Siobhan McDonough | Vox

Why are American lives getting shorter?

2022-12-22T10:59:59-05:00

Life expectancy for Americans born today has dropped sharply over the past two years. | Tang Ming Tung/Getty Images

Editor’s note, December 22: The Centers for Disease Control and Prevention has released new data finding that US life expectancy is the lowest it’s been since 1996. The original story on why American lives are getting shorter, first published on September 7, follows.

Life expectancy for Americans has suffered a historic drop in the last couple of years, according to new estimates from the CDC and a June preprint study. While every demographic’s life expectancy dropped in 2020 and 2021, Black, Hispanic, and Indigenous communities were hit the hardest.

Life expectancy at birth — or how long a person is expected to live if nothing in the world changes — is usually calculated by using death rate data within each age group. So while life expectancy isn’t a prediction of how long a baby born today will live, the drop reveals the scale of untimely deaths during Covid-19.

What we are seeing is the steepest drop in life expectancy since World War II.

The CDC report and other recent life expectancy research show that the pandemic’s impact has been massive, and its effects may well persist for years. The average life expectancy for all groups has gone down since 2019, from 79 years to about 76. For white and Black Americans, it’s the lowest it has been in over 25 years. And the preprint’s authors found that while other rich countries began to recover from the pandemic last year, the US has continued to decline.

The estimates for 2021 are based on provisional death rates, while data for 2019 and 2020 are final. Because every estimate takes different factors into account, it’s normal that their conclusions slightly vary. (The preprint factored in rapid uptake of Covid-19 vaccines for older populations, so its death rate estimates are lower than the CDC’s, said Ryan Masters, a social demographer at the University of Colorado Boulder and one of the preprint’s authors.)

All estimates show that life expectancy in the US has continued to decline, even as almost all rich countries have bounced back from lower life expectancies in the first year of Covid. “[The US] is one of the richest countries on the face of the planet,” said Laudan Aron, a senior fellow in the Health Policy Center at the Urban Institute and one of the co-authors of the June paper. “The fact we cannot translate our economic wealth into protecting our population and ensuring that everybody has a fair chance to live a long and healthy and productive life is a real failure.”

Why the decline in life expectancy is so stark

Before the pandemic, global life expectancy was consistently getting higher by a few months every year. Yet even in that context, there were already worrisome signals for the US. A few years ago, US life expectancy dropped slightly, by about a month, due to an increase in deaths from various diseases, like stroke and heart failure.

That drop pales in comparison to the three-year loss we’ve seen in the wake of Covid-19.

The June preprint found that the US was one of only two among 21 selected similar wealthy countries — along with Israel — in which life expectancy continued to decline last year. While most countries suffered hundreds of thousands of untimely deaths during the first year of Covid-19, once people began to get vaccinated, life expectancies for almost all the 21 countries either stayed the same or began to rise again, many up to their pre-pandemic levels.

The US started off with lower pre-Covid life expectancies than other rich countries like South Korea, France, and Australia. It has been the case for decades that the United States spends exorbitant amounts on health care, yet has worse health outcomes than comparable countries. Even before the pandemic, people in the US faced the opioid epidemic, gun violence, and higher chronic disease rates than people in other rich countries.

Many of the same underlying factors are why the US has failed to recover from Covid, according to experts. Lack of health access and a robust public health care system exacerbated Covid-19’s effects, said Noreen Goldman, a professor of demography and public affairs at Princeton University. The lack of national coordination to address the pandemic, and lower vaccination rates, said Goldman, have also been a factor in outcomes being worse in the US than other comparable countries.

Young people were dying more from Covid-19 in 2021 than 2020, said Theresa Andrasfay, a demography researcher at the University of Southern California. While age remains the biggest risk factor, more middle-aged adults who are not vaccinated are dying. Additionally, she said, high rates of chronic disease, obesity, and diabetes had not yet affected mortality statistics, but when a disease — Covid-19 — came along that had these as risk factors, “it was like lighting a match.”

Covid-19 has disproportionately affected already-vulnerable groups

In the United States, Covid-19 has affected some communities worse than others. Even pre-pandemic, life expectancies for different demographic groups were highly disparate due to structural factors, such as lack of access to health care. In 2019, the average life expectancy for Black men was 10 years lower than for white women.

“Health travels along with economic well-being, housing stability, food security,” said Aron, one of the preprint co-authors, and these circumstances are largely driven by systemic issues.

Even pre-pandemic, drivers of mortality like air pollution disproportionately affected Americans of color; Black Americans are more likely to live in areas with worse determinants of health outcomes because of racist policies like redlining. For Native Americans, said Goldman, there were already high poverty rates, unemployment, lack of water infrastructure, underlying health risk factors, and lower quality and less accessible health care.

Covid-19 only made this gap worse.

In 2020, Black Americans died from Covid-19 at twice the rate of white Americans. In the CDC’s latest estimates, while every demographic group experienced a decline in life expectancy, Native Americans, Black Americans, and Hispanic Americans all experienced more loss of life.

Men also experienced greater loss of life expectancy than women across every race/ethnicity group. As with other demographics, this was likely due to a number of factors, including men being more likely to have jobs that would expose them to the disease, behavioral differences in hand-washing and vaccines, and biological factors.

I asked Goldman, who authored (with Andrasfay) two papers about race/ethnicity disparities in life expectancy declines, about the factors that led to the particularly negative outcomes for Indigenous people. Despite a strong vaccination campaign, the pandemic exacerbated many of the factors — lack of infrastructure, chronic disease, an underfunded Indian Health Service — that had already led to lower life expectancies. “This is just an astounding loss,” she said.

Given many of the same drivers of deaths during Covid-19 were also causes of already bad US health outcomes, there’s no one policy that will turn this trend around. The same policies that will make health better overall will also make us better prepared the next time a health crisis emerges. Thinking ahead to preventing the next pandemic will also be crucial to ensuring that everyone in the US — particularly the most vulnerable populations — has the opportunity to live long, healthy lives.

When looking at statistics like this, said Aron, it’s important to think about the ripple effects of untimely deaths. Before someone dies, they may spend months suffering; and after they die, their family, friends, and community need to mourn and come to terms with their loss.

Covid-19 has been “not only a potentially mass disabling event, but a mass bereavement event,” she said. The decline in life expectancy isn’t just a blinking indicator of a national failure — it’s an index of the societal trauma that’s been playing out, over and over again, in our homes and communities.

“To experience any stalling or reduction in life expectancy is tragic,” said Masters. To see life expectancies reduced by 3, 4, 5, or 6 years, he said, is “mind-boggling and heartbreaking.”

Correction, September 7, 4:50 pm: A previous version of this story included a mistyped quote from scholar Laudan Aron. She said Covid-19 has been “not only a potentially mass disabling event, but a mass bereavement event.”

