MR. KOJO NNAMDIThough the disaster's still unfolding in Japan, earthquake-proof construction and strict building codes probably helped save many thousands of lives. In contrast, the major earthquakes in China in 2008 and in Haiti last year highlighted how many more lives are lost in badly constructed buildings. Governments and development organizations make decisions every day about where to spend limited funds, but less clear than the destruction caused by shoddy buildings is whether the problem can be addressed by aid or regulation in poor countries.

MR. KOJO NNAMDIOne development expert argues that better buildings is probably not the most cost effective way to save lives. And that while they grab headlines, disasters like earthquakes cause many fewer deaths than illnesses and other problems that are simpler to address. Here now to talk about that is Charles Kenny. He's a senior fellow at the Center for Global Development and the author of "Getting Better: Why Global Development is Succeeding and How We Can Improve the World Even More." Charles Kenny, thank you for joining us.

MR. CHARLES KENNYThank you very much for having me.

NNAMDIThe loss of life and damage in Japan are horrifying. The only glimmer of good news is with Japan's strict building codes seem to have helped to save lives. Most of the death and destruction were caused by the tsunami, not by the earthquake. How would you rate the technology Japan has when it comes to earthquake proofing buildings?

KENNYIt's great. It really works. And we know it works from the history of Japan itself. So there was a large earthquake in Kobe a few years ago in Japan that killed thousands of people. But buildings that were built after -- in 1971, earthquake code strengthened regulations on building techniques. They all survived. If there was any buildings that were built before that regulation, that collapsed.

NNAMDIBy contrast, what did we see in Haiti?

KENNYBuildings collapsing left, right and center. You know, an immense tragedy. So there was no -- there were no earthquake proof buildings. I mean, the U.N. building collapsed, for example.

NNAMDIAnd then the earthquake in China Sichuan region in 2008 about 7,000 school buildings collapsed. Do we know what building codes were like there?

KENNYBuilding codes weren't as good as they are in Japan. The trouble is that even standard building codes have nothing to do with earthquakes, just trying to keep buildings up, even when there isn't an earthquake, even those building codes weren't being followed in China. And there are allegations of corruption and mismanagement around that.

NNAMDIAfter China's earthquake, there was a lot of discussion about making sure that structures like schools and hospitals are better built, especially in earthquake prone areas. Does China now have the resources to do this?

KENNYI think China may, but China also has a lot of people dying from diseases and other causes that are easier to deal with. And that story is at least marginally true for China and it's completely true of a lot of poorer places, where a lot of earthquakes happen.

NNAMDIIndeed, disasters get a lot of attention in the media, for good reason. But you argue that everyday problems are much more deadly in the developing world. What do you mean by that?

KENNYWell, so, for example, in the average year, about 2,500 kids die because they're in school and their school collapses during an earthquake. And that's a tragedy. That's 2,500 deaths that shouldn't happen. But 8 to 10 million children worldwide died before they could even get to school. They die before the age of five. And so that's an immensely larger tragedy that we should tackle, I think, first because many of those deaths are very easily preventable.

NNAMDIYou've made a fairly provocative argument here, essentially a cost benefit analysis when it comes to saving lives in poor countries.

KENNYI certainly don't want to put a value on human life. And I think that every human life worldwide is, you know, invaluable and can't be priced. But what I would say is that in the world in which we live, in many developing countries the amount that's spent on health interventions each year is, you know, a few dollars. Now there's a calculation done in Turkey after an earthquake in Marmora near Istanbul in Turkey that killed 17,000 people. A calculation for each life saved by earthquake proofing technologies you'd have to spend $400,000 per year.

KENNYCompare that to things like breastfeeding and bed nets against malaria and vaccines and oral rehydration, that's just sugar and salt in water, which can cure diarrhea, which kills millions in the developing world. Each of those interventions costs cents, maybe a dollar and can save a life. And so when you compare the large cost, the $400,000 per life saved for earthquake proofing to these interventions that cost dollars and cents, it's clear where the money ought to be going first.

NNAMDIWe're talking with Charles Kenny. He's a senior fellow for global development ant author of the book "Getting Better: Why Global Development is Succeeding and How We Can Improve the World Even More." If you'd like to join the conversation, you know the drill. Call us, 800-433-8850. Do you think it's ethical or maybe necessary to make tradeoffs between different life saving measures in poor countries, as Charles Kenny is essentially proposing here? 800-433-8850 or you can go to our website, kojoshow.org. Charles Kenny, is it difficult to propose something like this, given that we are talking about human lives?

