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Does Dr. Kim Hold the Cure?

Posted on the 29 March 2012 by Center For International Private Enterprise @CIPEglobal
Does Dr. Kim Hold the Cure?

Jim Yong Kim, President of Dartmouth and nominee to be the next President of the World Bank. (Photo: Develop Economies blog)

On March 23, President Obama nominated Jim Yong Kim, physician, anthropologist, and current president of Dartmouth College, to be the next president of the World Bank following Robert Zoellick’s resignation. At first glance, it seems that Kim lacks expertise in the fields typically associated with the bank, such as finance, economic growth, diplomacy, or politics. (More information about past World Bank presidents and their backgrounds can be found here)

But could Kim’s atypical background benefit the Bank?

In 1987, Kim helped establish Partners in Health (PIH), an organization that developed a model of community-based healthcare to treat drug-resistant tuberculosis and HIV/AIDS. Among the other co-founders is Paul Farmer – an outspoken advocate in the field of global health who asserts that “structural violence” is a fundamental barrier to poverty alleviation.

Farmer’s view of structural violence purports that there are structures – such as bureaucracy, class, and gender –  that allow some to thrive while others suffer in poverty. Underlying the theory of structural violence is the idea that environmental conditions, whether historically determined or economically driven, ensure that violence, observed as poverty, will ensue. As such, the social ills of poverty result from structural violence, not from a lack of natural resources or from the actions of individuals.

The structural violence argument puts poverty within the realm of institutional analysis. Institutions, such as formal laws and traditional practices, can be thought of as “the rules of the game.” Good institutions affect all actors by incentivizing behavior that will lead to positive outcomes. Not only do institutions affect poverty and health, but they also determine the successes or failures of democracies and market economies.  Therefore, working with institutions is essential for development in sectors beyond health.

Although PIH bases its work on the premise of structural violence, it does not focus on reforming the underlying institutions and structures behind the poor health conditions it seeks to reverse. That is not to say that the organization does not do good work. In fact, its approach is profoundly innovative: by providing primary care and general nutrition supplements as part of visits regarding specific treatments, PIH makes its programs more effective. Furthermore, PIH works with community health workers that accompany patients throughout their treatment and monitor their needs for food, housing, and safe water.

Still, this all means that PIH addresses the symptoms, not the institutional causes, of structural violence. In that case, Partners in Health more closely resembles humanitarian aid or relief than development as such. Indeed, some donors are reluctant to fund some of PIH’s programs, arguing that PIH’s assistance is unsustainable and will always require donor funding. It is likely true that without PIH, the countries in which it works would not be able to maintain the high quality care that PIH provides.

Looking at Kim’s experience with Partners in Health and other areas of his record, one of the criticisms that has emerged is that he may lead the World Bank to focus more on humanitarian aid or charity work, which is usually more palliative than transformative. In contrast, the World Bank has historically sought to help countries transition into prosperous economies with capable governments that provide law and order, education, healthcare, infrastructure development, and so on. The World Bank does this by providing loans, grants, and technical assistance – not by working directly with individuals living in poverty.

At the same time, others have commended Kim’s nomination based on his many other qualifications, such as his appreciation for evidence-driven interventions, the fact that he is not a “Washington insider,” and his multicultural background.

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