Toward a world without poverty

Former World Bank President Jim Yong Kim, MD, PhD, speaks knowingly of those marginalized by technology and the industrial economy. He spent his formative years in rural Iowa and many of his high school classmates have been swept aside by the colossal changes in the U.S. economy.

An anthropologist and physician, the former president of Dartmouth College is a co-founder of Partners in Health, a legendary nonprofit global medical organization that fosters community-based health care in impoverished communities.

Before he was at its helm, Kim called for the World Bank to be abolished because its policies were failing the world’s poor. Perhaps it took that perspective to understand how to deliver on the bank’s promise to end extreme poverty in the world by 2030.

When President Barack Obama appointed Kim in 2012, he said that it was “time for a development professional to lead the world’s largest development agency.” Kim was reappointed in 2016, but in January announced he was cutting his tenure short to become a partner and vice chairman of Global Infrastructure Partners, a New York-based private equity fund and global infrastructure investor. He took over the role on Feb. 1. World Bank leaders named CEO Kristalina Georgieva as interim president.

Stanford Medicine’s executive editor, Paul Costello, conducted this interview via email before Kim left the World Bank. Though Kim resigned his position, we felt it was still important to hear his perspective because the changes he implemented could influence the bank’s initiatives for years to come.

Costello: Every person who walks through the door of the World Bank passes a large sign that says, “Our dream is a world free of poverty.” How does improving health on a global scale fit into the dream of ending poverty?

Kim: When I joined the World Bank in July 2012, I decided that we should translate this dream into measurable goals. With input from our member countries, we committed to twin goals that drive all of the bank’s work: ending extreme poverty by 2030, and boosting shared prosperity among the poorest 40 percent of people in every country. We also established that investing in people — through health and education — is one of the critical paths to reaching these goals, along with supporting inclusive, sustainable economic growth and helping countries build resilience to crises and risks.

Costello: You grew up in Muscatine, Iowa, a small rural town in the farmlands. How is your upbringing rooted in who you are today?

Kim: My Midwestern upbringing helps me understand the isolation we’re seeing in some countries — and, even more clearly, why it’s not the right solution to today’s challenges. Many of the people I grew up with are still in Muscatine. Only 10 percent of my classmates went to college. Most left school and went to work at the local steel mill, on their family farms or in factories, believing that they had a secure job for life.

But the impact of globalization has swept through many places like my hometown, altering the fabric of society and the quality of life. Mechanization and new technologies have disrupted traditional industrial production and changed the nature of work.

This trend is not unique to the United States — it’s affecting people around the world. In my view, we need more cooperation, greater economic integration and stronger partnerships than ever if we want the world economy to return to higher rates of inclusive, sustainable growth.

“My Midwestern upbringing helps me understand the isolation we’re seeing in some countries — and, even more clearly, why it’s not the right solution to today’s challenges.”

Costello: In what ways is the World Bank influencing health around the globe?

Kim: World Bank leaders are focusing on how to help countries invest more, and more effectively, in their people. In October, the bank launched the Human Capital Index, which ranks countries in terms of the quality of their investment in health, education and social protection. The index is part of the Human Capital Project to help developing countries build strategies to improve outcomes in these areas.

Another priority has been helping countries and the international community understand the challenge of global health as a systems and delivery problem, rather than just a disease problem. In a health crisis such as Ebola or HIV, the largest challenge is setting up the delivery systems that protect people from the diseases of today and from the diseases of tomorrow. There’s funding that can be channeled in that direction.

The World Bank can make a big difference by being really good at managing processes at a country level and at thinking about how to set up systems that deliver.

Costello: The Human Capital Project is a somewhat new program of the World Bank, the notion being that investing in people will have a profound impact on economic vitality. Can you describe the program and how it’s different from past initiatives? And why the term “human capital”?

Kim: Research shows that better outcomes in health and education are more powerfully correlated with economic growth than previously understood and can help drive poverty reduction all over the world. Human capital refers to the knowledge, skills and health that people accumulate over their lifetimes and bring to the economy.

Through the Human Capital Project, the World Bank is working with leading economists to shine a spotlight on how countries invest — and too often, don’t invest enough — to build the human capital stock of the next generation.

Costello: What’s the connection between income growth in developing nations and improved public health?

Kim: Let’s consider childhood stunting, which means that children younger than 5 are below height for their age because of such factors as chronic malnourishment and recurrent infections. The percentage of stunted children is staggering: 45 percent in Pakistan, 38 percent in India, 36 percent in Indonesia. And research shows that these children develop lower cognitive ability during their first 1,000 days of life. When they become adults, they’ll be less able to compete in a more technology-driven economy.

Attacking this issue is critical for economic growth. For example, stunting makes Indonesia’s per capita income 10.5 percent lower than it would be if no one in its workforce had been affected. The overall penalty for the East Asia and Pacific region is 7 percent of GDP; for Africa, it’s 9 percent of GDP.

Costello: You’ve cited a company called Zipline, where a group of rocket scientists use drones to deliver blood everywhere in Rwanda, as an example of a way to reduce costs and dramatically save lives. Are there other innovations on the global health front that are particularly exciting?

Kim: A recent World Bank partnership was established — working with Google, Amazon, Microsoft and such data providers as VanderSat — to develop an artificial intelligence model to help predict when and where a famine may occur.

Famine is a persistent issue in some of the poorest countries, but the larger problem is that responses to it come too late. The power of this innovative model is its ability to bring funding for humanitarian crises upstream, to prevent famines in the first place.

The World Bank also created the Pandemic Emergency Financing Facility to more quickly address global health threats. A $450 million policy will automatically disburse funds to the poorest countries when an epidemic reaches a critical stage.

Costello: What did you learn from the last Ebola crisis in West Africa that helped create this new funding mechanism?

Kim: For too long, the global community has suffered from a cycle of panic and neglect when it comes to pandemics by responding immediately to the crisis, then turning attention elsewhere once that crisis has abated.

For too long, the global community has suffered from a cycle of panic and neglect when it comes to pandemics by responding immediately to the crisis, then turning attention elsewhere once that crisis has abated.

With the 2014 Ebola crisis, we were unprepared to respond to an epidemic. The failure, over many years, to build effective health systems in every country meant that we weren’t able to prevent terrible tragedies — the deaths of more than 11,000 people and economic losses of billions of dollars in Guinea, Liberia and Sierra Leone.

The Pandemic Emergency Financing Facility was born out of this experience. It allows the World Bank to disburse funds immediately to governments and responding agencies to support a surge in health care needs when there’s an outbreak. Providing financing within hours and days eliminates the potential that funding shortages will constrain a response, and it helps save lives and protect economies.

PEF made its first disbursement for an Ebola outbreak in the Democratic Republic of Congo in mid-2018, providing a $12 million grant to support frontline response efforts.

Costello: You co-founded Partners in Health as a Harvard student in 1987 and have worked in the global health arena for most of your life. The nonprofit has helped bring modern medicine to the world’s poor. What lessons learned from that did you transfer to the World Bank?

Kim: When Paul Farmer, Ophelia Dahl and I co-founded Partners in Health, we took as our creed a cardinal principle of Catholic liberation theology of “a preferential option for the poor.” That drove us to insist that everyone — even people with complex health problems, and especially the poorest and most vulnerable — deserves treatment.

I took that principle to the World Bank Group — a moral obligation to provide everyone in our client countries with opportunities to achieve their highest aspirations. All people have hopes and aspirations, and they deserve good health care, quality education and the chance to live with dignity.