategies to upgrade the world’s statistical systems. 
The UN Sustainable Development Solutions Network will support the new Global Partnership by creating a new Thematic Network on Data for Sustainable Development, which will bring together leading data scientists, thinkers, and academics from across multiple sectors and disciplines to form a center of data excellence. We are delighted to be chairing this network, which has at its core a commitment to turn facts and figures into real development progress. 

Sequencing a Vampire 
And treatment is complex, requiring the kind of highly skilled medical staff that is difficult to find in the affected areas. The parasites that carry the infection – Trypanosoma brucei gambiense in central and western Africa and T. b. rhodesiense in eastern Africa – are transmitted through the bite of an infected tsetse fly (Glossina morsitans morsitan). 
Though the systematic screening and treatment of millions of people dramatically reduced disease transmission in the 1930’s, the relaxation of such efforts allowed HAT to reemerge in the 1950’s and 1960’s, reaching epidemic levels by early 1990’s. A World Health Organization campaign finally got the disease under control by 2008, with only about 10,000 people contracting it each year. 
And the threat is not limited to humans. African animal trypanosomiasis, or nagana, is caused by the parasites Trypanosoma congolense, T. vivax, and T. brucei – all of which are transmitted by the tsetse fly. 
Nagana, too, is fatal if left untreated, leading to considerable livestock losses. In cattle production alone, economic losses amount to an estimated $1-1.2 billion annually, with total agricultural losses reaching roughly $4.75 billion. 
Given the lack of effective vaccines and inexpensive, easily deliverable drugs, reducing tsetse numbers is the most effective approach to controlling such diseases. This can be achieved through traps and targets (insecticide-soaked screens), which attract the flies to a device that collects and/or kills them. 
But much can be done to enhance the effectiveness of these methods, whether by improving the devices themselves or by implementing control programs in various ecological settings. In both cases, a better understanding of tsetse biology is invaluable. 
The recently completed genome sequence of Glossina morsitans morsitans provides several clues that could transform tsetse research and disease-control practices. First, the researchers looked for clues about how the tsetse, which feeds exclusively on the blood of vertebrates, identifies its host. 
To this end, researchers analyzed genes for more than 12,300 proteins to understand critical processes like olfaction (smell), gustation (taste), and vision. They found that tsetse have fewer genes for olfactory and gustation receptors, and more genes for detecting carbon dioxide – key to helping them find a host. 
Researchers also pursued a deeper understanding of the genes involved in sensing colors, in order to help determine which shade of blue – the color that has long been known to attract tsetse flies – would work best for traps. Future research on the molecular aspects of olfaction and vision can guide the development of more effective mechanisms for luring flies to the traps or repellants that could be applied to animals to protect against tsetse bites. 
Similarly, knowledge of symbiosis and tsetse reproduction can be harnessed to develop new methods to control tsetse populations. Though tsetse flies cannot synthesize essential vitamins, for example, they host a variety of symbiotic bacteria that do it for them. 
The female supports the development of a single embryo that becomes a larva, which grows in its mother’s uterus, nourished by milk secreted by specialized glands. The female gives birth to a fully mature larva, which pupates and remains dormant underground until it hatches as an adult. 
The genome study revealed the molecular basis of this trait – novel proteins produced in the milk gland. Gene-expression studies have shown that when the female is pregnant, a 40% increase in gene activity in her milk gland accounts for almost half of all gene activity during pregnancy. 
Researchers have also found that a single transcription factor, the Ladybird late, regulates the synthesis of all milk proteins; without it, flies lose their fecundity. It has been suggested that chemical inhibitors for this factor could make it impossible for the fly to give birth, thereby reducing tsetse populations. 
Researchers have found a strong antioxidant response produced between pregnancy cycles, which helps the females to avoid damage from oxidative stress. Finding a way to prevent this antioxidant response could thus help to compromise females’ reproductive systems. 
Having the tsetse fly’s genetic blueprint is a critical first step toward developing mechanisms to reduce tsetse numbers. For the people of rural Africa, such advances cannot come soon enough. 

Pakistan’s War at Home 
SINGAPORE – Last month, after years of indecision, Pakistan’s military launched a full-scale military operation in the North Waziristan Tribal Agency aimed at eliminating terrorist bases and ending the region’s lawlessness. In particular, the army wants to clear out foreign fighters who are using the territory as a base for various jihads around the Muslim world. 
Operating from sanctuaries established in the tribal agency, various terrorist groups, in association with organizations elsewhere in the country, have already attacked Pakistan’s four neighbors – Afghanistan, China, India, and Iran. Of the region’s foreign fighters, Uzbeks belonging to the Islamic Movement of Uzbekistan have recently become the most visible threat, taking responsibility for the June 8-9 attack on Karachi’s Jinnah International Airport, in which 30 people, including all ten of the militants, were killed. 
In launching the North Waziristan operation, General Raheel Sharif, Pakistan’s new Chief of Army Staff, stated that his forces would draw no distinction between supposedly “good” and “bad” Taliban. The former, including the Haqqanis – named after Jalaluddin Haqqani, who led the Islamic resistance against Soviet forces in Afghanistan – had been trained and equipped by the Inter-Services Intelligence (ISI), Pakistan’s main security agency. 
The ISI countenanced this in the hope that the Pashtun group would later act as Pakistan’s proxies in Afghanistan after US combat troops depart at the end of 2014. But the Haqqanis, it appears, did not keep to any such bargain, and allowed their Uzbek guests in North Waziristan to launch the Karachi airport attack. 
Pashtuns, the main ethnic group on both sides of the Afghanistan-Pakistan border, are engaged in a bitter struggle in both countries to assert what they consider to be their legitimate political and economic rights. Karachi, hundreds of miles to the south, will not escape the fallout from the North Waziristan operation. 
The military, which planned to flush out the main militant hideouts with air strikes, and then send in ground troops, instructed residents to leave the area beforehand. Some 350,000 people have already fled, creating a humanitarian crisis on a scale similar to that in 2009 when the military broke the Taliban’s grip on the Swat Valley. 
The movement of so many people is likely to have a profound effect on Pakistan. According to a report by the United Nations High Commissioner for Refugees, released just five days after the assault, at the end of 2013 there were 51.2 million forcibly displaced people in the world, six million more than the year before, and the largest number since World War II. 
Pakistan plays host to more refugees than any other country, with 1.5 million registered in the country, in addition to an estimated 3.5 million internally displaced people. 
As has been the case on previous occasions, internally displaced people from North Waziristan are unlikely to remain in the camps set up for them in adjoining districts. Many will head for Pakistan’s large cities, particularly Karachi. 
The third wave comprised refugees displaced during Afghanistan’s war against Soviet occupation. And the fourth began in the early 2000s, following the US invasion of Afghanistan, which also gave rise to Pashtun resistance on both sides of the border, and contributed in turn to Islamic extremism in the tribal areas. 
They will be in no mood to lay down their arms if the municipal authorities fail to develop inclusive political institutions that give minority ethnic groups a fair political voice. In that case, the long-term consequence of the military’s North Waziristan campaign may well be more violence where it can cause the most damage. 

Israel’s Last Founding Father 
TEL AVIV – In 2006, a year before Shimon Peres was elected as Israel’s president, Michael Bar-Zohar published the Hebrew edition of his Peres biography. It was aptly titled Like a Phoenix: by then, Peres had been active in Israeli politics and public life for more than 60 years. 
He reached lofty heights and suffered humiliating failures – and went through several incarnations. A pillar of Israel’s national security leadership, he subsequently became an ardent peacemaker, always maintaining a love-hate relationship with an Israeli public that consistently declined to elect him Prime Minister but admired him when he did not have or seek real power. 
Undeterred by adversity, Peres kept pushing forward, driven by ambition and a sense of mission, and aided by his talents and creativity. He was a self-taught man, a voracious reader, and a prolific writer, a man moved and inspired every few years by a new idea: nanoscience, the human brain, Middle Eastern economic development. 
When his quest for power and participation in policymaking ended in 2007, he reached the pinnacle of his public career, serving as President until 2014. He rehabilitated the institution after succeeding an unworthy predecessor and became popular at home and admired abroad as an informal global Elder on the international stage, a sought-after speaker in international fora, and a symbol of a peace-seeking Israel, in sharp contrast to its pugnacious prime minister, Binyamin Netanyahu. 
By 1946, he was considered senior enough to be sent to Europe as part of the pre-state delegation to the first post-war Zionist Congress. He then began to work closely with Israel’s leading founder, David Ben-Gurion, at the Ministry of Defense, mostly in procurement, during Israel’s Independence War, eventually rising to become the ministry’s director-general. 
In that capacity, Peres became the architect of the young state’s defense doctrine. Running a sort of parallel foreign ministry, his main achievement was the creation of a close alliance and strong security cooperation – including with respect to nuclear technology – with France. 
In 1959, Peres moved to full-time politics, supporting Ben-Gurion in his conflict with Labor’s old guard. Later, he was elected to the Knesset, Israel’s parliament, and became Deputy Minister of Defense and subsequently a full member of the cabinet. 
His career entered a new phase in 1974, when Prime Minister Golda Meir was forced to resign after the October 1973 debacle, in which Anwar Sadat’s Egyptian forces successfully crossed the Suez Canal. Peres presented his candidacy, but narrowly lost to Yitzhak Rabin. 
Twice, in 1977, after Rabin was forced to resign, and in 1995-1996, after Rabin was assassinated, Peres succeeded his rival. He was also Prime Minister (a very good one) in a national unity government in 1984-1986; but, despite trying for nearly 30 years, he never won his own mandate from Israeli voters for the post he coveted the most. 
But, though he came tantalizingly close to a peace deal in 1987, when he signed the London Agreement with King Hussein, the agreement was stillborn. In 1992, the Labor Party’s rank and file concluded that Peres could not win an election, and that only a centrist like Rabin stood a chance. 
Rabin was determined to manage the peace process and assigned to Peres a marginal role. But Peres was offered by Rabin’s deputy an opportunity to champion a track two negotiation with the PLO in Oslo, and, with Rabin’s consent, took charge of the talks, bringing them to a successful conclusion in August 1993. 
Here was the prime example of competition and collaboration that typified the Rabin-Peres relationship. It took Peres’s boldness and creativity to conclude the Oslo Accords; but without Rabin’s credibility and stature as a military man and security hawk, the Israeli public and political establishment would not have accepted it. 
The grudging cooperation between Rabin and Peres continued until November 4, 1995, when Rabin was murdered by a right-wing extremist. The assassin could have killed Peres, but decided that targeting Rabin was the more effective way to derail the peace process. 
Peres began to play down the Nobel Peace Prize that he had shared with Yasser Arafat and Rabin after Oslo. The discrepancy between his stature on the international stage and his position in Israeli politics became glaringly apparent during these years – disappearing, however, when he became President in 2007. 
This was the secret of his international stature: people expect the leader of Israel, the man from Jerusalem, to be just that type of visionary figure. When the country’s political leadership does not meet that expectation, a leader like Peres assumes the role – and gains the glory. 

Securing the Rule of Law at Sea 
TOKYO – Japan is in a better position than ever before to play a larger and more proactive role in ensuring peace in Asia and the world. We enjoy the explicit and enthusiastic support of our allies and other friendly countries, including every ASEAN member country and the United States, Australia, India, the United Kingdom, and France, among others. 
In most Asia-Pacific countries, economic growth has nurtured freedom of thought and religion, as well as more accountable and responsive political systems. Though the pace of such changes varies from country to country, the idea of the rule of law has taken root. 
Regrettably, a large and relatively disproportionate share of the fruits of that growth is going toward military expansion. The sources of instability include not only the threat of weapons of mass destruction, but also – and more immediately – efforts to alter the territorial status quo through force or coercion. 
Recently, US President Barack Obama and I mutually reaffirmed our countries’ alliance as the cornerstone of regional peace and security. Moreover, the United States and Japan are strengthening trilateral cooperation with like-minded partners to promote regional and global peace and economic prosperity. 
By Roman times, the seas were open to all, with personal possession and partitioning prohibited. Since the dawn of the Age of Exploration, large numbers of people have crossed the seas for myriad reasons, and marine-based commerce has connected the world’s regions. 
It is the product of humankind’s collective wisdom, cultivated over a great many years for the wellbeing of all. Today, many benefits for humanity depend on the seas from the Pacific to the Indian Oceans remaining fully open. 
But what, exactly, does that mean? If we distill the spirit that we have infused into international law over the ages and reformulate it as three principles, the rule of law at sea becomes a matter of common sense. 
And, third, states should seek to settle disputes by peaceful means. All three of these very simple – almost self-evident – principles must be emphasized, because all governments in Asia and the Pacific must uphold them rigorously. 
Consider Indonesia and the Philippines, countries whose leaders have peacefully reached agreement on the delimitation of their overlapping exclusive economic zones. Likewise, my government strongly supports the Philippines’ call for a resolution to the territorial dispute in the South China Sea that is truly consistent with the three principles of international maritime law, just as we support Vietnam’s efforts to resolve conflicting territorial claims through dialogue. 
Rather than attempting to consolidate changes to the status quo by piling one fait accompli upon another, the region’s governments should make a firm pledge to return to the spirit and provisions of the 2002 Declaration on the Conduct of Parties in the South China Sea, to which all parties concerned previously agreed. In today’s world, countries should not fear that coercion and threats will replace rules and laws. 
Japan and China have an agreement that then-Premier Wen Jiabao and I concluded in 2007, during my first term as Prime Minister. We made a commitment to create a maritime and air communication mechanism in order to prevent unforeseen incidents between our countries from generating tensions and miscalculation. 
What Japan and China must exchange are words. Should we not meet at the negotiating table, exchange smiles and handshakes, and get down to talking? 
I believe that following through on the 2007 agreement would advance the cause of peace and stability in the entire region. But I also know that ensuring long-term security will require many more agreements, each one a crucial strand in a region-wide web of freedom and prosperity. 