Zeynep Tufekci has been consistently ahead of the curve on Covid-19

2022-10-18T18:10:30-04:00

Zeynep Tufekci, a sociologist and columnist at the New York Times, brought revelatory insights about human behavior into the discussion of the Covid-19 pandemic — even when those insights were unpopular. The result was a body of work that was consistently ahead of the curve on what was to come in the pandemic, and unusually perceptive about what we can learn from our mistakes.

Early in the pandemic, a couple of weeks before the CDC officially began to recommend masks, Tufekci wrote a Times piece on how masks work, arguing that health authorities’ messaging that discouraged their use was counterproductive. The contradiction in messaging that masks were both unnecessary for protecting people and yet needed to be saved for health care workers, she wrote, was confusing.

“How do these masks magically protect the wearers only and only if they work in a particular field?” she asked. By misleading people about masks because they didn’t want people to buy up masks that were in short supply, health authorities contributed to public distrust, Tufekci argued. “[D]uring disasters people can show strikingly altruistic behavior, but interventions by authorities can backfire if they fuel mistrust or treat the public as an adversary rather than people who will step up if treated with respect.”

Tufekci has stayed on the cutting edge of Covid-19 reporting since then. In July 2020, she wrote for the Atlantic on the importance of ventilation to prevent airborne transmission of Covid-19, before it was widely discussed. She also tackled the disparity in effectiveness among different mask materials, the delta and omicron variants, and broader public health messaging.

And there are warnings for the future: A few months ago, she wrote about how because there isn’t a ton of research about long Covid and its symptoms — similar to other chronic conditions — people are suffering, and likely will continue to suffer. Her writing has been consistently prescient, providing actionable advice for both health authorities and the general public on how best to handle what’s to come in a distressing, uncertain time.

Tufekci was a 2022 Pulitzer finalist for bringing “clarity to the shifting official guidance” around the pandemic through her work. She’s also now a visiting professor at the Columbia Journalism School, focusing on the intersection of technology and society — and hopefully serving as a model for budding journalists on how to follow true north even as the prevailing winds try to steer you astray.

Economics is more than just theory for Seema Jayachandran — it’s a way to help people

2022-10-18T18:11:16-04:00

An old joke goes like this: A physicist, a chemist, and an economist were stranded on a desert island with no implements and a can of food. The physicist and the chemist each devised an ingenious mechanism for getting the can open; the economist merely said, “Assume we have a can opener.”

At the risk of overexplaining the humor, the point is that economists — who belong to a field that has unparalleled influence over public policy — are too often blinded by the theoretical and the abstract.

But for Seema Jayachandran — who switched from her PhD in physics to economics two years into her studies — being an economist is her way of doing something “a little more grounded in the real world.” It’s not that Jayachandran fails to see the value in theoretical work. Rather, her number one goal is to make practical economics research more accessible to policymakers and the public, so that it might influence policy.

Jayachandran is an economics professor at Princeton University, co-director of the National Bureau of Economic Research’s Development Economics Program, and co-editor of the American Economic Journal: Applied Economics. Both in and outside of academia, she has worked to ensure that economics can measurably improve conditions for the people who need it most — especially women.

This ranges from research on female entrepreneurship and the effects of contraceptive use on breastfeeding to surveying the causes and consequences of rising female education and employment. “It’s very rewarding to work on something where you feel like your research can make other people’s lives a little bit better,” she said in an interview with Northwestern University’s Institute for Policy Research.

Much of Jayachandran’s initial research focused on what economic shifts and policies would do to women and girls. In her most well-known paper on gender inequality, she argued that we should expect gender gaps to naturally close as countries get richer due to shifts away from agriculture, technological advances, and reduced risks in childbirth. Importantly, though, she found that cultural norms, such as a focus on women’s “purity,” could counteract these trends toward gender equality.

Drawing on the importance of culture and policy, Jayachandran has tested specific interventions, including research on a conversation series in Indian schools that challenged students’ gender attitudes by having them talk about things like household chores. “It turned out that they all said women and girls do all the chores,” she said in an interview with the Federal Reserve Bank of Minneapolis. “And they then talked about, ‘Is that fair? Why is that?’”

Jayachandran’s concern for what economic policy can mean for those too often neglected by governments comes across even more strongly in her public-facing writing. In a New York Times article from 2017, she compared proposals for a public option in US health care with similar programs in India and Mexico; in another in 2020, she challenges assumptions about government spending, showing the fiscal returns to certain social programs. For the Indian Express, she wrote about India’s 21 million “unwanted” girls and how keeping track of their numbers is important in both alerting us to the problem and charting progress.

“People think [economics] is about the stock market, and money,” she said in an interview with the University of Barcelona. “But we study many things, including how to reduce gender inequality. That’s partly because economics is, at its heart, about incentives — what makes people do one thing or the other.”

Development programs don’t always work. Rachel Glennerster figures out how and why.

2022-10-21T11:55:46-04:00

Are government and nonprofit programs actually improving lives like they claim to? We don’t always know, but economist Rachel Glennerster has been working over the last three decades to figure out the best ways to ensure that they do.

Before the recent movement to try to bring rigor to global antipoverty programs, it was more difficult to tell whether a program was actually making a difference, or if improvements in lives were just a result of the world getting better over time. Glennerster — alongside other economists like the 2019 Nobel Prize winners Abhijit Banerjee, Esther Duflo, and Michael Kremer — helped normalize the use of evidence in global development and other anti-poverty work.

This has been predominantly through the use of randomized controlled trials (RCTs). An RCT randomizes which people receive a certain program or not — for example, a cash transfer for a vaccine, or an agricultural training program — and compares the groups to see if the program had an effect on people’s lives.

A key part of figuring out which problems to solve, Glennerster argues, is understanding which questions to ask and how to answer them. “A lot of development programs just fail because they’re trying to solve a problem that doesn’t exist,” she said on an 80,000 Hours podcast in 2018. In keeping with that, Glennerster has also touted methodological nimbleness as virtue — that other methods beyond RCTs might offer better answers for some of our big questions. “I think the right way to see things is you have a toolbox of ways to answer questions, and the right tool depends on the question that you’re asking,” she said.

Since the early 2000s, Glennerster’s career has spanned almost every aspect of research and practice: she has worked for the UK government, the Harvard Institute for International Development, and the International Monetary Fund. She’s led RCTs on health, education, gender, agriculture, conflict, and more — looking at whether policy changes have measurably improved people’s lives.

Notably, Glennerster spent 13 years as the executive director of the Abdul Latif Jameel Poverty Action Lab (J-PAL), a key leader in popularizing RCTs in development economics. During her time at J-PAL, she helped establish “Deworm the World,” a program that works with governments to provide over 1.3 billion school-based deworming treatments in India, Kenya, Nigeria, Ethiopia, and Pakistan.

After J-PAL, Glennerster brought an evidence-based mindset to foreign aid. As chief economist of the UK’s Foreign, Commonwealth and Development Office (FCDO), she looked at the cost-effectiveness of different programs and recommended “smart buys” to improve global education, including teaching to students’ learning levels instead of age and investing in pre-primary education.

