Best Things First

1. Global progress and SDG shortfalls: The world has made significant strides, but we're falling short on SDG promises

"Just a century ago, two-thirds of the world lived in a permanent state of hunger. Now, economic development and agricultural innovation have reduced this problem to the point where it affects less than one-in-ten people."

Remarkable progress: Over the past century, the world has made incredible strides in reducing poverty, hunger, and disease. Life expectancy has increased dramatically, and more children than ever are receiving education. However, we are still falling short on many of the ambitious Sustainable Development Goals (SDGs) set for 2030.

SDG challenges: Despite good intentions, the SDGs have struggled to accelerate progress beyond pre-existing trends. The goals are often criticized for being too numerous and lacking focus. For example:

• Hunger: The world is not on track to end hunger by 2030, with progress stalling or even reversing in recent years.
• Education: While more children are in school, learning outcomes remain poor in many countries.
• Health: Maternal and child mortality rates have decreased but not fast enough to meet SDG targets.

2. The power of prioritization: Focusing on the most efficient policies can yield remarkable results

"For about $35 billion per year, we can save 4.2 million lives annually, and we can make the poorer half of the world more than a trillion dollars better off each and every year."

Benefit-cost analysis: The book advocates for using rigorous benefit-cost analysis to identify the most efficient policies. This approach allows policymakers to maximize the impact of limited resources by focusing on interventions that deliver the highest returns on investment.

Top 12 policies: The research identifies 12 highly effective policies that could dramatically improve lives in low- and lower-middle-income countries:

• Tuberculosis treatment
• Education reforms
• Maternal and newborn health interventions
• Agricultural R&D
• Malaria prevention
• E-procurement
• Nutrition programs
• Land tenure security
• Chronic disease prevention
• Trade liberalization
• Childhood immunization
• Skilled migration

These policies collectively offer an astounding average return of $52 in social benefits for every dollar spent.

3. Education reimagined: Teaching at the right level and structured pedagogy can revolutionize learning

"Although the world has almost doubled its spending on each primary school student since 1990, learning levels have remained low."

Teaching at the right level: Many classrooms in developing countries have students with widely varying skill levels. By grouping students based on their current abilities rather than age, teachers can more effectively address individual needs. This can be done through:

• Technology: Using tablets with adaptive learning software for one hour per day
• Reorganization: Shuffling classes for part of the day to group students by skill level

Structured pedagogy: Providing teachers with detailed lesson plans, training, and ongoing support can dramatically improve the quality of instruction. This approach is particularly effective in contexts where teachers may have limited formal training.

Benefits:

• Cost-effective: These interventions deliver learning gains equivalent to 2-3 years of regular schooling for a fraction of the cost
• Scalable: Can be implemented across diverse educational systems
• High return on investment: Every dollar spent on these programs yields $65 in long-term economic benefits

4. Maternal and newborn health: Simple interventions can save millions of lives

"Every two minutes, a woman dies from pregnancy or childbirth complications, and nine babies die."

Basic Emergency Obstetric and Newborn Care (BEmONC): Providing essential services during childbirth can dramatically reduce maternal and newborn deaths. Key components include:

• Clean birth environments
• Neonatal resuscitation equipment
• Skilled birth attendants
• Basic medications and treatments

Family planning: Increasing access to family planning services allows women to better time and space pregnancies, reducing health risks.

Impact:

• Lives saved: These interventions could prevent 161,000 maternal deaths and 1.2 million infant deaths annually
• Cost-effective: For every dollar spent, $87 in social benefits are generated
• Long-term benefits: Improved maternal and child health leads to better educational outcomes and increased economic productivity

5. Agricultural R&D: Investing in innovation can dramatically reduce hunger

"By 2056, the additional R&D in developing countries would increase agricultural output by 10% and reduce food prices by 16% as compared to keeping investment where it is today."

