Bjorn Lomborg argues for the 'boring stuff' that could save 4.2 million lives each year

Bjorn Lomborg’s new book, Best Things First, highlights the 12 most effective investments for improving the world’s development outcomes related to poverty alleviation and health. At a time when the world is very much off course for achieving the Sustainable Development Goals (SDGs), Lomborg, his colleagues at the Copenhagen Consensus Center think tank, and collaborators highlight policies that deliver the most social benefits for each dollar invested. They estimate that by investing US$35 billion in the highest performing strategies each year, we could save an additional 4.2 million lives each year and grow the incomes of the poorest half of the world by more than 1 trillion U.S. dollars each year. This would drive tremendous progress towards delivering on the global goals by 2030.

Lomborg and his colleagues and research partners have evaluated more than 100 development policies to find the very best solutions. For example, by their calculations, increasing funding for childhood immunizations by US$1.7 billion could save half a million lives each year and provide a benefit-to-cost ratio of 101 – meaning that for each US dollar spent, the overall return or benefit to society is US$101. The maternal and newborn health investments they evaluated deliver US$87 for every US dollar spent, while malaria investments would deliver US$48 for every US dollar spent.

Lomborg, who is also a visiting fellow at Stanford University’s Hoover Institution, laid out his vision: “The SDGs are failing. We need to get together as a world right now and acknowledge that and say, ‘Look, it would be wonderful to deliver on all the promises. But given that we're not actually going to do so, we should focus instead on doing the best things first, and that would achieve an amazing outcome."

He added, “That’s the idea behind our research and book – to be able to show this to finance ministers and donors and say, ‘Not only is this a good outcome, but it is also a really good deal.’”

In advance of the 2023 SDG Summit on September 18-19 at the United Nations General Assembly, which marks the halfway point for achieving the SDGs, Exemplars News spoke with Lomborg about his book and the best way forward for the goals.

How does your lens – understanding the benefits relative to costs of policies and initiatives – help us identify priorities that we might otherwise miss? Is there something that lens might miss in itself?

Lomborg: The world currently has 169 priorities – the Sustainable Development Goals. But we don't have enough resources to achieve all of these priorities – that’s shown by the fact that we are so off-track. By promising everything, we are spreading our resources thinly across everything, delivering just a little good.

The premise of our book is to answer the question: "If you're not going to be able to accomplish all these great things at once, what should you focus additional resources on first?" What we're simply trying to say is maybe we should spend more on the things that deliver amazing benefits before we focus on the stuff that just delivers a little bit of benefit for every dollar spent.

Of course, economics is not the only part of this conversation. There are also moral and political considerations. Setting priorities should not only be about looking at benefit-cost ratios. But it is incredibly important to inform the moral and political discourse with quality data that tells us cost and benefits of different solutions. That can be a huge help to focus resources on places where we can do more good.

What do you think is driving our current funding priorities?

Lomborg: Sadly, a lot of this is driven by what gets attention. Politicians are constantly met with a lot of demands. It’s understandable that groups that shout the loudest will be addressed. It’s simplistic but it’s true to say that if a politician doesn’t address those groups, they will face problems when they run for re-election.

So, if we look at a lot of things that development agencies do today, there's a sense that they are trying to check all the boxes at once. They say, ‘This investment is both about women and it's also going to help education, and it’s going to create jobs and it’s going to close gender gaps. It's also a little bit about agriculture and health and sustainability, and all these other things.’

But when you try to check all the boxes in that way, your investment might only do a tiny bit of good for each one of these things you care about, often at a fairly high cost. In comparison, many of the things that our book calls for investment in do just one thing, but they do it really well.

Of course, we're not saying you should avoid complex projects. What we’re saying is that governments and donors should do what they do really effectively to dramatically improve society, rather than just check boxes.

Why have the 12 priorities you highlight, from tuberculosis (TB) to malaria and education to land rights, suffered from under-investment?

Lomborg: That is a good question. If we're saying these are amazing (investments), why is the world not doing them? One answer is that we are in some ways advocating for boring things. We're often arguing for issues and interventions that don't have great public relations or celebrity champions.

TB is one of those things. There is a lot of stigma about TB, to this day. Consider this surprising, and depressing, statistic: Because TB is such a stigmatized disease, one quarter of all people diagnosed with TB in Kenya end up with a divorce.

When you are cured, you stop talking about it. There are very few people who will go out publicly and say, ‘I had TB, it was terrible. I want to make sure everybody who has it gets diagnosed and treated.’ Often it is the poorest and the most marginalized groups that end up getting TB. People who live in slum neighborhoods, migrants, mine workers. These are people that have very little power and voice. Yet, more than a million people die every year from TB. It is the biggest infectious disease killer in 2023.

And our research – by global experts in TB – shows that for every dollar spent fighting TB smartly, you can deliver $46 of social benefit. For about $6.2 billion you could save more than 1 million lives annually across the next three decades. That's a fantastic outcome. But it's overlooked today, and there are a lot of other development priorities that get far more attention.

We hope that our work will empower the people who are campaigning for TB – and for issues like land rights, child immunization, maternal health, and malaria. We hope it will become a little easier to talk about these issues and to push them to the top of the agenda.

How are the SDGs helpful in setting goals and priorities?

Lomborg: If you look at the Millennium Development Goals (MDGs), they actually somewhat succeeded. There's very good evidence that for low- and middle-income countries, the simple and clear MDGs galvanized the international community to invest in reducing child mortality, maternal mortality, and getting kids into school. The MDGs encouraged governments and philanthropists to spend more money than we otherwise would've, and we spent that mostly on these critical issue areas.

But back in 2015 when we were negotiating the SDGs to replace the MDGs, the conversation quickly became about promising everything. Remember that there are 169 different SDG targets. That was deliberate. The idea from supporters was that the world would be so enthused that they’d put more money into everything, and – voila! – we’d solve all the world’s problems. Things did not turn out that way. Even if you were to ignore the damage done by the COVID pandemic, we will be 50 years late achieving the SDGs. That’s why we need to change tack.

Instead of trying to do everything and spreading the money thinly across 169 targets, let's just focus additional resources on the very, very best ways to make the world be much, much better by the end of this decade. Surely that's something we could all get enormously excited about. It feels wonderful to promise everything but given that we're not actually going to deliver that, maybe it'd be even more wonderful to promise the best things first and deliver on those amazing outcomes first.

For more on how we can better reach our global goals, read this Q&A with Madhukar Pai on how the 'know-do' gap undermines progress towards our health goals.