KENNYYes, but sadly necessary. So to take an analogy, we can save lives in the United States and in other rich countries by heart transplants. But heart transplants are amazingly complex procedures. They cost hundreds of thousands at a go. And they add a few years of life in the usual case. In developing countries, it's not just there's not enough money to give everybody who needs a heart transplant a heart transplant. There aren't the doctors. There isn't the health infrastructure to do it.

KENNYAnd the same story is true in the case of earthquakes. There aren't the engineers to construct these buildings and there certainly aren't the engineers working for government to make sure that the buildings are built according to earthquake code. There aren't, sadly, the engineers to make sure buildings are just constructed to a standard set of codes, you know, purely designed to keep the building up for 20 years without an earthquake. And so to go that extra step is just, you know, beyond the means of many developing countries at the moment, sadly.

NNAMDILet me take one more dogged desperate stab at this here. Why not at least focus on the most vulnerable major cities and spend our development dollars to make sure those cities are earthquake proof?

KENNYI think it's hard to argue against the idea that in very high earthquake prone areas, the hospital and perhaps the school ought to be retrofitted, made earthquake proof. Once you start going much further than that, again, you are spending money that could save a lot more lives elsewhere and so I would want to sort of draw the line quite carefully.

NNAMDIOrganizations like the Gates Foundation are, in fact, bringing vaccines and other critical medical help to places like Africa and making a big difference. But which organizations would focus on things like construction and engineering?

KENNYWell, a lot of development organizations do spend a lot of money building things. I'm on leave from the World Bank and the World Bank has a large infrastructure department that goes around building stuff, you know, roads and buildings, including hospitals and schools. Many other development agencies around the world do the same thing. And of course, governments. Governments around the world spend billions and billions and billions of dollars building buildings every year.

NNAMDISpeaking of government spending billions building buildings, let's go to Drew in Rockville, Md. Drew, you're on the air. Go ahead, please. Hi, Drew, are you there?

DREWI am. Can you hear me?

NNAMDIYes, we can.

DREWSo I just wanted to ask your guest, you know, I think it's a slightly specious argument to say that you can spend money on some of these less costly interventions, but not spend them on infrastructure building because they're not necessarily coming from the same place. There's government spending and then there's, you know, individual developers spending. So if a developer that's building a building has to meet a certain level of code, yeah, it may cost him more money, but it is not necessarily coming out of the same account as, let's say, the government putting fluoride into water or something like that.

DREWSo I don't necessarily think that the argument is to be said one versus the other. Maybe when it comes -- specifically when it comes to a government building, that argument holds. But when it comes to looking at, you know, putting more stringent codes on developers that are there for a profit, that makes sense to me.

NNAMDIHere now is Charles Kenny.

KENNYI think that's a fair point. A lot of construction is done by the private sector, not by government, although government is, you know, the biggest client for the construction industry in every country in the world. When it comes to the private sector, though, you can imagine two choices. One is you set in place codes that say you must build buildings to this standard and it costs the builder maybe 10 percent more to build the building. Or you could tax the developer a bit more, use that money to make sure there is universal vaccination coverage.

KENNYWhen it comes to government buildings itself, the relative effectiveness of earthquake strengthening can be so low that you might actually cost lives. So if you've got 10 million dollars to build a certain number of schools in developing countries and you spend that money on building better built schools, but you built fewer of them, you don't have as many kids in school. And putting kids in school is one of the most effective ways to reduce mortality rates worldwide.

NNAMDIHow expensive is it to make a building earthquake proof compared to regular construction?

KENNYIf you do it when you're building the building, it's only 10 percent. It's only adding 10 percent of the costs, which is not small, but not huge. If you retrofit, which is take an existing building and strengthen it, you know, costs go up to 30 percent or above, which means it's very, very expensive indeed.

NNAMDIThat kind of construction, it seems to me, is really out of reach in a lot of developing countries.

KENNYWell, I mean, arguably so. Certainly in cases in developing countries, including Turkey, where they've tried to put in a retroactive earthquake regulation, if you will, so they said that buildings must meet new codes even if they're old buildings. There's been a huge amount of trying to get around it, including large corruption cases.

NNAMDII was about to say the other big issue is enforcement of building codes. And in a lot of the poorer countries, even basic building codes are routinely ignored.

KENNYYes, and the case in Marmora in Turkey is where the 17,000 people died is a classic case. Seventy percent of the buildings in Istanbul don't meet existing code so there's a huge problem in enforcement here.

NNAMDIAnd a huge problem with corruption.

KENNYAnd a huge problem with corruption. And it has insidious effects so that poor people building houses not meeting code, because that's what they can afford to build, become prone to any policeman or local government official who wants to make a buck off them. They just have to go along and say, you didn't build to code, I'm going to knock it down if you don't pay me.

