Recent IMF/World Bank reforms have real limits, deftly illustrated by the cause of debt cancellation. Ministers from wealthy nations have almost universally conceded that debt is a crisis, but assistance has been slow in coming. The creditor-based system of debt relief administered by the IMF/World Bank doles out aid at levels based more on poor countries' ability to cough up future payments than on what they actually need to reach humanitarian targets like the Millennium Development Goals. As economist Jeffrey Sachs writes, "It is perfectly possible, and indeed is currently the case, for a country or region to have a 'sustainable' debt" under IMF/World Bank definitions "while millions of its people are dying of hunger or disease."