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A time for global healthhttp://bmj.com/cgi/content/full/325/7355/54
EditorialsA time for global healthA global effort on health could inspire, unite, and produce substantial improvement
The life expectancy of the 642 million people in sub-Saharan Africa is 51 years, 27 years less than that of those who live in rich countries. Mortality among those aged under 5 is 25 times higher in Africa than in rich countries. The World Health Organization's Commission on Macroeconomics and Health, which reported at the end of 2001, estimates that by 2010 about 8 million lives a year could be saved in low income countries by investing large sums and acting through simple and effective interventions. 1 2 But will it happen? The rich countries have a poor record in fulfilling their promises to poor countries. Nevertheless, a small group of people with considerable influence on global health who met recently in California agreed that the lives might be saved. Raising expectations too high could lead to huge disappointment, but the opportunities for substantial improvement in global health are probably better now than at any time in the past 20 years. Perhaps because of the report of the Commission on Macroeconomics and Health
health is "fashionable" with world leaders in a way that it never has
been before. Some 60 world leaders The interest of world leaders in health is being driven by increasing
recognition that investment in health is a motor for development and
that global health and global security are inextricably intertwined.
The Commission on Macroeconomics and Health was dominated by
economists and financiers, not health experts Rich countries as well as poor countries would benefit from this economic growth. Some of the thinking that led to the commission was that both rich donors and governments of poor countries would be more likely to invest in health if what might be called "a business plan" showed economic return. Since the commission began, however, and since the attacks of September 11 the world has come to worry as much about security as about economic growth. There is as yet no commission on global security and health, but security experts are concerned about health, particularly AIDS, malaria, and drug resistant tuberculosis. The United States, which gives a much lower proportion of its gross national product in aid than any other rich country, may well be persuaded to increase aid by anxieties about its own security. This has already begun, and as one contributor to the California meeting said: "I'd much rather they gave me aid because they feared me rather than pitied me." But then again, if security is the reason for giving aid the money may well not go to those who suffer the most but rather to those who present the biggest threat. The commission's formula for improving health is in essence investment by both rich countries and poor countries plus reform. There is often debate about which should come first with the poor countries preferring money from the rich and the rich favouring reform in the poor countries. The commission concludes that both are needed simultaneously, but much of the world's current inadequate aid is unspent, and too many of the world's poorest countries are run by gangsters who care little for their people, particularly women and children. Little satisfaction is to be had from watching a corrupt government use aid to feed its soldiers to keep the corrupt in power. Aid, just like medicines, can sometimes make problems worse rather than better. Some countries are in such disarray that little can be achieved. The chances, for example, of rolling back malaria in Sierra Leone in the next five years are probably non-existent, whereas much might be achieved in more stable countries such as Ghana or Tanzania. Should aid therefore be given first to such countries? These are difficult questions. One never ending debate in international health is how much should be spent
on sector wide reform, trying to improve the whole health system, and
how much on specific (vertical) programmes aimed at producing
improvement with particular problems Globalisation, concluded the commission, is on trial. It may mean the rich
continuing to neglect and exploit the poor, spending huge amounts on
their own defences to keep out the poor, and allowing deterioration
in global health and further environmental degradation. In that case,
riots will continue at the meetings of global leaders, and the world
may become steadily more unpleasant for all of us, rich and poor.
Alternatively, globalisation through increasing openness and
recognition of interdependence could lead to dramatic reductions in
poverty and improvements in health. Finding political commitment to
use the best of modern science and technology and the huge wealth of
the rich world to improve health would, says the commission, inspire
and unite peoples all over the world. BMJ, (rsmith@bmj.com)
Footnotes People present at the California meeting on global health included Richard Feachem (director, Institute for Global Health, San Francisco, and a member of the Commission on Macroeconomics and Health), Julio Frenk (minister of health, Mexico, and one of the people who set up the commission in his time at the WHO), Geeta Rao Gupta (president, International Centre for Research on Women), James Orbinski (past president, Médecins Sans Frontieres), and Nafis Sadik (former executive director, United Nations Population Fund). Since the meeting Richard Feachem has become the head of the Global Fund.4
Rapid Responses:Read all Rapid Responses
Other related articles in BMJ:
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Copyright 2012 by Vaccination News, A Non-Profit Corporation. All Rights Reserved. This content may not be copied unless permission in writing from Sandy Gottstein has been obtained. 
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 "A foolish faith in authority is the worst enemy of truth." -- Albert Einstein, letter to a friend, 1901 "I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education." -- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820 "What's the point of vaccination if it doesn't protect you from the unvaccinated?" -- Sandy Gottstein "Who gets to decide what the greater good is and how many will be sacrificed to it?" -- Sandy Gottstein |
including
both Fidel Castro and George Bush