Opinion

America’s Forgotten Allies in Syria

AFRIN, SYRIA – On January 20, Turkey began targeting northern Syria with airstrikes and heavy shelling in a campaign that it claims is designed to neutralize a security threat on its southern border. The area under attack, and Afrin, the city from which I fight, is controlled by the Kurdish People’s Protection Units (YPG).


As a commander in the Syrian Democratic Forces (SDF), which includes the YPG, let me be unequivocal: there is no truth to Turkey’s claims that we are waging war across the border. In fact, the opposite is true; with “Operation Olive Branch,” Turkey is attacking us. And yet, for reasons I cannot comprehend, it is doing so with tacit approval from the international community.

Our forces do not sponsor attacks against the Turkish state. (The YPG has only returned fire against Turkish positions that have shelled us.) Our only war is with jihadists from the Islamic State (ISIS), a fight the United States has supported us in waging. But now, with the fight against ISIS largely over, our international backers have grown quieter – just as Turkey’s rockets have gotten louder.

Ever since the Syrian conflict began in 2011, Turkey has aligned itself with the wrong side. It cooperated closely with the Salafist Ahrar al-Sham rebel group, whose leaders were al-Qaeda members in Afghanistan. Turkey also lent support to jihadists from al-Qaeda’s Syrian affiliate, Jabhat Fatah al-Sham (formerly the al-Nusra Front).

And, until recently, Turkish leaders turned a blind eye to the foreign fighters transiting through their country to join ISIS in Syria. In October 2014, then-US Vice President Joseph Biden told a public audience that Turkish President Recep Tayyip Erdoğan had privately admitted that Turkey had “let too many people through.” Though Biden later apologized for the revelation, it reaffirmed that Turkey has repeatedly mishandled its approach to the conflict.

The SDF, on the other hand, has supported the region’s democratic aspirations by fighting for a Middle East free of jihadists. For more than a year before ISIS became a household name in the US and Europe, our fighters were dying to keep the group at bay. We defended communities and minorities from the jihadists’ wrath, and prevented them from enslaving more women and stoning more dissidents than they did. And, by removing ISIS from the Turkish border, we thwarted the group’s efforts to extend its reach deeper into Europe.

Our campaign against ISIS in Kobanî in 2015 led the US to increase its delivery of weapons, training, and air support. Through this partnership, the SDF brought ISIS to the brink of collapse. But these battles also came at a steep cost to my soldiers, who bore the brunt of the jihadists’ ferocity; ISIS killed thousands of our fighters, while the US military, which suffered some 4,500 casualities during the Iraq War, has lost only four soldiers in Syria.

Now that the fight against ISIS is winding down, the US seems less eager to support us, which has allowed Turkey to fire missiles and artillery at us with impunity. According to the Syrian Observatory for Human Rights, at least 70 civilians – and 21 children – have been killed during the operation, while more than 100 SDF soldiers have perished, including one female soldier whose body was mutilated by Turkish forces. At the moment, we are exposed to the full wrath of a NATO army, without access to even a single helicopter to evacuate our wounded.

Turkey’s leaders claim they are fighting the SDF because we are “terrorists.” I challenge them to present evidence to support these claims. In reality, our biggest threat to Turkey is not our weapons, but our ideas and political organization. Erdoğan fears our democratic values; we have brought freedom to regions ruled by brutal dictatorship for most of five decades. As Erdoğan gives free rein to his autocratic tendencies, he worries that a true democracy on Turkey’s southern border could threaten his own grip on power.

For Erdoğan, the best scenario for Syria would a makeover as a Sunni Arab state, where Kurds and other minorities are sidelined. But, this would be to the detriment of Syria’s great diversity. In contrast, we support Syria’s ethnic and religious mosaic, and envision a future of coexistence among Christians, Circassians, and Yazidis – all groups that Turkey has shunned.

Erdoğan has claimed that he wants “to deliver Afrin to its real owners,” thereby enabling the more than 3.5 million Syrian refugees in Turkey to return “to their own land as soon as possible.” Yet, to many of us, Erdoğan’s true objective in Afrin is to make the region Kurdenrein, turning us into a minority in our own home. Where are we expected to go? Kurds are not squatters in Afrin.

As Erdoğan becomes increasingly erratic and alienates his Western allies, it is the Kurds who are suffering the most. We are willing to be good neighbors and work toward a negotiated settlement. But as long as Turkey continues to target us, drawing no meaningful condemnation for the assault, we will have no choice but to defend ourselves.

Mahmoud Berkhdan is a member of the general command of the Syrian Democratic Forces, based in Afrin, Syria.

By Mahmoud Berkhdan

Africa’s Manmade Water Crisis

SINGAPORE – About a decade ago, at a meeting of South African mayors convened by Lindiwe Hendricks, South Africa’s then-minister of water and environmental affairs, we predicted that an unprecedented water crisis would hit one of the country’s main cities within 15 years, unless water-management practices were improved significantly. That prediction has now come true, with Cape Town facing a shutdown of its piped water network. The question now is whether African leaders will allow our other projection – that, within the next 25-30 years, many more of the continent’s cities will be facing similar crises – to materialize.


Africa has long struggled with urban water and wastewater management. As the continent’s population has swelled, from about 285 million in 1960 to nearly 1.3 billion today, and urbanization has progressed, the challenge has become increasingly acute. And these trends are set to intensify: by 2050, the continent’s total population is expected to exceed 2.5 billion, with 55% living in urban environments.

The challenge African countries face may not be unique, but it is, in some ways, unprecedented. After all, in Western countries, urbanization took place over a much longer period, and against a background of steadily improving economic conditions. In building effective systems for water and wastewater management, cities had adequate investment funds and the relevant expertise.

In Africa, cities’ financial and management capacities are already overwhelmed. As a result, water and wastewater management has often fallen by the wayside, with policymakers focusing on water-related issues only when droughts and floods occur. The Third World Centre for Water Management estimates that only about 10-12% of Africa’s population has access to adequate domestic and industrial wastewater collection, treatment, and disposal.

