Has The U.N. Made The World A Better Place? The United Nations set an ambitious goal for 2015 -- to end extreme poverty and improve the lives of billions worldwide. Melinda Gates of the Bill and Melinda Gates Foundation, U.N. special advisor Jeffrey Sachs, and Amina Az-Zubair, advisor to the president of Nigeria, provide a status check on the U.N. Millennium Development Goals.
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Has The U.N. Made The World A Better Place?

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Has The U.N. Made The World A Better Place?

Has The U.N. Made The World A Better Place?

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This is TALK OF THE NATION. I'm Neal Conan, in New York City all this week.

Just down the street, presidents and prime ministers gather for the General Assembly of the United Nations, an annual meeting dismissed by some as a gab-fest at an institution that's outdated, bloated and ineffectual. But the U.N. may be the only organization of its size and stature that's also focused on peace, security and development.

The U.N. plays a part in nearly every major international event. It's put peacekeeping troops in Congo and disaster relief personnel in Haiti and Pakistan. It enlists social media giants and recruits experts to study climate change.

And this year, the General Assembly is focused on eight goals the world agreed on at the turn of the century to eliminate extreme poverty, improve people's health and fight disease, the Millennium Development Goals. Ten years later, just five years before the deadline, is the world a better place?

Later this hour, the one man whose job it is to make sure this week goes off without a hitch and keep every one of the 192 attending member nations happy, the U.N. chief of protocol takes us behind the scenes of the General Assembly. If you have questions for him about who sits where, when the handshake and when to bow, who takes the podium first -send us an email now. The address is talk@npr.org.

But first, if you've worked overseas in business, in the Peace Corps, for an NGO, tell us what you saw where you worked, good and bad. Is the world a better place? 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

We begin with two people leading the way on these Millennium Development Goals. Jeffrey Sachs is U.N. Secretary-General's special advisor on the Millennium Development goals, director of the Earth Institute at Columbia University, joins us from a studio at the U.N., and it's good to have you with us today.

Mr. JEFFREY SACHS (Special Adviser to United Nations Secretary-General Ban Ki-moon): Thanks a lot, Neal, great to be with you.

CONAN: And Melinda Gates is co-chairwoman of the Bill and Melinda Gates Foundation, which has promised more than $1.5 billion to programs related to the Millennium Development Goals, and she's with us here at our bureau in New York, and it's great to have you on TALK OF THE NATION.

Ms. MELINDA GATES (Co-chairwoman, Bill and Melinda Gates Foundation): Great to be here.

CONAN: And Melinda Gates, let me start with you. Five years from deadline, what gives you hope, what drives you crazy?

Ms. GATES: We have made more progress in the last 10 years on these Millennium Development Goals than at any other period in history. And so when you look at the Millennium Development Goal around poverty, to cut poverty in half, 1.3 billion people have lifted themselves out of poverty. To me, that is incredible hope.

In the areas that I'm most passionate about, childhood deaths and maternal deaths, we are seeing nation after nation starting to make progress. So even a country like Malawi, which is the sixth-poorest country in Africa, they are actually on track to make the child mortality numbers coming down in their country, and it's really incredible to see.

CONAN: And what drives you crazy?

Ms. GATES: What drives me crazy is when people think it's not possible. You know, when I'm on the ground in Africa, and I see governments building out an infrastructure that helps women get to clinics and save their lives and their babies' lives, and I see vaccinations making it to the most rural places in Ethiopia, and I see what's possible, it drives me crazy when people think it's not possible.

CONAN: Jeffrey Sachs, let's ask you, at the U.N., how far as the global recession pushed things back?

Mr. SACHS: I think that we have been making progress, actually, all through the decade. The recession, obviously, has taken a toll, but even before the recession, the gains were a bit sporadic and, you know, too slow to achieve the goals on their trajectory by the year 2015.

So the name of the game right now and the real purpose of this meeting, is to accelerate progress, to scale up what has been demonstrated to work. Melinda's been such a marvelous, wonderful leader in this effort, and what she's saying is absolutely right. There are demonstrated, proven technologies, some basic, some very recent and advanced, that are making all the difference, but they're not necessarily reaching all those who need to be reached.

