From "Marvelous Momentum" to Health Care for All: Success Is Possible With the Right Programs

Intelligent Design

Paul Farmer

The last quarter of the twentieth century saw little investment in international health or in the health problems of the world's poor. Over the past few years, as Laurie Garrett notes ("The Challenge of Global Health," January/February 2007), "driven by the HIV/AIDS pandemic, a marvelous momentum for health assistance has been built and shows no signs of abating." But after this upbeat introduction, Garrett proceeds to lay out the perils associated with this new momentum, chief among them that an influx of AIDS money has drawn attention away from other health problems of the poor, weakened public health systems, contributed to a brain drain, and failed to reach those most in need.

I respond as a physician who has lived through the dry spell, seen the rains coming, and witnessed the burgeoning of the first sprouts of hope in a long time. Because many others who work in places such as rural Africa and Haiti -- the examples used by Garrett in her essay -- also see the threat of bad seeds ruining the harvest, I will not dispute her argument about the disproportionate use of scarce health-care resources. In fact, I agree with most of her claims. I would rather focus on how the new enthusiasm about global health can be translated into efforts to close the widening "outcome gap" between rich and poor.

The stakes are enormous. It is well known in development circles that huge amounts of aid have often brought few improvements to the lives of the world's poorest. A first principle for the emerging global health movement, in fact, might well be "Do not emulate the mainstream aid industry." That said, aid is not bad in itself, and if managed appropriately it can achieve impressive results. The end of the funding drought has been a tremendous boon, especially for the destitute and sick (and those who provide care to them).

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