Given that the construction of the infrastructure and systems required to meet African cities’ water needs is likely to take some 20-30 years, governments’ sustained commitment is essential. A key imperative is the development of more environmentally friendly systems for wastewater disposal, as is cleaning bodies of water within and around urban centers that are already heavily contaminated.

Such an effort must be based on a comprehensive approach to assessing water quality that covers a wide range of pollutants – far more than the 10-40 that most African utilities now monitor – with the expectation that new pollutants will be added as they emerge. Cities like Singapore now regularly monitor 336 water quality parameters to ensure water safety. To that end, Africa will need access to the relevant expertise, adequate funding, and well-run laboratories – all of which are currently in short supply.

Funding such efforts will not be easy. For one thing, official corruption has long undermined investment in the planning, design, and construction of water infrastructure, as well as the effective management of existing infrastructure. For another, the social value of water – including its central role in many African religions – has long limited governments’ ability to create a viable funding model for water utilities.

Though countries are often eager to trade resources like oil, gas, minerals, timber, and agricultural products, no country in the world sells its water to other countries. Canada approved the North American Free Trade Agreement only after its parliament confirmed that the agreement would not apply to water in its natural state. In federal countries like India and Pakistan, even individual provinces refuse to consider giving water to their neighbors.

Countries don’t make much money from water domestically, either. In 2001, South Africa introduced a “Free Basic Water Policy,” according to which all households, regardless of size or income, receive six kiloliters (1,585 gallons) of water per month at no cost. One might argue that this is because water is necessary for survival. But so is food. And while both water and food are guaranteed in South Africa’s constitution, only water is provided for free.

And South Africa is no anomaly. In most urban centers worldwide, water is free or highly subsidized, and politicians are reluctant to change that. Singapore’s water price did not rise at all from 2000 to 2016, and Hong Kong’s water prices haven’t changed since 1996, even as the price of everything else has risen.

While water obviously shouldn’t become an expensive luxury good, governments’ reluctance to charge appropriately for it has undermined their ability to invest in water utilities, including proper wastewater collection and treatment. Far from leveling the playing field, this has made urban water management in most cities less equitable, because the state is unable to provide the necessary services in an efficient, sustainable, or comprehensive way.

When Cape Town’s water network is shut down because reservoirs have become dangerously low – probably on July 9 – residents will have to stand in line at one of 200 water-collection points, in order to collect 25 liters per person per day. That task will be particularly hard on poor and otherwise vulnerable people.

As South Africa’s politicians and media debate the causes of this crisis, they often focus on climate change – a culprit that cannot talk back. But the fact is that the dismal state of urban water management – exemplified by the fact that 36% of the water in South African cities is either lost due to leakage or not paid for, compared to 3.7% in Tokyo and 8% in Phnom Penh – remains a leading reason for the shutdown.

Managing urban water is not rocket science. Solutions have been well known for decades, and the needed technology, expertise, and even funds are available. What has been missing is political will, sustained public demand, and continuous media scrutiny. Cape Town’s crisis should serve as a wake-up call for all of Africa. Unfortunately, like Africa’s water resources, it is most likely to be wasted.

Asit K. Biswas is Distinguished Visiting Professor at the Lee Kuan Yew School of Public Policy, National University of Singapore. Cecilia Tortajada is Senior Research Fellow at the Institute of Water Policy, Lee Kuan Yew School of Public Policy, National University of Singapore.

By Asit K. Biswas and Cecilia Tortajada

In Search of a Global Refugee Strategy

BRASÍLIA – Next week, leaders from Latin America and the Caribbean will meet in Brazil to discuss solutions to the global refugee crisis. Observer countries, international organizations, and representatives of civil society will also take part in the dialogue, which will be co-hosted by the Brazilian government and the Office of the United Nations High Commissioner for Refugees.


The aim of the two-day gathering is to strategize new ways to assist the millions of displaced people in the region and around the world. Our conclusions will help form the regional contribution to a new “global compact on refugees,” which will be presented to the UN General Assembly later this year.

Addressing the plight of refugees is one of the greatest challenges currently facing the international community. With some 65.6 million people forcibly uprooted by violence, natural disasters, and economic hardship, there are more displaced people today than immediately after World War II. But, because no country is immune to the consequences associated with large movements of refugees, only a coordinated response can ameliorate the suffering. Rather than closing borders, as some governments have done, the international community must work together to address the issue of global displacement.

As we search for solutions, it is important to remind ourselves that while refugees may flee for different reasons, they are united by hardship. As UN Secretary-General António Guterres notes, refugees are the “most vulnerable of the vulnerable,” people who have been driven from their countries, families, and friends, not by frivolous impulse, but by persecution and conflict. In other words, no matter where refugees are going, they are running for their lives.

In response to this tragic reality – and despite being saddled by a severe fiscal crisis that has led to austerity measures at home – Brazil’s government has accelerated efforts to protect those arriving on our shores. Through the establishment of new integration and resettlement programs, Brazil is reinforcing an open-door policy toward refugees, the displaced, and the stateless, while also signaling our leadership on this issue.

For example, in January 2012, Brazil established a humanitarian visa program to benefit Haitians forced to flee after the devastating 2010 earthquake. More than 85,000 Haitians migrated to Brazil, and all had their legal status quickly resolved, enabling them to work, study, and use the public health-care system. This effort not only afforded a degree of dignity to the displaced; it also helped insulate refugees from “coyotes,” smuggling networks that prey on the destitute and desperate.

Then, in 2013, another humanitarian visa program was created, this time to benefit people affected by the conflict in Syria; more than 10,000 entry visas were eventually allocated as part of that initiative. Finally, in late 2017, Brazil adopted a new national migration law, which guarantees migrants the same legal protections as citizens, in line with the human-rights principles that inform Brazil’s foreign policy. The legislation also helped simplify the naturalization process for the stateless, virtually eliminating the issue of statelessness in Brazil.

