I just finished Mountains Beyond Mountains, a biography of Dr. Paul Farmer. He is a brilliant Harvard-educated doctor who has dedicated his life to helping the world's poorest people, specifically in rural Haiti. Farmer himself is a fascinating character, but what has most interested me so far is the question of poverty.
According to the book's very vivid descriptions, Haiti is a miserable place: environmentally degraded (much of it is apparently dusty moonscape, thanks to deforestation and topsoil loss), filthy, lacking almost all public amenities (like roads or clean water), and extremely crowded with sickly, extremely ignorant, malnourished, abused (by the government, mostly) peasants. The author refers to it as a "war zone" more than once.
Farmer, a rather saintly person, is terribly concerned (indeed, obsessed) with helping the unfortunate people of Haiti. He attempts to do this through providing high-quality (first world level, if possible), free medical care, and by extension other services (constructing better housing than the typical miserable shack, providing education, putting in public latrines and sources of clean water, etc). To this end, he has created an entire large charity dedicated to providing the world's poor with medical care (they operate not just in Haiti, but also in Rwanda, Peru, Chiapas, etc).
It all sounds so wonderful: preventing little children from dying of treatable diseases, delivering quality health care to EVERYONE who needs it, regardless of the ability to pay, tangibly benefiting the world's neediest people...And yet, as I read the book, I kept thinking that all of the (heroic) efforts and (generously donated) resources were being misapplied.
In a way this isn't true of course: for each individual (and their loved ones), receiving medical treatment makes a big difference: the difference between life and death, in fact. But it's like being a medic in the middle of a war: yes, you can stop the bleeding of this or that soldier, but while people are continuing to shoot at each other you aren't going to make any real progress. In fact, in a situation like Haiti's (where the land is terribly overpopulated and can't actually support the current number of people living there), providing really good medical treatment might just make the situation worse (since now the available land will have to support many more).
A solution for "the problem of Haiti" has already been found. Haiti is uniquely miserable now, but just a few hundred years ago, everywhere was like Haiti. In fact, Haiti is significantly better off, because they have access (even if it is limited and spotty) to the resources of the modern world (like the medical services Farmer supplies).
For thousands of years, most people lived lives of grinding poverty. They couldn't afford to eat meat more than a few times a year: their diet was monotonous in the extreme (a single kind of grain, vegetables in season and seasoning if they were lucky) and highly inadequate. So most people were stunted: the average Dutch man used to be 5'4" (he is now 6 feet). They lived in single-room, highly uncomfortable hovels and were totally ignorant. Most people never even ventured more than a few miles from their place of birth, in part because they couldn't: a large percentage of them were slaves/serfs.
Violence was commonplace and constant. From childhood, most people were frequently, brutally beaten (Martin Luther, when describing his youth, describes his mother beating him "to a pulp" for stealing a nut at around age 5: this was quite ordinary). This continued in adulthood: masters were legally entitled to beat (or kill) servants, husbands to beat (or kill) wives, the upper classes to beat (or kill) the lower. Since justice was capricious and scanty (police were too expensive), the crime rate was extremely high (the murder rate was perhaps 10 times that of the contemporary United States, or over 7 times that of Haiti).
While of course there was regional variation, it's important to realize that almost everywhere was like this. China, Europe, Mesoamerica...it's all the same, a depressing record of exploited peasants living under the twin threats of famine and sudden death (whether by disease, war, the state or unfriendly neighbors). Hunter-gatherer life was little better, with even higher rates of violence and the possibility of starvation never far away, even if the exploitation was less.
Haiti is now the exception. Hundreds of millions of people live lives of comfort, safety and ease, with problems like being too fat (from all the rich, varied food they consume) . The murder rate has plummeted, as has casual violence; most people are literate; and human living environments have never been cleaner (to the point that it may be causing allergies). And we own so much more: a wealthy peasant might own one bed, two stools and a couple pots (no, really!)
Even in 1850 London (possibly the richest place on earth at the time) the streets were filled with children dying of starvation and exposure and people making their living by collecting dog feces, nails, or bones while standing in untreated sewage (no, really).
So what happened? The answer is simple: technology. Specifically, industrialization. Previously, a gain in resources for one meant taking it away from someone else (the way a king would take his peasants' grain). But industrialization increased the size of the pie. A cobbler might make one pair of shoes a day: the factory could make hundreds. Now everyone could have shoes! Crop yields increased dramatically: suddenly there was more than enough food to feed everyone (hunger today is due almost entirely to poor distribution: past famines happened because there just wasn't enough food to eat). Greater resources meant that people could spend money on things beyond basic survival: universal education, investments in scientific research, road building and other public works projects, a highly trained police force, tree planting...the list is mind-boggling. The world finally bid goodbye to a subsistence economy and entered the modern era, where the main problem is now the wise management of resources (rather than simply struggling to find them).
Haiti needs to do the same: and if it does, it will not need massive fundraising efforts to prevent people dying of cholera. Building roads (and later, factories) seems so much more important to me than building a hospital, even if it is not as emotionally appealing.