The Second Opening of Japan 
TOKYO – US President Barack Obama is visiting Tokyo at a unique moment in my country’s history, with Japan’s economy moving onto a stable new growth path that will take full advantage of its geographic position. Japan no longer considers itself the “Far” East; rather, we are at the very center of the Pacific Rim, and a neighbor to the world’s growth center stretching from Southeast Asia to India. 
There can be little doubt that this growth center will continue to propel Japan’s economy for the foreseeable future. Japanese direct investment is expanding in Vietnam and India, for example, which will boost demand for Japanese machine tools and capital goods. 
But, to maximize its opportunities, Japan must open its economy further and become a country that actively incorporates capital, human resources, and wisdom from abroad. Japan must be a country capable of growing by channeling the vitality of a growing Asia. 
To this end, we have sharply accelerated the pace of negotiations on economic partnership agreements, or EPAs, with various partners around the world. Earlier this month, Australian Prime Minister Tony Abbott and I reached agreement in principle on a Japan-Australia EPA. 
Both Japan and the United States attach great importance to rules, uphold the principles of freedom and democracy, and possess the most advanced technologies and industries. We intend to overcome our differences and together forge, in the form of the TPP, a twenty-first-century economic order for Asia and the Pacific that will serve as an unshakable foundation for growth. 
My government is also pushing hard to realize an EPA with the European Union. Given that the US and the EU already are engaged in trade talks, an EPA between Japan and the EU, coupled with the TPP, will give rise to a truly immense market – a single enormous growth engine that will benefit the entire global economy. 
But Japan’s economic frontiers extend well beyond Asia and the Pacific, to Latin America and Africa – more reason to abandon our long-held inward-looking perspective. A large number of highly motivated and ambitious young people have already come to Japan from around the world, especially from neighboring Asian countries, to study or work. 
In the near future, we will designate six National Strategic Economic Growth Areas – Tokyo, Kansai, Okinawa Prefecture, and the cities of Niigata, Yabu, and Fukuoka – to serve as models for the rest of the country. In health care, education, agriculture, and employment practices, we are identifying policies and practices that have fallen out of step with today’s needs, and we will move quickly to reform them. 
I am also now urging publicly traded companies to add at least one woman as a board member. Once we reach the point at which it is no longer news to have a woman or a non-Japanese serving as a CEO, Japan will have reinvented itself and recovered its true spirit of risk-taking and innovation. 
“Womenomics” tells us that a society in which women are dynamically engaged will also have a higher birth rate. My government intends to address, urgently, the need to expand day-care facilities and other such infrastructure as the foundation for a society that benefits from all of its members’ skills and talents. 
We are fully capable of change; indeed, we relish it, as the world will see in the months and years to come. But some things about Japan are unchanging, and some must not be changed. 
And our embrace of our global responsibilities extends to Japan’s Self-Defense Forces. Members of the Self-Defense Forces displayed exemplary cooperation with the US and Australian armed forces in the wake of the Great East Japan Earthquake in 2011, and they have earned deep appreciation and respect everywhere they have been deployed, including Haiti, Indonesia, and most recently, the Philippines. 
To make a proactive contribution to peace means that Japan will bear its own share of responsibility for assuring the security that supports global prosperity and stability. Working alongside countries with which we share common values and interests, we will safeguard and cultivate international public goods, ranging from space and cyberspace to the skies and the seas. 
As the world will see during Obama’s visit, Japan is back and thriving. And its return is indispensable for global stability and prosperity. 

The Solar Price Revolution 
POTSDAM – A silent revolution is under way. In November, Dubai announced the construction of a solar energy park that will produce electricity for less than $0.06 per kilowatt-hour – undercutting the cost of the alternative investment option, a gas or coal-fired power plant. 
The plant – which is expected to be operational in 2017 – is yet another harbinger of a future in which renewable energy crowds out conventional fossil fuels. Indeed, hardly a week seems to pass without news of a major deal to construct a solar power plant. 
There can be no doubting that these developments are good for the fight against climate change. But the major consideration driving them is profit, not the environment, as increased efficiency in energy distribution and, where necessary, storage, reduces the cost of producing renewable energy. 
As efforts to improve the management of electricity from fluctuating sources yield further advances, the cost of solar power will continue to fall. Within ten years, it will be produced in many regions around the globe for 4-6 cents per kilowatt-hour, according to a recent study by the Fraunhofer Institute for Solar Energy Systems (commissioned by the think tank Agora Energiewende). 
As Patrick Graichen, Agora’s executive director, points out, most forecasts of the world’s future energy supply fail to take into account solar power’s looming victory over its fossil-fuel competitors. Updating them would paint a realistic picture of the costs and impact of our energy production and consumption on the world’s climate, reveal the importance of renewable energy to economic development, and enable better planning of energy infrastructure. 
We should not underestimate the tremendous potential the sun and wind have for building global wealth and fighting poverty. As solar power becomes increasingly cost-effective, countries located within the planet’s sun belt could develop entirely new business models as cheap, clean energy enables them to process their raw materials locally, adding value – and profit – prior to export. 
Unlike large-scale conventional power plants, solar installations can be built in months; in addition to being cost-effective, they provide a quick means of responding to growing global demand. And, because solar plants can generally be operated independently of complex interregional electricity grids, they provide less developed countries a way to electrify their economies without building expensive new infrastructure. 
Solar power plants thus could play the same role for energy that mobile phones did for telecommunications: rapidly reaching large, underserved communities in sparsely populated regions, without the need to invest in the cables and accompanying infrastructure that once would have been necessary. In Africa, 66% of the population has gained access to electronic communications since 2000. 
The time to invest in large-scale solar energy production is now. For starters, construction costs for solar power plants are finally low enough to produce electricity at a competitive, stable price for more than 25 years. 
This is a decisive factor for the economic viability of solar power plants, because they need very little maintenance but require relatively high upfront investment. The Fraunhofer study shows that differences in capital expenditure are as important for costs per kilowatt-hour as differences in sunlight. 
But the cost of capital is something over which a country can maintain a certain amount of control. By creating a stable legal framework, providing credit guarantees in the context of international agreements, and involving central banks in large-scale investments, governments can help to make solar power more accessible. 
Technological breakthroughs have boosted these energy sources’ competitiveness relative to fossil fuels. As a result, instruments that make their adoption more affordable are becoming some of the most important weapons we have in the fight against climate change. 

New Frontiers in Affordable Housing 
With demand far exceeding supply, the adverse effects – on mobility, productivity, and growth – are (or will be) increasingly apparent. Fortunately, there are ways to narrow the affordable-housing gap substantially, using mostly market-based approaches at the municipal level. 
Worldwide, 330 million low- and moderate-income urban households either live in substandard housing or are so financially stretched by housing payments that they must forgo spending on essentials like health care and education. By 2025, that figure could reach 440 million households, or about 1.6 billion people (one-third of the world’s urban population) – and that does not even cover some of the world’s poorest people, who often live outside of cities, on urban streets, or as squatters, leaving them unaccounted for in census estimates. 
Replacing today’s substandard housing and building the additional units needed by 2025 would require an investment of an estimated $16 trillion – a daunting figure, to say the least. But there are four key “levers” that can reduce the cost of housing delivery by 20-50%, thereby making housing affordable (amounting to no more than 30% of total income) for households earning 50-80% of the median income in most cities. 
The first lever is more efficient land use. Acquisition of land for development in the right location at a reasonable price has the greatest potential for reducing housing costs. 
Location is especially important in developing countries, where many areas lack adequate transport, water, electricity, and sanitation infrastructure. Investment in these areas would improve and expand land use – whether by unlocking unused land or equipping areas to support more inhabitants – thereby helping to reduce housing costs. 
Similarly, cities can loosen land-use restrictions, such as unit size requirements, to allow for higher-density, and thus more valuable, projects. In exchange for providing the increased value to real-estate developers, municipal authorities could require that a portion of the land or a certain number of units be set aside for affordable housing. 
The final step toward improving land use is the implementation of measures to discourage land hoarding. China, for example, imposes an idle-land tax on formerly public land if its owners fail to initiate the development process within a year. 
This brings us to the second key lever to expand affordable housing: a more cohesive and efficient construction industry. As it stands, the housing-construction industry is highly fragmented, impeding its ability to take advantage of economies of scale, and builders often rely largely on the same methods used 50 years ago. 
By standardizing design elements like ceiling heights, fixtures, and flooring, construction companies can cut costs and raise productivity, as workers gain experience with repetitive tasks. Further savings are possible through industrial approaches, such as the use of components – for example, walls and flooring slabs – built offsite. 
The third key lever to make housing more affordable relates to operations and maintenance – everything from heating the building to repairing cracked tiles – which account for 20-30% of total housing costs. Here, the biggest opportunity lies in efforts to improve energy efficiency, with insulation, windows, and other retrofits generating energy savings of 20-30%. 
Additional savings would be possible if maintenance and repair companies were more transparent and competitive, and operated on a larger scale. To this end, public institutions could certify and list suppliers that meet quality standards, or bring owners together in buying consortia – an approach that has helped the United Kingdom’s social-housing agencies cut costs on some items by more than 20%. 
The final affordable-housing lever is expanded access to finance, especially for low-income households, which often face the highest borrowing costs – if they can gain access to finance at all. For the world’s many “unbanked,” who cannot accumulate savings or establish a credit record, the only option is to pay steep risk premiums for high loan-to-value mortgages. 
To expand access to finance, countries can improve underwriting by establishing credit bureaus, which are uncommon in developing economies, and training and certifying property appraisers. In some countries, collective-savings programs – that is, provident funds and building societies – have helped low-income households to accumulate down payments, with the pooled savings also providing capital for low-interest mortgages. 
At the same time, to reduce financing costs for developers, municipal bodies can “de-risk” projects by committing to purchase affordable units or guaranteeing qualified tenants. Cities can also streamline approval processes to accelerate completion. 
These four levers, if used systematically, can reduce the costs of housing for those who need it the most, while creating a better-functioning market that provides more choices for households across income levels. Indeed, while municipal and national governments will have to take additional measures to address the needs of their poorest citizens, cities have powerful tools at their disposal for closing their affordable-housing gaps. 
Though no single solution will work everywhere, initiatives that integrate land policy and more accessible finance with efforts to modernize housing construction and management can lead to progress everywhere. 

Somalia’s New Pirates 
Our rich marine waters are some of the most productive in the world, teeming with schools of yellowfin tuna, blue marlin, dolphinfish, and sardines. For more than 30 years, however, this bountiful marine wilderness has also been a source and site of conflict, as foreign illegal, unreported, and unregulated (IUU) fishing vessels have plundered our waters – stealing our fish and selling their catches at distant ports. 
Just a few years ago, the encroachment of illegal, unreported, and unregulated fishing vessels sparked a wave of piracy in Somalia that cost the global maritime shipping industry billions of dollars in lost revenue. As illegal foreign fishing vessels fled our waters, Somali pirates quickly shifted their focus toward more lucrative vessels, such as cargo ships and oil tankers. 
A new report by the group Secure Fisheries, called Securing Somali Fisheries unveils new satellite data showing that foreign IUU fishing vessels are now catching three times more fish than Somalis. They are targeting some of the highest-value fish in our waters, leaving their Somali counterparts to compete over lower-value fish. 
The report shows that, making matters worse, these foreign fleets have contributed to overfishing our swordfish, snapper, marlin, and shark populations. Foreign bottom trawlers have fished recklessly and acted with impunity, dragging heavy nets, razing the bottom of our seafloor, and damaging an astounding 120,000 square kilometers (46,000 square miles) of important marine habitat. 
This past December, we also passed the Somali Fisheries Law, which explicitly outlaws bottom trawling. This groundbreaking legislation calls for improved monitoring of fish landings, an ecosystem-based approach to fisheries’ management whereby the area would be managed holistically, and the protection of threatened and endangered fish species. 
But, despite all our progress in strengthening fisheries’ management domestically, we lack the ability to police our vast waters. The international community could make a significant difference in this area, by helping my government monitor and control Somalia’s EEZ, as well as through improved sharing of the critical intelligence gathered by international naval patrols. 
According to the Secure Fisheries’ report, eliminating IUU fishing today would enable Somalia to begin to license and sell commercially valuable tuna sustainably, generating up to $17 million per year. These funds could then be reinvested into better infrastructure – such as port construction, improved cold storage, and modern processing facilities – to support our artisanal and industrial fishing fleets. 
The elimination of IUU fishing would also allow our overfished stocks to recover and help build a prosperous Somali domestic fishery, along with increased government support and funding for data collection and resource management. The report shows that healthy fish stocks could provide significantly greater amounts of resources than they currently do. 
Fishing in Somali waters must not be allowed to remain a free-for-all, where far-flung foreign fleets exploit the ecosystem in unsustainable ways. I call upon the international community to collaborate with my government to ensure that IUU fishing in Somali waters is stopped for good. 
Doing so would improve maritime security and promote a vibrant domestic fishing industry that benefits and helps sustain all Somalis. A sustainable, dynamic fishing industry would help us build a more stable and prosperous Somalia. 

