To the Editor:
Laurie Garrett makes it painfully clear how shortsighted and dysfunctional our response to the global health crisis has been to date.
Garrett correctly points out that it will take more than money to make an impact on global public health, and she correctly states that unless we start tackling public health in general instead of narrow, disease-specific problems, we may end up worse off. But while her diagnosis is on target, her prescription misses the mark, because she misses the most basic factors underlying not only successful health infrastructures but also successful prevention programs and a successful health industry: good governance and a respect for human rights.
In a 2004 article in the British Medical Journal, Alvaro Franco and his colleagues plotted life expectancy and maternal and infant mortality in 170 countries against the "freedom index" -- a measure of political rights and civil liberties produced by Freedom House. The authors found a significant relationship between high freedom ratings and good health indicators, even controlling for wealth and the size of the public sector. A 2006 study by Daniel Reidpath and Pascale Allotey examined 176 countries using World Bank data and found similar results. It is reasonable to conclude that individuals are healthier and live longer where governments respect human rights.
Garrett's call to step back from disease-specific programs to focus on health infrastructure, and the industrial infrastructure that supports it, will bear no better results than the system she currently laments unless there is a simultaneous attempt to strengthen civil-society institutions and foster greater respect for the rights of individuals. Good governance and the protection of human rights help to ensure accountability, transparency, and participation -- and hence productive investment in health. Anticorruption efforts encourage industry formation, and free societies tend to keep highly trained -- and desperately needed -- health professionals from emigrating.
Sustainable and meaningful improvements in global health will only come with greater recognition and respect for human rights.
Director, HIV/AIDS Program, Human Rights Watch