Over the last three decades, public funding for global health organizations has dried up. Private companies are writing checks to fill the gap, and, accordingly, they are bending the agenda toward their interests. Realigning priorities, however, will mean getting more private firms involved, not less.
For decades, the WHO has debated whether to address specific diseases or to broadly strengthen healthcare systems. With the increasing threat of noncommunicable diseases, however, the WHO has to double down on the latter, and convince states that health concerns are integral to decisions about trade, agriculture, and urban planning -- the whole of government.
For the second time in less than six months, polio vaccine workers in Pakistan have come under fire. For the gunmen, killing health care workers has been seen as a legitimate response to a nefarious extension of Western power. And, for the CIA, faux vaccine campaigns have sometimes been justified as part of the war on terror. Both sides are wrong: denying or providing health care should never be an instrument of statecraft.
A WHO malaria project in Cambodia. (Gates Foundation / flickr)
Global health programs now teeter on the edge of disaster. The world economic crisis and the politics of debt reduction are threatening everything from malaria control and AIDS treatment to well-baby programs and health-care worker training efforts. And even if the existing global public health architecture survives this time of parsimony and austerity, it will have been remodeled along the way.
Prior to 2000, the links between global health programs in poor and middle-income countries and changing foreign policy priorities in wealthy nations were weak, largely because the programs themselves were just not that large. In 1999, for example, total health spending in developing countries -- for efforts ranging from clean water provision and government clinics to vaccination campaigns and HIV treatment -- was about $5.6 billion, with the United States government providing roughly a third of that and U.S. private donors another tenth. But over the next decade, the picture changed dramatically, driven by a continuing economic boom and alarm over the expanding AIDS pandemic.
Read more at at Foreign Affairs' Special Report: Global Public Health.