Editor’s Note: Few outside of the global health ‘industry’ were likely paying much attention to the 66th meeting of the World Health Assembly in Geneva, which just ended. One who did pay close attention is Laurie Garrett, a journalist and global health expert at the Council on Foreign Relations. Laurie published a good series of reports on the main issues at the meeting, which can all be read at her blog. She looked at the fuss over some Dutch scientists patenting a new virus (or, arguably, their methods of studying it), the climate-health connection and other issues.
Her posts provide great insight into matters of concern at the World Health Organization and the doings of the global health community. I asked Laurie, a friend and colleague of long-standing, to write an introductory summary to her blog posts and explain why she’s concerned about the ‘survival’ of global health.
A few years ago I was speaking at the World Economic Forum in Davos, trying to get extraordinarily wealthy, powerful individuals to give a few minutes attention to HIV, TB, emerging diseases, inequities in access to treatment for cancer and heart diseases and other global health issues.
During a break I grabbed a bite with two of Global Health’s most famous men – one, an economist, the other a physician. For a few minutes the physician raged about what an awful, disastrous mess the World Health Organization was, concluding, “It’s in the way more than it helps for anything.”
“Well,” said the economist, “My obstacle is the World Bank.” And after ranting about all the failures and political horrors he perceived at the Bank the economist concluded, “Let’s tear the damned Bank down.”
The two jokingly argued about which institution, WHO or the Bank, was worse and therefore first ought to be destroyed. After the economist departed, the physician chuckled and said a new Bank designed by that economist wouldn’t be any better.
“But would a new WHO be any better than the one we have now,” I asked? “Given it must be the voice of 200 countries, won’t it always, by definition really, be a failure for some or many?”
The physician sighed, and said. “If we didn’t have the World Health Organization, we would have to invent it, and yes, it would probably end up just the way it is.”
The challenges for Global Health in 2013 are very different from those that spawned this heated conversation in Davos in 2004. Global Health succeeded in garnering the attention of the rich and powerful, got its places at the tables of the G8, Davos, Aspen, EC, ASEAN, APEC – you name it. The money poured in, some spectacular achievements followed, but by 2010, thanks largely to the worldwide recession, the monetary helium started leaking out of the Global Health balloon.
Today the UN system, along with hundreds of ancillary entities and notable world leaders, is debating the post-MDG, post-2015 targets, in an atmosphere of financial austerity. Secretary General Ban Ki-Moon has repeatedly called for a tightly synergized agenda, in which development, health, anti-poverty, climate and food targets are tightly interwoven, and present more opportunities for bridging the activities of currently separated agencies and multilaterals.
The most frequently discussed targets for health in this new algorithm are overall health systems development and provision of family bankruptcy-sparing health coverage for all. Governments in such schemes would be responsible for the health of their people, less reliant on external financial support, and far more dependent on technical advice regarding such things as insurance, pharmaceutical purchasing and processing, healthcare worker training and sustainable health infrastructure creation.
If the UN opts to follow this course for Global Health, pressure to provide technical support for a broad swath of diseases, prevention and wellness efforts, medical education and infrastructure will fall on the existing Global Health super structure. It is doubtful significantly more funding will support that added mandate.
As Dr. Margaret Chan noted in her remarks to the Assembly, the new agenda for her WHO is more likely to put the agency in conflict with sources of great wealth, as broad principles of wellness add the food and beverage industries to tobacco and pharmaceuticals to the list of Fortune 500 corporations whose products may be deemed by WHO unhealthy for human consumption. Or those products may be named healthy – even essential – but not at the prices set by manufacturers. Effective campaigns targeting sugar, salt, excessive carbohydrates, drug and medicine prices and food processing could very likely further diminish donor support for WHO and Global Health, writ large, as the industries pressure their governments to demonstrate political backing for multi-billion dollar corporations, and the jobs that they generate.
Can Global Health survive this transition? Who ought to take the lead – what agency or organization? What issues should Global Health be addressing that it currently fails to tackle or handles poorly? Where will its resources come from, and how will donors fit into the country-driven picture?
If you’re interested or concerned about these questions, read much more at Laurie’s blog posts.