Every country has a responsibility to help those in need. Nevertheless, at the moment, some countries are doing more than others to assist refugees. Of the world’s refugee population, 84% are currently hosted by developing countries. As that figure clearly shows, a new approach, based on shared responsibilities, is urgently needed. That is why the regional meeting that Brazil is hosting next week is so important. Simply put, we want to share what we have learned.

For decades, Latin American and Caribbean countries have pursued a unified approach to aiding the displaced, while our legal frameworks have set the global standard for refugee protection. For example, in 1984, the region’s landmark Cartagena Declaration on Refugees committed signatories to the principle of non-refoulement. Three decades later, regional governments renewed this pledge by adopting the Brazil Declaration and Plan of Action, which aims to end statelessness in the region by 2024, among other goals.

These multilateral agreements are in addition to unilateral policies adopted by countries in the region. Such policies include constitutional protections for asylum seekers, provision of temporary identification documents, and guaranteed access to public education, banking, and health-care services.

As these measures demonstrate, governments in Latin America and the Caribbean have laid the groundwork to strengthen the international response to the world’s refugee crisis. Brazil’s goal is to channel the region’s collective experience into a more equitable, global solution. When the region’s leaders meet in Brasília next week, and then join world leaders in New York later this year, we must inspire one another to ease the suffering of the many millions who have suffered enough. Only through open doors – and open arms – will the world’s refugees find safety.

Aloysio Nunes Ferreira is the Minister of Foreign Affairs of Brazil.

By Aloysio Nunes Ferreira

Three Humanitarian Challenges for Africa in 2018

NAIROBI – In mid-2017, when a cholera outbreak in Somalia threatened to overwhelm local hospitals, health experts feared the worst. With crippling drought, malnutrition, and poverty already endemic, an outbreak of deadly diarrhea seemed destined to paralyze the fragile state. But, despite the dire predictions, institutional paralysis was avoided. Although hundreds died and many more became sick, the collective response managed by governments, NGOs, and local communities, including the national Red Crescent Societies supported by the Red Cross movement, contained the disease.


Somalia’s experience gives me great hope for Africa’s future. But it also serves as a reminder that local capacity is easily inundated during times of crisis. While some parts of Africa have become self-sufficient in terms of public health, others continue to lean heavily on global aid. For these areas, partnership is the best means of minimizing risks.

In particular, three key challenges this year are likely to pose the severest tests of Africa’s ability to manage humanitarian crises.

The first challenge is violence in the Democratic Republic of the Congo. Last year, conflict in the DRC’s central Kasai region displaced some 1.4 million people, bringing the total displaced population to 4.1 million – the largest concentration of internal refugees anywhere in Africa. The violence has exacerbated food insecurity, with more than three million people severely undernourished.

Unfortunately, the Kasai crisis is expected to worsen in 2018. A recent assessment by the Red Cross Society of the DRC warns that the number of people displaced will continue to rise, and with a fast-spreading cholera outbreak threatening the region, a coordinated plan of action is urgently needed.

The second challenge this year is Somalia’s food insecurity, which, according to the Famine Early Warning Systems Network, is expected to intensify this year. Below-average rainfall in 2017 stunted harvests, and most regions have not fully recovered. As humanitarian aid is channeled to the country, efforts must be made to target long-term solutions, such as improving agricultural output, educational access, and economic opportunity. Historically, most aid to the country has been earmarked for emergency relief; even the collective cholera response was narrowly focused on short-term health. But Somalia desperately needs a more holistic, long-term development strategy.

Finally, the very scourge that Somalia contained last year will continue to rear its head elsewhere in the region. Yemen’s cholera outbreak is now the largest in history, having already surpassed one million confirmed cases, and, despite years of international assistance, the threat continues to stalk Africa. In the last four decades, African countries reported over three million suspected cholera cases to the World Health Organization and new cases are cropping up this year in Africa’s east-central and southern regions.

Fortunately, there is hope that Somalia’s containment success in 2017 can be replicated, provided that communities and individuals are well aware of the disease and related risks, and that local actors receive the needed resources. The Global Task Force on Cholera Control, which seeks to build local and international support for improved health care and sanitation, has published a global roadmap for ending cholera by 2030. Although that is an ambitious target, it is achievable if international organizations and local governments work together.

Natural and manmade crises will continue to plague Africa, but organizations like mine are working hard to bring about a brighter future through improved capacity building. To succeed, however, local and international development partners must reorient their thinking; humanitarian aid alone will not solve Africa’s myriad challenges. While money is clearly needed, it must be spent more strategically to improve structural weaknesses that perpetuate instability. For example, if more funding were devoted to community-level health care projects, local organizations would be better positioned to lead when outbreaks threaten.

Put simply, the international development community must do more to invest in grassroots solutions, empowering Africans rather than treating them as subcontractors to their own suffering. Not only are local organizations better positioned to navigate complex cultural and linguistic landscapes; they also have more to lose if they fail.

Last year was devastating for many Africans, as millions suffered from drought, hunger, and violence. But in Somalia, a coordinated response to a serious health threat offered new hope for a more secure future. When local ingenuity and international support align, the cycle of suffering can be broken. For many African countries, the ability to look confidently beyond the next crisis is the first step on the long road to self-reliance.

Fatoumata Nafo-Traoré is Regional Director for Africa for the International Federation of Red Cross and Red Crescent Societies.

By Fatoumata Nafo-Traoré

The World Bank Needs to Return to Its Mission

NEW YORK – The World Bank declares that its mission is to end extreme poverty within a generation and to boost shared prosperity. These goals are universally agreed as part of the Sustainable Development Goals. But the World Bank lacks an SDG strategy, and now it is turning to Wall Street to please its political masters in Washington. The Bank’s president, Jim Yong Kim, should find a better way forward, and he can do so by revisiting one of his own great successes.


