What Bad Backs Can Teach Us About Development Work
As a development economist I naturally spend a lot of time thinking about issues related to economic development. I also have a chronic bad back, and unfortunately spend a lot of time thinking about my bad back too. Recently this has caused me to think about what bad backs can teach us about economic development.
What made me bring these two profound bodies of thought together was the advice about my bad back given to me by two different doctors, Doctor A and Doctor B. Doctor A told me that for my bad back to get better, I should wear a back brace frequently, all the time if possible. “This will help facilitate the healing. Keeps things from rattling around inside,” he said. So with high hopes, I eagerly applied the brace.
But recently I visited Doctor B, a spinal surgeon. He saw my brace, shook his head with furrowed brow, and gave me one of those tsk-tsk doctor looks. “I see you’re wearing a brace,” said Doctor B. “I worry about those. May lead to muscle atrophy and that back will never heal.” My countenance fell. “But my other doctor…uh…I try to do lots of sit-ups,” I replied lamely.
One of the problems with bad backs is nobody really knows what works and there is lots of contradictory advice. Likewise, one of the problems with economic development is that nobody really knows what works and there is lots of contradictory advice. But the contradictory advice between Doctors A & B about back braces brings up an even deeper question that affects both bad backs and bad economies. How much help is too much?
My hunch, a hunch that is shared by a number of development economists, including the likes of Bill Easterly at NYU and many others, is that too much is probably less than we think it is.
In thinking about economic development, we occasionally need to consider how, for example, Sweden became Sweden, or Singapore became Singapore. These processes were admittedly complex and nuanced, but the important point is that the evolution of these economies did not come about through armies of foreign non-government organizations (NGOs) stepping in to help. They developed through a complicated interaction of domestic aspirations, decent governance, and the ensuing emergence of institutions built to foster economic development and prosperity.
What I am about to say is not based on any serious empirical study, but I worry about countries like Haiti. Haiti is a country that has been NGO’d to death. Part of this may lie in its proximity to the United States and the dramatic contrast between the poverty in Haiti and the vast wealth of its northern neighbor. But this has resulted in foreign NGOs seemingly taking over nearly every aspect of Haitian life. So many of my Christian brethren have (commendably) been willing to go
to where the need is greatest, and at great cost to themselves. But they have perceived Haiti as this perpetual basket case of chronic poverty, and have responded by opening up the latest NGO in Cap-Haïtien or Port-au-Prince. The diagram here shows the proliferation of NGOs in Haiti. There are hundreds by a modest count. At the time of the 2010 earthquake, there were 45,000 Americans in Haiti, and not many of these were down for a sleepy vacation. Most were aid workers, and since the earthquake there is more NGO work in Haiti than ever.
The work of many of these NGOs is to be lauded, but another result is now the following: If parents want to send their child to a good school, why choose the Haitian public school when the school run by the NGO is so much better? Why go to a Haitian bank for a microloan when the local NGO microlender is available? When a child is sick, who wouldn’t prefer the shiny hospital run by the NGO to the local Haitian hospital?
The point is that for all of our good intentions, we haven’t allowed the conditions to exist for countries like Haiti to grow and develop on their own terms. We have kept them in an economic back brace as their own muscles have atrophied.
This atrophy occurs in different forms. Consider a child growing up in Haiti and what the ubiquitous presence of NGOs teaches that child to believe about herself. Granted, it may teach a child that outsiders care for her. But it also may teach the child that she is fundamentally incapable, at the mercy of the benevolence of others. These are not good lessons for the development of aspirational hope and human agency. They teach children that they are to be pitied, worthy recipients of aid. Indeed this is what we find evidence of in our study with TOMS Shoes in El Salvador. Children in the treatment group who had received the free shoes at baseline were about 10 percentage points more likely to say that outsiders should provide for the needs of their families. Now of course aid dependence has to be compared to the positive impact of an intervention, but it is another side to the coin that is not good news.
Secondly, the ubiquitous spread of NGO work may simply just crowd out the emergence of not only sustainable domestic enterprises (financial firms, private schools, construction firms, medical clinics and so forth), but even more importantly, the institutions that allow prosperity to take root. In every historical example of successful transition from widespread poverty to widespread prosperity, we observe the development of these institutions. And one of the most important steps in the transition for poor countries is for them to be allowed to develop and strengthen these muscles.
All of this is not to say that we should not pursue effective interventions in poor countries. Some of these do indeed work, and work well, but we need to be smarter about how, when, how much, and for how long we intervene. If we ignore these considerations, the result may be the perpetual back brace.
Follow Bruce Wydick on Twitter @BruceWydick.