Trade in a Time of Protectionism 
COLOMBO – As China’s economy slows and growth in the developed world remains anemic, governments across Asia are working to keep their economies on an upward trajectory. In Sri Lanka, where I am Prime Minister, the challenge is to find a way to accelerate our already steady economic growth. 
One thing is clear: We cannot expect the rest of the world to welcome our economic ambitions the way it once opened its arms to China’s rapid rise as an economic power or – in earlier decades – cheered on the growth of Japan and the so-called Asian Tigers, including South Korea. 
Today, we Asians are witnessing, on an almost daily basis, fierce political assaults on the tools and policies that have helped lift hundreds of millions of our citizens out of poverty. Indeed, this year, free trade appears to be the scapegoat of choice among the world’s assorted populists and demagogues. 
In the United States’ presidential election campaign, for example, the leading candidates in both the Republican and Democratic primaries have questioned the wisdom of seeking greater openness in world trade. In the United Kingdom, euroskeptics campaigning for the country to leave the European Union denigrate the benefits of the single European market. 
Similarly, Indian Prime Minister Narendra Modi has been unable to convince state governors to lower trade barriers within the country. And in Sri Lanka, the “economic and technology agreement” that my government recently planned to sign with India, in order to bring about greater economic integration, has come under ferocious political attack. 
After all, much of the past four decades of robust growth can be attributed to the fact that world markets were receptive to Asian goods. All we needed to do to get our economies growing, it seemed, was to identify our comparative advantage, produce quality goods at competitive prices, and then export as much as we could. 
Even today, with world trade in the doldrums, regional trade remains a key component of these countries’ growth strategies. In South Asia, however, we have been much slower to take advantage of the opportunities that can arise from more open trade – with regrettable consequences: The region is home to 44% of the world’s poorest people. 
But with free trade rapidly becoming a global bugbear, the window for generating growth by tapping into world markets appears to be closing quickly. If trade is to become a key driver of growth in Sri Lanka or elsewhere in the region, we will most likely have to generate it ourselves – by transforming South Asia from one of the world’s least economically integrated regions into one of its most integrated. 
This vast untapped potential presents the region with an opportunity for growth that does not rely on the strength of the world economy. Last year, the World Bank estimated that annual trade between India and Pakistan could jump from $1 billion today to $10 billion – if tariffs and other barriers were slashed to levels recommended by the World Trade Organization. 
These obstacles were supposed to be swept away with the establishment of the South Asian Association for Regional Cooperation, the largest of all the world’s regional trading blocs, with close to two billion people. But SAARC’s reliance on bilateral negotiations has slowed the process to a crawl, keeping the region much poorer than it needs to be. 
Our still largely agrarian countries, with much of their territory in low-lying coastal regions, are dangerously exposed to rising sea levels and violent weather. Receding Himalayan glaciers will disrupt the lives – and livelihoods – of some 600 million people in Pakistan, Nepal, and northern India. 
Indeed, there is political opposition to greater regional economic integration in every SAARC country. But the scale of the challenges facing the region should impel all of SAARC’s members toward greater cooperation. 
It is time for SAARC’s member governments to rise to the challenge. By working together, we can lay the foundations of a regional economy as dynamic as that of our neighbors to the east. 

Sri Lanka’s Chinese Election 
NEW DELHI – Sri Lanka’s parliamentary election this month promises to shape not only the country’s political future, but also geopolitics in the wider Indian Ocean region, a global center of trade and energy flows that accounts for half of the world’s container traffic and 70% of its petroleum shipments. The country’s strategic importance has not been lost on China, which has, to the dismay of India and the United States, been working hard to strengthen its presence in the Indian Ocean. 
A leading contender in Sri Lanka’s upcoming election is former President Mahinda Rajapaksa, whose nine-year tenure, which ended in January with a shock defeat in the presidential election, was characterized by rising authoritarianism, nepotism, and corruption. To be sure, Rajapaksa brought an end to the 26-year Tamil insurgency in 2009, causing many in the country’s dominant Sinhalese community to view him as a hero. 
(India has a sizeable Tamil population.) But the country’s relationship with China improved markedly, with Chinese firms winning a series of lucrative construction contracts that would secure Sri Lanka’s position as a key stop on China’s “maritime Silk Road” connecting Asia to Africa and the Middle East. 
The maritime Silk Road is not just a trade initiative; it will also provide several access points for China’s navy in the Indian Ocean region, through accords for refueling, replenishment, crew rest, and maintenance. This fusion of economic and military interests was apparent last fall, when Chinese attack submarines, in their first known voyages to the Indian Ocean, docked at the new Chinese-owned container terminal in the Sri Lankan capital of Colombo. 
Rajapaksa’s successors, President Maithripala Sirisena and Prime Minister Ranil Wickremesinghe, seemed to recognize the risks that such collaboration with China entails. Indeed, during the presidential election campaign, Sirisena – who had served as Minister of Health in Rajapaksa’s cabinet, before quitting to run against his former boss – has said that the contracts awarded to China by Rajapaksa are ensnaring Sri Lanka in a debt trap. 
Likewise, in his election manifesto, Sirisena warns: “The land that the White Man took over by means of military strength is now being obtained by foreigners by paying ransom to a handful of persons… If this trend continues for another six years, our country would become a colony and we would become slaves.” While the manifesto does not mention China by name, the implication is clear. 
Once in power, Sirisena’s government put on hold the construction by Chinese firms of a $1.4 billion city on reclaimed land, and ordered investigations into environmental violations and corruption, including an alleged $1.1 million bribe by a Chinese state-run firm to Rajapaksa’s failed presidential reelection campaign. Moreover, by passing a constitutional amendment, Sirisena rescinded some of the presidential powers that Rajapaksa had added, as well as restoring the two-term limit. 
Last month, however, Sirisena suddenly decided to allow Rajapaksa to contest the parliamentary election on the ticket of the Sri Lanka Freedom Party – control of which Sirisena wrested from Rajapaksa after winning the presidency. It seems that Sirisena’s increasingly strained relations with Wickremesinghe, whose pro-democracy United National Party is the SLFP’s main opponent in the upcoming election, together with growing factionalism within the SLFP, left the president little choice but to accommodate Rajapaksa. 
If the SLFP were to win a majority in Parliament, it is not inevitable that Rajapaksa would lead the new government; that decision would be up to Sirisena. The question, then, is how far Sirisena will go in accommodating his predecessor, and what Faustian bargain has he perhaps struck to win a parliamentary majority. 
It should be noted that, even if Rajapaksa does not become prime minister, he is likely to win a seat in Parliament, providing him with the influence and political standing he needs to lead his SLFP faction more openly. But, of course, his influence over national policy would be much greater as prime minister. 
Rajapaksa’s authoritarian impulses mirror those of Turkey’s Recep Tayyip Erdoğan, who, after serving as Prime Minister for more than a decade, became his country’s first directly elected president last year. Just as Erdoğan fans Islamism in Turkey, Rajapaksa fuels Sinhalese nationalism in Sri Lanka. 
China, however, would undoubtedly celebrate the return to power of Rajapaksa, who has accused Sri Lanka’s current government of “treating China like a criminal.” Such a result would help ensure that the country becomes a key component in China’s Indian Ocean strategy. 
In the coming election, Sri Lankan voters will effectively decide whether their country should kowtow to China’s regional ambitions or shape its own destiny by promoting an independent foreign policy and an open economy. One hopes that they choose the latter option. 

Winning Sri Lanka’s Peace 
In Iraq, a quick military victory over Saddam Hussein’s regime soon gave way to insurgency, civil war, and the rise of the murderous Islamic State. In Libya, Syria, Yemen, and elsewhere, the hopes unleashed by the Arab Spring have similarly turned into an often-violent despair. 
Today, a half-decade after the end of its 36-year civil war, Sri Lanka is at a crucial moment in its own efforts to consolidate peace and secure its long-term benefits. Newly elected President Maithripala Sirisena and I, as prime minister, are determined to win that peace, and to help our country become what it always should have been: a prosperous Asian island of democracy, civility, and open society. 
The risks of a failed peace are appearing only now, because, since 2009, when the war with the Tamil Tigers ended in an enormous spasm of violence, the government led by former President Mahinda Rajapaksa made only the most half-hearted of efforts to bring about reconciliation with our Tamil citizens. Reconstruction of war-ravaged Tamil districts, as well as other parts of our society damaged by years of fighting and terrorism, has barely begun. 
But, though his divide and rule strategy worked for a while, allowing him to concentrate an unprecedented amount of power in his own hands, it could not hide the truth of our social divisions and continuing impoverishment. So, in the presidential election of this past January, Sirisena stunned the world by creating a winning coalition of Sri Lankans of all faiths and ethnicities who want to rebuild their democracy, not continue down the path of authoritarian rule. 
In the months since Sirisena’s triumph, Sri Lankan democracy has been revived, and the hard work of building a durable domestic peace has begun. We plan to quickly call a Parliamentary election, which will take place one year ahead of schedule, in order to replace Rajapaksa’s echo chamber with a fully functioning assembly, one that holds the government to account. 
Moreover, presidential power is now exercised within the limits established by law, not according to the whims of one man. Our judges no longer feel intimidated. 
As we liberate all of our citizens from fear, we will rebuild Sri Lanka as a free society. The authoritarian model of capitalism that Rajapaksa introduced to our country, and that much of the world seems to be embracing nowadays, is not for us. 
Our experience with authoritarian rule, however, is that it undermines the goal of post-conflict reconciliation and reconstruction by its need to maintain our society’s divisions artificially. The best way to avoid a relapse into conflict and arbitrary rule is to ensure that Sri Lanka’s leaders are held accountable through representative institutions. 
But we cannot fully turn the page on authoritarian rule, restore the full range of democratic freedoms, and rebuild our economy in an inclusive way on our own. Too much of our country’s wealth has been damaged by war, taken flight abroad, or been siphoned off through corruption. 
So we need the world’s democracies to stand with us and support us, lest our people become discouraged and be tempted by the autocratic forces waiting in the wings to return to power in the coming parliamentary election. We need to demonstrate to our people that reconciliation, democracy, tolerance, and the rule of law constitute the only route to long-term peace and shared prosperity. 
Though our political institutions need a thorough overhaul, I am proud to say that, despite Rajapaksa’s best efforts to corrupt and hollow them out, our victory was made possible because the election commission and court workers adhered to the law. Equally important, when the votes were counted, Sri Lanka’s military leaders honored their oaths and bravely rebuffed Rajapaksa’s unconstitutional order to annul the election and maintain him in power. 
These acts of civic heroism form a strong basis on which to refound Sri Lanka’s state and society. With the world’s help, we will do just that. 

An Economist’s Guide to War and Peace 
NEW YORK – Stories of conflict fill today’s headlines: whether it is Syria’s civil war, street battles in Ukraine, terrorism in Nigeria, or police crackdowns in Brazil, the gruesome immediacy of violence is all too apparent. But, while commentators debate geostrategic considerations, deterrence, ethnic strife, and the plight of ordinary people caught in the middle, dispassionate discussion of another, vital aspect of conflict – its economic cost – is rare. 
The global cost of containing violence or dealing with its consequences reached a staggering $9.5 trillion (11% of global GDP) in 2012. This is more than twice the size of the global agriculture sector and dwarfs total spending on foreign aid. 
To a large extent, this is because military campaigns are usually motivated by geostrategic concerns, not financial logic. Although opponents of the Iraq war might accuse the United States of coveting the country’s oil fields, the campaign was uneconomical, to say the least. 
Similar doubts accompany arms spending during peacetime. One might, for example, question the financial logic of Australia’s recent decision to spend $24 billion on the purchase of problem-plagued Joint Strike Fighters while simultaneously preparing the country for the most stringent budget cuts in decades. 
Tough and expensive law-and-order campaigns, for example, though appealing to voters, generally have little effect on underlying crime rates. Whether it is a world war or local policing, conflicts always involve big increases in government spending; the question is whether they are worth the cost. 
The military, the police, or personal security details are often a welcome and necessary presence, and, if properly deployed, will save taxpayers’ money in the long run. The pertinent issue is whether the amount spent in each instance is appropriate. 
Effective budgeting for potential or ongoing conflict is best achieved by emphasizing prevention. We know what underpins peaceful societies: an equitable distribution of income, respect for minority rights, high education standards, low levels of corruption, and an attractive business environment. 
Moreover, when governments overspend to contain violence, they waste money that could otherwise be invested in more productive areas, such as infrastructure, business development, or education. The higher productivity that would result, say, from building a school rather than a jail, would improve citizens’ wellbeing, thereby reducing the need to invest in violence prevention. 
Mark Adelson, the former chief credit officer of Standard & Poor’s, estimates that total global losses from the crisis were as high as $15 trillion in 2007-2011, which is just half the cost of spending on violence during the same period. If policymakers dedicated the same amount of time and money to preventing and containing conflict, the payoff, in terms of less violence and faster economic growth, could be huge. 
Globally, they already spend 75 times more on violence containment than their total combined overseas development aid. And it is no coincidence that countries with the highest expenditure on violence as a percentage of GDP are also among the world’s poorest – North Korea, Syria, Liberia, Afghanistan, and Libya to name a few. 
Apart from the obvious humanitarian reasons for investing in peace, especially when carried out within established international development frameworks, such investment is also one of the most cost-effective ways to develop an economy and balance a budget. That makes it a discussion well worth having. 

A Bad Bet on Synthetic Biology 
LAS VEGAS – Las Vegas seems to be an apt place to launch a risky corporate gamble that could destroy the livelihoods of millions of small-scale farmers. Earlier this month, the international food conglomerate Cargill chose the city’s famous Strip to introduce what it hopes will be its next blockbuster product: EverSweet, a sweetener made of “the same sweet components in the stevia plant.” 
And yet, despite Cargill’s heavy reliance on stevia in its promotional material, EverSweet does not contain a single leaf of the plant. Cargill’s new product is an example of synthetic biology, a form of genetic engineering that uses modified organisms to manufacture compounds that would never be produced naturally. 
Even as it attracts billions of dollars in investment, it is the subject of growing international concern. Tellingly, Cargill does not advertise its use of the controversial technology; instead, the company describes EverSweet as the product of “specially crafted baker’s yeast,” as if it were a recipe brewed for centuries in Bavarian villages. 
Discerning the risks that may be posed by food ingredients made from this kind of genetic engineering – different from those known from other types of transgenic foods – is still at an early stage. In a recent opinion, European Union scientific committees concluded that while the risk assessment used for evaluating genetically modified organisms should be applicable to aspects of synthetic biology, in specific cases new approaches may be needed to evaluate the safety of the technology. 
More recently, it has become a food-industry craze, driven in part by fear of obesity lawsuits. As major brands like Coke and Pepsi aggressively market stevia-sweetened cola drinks as natural and healthy, the agricultural acreage of the plant has exploded. 
For Ann Nduta Kanini, a widowed mother of eight, selling stevia has allowed her to send her children to school and put food on the table. When we asked Paul Mwangi Kigaa, another small-scale farmer, what Cargill’s use of synthetic biology would mean for him and his neighbors, he answered that “growing stevia in their factories will affect our lives!” 
Moreover, poor farmers have been actively encouraged to invest in stevia, because its cultivation can help preserve fragile and unique ecosystems. In its annual survey of leading global risks, the World Economic Forum noted that, “the invention of cheap, synthetic alternatives to high-value agricultural exports … could suddenly destabilize vulnerable economies by removing a source of income on which farmers rely.” 
Indeed, the world’s largest cosmetics, flavor, and fragrance companies are hoping that synthetic biology will help them replace more than 200 natural botanical extracts. According to the International Federation of Essential Oils and Aroma Trades (IFEAT), around 95% of these botanical products are produced by small-scale farmers, bringing much-needed cash income to some of the world’s poorest communities. 
Similarly, Häagen-Dazs confirmed that it will not use vanilla flavor produced through synthetic biology in its ice cream. And, after the natural cleaning products brand Ecover was petitioned by tens of thousands of angry consumers, the company quickly rolled back an experiment in which it used algal oil produced through synthetic biology in a laundry detergent. 
The Non-GMO Project, an increasingly influential labeling organization, has ruled that the 33,000 products carrying its seal must not use synthetic biology. Meanwhile, the European Stevia Association (EUSTAS), has expressed concern that EverSweet will undermine stevia’s reputation as safe and natural. 
The dark clouds gathering around synthetic biology may not have been visible at Cargill’s sunny product launch. But, by competing with poor farmers and misleading consumers about the origins of its ingredients, EverSweet and other examples of synthetic biology are generating bitterness at both ends of the product chain. 