Glennerster finished her appointment at the FCDO in 2021 and is now a professor at the University of Chicago, where she’s continued her research on topics such as the Covid-19 vaccine supply and the effect of mass media on contraceptive use.

“I think there is an ethical imperative for people who are designing [programs] to think very hard about what the evidence says behind what they’re doing and to be aware that just having good intentions doesn’t always mean that you are doing good,” she told Harvard Law School’s The Practice. “You should take into account and think about your ethical responsibility to know what you’re doing before you intervene in other people’s lives.”

Kanika Bahl is finding the unicorns of international development

2022-10-18T18:00:53-04:00

If you only had $100 to spare in your budget, you’d want to spend it the best way possible.

The same is true for governments looking to bring vital health or sanitation services to more people. As the CEO of the nonprofit Evidence Action, Kanika Bahl works to disrupt traditional international development to help find, fund, and scale the approaches that drive outsize impact for every dollar spent. The result: effective and efficient poverty interventions that reach millions around the world.

Bahl’s experience in business, microfinance, and emerging markets finance — including at the nonprofits Clinton Health Access Initiative and Results for Development — influences the approach she takes at Evidence Action. “I take the lens of an investor,” she told me. “Whether that’s a country government or an international donor with very scarce resources, I ask myself what allocation offers the highest ‘return’ for every dollar spent in terms of buying better health, nutrition, improved income.”

Sometimes a program can be effective but isn’t reaching nearly as many people as it could. That’s where Evidence Action comes in, working with governments to scale programs that have been proven to have high potential to change lives.

Health, nutrition, and sanitation are their current focus areas, but they’re also looking for any cost-effective intervention. Bahl describes these programs as the “lowest-hanging fruit” in international development — the actions that are life-saving, cheap, and easy to implement in partnership with governments, but that people just aren’t doing yet.

To borrow language from the tech industry, Evidence Action works as an accelerator for these cost-effective ideas, taking an almost VC approach to development work. Evidence Action screens potentially high-impact interventions for cost-effectiveness and scalability over six “funnel” stages, only letting the most promising ideas go through each stage. Just 2 percent make it to the final scaling stages, to then hopefully be implemented or expanded by the governments of multiple countries.

“What we’re trying to do is find the unicorns of international development,” Bahl said.

Evidence Action has indeed found some unicorns. The organization’s Dispensers for Safe Water and Deworm the World programs have reached hundreds of millions of people globally with chlorinated water and deworming pills, respectively; the results have been profiled (and scrutinized) by Vox.

One of their newest programs screens and treats maternal syphilis. In any given year, about a million pregnant women have active syphilis, and more than a third of these infections can impact the child: early births, deaths (both stillbirth and within the first month of being born), and severe disability. Testing and treatment is fast and cheap, but rarely done. So Evidence Action partnered with the Liberian government to test for both HIV and syphilis, which only costs $0.35 more than testing for HIV alone. Now, 67 percent of women have been screened for syphilis, rather than 6 percent.

With many of these programs, Bahl said, it’s important to have “governments in the driver’s seat.” The path to scale is ultimately through the government, but Evidence Action can help put a foot on the pedal.

Ahmed Mushfiq Mobarak wants to find out what makes antipoverty programs effective

2022-10-18T18:11:58-04:00

No one likes failure. That’s especially true when failure leads to terrible consequences: a family not being fed, constant power outages, widespread death from a pandemic.

The financial and human consequences of failure are even bigger for decisions at the level of a region or whole country. Growing up in Bangladesh, Ahmed Mushfiq Mobarak, an economics professor at Yale, witnessed how the actions of the government and NGOs could impact lives for better or worse. Untangling how to make these programs work for as many people as possible is what Mobarak has done every day for the last 20 years.

Mobarak has worked in areas from air pollution to sanitation, but perhaps the most famous example from his research, illustrating the importance of scaling up such work, is seasonal migration. In widely cited experiments, Mobarak’s team found that giving low-income people in Bangladesh some money to temporarily move to the city to work during the “lean season” increased their family incomes.

This experiment was part of an effort to make the international development field more evidence-based. Through randomized controlled trials (RCTs), researchers can test the effectiveness of programs — in this case, giving people money to temporarily migrate to find a job — with some randomly selected people, and comparing the outcomes of the people who got the program with those who didn’t.

The findings sounded great, but the story doesn’t end there. The migration paper inspired the nonprofit initiative No Lean Season, which gave a travel subsidy to people in Bangladesh who wanted to seasonally migrate for work. But when the program was scaled to millions of people, it had no effect. Based on the evidence at scale, No Lean Season stopped in 2019.

That’s part of the learning process for research. And while finding a program doesn’t work at scale might seem like a setback, being able to test whether policies work at different levels and adjust accordingly is a very good thing and something more governments and policy-making organizations should do.

Lessons on scale are vital to consider for policy based on randomized experiments, which is a focus of Mobarak’s work at the Yale Research Initiative on Innovation and Scale (Y-RISE).

Y-RISE works in areas as varied as microfinance, refugee integration, and childhood development. Bringing programs in areas like health and agriculture to scale carries with it lots of challenges — changes in government behavior, effects on macroeconomic growth, implementation difficulties — but if done well, it can improve the lives of millions of vulnerable people.

Y-RISE aims to do just that.

“The world becomes vastly more complicated when a program is scaled up,” he said at the launch of the initiative in 2018. A program that might work with a couple of villages might not work on a national level; a program that works in Bangladesh is not guaranteed to work in Kenya. And when a program with promising results is tested multiple times and scaled in the real world, we can gain a lot of insight into what parts might work in the future and how to reform a program — or stop funding it altogether.

Another area necessary for large-scale policy that Mobarak studies is “spillover effects” — the positive or negative effects of programs on people who don’t receive them. In a study on latrine subsidies, Mobarak and a team found latrine usage — which decreases the spread of pathogens — increased not only among subsidy recipients but also their neighbors, and that these effects were higher among poorer people in denser neighborhoods. While this hasn’t yet been tested at a larger scale, information about who programs will have the largest impact on is part of the learning process governments can use when deciding who to reach with limited resources.

In keeping with his work on scale and behavior, Mobarak’s current projects include ongoing research into pandemic response in low- and middle-income countries, and how to promote technology adoption. The world is ever-changing, and his research continues to provide insight on the varied policies that allow people to thrive and catalyze economic growth.

“If we better understand what constraints people are under,” he said in an interview with Yale, “we’re able to design policies to address those constraints.”

American trains aren’t great — but you should still take them anyway

2023-07-06T13:57:10-04:00

Last year, I took the Amtrak from Chicago to San Francisco in coach, and loved it so much that I did it again. So this summer, I decided to take four more long-distance trains: San Francisco to Seattle, Seattle to Chicago, Chicago to New Orleans, and New Orleans to Los Angeles. (I flew from Los Angeles home to San Francisco because of timing issues, which is a big problem with US rail — something we’ll get into later.)