NNAMDIOn to Sabrina in Fairfax, Va. Sabrina, you're on the air. Go ahead, please.

SABRINAMy comment, I agree with your guest in that -- what he's saying because I think we do assign a value to...

NNAMDISpeak closer into your telephone, Sabrina, you're fading on us.

SABRINAOh, pardon me. I'm on a mobile. That you have to make a choice. There's only limited dollars. And it seems if you make the less expensive choice to save more lives in an easier fashion that's easier to disperse than say building regulations, where perhaps in certain countries you would only be affecting a smaller percentage of the people in the country, it seems that going with the more cost effective solution is logical to me.

NNAMDIOkay. I'm glad you made that point, Sabrina because, Charles Kenny, let's use Haiti as an example. Haiti was not at high risk for an earthquake. So one of the problems we have is that earthquakes are quite unpredictable. Haiti was not seen as having a high probability of an earthquake so Haiti would be a good case in point for what you are talking about.

KENNYRight, indeed. If you look at seismic risk maps, Port-au-Prince was not in the top zones of those maps. The Dominican Republican actually has -- is more at risk, according to those measures. So you have a number of problems. You have, do we know where an earthquake will strike, and the short answer is no. We can make predictive statements, but we don’t' know. And actually, most places where an earthquake might strike it doesn't.

KENNYAnd so you can build a lot of buildings that are built to earthquake code, and that code is never needed.

NNAMDIBut you're also not saying that earthquake preparedness is a mistake.

KENNYOh certainly not. There are other things one can do, you know, preplaced supplies. For example, one of the tragedies in Haiti was that some time after the earthquake cholera broke out. Now, cholera should not have broken out in Haiti. We should have been prepared for that, and there are reasonably simple ways to prepare for that. We did a pretty good job at response once it emerged, but we should have been quicker on the go. So there are definitely other things one can do.

NNAMDISabrina, thank you for your call. Here is Anne in Washington, D.C. Anne, your turn.

ANNEThank you for taking my call. I feel that there is a rather large omission in the analysis that's being given and that has to do with the developing countries' lack of political control over their resources. I mean, historically, the relationship has been that the advanced industrialized countries have a colonial and imperious relationship where they use developing countries as a dumping ground for manufacture projects, for products for cheap labor and for extraction of raw materials.

ANNEThe resources are not in the control of the people in the developing countries which is a cardinal issue, and the tensions over democratic control in those nations. So I don't know when the -- your guests are speaking of we, who they're speaking of. If these countries were in control, or the peoples in these countries had democratic rights and were in control of their resources, I think that they should be making, and would be making a choice to ensure the safety of their citizen rate. And they would be able to do so if the -- if their gross national product wasn't completely siphoned or nearly completely siphoned off by the advanced industrialized countries. Thank you very much.

NNAMDIHow would you respond to that macroeconomic analysis, Charles Kenny?

KENNYThe reason we're in this awkward place of having this rather painful discussion is because poor countries are poor, and I agree, the ultimate answer to this is for poor countries to become rich. And then everything will be better. The good news I should say, if there's a sort of silver lining to story, is that we are talking about some deaths that are caused by something that is very difficult to deal with. It's institutionally complicated. You need regulations and you need people to enforce them.

KENNYIt's expensive. You need engineering solutions which are complex. Most -- the vast majority of deaths in the developing world are not caused by that kind of problem. They're caused by things that are simple to deal with, and that we have answers to. And so even without a huge amount of income growth we can challenge and tackle those problems and make huge headway.

NNAMDIGot to take a short break. If you have called, stay on the line. We will get to your call. The number is 800-433-8850. Would you prefer aid to help the largest number of people, or do you think disaster preparedness is essential, or disaster -- anti-disaster construction is essential? 800-433-8850. Send us a tweet @kojoshow, e-mail to kojo@wamu.org. I'm Kojo Nnamdi.

NNAMDIWelcome back to our conversation on how we respond to earthquakes, and the difference between that response, and what we can be doing with development aid that might in fact be helping a lot more people. We're talking with Charles Kenny. He's a senior fellow at the Center for Global Development, and the author of "Getting Better: Why Global Development is Succeeding, and How We Can Improve the World Even More." Why do you say global development is succeeding?

KENNYBecause on almost any measure you can think of, things are getting better, not just in rich countries, but in poor countries, and in countries that have seen almost no development progress for the last 2000 years. So for example, over the last 100 years, the percentage of kids who die before they reach their first birthday, the proportion has dropped from sort of one in five kids to one in 20.