Africa’s Farms of the Future 
For Africa’s farmers, the challenges are particularly pronounced. Given the vast economic and social benefits of a dynamic and modern agricultural sector, providing farmers with the incentives, investments, and regulations that they need to succeed should become a top priority. 
The recent boom in Africa’s telecommunications sector – which has revolutionized entire industries, not to mention people’s lifestyles – demonstrates just how effective such an approach can be. There are more than a half-billion mobile connections on the continent today; indeed, in many respects, Africa leads the world in mobile growth and innovation. 
Why, instead of bumper crops, does Africa have an annual food-import bill of $35 billion? According to the Africa Progress Panel’s latest annual report, Grain, Fish, Money – Financing Africa’s Green and Blue Revolutions, the problem is straightforward: the odds are stacked against Africa’s farmers. 
These farmers, who cultivate plots about the size of one or two football fields, typically lack reliable irrigation systems and quality inputs, such as seeds and soil supplements. Moreover, they rarely earn enough to invest in the needed machinery, and cannot gain access to credit. 
Maize yields, for example, are set to decline by one-quarter over the course of the twenty-first century. And, when the crops are ready, farmers face major obstacles – including inadequate rural road systems and a lack of cold storage facilities – in delivering them to the market. 
Despite these risks, which dwarf those faced by the telecoms industry, Africa’s smallholders remain as efficient as their larger counterparts – a testament to their tenacity and resilience. Yet, instead of supporting farmers, African governments have erected even more obstacles to growth, including excessive taxation, insufficient investment, and coercive policies. 
Africa’s farmers need an enabling environment that enables them to overcome the challenges they face. In such a context, the continent’s agricultural sector could unleash a revolution akin to that fueled by the communications industry. 
The good news is that both the private and public sectors – motivated by soaring demand for food, especially in Africa’s rapidly growing cities, and rising global food prices – seem ready to propel this shift. Private firms have begun to channel investment toward Africa’s agricultural sector, including through initiatives like Grow Africa (of which I am co-Chair), which facilitates cooperation between national governments and more than a hundred local, regional, and international companies to achieve targets for agricultural growth. 
For their part, African governments and development partners, recognizing the central role that agriculture can play in their economic-development agendas, have begun to reverse a three-decade decline in public investment in agriculture. In fact, agriculture has the potential to reduce poverty twice as fast as any other sector. 
The impact of such efforts is already becoming apparent in many parts of the continent. From Ghana to Rwanda, high levels of agricultural investment are fueling impressive economic growth in rural areas, thereby boosting job creation and reducing poverty and hunger. 
To sustain them, African governments must recommit to the African Union’s Maputo Declaration on Agriculture and Food Security, which includes a pledge to channel at least 10% of their budgets toward agricultural investment. And, they must provide farmers with the infrastructure, energy supplies, and supportive policies that they need in order to get their products to the market. 
Mobile technology has already begun to transform Africa’s agricultural industry, by providing farmers with valuable information like market prices, input support through e-vouchers, and even access to credit. Many of these innovative services are more accessible to African smallholders than they are to their American or European counterparts. 
Finally, private-sector actors, farmers’ organizations, and civil-society groups must cooperate to advance agricultural development. For example, the Alliance for a Green Revolution in Africa, supplies high-quality seeds – many of which are drought-resistant – to millions of smallholder farmers across the continent. 
With broad action on policy, investment, and technology, Africa’s farmers can double their productivity within five years. It is time to give the agriculture sector the opportunity that all Africans need to usher in an era of shared prosperity. 

From Poverty to Empowerment 
MUMBAI – As India gears up for its general election next month, it has some cause to celebrate: extreme poverty is finally in retreat. In 2012 – two decades after the government launched a series of economic reforms aimed at opening up the economy – the official poverty rate had reached 22%, less than half the rate in 1994. 
Indeed, the extent of the task is reflected in a new McKinsey Global Institute report, “From Poverty to Empowerment,” which uses an innovative analytical framework, the “empowerment line,” to estimate the cost to the average citizen of fulfilling eight basic needs: food, energy, housing, potable water, sanitation, health care, education, and social security. According to this metric, 56% of Indians in 2012 “lacked the means to meet essential needs.” 
Remarkably, this number is more than 2.5 times larger than the number of people still living below the poverty line in India. Even more striking is that the “empowerment gap” – that is, the additional consumption required to bring these 680 million people to the empowerment line – is seven times larger than the cost of eliminating extreme poverty. 
Furthermore, while the empowerment line is a measure of individual consumption, a household’s ability or willingness to spend is not sufficient to guarantee a decent life. People also need access to community-level infrastructure like health clinics, schools, power grids, and sanitation systems. 
What can India’s government do to provide its citizens with the dignity, comfort, and security that they deserve? Given that roughly half of current public spending on social programs fails to deliver better outcomes for the poor, simply directing more funds through existing channels is unlikely to have much of an impact. 
India’s economy has slowed in recent years. If economic growth remains on its current trajectory, with no major reforms, more than one-third of the population will remain below the empowerment line in 2022, with 12% still trapped in extreme poverty. 
To avoid such an outcome, India’s government should pursue a set of bold reforms that boost growth by encouraging businesses to invest, scale up, and hire. The reform agenda should be based on four key priorities: 
· The addition of 115 million non-agricultural jobs over the next decade to absorb the growing pool of workers and accelerate the shift toward more modern industries. 
· A doubling of agricultural productivity growth, in order to raise India’s farm yields to the levels achieved in other emerging Asian countries. 
· A doubling of real (inflation-adjusted) public spending on social services over ten years, with much of the increase allocated to fill gaps in health care, the provision of clean drinking water, and sanitation. 
· An overhaul of social-service delivery. 
With the right set of measures, more than half a billion people could cross the threshold of consumption required for an economically empowered life, and Indians could gain access to more than 80% of the basic services they need by 2022. Jobs and productivity growth could contribute 75% of the potential gains, while increased public spending alone, without measures to improve its effectiveness, would contribute less than 10%. 
To realize this potential, policymakers should eliminate arcane regulations that handcuff businesses; accelerate infrastructure projects; make the labor market more flexible; remove market distortions; and expand vocational training for the poor and uneducated. At the same time, they should work to place the efficiency of all public spending on par with that in India’s best-performing states. 
Common-sense strategies – such as improving coordination among the plethora of ministries and departments that comprise the bureaucracy, and establishing accountable and empowered agencies to deliver results in high-priority areas – could go a long way toward meeting this demand. Moreover, technology could be used to streamline government services and render them more transparent. 
India’s young and dynamic population is demanding a better quality of life. With strong and sustained political will and results-oriented policies, India’s government can deliver it. 

Fighting Climate Change Region by Region 
LONDON – A new global agreement to address climate change is taking shape, with the United States joining the European Union in formally submitting its plan to cut greenhouse-gas (GHG) emissions to the United Nations Framework Convention on Climate Change (UNFCCC). The US has sent a strong signal by being one of the first to offer this commitment to concrete climate action. 
Together, these plans (known as “intended nationally determined contributions,” or “INDCs”) will represent a collective global effort to invest in a prosperous, low-carbon future. 
And today, we, as co-chairs of The Climate Group’s States & Regions Alliance, call on national government leaders to join that effort with ambitious climate plans. We make this call to our national leaders because we believe it is right, and because we know it is possible. 
We believe it is right because, as the leaders of large state and regional governments, responsible for implementing our own climate plans, we have learned that addressing climate change is both a duty and an opportunity. It is a duty, because climate change now affects our everyday lives. 
Each of our regions has reduced GHG emissions to 1990 levels or below; and, since we began, our economies have more than doubled in size. This has been achieved partly through the innovative policies adopted by our respective governments. 
On January 1, 2014, Québec linked its carbon market with California’s, creating the largest regional carbon market in North America. All the revenues generated by the sale of Québec emission units go into the province’s Green Fund, and are reinvested in initiatives aimed at further reducing GHG emissions and helping Québec’s residents adapt to the effects of climate change. 
As a result of the program, almost all Basque municipalities have adopted such plans, consisting of more than 25,000 projects in areas such as mobility, waste management, and economic development. These local plans are now driving sustainable development in the region, with knowledge sharing among municipalities laying the foundation for further progress. 
South Australia, meanwhile, has developed the most supportive regulatory framework for renewable energy investment in Australia, enabling an increase in renewables’ share in power generation from virtually zero in 2003 to almost 40% today. This shift is putting downward pressure on wholesale electricity prices and offsetting the cost of South Australia’s Renewable Energy Target in the short term, all to the benefit of consumers. 
We have taken the lead, working to cut emissions by 20% by 2020 in the Basque Country and Québec, and by 60% by 2050 in South Australia – but we need partners at the national level. In our regions, businesses need consistent, long-term policy signals in order to make further investments toward a low-carbon economy. 
So, as we prepare for the UN Climate Change Conference in Paris in December, we encourage our national leaders not to waver. On the contrary, they should join us at the forefront of the fight against climate change by putting forward ambitious national plans that leverage the leadership of subnational governments to achieve the needed GHG emissions reductions. 

Data for Development 
Elections are managed with biometrics, forests are monitored by satellite imagery, banking has migrated from branch offices to smartphones, and medical x-rays are examined halfway around the world. With a bit of investment and foresight, spelled out in a new report, prepared by the UN Sustainable Development Solutions Network (SDSN), on Data for Development, the data revolution can drive a sustainable development revolution, and accelerate progress toward ending poverty, promoting social inclusion, and protecting the environment. 
The world’s governments will adopt the new Sustainable Development Goals (SDGs) at a special United Nations summit on September 25. The occasion will likely be the largest gathering of world leaders in history, as some 170 heads of state and government adopt shared goals that will guide global development efforts until 2030. 
The data revolution gives governments and businesses new and greatly improved ways to deliver services, fight corruption, cut red tape, and guarantee access in previously isolated places. Information technology is already revolutionizing the delivery of health care, education, governance, infrastructure (for example, prepaid electricity), banking, emergency response, and much more. 
Officials can now maintain real-time dashboards informing them of the current state of government facilities, transport networks, emergency relief operations, public health surveillance, violent crimes, and much more. Citizen feedback can also improve functioning, such as by crowd-sourcing traffic information from drivers. 
The data revolution can help to ensure that verifiable data are accessible to the general public and the intended recipients of public and private services. When services do not arrive on schedule (owing to, say, a bottleneck in construction or corruption in the supply chain), the data system will enable the public to pinpoint problems and hold governments and businesses to account. 
The Millennium Development Goals, which were set in the year 2000, established quantitative targets for the year 2015. But, although we are now in the MDGs’ final year, we still lack precise knowledge of whether certain MDG targets have been achieved, owing to the absence of high-quality, timely data. 
The data revolution can end the long lags and dramatically improve the quality of the data. For example, rather than relying on household surveys every few years to calculate the mortality rate, systems of civil registration and vital statistics can collect mortality data in real time, with the added benefit of information on cause of death. 
Likewise, poverty data could be collected at relatively low cost and with much higher frequency than today, by using smart phones to replace paper-based surveys. Some analysts have suggested that the use of mobile phones could bring down the cost of surveys by up to 60% in some East African countries over a ten-year period. 
The data revolution offers a breakthrough opportunity for service delivery, management, accountability, and validation, thanks to a dense ecosystem of technologies that collect information in multiple ways: remote sensing and satellite imagery, biometric data, GIS tracking, facilities-based data, household surveys, social media, crowd-sourcing, and other channels. 
To support the SDGs, such data should be publicly available for all countries at high frequency – at least within one year for key targets, and in real time in sectors where service delivery is vital (health, education, and the like). Private companies, including telecoms, social marketing companies, systems designers, survey firms, and other information providers, should all be integrated into the data “ecosystem.” 
In preparing the new report, the SDSN teamed up with several partner agencies to prepare a “needs assessment” on how to launch the data revolution for the SDGs. The report offers an action plan that builds on partnerships between national statistical systems and private information firms and other non-governmental data providers. 
While the cost estimates are necessarily provisional, especially in this era of disruptive technological change, the new study suggests that proper data systems for the SDGs will require at least $1 billion per year to cover all of the 77 lower-income countries. Of that sum, around half should be financed through official development assistance, which implies an increment of at least $200 million per year above current donor flows. 
In July, the world will assemble in Addis Ababa for the International Finance for Development Conference, and just weeks after that, at UN Headquarters to adopt the SDGs in late September. With quick action before these two summit meetings, the world will be ready to launch the SDGs with the data systems that they need to succeed. 

