18 September 2006

Are Global Health Problems a Matter of Charity? No.

I just came across this essay from the New England Journal of Medicine: "Global Health: The Gates-Buffett Effect," by Susan Okie, M.D., who is a contributing editor to the NEJM. In the essay Okie generally (and, rightly in my view) praises the Gates Foundation for its efforts to address problems of global health. She makes it clear that those efforts are in themselves insufficient given the scale of the problems. She suggests in conclusion that "Perhaps the Gates Foundation's greatest influence derives from its assumption that intractable problems can be solved, given enough money and international cooperation."

This essay raises a couple of important points mostly by neglecting them entirely. First as Okie points out:

"Yet the projected cost of solving major health problems in the developing world is far higher than even the most optimistic projections for giving by Gates. In 2000, the United Nations adopted Millennium Development Goals to be achieved by 2015; they included substantially reducing child and maternal mortality, reversing the spread of HIV-–AIDS and malaria, and reducing the prevalence of tuberculosis and associated mortality. It is estimated that to meet these health goals, international aid would have to increase by a factor of three to seven."

This may seem insurmountableble hurdle until we recognize that the share of GNP given international aid by most "advanced" nations is pathetically small. I recently posted on a book by economist Bob Sutcliffe that uses graphics to provide 100 Ways of Seeing an Unequal World; I recommend his way #92 - "Aid as Share of National Income." There we see that only Denmark gives as much as 1% of GNP international aid. The US gives 1/10th of that. On average, donor countries give just 0,35% of GNP for such purposes. And that is total international aid, not just that directed at health problems. So, Okie may be making the wrong inference; it may be that the cost of remedying global helath problems actually is relatively small! It would simply require the nations in the developed world to be less niggardly.

That leads to the second point. I applaud the Gates Foundation; it is doing much good. In particular, as Okie makes clear, the Foundation is leveraging the dollars it distributes into pressure on various actors to start cooperating! But one lesson that people might take from the Gates Foundation's activities is that major international problems are a matter of philanthropy or charity and not a political - meaning governmental - responsibility. Okie is right - all the charity in the world will likely remain insufficient. But that means re-thinking the nature of the task. Global health and other international problems, are simply not matters of charity. They are matters of politics. In that sense Bill & Melinda Gates may be misleading us.

[Thanks to Abbas Raza over at 3 Quarks Daily bringing the Okie essay to my attention!]

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