KENNYAnd countries as poor and as wretched at Haiti or Burma, see mortality rates -- infant mortality rates lower than any country in the world 100 years ago. Even just since 1960, if you take -- there were nine million kids born last year who wouldn't have made it to their first birthday if it wasn't for the fact that mortality rates had dropped so fast since 1960. And this progress has been truly ubiquitous. So, you know, Africa, Asia, Europe, everywhere has seen this progress.

NNAMDIYou point out that getting kids to school, especially girls, is actually one of the most effective ways to helping kids survive in poor countries.

KENNYYes. I think it's both a symptom and a cause. So as a symptom, putting girls in school is making a statement about how much you value girls. That, you know, you're willing to have them in school rather than in the fields as it might be. You're investing in their future. And that alone means that, you know, they're gonna be better nourished. They are gonna grow up to have a stronger role in the household and be able to make decisions about things like how to look after the next generation of kids.

KENNYBut also, when you go to school, hopefully you learn to read. You learn lots of useful skills that you can use in order to learn about very simple techniques in order to improve the chances that your kids will survive. But also to take, you know, a proper role in democracy and, you know, various other roles in life.

NNAMDIIt's an interesting argument, but is development aid organized in such a way that funds are allocated either to construction or the vaccines? Here's a part of an e-mail we got from Constance in Silver Spring. "If the $400,000 per life saved in Istanbul does not go to earthquake proof buildings, what guarantee do we have that the same $400,000 goes to buy bed nets and rehydration salts for Africa?"

KENNYIt's a valid question, and we don't know is the short answer. Having said that, we do know that aid that has gone to health interventions and to education has had an impact. And the clearest example is smallpox. In the last century, 300 to 500 million people died of smallpox. Unless some nut let smallpox vaccine out of the few labs where it remains, nobody's gonna die of smallpox in the next century.

KENNYAnd that has got a lot to do with the World Health Organization and various donor organizations working with governments to make sure that there was pretty much universal vaccination against smallpox worldwide. It's a huge success.

NNAMDIDo you think aid and technology are making a difference in the developing world? Call us 800-433-8850. Here is Rod in McLean, Va. Rod, your turn.

RODThanks for taking my call. It seems to me that one thing that is being ignored in the analysis is the effect on society from the loss of infrastructure, the disruption to education, jobs, and the loss of investment from a big earthquake destroying cities.

NNAMDICare to respond to that, Charles Kenny?

KENNYYes. And it's tragic. I would say that earthquake building codes in the United States and elsewhere in the world are not actually designed to make sure that the infrastructure survives the earthquake completely intact. They're designed to make sure that the infrastructure survives well enough that people can get out of the building in time before the building collapses. So the costs in terms of rebuilding aren't much different between, you know, countries with quite strong earthquake regulation and those with weak regulation. Because that's not what the regulations are about.

NNAMDIHere's the rest of the e-mail we got from Constance in Silver Spring. "Cities are important economic centers for the city dwellers and for people in the countryside. If cities are destroyed by earthquakes, both city dwellers and people in the countryside will suffer. Will anyone get help in the countryside while victims are being dug out of the ruins of Istanbul and the city is being rebuilt? Probably not. Earthquakes are aid sinks that absorb a large percentage of available government and charity funding."

KENNYIt is certainly true that disasters attract a lot of funding sort of, if you will, per death, the amount of resources going to disasters is way higher than the amount of resources going to things like measles or tetanus. But having said that, I think earthquakes can have a hideous short-term impact on the economy, beyond the human tragedy. They can have a short-term impact on the economy. But countries do tend to bounce back quite fast from earthquakes.

KENNYAnd the -- sort of the economist answer for why that is, is that it turns out that being rich is more about the strength of your institutions and the way government functions and so on, than it is about physical infrastructure. That in a way, physical infrastructure is the easiest part of the problem. If you can get everything else right, you'll get the infrastructure broadly right.

NNAMDICharles Kenny is the author of "Getting Better: Why Global Development is Succeeding, and How We Can Improve the World Even More." He's a senior fellow at the Center for Global Development. Would it be more effective for example, instead of building earthquake-proof buildings, would it be more effective for example to better prepare those living on the coast for rising sea levels and for tsunamis?

KENNYCertainly flood protection has a unique -- a different feature from earthquake protection, in that flood protection, you need to build one flood wall. It's not that every building needs to be protected against rising water. So it's more of a classic sort of public good piece of infrastructure. So that can be more effective. Again, we face a problem which is, you know, where and when and how big. I mean, and -- what happened, you know, the tragedy in New Orleans is a sign of the problem that, you know, we built for flood waters that came every hundred years, and then the 200-year flood arrived.

NNAMDIHere we go to Tracy in Falls Church, Va. Tracy, you're on the air. Go ahead, please.

