The Guide to Giving outlines eight initiatives where the Nobel laureates believe that very small investments could achieve significant benefits.
It recounts the stories of people like Samia Khatun, a 21-year-old Indian suffering from goiter, a swelling of the thyroid gland caused by iodine deficiency.
Goiter was wiped out years ago in the developed world through the simple, cheap innovation of iodizing salt, yet one-third of developing world households still lack this protection.
When our researcher met Samia in Kolkata, she had been suffering, undiagnosed, for several years and had trouble eating. Iodizing salt costs just five cents a year per person reached. For just $19 billion or so—a relatively tiny overall sum—we would create benefits from health and productivity worth about $570 billion. In other words, each dollar achieves about $30 of benefits.
In addition to shorter-term micronutrient initiatives like fortification and supplements, the expert panel highly recommended investments in biofortificationandcommunity nutrition programs. Biofortification means developing nutrient-rich versions of staple crops and is especially relevant to remote places where supplement programs might not reach. A key opportunity for educational nutrition programs occurs during a mother's pregnancy, because undernutrition in infants is extremely difficult, if not impossible, to reverse.
Expanding vaccination coverage, de-worming, and combating malaria were three initiatives that the expert panel ranked highly that would have dramatic effects on child health.
Consider vaccination coverage for a moment: Research by David Bloom for Copenhagen Consensus makes the case that, traditionally, estimates of the benefits of vaccination coverage have been too narrow because they ignore nonhealth benefits such as increased educational performance, and that decision-makers have failed to take into account cost savings that can be achieved by combining several vaccines. Bloom's conclusions, and the Nobel laureate expert panel findings, suggest there is a very strong case for putting even more emphasis on expanded vaccination coverage for children in the developing world.
Under the topic of education and empowerment, the experts gave a high ranking to three initiatives. One was designed to support womens' reproductive role, where research shows that a relatively small overall investment ($3.9 billion in total) in family planning and maternal health initiatives such as providing emergency contraception in sub-Saharan Africa and South Asia could save 1.4 million infant lives and avert 142,000 pregnancy-related deaths.
The second initiative they ranked highly was designed to increase girls' access to education, by supporting programs where mothers receive payments when their daughters remain in school.
And the third was initiatives designed to lower the price of schooling. For me, the benefits of this approach were driven home when a Copenhagen Consensus researcher met George Kuria, a 13-year-old boy in Nairobi, who dreams of becoming a lawyer but who dropped out of school because his mother could not afford the uniform or $2.50 fee for each three-month school term.
A relatively large amount of money is spent each year in an effort to get more—and better—education to children in the developing world. But a lot of this money could be better spent. Experience shows that simply building more schools is not the best approach. In much of the world, schools already exist where most children live. Research by Peter Orazem suggests that the best—and most cost-effective—approach is to focus on eliminating grade-school drop-outs, and he advocates a range of grants and vouchers designed to lower the costs that parents face. George Kuria's mother put it in stark terms: "Going to school will change his life," she says. "But right now we don't have money."