And what this meeting has to accomplish is a breakthrough to ensure that there's a large, significant, worldwide scaling-up of progress. If that happens, the MDGs will be achieved.

CONAN: MDGs, the Millennium Development Goals. It's a catch initials you're going to be hearing a lot over the next week. But what's in the way, Jeffrey Sachs? Is it resources? Is it political will?

Mr. SACHS: It's both of those, and they're interconnected. The rich countries have promised, during the past decade, several high-level headline promises. In 2002, they promised to make efforts to reach 0.7 percent of the national income as development aid. What that means simply is 70 cents out of every $100 of national income, modest but very important.

In 2005, the same group of countries essentially promised to double aid to Africa by this year. In 2009, the same group of countries promised $22 billion over three years for peasant farming because poor people in the rural areas could be lifted out of poverty if they could be more productive in their farming.

And at the end of last year, the same group of countries promised $10 billion a year to address climate change, both adapting to climate change, becoming more resilient to it, and adopting new low-carbon energy systems.

Now the fact of the matter is that in all four of these major headline promises, it's us, actually, not the poorest countries, but it's us who have fallen short of the commitments.

And what I see on the ground as I travel around the world and have been doing so during the last 10 years, the same places that Melinda mentioned, is that when there is effective financing linked to effective technologies and smart programs, you get breakthroughs.

When you have those smart programs and effective technologies, but they can't reach those in need because the coffers are dry, then you see continued suffering that is so disturbing and shocking that that's what drives me up the wall. That's what has to be solved at this meeting.

CONAN: Let's get some callers in on the conversation, 800-989-8255. Email us, talk@npr.org. Again, we're talking with Jeffrey Sachs and Melinda Gates. Let's go to Loni or Louis(ph), excuse me. Louis is on the line from Orlando.

LOUIS (Caller): I've been accused of being loony, also, but this is Louis.

(Soundbite of laughter)

LOUIS: I am a taxpayer in Florida. I have a lot of sympathy for Haiti, but as a taxpayer, I'm really offended to have to foot the bill for tens of thousands of Haitian refugees that come here and, you know, flood our schools, use hospital care, I mean, the typical immigrant argument.

And yet Haiti is, like, literally a stone's throw from Florida, and we're talking about Africa. How about the Africans who were forced to Haiti 200 years ago by the French? When are we going to get that country in gear?

CONAN: Well, Jeffrey Sachs, that's it's more your bailiwick than Melinda Gates.

LOUIS: Oh, really. I thought you guys were dealing with, you know, the poverty rate worldwide. So you're focused just Africa, not the Caribbean basin or South America?

CONAN: Not at all. We'll try to get a response to you.

Ms. GATES: No, it's all.

LOUIS: Okay, thanks.

Mr. SACHS: Louis is right. In fact, Haiti could have made major breakthroughs, and we've not done what we should have done and could have done in an organized way to help Haiti out of its continued misery and suffering.

And even after the horrendous earthquake, one of the greatest life-takers of all natural disasters in human history, the fact of the matter is that the United States and other countries have not gotten organized to help.

And this is a continuing reality, and ironically, Haiti is, of course, subject to the same kind of breakthroughs that we've mentioned. Haitian farmers could triple or quadruple their food production. Disease burdens could come down. Indeed, some of the most pioneering efforts proving that - of how to bring health to low-income settings began in Haiti.

Of course, children could be in school. Basic infrastructure could be built. There's no fundamental impediment. We end up spending a tremendous amount on peacekeeping and, as Louis said, on refugees and desperate people because we don't invest ahead of the curve.

This is the biggest mistake. We want, in general in the United States, until a massive crisis explodes. Then we respond when it's very expensive to do so, usually for a short burst but without the long-term investments that could make all the difference.

CONAN: Melinda Gates, is the foundation active in Haiti? Is this an area of interest, particularly again, on that peasant farmer issue?

Ms. GATES: We're yes, we're definitely interested in Haiti. And I think what Jeffrey says about working upstream is the point of all these Millennium Development Goals, is that you have to go up front and give people what they need.

It's a farmer having the right type of seed so they can grow a drought-resistant or pest-resistant crop. Whether they live in Haiti or whether they live somewhere in Kenya or Tanzania, it doesn't matter. They need the local seed that will help them get their production up so they can feed their family and eventually get some grains on the local market.