Seize the Sustainable Future 
Technological breakthroughs have put renewable energy on a competitive footing with fossil fuels. And the international community seems poised to forge critical agreements on sustainable development and the fight against climate change. 
And yet the risk remains that these gains will be frittered away, as policymakers, business leaders, and investors focus on short-term concerns at the expense of looming threats to the global economy. If we are to lock in our progress, we will need to address the failures of our financial system at their roots, putting in place standards, regulations, and practices that make it compatible with the long-term needs of a more inclusive, sustainable economy. 
The transition to a green economy now seems to be a certainty, rather than a hopeful aspiration, as growing public acceptance and technological advances make investments in clean energy increasingly practical. In 2014, global investment in renewable energy increased by 17%, even as oil prices plummeted, according to a recent report by the United Nations Environment Programme (UNEP). 
Stock exchanges from Shanghai to São Paulo have established reporting requirements to inform investors about how companies are weaving sustainability into their strategies. Green bonds have taken off, with upwards of $40 billion issued in 2014, and they are likely to become only more popular as clearer standards and regulations are established. 
September will mark the launch of the UN’s Sustainable Development Goals, the world’s first universally adopted, measurable targets for ending poverty and hunger while protecting the environment and the planet’s natural-resource base. And, later this year, the international community is expected to agree on binding commitments to cut emissions and finance the fight against climate change. 
More than 80% of the 140 countries surveyed in UNEP’s “Inclusive Wealth” report registered a deterioration in their stock of natural capital. The economic damage resulting from environmental degradation is estimated to be roughly $7 trillion a year, much of it irreversible. 
What is needed is a major international effort to realign financial and capital markets in ways that support sustainable development. Our financial system’s current design all but guarantees what BoE Governor Mark Carney has called the “tragedy of horizons” – a market failure resulting from the inability of investors, companies, and governments to act on problems, such as climate change, with consequences that will be felt only far in the future. 
Policymakers and business leaders cite many reasons for focusing on immediate concerns. Indeed, the very policy actions needed to reduce the risks of another financial crisis force banks and asset managers to lend and invest for the short term, passing up often more profitable, but less liquid, longer-term opportunities. 
Short-term pressures will always be present, but they can be overcome with the proper tools: improved pricing of environmental risks, climate-sensitive credit ratings, environmental lender liability, and efforts to mitigate the environmental risks to financial stability. A sustainable future is within reach, but only if we put in place the policies that make it possible. 

Leaving Our Children Nothing 
STOCKHOLM – Our generation has a unique opportunity. If we set our minds to it, we could be the first in human history to leave our children nothing: no greenhouse-gas emissions, no poverty, and no biodiversity loss. 
The 17 goals range from ending poverty and improving health to protecting the planet’s biosphere and providing energy for all. They emerged from the largest summit in the UN’s history, the “Rio+20” conference in 2012, followed by the largest consultation the UN has ever undertaken. 
Unlike their predecessor, the Millennium Development Goals, which focused almost exclusively on developing countries, the new global goals are universal and apply to all countries equally. Their adoption indicates widespread acceptance of the fact that all countries share responsibility for the long-term stability of Earth’s natural cycles, on which the planet’s ability to support us depends. 
Indeed, the SDGs are the first development framework that recognizes a fundamental shift in our relationship with the planet. For the first time in Earth’s 4.5-billion-year history, the main factors determining the stability of its systems are no longer the planet’s distance from the sun or the strength or frequency of its volcanic eruptions; they are economics, politics, and technology. 
Geologists call this period the Holocene. More recently, we have moved into what many are calling the Anthropocene, a far less predictable era of human-induced environmental change. 
This fundamental shift necessitates a new economic model. No longer can we assume – as prevailing economic thinking has – that resources are endless. 
And yet, far from being utopian, the SDGs are achievable by 2030. Some countries, including Denmark, Finland, Norway, and Sweden are well on the way to achieving many of them, and much progress is being made elsewhere around the world. 
According to a recent World Bank report, about 30% of them live in India, a sleeping giant about to industrialize, given the right incentives. Poverty is declining in other countries as well, including Nigeria (where 10% of the poorest live), China (home to 8%), and Bangladesh (6%). 
The main source of doubt concerns wealthy countries’ commitment to help developing countries cut greenhouse-gas emissions as they end poverty. Without the proper assistance, poor countries risk becoming locked into reliance on coal and oil for at least another generation, putting the entire planet in danger of out-of-control climate change. 
World leaders need to realize that the cost of transforming the global energy system is far less than coping with the consequences of burning the planet’s remaining fossil fuels. Research published this month concluded that consuming all remaining hydrocarbons would result in the melting of the entire Antarctic ice sheet, potentially raising sea levels by 58 meters. 
Fortunately, there is abundant evidence that countries and industries can thrive without contributing to climate change. By 2030, several countries are likely to have freed themselves from fossil fuels, with Sweden, France, and Germany probably in the lead. 
The value of biodiversity is that it makes our ecosystems more resilient, which is a prerequisite for stable societies; its wanton destruction is akin to setting fire to our lifeboat. Ending poverty and reducing emissions, including by effectively managing land use and halting deforestation, will go a long way toward stopping the trend and reversing the damage. 
At the same time, all industries, from information technology to agriculture, depend on services provided by nature. Managing forests, rivers, grasslands, and coral reefs in sustainable ways makes them more resilient and increases their ability to absorb greenhouse gases, which is good for business. 
We are the first generation that can make an informed choice about the direction our planet will take. Either we leave our descendants an endowment of zero poverty, zero fossil-fuel use, and zero biodiversity loss, or we leave them facing a tax bill from Earth that could wipe them out. 

A Year of Ocean Regeneration 
They supply 50% of the oxygen we breathe, feed billions of people, and provide livelihoods for millions more. They are the great biological pump of global atmospheric and thermal regulation, and the driver of the water and nutrient cycles. 
Though the ocean has been integral to slowing climate change, absorbing over 30% of the greenhouse-gas emissions and 90% of the excess heat generated since the Industrial Revolution, the cost has been huge. Ocean acidification and warming has been occurring at alarming rates, and are already having a serious impact on some of our most precious marine ecosystems – an impact that will only intensify. 
The adverse weather resulting from the phenomenon – which originates in the Pacific, but affects the ocean worldwide – is expected to affect adversely over 60 million people this year, compounding the misery wrought last year. It is a sobering reminder of our vulnerability to both natural and human-induced shocks to the earth’s systems. 
Despite all of this, we continue to degrade our oceans through the relentless destruction of habitats and biodiversity, including through overfishing and pollution. Disturbingly, recent reports indicate that the ocean may contain one kilogram of plastics for every three kilograms of fish by 2025. 
Urgent action must be taken not just to address climate change broadly by reducing greenhouse-gas emissions, but also to enhance the health and resilience of our oceans. Fortunately, in 2015 – a watershed year for global commitments – world leaders established conservation and restoration of the world’s oceans as a key component of the new United Nations development agenda, underpinned by 17 so-called Sustainable Development Goals. 
Specifically, SDG 14 commits world leaders to end overfishing, eliminate illegal fishing, establish more marine protected areas, reduce plastic litter and other sources of marine pollution, and increase ocean resilience to acidification. The Global Ocean Commission celebrated this strong endorsement of urgent action to protect the ocean, which closely reflects the set of proposals contained in the Global Ocean Commission’s 2014 report From Decline to Recovery: A Rescue Package for the Global Ocean. 
But how far and how fast we travel is yet to be determined. And the task ahead – translating admirable and ambitious commitments into effective collaborative action at the local, national, and international levels – is immense. 
Unlike other SDGs – such as those related to health, education, or hunger – there is no single international body charged with driving forward the implementation of the ocean SDG. As a result, it is not clear who will be responsible for monitoring and measuring progress and ensuring accountability. 
To ensure that SDG 14 does not fall by the wayside, the governments of Fiji and Sweden proposed convening a high-level UN conference on ocean and seas in Fiji, with Swedish support, in June 2017. Their proposal was subsequently co-sponsored by 95 countries and adopted unanimously in a UN General Assembly resolution. 
By drawing attention to the progress being made toward meeting SDG 14 targets and shining a spotlight on where results are lagging, the conference will provide a much-needed “accountability moment.” At the same time, by bringing together relevant stakeholders, it will help to catalyze deeper cooperation among governments, civil society, and the private sector. 
As the Global Ocean Commission’s work comes to a natural conclusion, its many partners and supporters will be working hard to sustain this momentum, ensuring that building healthy and resilient oceans remains a global priority until it is a global reality. The key to success, according to the Global Ocean Commission’s final report, will be the creation of an independent, transparent mechanism for monitoring, measuring, and reporting on the essential actions needed to achieve the SDG 14 targets, as well as additional UN conferences between now and 2030. 
Current and future generations alike need – and deserve – a healthy, resilient ocean. Growing awareness of – and strong commitments to resolve – the challenges facing our oceans is heartening. 

Why the Sustainable Development Goals Matter 
ROME – Following the progress made under the Millennium Development Goals, which guided global development efforts in the years 2000-2015, the world’s governments are currently negotiating a set of Sustainable Development Goals (SDGs) for the period 2016-2030. The MDGs focused on ending extreme poverty, hunger, and preventable disease, and were the most important global development goals in the United Nations’ history. 
But will a new set of goals help the world shift from a dangerous business-as-usual path to one of true sustainable development? Can UN goals actually make a difference? 
In September 2000, the UN General Assembly adopted the “Millennium Declaration,” which included the MDGs. Those eight goals became the centerpiece of the development effort for poor countries around the world. 
There has been marked progress on poverty reduction, disease control, and increased access to schooling and infrastructure in the poorest countries of the world, especially in Africa, as a result of the MDGs. Global goals helped to galvanize a global effort. 
No one has ever put the case for goal-based success better than John F. Kennedy did 50 years ago. In one of the greatest speeches of the modern US presidency, delivered in June 1963, Kennedy said: “By defining our goal more clearly, by making it seem more manageable and less remote, we can help all people to see it, to draw hope from it and to move irresistibly towards it.” 
The world needs to be oriented in one direction to fight poverty or to help achieve sustainable development, but it is very hard in our noisy, disparate, divided, crowded, congested, distracted, and often overwhelmed world to mount a consistent effort to achieve any of our common purposes. Adopting global goals helps individuals, organizations, and governments worldwide to agree on the direction – essentially, to focus on what really matters for our future. 
A second function of goals is to create peer pressure. With the adoption of the MDGs, political leaders were publicly and privately questioned on the steps they were taking to end extreme poverty. 
A third way that goals matter is to spur epistemic communities – networks of expertise, knowledge, and practice – into action around sustainable-development challenges. When bold goals are set, those communities of knowledge and practice come together to recommend practical pathways to achieve results. 
Community leaders, politicians, government ministries, the scientific community, leading nongovernmental organizations, religious groups, international organizations, donor organizations, and foundations are all motivated to come together for a common purpose. That kind of multi-stakeholder process is essential for tackling the complex challenges of sustainable development and the fight against poverty, hunger, and disease. 
Kennedy himself demonstrated leadership through goal setting a half-century ago in his quest for peace with the Soviet Union at the height of the Cold War. In a series of speeches starting with his famous commencement address at American University in Washington, DC, Kennedy built a campaign for peace on a combination of vision and pragmatic action, focusing on a treaty to end nuclear tests. 
Just seven weeks after the peace speech, the Americans and Soviets signed the Limited Test Ban Treaty, a landmark agreement to slow the Cold War arms race that would have been unthinkable only months earlier. Though the LTBT certainly did not end the Cold War, it provided proof that negotiation and agreement were possible, and laid the groundwork for future pacts. 
Good policy design, adequate financing, and new institutions to oversee execution must follow goal setting. And, as outcomes occur, they must be measured, and strategies must be rethought and adapted in a continuing loop of policy feedback, all under the pressures and motivations of clear goals and timelines. 
Just as the world has made tremendous progress with the MDGs, we can find our way to achieving the SDGs. Despite the cynicism, confusion, and obstructionist politics surrounding efforts to fight poverty, inequality, and environmental degradation, a breakthrough is possible. 
In his final address to the UN in September 1963, Kennedy described contemporary peacemaking by quoting Archimedes, who, “in explaining the principles of the lever, was said to have declared to his friends: ‘Give me a place where I can stand – and I shall move the world.’” Fifty years on, it is our generation’s turn to move the world towards sustainable development. 

Sustainable Energy Now 
WASHINGTON, DC – The world has never been closer to achieving the dream of a more sustainable and secure energy future. Renewable energy from the wind and sun is becoming competitive with fossil-fuel-based power generation, and oil prices are hitting lows not seen for years. 
With the oil-price drop that started in mid-2014, the first priority became clear: reform fossil-fuel subsidies before prices go back up. These subsidies have sapped government budgets, encouraged wasteful energy use, and increased pollution and carbon-dioxide emissions. 
But phasing out fossil-fuel subsidies, while critical, is only a first step in the right direction. By taking advantage of new technologies, now widely available at affordable prices, countries can finally move toward long-term energy security and away from the inherent volatility of oil markets. 
For low-income countries, this means reducing the use of imported oil to produce electricity. Kenya, for example, depends on heavy fuel oil and diesel for 21% of its electricity; the comparable figure in Senegal is a whopping 85%; and some island states use imported diesel for all of their electricity needs. 
For some countries, this is currently the only viable option, but over the long run this dependence can mean higher energy costs and vulnerability to price volatility and supply shocks. With the right policies and international support, these countries can invest in the infrastructure needed to achieve a more diversified energy mix. 
According to a new World Bank report, as of 2014, 144 countries had established national plans to expand renewable energy, and almost 100 had set specific targets and incentives. In just seven years, from 2006 to 2013, the world’s installed capacity for wind power quadrupled, while use of photovoltaic systems grew almost 20-fold. 
In Mexico, ambitious and frequently remote renewable-energy projects – hydropower, solar, and wind – are being connected to the grid. China, which has the world’s largest installed capacity for renewable energy, is studying the requirements and costs of upgrading the grid to bring in higher levels of distributed solar power. 
As the World Bank report shows, with the right investments and policies, countries can now meet a large share of their electricity needs from variable renewable energy without compromising the reliability of the grid or the affordability of electricity. These investments include energy storage, improved forecasting systems, and smart grids – all of which have benefited from breakthroughs in technology and falling prices. 
For poorer rural areas, this means creating a fertile environment for entrepreneurs and small power producers to develop mini-grids – generally powered by solar, small hydro, or solar-diesel hybrids – that can bring electricity to communities that would otherwise wait for years for grid connections. In Tanzania, small power producers are now able to sell to customers without going through a lengthy licensing process. 
This is a challenge even for high-income countries such as Germany and the United States, where some utilities are seeing their business upended as consumers sell power back into the grid. Here, developing countries, with less invested in traditional business models and facing an urgent need for power supplies, may be able to leapfrog the advanced countries, just as they have with mobile phones. 
Truly sustainable energy is not only clean, with a minimal impact on pollution and CO2 emissions. It is also affordable for governments and citizens alike; it is reliable, drawing on sources upon which we can depend for decades to come; and it contributes to shared prosperity, by bringing services and benefits to all members of society. 
Thanks to lower oil prices, innovation, and economies of scale in the renewable-energy sector, that vision can now be turned into reality. 