Along the way, I learned about America. I saw the quaint lakes of the Upper Midwest, the humid clouds of the Mississippi Delta, the breathtaking mountains of Montana, and the endless hills of West Texas. I saw beautiful sunsets in northern Washington and Chicago and the Arizona desert. Most of all, I met people with wildly different life experiences from me — people rebuilding their homes after Hurricane Ida, blues musicians from Chicago, overnight commuters through the Great Plains for work, people talking about their experiences in the military, or farming, or being grandparents.

Taking the train is not only more scenic, but is much more environmentally friendly than either driving or flying. UK data shows taking even a less-efficient train has about one-sixth to one-fourth of the carbon footprint of flying, and about one-fourth of the carbon footprint of driving a non-electric car. An analysis from areas of Europe with more environmentally friendly trains found the environmental benefits to be even higher. It can also be inexpensive: I did this all with a flat-rate rail pass, which allowed me to take a certain number of segments within a set time period — more on that later, too.

Despite all its positives, rail in America has serious issues. Long-distance trains in the US are abysmally slow, and until (unless?) we get high-speed rail it’s an inefficient and sometimes frustrating way to travel. But if you’re willing to put up with the delays, it’s also (in my opinion) the most rewarding way to travel around the country, with beautiful views you can’t see anywhere else, more comfort than a car or plane, and the opportunity to meet people from all over the US — and world. So if you’re thinking of making the journey, here’s what to expect, and how to make the most of your trip.

Long-distance trains in the US are very, very slow

A hundred years ago, the US was a rail innovation leader. Unfortunately, things haven’t improved much since then. Passenger rail is actually slower now than it was in the 1920s.

The reasons for the decline of rail are many: fewer tracks paired with the rise of freight trains, the rise of highways as cost-effective competitors, and most simply and most crucially, the fact that new rail isn’t being built.

It doesn’t seem like high-speed — or any speed — rail will be able to be built at scale any time soon. Rail projects in the US face a lack of federal investment — recently, the Inflation Reduction Act focused $50 billion on cars and only a few billion dollars on any transit alternatives; and the US funds only 25 percent of infrastructure at a federal level, much less than many European countries — and also a lack of state-level support, in part due to high cost of land and construction.

This Vox video gives some reasons California’s high-speed rail is “decades late and way over budget”: Local politicians want it to run through their towns, which continually delays the project and makes the train slower and less efficient; people misuse environmental reviews to stop trains from coming to their neighborhoods, which creates legal costs for the government; and the government, in contrast to Europe, hires more expensive consultants instead of full-time engineering experts.

Adding to the slowness, freight rail, which transports cargo, not people — and which came to national attention in the narrowly averted rail strike in September 2022 over working conditions — owns the tracks in all of the US outside the Northeast Corridor from Washington, DC to Boston. This means passenger rail will often stop, sometimes for hours at end, for freight; and is a major reason that over 40 percent of long-haul Amtrak trains arrive behind schedule. In the Northeast Corridor, performance is much better.

While the US has regressed, other countries have progressed. Even lower-speed regional rail and streetcars, common in other parts of the world and the US past, are missing in much of the US due to disinvestment in favor of cars; and high-speed rail is essentially nonexistent. Critics of rail argue that the US is too big to feasibly have high-speed rail outside of population centers, but China does. The fastest rail lines in Europe and Asia travel on average upwards of 150 mph — and have capacity to go even faster — while the only classified high-speed rail in the US (the Amtrak Acela, which goes up to 150 mph and travels at about an average of 67 mph) travels at less than half that speed.

Next month I am traveling from NYC to Chicago, the 3rd busiest air route in the country, which takes 19.5 hours via Amtrak on a daily train. This is the same distance as Beijing to Shanghai, which takes only 4.3 hours and leaves every 20 minutes. This country can do better. pic.twitter.com/bfV0pGG5Vg
— Hayden (@the_transit_guy) August 17, 2022

Because we don’t have high-speed rail, the major downside of rail travel is speed. Outside of the Northeast Corridor, flying — even with all the time you have to spend getting to airports far outside the city center — is much faster. It’ll take you a couple days to get from Chicago to any West Coast city via train, and even regional travel such as Chicago to Minneapolis takes about 8 hours — a trip that would take between 2-3 hours in many European or Asian countries.

How to take the train

If you have the time, there are many reasons worth looking into taking the train for long-distance trips. On the train, you don’t have to worry about driving your car or paying for gas or stopping for food. In sleeper trains, meals are included with the price; in coach you have access to a cafe car with limited food offerings — I usually choose to bring my own food.

Trains in coach are often cheaper than air travel, particularly during times of high demand. I couldn’t have afforded to fly to Seattle, Chicago, New Orleans, and LA during this summer of high prices — and I did this all using the $499 USA Rail Pass, which allows you to take 10 trips of any length (as long as you don’t transfer trains) in a 30 day period. I would’ve been able to travel to New York, San Diego, and any of the cities along those routes at no extra cost. If you’re transporting a lot of luggage, it’s also a potentially budget-friendly option. Last year, I had to figure out how to get my bike from Chicago to San Francisco, and I was able to take it on the California Zephyr for only $20. You also get two 50-pound suitcases for free.

There are downsides to coach. It has no showers and the bathrooms aren’t great, although in certain models of car the bathrooms are more spacious and give you more room. The only food offered is for purchase in the cafe car and has limited selection, so I’d recommend bringing your own food. But coach is, unfortunately, probably the only truly affordable way to take the long-distance train.

If you have the money, there are multiple types of sleeper cars, the most common of which are roomettes — the cheaper option with your own space and shared restroom and shower — and bedrooms, which are larger and have their own bathroom and shower. Roomettes start at just under $700 per person for the long-haul (2-day) trains, while bedrooms will run you over $1,000. There are also accessible bedrooms and family bedrooms. Traveling with kids can obviously be a barrier in terms of time and cost, but for those who can afford it, it’s easier for families to travel in roomettes or sleeper cars for long-haul trains, and kids under 2 travel for free. A friend with a baby recently booked a Chicago-Seattle roomette for his family around Christmas and said that even with the cost, it was cheaper than flying that season.

A final thing to watch out for is the train might make you or your traveling companions motion sick. After I finished my journey, I got land-sickness for a couple of nights after being on the train for so long — I’d wake up and feel like I was still on the train, which was somewhat unpleasant. In general, if you’re traveling in coach you’ll want to pack a blanket and pillow, and whether you’re in coach or sleeper I’d recommend motion sickness medicine and slip-on shoes to walk around the train.

