The Illusion of Sustainability

Michael Kremer, Edward Miguel

NBER Working Paper No. 10324
Issued in February 2004, Revised in August 2006
NBER Program(s):Economic Fluctuations and Growth, Health Care, Public Economics

The history of foreign development assistance is one of movement away from addressing immediate needs and toward focusing on the underlying causes of poverty. A recent manifestation is the move towards sustainability,' which stresses community mobilization, education, and cost-recovery. This stands in contrast to the traditional economic analysis of development projects, with its focus on providing public goods and correcting externalities. We examine evidence from randomized evaluations on strategies for combating intestinal worms, which affect one in four people worldwide. Providing medicine to treat worms was extremely cost effective, although medicine must be provided twice per year indefinitely to keep children worm-free. An effort to promote sustainability by educating Kenyan schoolchildren on worm prevention was ineffective, and a mobilization' intervention from psychology failed to boost deworming drug take-up. Take-up was highly sensitive to drug cost: a small increase in cost led to an 80 percent reduction in take-up (relative to free treatment). The results suggest that, in the context we examine, the pursuit of sustainability may be an illusion, and that in the short-run, at least, external subsidies will remain necessary.

download in pdf format
   (357 K)

email paper

The NBER Bulletin on Aging and Health provides summaries of publications like this.  You can sign up to receive the NBER Bulletin on Aging and Health by email.

Machine-readable bibliographic record - MARC, RIS, BibTeX

Document Object Identifier (DOI): 10.3386/w10324

Published: Kremer, Michael and Edward Miguel. “The Illusion of Sustainability.” Quarterly Journal of Economics 122, 3 (2007): 1007-1065. [re-printed in Reinventing Foreign Aid, (ed.) William Easterly, MIT Press] citation courtesy of

Users who downloaded this paper also downloaded* these:
Jagannathan and Sherman w12151 Why Do IPO Auctions Fail?
Kremer and Olken w8257 A Biological Model of Unions
Heal w17008 Sustainability and its Measurement
Arrow, Dasgupta, Goulder, Mumford, and Oleson w16599 Sustainability and the Measurement of Wealth
Miguel and Kremer w8481 Worms: Education and Health Externalities in Kenya
NBER Videos

National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138; 617-868-3900; email:

Contact Us