Dr. Alejandro Toledo, former president of Peru, describes his vision as “democracy that delivers.”

“My colleagues and I who have taken the challenge of public life as a vocation and a life commitment,” Toledo says, “cannot but feel concerned about the great challenges faced by our continent where half its population lives between poverty and misery and where inequalities and social exclusion are at their highest.” Toledo has spent the past academic year in residence at the Center on Democracy, Development, and the Rule of Law, applying theoretical rigor to a bold new plan for Latin America and also making a sweeping call to action. At the same time, as Distinguished Visiting Payne Lecturer for the Freeman Spogli Institute, Toledo has shared his vision and his plans for the future with the Stanford community in a three-part special Payne Lecture Series, titled “Can the Poor Afford Democracy? A Presidential Perspective.”

Forty percent of Latin Americans — 230 million people — are trying to survive on less than $2 a day, and 110 million live on less than $1 a day, Toledo is quick to point out. He also notes that income levels do not reflect the “drama of poverty”— things like infant mortality, malnutrition, lack of access to health care and education, and ethnically based social exclusion. Impoverished populations see corruption, exclusion, and economic inequality, and they begin to associate these things with democracy and become impatient with it. Toledo is calling for leaders to have the courage to invest in human development through nutrition, education, and microfinance programs and to make decisions that may not have short-term political benefits. “This is a moment for more leadership and less politics,” he said in January.

With the Global Center for Development and Democracy, the non-governmental organization that he founded, Toledo is organizing a new, broad-sweeping initiative to construct a social agenda for democracy in Latin America for the next 20 years. This Social Agenda for Democracy Initiative will identify specific and measurable goals to demonstrate that democracy is capable of “delivering concrete results to the poor.” To do this, Toledo says, the group of former Latin American presidents, democratic leaders, experts, and exponents of civil society that he is organizing will need to map out an agenda for both stimulating economic growth and reducing inequality and exclusion. Their agenda will be supported by parallel and ongoing efforts to promote and strengthen democratic institutions including judicial systems, freedom of speech, human rights, and the independence of all branches of government.

Toledo’s working group met for the first time on November 26, 2007, at the National Endowment of Democracy in Washington, D.C. The core team is made up of 12 former presidents, including Presidents Vicente Fox (Mexico), Fernando H. Cardoso (Brazil), Carlos Mesa (Bolivia), Ricardo Lagos (Chile), Cesar Gaviria (Colombia), Jose Maria Aznar (Spain), Rodrigo Carazo (Costa Rica), and Ricardo Maduro (Honduras). The group met again in Lima, Peru, on April 25, a meeting that Toledo is particularly excited about. “Our meeting in Lima has special significance for the initiative,” Toledo explains. “First, because the Latin American, Caribbean, and European Union Summit between 60 heads of state was held this year in Lima, just one month later, and second, because the theme of this year’s summit is ‘Poverty, Inequality, and Exclusion.’”

Which is the task that lies before Toledo and his colleagues.

One of the main aims of the Social Agenda for Democracy Initiative is to develop a social matrix to measure progress on key indicators such as economic growth, health, education, employment and salaries, poverty and income distribution, and access to technology. Several working group members reported on May 14 to the Latin American, Caribbean, and European Union Summit on the Social Agenda for Democracy Initiative and their progress in constructing this social matrix — giving the bold plan of this already super-charged group additional visibility and opportunity for capacity building. The group will meet two more times in 2008: in Bolivia this July and again in September in Sao Paulo, Brazil.

For Toledo, the link between democracy and social change is palpable — he is both the product of and an advocate for the transformative powers of these two processes. Democratically elected in 2001, Toledo was Peru’s first president of indigenous descent, having grown up in an impoverished and remote Andean village. “For 500 years, someone with my ethnic background was never accepted to be a candidate,” Toledo said in May, in his final Payne lecture. “I was a political intruder in the establishment of politics in Latin America and in Peru.”

