Money or Die

A Watershed Moment for Global Public Health

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.

In the spring of 2000, the Clinton administration officially defined HIV and emerging diseases as national security threats, which expanded U.S. grounds for engagement in global health. At a major international conference that summer, former South African President Nelson Mandela framed equitable access to HIV treatment and prevention as the primary moral challenge of the twenty-first century. The call resonated with antipoverty activists, including the rock star Bono and the economist Jeffrey Sachs; health advocacy groups such as Médecins Sans Frontiers, Partners in Health, and ACT UP; and institutions such as the World Health Organization, UNICEF, and the United Nations AIDS Program. Microsoft founder Bill Gates and his wife, Melinda, stepped up their breathtakingly generous philanthropic efforts in global health through their Gates Foundation. And in his 2003 State of the Union address, U.S. President George W. Bush proposed a multibillion-dollar program to tackle AIDS in

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