Why I Never should have Chosen to Study International Development (and Why I’m Glad that I Did)

I’ve always thought that the world is a pretty complicated place.  I’ve never really understood what sort of things I really ought to do or the sort of person that I really ought to be.  The moral ambiguity intrinsic to the human experience has often frustrated me.  But before university, I was pretty sure that I knew one thing for certain: I knew that helping others less fortunate than me was a good thing to do.  And thus I believed that studying international development would provide me with a clear understanding of what it is that the world really needs, thereby piercing through the clouds of the nebulous morality enshrouding all of life’s decisions with a ray of indubitable clarity and purpose.  Certain facts in my mind seemed indisputable: poor people need help, we know how to help them, and we have the resources to do so.  The world just needed motivated people who were willing to act in order for things to get better.

It is obvious to me now, as I’m sure it is to any of my classmates reading this blog, that this belief was somewhat misguided.  That’s because, as I soon found out, nothing at all is certain in international development.  As it turns out, poor people don’t necessarily need help.  And often when we think we know how to help them, we only make things worse.  And resources are not unlimited, which means that short term improvements in human well-being may actually make everything more difficult in the long run.  In fact, I don’t think I’ve ever studied a problem in my three years of university so far, where all of the ‘experts’ agreed on any one ‘right’ course of action.

In fact, if moral clarity was something that I had really wanted, then international development was probably one of the worst areas of study that I could have chosen.  This is true not only because every situation in the field is so complicated, but because every problem in international development has incredibly high stakes, since every development decision has the potential to interfere with the life of some other human being in a fundamental way.  When international development institutions debate whether or not to provide food aid to people in need, when they consider whether or not health care provision is a viable option in a remote area, or when they consider whether or not loans should be used as incentives to reform governments to promote growth, the implications of these decisions on individual humans living in the Global South can be life-changing.  And while it may seem arrogant to assume that the choices we make in the Global North can be so important to the rest of the world, the massive levels of inequality present in global society mean that such power often really does lie in the hands of a few well-meaning but confused North Americans.

To be involved in international development means, therefore, that one must become embroiled in the difficult ethical questions surrounding development practice.  Through my time in university, I’ve come to the realization that such questions will never be avoidable, and I’m glad that I’ve chosen to engage these issues, rather than ignore them.  Despite my lack of understanding, I still know that I’m pretty fond of the Earth and of most of the people who live here.  And I’d rather do something about the challenges that humanity faces and will continue to face than ignore them and hope that they solve themselves.  And while I don’t believe that my contribution will ever be meaningful enough to really make a significant difference, I might as well do what I can.  Because somebody has to, and it may as well be me.

Partners in Health

Recently, Barack Obama announced that Jim Yong Kim has been nominated by the United States to lead the World Bank as the next president.  A surprise candidate, Kim is best known for his role in founding the NGO Partners in Health (PIH), along with Paul Farmer and a few other individuals in 1987.  Kim’s nomination has made many hopeful that his new leadership might bring about meaningful change within the World Bank, and his candidacy has provided many an INDEVOUR with fodder for insightful blog posts regarding the needs of this institution.  Yet I believe that a discussion about PIH’s role in global health care provision is equally necessary, and since I’ve had the opportunity to research this organization over the course of the term, I’ve decided to discuss PIH’s revolutionary approach to health care and to talk about the implications of the organization’s philosophy.

PIH is a not-for-profit that works to provide health care to people in need around the world.  Throughout their history, PIH has been known for succeeding in bringing high- quality levels of basic health care to areas of the world where such undertakings were not thought to be possible.  When major global health organizations like the WHO warned that providing health care in rural areas of poverty-stricken countries would require too many resources, PIH proved such criticisms false.  And they continue to do so by maintaining a strong commitment to the belief that health care is a fundamental human right, and that every individual therefore deserves access to basic care.

This commitment has allowed PIH to defy critics and has changed the way many look at health care in the Global South, though it necessarily gives rise to numerous ethical dilemmas.  When faced with challenges and criticisms, PIH has remained determined to bringing health care to those who need it.  No matter the cost, PIH maintains a focus on providing whatever is needed to treat the needs of the people who have been left behind by other global health organizations.  And these people tend to be located in remote areas, where providing access incurs an extremely high cost.  This means that PIH must necessarily pay a high price for the success of their model, since they have chosen to work in areas deemed too expensive by other organizations.  PIH remains committed, however, to doing whatever is necessary to help those that they work with, without considering how the resources they use might be spent to help others elsewhere. 

And this is where PIH’s model draws criticism.  Some argue that, because the world we live in is one of limited resources, and because only so much money is available for health care, a system of provision that does not take cost into account only ends up excluding other individuals from access to care. By choosing to provide health care at a high cost in remote places, the opportunity cost of PIH’s model is decreasing the total amount of improvement to human well-being that could be achieved through a more efficient approach to health care distribution. Yet because health care is a human right, defenders of PIH argue that it is not right to treat or not treat individuals based on such utilitarian equations, and that no individual would ever really accept such reasoning if their own life was in danger.

And this commitment is why I believe that PIH is such an important voice in today’s global health discourse.  PIH has changed the way that we can talk about health care.  We can no longer say, with respect to the needs of individuals in areas with limited access to health care, that it is “too expensive to reach them”, because PIH has shown that we can say in response: “Yes, it is very expensive, but it is still possible, and to do otherwise would be inexcusable”.  And economic arguments against such action seem ridiculous when one considers the way that global resources are distributed.  For example, in 2009, $10 billion was spent on cosmetic surgery in the US alone.  In the same year, revenue for PIH totaled only $63 million.  Clearly, there is no ‘shortage’ of resources available for health care.  And PIH has proven that, with the proper resources, basic health care can be provided, even to those in remote areas who lack the ability to pay. 

What do you think?  Is PIH too idealistic?  Please comment.

Dan