“I AM not aware of any maternal deaths in the community in the past two or three years,” says the medic on duty at a remote rural clinic in the Terai, Nepal’s lowlands. “I think this is because medicines are available, services are free and we have a 24-hour delivery service.” A young mother at the post agrees. She tells researchers from Britain’s Overseas Development Institute (ODI), a think-tank, “When I gave birth several years ago, I was not taken to a health facility. But recently my in-laws decided to take my sister-in-law…because [of] the 24-hour delivery.”

Nepal’s improvements to maternal health have been extraordinary. In the early 1990s Nepal was one of the poorest countries in the world. It is still the poorest country in South Asia; its income has grown respectably, though not quickly; and it has had a civil war. Yet by doubling health spending and concentrating on the poorest areas it cut maternal mortality in half between 1998 and 2006 and reduced deprivation and misery by more than its income gains alone would suggest. On a measure called the MPI, or multidimensional poverty index, invented by Sabina Alkire at the Oxford Poverty and Human Development Initiative, since 2006 Nepal has seen the largest falls in poverty, broadly defined, of any country in the index.

This provides a microcosm of the changes that development agencies want to see spread globally. Between 1990 and 2010 the proportion of the population living on less than $1.25 a day in developing countries halved to 21%, or 1.2 billion people (see chart). That enabled the 189 governments who signed a pledge to halve the share of the poorest between 1990 and 2015 to claim they had met their goal early.

It is not clear how much the pledge itself caused the fall in poverty—arguably not much, since China, where the biggest decline took place, took no notice of the goal. Still, the correlation has been strong enough for almost all countries to want a new set of global development aims after the current lot expires in 2015. On September 25th their delegations will gather at the United Nations in New York to refine the list of proposed “Sustainable Development Goals”. Jeffrey Sachs, a professor at Columbia University, says rather grandly that these “have the potential to open up a new era of technological and organisational breakthroughs” (see article). Barack Obama has committed the American administration to the aim of eradicating extreme poverty by 2030, meaning to reduce the percentage of people in the world on $1.25 or less to 3%. Britain’s prime minister, the World Bank and a series of international charities have signed up to that goal, as well. Yet as Nepal shows, cutting poverty is not just about boosting incomes. Deprivation takes many forms, including the lack of schools, clean water, medicines and family planning. Using her MPI measure, Ms Alkire finds that about one-sixth of Vietnam’s population is poor by income, and one-sixth is “multidimensionally poor”. But they are not the same people: only about a third of the groups overlap. Emma Samman of ODI says, “It is not clear that the $1.25-a-day poverty line, the measure upon which this vision of a poverty-free world exists, is necessarily the best way to think about and measure poverty.” So charities and others are urging the governments meeting in New York to adopt exacting targets for non-income measures of deprivation. Save the Children thinks the world should aim to end preventable deaths in childbirth by 2030; ensure universal safe water; reduce child mortality from about 50 per 1,000 live births to 20; and halve the rate of child stunting (meaning below-average growth in childhood, a measure of malnutrition). Several countries have managed to reduce the social deprivations that the poor face (bad education, health and so on) by more than they have improved the incomes of the poorest. Nepal is one. Bangladesh is another: it has made some of the greatest improvements in infant and maternal mortality ever seen, despite modest income growth. But these are exceptions.

The mark of zero

Globally, it has been much harder to improve the social aspects of poverty than the purely economic one (income). Look at the current set of UN development goals. The income target was met five years early. But the world is nowhere near meeting its goals of cutting child mortality by two-thirds and maternal mortality by three-quarters in 1990-2015. Both are down by less than half. The targets on sanitation and education will be missed, too.

Those who argue for ambitious social targets nevertheless say they could be hit if—in the words of Save the Children—governments “get serious about addressing income inequality and improving governance.” The charity reckons that if things go on improving as they are 83% of the world’s people will have access to proper sanitation by 2030. Not bad. But if income equality were narrower (meaning if each country were to achieve the lowest level of inequality it has had since 1980) then the share would rise to 90%. If you add improvements in government effectiveness (measured by the World Bank’s governance indicators) the share would rise to 94%—not far from the charity’s ideal of sanitation for all. Kevin Watkins, the head of ODI, says that “reducing extreme inequality is…a condition for achieving absolute goals, such as extreme-poverty eradication, prevention of avoidable child deaths and universal schooling”.

The trouble is that inequality is extremely hard to change. The rich and powerful have an incentive not to change it too much. And the benefit of doing so may anyway be marginal. A new study by David Dollar, Aart Kraay and Tatjana Kleineberg of the World Bank finds that almost four-fifths of the improvement in the incomes of the poorest 40% in 118 countries is attributable to improvements in average incomes—ie, it comes from general economic growth, not redistribution.

That still leaves a fifth that might be perked up by policies tailored specifically for the poor, and these would be required to get extreme poverty to zero. But if there were a trade-off between growth and equity, growth would be more important. And as the report concludes, “historical experience in a large sample of countries does not provide much guidance on which combinations of macroeconomic policies and institutions might be particularly beneficial for promoting ‘shared prosperity’ [a buzzword of the World Bank] as distinct from simply ‘prosperity’.”

A similar point can be made about calls for better governance. Improving accountability, transparency and effectiveness would be an excellent idea. But setting targets for those is difficult. Moreover, as extreme poverty falls, more of the core of deprivation will be in fragile and failing states such as Congo and Afghanistan—the very ones whose governments will be hardest to improve because they barely exist.

None of this means those gathering in New York next week are doomed to fail. The goal of eradicating extreme poverty is closer than ever; Nepal shows what can be done. But defining extreme poverty beyond the simple $1.25 a day is hard and deciding how to target social problems harder still. It will be an uphill struggle.