Some of the world’s leading global health number-crunchers, at the Seattle-based Institute for Health Metrics and Evaluation, wanted to know if a perceived slowdown in what had been a rapidly increasing war chest for fighting diseases of poverty represented The End of the Global Age for global health.
Funding has flattened out, the study reports, but on a plateau that reveals one category of huge neglect – non-communicable diseases.
“From the late 1990s to 2010, we saw a period of rapidly increasing funding for global health,” said Michael Hanlon, one of the lead authors of the report released today entitled Financing Global Health 2012: The End of the Golden Age? The IHME report follows up several earlier, similar reports which revealed a plateau, and even a decline between 2010 and 2011, in new funding for global health activities.
“I think the good news here is that we’re not seeing a decline yet and are maintaining a high level of funding,” Hanlon said. “That could change, of course, but I think it’s fair to say we’ve ended the phase of rapid increases in funding and entered a new phase, a maintenance phase.”
Here’s an illustration from the IHME report showing, over the past 10 years or so, the overall increase in development assistance for health (DAH).
Whether this is good enough (relative to what we spend on dog food, cosmetics and bottled water – not to mention military adventures or bailing out struggling bankers) is another question, of course. And whether the money is going where it’s most needed is another question raised by this report. Following are some highlights:
Total global health spending (DAH) in 2012, based on preliminary estimates, amounted to $28.1 billion. The 2012 increase represents a 2.5% increase over the previous year. (Note: I will generally use ‘global health spending’ to mean DAH in the list below, for simplicity’s sake.)
- One of the top sources of global health funding, the Gates-sponsored Global Alliance for Vaccines and Immunization (GAVI) had exceptionally strong rates of growth. In 2012, expenditure by GAVI reached an estimated $1.76 billion in 2012, a 41.9% increase over 2011.
- The sub-Saharan African region received the largest share of global health funding (DAH). In 2010 (the most recent year for which recipient-level estimates are available), sub-Saharan Africa’s share was $8.1 billion, or 28.7% of total spending.
- Many of the countries with the highest disease burdens do not receive the most global health funds. Of the top 20 countries with the highest all-cause disability adjusted life years, or DALYs, only 12 are among the top 20 recipients of global health funding. However, seven of the remaining eight countries are classified as middle-income by the World Bank.
- With respect to the globeal health spending allocated to specific health focus areas, funding for HIV/AIDS, tuberculosis, and maternal, newborn, and child health continued to grow through 2010 (the most recent year for which focus area estimates are available). Spending for health sector support, noncommunicable diseases, and malaria fell slightly from 2009 to 2010.
“There were predictions that the sky was going to fall on global health funding, but that didn’t happen,” Christopher Murray, the institute’s director, said in a statement. Still, Murray said, “The projections for further cutbacks in development assistance do not augur well….”
“One of the most interesting things to me in this report is how little of the (global health funding, DAH) is being spent on non-communicable diseases,” said Annie Haakenstad, Hanlon’s colleague on the project. She noted that the IHME’s previous report on the Global Burden of Disease clearly showed that non-communicable diseases (NCDs) like heart disease or diabetes are on the rise and already represent a major contributor to death and disability.
“And yet the amount of funding for these diseases is incredibly small,” Haakenstad said. “I think for 2010 it was only something like $185 million spent on NCDs out of the total of $28.2 billion.”
Added Hanlon: “Calling that zero, as a rounding error, would not be an exaggeration.”
“This analysis highlights the mismatch between donor priorities and global health needs,” said Amanda Glassman, Director of Global Health Policy and a senior fellow at the Center for Global Development. “Before you can make a decision on where to allocate resources, you must first understand where that money is most needed.”
So, the number crunchers say, the good news here is that the spending on global health remains relatively stable despite the economic slowdown and a tendency for governments (and donors) to tighten their budgetary belts by cutting spending overseas.
But the bad news is that this period of stability may not last, and there may already be a “serious mismatch” between where the money goes and where the need is greatest.