Laurie Garrett on The Challenge of Global Health

[Guest guest]

The Challenge of Global Health By Laurie Garrett

Special to washingtonpost.com's Think Tank Town

Wednesday, January 3, 2007; 12:00 AM

As I describe in my Foreign Affairs article " The Challenge of Global

Health " (January/February 2007), we find ourselves in a paradoxically

perilous moment. Health philanthropy that just five years ago

witnessed " large " donations in the tens of millions now routinely

hears of awards exceeding $200 million, targeting single projects. A

sense of urgency, both genuinely driven by expanding pandemics and

politically propelled by a wealthy-nation public that demands

immediate results, is pushing money into the coffers of poor nations'

ministries of health and a vast array of nongovernmental and

faith-based humanitarian organizations. But on the ground, where the

health needs are the greatest, decades of neglect have rendered

hospitals, clinics, laboratories, medical schools, and the pool of

health talent dangerously deficient. As a result, this Age of

Generosity could, with equally likelihood, usher a time of spectacular

improvements in the health of billions of people, or push societies

into even deeper trouble.

To witness the untoward, and unintended, effects of health generosity

Americans need go no further than a 45 minute plane flight from Miami,

to Haiti. This country with the highest HIV infection rate in the

Americas is managing one of the best AIDS treatment programs seen in

any poor country in the world, thanks in part to U.S. government

support. But as Haiti pushes down its HIV rates and treats people with

AIDS, all its other health markers deteriorate.

More than 5,000 Haitians now get daily medicines to control their HIV

infections, and the prevalence of HIV has plummeted from a 2002 high

of six percent in the general population to today's 3 percent. For a

war-torn, impoverished nation in which 80 percent of the population

lives on less than $2 a day these are grand achievements. But Haiti

has gone backwards since 1985 in every health indicator except AIDS.

When civil turmoil commenced in 1986, ushering in economic collapse,

Haiti's medical and public health systems fell to pieces. Surveys

showed that Haitians were dying younger ? life expectancy for men is

now merely 51 years. More women were dying in childbirth, with a

national maternal mortality rate that is the highest in the Western

world. Today Haiti needs 5,000 nurses and 2,000 doctors. Expatriate

physicians, mostly working in New York and Florida, keep the hospitals

of Haiti alive with their remittances, Bijou says. But you can only do

so much with charity.

Haiti reflects the paramount problem facing global health leaders

worldwide today: There is money on the global health table, thousands

of nongovernmental and humanitarian groups vie to spend that cash on

the ground, and a profound sense of charity is pervasive in the

wealthy world. Some NGOs have shown real success in treating AIDS and

slowing spread of HIV in poor countries. But it takes a state, a

health system and an infrastructure to raise all boats in a murky sea

of health needs.

Tackling the diseases of global poverty has over the last six years

become a key feature of the foreign policies of European, North

American and some wealthy Asian nations. For some of the G-8 nations

-- which have committed to spending $50 billion a year on global

health and poverty alleviation by 2010 -- stopping the spread of HIV,

tuberculosis, drug-resistant malaria and other major killers is a

pivotal form of public diplomacy. The United Kingdom's Gordon Brown

has framed the fight against disease in epic proportions, calling for

a $300 billion war chest to execute a penultimate moral and diplomatic

battle against poverty and premature death. For some G-8 players,

spending copiously to diminish the global burden of disease is as much

about self-interest as altruism: Spreading microbes know no borders.

If the global community, and in particular the U.S. foreign aid

establishment and WHO leadership, do not handle this historic moment

with great care, the end result of this Age of Generosity may well be

an increase in mortality in key poor countries.

http://www.washingtonpost.com/wp-dyn/content/article/2007/01/02/AR2007010200575.\

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Laurie Garrett is a Senior Fellow for Global Health at the Council on

Foreign Relations.