That's one thing you can do, and that's if you look at the Millennium Development Goals, and you say we've made so much progress on poverty -Ghana's a shining example of this because their government invested in that type of infrastructure and getting the seeds to the people that they needed.

CONAN: Let's go next to William(ph), William with us from Oakland.

WILLIAM (Caller): Hi, I'd like to find out a little bit more about how you're encouraging agriculture. Are you encouraging farmers to drop sort of the local crops and take up export crops? Because I think that, it seems to me, it would be going in the wrong direction. And how are you going to measure the actual agricultural progress? Is it in terms of food or income? And if you could just outline quickly some specific goals and what you see so far in terms of meeting those goals. Thank you.

CONAN: Melinda Gates?

Ms. GATES: Sure. So what we're encouraging local farmers to do in Africa is to pick up the seeds that they're interested in for their local crops. And what you find is that they actually have very specific preferences.

Just like we do here, they have specific preferences around maize, specific preferences around beans that they like to grow, and what we're trying to do is give them the right inputs, the seeds and the, if it's fertilizer that they need so that they can grow enough for their family, give them mechanisms for doing a little bit of storage so that then, they're not if they do want to take some of their crop to the local market and sell them, they can store the grains, have access to the market there and then sell in the market when the prices are actually still high, not when everybody's flooding their own market with lots of goods.

So you've got to give them the inputs they need for their own specific area to feed their family. and what that does is allow a farmer to lift him or herself - many of these cases, these African farmers are women -to provide enough income for their families so that they can save a little bit to put their child in school or when they have a health emergency to pay for the birth, let's say, of a baby or an emergency in the family. And we're seeing this, worldwide, make a difference in lots of places.

CONAN: We're in New York City for the 65th United Nations General Assembly, talking about the Millennium Development Goals, which aim to eliminate extreme poverty, improve people's health and fight disease. Ten years later, is the world a better place, specifically where?

We want to talk with those of you who've worked overseas for the Peace Corps or NGOs or in business. What have you seen where you worked? 800-989-8255. Email talk@npr.org. Stay with us. I'm Neal Conan, TALK OF THE NATION, NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan, and this week, we're in New York City.

U.N. Secretary-General Ban Ki-moon released a report this week laying out major achievements of the organization's push to end poverty, hunger and disease. He pointed to expanded access to clean water, strengthened control of malaria and tuberculosis, also increased access to HIV treatment as successes.

Ban Ki-moon also urged members to stay committed to the Millennium Development Goals they set 10 years ago. But there have been some criticisms about how world leaders tackle those goals, including complaints about accountability and the lack of a blueprint for how to achieve the goals.

Today, we're talking about the U.N.'s Millennium Development Goals and what impact they've had, if any. You can find a list of the goals at our website, at npr.org. Click on TALK OF THE NATION.

We want to hear from NGO employees, Peace Corps volunteers, those of you who've worked in business overseas. Tell us about what you know about progress or lack of progress made where you worked, 800-989-8255. Email us, talk@npr.org. Click on TALK OF THE NATION.

Our guests are Jeffrey Sachs, U.N. secretary-general's special advisor on the Millennium Development Goals; and Melinda Gates, co-chairwoman of the Bill and Melinda Gates Foundation, the world's largest charity. It distributes billions of dollars in grants. Among its many recipients, the foundation has generously supported NPR News for several years. Of course, we thank them for that.

Let's see if we can get another caller on the line. Let's go to Cynthia(ph), Cynthia with us from Jacksonville. Cynthia, are you there? Let's go instead to this is Robert(ph), Robert with us from Del Ray in Florida.

ROBERT (Caller): Hi, Neal. I just had a question about if there's going if the U.N. was planning any subsidies for farmers in Africa. I know that a lot of farmers, corn farmers in America have trouble turning profits on what they grow, and if it weren't for the subsidies provided by the government, then most farms would go under. And I'll take my response off the air. Thank you.

CONAN: Thanks very much. Jeffrey Sachs?