Targeting Non-Communicable Diseases 
Non-communicable diseases (NCDs) – such as heart disease, diabetes, and cancer – now account for two-thirds of all deaths worldwide. In addition to cutting lives short, NCDs exact a massive economic toll on their victims, their families, and their communities, sapping economic productivity and driving up medical costs. 
In September, the United Nations adopted the Sustainable Development Goals, a set of 17 objectives that will guide the global development agenda for the next 15 years. Alongside targets like eliminating poverty and measures to protect the environment is a commitment to reducing mortality caused by NCDs – the first time the UN’s official development agenda has taken direct aim at the problem. 
The physical and economic burdens associated with NCDs fall the hardest where they are least easily borne: low- and middle-income countries, where 80% of NCD-related deaths occur. Millions of people who have recently escaped poverty could be pushed back into it as a result. 
The attention and peer pressure generated by the SDGs can help drive progress. But achieving the targets will require sustained focus, drawing on the resources and expertise of governments, international non-profit organizations, and, crucially, the private sector. 
My experience in the health sector has led me to conclude that two important factors will prove crucial in addressing the challenges posed by NCDs. Progress will depend, first and foremost, on crafting effective local approaches that can be adapted, replicated, and scaled up. 
In 2013, for example, the Carlos Slim Foundation conducted a rigorous baseline assessment at eight primary-care clinics to understand the state of diabetes prevention and treatment. Based on the data gathered during the study, the Foundation piloted what is known as the CASALUD model to improve screening, treatment, and prevention using low-cost, user-friendly devices that can measure a range of relevant vital signs, including blood glucose levels. 
The approach was so effective that Mexico’s health office is using the CASALUD model as the basis for its national campaign to fight obesity, which can fuel diabetes and other NCDs – a great example of scaling up based on local experience. 
This includes not only the mobilization of private investment, but also the deployment of the vast amounts of technical, operational, and locally tailored expertise that private companies have gained in the course of doing business around the world. By forming partnerships with governments and international and local organizations, companies can help reduce the impact of devastating and costly diseases. 
I know this because my company is involved in just such an effort: the Lilly NCD Partnership, in which we are cooperating with partners and the governments of India, Mexico, South Africa, and Brazil to tackle NCDs. In Brazil, for example, we are working closely with key local organizations, including the Federal University of Rio Grande do Sul, to improve disease prevention – with a focus on helping mothers who were diagnosed with gestational diabetes while pregnant and are now at risk of developing type 2 diabetes. 
Ensuring the success of the SDGs – including the reduction of mortality from NCDs – will require companies to move beyond traditional philanthropy and forge creative solutions to socioeconomic problems. If we recognize that innovation stems from understanding local conditions and optimizing the vast resources of the private sector, we can ensure better health – and more rapid economic growth – far into the future. 

Big Polluters, Pay Up 
In Vietnam, the same deluges caused toxic slurry pits from coal mines to overflow and run through villages, and into the World Heritage-listed Ha Long Bay; the death toll was 17. As such weather events become increasingly frequent and intense, the need to mitigate and adapt to climate change is becoming more urgent than ever. 
And make no mistake: These events are, at least partly, the result of climate change. As the climate scientist Kevin Trenberth of the US National Center for Atmospheric Research points out, nowadays, “[a]ll weather events are affected by climate change, because the environment in which they occur is warmer and moister than it used to be.” 
The effects faced by the people of Myanmar and Vietnam are considered unavoidable costs of failing to adapt to climate change, which officials classify as “loss and damage.” But such language fails to capture the full scale of the consequences – especially their impact on human lives. 
This kind of bloodless rhetoric reflects the inadequacy of the responses to climate change that international negotiations have so far produced. In fact, if the industrialized world had done what was needed to stop climate change, as promised a generation ago, Myanmar and Vietnam most likely would have been spared their recent “loss and damage.” 
The so-called advanced economies failure to fulfill their commitments means that Myanmar and Vietnam are hardly the most vulnerable developing countries today. The tiny island states of the Pacific, for example, have been unable to erect adequate defenses against the “king tides” that are encroaching on their land and causing the freshwater “lenses” beneath their atolls to become brackish. 
But it gets even more perverse. Those behind the problem – the world’s biggest polluters – continue to reap billions in profits, while receiving huge energy subsidies from governments (projected to reach $5.3 trillion in 2015, or about $10 million per minute). 
According to a 2013 study by the scientist Rick Heede, nearly two-thirds of carbon dioxide emitted since the 1750s can be traced to just 90 of the largest fossil fuel- and cement-producing entities, most of which still operate. Fifty are investor-owned companies, including ChevronTexaco, ExxonMobil, Shell, BP, and Peabody Energy; 31 are state-owned companies, such as Saudi Aramco and Norway’s Statoil; and nine are states like Saudi Arabia and China. 
Recognizing the blatant injustice – not to mention the destructiveness – of this state of affairs, a new initiative, launched by the Carbon Levy Project and supported by a growing number of individuals and organizations, has emerged to demand compensation for vulnerable developing countries from the big polluters. Specifically, the Carbon Levy Project proposes a tax at the point of extraction for fossil fuels. 
Such a tax is consistent with international law, including the “polluter pays” principle, and would provide a new and predictable source of finance – amounting to billions of dollars – for the communities that need it most, without letting governments off the hook for providing public sources of finance. And, by raising the cost of extracting fossil fuels, it would contribute to the eventual phase-out of a sector that has no place in a climate-safe world. 
A Peruvian farmer now intends to sue the German coal company RWE to cover the costs of protecting his home, which lies in the flood path of a glacial lake. And the signatories of the Peoples’ Declaration for Climate Justice from Pacific Island countries are committed to bringing a case against big polluters for activities resulting in the destruction of their homes. 
If no action is taken, such lawsuits will only become more frequent and difficult to defeat. Big Oil, Big Gas, and Big Coal need to accept responsibility for climate change and start making real contributions to adaptation, or prepare to battle for their own survival – a battle that, in the long term, they simply cannot win. 

Securing a Sustainable Future 
LONDON – When Karl Marx and Friedrich Engels wrote that “All that is solid melts into air,” they intended it as a metaphor for the disruptive transformations that the Industrial Revolution implied for established social norms. Today, their words can be taken literally: Carbon-dioxide emissions and other industrial pollutants released into the atmosphere are changing the planet – with huge implications for the environment, health, population movements, and social justice. 
In 2007, Nelson Mandela founded The Elders to address just such risks, mandating this independent group of former leaders to “speak truth unto power.” That is what we will do at the launch of the new Sustainable Development Goals at the United Nations General Assembly later this month. 
The MDGs helped millions of people escape illiteracy, disease, and hunger, and placed development at the heart of the global political agenda. However, their overall impact was often inadequate, particularly in fragile, conflict-ridden states – and they failed to include sustainability in their targets. 
The SDGs represent a quantum leap forward, because they recognize the vital links among challenges – including poverty in all its forms, gender inequality, climate change, and poor governance – that must be addressed in tandem. Seventeen separate goals may seem unwieldy, but their cumulative effect should mean that no topic or constituency falls through the cracks. 
As former leaders from the global North and South, respectively, we are particularly pleased that the SDGs will apply to all UN member states and not just those in the developing world. In this way, we hope they will become as “universal” as the Universal Declaration of Human Rights – a vital element of the civic armory in the fight for fairness. 
Fine words are not enough; leaders must commit to putting them into action, and civil society must be vigilant in tracking progress and blowing the whistle when not enough is being done. Too often, summit declarations have melted into air once the delegations went home and short-term political calculus regained the upper hand. 
The decisions taken this year, at the SDG summit and at the climate conference in Paris in December, will have a lasting impact on our planet’s future. A stable climate underpins prosperity, poverty reduction, and the rule of law. 
We do not face a choice between reducing poverty and addressing climate change, as the fossil-fuel companies maintain. Indeed, the dangerous effects of climate change threaten to undo the development gains that the MDGs helped to achieve. 
At the same time, there is an emerging consensus – among grassroots organizations and central bankers alike – that inequality poses a serious threat to people’s livelihoods and prosperity worldwide. Globalization has led to a weakening of social contracts within nation-states and regional blocs and even among continents. 
Sustainable prosperity requires that all groups within a society share equitably in the benefits of economic growth – especially as our societies become ever more interdependent. For this reason, we are particularly encouraged by Goal 10 of the SDGs, with its commitment to reducing inequality within and among countries, as well as the focus on gender equality throughout the goals. 
The report defined the concept of “sustainable development” and called for radical change. It warned that, “Unless we are able to translate our words into a language that can reach the minds and hearts of people young and old, we shall not be able to undertake the extensive social changes needed to correct the course of development.” 
Sustainable growth and development policies cannot be imposed by diktat; they must be designed and implemented in a way that heeds the views and experiences of ordinary citizens. To implement the SDGs and minimize climate change, massive shifts will be required to move away from our fossil-fuel-driven economic model. 
World leaders must have the courage to take bold decisions, explain their necessity, and implement them in a just and effective way. They have no right to deny a decent future to our grandchildren. 

The Promise of Regrexit 
LONDON – Until the people of the United Kingdom voted to leave the European Union, the refugee crisis was the greatest problem Europe faced. Indeed, that crisis played a critical role in bringing about the greater calamity of Brexit. 
The vote for Brexit was a great shock; the morning after the vote, the disintegration of the European Union seemed practically inevitable. Brewing crises in other EU countries, especially Italy, deepened the dark forecast for the EU’s survival. 
The erstwhile leaders of the “Leave” campaign have engaged in a peculiar bout of internecine self-destruction, and some of their followers have started to glimpse the bleak future that both the country and they personally face. A sign of the shift in public opinion has been a campaign, supported by more than four million people so far, to petition Parliament to hold a second referendum. 
Just as Brexit was a negative surprise, the spontaneous response to it is a positive one. People on both sides of the cause – most important, those who didn’t even vote (particularly young people under 35) – have become mobilized. 
The post-referendum turmoil has highlighted for people in Britain just what they stand to lose by leaving the EU. If this sentiment spreads to the rest of Europe, what seemed like the inevitable disintegration of the EU could be instead creating positive momentum for a stronger and better Europe. 
The popular vote can’t be reversed but a signature collecting campaign could transform the political landscape by revealing a newfound enthusiasm for EU membership. This approach could then be replicated in the rest of the European Union, creating a movement to save the EU by profoundly restructuring it. 
European leaders should recognize their own mistakes and acknowledge the democratic deficit in the current institutional arrangements. Rather than treating Brexit as the negotiation of a divorce, they should seize the opportunity to reinvent the EU – making it the kind of club that the UK and others at risk of exit want to join. 
If disaffected voters in France, Germany, Sweden, Italy, Poland and everywhere else see the EU benefitting their lives, the EU will emerge stronger. If not, it will fall apart faster than leaders and citizens currently realize. 
Prime Minister Matteo Renzi is caught in a “Catch-22” situation: if he cannot resolve the banking crisis in time, he will lose the referendum. That could bring to power the Five Star Movement, a partner of the pro-Brexit UK Independence Party in the European Parliament. 
Europe’s leaders must recognize that the EU is on the verge of collapse. Instead of blaming one another, they should pull together and adopt exceptional measures. 
Those fortunate countries that are not members of the eurozone should not face discrimination. If the eurozone wants to be more closely integrated, as it should be, it needs to have its own treasury and budget, to serve as a fiscal authority alongside its monetary authority, the European Central Bank. 
Second, the EU should put its excellent and largely untapped credit to use. Leaders would be acting irresponsibly if they failed to employ the EU’s borrowing capacity when its very existence is at stake. 
Ukraine is fortunate to have a new government that is more determined and more likely to deliver the reforms for which both its citizens and its outside supporters have been clamoring. But the EU and its member states are not providing the support that Ukraine deserves (the US is much more supportive). 
Fourth, the EU’s plans for dealing with the refugee crisis need to be thoroughly revised. They are riddled with misconceptions and inconsistencies that render them ineffective. 
If the EU makes progress along these lines, it will become an organization to which people will want to belong. At that point, treaty change – and further integration – will once again become possible. 
If Europe’s leaders fail to act, those who want to save the EU in order to reinvent it should follow the lead of the young activists in Britain. Now more than ever, the EU’s defenders must find ways to make their influence felt. 