People and places

The best things about the train are the scenery and the people. There’s no better way to see the scope of America. One of the most incredible experiences of my life was waking up in the middle of Glacier National Park in Montana; I saw the sun rise and set on Mount Shasta, the Great Plains, the deserts of Arizona and Utah, and the mountains towering over California’s Inland Empire cities. The scenery in Colorado, Washington, and Montana is the most spectacular, but I also loved the quiet beauty of Mississippi’s wetlands and Wisconsin’s lakes. Slow travel is an almost meditative experience, with nowhere to go or be except to watch the world pass by.

The train is one of the few places in American public life where people really want to talk to each other. It’s also one of the few places where you meet people with a diversity of life experiences (excepting public transit, though most people on the subway and bus don’t want to talk). People who take the train, particularly in coach, are pretty representative of the US.

I had incredible conversations on the train, from learning about the Great Migration and Chicago’s transformation over the last 50 years from a couple who’d experienced it, to hearing about flooding and community in Louisiana from the mostly local passengers and crew on the train to New Orleans, to discussing moving to California by train with a young couple and their kids. Meeting such a diverse group of people and traveling through less-traveled areas of the US was also a sobering experience — the train stops not only in big cities, but in small towns with high poverty and infrastructure in ruins, and regional passengers are often from areas that the United States’ vast wealth has left behind.

Be sure to spend time in the observation car and talk to people — I also talked to people in the coach car, but the observation car is specifically set up for being social.

The train isn’t viable for every journey, but it is a wonderful way to see and learn about all sides of America: the good and the bad, the strange and the beautiful. Long-distance rail may change the way you see the country — I know it did for me.

Yet another inflation problem

2022-09-07T16:06:57-04:00

The global inflation crisis has hit Americans’ wallets hard — but its consequences have been even graver for large swaths of the world. According to a report last month from the World Bank, food in many countries is now 10 to 30 percent more expensive than it was a year ago.

High food prices have a ripple effect on everything from nutrition and migration to conflict and even gender relations. Although food inflation rates aren’t as high as they were when the war in Ukraine started, any increase in the price of staples like wheat and oil puts the hundreds of millions of people in low-income countries who spend half their money on food at risk of hunger.

Inflation compounds a global food crisis that finds hundreds of millions of people suffering from malnourishment. Where food is most unaffordable, malnutrition is widespread, meaning people are underweight and have vitamin deficiencies, and children aren’t growing as tall as they should. Food insecurity not only affects health but also forces people to leave their homes and increases risk of conflict.

The three countries with the highest food inflation — Lebanon, Zimbabwe, and Venezuela — had already experienced hyperinflation in recent years. (Hyperinflation is commonly defined as very high inflation, typically a monthly rate of around 50 percent.) But in the last year, many other low- and middle-income countries have also experienced the twinned inflation and food crises that have plagued these three countries.

The worsening picture for food security is just one of the most consequential impacts of the global rise in prices.

We’ve seen a respite from spiraling prices — but food is still more expensive compared to a year ago

The world hunger situation is better than it was at the beginning of the war in Ukraine six months ago.

Global food prices have dropped for five consecutive months and are now back to their levels from before the war, which had precipitated a spike. According to the United Nations’ Food and Agriculture Organization (FAO), prices fell in August in all measured categories: cereals, oil, dairy, meat, and sugar.

Over 200 million fewer people are now estimated to be food-insecure than at the beginning of the war or even the end of 2021, when food prices were at 10-year highs due to rising energy prices, weather, and an increase in global demand.

But that bit of respite is happening amid a global food situation that’s still largely dismal. International cereal prices in August were 11.4 percent higher than they were a year before, and the FAO’s food price index, which measures monthly food price changes, is overall still much higher than in recent years.

The upshot: Far too many people still can’t afford the food they used to eat.

How inflation affects hunger

Most of the countries with the highest food inflation in the world, such as Venezuela, Zimbabwe, and Lebanon, have had uniquely high inflation for years.

Venezuela went through hyperinflation from 2017 to earlier this year, said Diego Santana Fombona, an economist at Ecoanalítica, a consultancy in Caracas. The main reason for this hyperinflation, he said, was that the government increased money supply in response to decreasing oil and tax revenue. While the government began decreasing money supply and allowing foreign currencies such as the dollar to circulate in 2019, hyperinflation persisted until the beginning of this year.

While Venezuela’s inflation has somewhat lessened in recent months, food inflation — along with inflation in other necessities such as transport and health care — is higher than overall inflation. This means that for years, people have no longer been able to afford the foods they used to. For Venezuelans living in extreme poverty, it’s been hard to maintain a nutritionally diverse diet that incorporates vegetables, cheese, and meat, said a humanitarian worker at an NGO in Caracas, who asked to remain anonymous because of their organization’s communication policy. Breads and cereals are now what people can afford to eat — but if they have the extra money, they’ll opt for protein, because “if you have a little bit of chicken and fish in your home, you are rich.”

“People are eating but not well, and they are used to not eating well,” said the NGO worker. “The food insecurity situation has been present for so many years that for many people, especially young people, this is the only thing they remember.”

This year, most of the world has begun to experience what happens when food prices spiral. Even in countries where food inflation isn’t completely out of control, it’s affecting diet and nutrition. In the US, for example, a dozen eggs that would’ve cost $1.53 in 2019 (adjusted for inflation) cost $1.67 in 2021. So unless someone’s salary has increased by the same amount in the last couple of years, food — particularly animal products — is taking more of their income.

And while people in the US spend about 10 percent of their incomes on average on food, in poorer countries this share can be as high as 50 percent, the authors of the World Bank Food Security Update told me in an email.

Preventing hunger and its ripple effects

Unaffordable food causes other problems. In addition to health and growth issues, malnutrition causes cognitive problems for young children that may affect them their whole lives. Women are more likely to be undernourished than men, and that gender gap only grew last year, adding to the burden women faced in pandemic job loss and unpaid caregiving.

In countries where people can’t pay for food for their families, they look for work in other regions or countries. This leaves them vulnerable to human trafficking, while leaving their children can be traumatic for families. Famine also forces people from their homes.

“We need humanitarian aid going to countries that are most in need,” said Marco Sanchez Cantillo, co-author of the FAO’s 2022 food security and nutrition report. To prevent hunger and prepare for shocks in the long run, said Sanchez Cantillo, governments will need to address more structural factors to make food systems more sustainable: for example, reducing food waste, building rural roads, and supporting more nutritionally diverse foods.

The authors of the World Bank report said that in addition to taking steps to make fertilizers more affordable and available, governments can set aside trade restrictions, avoid stockpiling food, and provide cash transfers to vulnerable households.

Global hunger has been going in the right direction for a few months, but the inflationary environment is still a cause for concern. Hundreds of millions of people can’t afford the food they could pre-pandemic, and it’s the poorest people around the world who continue to be hit the hardest.

The US spends billions on foreign aid. But it doesn’t know how much good our money is doing.