Focused investment: Directing more resources to agricultural research and development in low- and lower-middle-income countries can yield significant returns. This includes:

• Internationally aligned research centers
• National agricultural research systems
• Innovation to improve research efficiency
• Private sector investment in developing countries

Benefits:

• Hunger reduction: Could help over 130 million people avoid malnutrition by 2030
• Economic gains: Every dollar invested yields $33 in benefits
• Climate impact: Improved efficiency could reduce global climate emissions by more than 1%

6. Fighting infectious diseases: Targeted efforts against tuberculosis, malaria, and childhood diseases are highly effective

"With vaccines, humanity has a miraculous tool to turn the tide. One of the most successful public health interventions ever, immunization saves millions of lives each year."

Tuberculosis: Increasing diagnosis and treatment adherence could save 600,000 lives annually at a cost of $1 billion per year.

Malaria: Expanding the use of insecticide-treated bed nets could prevent 200,000 deaths each year for $1.1 billion annually.

Childhood immunization: Increasing vaccination rates could save 500,000 lives per year at a cost of $1.7 billion.

Key points:

• High return on investment: These interventions deliver between $46 and $101 in benefits for every dollar spent
• Proven strategies: Build on existing successful programs and technologies
• Broad impact: Reducing infectious diseases improves economic productivity and quality of life

7. Tackling chronic diseases: Cost-effective measures can prevent millions of deaths

"Even in low- and lower-middle-income countries, chronic disease deaths are now much more frequent than infectious disease deaths."

Effective interventions:

• Tobacco taxation and regulation
• Alcohol regulation
• Salt reduction campaigns
• Cardiovascular disease prevention and treatment

Impact:

• Lives saved: These policies could prevent 1.5 million deaths annually
• Cost-effective: Returns range from $23 to $101 per dollar spent
• Addressing a growing burden: Chronic diseases are an increasing concern in developing countries

8. E-procurement: Digitizing government purchases can significantly reduce corruption

"Procurement is a government's number one corruption risk: Every phase of a procurement process includes the risk of bribes, kickbacks, and collusion."

Benefits of e-procurement:

• Increased transparency
• Reduced opportunities for corruption
• More efficient government spending
• Increased competition among suppliers

Economic impact:

• Lower-middle-income countries: $309 in benefits for every dollar spent
• Low-income countries: $38 in benefits per dollar invested
• Potential savings: 6.75% reduction in procurement costs

9. Nutrition: Targeted interventions in the first 1,000 days of life yield lifelong benefits

"The greatest nutritional challenge is long-term undernutrition in children. The most important impact happens within a child's first 1,000 days, from conception until the child is two years old."

Key interventions:

• Multiple micronutrient supplements for pregnant women
• Calcium supplementation during pregnancy
• Complementary feeding promotion
• Small-quantity lipid-based nutrient supplements (SQ-LNS)

Impact:

• Stunting reduction: Could prevent stunting in millions of children
• Long-term benefits: Improved cognitive development, educational outcomes, and adult productivity
• Cost-effective: Returns range from $14 to $38 per dollar invested

10. Trade and migration: Lowering barriers can boost global prosperity and reduce inequality

"Economic evidence shows that one of the best ways to reduce inequality between nations is to allow workers to migrate to rich countries, where they will be much more productive."

Trade liberalization:

• Benefits: Increased competition, innovation, and economic growth
• Impact: A 5% increase in global trade could yield $11 in benefits for every dollar of cost
• Distributional effects: Greatest benefits accrue to low- and lower-middle-income countries

Skilled migration:

• Proposal: Increase highly skilled migration by 10%
• Benefits: Improved productivity, knowledge transfer, and remittances
• Return on investment: $20 in benefits for every dollar spent

11. Land tenure security: Formalizing property rights can unlock economic potential

"The World Bank estimates that 70% of people have no access to formal land registration systems."

Benefits of secure land tenure:

• Increased agricultural investment and productivity
• Improved access to credit
• Reduced conflicts over land
• Higher property values

Implementation:

• Rural areas: Focus on mapping and registering individual and communal land
• Urban areas: Formalize property rights, including in informal settlements
• Digitization: Create efficient, transparent land administration systems

Impact:

• Rural areas: Potential 15% increase in household incomes
• Urban areas: 25% increase in property values
• Return on investment: $18 to $30 in benefits per dollar spent

Last updated: April 23, 2025