Mr. SACHS: In fact, also to answer not only Robert's question but the preceding question that Melinda discussed, if poor African farmers gain access to the inputs that Melinda was mentioning, high-yield seed, some storage, fertilizer, the output per acre basically can triple or quadruple.

If it's possible to add irrigation, it's possible to raise it tenfold the amount of food and other agricultural produce.

So the problem is that when these peasant farmers who have almost nothing at the beginning try to gain these inputs, they can't afford them out of their own income, and the banks aren't lending them money. There is no collateral, and there is no capacity to borrow.

And so to get started as commercial farmers rather than subsistence farmers requires a period of help, and that kind of help can be in the form of a subsidy like Robert mentioned.

The premier case of this is the country of Malawi. The secretary-general mentioned this in his speech this morning in the General Assembly. He visited a Millennium Village in Malawi that used to be completely hunger-stricken. Now it has a great grain bank of surpluses generated year after year.

The difference is that these farmers are gaining access through a kind of subsidy, a voucher ticket, to a bag of fertilizer and a bag of high-yield seed. And their production has gone up roughly four times.

So instead of being absolutely impoverished and hungry and the children sick and stunted, now you have a community that grows more than it eats. It takes the grain to the market. It earns income. It provides school meals.

And it's filled a giant warehouse that when the village first constructed it was laughed at by the neighbors, saying what would you ever do with such a large, empty grain warehouses for an airplane hangar, and now it's filled with bags of maize, which the secretary-general saw when he visited this place a couple of months ago.

The whole point is very practical, targeted technologies, and if we can help these small-holder farmers get these inputs, as Melinda was saying, a breakthrough can occur. Hunger could be decisively defeated. Africa could become not only self-sufficient in food rather than being a large grain importer as it is right now, but Africa actually could become a net grain exporting region.

CONAN: Let's see if we can go next to this is Cathy(ph), Cathy with us from Pepperell, Massachusetts.

CATHY (Caller): Hi, thanks for taking my call.

CONAN: Sure.

CATHY: I have a question. I lived and traveled in Central and South America last year, and I have always been curious about the issue of population control and birth control and that end of it. And I don't really ever hear people talking about that. And I am just, I feel like this is a perfect time to call and ask. So I'll take my answer off the air, thanks.

CONAN: Thanks very much, and Melinda Gates, I know this is something that you've been involved with.

Ms. GATES: Yes, great question, which is really - family planning has to be part of a comprehensive maternal and child-care plan. We know that there are 200 million women who don't have access to family planning tools that absolutely want them, and if you gave them access to the basic kind of family planning tools that we have here in the United States and let them choose, we can reduce maternal deaths by 30 percent and childhood deaths by 20 percent.

And when I go out to these places, and I visit women in these clinics on the ground in Africa, much like the caller was saying that she's seen in Central America and South America, women are asking for these tools, and they're saying to me: I got Depo-Provera three months ago, and now it's stocked out. Why is it that I can't have it?

If we're going to achieve these Millennium Development Goals, we're going to have to get reproductive tools out to women because they do want them, and they will use them, and they want to bring down their birth rate so that they then have a chance to feed their children and to educate their children, which is their goal, much like us. They want a healthy and happy future for their child, just as much as we do here.

CONAN: We also know that if the economic situation can be improved for women, they tend to have smaller families. But there are other things going on, too. People say wait a minute, we have priorities that are not being met.

There are protests today in Philadelphia and here in New York from AIDS activists saying as more money has gone towards women and children, less money, percentagewise, is going to AIDS, and these concerns are very real.

Ms. GATES: Well, in fact, the AIDS community has had a tremendous amount of funding thanks to the earlier program by PEPFAR by the previous administration. And, you know, if you'd said to us that AIDS could have made as much progress as it had in the last eight years, it really is the funding that came into that area.

And it's not that funding takes from one area or gives to another. Maternal and child health issues really are just now becoming onto the agenda in a very serious way. And I don't see when Bill and I look out across the foundation, the governments that we're calling on to fund these things, it's not an either-or. AIDS is part of the picture and needs to continue to be funded, but as do these maternal and child health issues, as well.

CONAN: Jeffrey Sachs, AIDS is not just in terms of private donors like the Bill and Melinda Gates Foundations. It's a governmental obligation, too. Promises have been made.