In his five-year term as president, Toledo achieved 6 percent average annual growth, increased foreign direct investment by 50 percent, balanced the budget, and brought 25 percent of the population above the poverty line. He also initiated a program called Juntos, or “Together,” a system of conditional, direct cash transfers to female heads of the poorest households. In return for obtaining pre- and post-natal checkups, vaccinating their children, and making sure their children went to school, the women received $30 per month to invest in their economic self-sufficiency. The short-term solution provided by Juntos was initially criticized by the IMF but has been so successful that it is now being evaluated as a policy option by both the IMF and the World Bank and has been continued by the current government.

In his first Payne lecture, held in January, Toledo interwove firsthand observations with quantitative research to support his argument that a reduction in poverty and inequality does not necessarily follow economic growth. While he has “cautious optimism” that Latin America is poised to “make a substantial jump and take a prominent place in the world economy in the next 15 to 20 years,” he said that only an ambitious social agenda to reduce poverty and inequality will stimulate economic growth, strengthen democratic institutions, and consolidate democratic governance in the region.

Having analyzed the relationship between democratic reform, economic growth, and poverty, inequality, and social exclusion in Latin America, Toledo focused his second Payne lecture, in April, on some of the political dynamics in Peru leading up to his election to president. His multimedia presentation included footage of the mass protests that followed Alberto Fujimori’s controversial re-election to a third term in 2000 amid allegations of electoral fraud. Fujimori ultimately agreed to schedule a new election the following year and stepped down as a candidate.

In his third and final Payne lecture, on May 14, Toledo answered the question that served as the organizing principle for the series: Can the poor afford democracy? Yes, he said — but more importantly, “Democracy cannot afford to neglect the poor.”

Like Toledo, former president of Mexico and Social Agenda for Democracy colleague Vicente Fox sees positive economic and social growth for Latin America. He accepted Toledo’s invitation to visit the Stanford community and on March 5 spoke with intensity about Latin America’s prospects for both social welfare and economic well-being in the coming century. Mexico, which Goldman Sachs recently projected to be the world’s fifth largest economy by 2040, was emblematic of this electrifying future, he said. On the one hand, there is great promise for economic growth, stability, and entrepreneurship; and with this great promise, he was careful to note, comes great responsibility for the reduction of poverty and inequality through a “package of powerful social policies.”

Looking ahead, Fox hoped that Latin American democracy would not to be taken for granted; “it has to be nourished, it has to be taken care of, it has to be promoted.” But his outlook for Latin America is that this is a time for its countries to consolidate democracies and freedoms, consolidate economies, and promote new leadership. After years of military dictatorships, corruption, inefficiency, and poor development, “People decided to go for change,” Fox said, “and change is a magic word. It moves people to action.”

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At the volunteers’ home base in the town of San Lucas Toliman (1) an earlymorning gathering of medical trainees from Stanford, Harvard, and Columbia combs through donated medical supplies, organizing them for deployment in the field. Bronwyn Baz, MD (standing center), a Stanford pediatric resident, is on her fourth visit to the area and serves as a team leader. FSI’s Cross-Campus International Fund is sponsoring her trip to Guatemala this summer.¹

Patients crowd into the makeshift clinic, set up that day in the dusty outbuilding of a local elementary school (2) as part of an organized program of health services. Devin Briski (seated), a 16-year-old volunteer from Menlo School, searches the village’s patient records, while Stanford medical student Kimberly Montez stands behind her, ready to see her first patient. Working with the health promoters from the village, the clinic was able to serve 100 or more villagers in a single day.

Stanford infectious disease specialist Manual Amieva (3) examines a child as Harvard medical students Norris Kamo and Shanthini Kasturi gain valuable primary care skills under the close supervision of Amieva and other physicians. The students encounter a variety of medical problems, from severe scabies to epilepsy. Gastrointestinal infection and diarrhea are particularly insidious and widespread health threats.

With tooth decay rampant, volunteers try to schedule regular visits to local schools to administer prophylactic fluoride treatments (4) and dispense basic dental supplies, such as toothbrushes and toothpaste, to children.

¹FSI welcomes donor participation in its cross-campus international fund to help sponsor medical trainees' travel to Guatemala and other developing countries as part of the Stanford School of Medicine's commitment to international health.