Development is not only about income. Health and education are part of what it means to live well, and they also make people more productive. Some of the clearest successes of the past century have come in these areas.

Health and vaccines

Smallpox, which killed hundreds of millions of people over the twentieth century, was declared eradicated by the World Health Organization in 1980 after a global vaccination campaign, the first human disease to be eliminated worldwide. Childhood vaccines against measles, diphtheria, tetanus, whooping cough and polio have since reached most of the world's children, supported by international efforts such as the vaccine alliance Gavi, founded in 2000.

The results show up in child mortality. The number of children who die before their fifth birthday each year has fallen by more than half since 1990, though in the early 2020s about five million a year still did, mostly from preventable causes. Cheap interventions played a large role: vaccines, oral rehydration therapy (a simple solution of salt, sugar and water for diarrhea), insecticide-treated bed nets against malaria, and better nutrition. Health gains often come before income gains; some poor countries have life expectancies close to those of much richer ones.

Schooling

Primary school enrollment has risen dramatically, and in most regions girls now enroll at rates close to boys. Studies across many countries estimate that each additional year of schooling raises a person's earnings by roughly ten percent on average, with wide variation. Education also brings benefits beyond income: better health, more say in family and civic life.

But schooling is not the same as learning. In many low-income countries, large shares of children who finish several years of primary school cannot read a simple paragraph or do basic arithmetic. The World Bank called this a learning crisis in 2018. Research suggests that teaching children at their actual level, rather than strictly following the curriculum, and making sure teachers are present and supported, can help a great deal.

Women's empowerment

Many development thinkers now see the position of women as central. Educating girls is linked to later marriage, fewer and healthier children and higher family incomes. When women control more household income, studies often find more spending on children's food and schooling. Sen drew attention to the “missing women”: in some regions there are far fewer women than biology would predict, because of neglect and discrimination from birth onward, a stark measure of unequal worth.

Empowerment is not only a means to growth. On a capability view, it is part of what development is: women having the same real freedom as men to choose their lives.

Microfinance, stated carefully

In the 1970s and 1980s the Bangladeshi economist Muhammad Yunus founded the Grameen Bank, which made small loans to poor people, mostly women, without collateral, relying on groups of borrowers to support each other. Microfinance spread worldwide, and Yunus and the bank shared the Nobel Peace Prize in 2006. Many hoped it would be a powerful tool against poverty.

The evidence has been more modest. A set of randomized studies in several countries, published together in 2015, found that access to microcredit did not, on average, transform incomes or women's empowerment, though it gave some households more flexibility and helped some existing businesses grow. Some borrowers have struggled with debt. Most researchers now see microfinance, including savings and insurance, as a useful financial service for poor people rather than a cure for poverty.

Worked example: one family over two generations

Follow a fictional family in a rural district to see how health, education and empowerment interact.

In the 1980s, Amina was born in a village with no clinic. Two of her siblings died before age five, one of measles and one of diarrhea. She attended school for three years, then left to help at home. She married at sixteen and had six children.

By the time Amina's children were young, much had changed. A vaccination campaign reached the village, and a health worker taught mothers to mix oral rehydration solution. All six children survived. A new primary school opened, and Amina was determined that her daughters would attend.

Her eldest daughter, Halima, finished secondary school. She married at twenty-three and had two children. She works as a teacher and controls her own salary, much of which goes to her children's schooling and food. Each extra year of schooling likely raised her earnings, and her education is linked to her later marriage and smaller family.

Amina once borrowed from a microfinance group to buy a sewing machine. The business helped in good months, but when she fell ill she struggled to repay, and the loan became a worry. It did not transform the family's income; Halima's education did far more.

Notice what made the difference: cheap health measures, a school that actually taught, and a girl's chance to finish her education. Income rose, but health and schooling came first, and they changed what each generation of women could choose to do and be.