Mr. SACHS: One of the biggest breakthroughs in this whole process is something that Bill and Melinda helped to get started 10 years ago and I worked on with Kofi Annan. And that is the Global Fund to Fight AIDS, TB and Malaria.

That is a very creative, novel organization in which donor governments and the Bill and Melinda Gates Foundation and others have pooled resources into a single fund to make a very businesslike, organized, rigorous way to scale up AIDS programs, as well as malaria and TB programs, in low-income countries.

It's been a tremendous success. Millions of lives have been saved. Now hundreds of millions of anti-malaria bed nets also have been distributed thanks to that fund.

Ironically, the fund is short of cash right now, in fact desperately so, and at the same time as we bring this new agenda of maternal and child health so critically onto the agenda, the African leaders are saying great, we desperately need this, but please put it in the Global Fund to Fight AIDS, TB and Malaria because it's really the same local health care system that we need to support.

And all of these efforts, whether it's the disease control or safe childbirth or neonatal resuscitation, all involve the same clinics, the same community health workers, the same interconnected processes. And that's why I said a few minutes ago that the real challenge here is linking the scaled-up financing with the scaled-up investments on the ground in the villages that Melinda and I are seeing all the time and seeing great success when they're able to access resources and seeing tragedy when they're not able to access those lifesaving resources.

CONAN: Joining us now is Amina Az-Zubair, who serves as special advisor to Nigerian President Goodluck Jonathan on the Millennium Development Goals. She joins us from Studio 5 at the United Nations, and thank you for being with us today.

Ms. AMINA AZ-ZUBAIR (Advisor to the President of Nigeria, Goodluck Jonathan): Thank you, a pleasure.

CONAN: And Nigeria, how is Nigeria progressing on the MDGs? Are you going to meet your targets?

Ms. AZ-ZUBAIR: We are, as we say in Nigeria, by God's grace. But on a serious note, I think we've made a lot of real progress over the last four to five years, and it's that progress that, as we take stock, we're very clear about the challenges and gaps going forward in that last mile. And it's some of those progresses that we've made in maternal health, in child health, in the access to potable water, education that we're sharing at this U.N. General Assembly. So I think we have got a way forward. We know what to do. Going to scale is going to be critical in this and getting the investments in, and for our partners to meet the commitments that have been long pledged to making this happen.

CONAN: One of the issues that we knew came up in Nigeria over the past two years was in the effort to eradicate polio and the resistance to that effort in some parts of the country, particularly among some of the Muslim community. Has this effort gone ahead?

Ms. AZ-ZUBAIR: The effort went ahead. In fact, that is one of the success stories, I think, for us, of the year. Polio has now been - it's a 99 percent success story. We have two or three cases which we've located, but essentially, quite right, there were a lot of - there's a lot of pushback on the polio, the immunization some years ago. And what really made it click were the partnerships. Partnerships, first of all, from our international community, particularly Bill and Melinda Gates Foundation, which provided an opportunity to bring in - my country is one that's made up of 36 federating units. And so when you're going down to that level, the partnerships are important.

And engaging them, we found a platform to do that. Going into the local governments and the villages, it was - the key to it were the traditional rulers, engaging them in the advocacy, in taking part in the immunization days, and it was phenomenal. Over a period of about 12 to 14 months, we crashed the polio, and have now can be said to eradicate it.

Still, challenges in terms of ensuring that we put in routine immunization, which is key to sustaining the gains that we've made. And I believe that with these successes that we're gaining traction and acceptance, and people are asking for more in terms of putting in place a good primary health care system, not that it's just a campaign once every few months, but that on a daily basis, on a routine basis, mothers can bring their children to our primary health care centers and they can get routine immunization.

CONAN: And AIDS? How is the battle against AIDS developing in Nigeria?

Ms. AZ-ZUBAIR: The battle against AIDS has actually stopped, and we reversed that trend. We've increased the number of centers that are providing ARVs. Clearly, more support - again, the Global Fund has been instrumental in providing headway on that. I think the challenge that we have now really is mother-to-child transmission and to make available more to mothers. Before, I think the centers - really, the maternal health issue had not been put on the front burner, and it had gone sort of - we were grappling with the challenges of our women dying at childbirth, and then suddenly, we were finding that with the numbers and the population that we have in Nigeria that also, too, is a big issue is the mother-to-child transmission. And we have a program to increase that coverage by 30 percent, and within the next few years, to try to cover that altogether.