2022-08-02T13:58:26-04:00

Volunteers at the Zanzalima Camp for Internally Displaced People unload 50-kilogram sacks of wheat flour that were a part of an aid delivery from USAID on December 17, 2021, in Bahir Dar, Ethiopia. | J. Countess/Getty Images

In 2021, USAID — the agency of the US government tasked with international development — disbursed $28.3 billion in foreign aid to an assortment of humanitarian causes ranging from hunger programs to medical treatment to education.

But how much good is this money doing? And is that money accomplishing as much as it could be?

The answer, it turns out, is much more difficult to find than you would think — and that’s a problem. USAID is one of the most consequential institutions in the world when it comes to aid for the poor.

Since the world’s resources aren’t unlimited, we have a “moral imperative to use evidence and data to ensure we get the most impact per dollar spent as possible,” says Anne Healy, former head of USAID’s Development Innovation Ventures.

Over the past two decades, researchers have become much better at determining whether a certain idea actually achieves intended goals. The focus on results — evaluating whether a program benefits people cost-effectively — has changed philanthropy and even the US government’s domestic programs.

In theory, USAID recognizes the importance of making sure their programs work. But in practice, it’s largely failing to do so.

Two USAID reviews, one by USAID’s office of the inspector general in 2019 and another commissioned by the agency in 2020, reveal two dismal facts: The agency gives out billions to programs that don’t achieve their intended expectations, and, worse, it’s not even sure of the impact of most of the money it gives in aid. Recent agency moves and statements suggest that USAID wants to fix this problem. Whether it can will determine the fate of billions of dollars — and the health and well-being of many millions around the world.

How USAID works

Since 1961, USAID has poured hundreds of billions of dollars into foreign aid, with the aim of delivering humanitarian assistance to millions globally. Foreign aid accounts for less than 1 percent of the US federal budget — far less than what most Americans think it does. But because of the federal budget’s massive size, even 1 percent is much larger than all of private philanthropy for global development in a given year combined. USAID spends tens of billions of dollars a year on global development programs, the largest categories of which are health, humanitarian assistance, and economic development.

The agency, which works in over 100 countries, usually doesn’t implement programs directly, but partners with different organizations, including NGOs, universities, and faith-based and community groups. Its yearly grants and contracts comprised on average almost $18 billion over the last decade.

When looking into USAID’s effectiveness, it’s important to note that other US government priorities will influence how money is allocated even before USAID itself can make any decisions. As an example, USAID presents its budget requests within five strategic foreign aid objectives developed by the State Department: humanitarian assistance, peace and security, democratic governance, economic growth, and social services.

Foreign aid has of course been deployed by US administrations to advance their geopolitical goals. But that complicated record doesn’t mean aid can’t do a lot of good. USAID has been a major contributor to polio eradication in over 100 countries. PEPFAR, the US government’s anti-HIV/AIDS initiative, has led to an estimated 20 percent lower mortality rate in countries that received its aid, and has saved millions of lives. USAID’s Development Innovation Ventures, which funds innovative projects around the world, has funded a handful of highly cost-effective programs in global health and education. USAID has contributed to many other effective global health programs, including developing meningitis vaccines that prevented an estimated 1 million cases.

US foreign aid isn’t working as well as it should

But those success stories can obscure an uncomfortable truth: We don’t really know whether most of US foreign aid is improving anyone’s lives.

To understand why this is, let’s look at USAID’s own evaluations of its programs. In-house reports on the impact of USAID programs abide by the usual academic standards — they need adequate sample sizes and valid control groups, among other criteria. The agency uses a checklist to monitor whether each impact evaluation meets these different criteria, and gives them a quality designation. These evaluations are only one way USAID monitors performance — for other programs, they instead monitor processes or use qualitative work — and they are meant to assess whether or not USAID-funded programs are achieving milestones, such as lowering malnutrition.

But to prove success, the evaluations have to be high-quality, and most of them are not.

“USAID is failing to generate rigorous evidence on which of its programs do or do not work,” wrote three former USAID administrators in an article for the Wilson Center in 2021.

For one thing, USAID’s own efforts to assess its programs’ impact leave a lot to be desired. Most of the agency’s impact evaluation reports are not high or even acceptable quality by the agency’s own standards of rigor.

The aforementioned internal review from 2020 revealed that most USAID-conducted impact evaluations of programs didn’t include one or more key quality elements like sample size, research/evaluation hypotheses, missing data, and other key components to understanding whether the results of an evaluation should be accepted as valid or not.

46 percent of the reports either didn’t have a comparison or control group, or didn’t provide enough statistics on a control group to be accurate.

Only 3 percent met USAID’s highest standards of quality. A bad impact evaluation is a waste of money, and it can even lead to funding going to ineffective programs.

USAID also seemingly keeps paying out contracts to projects that don’t even work at a most basic level. A 2019 study by USAID’s inspector general of 81 USAID grants found that over 40 percent of programs achieved only half of expectations, which meant they self-reported that they didn’t achieve much of what they’d been paid to do by the grant.

The inspector general’s report outlined major concerns with even the awards that did achieve results. For example, one program reported achieving 110 percent of expected results for preventing and managing malnutrition in West Africa. But this was only because they were measuring radio outreach — people who heard about the program on the radio — as a “success”: Most people were not actually receiving malnutrition services, which was the real goal.

According to a USAID spokesperson, the agency has begun “addressing many of the gaps and shortcomings identified” in the 2019 report, as well as some of the recommendations from the 2020 report, including updating its impact evaluation guidance and requiring cost analysis in impact evaluations.

Additionally, USAID is not using outside evidence in the way it could be. While USAID has standards and processes for conducting evaluations, it has fewer processes to ensure evidence from elsewhere is being used, experts told me.

For example, let’s say a university study finds strong evidence that a certain approach to reducing childhood malnutrition is cost-effective. USAID could do more to consider this approach, even if it’s not research it conducted itself.

USAID doesn’t have a monopoly on finding evidence for program effectiveness. There are research institutions, think tanks, and policy organizations in the countries in which USAID works. Having a more systematic way to compile, outsource, and use the evaluations of entities that are already working in relevant areas would help make sure that program and funding decisions at USAID are supported by the best available evidence, said Healy.

USAID is potentially missing out on funding many effective organizations

Zooming out a bit, a systemic problem that likely contributes to USAID’s ineffectiveness is the way it doles out grants.

Unfortunately, the way USAID’s grant structures are set up now means there’s not much incentive for contractors to produce results. The most common form of USAID grants are what’s known as cost-plus grants, which basically means a contractor draws up a list of their expected costs and USAID pays them — regardless of whether they achieve results.

An alternative form of grant, fixed-amount grants, pay contractors when they achieve predetermined milestones and results. These are better, but they’re not yet widely deployed in government grantmaking. USAID deems fixed-amount awards most appropriate when the work has milestones that can be priced with reasonable certainty. USAID might not use them when a project lacks this information, and they also require ceding some direct government oversight of grants.