Kim and I worked closely together from 2000 to 2005, to scale up the world’s response to the AIDS epidemic. Partners in Health, the NGO led by Kim and his colleague, Harvard University’s Paul Farmer, had used antiretroviral medicines (ARVs) to treat around 1,000 impoverished HIV-infected rural residents in Haiti, and had restored them to health and hope.

I pointed out to Kim and Farmer 18 years ago that their success in Haiti could be expanded to reach millions of people at low cost and with very high social benefits. I recommended a new multilateral funding mechanism, a global fund, to fight AIDS, and a new funding effort by the United States.

In early 2001, UN Secretary-General Kofi Annan launched the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and in 2003 US President George W. Bush launched the PEPFAR program. The World Health Organization, led by the Director-General Gro Harlem Brundtland, recruited Kim to lead the WHO’s scale-up effort. Kim did a fantastic job, and his efforts provided the groundwork for bringing ARVs to millions, saving lives, livelihoods, and families.

There are four lessons of that great success. First, the private sector was an important partner, by offering patent-protected drugs at production cost. Drug companies eschewed profits in the poorest countries out of decency and for the sake of their reputations. They recognized that patent rights, if exercised to excess, would be a death warrant for millions of poor people.

Second, the effort was supported by private philanthropy, led by Bill Gates, who inspired others to contribute as well. The Bill & Melinda Gates Foundation backed the new Global Fund, the WHO, and the Commission on Macroeconomics and Health, which I led for the WHO in 2000-2001 (and which successfully campaigned for increased donor funding to fight AIDS and other killer diseases).

Third, the funding to fight AIDS took the form of outright grants, not Wall Street loans. Fighting AIDS in poor countries was not viewed as a revenue-generating investment needing fancy financial engineering. It was regarded as a vital public good that required philanthropists and high-income countries to fund life-saving treatment for poor and dying people.

Fourth, trained public health specialists led the entire effort, with Kim and Farmer serving as models of professionalism and rectitude. The Global Fund does not stuff the pockets of corrupt ministers, or trade funding for oil concessions or arms deals. The Global Fund applies rigorous, technical standards of public health, and holds recipient countries accountable – including through transparency and co-financing requirements – for delivering services.

The World Bank needs to return to its mission. The SDGs call for, among other things, ending extreme poverty and hunger, instituting universal health coverage, and universal primary and upper secondary education by 2030. But, despite making only slow progress toward these goals, the Bank shows no alarm or strategy to help get the SDGs on track for 2030. On the contrary, rather than embrace the SDGs, the Bank is practically mute, and its officials have even been heard to mutter negatively about them in the corridors of power.

Perhaps US President Donald Trump doesn’t want to hear about his government’s responsibilities vis-à-vis the SDGs. But it is Kim’s job to remind him and the US Congress of those obligations – and that it was a Republican president, George W. Bush who creatively and successfully pursued the battle against AIDS.

Wall Street may help to structure the financing of large-scale renewable energy projects, public transport, highways, and other infrastructure that can pay its way with tolls and user fees. A World Bank-Wall Street partnership could help to ensure that such projects are environmentally sound and fair to the affected communities. That would be all for the good.

Yet such projects, designed for profit or at least direct cost recovery, are not even remotely sufficient to end extreme poverty. Poor countries need grants, not loans, for basic needs like health and education. Kim should draw on his experience as the global health champion who successfully battled against AIDS, rather than embracing an approach that would only bury poor countries in debt. We need the World Bank’s voice and strenuous efforts to mobilize grant financing for the SDGs.

Health care for the poor requires systematic training and deployment of community health workers, diagnostics, medicines, and information systems. Education for the poor requires trained teachers, safe and modern classrooms, and connectivity to other schools and to online curricula. These SDGs can be achieved, but only if there is a clear strategy, grant financing, and clear delivery mechanisms. The World Bank should develop the expertise to help donors and recipient governments make these programs work. Kim knows just how to do this, from his own experience.

Trump and other world leaders are personally accountable for the SDGs. They need to do vastly more. So, too, do the world’s super-rich, whose degree of wealth is historically unprecedented. The super-rich have received round after round of tax cuts and special tax breaks, easy credits from central banks, and exceptional gains from technologies that are boosting profits while lowering unskilled workers’ wages. Even with stock markets’ recent softness, the world’s 2000+ billionaires have around $10 trillion in wealth – enough to fund fully the incremental effort needed to end extreme poverty, if the governments also do their part.

When going to Wall Street, or Davos, or other centers of wealth, the World Bank should inspire the billionaires to put their surging wealth into personal philanthropy to support the SDGs. Bill Gates is doing this, with historic results, for public health. Which billionaires will champion the SDGs for education, renewable energy, fresh water and sanitation, and sustainable agriculture? With a clear SDG plan, the World Bank would find partners to help it fulfill its core, historic, and vital mission.

Jeffrey D. Sachs, Professor of Sustainable Development and Professor of Health Policy and Management at Columbia University, is Director of Columbia’s Center for Sustainable Development and the UN Sustainable Development Solutions Network.

The World Bank Needs to Return to Its Mission

NEW YORK – The World Bank declares that its mission is to end extreme poverty within a generation and to boost shared prosperity. These goals are universally agreed as part of the Sustainable Development Goals. But the World Bank lacks an SDG strategy, and now it is turning to Wall Street to please its political masters in Washington. The Bank’s president, Jim Yong Kim, should find a better way forward, and he can do so by revisiting one of his own great successes.


Kim and I worked closely together from 2000 to 2005, to scale up the world’s response to the AIDS epidemic. Partners in Health, the NGO led by Kim and his colleague, Harvard University’s Paul Farmer, had used antiretroviral medicines (ARVs) to treat around 1,000 impoverished HIV-infected rural residents in Haiti, and had restored them to health and hope.

I pointed out to Kim and Farmer 18 years ago that their success in Haiti could be expanded to reach millions of people at low cost and with very high social benefits. I recommended a new multilateral funding mechanism, a global fund, to fight AIDS, and a new funding effort by the United States.