CONAN: We're talking...

Dr. SACHS: If I may comment just very briefly, I think it's worth the listeners knowing that Nigeria was completely drowning in debt, and then negotiated a debt reduction - a debt cancelation agreement with their creditors five years ago and pledged that it would use about a billion dollars a year of the saving that it otherwise would have spent to achieve the goals that Amina Az-Zubair is discussing right now. So she's heading a program that's based specifically on the gains from debt cancelation. It's given a fresh start to the country and its democracy and the fight against disease. And people often say, oh, why should we do that? But Nigeria is the perfect illustration of exactly why, to have a fresh start.

CONAN: Jeffrey Sachs, the U.N. secretary-general's special adviser on the Millennium Development Goals. As you heard just a moment ago, Amina Az-Zubair, special adviser to Nigerian President Goodluck Jonathan, on the MDGs. Also with us, Melinda Gates of the Bill and Melinda Gates Foundation. You're listening to TALK OF THE NATION, from NPR News.

And let's see if we can go to Dave, and Dave's with us from Mitchell, South Dakota.

DAVE (Caller): Yes. I have a question which picks up on a theme that Dr. Sachs has put forth in the past which he called clinical economics, meaning that you need to look at the specifics, a particular locale, to determine what's necessary. The particular question - this for both of them - is what do you do when the clinical situation says that the fundamental problem is a dysfunctional central government?

I don't mean here to be playing the blame-the-victim problem, because it's not the - it's not the fault of the people on the ground. But in cases like Somalia or Sudan, or one might even to some extent make the case of Haiti, it seems that the central government's inability to get its act together could get in the way. What's your strategy for getting around those kinds of problems?

CONAN: Jeffrey Sachs? Hello?

Dr. SACHS: Avoid...


Dr. SACHS: Yes, can you hear me?

CONAN: Yes, go ahead.

Dr. SACHS: Oh, good. Thank you. The first and best strategy, of course, is to avoid disaster in the first place, and I'll just refer quickly to Yemen. I went five years ago, at the request of the president of Yemen. I came back and I said this country is absolutely experiencing extreme water stress, environmental collapse, hunger. We've got to do something about it.

Washington, frankly, ignored that. Five years later, there is a war underway, and American troops are there, drone missiles and all the rest. We wait so long until it's disaster. But I think it's also true, Dave, that there are situations that, once they have gotten out of control, are very hard for us to solve.

I would cite Zimbabwe as a country where Mr. Mugabe has thuggishly held onto power for so long. He and his clique have really wrecked that country. And this is not something that can be solved from the outside. I don't believe that one country can determine another country's politics. It is, however, a tragedy to see. Then there are other cases like Somalia - very complicated - because this country is in such extreme drought, such extreme environmental crisis, there is no solution unless we somehow find new ways to invest in irrigation and water management, in livelihoods strategies and so forth. War will never do it.

And yet, unfortunately, the United States has engaged increasingly in lots of military activities in these environmentally degraded areas. This is a mistake, because it can't work. We need to find an environmental and developmental approach. It's going to be a lot cheaper, and it's actually going to solve the problems if we're creative about it.

CONAN: And I'm afraid we're going to have to leave it there. Jeffrey Sachs, thanks very much for your time today. Appreciate it.

Dr. SACHS: Oh, a pleasure. Thank you.

CONAN: Jeffrey Sachs, the U.N. secretary general special adviser on the Millennium Development Goals, director of the Earth Institute at Columbia. We'd also like to thank Amina Az-Zubair, who is the special adviser to Nigerian President Goodluck Jonathan on the Millennium Development Goals. Thank you today. And our thanks again to Melinda Gates, the co-chair of the Bill and Melinda Gates Foundation, who joined us here at NPR's bureau in New York.

Coming up next, we're going to be talking with the man who has to juggle all the nations' interests in the air: the head of protocol at the United Nations.

Stay with us. I'm Neal Conan. It's the TALK OF THE NATION, from NPR News.

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