The other problem with the USAID grants process is that it’s so complicated to navigate that legacy government contractors who know how to write grant applications have a major edge, experts told me. (To be sure, these problems exist across international granting organizations, and both small organizations and USAID administrators have acknowledged the high barriers to entry and importance of greater inclusion.)

Eliya Zulu, executive director of the African Institute for Development Policy, a research and policy organization based in Kenya and Malawi, described the process of putting together a successful USAID bid for his organization as a “huge nightmare.” The process included overtime work, over 150 support documents, and staffing that smaller organizations simply don’t have. A lot of legacy organizations have business development units focused on such tasks, he said, while a worthy but smaller organization might not have the same support.

This leads to a situation where the vast majority of USAID money is going to only 75 organizations, and only 6 percent of grants are given to organizations based in USAID-recipient countries. While legacy contractors aren’t inherently ineffective, the complicated process means smaller organizations, especially those based in the Global South, are often left out of awards, when even a small grant could make a big difference.

This means thousands of innovative Global South-led and -based organizations — groups which may be more effective because they understand local context better and interact with local policy actors to make sure effective programs continue after USAID leaves — are not receiving funding because of bureaucratic issues.

USAID recognizes that this way of doing business is a problem. During USAID’s annual small business conference last year, USAID administrator Samantha Power stated how the limited number of contractors “holds back healthy competition, limits our exposure to new approaches, robs small businesses of the chance to gain valuable experience, and doesn’t make the best possible use of valuable taxpayer dollars.”

The most effective aid, said Zulu, will be evidence-backed and in equitable partnership with governments and organizations that ensure it’s focused on the needs of the people it is going to — and that’s not what’s happening now.

Signs of a shift

The shift that needs to happen at USAID is so simple it seems silly to say out loud: The agency should fund things that are proven to work, and stop funding things that are proven not to work. But saying it is one thing. Doing it is another.

One thing USAID could do is focus on the evidence for different sectors about effective uses of money, said Ruth Levine, CEO of IDinsight, a global development data analytics and advisory organization. “Really importantly, what we have learned about things that absolutely do not work, don’t do those again.” (Disclosure: I worked at IDinsight from 2017 to 2020.)

A good start would be revisiting its process of awarding grants.

Experts told me a way to improve USAID’s record is to give out more fixed-amount awards. These pay contractors when they reach pre-negotiated milestones, meaning they’re more likely to pay for outcomes and results than other types of grant.

Fixed-amount awards currently account for only about 8 percent of USAID’s grants, but could and hopefully will be expanded — in March, a senior official announced plans for more fixed-amount awards and work with more contractors from the Global South. There’s also a lot of flexibility in how they’re implemented. They could potentially, for example, have components that pay for results, but also account for startup costs for a newer organization.

Walter Kerr, the director of Unlock Aid, a global development innovation coalition, noted that in addition to incentivizing based on outcomes and results, these awards are a “great way to mitigate against concerns that some members of Congress have around fraud, waste, and abuse because you only pay for what you get.”

There’s also awarding more money to smaller organizations and those based in the Global South. There have been green shoots here: The New Partnerships Initiative, USAID’s plan to diversify its partners, has awarded hundreds of millions of dollars to “new and underutilized partners” since it began in 2019. Meanwhile, in an exchange at a Senate Foreign Relations Committee meeting in May, Power reiterated USAID’s goals to reduce administrative burden in granting and send 25 percent of foreign assistance to local organizations.

Related to such a reform could be a reorientation toward doling out more direct grants to governments instead of middlemen. Governments have more mechanisms in place than an outside contractor for identifying their problems, finding the people who need help, and continuing programs after USAID leaves. The government actually provides services; it can often procure, for example, health equipment more cost-effectively than USAID buying it.

But less than 4 percent of US foreign aid is channeled through governments. Compare that with a country like Japan, which channels nearly half of its foreign aid this way. In the few cases where bilateral government aid has been tried by the US, it has been effective.

The US has existing grant mechanisms it could expand to increase direct bilateral aid, including the Economic Support Fund, which is used to provide money directly to countries of strategic significance. Experts told me, however, that reforming aid to go directly to governments would be a heavier and longer-term lift than, for example, more fixed-amount awards or support for local NGOs.

Beyond the mechanics of grant-making, USAID could look to the example of the UK’s Foreign, Commonwealth, & Development Office, which has an empowered chief economist and an office that conducts independent reviews of evidence for large spending decisions, and then presents recommendations to senior policymakers. USAID has already shown signs of moving in this direction, such as Power’s announcement last year to start an expanded chief economist office and a behavioral science unit.

And there’s work already happening within the agency that USAID can foreground and scale up. The Development Innovation Ventures office (DIV), for instance, has been a promising testing ground for funding effective programs. DIV invests in potentially high-impact projects, looks for evidence of impact, and pays for results. It has funded new, Global South-based partners, and has funded interventions that have proven to be highly cost-effective at preventing childhood diarrhea, reducing road deaths and injuries, and more.

DIV accounts for only about 0.1 percent of USAID’s budget, said Healy, who was a leader of DIV, but that belies the potential impact of adopting some of its approaches. “The real opportunity for DIV,” Healy told me, “is influencing the 99.9 percent of USAID’s other spending.”

These moves are promising signals of a shift away from business as usual and an embrace of more evidence-based approaches. Which is good, because the time for change is long overdue. USAID has for years identified its own need for reform, but little change has happened. Evidence has told us so much more about how to help the world’s neediest. It’s time for that attitude to sweep through the halls of American diplomacy.

During Covid, most governments just gave people money

2022-07-27T03:33:10-04:00

The United States’ CARES act stimulus checks sent out after the start of the pandemic were a historic milestone, reaching over 80 percent of Americans and helping move millions of people at least temporarily out of poverty. But the US was far from the only country to quickly give people money in response to the pandemic. Almost every country in the world had some sort of Covid-19 cash aid program, from tiny programs reaching fewer than 1,000 people in places like Belgium and Gabon to massive initiatives in countries like India and Japan.

An estimated 1.36 billion people — over 16 percent of the global population — received some sort of cash-based Covid-19 relief in the largest rollout of cash transfers in history, as governments worked to deploy vital social support in record time, according to a World Bank report released earlier this month.

The global scale of transfers was unprecedented; in some countries, this was the first time an unconditional cash transfer had ever been tried. It was also the first time that workers — not just children, retirees, or others outside the workforce who more often receive cash support — had received no-strings-attached cash at this scale. According to the report, the transfers hold “a historical and symbolic value” that might work to dispel the (largely unfounded) idea that cash transfers disincentivize work.

But providing such quick relief was inherently imperfect, so much so that calculating the exact numbers of people globally who benefited is almost impossible, given that payments were tracked differently in different countries, and many governments don’t have accurate data on whether payments were received. Even the US had challenges delivering money to people who were too low-income to file tax returns. These obstacles were even greater in poorer countries with less developed banking systems and more rural populations.