TRACYHi. I just wanted to ask the guest what accountability does the developing country provide for the world health organization or any organization that funds with anything like vaccination or building codes for an earthquake or anything. Because there is a lot of corruption in developing countries so how do they do the accountability?

NNAMDIThere is a lot of corruption in development, but are we getting better at making them -- those countries more accountable for what they do with the development aid they receive?

KENNYThere is a lot of corruption in development, and there is a lot of corruption in developing countries. There are lots of different methods that are being used to try to reduce the impact of that corruption on outcome, so things like greater transparency and audits and so and so forth. What I would say thought is that there are a number of countries in Africa that are pretty much as poor as they have ever been, but they are providing a quality of service that is much, much better than European or American countries when providing when European and American countries were that poor.

KENNYSo, you know, 87 percent of kids are in primary school around the world, including, you know, the great majority of kids in Africa. You'd not say that of Britain in 1800 when it was about as rich as that African countries today. So I'm not saying that there isn't corruption and there aren't problems. What I am saying is that given that corruption and those problems, these countries are providing a remarkable level of public services.

NNAMDIWell, why does the doom and gloom view tend to persist? Why does that perception tend to persist?

KENNYBecause the story of kind of people living well and going off to work is not a terribly interesting story. I think that there's a real problem in selling banality, if you will. You know, the great thing that is happening more and more in Africa and around the world is nothing's happening during the day. But it's really hard to make a news story out of that.

NNAMDIHere is Palmer in Loudon Country, Va. Palmer, you're on the air. Go ahead, please.

PALMERHello. Thank you. Thank you for taking my call. I was wondering, earlier you had talked about the seismic rates and the ability to predict earthquakes. And I was wondering in the future if these rates are improved through the scientific method, if we are able to predict earthquakes, if that would change the formula for spending that you are advocating.

NNAMDICharles Kenny?

KENNYYes, it would. It would probably depend how we got better at predicting. If we got better at predicting exactly how likely it was there was to be a big earthquake at some point in the next 20 years, that would speak strongly to more focused and targeted expenditure on making earthquake-proof infrastructure. If what changed was we got better at predicting a big earthquake a day or two out, it would be more about preparedness. It would be more about making sure we had a plan in place to get people out of where the earthquake was gonna happen.

NNAMDIMost people think overpopulation is one of the world's biggest problems right now, particularly in developing countries. But you looked at Africa, and you found no link between population growth and declining income.

KENNYThat's right. So the traditional Malthusian story is that countries that see fast population growth see dropping incomes. And the dropping incomes causes rising mortality and that brings population back down again. That situation doesn't apply in Africa. It doesn't apply anywhere in the world anymore. So in Africa we're seeing rising populations, although at a tapering level. We're seeing much improved child health, and we're seeing rising incomes. Actually, in the last ten years, some of the fastest growing countries in the world have been in Africa.

NNAMDIBut what about the argument that there's only a finite amount of food, a finite amount of resources available?

KENNYThat's the argument that Maltheus made 200 years ago, and now there are 10, 15 times as many people, most of whom are much, much richer. So there isn't a finite amount of food we're about to hit any time soon. We can produce a lot more food using existing technologies. And we can produce a lot more income using existing technologies to make sure the people can afford to buy that food. So we haven't hit any natural limit to growth yet I don't think.

NNAMDISo, therefore, is technology another reason to be hopeful about this?

KENNYAbsolutely. I think the technologies of vaccines, of rubber tires, of radios, Internet, you know. All of these technologies really have made a difference to the quality of life in people worldwide not just in rich countries.

NNAMDIGot time for one more call. It's Kadani (sp?) in Washington, D.C. Kadani, you have about 20 seconds.

KADANIYes, sir. Kojo, I don't know which city, but I'm sure it was not in Istanbul the last time earthquake they have in Turkey was -- everything was destroyed. Only the mosque stand out. And after they made the investigation, they found out that, I guess, the workers didn't have drive and profits (unintelligible) . That's why we (unintelligible) . They follow the building code. Thank you.

NNAMDINo building codes followed in that situation, Charles Kenny. We talked about that earlier.

KENNYWe did, and I think it's a fascinating case that sort of when incentives line up if you will and people are building a mosque, then they get it right.

NNAMDIAnd I'm afraid that's all the time we have. Charles Kenny is a senior fellow at the Center for Global Development and the author of "Getting Better: Why Global Development is Succeeding and How We Can Improve the World Even More." Charles Kenny, thank you for joining us.

KENNYThank you very much for having me.

NNAMDIThank you all for listening. I'm Kojo Nnamdi.