Tibet After the Dalai Lama 
NEW DELHI – On the 80th birthday of the 14th Dalai Lama, who has been in exile in India since 1959, Tibet’s future looks more uncertain than ever. During his reign, the current Dalai Lama has seen his homeland – the world’s largest and highest plateau – lose its independence to China. 
China already appointed its pawn to the second-highest position in Tibetan Buddhism, the Panchen Lama, in 1995, after abducting the Tibetans’ six-year-old appointee, who had just been confirmed by the Dalai Lama. Twenty years later, the rightful Panchen Lama now ranks among the world’s longest-serving political prisoners. 
This year marks one more meaningful anniversary for Tibet: the 50th anniversary of the founding of what China calls the “Tibet Autonomous Region.” The name is highly misleading. 
China became neighbors with India, Nepal, and Bhutan, and gained control over the region’s major river systems. Rivers that originate in water-rich Tibet are vital to support the world’s two most populous countries, China and India, as well as the arc of countries stretching from Afghanistan to Vietnam. 
After all, since fleeing to India, the Dalai Lama – Tibet’s rightful political and spiritual leader (though he ceded his political role to a democratically elected government in exile in 2011) – has been the public face of resistance to Chinese control of Tibet. In recent years, however, China has employed its growing influence – underpinned by the threat of diplomatic and economic pain – to compel a growing number of countries not to receive the Dalai Lama, thereby reducing his international visibility. 
China’s government, having issued a decree in 2007 that bans senior lamas from reincarnating without official permission, is essentially waiting for the current Dalai Lama to die, so that it can exercise its self-proclaimed exclusive authority to select his successor. China’s leaders seem not to be struck by the absurdity of an atheist government choosing a spiritual leader. 
The aging Dalai Lama has publicly discussed a range of unorthodox possibilities for the future disposition of his soul – from being reincarnated as a woman to naming his successor while he is still alive. Moreover, he has suggested that the next Dalai Lama will be found in the “free world,” implying that he will be reincarnated as a Tibetan exile or in India’s Tawang district, where the sixth Dalai Lama was born in the seventeenth century. 
Such declarations have motivated China to claim, since 2006, India’s entire Arunachal Pradesh state as “South Tibet” and to press India, in the negotiations over the long-disputed Himalayan border, to relinquish at least the part of the Tawang district located in that state. But the declaration that has most infuriated China was the one he made last December, suggesting that he would be the last Dalai Lama. 
China knows that there is every reason to expect that restive Tibet, whose people have largely scorned the Chinese-appointed Panchen Lama as a fraud, would not accept its chosen Dalai Lama. If the Dalai Lama issued clear guidelines about his own reincarnation, Tibetans would be even less likely to accept China’s appointment. 
The biggest risk stemming from the Dalai Lama’s passing is violent resistance to Chinese repression in Tibet. As it stands, the Dalai Lama’s commitment to nonviolence and conciliation – exemplified in his “middle way” approach, which aims for Tibet to gain autonomy, but not independence – is helping to ensure that Tibetan resistance to Chinese rule remains peaceful and avoids overt separatism. 
Indeed, over the last 60 years, Tibetans have pursued a model resistance movement, untainted by any links with terrorism. Even as China’s repression of Tibet’s religious, cultural, and linguistic heritage becomes increasingly severe, Tibetans have not taken up arms. 
Younger Tibetans already feel exasperated by China’s brutal methods – not to mention its sharp rebuff, including in a recent white paper, of the Dalai Lama’s overtures. Against this background, a Chinese-appointed “imposter” Dalai Lama could end up transforming a peaceful movement seeking autonomy into a violent underground struggle for independence. 
Given that the rightful Dalai Lama would be a small child, and thus incapable of providing strong leadership to the resistance movement, such an outcome would be all the more likely. China exploited just such a situation, when the current Dalai Lama was only 15, to invade and occupy Tibet. 
After the 13th Dalai Lama died in 1933, a leaderless Tibet was plagued by political intrigue, until the present Dalai Lama was formally enthroned in 1950. The next power vacuum in the Tibetan hierarchy could seal the fate of the Dalai Lama lineage and propel Tibet toward a violent future, with consequences that extend far beyond that vast plateau. 

Is 70 Too Old for the UN? 
NEW YORK – As world leaders prepare to gather next week at the United Nations in New York to ratify the new Sustainable Development Goals (SDGs) and commemorate the UN’s 70th anniversary, for many a fundamental question has become inescapable. In the face of growing global disorder – including turmoil in the Middle East, waves of migrants flooding into Europe, and China’s unilateral moves to enforce its territorial claims – does the UN have a future? 
Despite more than two decades of talk, the Security Council’s permanent membership (China, France, Russia, the United Kingdom, and the United States) still reflects the geopolitical realities of 1945, not 2015. Denied accommodation in the Bretton Woods institutions (the World Bank and the International Monetary Fund) commensurate with its economic clout, China has established its own alternatives, which other countries have flocked to join. 
Yet the UN should not be written off. It continues to serve a vital purpose, and its history suggests that it can be revitalized to meet the needs of the twenty-first century. 
The UN began, in 1945, as a vision shared by the leaders of the victorious Allies, who were determined to ensure that the second half of the twentieth century did not play out like the first half. After two world wars, countless civil wars, brutal dictatorships, mass expulsions of populations, and the horrors of the Holocaust and Hiroshima, “never again” was not just a slogan: the alternative was too apocalyptic to contemplate. 
To this end, the Allies sought an alternative to the balance-of-power politics that had wreaked such havoc in the preceding five decades. Their idea – now called “global governance” – was to create an institutional architecture that could foster international cooperation, elaborate consensual global norms, and establish predictable, universally applicable rules, to the benefit of all. 
And yet global statesmen made good use of the new organization as a forum to contain superpower tensions. Peacekeeping missions, not even mentioned in the Charter, were devised to contain conflicts around the world, and to prevent them from igniting a superpower conflagration. 
Moreover, the UN’s contribution to peace during the Cold War is not the whole story. Its decolonization efforts freed millions from the yoke of imperialist oppression. 
As global governance has evolved, the UN system has become the port of call for innumerable “problems without passports”: the proliferation of weapons of mass destruction, the degradation of our common environment, epidemics, war crimes, and mass migration. Such problems require solutions without passports, because no country or group of countries can solve them alone. 
With universality comes legitimacy. Because all countries are members, the UN enjoys a global standing that gives its decisions and actions a degree of authority that no individual government enjoys beyond its own borders. 
Instead, the metaphor for today’s globalized world is that of the World Wide Web, in which we increasingly function through multiple networks. Sometimes those networks overlap, with common participants, and sometimes they are distinct; they all serve our interests in different ways and for different purposes. 
Many countries once felt insulated – by wealth, strength, or distance – from external dangers. But now they realize that local security forces are not enough to protect their citizens, and that the safety of people everywhere depends on internationally coordinated efforts to combat terrorism, pollution, infectious diseases, illegal drugs, and weapons of mass destruction, and to promote human rights, democracy, and development. 
But at its best and its worst, the UN is a mirror of the world. As the legendary Secretary-General Dag Hammarskjöld famously put it, “The United Nations was not created to take mankind to heaven, but to save humanity from hell.” 
I believe strongly that the UN needs reform, not because it has failed, but because it has succeeded enough to be worth investing in. As the agreement on the SDGs demonstrates, there is much that can be accomplished with the UN as the lynchpin of our system of global governance. 
Moreover, the UN has proved a remarkably adaptable organization; it would not have survived so long if it was not. While it must be reformed to accommodate today’s world, all that is needed is a smidgen of the statesmanship shown seven decades ago, when world leaders subordinated their immediate short-term interests to a long-term vision of the kind of world they wanted their children to inhabit. 
The UN remains the source of laws and norms that countries negotiate together and agree to uphold as the “rules of the road.” And it remains the pre-eminent forum where sovereign states can come together to share burdens, address shared problems, and seize common opportunities. 
But they must be buttressed if they are to withstand the ongoing shifts in countries’ strategic weight. As the UN turns 70, it is time to reaffirm its founders’ guiding vision – a vision born of devastation that remains a source of universal hope for a better world. 

The Paris Climate-Change Spectacular 
The cast will be huge: presidents and prime ministers at center stage, supported by thousands of extras, including protesters, riot police, and busloads of media. The script may still be under wraps, but the plot has already leaked: This time, in sharp contrast to the failed negotiations in Copenhagen in 2009, the planet is going to win. 
Governments have agreed to voluntary reductions in greenhouse-gas emissions that will prevent the planet from heating more than 2° Celsius. Then, in a stunning deus ex machina, it will be revealed that the world’s largest fossil-fuel companies – the so-called supermajors – have agreed to bring net emissions to zero by 2100, by capturing carbon at the source, sucking it out of the atmosphere, and storing it underground. 
The technology required has yet to be invented, and bringing net emissions to zero simply is not possible. And, like a Hollywood production, the Paris conference’s message will have been heavily influenced by those who have the most money. 
The world’s energy infrastructure – finely tooled for the use of fossil fuels – is worth $55 trillion. The paper value of the fossil-fuel reserves – most of them owned by the supermajors – is some $28 trillion. 
The fossil-fuel industry’s influence is evident in the fact that governments worldwide are expected to spend some $5.3 trillion this year subsidizing it, including the massive outlays necessary to counteract its adverse health and environmental effects. In other words, the governments meeting in Paris spend more subsidizing the causes of climate change than they do on global health care or, for that matter, on climate-change mitigation and adaptation. 
The effort that will receive the greatest amount of attention is bio-energy with carbon capture and storage (BECCS). In May, the United States Department of Energy convened a private meeting to discuss this technology, which will be the fig leaf used by the supermajors to protect their assets. 
Deploying BECCS, however, would require the world to maintain an area 1.5 times the size of India, full of fields or forests capable of absorbing vast amounts of carbon dioxide, while still providing enough food for a global population that is expected to exceed nine billion by 2050. By then, the technology’s advocates promise, biological sequestration will be joined by programs that capture emissions as they are released or pull them out of the air to be pumped into deep subterranean shafts – out of sight and out of mind. 
Fossil-fuel producers promote carbon capture to allow them to keep their mines open and pumps flowing. Unfortunately for the planet, many scientists consider it technically impossible and financially backbreaking – especially if such technology is to be deployed in time to avert chaotic climate change. 
Preventing temperatures from rising out of control will require a second geoengineering fix, known as solar radiation management. The idea is to mimic the natural cooling action of a volcanic eruption, by using techniques like the deployment of hoses to pump sulfates 30 kilometers into the stratosphere to block sunlight. 
The United Kingdom’s Royal Society believes that the need for such technology may be unavoidable, and it has been working with counterparts in other countries to explore ways in which its use should be governed. Earlier this year, the US National Academies of Science gave the technique a tepid endorsement, and the Chinese government announced a major investment in weather modification, which could include solar radiation management. 
Unlike carbon capture, obstructing sunlight actually has the potential to lower global temperatures. In theory, the technology is simple, cheap, and capable of being deployed by a single country or a small group of collaborators; no UN consensus is required. 
The technology could buy time, but it surrenders control of the planetary thermostat to those who hold the hoses. Even the technology’s advocates concede that their computer models predict that it will have a strong negative impact on tropical and subtropical regions. 
The story that the Paris conference’s producers will ask viewers to believe relies on technologies that are no more effective than smoke and mirrors. It is important that we learn to see past them. 

The Year of Resilience 
NEW YORK – Ten years ago this month, representatives from 168 United Nations member states met in Kobe, the capital of Japan’s Hyogo Prefecture, to decide how to manage risk better in the wake of the devastating Indian Ocean tsunami, which claimed more than 227,000 lives. Over five days, which included the anniversary of the 1995 Kobe earthquake, they crafted the Hyogo Framework for Action (HFA), composed of a raft of measures designed to “reduce the losses in lives and social, economic, and environmental assets of communities and countries.” 
In two months, UN member states will gather for the third World Conference for Disaster Risk Reduction in another Japanese city synonymous with disaster risk: Sendai – the center of the Tōhoku region, which bore the brunt of the 2011 earthquake and tsunami that led to the Fukushima nuclear meltdown. One question will be on everyone’s mind at the meeting: Has the world lived up to the HFA’s ambitious goals? 
The evidence of the last decade – which has been marked by some of the worst natural disasters on record – is far from favorable. Port-au-Prince collapsed in an earthquake. 
These disasters serve as a stark reminder of the need for instruments like the HFA, especially because the drivers of disaster risk – improper land use, non-existent or poorly implemented building codes, environmental degradation, poverty, climate change, and, most important, weak governance by inappropriate and insufficient institutions – still abound. That is why world leaders need to agree on an updated version of the HFA at the Sendai conference. 
To be sure, there have been some important, albeit less noticeable, successes over the last ten years. In Asia, where 80% of the world’s disasters are concentrated, the number of people directly affected has dropped, decade-on-decade, by almost one billion, owing to measures like the Indian Ocean tsunami early-warning system. 
Indeed, timely evacuations in the face of accurately forecasted major storm systems have enabled the Philippines and India to save thousands of lives just in the last year. And, over the last three years, China has worked hard to keep economic losses within its 1.5%-of-GDP target. 
Ethiopia has developed a sophisticated data-management system to help guide its efforts to address not only drought but also other natural hazards. Both countries – and many others – have incorporated the study of disaster risk into their school curriculum. 
In Latin America, a cost-benefit analysis in Ecuador has concluded that each dollar invested in disaster risk reduction, by eliminating recurring losses from floods and storms, ultimately provides $9.50 in savings. Similarly, the European Union estimates that €1 ($1.18) spent on flood protection brings €6 in savings. 
In the United Kingdom, for example, investment in flood defenses meant that 800,000 properties were protected during last winter’s storms, significantly reducing the bill for response and recovery. 
In the last 44 years, disasters caused by weather, climate, and water-related hazards have led to 3.5 million deaths. Though progress has been made in reducing disaster-related mortality – according to the Center for Research into the Epidemiology of Disasters, the number of disaster-related deaths has not increased significantly in the last decade, despite the uptick in disasters – this figure remains far too high. 
Moreover, even where people’s lives are saved, their livelihoods are often decimated. Since 1960, disasters have cost the world more than $3.5 trillion, with both developed and developing countries paying a huge price in terms of lost productivity and damaged infrastructure. 
That is why, at the upcoming UN conference in Sendai, world leaders must agree, through a revised HFA, to scale up their efforts to cope with the risks posed by rising sea levels, global warming, rampant urbanization, and rapid population growth. Only with strong political commitment at the highest level can real progress toward a safer, more sustainable future be made. 
It should not be difficult to win support for a revised HFA. After all, there is no compelling – or even rational – reason why a finance minister or CEO would choose to pay for recovery but not to invest in prevention. 
It is time for the world to embed resilience to disasters into the industrialization process and the development of towns and cities, accounting for factors like seismic threats, flood plains, coastal erosion, and environmental degradation. If the UN conference produces the right agreement, resilience can become the hallmark of 2015, setting the tone for agreements later in the year on climate change and sustainable development – both of which hold important implications for disaster risk. 

