The pros and cons of having a doctor run the World Bank
By Brad Plumer,
The White House has tapped Jim Yong Kim, a public health expert (and president of Dartmouth College), to head the World Bank. That’s a big departure. Past World Bank presidents have often been market- and economics-oriented guys. What will it mean to have a doctor in charge for a change?
Development experts see real pros and cons to the move. Public health is a huge part of development — in recent years, lot of money has gone into fighting malaria and HIV/AIDS. Yet it’s not necessarily the World Bank’s specialty, says Todd Moss, a senior fellow at the Center for Global Development. “Their strength is in financial management, infrastructure, even agriculture,” Moss says. The World Bank, which provides low-interest loans to developing countries, has actually been shifting away from health in recent years, ceding a lot of HIV/AIDS work to well-funded nonprofits like the Gates Foundation. (That said, the bank’s still a major source of anti-malaria funding.)
Could Kim change that and push the World Bank back toward public health? Moss says that’s not a given. Much of the World Bank’s agenda is set by its 187 shareholder countries. A president can influence that agenda — the previous president, Robert Zoellick, nudged the bank to focus more on tourism development — but mainly at the margins. And the United States, which has a major voice in the bank, may not want to see such a shift. “The United States loves to invest in public health,” Moss says. “But we already have PEPFAR [the government’s AIDS relief program], and the U.S. Agency for International Development is already health-dominated. I’m not sure whether the Treasury Department would want the World Bank to move back into health as well.”
Meanwhile, William Easterly, a former World Bank economist and professor at New York University, worries about the pitfalls of having a doctor at the head of the World Bank, rather than someone more economics-oriented. “As president, you’re fundamentally making decisions that are guided by economics,” he says. “You’re trying to divvy up scarce funds and focus on the world’s most pressing needs.”
This is true even in public health, Easterly notes. Economists have found that certain treatments — such as oral rehydration for babies with diarrhea — are terrific bargains, while other investments in antiretroviral drugs for HIV/AIDS may not have as great a payoff. “You have to have the mind-set to allocate scarce funds, rather than approaching the problem as if we have unlimited resources for suffering people,” he says. And Easterly worries that too many doctors and public health experts, in his experience, are resistant to this approach. “Frankly,” he adds, “I see some danger signs in this kind of pick.”
Others are more positive. Felix Salmon, who’s been following the World Bank nomination process closely, comments: “Kim’s prowess when it comes to navigating Washington’s labyrinthine power structures is unknown; I hope he’s up to the job,” he writes. “But he’s going to bring passion and dedication to his task of poverty reduction, along with a welcome bias towards bottom-up rather than top-down solutions. And I suspect that the World Bank’s board will find it easy to rubber-stamp his nomination.”