Book Summary - Best Things First (Bjorn Lomborg)
Summary: Advocates for 12 interventions based on their Benefit-Cost Ratio (BCR) to deliver massive social and economic returns for a relatively small financial investment: Tuberculosis, Education, Maternal and Newborn Health, Agricultural R&D, Malaria, E-Procurement, Nutrition (Micronutrients), Chronic Disease (e.g. Hypertension), Childhood Immunization, Land Tenure Security, Skilled Migration, Trade Liberalisation.
1. Best Things First (Bjorn Lomborg). May 2023
[Google Gemini summary]
Executive Summary: The Efficiency of Compassion
In Best Things First, Bjorn Lomborg argues that global development is currently suffering from "priority fatigue." The UN’s 169 Sustainable Development Goals (SDGs) are so numerous that they essentially mean there are no priorities. By trying to fix everything—from climate change to gender equality to sustainable cities—we end up spreading resources too thin.
Lomborg’s thesis is built on Benefit-Cost Analysis (BCA). He asks a cold but necessary question: If you have an extra dollar to save a life, where does it do the most good?
Part 1: The Economic Framework
Lomborg uses a specific metric: The Social Return on Investment (SROI).
Low Impact: Many popular programs yield $2 or $3 for every $1 spent.
High Impact: The "Golden 12" yield an average of $52 of social good for every $1 spent.
Lomborg argues that by shifting just $35 billion of the current $150+ billion global aid budget toward these 12 areas, we could generate $1.1 trillion in economic benefits for the world's poor.
Part 2: The 12 High-Impact Solutions
1. Tuberculosis (TB)
TB is the world’s deadliest infectious disease, yet it is often ignored because it primarily affects the poor.
The Cost: Diagnosis and a 6-month course of medicine is cheap.
The Benefit: Saving a productive adult life for a few hundred dollars.
ROI: $40 for every $1 spent.
2. Education (Learning, Not Just Schooling)
Lomborg distinguishes between schooling (sitting in a chair) and learning.
Solution: Structured Pedagogy (providing teachers with detailed lesson plans) and Teaching at the Right Level (grouping kids by what they know, not their age).
ROI: $65 for every $1 spent.
3. Maternal and Newborn Health
Focusing on the 24 hours around birth. Simple interventions like basic resuscitation equipment and clean birthing kits can prevent millions of deaths.
ROI: $87 for every $1 spent.
4. Agricultural R&D
The world needs to produce more food on less land to keep prices low and protect forests.
Solution: Funding the CGIAR (global research partnership) to create high-yield, climate-resilient seeds.
ROI: $33 for every $1 spent.
5. Malaria
While we wait for a perfect vaccine, bed nets and indoor spraying remain the most cost-effective ways to prevent one of history's greatest killers.
ROI: $24 for every $1 spent.
6. E-Procurement
Corruption in government contracts wastes billions.
Solution: Moving all government bidding processes online to increase transparency and competition.
ROI: $88 for every $1 spent (due to massive savings in tax dollars).
7. Nutrition (Micronutrients)
Focusing on the first 1,000 days of a child's life.
Solution: Providing "sprinkles" (micronutrient powders) and fortifying flour or salt with iodine and iron. This prevents stunting and increases lifetime IQ/earnings.
ROI: $33 for every $1 spent.
8. Chronic Disease (Hypertension)
Heart disease is now a massive killer in the developing world.
Solution: Cheap blood pressure medication (pennies per pill) distributed through community health workers.
ROI: $16 for every $1 spent.
9. Childhood Immunization
Expanding routine vaccinations for things like measles, polio, and rotavirus.
ROI: $60 for every $1 spent.
10. Land Tenure Security
When farmers don't "own" their land legally, they won't invest in it.
Solution: Digitizing land registries and providing legal titles.
ROI: $30 for every $1 spent.
11. Skilled Migration
Allowing more high-skilled workers to move to where they are most productive.
ROI: Extremely high (over $100 in some models), though politically difficult.
12. Trade Liberalization
Completing the "Doha Round" of trade talks to reduce tariffs.
ROI: $7 for every $1 spent (lower than others, but the absolute dollar scale is trillions).
Part 3: The Controversial "Omissions"
Lomborg is famous (or infamous) for his stance on Climate Change. In this book, he doesn't say climate change isn't real; he says the ROI is currently poor compared to the 12 items above.
He argues that spending trillions to slightly lower temperatures in 100 years is less efficient than spending billions to save millions of lives today.
His preferred climate solution is R&D into Green Energy, not carbon taxes that hurt the poor.
Conclusion: The "Math" of Moral Progress
The book concludes that we are at a crossroads. We can continue with the UN’s "wish list" approach, which feels good but moves slowly, or we can use the "Best Things First" approach, which is mathematically proven to lift the world out of poverty faster.
Final Thought: Lomborg’s message is ultimately optimistic. We have the money and the technology; we just lack the focus to spend it where it actually works.