Despite the global inequalities and logistics issues the report highlights, the scale of cash transfers remains incredible for such rapidly deployed social assistance programs. Yet the successes and failures of different governments to quickly reach the people most in need can provide vital lessons for the future, when such programs will be even more necessary in times of crisis and instability.

Cash transfers mirrored global inequality

Over 95 percent of countries in the world gave some form of cash transfer, from programs that attempted to reach almost everyone to programs targeted at only the poorest residents to programs specifically aimed at families with children. The sweeping extent of cash transfers and the disparity in global resources in the face of a global health threat reflect a world that has proven more willing to address poverty with cash, especially in moments of extreme crisis, but is still deeply unequal.

This support was vital at a time when people were in urgent need of health services and 8.8 percent of working hours — the equivalent of 255 million jobs — were lost globally, four times more than during the 2009 financial crisis. Covid’s impact was felt everywhere, but people in low- and middle-income countries were and continue to be hit hardest economically, resulting in disproportionate income loss, hunger, and extreme poverty. Covid-19 vaccination in most of Africa remains low; in Nigeria, a country of over 200 million people, vaccine coverage is under 20 percent as of July 2022, a year and a half after vaccination campaigns began in the US.

Related to this, cash relief mirrored entrenched global inequalities and lack of funds in low-income country governments. People in poor countries received on average much smaller sums, even accounting for lower costs of living. High-income countries, like the US and Japan, gave an average of $525 per person, while people in countries like Togo and Madagascar, classified by the World Bank as low-income, received only $42 on average. Rich countries also reached more people than poorer countries: 44 percent of the population was reached on average in high-income countries, around 25 percent for middle-income countries, and just 8 percent for low-income countries.

We won’t know the full effects of most of these cash transfers on global poverty, which rose substantially during the pandemic (but likely not as much as it would have), for a few years. Most of the preliminary studies cited in the report found cash transfers had some positive effects but couldn’t fully offset most of the damage of the pandemic. Still others found more strongly positive effects on health, food security, and poverty reduction, while a handful of studies found no (or even somewhat negative) effects. People in the US commonly spent money on child expenses, rent, and paying off debt, according to the report, while people in India, according to surveys by the consulting firm MicroSave and others spent their money largely on food, rent, and other household items.

The tricky logistics of quick cash transfers

Most governments were able to deploy money fairly quickly but faced logistical hurdles when trying to identify whom to give money to and how. Some were pandemic-related — such as fears of getting sick while going to the bank — and others were due to preexisting systemic issues. Even in the US, 9 million income-eligible Americans did not receive their first CARES Act checks until October 2020, mostly because they were too poor to have filed tax returns. In other countries, digital cash transfers (through phones or bank accounts) were also slower and more difficult to access for people who lacked tax returns and bank accounts.

Countries used a mix of existing systems and new methods to implement cash transfers. Togo, a West African country of about 8 million people, reached about 10 percent of people with digital cash transfers. Because of limited funds, the government of Togo targeted those who were most in need. This was done in two waves: first giving digital cash transfers to people in urban areas, and second to people in rural areas, whose income levels were identified by satellite imagery — such as by looking at roof and road materials — and cellphone data. “We were able to pay 140,000 people in a matter of weeks,” said Michael Kayemba, director of innovation of GiveDirectly, a nonprofit involved with the second phase. (Disclosure: I’ve previously donated to GiveDirectly.) These new uses of technology allowed them to reach people much more quickly than in pre-Covid efforts. For example, in Uganda — which lacked this system — he notes it took GiveDirectly five years to reach the same number of people.

But in Togo, only 50 percent of individuals and 77 percent of households in rural areas have phones — and a mobile-money-based system obviously excluded those who didn’t own a phone. “It’s either pay some or not be able to pay anyone at all,” Kayemba said, illustrating some of the tough choices governments and other actors needed to make during the crisis.

While India had an existing system of cash transfers related to employment and pensions, the Covid-19 transfers were effectively the first unconditional cash transfers in India, said Anmol Somanchi, an economics graduate student at the Paris School of Economics. India’s large-scale transfers to women were sent out in early April 2020.

But about half of women in India, including an estimated 176 million poor women, didn’t have the right kind of bank account to even be considered for transfers. And out of the 200 million recipients cited in the World Bank study, only about two-thirds actually received the money, Somanchi told me. Part of the problem lies in banking logistics. In a nationwide household survey of pandemic social protection, Anurodh Giri and Kritika Shukla of MicroSave learned some people didn’t receive the cash due to inactive bank accounts. In certain cases, people might have received the money but reported not receiving it because they were unaware they’d received it or because banks withdrew the funds automatically for loan repayment. Many of those who did receive money did not withdraw the cash transfers because of fear of sickness or police brutality during India’s strict lockdown; banks not letting them in for small-value withdrawals; or the need for long walks to the bank.

Transfers globally were, on average, 70 percent higher than pre-Covid transfers and reached many more people worldwide, but often still weren’t enough to meet additional needs caused by sickness and unemployment. “500 rupees [about $7] for one and a half months for an average family of five is nothing,” Himanshu, an economics professor at Jawaharlal Nehru University, told LiveMint in April 2020. Even in a country in which half of people live on less than $3.20 a day, this cash assistance (which came in three installments of 500 rupees each) was not nearly enough to cover people’s needs for months.

Thankfully, people didn’t have to live on cash alone. Almost every country also implemented some form of in-kind assistance such as rations or school feeding, as well as programs that can support work through measures like wage subsidies. India, for example, expanded its labor payments, free cooking gas program, and free food rations. India’s overall relief programs appeared to reach low-income households as efficiently as they reached high-income ones.

How can cash cushion future shocks?

To rapidly respond to future pandemics or other crises, countries can build out their social protection systems — cash transfers included — now.

Around the world, programs or registries that already existed and scaled up during Covid-19 were able to deliver money and services faster than those that were spun up during the pandemic. In the Philippines, those who were already enrolled in a social registry for an existing program received their payments within 13 days, compared to over three months for those who had to manually enroll. India’s in-kind food transfer system likely reached more of its intended recipients than cash aid, said Somanchi, because it had been running for over 30 years. People knew that the food transfer was happening and what they were supposed to receive; there was confusion around the type of bank accounts needed and overlap with other cash schemes for the new cash program.

Kayemba was optimistic that governments can maintain digital systems in the future as more and more people get cellphones, while mitigating risks of data security and fraud. As technology continues to improve, countries like Togo that lack existing social registries will more easily be able to get mobile money to the people who need it most.

Once a high-quality system — digital or manual — is set up, it’s much easier to use it rapidly in the future. “It was crucial that the government implemented some form of cash transfer,” said Somanchi. Cash transfers given at unprecedented scale appeared to have mitigated some of the worst effects of the pandemic — in health, hunger, and poverty — around the world. Even if imperfect, the Covid-19 response shows what governments can do, and the next time a crisis hits, how they can do even better.