Foreign Affairs - The Challenge of Global Health - Laurie Gar...

Summary:  Thanks to a recent extraordinary rise in public and private giving, today more money is being directed toward the world's poor and sick than ever before. But unless these efforts start tackling public health in general instead of narrow, disease-specific problems -- and unless the brain drain from the developing world can be stopped -- poor countries could be pushed even further into trouble, in yet another tale of well-intended foreign meddling gone awry.

Highlighted by ddobbs

Less than a decade ago, the biggest problem in global health seemed to be the lack of resources available to combat the multiple scourges ravaging the world's poor and sick. Today, thanks to a recent extraordinary and unprecedented rise in public and private giving, more money is being directed toward pressing heath challenges than ever before. But because the efforts this money is paying for are largely uncoordinated and directed mostly at specific high-profile diseases -- rather than at public health in general -- there is a grave danger that the current age of generosity could not only fall short of expectations but actually make things worse on the ground.

Highlighted by ddobbs

This danger exists despite the fact that today, for the first time in history, the world is poised to spend enormous resources to conquer the diseases of the poor. Tackling the developing world's diseases has become a key feature of many nations' foreign policies over the last five years, for a variety of reasons. Some see stopping the spread of HIV, tuberculosis (TB), malaria, avian influenza, and other major killers as a moral duty. Some see it as a form of public diplomacy. And some see it as an investment in self-protection, given that microbes know no borders. Governments have been joined by a long list of private donors, topped by Bill and Melinda Gates and Warren Buffett, whose contributions to today's war on disease are mind-boggling.

Highlighted by ddobbs

It takes states, health-care systems, and at least passable local infrastructure to improve public health in the developing world. And because decades of neglect there have rendered local hospitals, clinics, laboratories, medical schools, and health talent dangerously deficient, much of the cash now flooding the field is leaking away without result

Highlighted by ddobbs

in all too many cases, aid is tied to short-term numerical targets such as increasing the number of people receiving specific drugs, decreasing the number of pregnant women diagnosed with HIV (the virus that causes AIDS), or increasing the quantity of bed nets handed out to children to block disease-carrying mosquitoes. Few donors seem to understand that it will take at least a full generation (if not two or three) to substantially improve public health -- and that efforts should focus less on particular diseases than on broad measures that affect populations' general well-being.

Highlighted by ddobbs

The fact that the world is now short well over four million health-care workers, moreover, is all too often ignored.

Highlighted by ddobbs

one out of five practicing physicians in the United States is foreign-trained, and a study recently published in JAMA: The Journal of the American Medical Association estimated that if current trends continue, by 2020 the United States could face a shortage of up to 800,000 nurses and 200,000 doctors

Highlighted by ddobbs

Yet the visionary leadership required to tackle such problems is sadly lacking. Over the last year, every major leadership position on the global health landscape has turned over, creating an unprecedented moment of strategic uncertainty. The untimely death last May of Dr. Lee Jong-wook, director general of the World Health Organization (WHO), forced a novel election process for his successor, prompting health advocates worldwide to ask critical, long-ignored questions, such as, Who should lead the fight against disease? Who should pay for it? And what are the best strategies and tactics to adopt?

Highlighted by ddobbs

Few of the newly funded global health projects, meanwhile, have built-in methods of assessing their efficacy or sustainability. Fewer still have ever scaled up beyond initial pilot stages. And nearly all have been designed, managed, and executed by residents of the wealthy world (albeit in cooperation with local personnel and agencies). Many of the most successful programs are executed by foreign NGOs and academic groups, operating with almost no government interference inside weak or failed states.

Highlighted by ddobbs

As a result, the health world is fast approaching a fork in the road. The years ahead could witness spectacular improvements in the health of billions of people, driven by a grand public and private effort comparable to the Marshall Plan -- or they could see poor societies pushed into even deeper trouble, in yet another tale of well-intended foreign meddling gone awry

Highlighted by ddobbs