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In a world with lots of problems and even more proposed policies to address each of these problems, it makes sense to study the possibilities–and then to prioritize policies with highest estimated ratio of benefits to costs. The Copenhagen Consensus think tank carried out this exercise and came up with 12 policies. A special issue of the Journal of Benefit-Cost Analysis (Spring 2023 14: S1) has a symposium of 12 open-access papers describing the calculations for each policy. The overview essay by Bjorn Lomborg carries the unwieldy but descriptive title “Save 4.2 Million Lives and Generate $1.1 Trillion in Economic Benefits for Only $41 Billion: Introduction to the Special Issue on the Most Efficient Policies for the Sustainable Development Goals.” He writes:

The approaches cover tuberculosis, education, maternal and newborn health, agricultural R&D, malaria, e-procurement, nutrition, land tenure security, chronic diseases, trade, child immunization, and skilled migration. Spanning 2023–2030, these policy approaches are estimated to cost an annual average of $41 billion (of which $6 billion is non-financial). They will realistically deliver $2.1 trillion in annual benefits, consisting of $1.1 trillion in economic benefits and 4.2 million lives saved. The pooled benefit–cost ratio of all 12 investments is 52.

You can check out the essays for yourself, but here’s just a little more information:

• A global plan to increase spending on responding to tuberculosis could lead to “27.3 million averted deaths over the 27-year period between 2023 and 2050, or 1 million averted deaths per year on average.”
• Two policies could use education resources more effectively: “The first approach is called “teaching at the right level.” This intervention takes students out of age-based classes for 1 hour a day to learn at their specific learning level, either physically or with a tablet. Material is tailored so children are not lost or bored. Just 1 hour a day for a year can make the full school year deliver learning that would have taken 2–3 years otherwise. The second strategy is `structured pedagogy.’ As used successfully in Kenya, teachers are provided with lesson plans and supported with workshops and text messages. The extra cost for one student for 1 year is less than $8, and it has been shown to deliver learning that is equivalent to almost 1 extra year of schooling.”
• Higher spending on global agricultural R&D, via national-level programs, international research coordination, and involvement of private firms can increase output and farm incomes, while also reducing food prices and hunger. “The average increased spending annually is about $5.2 billion, with annual benefits of $184 billion. Over the entire 35-year period, the average BCR [benefit-cost ratio] is 33.”
• Improving the use of long-lasting insecticide-treated nets can prevent malaria. “The study estimates the costs and benefits of scaling up the number of LLINs by 10 percentage points in the 29 highest-burden countries in Africa from 2023 to 2030. By the end of the decade, this effort will have halved deaths from malaria. Each dollar spent will deliver $48 of social benefits.”
• Scaling up the access to maternal and neonatal health interventions . Focusing in 55 lower-income countries can save more than 160,000 mothers and 1.2 million children each year.”
• When government uses e-procurement, it can reduce the cost of government spending and reduce corruption. The study looks at “11 e-procurement initiatives in low-income countries like Bangladesh and Rwanda, middle-income countries such as Ukraine and Tunisia, and high-income countries like Italy and South Korea. They show that the cost is likely very low. Over the first 12 years, costs average $16.7 million, irrespective of a country’s size – a trivial sum compared to most government budgets. “The average reduction in procurement prices is 6.75%, leading to savings by 2030 worth more than $100 million per year for an average low-income country. In lower middle-income countries, the average savings are more than $1 billion per year.”
• Improving children’s diets in their first 1,000 days pays off. “The first two policies focus on micronutrients for pregnant women, with a BCR of 24. The third and fourth policies focus on two ways of promoting complementary feeding in the 40 low- and lower middle-income countries with the highest rates of stunting. The third intervention delivers only information to the top 40%, who can afford food but need more guidance (BCR of 16), while the fourth intervention focuses on the lower 60%, who need both information and more food, which means higher costs, leading to a lower BCR of 7.5. Finally, the fifth intervention examines the costs and benefits of 1Small quantity lipid-based nutrient supplements,’ which delivers a BCR of 14.”
• Improving property rights in lower-income countries involves many steps: “surveying and registering land, digitizing land registries, and operation costs, along with the need to strengthen institutions and resolving land disputes.” But estimates for sub-Saharan Africa suggest the “BCR is 18 for rural areas, and the BCR is 30 for urban areas.”
• Tackling noncommunicable diseases can have big payoffs, including cardiovascular preventive care (like meds to lower blood pressure) as well as policies related to tobacco, alcohol, and salt use: “In total, the cost of introducing all these approaches across low- and lower middle-income countries requires an annual additional $4.4 billion and this will save about 1.5 million lives, delivering a BCR of 23.”
• A 5% increase in global trade, after taking into account both benefits and costs to those in industries exposed to imports, has a BCR for high-income countries of “only” 7. ” However, for the poorer half of the world, the benefits are vastly higher than the costs, with a BCR of 95.”
• Increased childhood immunization programs in 80 low- and middle-income countries could cost $1.7 billion, but with benefits outweighing costs by more than 100 to 1. Specific vaccines are “the pentavalent vaccine, human papillomavirus (HPV) vaccine, Japanese encephalitis (JE) vaccine, measles (MCV) vaccine, measles-rubella (MR) vaccine, meningococcal conjugate A (Men A) vaccine, pneumocccal conjugate (PCV) vaccine, rotavirus vaccine, and yellow fever (YF) vaccine.”
• A 10% increase in the “skilled migration” that has already taken place, where this includes “physicians, engineers or STEM workers, and other persons with advanced education,” seems politically possible. “In total, 10% more highly skilled migration can deliver a global BCR of 20, and within Africa of 4–7.”

A proposal to spend $41 billion per year is of course a lot of money, but some perspective is useful. The proposed US budget that President Biden sent to Congress earlier this year suggested $7.3 trillion in total spending. Divided over 365 days, this represents is average spending of $20 billion per day, every day US federal budget. Thus, the proposed amount is two days of federal spending out of the year. Of course, there’s no reason why the US government should pay the entire bill, except for the political optics of having the United States save millions of lives and more than $1 trillion in costs. We could negotiate with the governments of other high-income countries to pay half the cost. Or we could work with private charities: US charitable giving about $500 billion in 2024.

Yes, of course, there can be multiple slips between the cup and the lip in supporting these kinds of programs. They need to be run transparently and effectively. But the potential payoffs are remarkable.

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