Two reports in the last several weeks, both of them in The Lancet, are worth looking at together.
One was from Dr. Chris Murray and his data-crunchers at the Seattle-based Institute for Health Metrics and Evaluation, which reported a big increase in global health spending. The other, more recent one is from a Georgetown University professor who says we aren’t spending enough – in the right way — to make a difference.
Murray and his team reported a few weeks ago that international assistance spending on health has quadrupled over the last 20 years. That was largely considered good news, except for the fact that some poor countries have decreased their own public spending on health in proportion to how much foreign assistance they receive (Seattle Times). That’s the bad news part of this trend and it may really be bad, if not kind of sneaky, but the reality is probably a bit more complicated. This is because health, especially in many of these poor countries, is often not solely — perhaps not even primarily – determined by what is spent on health care.
This is the point made in the current Lancet by Lawrence Gostin, a Georgetown professor specializing in global health law. Gostin’s argument, (which he made earlier and is freely accessed here) notes that the international community still spends a relatively paltry amount on health. Yes, health spending as foreign assistance is now more than $20 billion annually, which sounds impressive. But Gostin compares this to the $300 billion spent just on agricultural subsidies (aka food aid, in which the U.S. is the main player and which many say hurts smallholder farmers while increasing poor country aid dependence) and the $1.5 trillion spent on foreign military ventures. Put in that context, he notes that foreign assistance on health accounts for about 1 percent.
Gostin says we need a new Global Plan for Justice, in which all developed countries will contribute 0.25% of their Gross National Income to fund a broad spectrum of programs incorporating health improvements together with water, sanitation and many of the other problems that are the “underlying” causes of poor health in poor countries. This amount, he says, is easily attainable and in line with previous aid pledges made (though not always fulfilled) by rich nations.
Well, okay, here we have another global fund idea (see my earlier post). Gostin may have made his proposal even more confusing by throwing in climate change mitigation as an additional focus. Chances are it won’t fly. But it’s worth thinking about.
Many public health experts and economists say it’s clear that improving health in poor countries is the most cost-effective way to affect a lot of other socioeconomic improvements. If people are healthy, they can work more and provide for their family. If kids are healthy, they learn better. The list goes on. Others focus on the “social determinants of health” and contend the key to improving health is first making more fundamental improvements in basic infrastructure like schools, roads, water and, of course, government.
Murray’s report and Gostin’s pitch should remind us that any effort to improve health in poor countries will not be simple to accomplish or even measure.