In early 2001, UN Secretary-General Kofi Annan launched the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and in 2003 US President George W. Bush launched the PEPFAR program. The World Health Organization, led by the Director-General Gro Harlem Brundtland, recruited Kim to lead the WHO’s scale-up effort. Kim did a fantastic job, and his efforts provided the groundwork for bringing ARVs to millions, saving lives, livelihoods, and families.

There are four lessons of that great success. First, the private sector was an important partner, by offering patent-protected drugs at production cost. Drug companies eschewed profits in the poorest countries out of decency and for the sake of their reputations. They recognized that patent rights, if exercised to excess, would be a death warrant for millions of poor people.

Second, the effort was supported by private philanthropy, led by Bill Gates, who inspired others to contribute as well. The Bill & Melinda Gates Foundation backed the new Global Fund, the WHO, and the Commission on Macroeconomics and Health, which I led for the WHO in 2000-2001 (and which successfully campaigned for increased donor funding to fight AIDS and other killer diseases).

Third, the funding to fight AIDS took the form of outright grants, not Wall Street loans. Fighting AIDS in poor countries was not viewed as a revenue-generating investment needing fancy financial engineering. It was regarded as a vital public good that required philanthropists and high-income countries to fund life-saving treatment for poor and dying people.

Fourth, trained public health specialists led the entire effort, with Kim and Farmer serving as models of professionalism and rectitude. The Global Fund does not stuff the pockets of corrupt ministers, or trade funding for oil concessions or arms deals. The Global Fund applies rigorous, technical standards of public health, and holds recipient countries accountable – including through transparency and co-financing requirements – for delivering services.

The World Bank needs to return to its mission. The SDGs call for, among other things, ending extreme poverty and hunger, instituting universal health coverage, and universal primary and upper secondary education by 2030. But, despite making only slow progress toward these goals, the Bank shows no alarm or strategy to help get the SDGs on track for 2030. On the contrary, rather than embrace the SDGs, the Bank is practically mute, and its officials have even been heard to mutter negatively about them in the corridors of power.

Perhaps US President Donald Trump doesn’t want to hear about his government’s responsibilities vis-à-vis the SDGs. But it is Kim’s job to remind him and the US Congress of those obligations – and that it was a Republican president, George W. Bush who creatively and successfully pursued the battle against AIDS.

Wall Street may help to structure the financing of large-scale renewable energy projects, public transport, highways, and other infrastructure that can pay its way with tolls and user fees. A World Bank-Wall Street partnership could help to ensure that such projects are environmentally sound and fair to the affected communities. That would be all for the good.

Yet such projects, designed for profit or at least direct cost recovery, are not even remotely sufficient to end extreme poverty. Poor countries need grants, not loans, for basic needs like health and education. Kim should draw on his experience as the global health champion who successfully battled against AIDS, rather than embracing an approach that would only bury poor countries in debt. We need the World Bank’s voice and strenuous efforts to mobilize grant financing for the SDGs.

Health care for the poor requires systematic training and deployment of community health workers, diagnostics, medicines, and information systems. Education for the poor requires trained teachers, safe and modern classrooms, and connectivity to other schools and to online curricula. These SDGs can be achieved, but only if there is a clear strategy, grant financing, and clear delivery mechanisms. The World Bank should develop the expertise to help donors and recipient governments make these programs work. Kim knows just how to do this, from his own experience.

Trump and other world leaders are personally accountable for the SDGs. They need to do vastly more. So, too, do the world’s super-rich, whose degree of wealth is historically unprecedented. The super-rich have received round after round of tax cuts and special tax breaks, easy credits from central banks, and exceptional gains from technologies that are boosting profits while lowering unskilled workers’ wages. Even with stock markets’ recent softness, the world’s 2000+ billionaires have around $10 trillion in wealth – enough to fund fully the incremental effort needed to end extreme poverty, if the governments also do their part.

When going to Wall Street, or Davos, or other centers of wealth, the World Bank should inspire the billionaires to put their surging wealth into personal philanthropy to support the SDGs. Bill Gates is doing this, with historic results, for public health. Which billionaires will champion the SDGs for education, renewable energy, fresh water and sanitation, and sustainable agriculture? With a clear SDG plan, the World Bank would find partners to help it fulfill its core, historic, and vital mission.

Jeffrey D. Sachs, Professor of Sustainable Development and Professor of Health Policy and Management at Columbia University, is Director of Columbia’s Center for Sustainable Development and the UN Sustainable Development Solutions Network.

By Jeffrey D. Sachs

A People’s Democracy in America

BERKELEY – You’ve probably heard this before: Markets are soaring, and wealth is growing, but most of the gains are going to those at the top. Rapid technological advances are transforming daily life and creating new industries, but are also fueling anxiety about lost jobs and occupations. People are increasingly angry at giant corporations’ perceived monopolistic power. Cities are thriving as magnets for the wealthy and ambitious, but rural residents often feel left behind. Anti-immigrant sentiment has become intense, and sometimes violent. Women are challenging male power in viral protests. Political corruption is fueling widespread fury, with many convinced that moneyed interests have captured their democratic institutions. Trust in political parties is at new lows. And amid all the dismay and dysfunction, some of the new plutocrats have stepped up as philanthropists to underwrite social reform.


Yes, it all sounds like Trump-era America. But these conditions also prevailed more than a century ago, during the Progressive Era of the early 1900s.

Disgusted by the massive inequalities of the Gilded Age, the first Progressives sought comprehensive reform. Changes to the US Constitution adopted during this period include the introduction of the federal income tax with the Sixteenth Amendment, direct election of senators with the Seventeenth Amendment, the prohibition of alcohol with the Eighteenth Amendment (some ideas were really bad), and women’s suffrage with the Nineteenth Amendment.

