‘Optimism is a Moral Choice’
World Bank’s Kim Describes Conversion at Chat
Photo: Chia-Chi Charlie Chang
Eighteen years before he was named 12th president of the World Bank Group in 2012, Dr. Jim Yong Kim was advocating for the bank to be mothballed; 1994 was the bank’s 50th year, and Kim thought an appropriate birthday gift that year would be to shut it down.
In those days, as one of the founders, along with Dr. Paul Farmer, of Partners in Health (PiH), a global health group with origins at Harvard University, Kim considered the World Bank a dinosaur. By insisting on strict repayment schedules, the bank was forcing poor countries that had borrowed money into austerity measures that hurt the poor. Desperately needed funds were taken from health care and education to pay back creditors.
In a chat onstage Mar. 12 in Masur Auditorium with NIH director Dr. Francis Collins, Kim described his conversion from M.D./Ph.D. anthropologist with front-line experience combatting infectious diseases among the world’s poorest populations to unexpected bank president whose keen eye for the needs of the world’s developing nations trumped his dearth of financial expertise.
‘Something Like a Movement’
There was a good reason that warm and sustained applause greeted Kim as he took the stage for his interview. For the previous hour and 41 minutes, the audience had watched the film Bending the Arc, which traced PiH’s development from its genesis in late-night dormitory conversations in Cambridge to crucial, even heroic, interventions in Haiti (first for tuberculosis, then HIV), Peru (multidrug resistant TB) and Rwanda (Ebola).
In perhaps the film’s emotional zenith, Kim recounts with tearful astonishment the recovery of a young Peruvian man whose advanced MDR-TB was cured by PiH physicians. This was only after much of the world, including authorities in the United States, had argued that such cases should be allowed simply to run their course, too expensive to address.
“With Paul Farmer and others, I learned how to take social justice and turn it into real work on the ground,” says Kim in the film, noting that the Catholic church’s liberation theology provided the moral buttress for work many of their peers thought was hopeless, maybe even crazy. “We realized that this could be something like a movement.”
Along with activist Ophelia Dahl and others, the Harvard grad students believed that “there was no such thing as a basket-case country,” said Kim.
Known for his comment, “Optimism is a moral choice,” Kim put that observation in context: “Pessimists will probably live out their own very low ambitions,” he said. “The key for me today is to have pessimism of the intellect, but optimism of the will.”
Noted Dahl in the movie, “So much of this work is built on love.”
Collins Conducts Interview
Once the film ended, Collins’ first question was about the power of an individual patient to become the start of “big, bold programs.”
“We learned early on that you can’t do this work unless you allow your soul to be fractured,” said Kim. “If you can shrug it off, Partners in Health is probably not for you.”
Photo: Chia-Chi Charlie Chang
When he first went to Haiti, Kim found “bodies that reflected all of the ills that the world has to offer…It made us humble, but it also made us angry…We were determined to stick with people who had been abandoned.”
The PiH team reflected long and hard on the best approach to human suffering, he said. “Would it be cost-effectiveness? We rejected that analysis. We were inspired by liberation theologians to stand by and be with the poor, to see the world from their perspective. Many people are unwilling to do so.”
Asked if he and Farmer always agreed on things, Kim said, “We argued all the time. To this day we argue intensely about things, but our moral foundations are built on the same architecture.”
For example, when World Bank assistance was sought for the Ebola crisis of 2014, Kim’s first call was to Farmer. His second call was to NIAID director Dr. Anthony Fauci.
“The board voted 25-0 to fund the work,” Kim reported.
Noting that “the World Bank used to be your enemy,” Collins asked, “How did you end up being in charge of the place?”
Kim responded that one of his predecessors, James Wolfensohn, had already begun to change the bank’s culture.
First, Grow Rich
“The original idea of the bank was, first grow rich, then invest in things like health and education,” said Kim. That view has evolved, he explained, as the world’s finance ministers have come to appreciate the work of people like Dr. Chris Murray, whose studies on the global burden of disease have been eye-opening. “Investment in health and education—not hard infrastructure—is the best driver of economic growth,” Kim said.
“So is [your work] all exhortation?” wondered Collins.
“That’s the last argument I had with Paul,” Kim replied, “—what the bank should do.”
Knowing that heads of state and finance ministers are keenly aware of how they stack up against their peers, the World Bank has commissioned the Human Capital Index, which Kim expects will pack a punch.
“They pay attention if you rank them,” he said. “No one wants the shame of being ranked lower than a nation you felt superior to.”
Among the metrics is learning-adjusted years of education vs. actual years of education. A year of education in Singapore, for example, is worth 2 years of education in Yemen.
“Once the rankings come out, that will get their attention,” said Kim, who hopes the index will spur self-funding initiatives and grow indigenous political will.
Kim said even a well-funded bank can’t come close to solving such challenges as the estimated $3 trillion it would take to tackle the world’s sexually transmitted diseases alone.
The Robots Are Coming
Kim sees a world where automation—robots and 3-D printing, for example—is expected to result in loss of half the world’s jobs.
“This is just nuts—it’s an absolute emergency,” he said, particularly for poor countries dealing with stunting in both education and human development. “What are these people going to do? We already have machines that can go down a row of strawberries and raspberries and just pick the strawberries.”
Kim said Chinese entrepreneur Jack Ma of the tech conglomerate Alibaba Group has predicted that all muscle-power jobs and all knowledge jobs “will be done by machines very soon…People won’t spend nearly as much time working…What’s going to happen in Africa? I don’t know, I just don’t know. We need NIH to teach us what people can do.”
Kim is heartened by the prediction that, by 2025, broadband communications will be truly global, “and then aspirations will skyrocket. That’s my obsession these days.”
He concluded, “Human capital is the most important driver of economic growth—that’s what we believe. How do you make the system, as is, work for everybody on the planet?”
He cautioned, “Don’t drop what you’re doing and become Paul Farmer,” suggesting that his friend Farmer is the only one who could successfully pull that off. But Farmer loves what he’s doing, said Kim, “so you should do every day what you absolutely love to do.”