Women’s Rights and Customary Wrongs 
SEATTLE – One of the greatest challenges facing women in much of the world is the gap between their legal rights and their ability as individuals to claim them. National constitutions are increasingly likely to guarantee gender equality, but many also recognize the authority of parallel legal systems based on custom, religion, or ethnic affiliation. 
In 1999 and 2000, two young Tanzanian tailors, married in their teens and widowed in their twenties with four children between them, were dispossessed of their homes under their ethnic group’s customary laws of inheritance. Those customary laws give male relatives a greater claim to the deceased’s possessions than female members of his family, and typically bar wives altogether and give short shrift to daughters. 
With the help of Tanzania’s Women’s Legal Aid Center and Georgetown University’s International Women’s Human Rights Clinic – which I previously directed – they challenged the decision in the High Court of Tanzania. In 2006, the High Court concluded that customary laws on inheritance were “discriminatory in more ways than one,” but it refused to overturn them. 
The women ultimately took their case to the United Nations (UN), where they have now struck a historic victory for equality for millions of women around the world. Tanzania is a party to the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and its protocol. 
On March 15, the UN committee declared that Tanzania had violated its international human-rights obligations. “The right of women to own, manage, enjoy, and dispose of property,” the committee ruled, “is central to their financial independence and may be critical to their ability to earn a livelihood and to provide adequate housing and nutrition for themselves and for their children.” 
The committee asserted that, in order to comply with the treaty’s human rights mandate, Tanzania would have to repeal and amend customary inheritance laws that discriminate against women. It also recommended that the country educate women about their rights under CEDAW and train judges, lawyers, local authorities, and traditional leaders in order to build support for removing discriminatory practices from customary law. 
India, for example, enacted legislation ten years ago to provide sons and daughters with equal claim to inherit family land in most situations. And yet a survey of women in three rural Indian states by the international land-rights NGO Landesa found that two-thirds did not know of any woman who had inherited land from her parents. 
And a study in Nepal found that children whose mothers owned land were 33% less likely to be malnourished. The benefits are much more than economic: In India, women with secure rights to land were found to be eight times less likely to suffer domestic abuse. 
The UN ruling has buoyed the hopes of women worldwide that their countries will be forced to address the injustices that may be found in some customary law and where bias hinders implementation of progressive legislation. Legislators in South Africa and Kenya have been grappling with the issue. 

Using Antibiotics Wisely 
LONDON – To solve the problem of antimicrobial resistance, the world needs not only new drugs, but also new behavior – by all seven billion of us. Because of the misuse and overuse of antibiotics, common infections such as pneumonia and tuberculosis are becoming increasingly resistant to existing treatments; in some cases, they have become completely immune. 
According to the Review on Antimicrobial Resistance, which I chair, drug-resistant infections kill at least 700,000 people every year. By 2050, if nothing is done to address the problem, some ten million people a year could be dying from maladies that were once treatable. 
We also need to reduce our demand for antibiotics and understand that they can sometimes do more harm than good. According to one estimate, nearly half of all prescriptions for antibiotics in the United States are inappropriate or unneeded. 
Most people are either completely oblivious to antimicrobial resistance or incorrectly believe that it is an individual’s body that becomes drug resistant – not the bacteria itself. A better understanding of when to use antibiotics, and how to use them effectively, will help people use them responsibly. 
We need campaigns like the one introduced by the Australian charity NPS MedicineWise, which held a competition for videos promoting public awareness of antibiotic use. The result was a series of short, witty films explaining simply and humorously how antibiotics can be misused. 
These types of efforts are needed worldwide, particularly in the largest and most rapidly growing countries. The BRIC countries – Brazil, Russia, India, and China – consume fewer antibiotics per person than the US. 
Pessimists will claim that behaviors are hard to change, especially when doing so depends on explaining the science of germs to uneducated audiences. That line of thinking brings to mind one of the most abhorrent arguments against making HIV medicines affordable for patients in lower-income countries: People in Africa have no watches, so they will not be able to take their antiretroviral medicine three times a day. 
The truth, as researchers have shown, is that Africans are perfectly capable of reliably adhering to antiretroviral therapy – often more so than North Americans. Indeed, in July, UNAIDS announced that the goal of having 15 million people on life-saving HIV treatment by the end 2015 was met ahead of schedule. 
We need a similar effort to address the perils of antimicrobial resistance. European Antibiotic Awareness Day, on November 18, is a good start; but we must also find new, creative ways to spread the message. 
In areas where literacy rates are high, sending text messages can be a rapid and effective way to spread a message. Research in Europe and the US shows that 90% of text messages are read within three minutes of being received. 
In China – home to the world’s largest Internet base, with 641 million users – 80% of doctors use smartphones for professional purposes, including by providing medical advice via social media, with some practitioners attracting millions of followers. Enlisting these medical social-media superstars to educate the public on the urgency of antimicrobial resistance is an exciting opportunity. 
An anti-smoking social-media campaign led by the World Health Organization provides another model that could be followed. Posts by Chinese celebrities were used to increase awareness of a law banning smoking in indoor public spaces. 
In India, a clever campaign called SuperAmma used images of people exposed to unsanitary situations to encourage hand washing. The campaign successfully and sustainably increased regular hand washing from 1% of the groups involved to about 30%. 
The cost of a global effort to raise awareness of the threat of antimicrobial resistance would be miniscule compared to the amount being spent to develop new drugs and technologies, which in any case will take years to become available. Countries should urgently put in place educational campaigns and begin to change behaviors. 


War and Peace and Water 
WASHINGTON, DC – India is currently facing its worst water crisis in years, with an estimated 330 million people – one-quarter of its population – affected by severe drought. Ethiopia is also dealing with its worst drought in decades, which has already contributed to the failure of many crops, creating food shortages that now affect around a tenth of the population. 
One of the first in recorded history erupted around 4,500 years ago, when the city-state of Lagash – nestled between the Tigris and Euphrates rivers in modern-day Iraq – diverted water from its neighbor, Umma. Competition for water sparked violent incidents in ancient China and fueled political instability in Pharaonic Egypt. 
But, within countries, competition for scarce water is becoming a more common source of instability and conflict, especially as climate change increases the severity and frequency of extreme weather events. As we detail in our new report “High and Dry: Climate Change, Water and the Economy,” limited and erratic water availability reduces economic growth, induces migration, and ignites civil conflict, which fuels further potentially destabilizing migration. 
In Sub-Saharan Africa, for example, periods of low rainfall over the last 20 years have often been followed by spikes in violence, civil wars, and regime change. And in many parts of rural Africa and India, a decline in rainfall has acted as a “push factor” for internal or cross-border migration to more water-abundant places, often cities, creating new social pressures as the numbers of displaced people grow. 
In our report, we predict that water scarcity could act as a conflict-risk multiplier, fueling cycles of resource-driven conflict, violence, and displacement, especially in already water-stressed regions, such as the Middle East and the Sahel in Africa, where agriculture remains an important source of employment. 
Fortunately, there is a way to avoid the cycle of poverty, deprivation, and conflict. If countries take action now to implement effective water-management policies and practices, backed by well-designed incentives, they can not only reverse the slide toward water scarcity, but also raise their rates of economic growth by as much as six percentage points per year. 
But, of course, agriculture remains critical to feed the population. So the government has been investing in modernizing irrigation infrastructure to provide farmers with more efficient water services that enable them to adjust more easily to variations in water availability. 
The Moroccan authorities are also working to improve groundwater governance, to avoid over-extraction. Farmers engaged in rain-fed agriculture receive support that helps them to make better use of rainfall – such as through the introduction of climate-resilient practices like direct seeding – resulting in higher yields than traditional practices produce during dry years. 
At the core of effective water-management strategies will be improved planning for water-resource allocation, the adoption of incentives to increase efficiency, investment in infrastructure for improved water security, and better urban planning, risk management, and citizen engagement. The recently created International High-level Panel on Water, comprising ten heads of state, will be promoting precisely this agenda to foster better water management globally. 
But, as countries develop their strategies, they can look to one another for ideas and insights into what works – and what doesn’t. With strong and prudent action, governments around the world can cope effectively with the natural limitations and uncertainties affecting water resources, ensuring that their people and economies are prepared for what might lie ahead. 

Prepping Gay Men for PrEP 
LONDON – In October, two groups researching the effectiveness of a potential breakthrough drug in the fight against HIV did something unusual. They announced that the therapy they were testing, an antiretroviral drug called Truvada, had proved effective enough to end the randomized phases of the trials, and that they were offering the pill to all of the studies’ participants. 
The researchers found that gay men who take Truvada, in addition to using condoms when they have sex, were significantly less likely to contract HIV. This is further evidence of the effectiveness of pre-exposure prophylaxis (PrEP), a technique by which people who are HIV-negative use antiretroviral drugs to protect themselves from infection. 
Those fighting to prevent the spread of HIV/AIDS thus have a new tool in their arsenal. The question now is how best to deliver it to those who need it most: gay men in developing countries. 
This summer, the World Health Organization took an important step to that end, recommending PrEP for all gay men and men who have sex with men, making it the first major international health organization to do so. The WHO estimates that increased use of PrEP could reduce HIV infections by up to 25% over the next decade among men who have sex with men (this category includes anyone with elevated risk, not just those who identify as gay). 
But an important obstacle remains: the legal predicament of gay men in much of the developing world. In countries like Nigeria, where anti-homosexuality legislation has recently been approved, those following the WHO’s new PrEP guidelines could find themselves subject to imprisonment. 
The climate of officially sanctioned homophobia in Nigeria has already set back the fight against AIDS. In 2006, a study found that 13% of men who have sex with men in Nigeria were HIV-positive, compared to 4.5% of all Nigerians. 
Two years ago, a young HIV-positive Nigerian man contacted me on Facebook to tell me about his monthly ordeal at the clinic. The nurse at the hospital spent more time lecturing him on the evils of homosexuality than telling him about the drugs he was taking and their possible side effects. 
A preliminary report from the Solidarity Alliance Nigeria, a coalition of gay, lesbian, bisexual, and transgender (LGBT) organizations, details a huge decrease in the use of HIV services by men who have sex with men in the six months following the enactment of the anti-gay legislation. The decrease ranges from 40% in Lagos – Nigeria’s most cosmopolitan city – to 70% in Kano, a predominantly Muslim state. 
Nigerians living with HIV must do more than just fight the infection; they also must brave social stigma, weather discrimination by secular and religious institutions, and now, potentially, face threats from the legal system. In this environment, the promise of PrEP begins to dim, as the risks of seeking treatment outweigh the potentially life-saving benefits. 
The story is similar in Uganda. Last spring, as legal persecution of gays there mounted, the government raided an HIV clinic and withheld its operating license for providing care and support to HIV-positive men who have sex with men. 
As an African activist with more than ten years of experience in the fight against HIV, I hope that the WHO will build on its important first step of advising the use of PrEP. That means initiating a public conversation with countries like Nigeria, Uganda, Gambia, and Russia on the importance of inclusion in the battle against HIV. 
The WHO should make it clear that while it may not be advocating for LGBT political rights, it is determined to ensure that all those who can benefit from PrEP are able to access the necessary drugs, without fear of legal consequences. Researchers, drug companies, and human-rights campaigners must take up the fight to ensure that PrEP is made available – without risk – to those who need it most. 


Women’s Development Goals 
NEW YORK – As the 2015 deadline for the United Nations Millennium Development Goals (MDGs) approaches, world leaders will face a choice: move the goal posts back another decade or two, or hold accountable those who have failed to deliver on their commitments. For women, the choice is clear. 
In 1978, at the International Conference on Primary Health Care in Alma-Ata, 134 states signed a declaration calling for adequate health care for all by the year 2000. Sixteen years later, in 1994, in Cairo, 179 governments embraced reproductive rights as a basic human right and adopted resolutions to ensure the provision of universal access to a full range of reproductive health services, including family planning. 
Yet those deadlines had come and gone when, in September 2000, during the 55th UN General Assembly, leaders of 189 nations adopted the MDGs. And several other commitments and resolutions were undertaken by world leaders before and after the MDG declaration. 
So, where are we now? 
We know that several MDG targets have already been met. Extreme poverty has been more than halved since 2000, to about 22% in 2010 – taking almost 700 million people out of the ranks of the world’s poorest. 
Billions of people have access to improved drinking water; and many have gained access to sanitation (though a billion people still have to resort to open defecation – a major health risk). There has also been progress on gender equality. 
But the picture quickly becomes cloudy. Though chronic under-nutrition among young children has declined, one in four children – 162 million children, according to the World Health Organization – are still affected by stunting. 
Indeed, maternal and child mortality has decreased by millions, but many of these preventable deaths are still claiming the lives of hundreds of thousands of women and children each year. Moreover, the UN Foundation reports that 222 million women still cannot access the most basic information, products, and services that would enable them to decide how many children to have and to time their pregnancies in ways that preserve their health, enable them to pursue an education, and improve their lives. 
The UN secretary-general’s 2013 report “A Life of Dignity for All” calls for a universal agenda to ensure that no one is left behind. But millions of people – and particularly women – already are being left behind. 
And, because world leaders and their development partners have failed to meet women’s basic reproductive-health needs once again, it will be more difficult to achieve concrete progress toward realizing the agenda for sustainable development. 
The UN’s own calls to accelerate momentum at the launch of the 500-day countdown to the MDGs’ expiry highlight the fact that inequality, maternal mortality from childbirth, lack of universal education, and environmental degradation remain serious challenges. To truly affect change – and not only for women – we need global support for access to family planning, women’s and children’s health services, and support for empowerment initiatives. 
When we leave women behind, we leave their communities behind, too. No one disputes that development must be inclusive and equitable. 
What is missing from the diplomatic discourse is a strong framework to hold governments and development partners accountable for translating lofty ideals like human rights – particularly the right to access basic health and social services – into practical solutions. 
We must break away from the current unwritten code of “zero accountability” for leaders who fail to honor their own commitments to internationally agreed goals. In short, our governments must begin to do what they have promised.