Progressives wanted citizens to rule more directly, overturning a powerful and often corrupt political-industrial complex that had gradually usurped their rights. They championed recall votes as a way to remove leaders and officials serving vested interests rather than citizens. They created direct primary elections, empowering citizens to choose which candidates to nominate, thereby undermining the power of party “machines.” And in 1902, Progressives in Oregon won overwhelmingly approval of a ballot measure creating the initiative and referendum processes. Since then, most states have adopted these fundamental democratic processes, enabling citizens to introduce or approve proposed laws or amendments to their state constitutions.

As James Fishkin of Stanford has written, “deliberative democracy” has a long history, extending back to the original democracy in Greece in the fifth century, BC. In this model, informed and engaged citizens directly set the agenda for their representatives (though not with the Greeks’ narrowly circumscribed definition of who is a citizen).

Today, a new generation of progressive federalists are leveraging the initiative process to give citizens power over policy. The specifics of how citizens can put measures to a popular vote or require the legislature to address them vary substantially from place to place, but 26 states and hundreds of cities, accounting for more than 70% of the US population, have initiatives in their governance tool box.

Sometimes initiatives have created ongoing challenges for elected leaders, as has been the case with California’s Proposition 13, which capped state property taxes when it passed in 1978. And sometimes they have addressed frivolous issues, as was the case with a failed attempt in 2016 to require condoms in pornography. But they have also been fundamental to major reforms that have reshaped governance, especially in California. Citizen-based redistricting, open primaries, changes to term limits, majority-vote budgets, a rainy-day fund, and legislative transparency have all been the direct result of civic-minded leaders deploying the initiative process for the public good.

California is not alone. In the last several years, the initiative process has led to redistricting in Arizona, and ranked-choice voting in Maine. In many other states, voters have approved public financing of elections, the adoption and preservation of Medicaid expansion, and marijuana legalization. Voter initiatives in several cities have also resulted in significant increases in the minimum wage and other worker benefits. On average, 150-200 initiative measures are on the ballot in states across the US every election year.

Now, leading reformers are seeking to launch a movement to use initiatives in a more coordinated national campaign. The lessons learned from the minimum-wage campaigns show the promise of such an effort. Beginning in mid-2016 in California and Washington, DC, ballot measures to raise minimum wages passed with overwhelming support. In November 2016, even as Donald Trump was winning the presidency, minimum-wage increases passed in Arizona, Colorado, Maine, and Washington by margins of 10-18 percentage points. Total spending of $25 million (less than was spent on a special election for the House of Representatives in Georgia) brought 8.1 million workers in six states a pay raise of over $2.5 billion (growing to more than $20 billion when fully implemented).

In November of this year, Maine shocked observers again, when voters there approved Medicaid expansion by 59-41%, overturning five vetoes by Governor Paul LePage of legislative efforts in favor of the expansion. For a total campaign cost of $1.7 million, 89,000 Maine citizens now stand to gain health insurance.

Watch this space. In 2018, initiatives for democratic reforms – including redistricting, stricter ethics standards, and broader voting rights – are in the process of being qualified across the country. These measures build on a legacy of reforms that have spread across the country over the last few election cycles.

The original Progressives would be proud. It may have taken more than a century, but their effort to ensure that democracy actually works, by putting power in the hands of citizens through the initiative process, created what may be the most powerful reform tool in US history. Let’s hope so.

Laura Tyson, a former chair of the US President’s Council of Economic Advisers, is a professor at the Haas School of Business at the University of California, Berkeley, and a senior adviser at the Rock Creek Group. Lenny Mendonca, Chairman of New America, is Senior Partner Emeritus at McKinsey & Company.

By Laura Tyson and Lenny Mendonca

Volkswagen’s Monkeys

MELBOURNE – Late last month, the New York Times reported that researchers used monkeys to test the effects of inhaling diesel fumes from a Volkswagen. The research was commissioned by the European Research Group on Environment and Health in the Transport Sector, an organization funded entirely by three big German car manufacturers: Volkswagen, Daimler, and BMW.


The reaction to this revelation has been unequivocal repudiation – by the public, the German government, and Volkswagen itself – of the use of the monkeys. Why? Could the vehemence of the response indicate a tectonic shift in ethical attitudes toward animals? To answer that question requires examining some details about the experiments and the reaction to them.

The research, carried out in in Albuquerque, New Mexico, involved placing ten monkeys in small airtight containers into which, over a period of four hours, the exhaust fumes were piped. Later, a tube was stuck down the monkeys’ throats to take tissue samples from their lungs.

It is clear that the experiments were extremely distressing for the monkeys. The Guide for the Care and Use of Laboratory Animals, a manual of good practice for those who use animals in research – published by the US National Academies of Sciences, Engineering, and Medicine and now in its eighth edition – states: “Like all social animals, nonhuman primates should normally have social housing.” These monkeys were confined in individual chambers and forced to breathe polluted air, including exhaust fumes from an older Ford truck, which was supposed to enable a comparison with the cleaner Volkswagen. A video of the experiments included in the Netflix documentary “Dirty Money” shows a monkey in a state of panic, pawing at the window of the chamber in a desperate effort to escape.

Making matters worse, we now know that the only results the experiments could have yielded would have been misleading. Unknown to Jake McDonald, the scientist who oversaw the research, the Volkswagen that was used to produce the exhaust gases had software installed that reduced emissions under laboratory testing conditions, so the results could not provide reliable information on the health hazards of the car’s emissions during normal driving. No wonder McDonald told the Times, “I feel like a chump.”

The reaction to the news about the research was swift. Two days after the story broke, the Volkswagen Group tweeted that it “explicitly distances itself from all forms of animal cruelty. Animal testing contradicts our own ethical standards.”

Over the next two days, criticism mounted. At a meeting in Brussels, Volkswagen Group CEO Matthias Müller addressed the experiments, saying that the European Research Group’s methods were “totally wrong.” He added: “There are things you just do not do.” Thomas Steg, Volkswagen’s chief lobbyist, told a German newspaper: “We want to absolutely rule out testing on animals for the future so that this doesn’t happen again.” This didn’t help Steg himself, whom Volkswagen promptly suspended.

