Jeffrey Sachs

A noted economist and special advisor to the U.N. Secretary General, Sachs delivered the139th Cutter Lecture on Preventive Medicine, "Saving 8 Million People a Year: Scaling up Public Health in the Poorest Countries." He is current director of The Earth Institute at Columbia University.

The Cutter Lecture was sponsored by the Department of Epidemiology and marked the inaugural talk of the "Dean’s Distinguished Lecture Series." The next talk in the series is scheduled for January 29.

A webcast of Sachs’ talk is available at http://www.hsph.harvard.edu/cutterlecture.

"There is absolutely no reason to accept the proposition that millions of people will die this year because they happen to be poor," Sachs said. Not only can things be done to prevent those deaths, he said, but some of the interventions are straightforward and easy to do. "I’m sure we will do it. The biggest shock and paradox is that we haven’t done it yet."

Focusing on Africa in particular, Sachs offered some alarming numbers:

• Every day, 20,000 people die of AIDS, TB and malaria, although all three diseases are preventable and treatable.

• About 30 million Africans currently are infected with HIV, four million with advanced HIV disease. Of those four million, only about 50,000 are on anti-retroviral therapy.

• The total funding given by all nations for control of malaria in Africa is $100 million, nowhere near enough to fight the continent’s estimated 500 million clinical cases, mostly among children, according to Sachs.

He believes that long-held but faulty beliefs have undermined many efforts by wealthy nations to aid their poorer neighbors. "The big myth is that we’ve poured so much aid down the drain and there’s nothing more we can do," Sachs explained. "The fact is, we haven’t even begun to try."

The U.S. provides the least amount of aid, per citizen, of any donor nation among rich nations, he added.

Sachs went on to say that, considering what is known about infectious diseases and what resources are available, "We ought to save eight million lives every year, and we ought to get on with it now. "

Sachs described his advisory role at the U.N., which involves the Millennium Development Goals (MDG). In 2000, the U.S. and 188 other member nations signed the Millennium Declaration, promising to attack global problems of poverty and hunger, as well as a lack of access to sanitation, safe water and public health. Spelling out goals, the pact sets a wide range of poverty-reduction targets for 2015.

Sachs called for an additional, more expeditious plan that would ramp-up health care in remote areas in a 10-year timeframe.

Simple interventions can make a significant impact, Sachs said, yet donor programs sometimes fail to meet the challenge. At best, for example, two percent of African children sleep under bed nets, which deter mosquitoes and subsequently interfere with malaria transmission. Yet stores of the netting are sitting unused in warehouses in Africa. Small fees are charged for the bed nets due to a misguided assumption that requiring people to pay will increase their personal investment–and therefore the likeliness of the nets’ use. This is a repeatedly disproved argument that only "rich people could invent," said Sachs. At $2 to $3, the bed nets are still too expensive for poverty-stricken people. The nets should be handed out for free, said Sachs, for example, after weekly church services when the community has gathered.

Professionals in public health and medical fields must be trained to work in low-income, high-risk areas, Sachs continued. He suggested that public health programs and medical schools require internships and residencies in poor regions. That way, he said, thousands of professionals could work in poor countries every year.

Citing the role of universities, Sachs stressed the importance of institutions such as Harvard. He hopes that someone at HSPH will research and write a textbook for strategic advisors to governments to use in order to meet the challenge of the U.N.’s Millennium Development Goals.

-PHC