The other funders of the European Research Group quickly distanced themselves from the experiment. Daimler said that it was “appalled” by the studies, and would investigate them. BMW said that it did not participate in the research. Representatives of General Motors, Ford, and Fiat Chrysler said that they do not test the effects of emissions on humans or animals.

The public response to the experiments reached a level that even the German government could not ignore. Steffen Seibert, a spokesperson for Chancellor Angela Merkel, said that “the disgust many people are feeling is absolutely understandable,” and that the tests on monkeys “can in no way be ethically justified.”

I have been arguing against the way we treat animals for the past 45 years, yet I have never seen such categorical repudiation of experiments on animals by senior corporate executives and government spokespeople as we are witnessing in Germany now. If the reactions had condemned Volkswagen for seeking to mislead the public by supplying the researchers with a rigged car, I would not have been surprised. But Volkswagen’s use of “defeat devices” in its cars to cheat on emissions tests has been known since 2015. It is the abuse of the monkeys that is driving the condemnations, and the desire of the companies to distance themselves from the research.

It is not news that animals suffer in painful and unnecessary experiments. In every edition of Animal Liberation since the original in 1975, I described dozens of experiments in which the suffering of animals was severe and the likelihood of any significant benefit to human health or wellbeing was as remote as it was in the Volkswagen experiments. Today, organizations like People for the Ethical Treatment of Animals continue to highlight how millions of animals – including monkeys – suffer in unnecessary experiments.

Nearly three million animals are used in experiments in Germany each year. If Volkswagen, Daimler, BMW, and the German government are saying that experiments like those commissioned by the European Research Group to test the health impact of diesel exhaust are unethical, then many other experiments also fail to meet the same ethical standard.

What has changed, gradually and over several decades, is concern for animals. A 2015 Gallup poll showed that almost one in three Americans agreed with the statement that animals should be given the same rights as people, while nearly all the rest (62%) thought that animals should be given some protection. In Germany, 89% of those polled said that they oppose animal testing that causes pain and suffering. In several other European nations, including France, Italy, and the United Kingdom, opposition was also above 80%.

No car manufacturer or other corporation that values its brand can afford to alienate 80% of its potential customers. If, as Merkel’s spokesperson said, the use of monkeys to test the safety of emissions from diesel engines “can in no way be ethically justified,” it becomes possible to hope that the end of painful experiments on animals is not far away.

Peter Singer is Professor of Bioethics at Princeton University, Laureate Professor at the University of Melbourne, and founder of the non-profit organization The Life You Can Save. His books include Animal Liberation, Ethics in the Real World, and, with Katarzyna de Lazari-Radek, Utilitarianism: A Very Short Introduction.

By Peter Singer

A People’s Democracy in America

BERKELEY – You’ve probably heard this before: Markets are soaring, and wealth is growing, but most of the gains are going to those at the top. Rapid technological advances are transforming daily life and creating new industries, but are also fueling anxiety about lost jobs and occupations. People are increasingly angry at giant corporations’ perceived monopolistic power. Cities are thriving as magnets for the wealthy and ambitious, but rural residents often feel left behind. Anti-immigrant sentiment has become intense, and sometimes violent. Women are challenging male power in viral protests. Political corruption is fueling widespread fury, with many convinced that moneyed interests have captured their democratic institutions. Trust in political parties is at new lows. And amid all the dismay and dysfunction, some of the new plutocrats have stepped up as philanthropists to underwrite social reform.


Yes, it all sounds like Trump-era America. But these conditions also prevailed more than a century ago, during the Progressive Era of the early 1900s.

Disgusted by the massive inequalities of the Gilded Age, the first Progressives sought comprehensive reform. Changes to the US Constitution adopted during this period include the introduction of the federal income tax with the Sixteenth Amendment, direct election of senators with the Seventeenth Amendment, the prohibition of alcohol with the Eighteenth Amendment (some ideas were really bad), and women’s suffrage with the Nineteenth Amendment.

Progressives wanted citizens to rule more directly, overturning a powerful and often corrupt political-industrial complex that had gradually usurped their rights. They championed recall votes as a way to remove leaders and officials serving vested interests rather than citizens. They created direct primary elections, empowering citizens to choose which candidates to nominate, thereby undermining the power of party “machines.” And in 1902, Progressives in Oregon won overwhelmingly approval of a ballot measure creating the initiative and referendum processes. Since then, most states have adopted these fundamental democratic processes, enabling citizens to introduce or approve proposed laws or amendments to their state constitutions.

As James Fishkin of Stanford has written, “deliberative democracy” has a long history, extending back to the original democracy in Greece in the fifth century, BC. In this model, informed and engaged citizens directly set the agenda for their representatives (though not with the Greeks’ narrowly circumscribed definition of who is a citizen).

Today, a new generation of progressive federalists are leveraging the initiative process to give citizens power over policy. The specifics of how citizens can put measures to a popular vote or require the legislature to address them vary substantially from place to place, but 26 states and hundreds of cities, accounting for more than 70% of the US population, have initiatives in their governance tool box.

Sometimes initiatives have created ongoing challenges for elected leaders, as has been the case with California’s Proposition 13, which capped state property taxes when it passed in 1978. And sometimes they have addressed frivolous issues, as was the case with a failed attempt in 2016 to require condoms in pornography. But they have also been fundamental to major reforms that have reshaped governance, especially in California. Citizen-based redistricting, open primaries, changes to term limits, majority-vote budgets, a rainy-day fund, and legislative transparency have all been the direct result of civic-minded leaders deploying the initiative process for the public good.

California is not alone. In the last several years, the initiative process has led to redistricting in Arizona, and ranked-choice voting in Maine. In many other states, voters have approved public financing of elections, the adoption and preservation of Medicaid expansion, and marijuana legalization. Voter initiatives in several cities have also resulted in significant increases in the minimum wage and other worker benefits. On average, 150-200 initiative measures are on the ballot in states across the US every election year.

Now, leading reformers are seeking to launch a movement to use initiatives in a more coordinated national campaign. The lessons learned from the minimum-wage campaigns show the promise of such an effort. Beginning in mid-2016 in California and Washington, DC, ballot measures to raise minimum wages passed with overwhelming support. In November 2016, even as Donald Trump was winning the presidency, minimum-wage increases passed in Arizona, Colorado, Maine, and Washington by margins of 10-18 percentage points. Total spending of $25 million (less than was spent on a special election for the House of Representatives in Georgia) brought 8.1 million workers in six states a pay raise of over $2.5 billion (growing to more than $20 billion when fully implemented).

In November of this year, Maine shocked observers again, when voters there approved Medicaid expansion by 59-41%, overturning five vetoes by Governor Paul LePage of legislative efforts in favor of the expansion. For a total campaign cost of $1.7 million, 89,000 Maine citizens now stand to gain health insurance.

Watch this space. In 2018, initiatives for democratic reforms – including redistricting, stricter ethics standards, and broader voting rights – are in the process of being qualified across the country. These measures build on a legacy of reforms that have spread across the country over the last few election cycles.

The original Progressives would be proud. It may have taken more than a century, but their effort to ensure that democracy actually works, by putting power in the hands of citizens through the initiative process, created what may be the most powerful reform tool in US history. Let’s hope so.

Laura Tyson, a former chair of the US President’s Council of Economic Advisers, is a professor at the Haas School of Business at the University of California, Berkeley, and a senior adviser at the Rock Creek Group. Lenny Mendonca, Chairman of New America, is Senior Partner Emeritus at McKinsey & Company.

By Laura Tyson and Lenny Mendonca

The Health Costs of Tax Reform

NEW YORK – The sweeping tax bill that US President Donald Trump signed into law on December 22, 2017, may have been presented as an early Christmas gift. But to the millions of Americans whose health outcomes will worsen as a result, the legislation looks more like a costly white elephant.


The Tax Cuts and Jobs Act targets health care in the United States in three major ways. First, it eliminates the individual mandate, a provision of the 2010 Affordable Care Act (Obamacare) that imposes a tax penalty on people who go without health insurance. According to the Congressional Budget Office (CBO), this repeal alone will reduce the number of insured Americans by 13 million over the next decade, and increase average health-insurance premiums by about 10%. Moreover, eliminating the individual mandate could disrupt health-insurance markets, because there will be fewer younger, healthier people purchasing insurance.

Second, the CBO estimates that the law will add $1.45 trillion to the deficit over the next decade, which could trigger spending cuts to health-insurance programs for the elderly, poor, and disabled, such as Medicare and Medicaid. These programs are already some of the government’s largest budget items, accounting for $1 trillion in spending – 26% of the federal budget – in 2016. Any cuts to them made in the name of deficit reduction will disproportionately harm the most vulnerable.

Third, the tax law will decrease consumer health-care spending and adversely affect health outcomes among poor and at-risk populations. Although the law was sold as a tax “cut,” it will actually reduce the after-tax income of some 53% of Americans, while boosting the incomes of the richest 5%.

According to the Joint Committee on Taxation, an independent body that evaluates tax proposals before Congress, Americans earning more than $1 million per year will see their annual tax bill fall by an average of $12,865 over the next decade. For the poorest Americans, however, the tax burden will rise during this period. Those earning less than $10,000 per year will be subject to an average annual tax hike of $152, and those earning $10,000-$20,000 per year will face an average annual increase of $2,563.

Income has a huge impact on health outcomes. A 2016 study published in the Journal of the American Medical Association found that American men with incomes in the top 1% live 15 years longer than the poorest 1%; for women in these respective groups, the gap is ten years. The tax law could worsen these disparities by lowering the incomes of low- and middle-income Americans, many of whom are already living shorter lives, owing partly to the opioid crisis that is ravaging much of the country. In 2016, for example, life expectancy fell for the second consecutive year, by 0.1 years, to 78.6.

Because the poor, unemployed, and uninsured suffer disproportionately from opioid abuse and addiction, the tax law puts their health further at risk. Falling incomes and rising deficits could translate into less stable health-insurance markets and cuts to Medicaid, which reimburses prescriptions for naloxone, a drug used to reverse opioid overdoses.

Evidence from two of the states that have been hit hardest by the opioid epidemic is sobering. Last year, researchers at Harvard University found that in Massachusetts, which has expanded its Medicaid coverage in recent years, 868 opioid-related deaths were averted in 2016, whereas only 11 opioid-related deaths were averted in Tennessee, which did not expand its Medicaid program. The researchers concluded that, “Medicaid expansion helped put more purchasing power into the hands of laypersons and in so doing, expanded the use of naloxone, thereby saving lives.”

Each of the tax law’s injustices – fewer Americans with health coverage, stripped-down public programs, lower incomes for the poor, less access to substance-abuse treatment – is unambiguously bad for health outcomes. Taken together, they will have an adverse effect on worker productivity, thus undermining overall economic growth.

Some argue that the CBO’s initial forecast of the impact of repealing the individual mandate was overly dire, and that many Americans will purchase insurance even in the absence of a penalty. And, to be sure, there is no guarantee that spending for Medicare and Medicaid will be cut, given that the expansion of Medicaid under Obamacare has made the program even more popular among those it serves.

But even if these two assumptions prove to be unfounded, the unintended consequences of the new tax law will still threaten Americans’ wellbeing. The bill was rushed through Congress and signed into law without any meaningful debate about its potential effects on health care. As the law’s provisions take effect, policymakers must start paying closer attention. Otherwise, the legislation could end up costing Americans something more valuable than money: their health.

David Blumenthal, former National Coordinator for Health Information Technology, is President of the Commonwealth Fund.

By David Blumenthal

Top
We use cookies to improve our website. By continuing to use this website, you are giving consent to cookies being used. More details…