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RealClearPolitics - Articles - Laurie Garrett

Last Build Date: Sat, 13 Jan 2007 00:43:33 -0600

Copyright: Copyright 2007

The Challenge of Global Health

Sat, 13 Jan 2007 00:43:33 -0600

Thanks to their efforts, there are now billions of dollars being made available for health spending -- and thousands of nongovernmental organizations (NGOs) and humanitarian groups vying to spend it. But much more than money is required. It takes states, health-care systems, and at least passable local infrastructure to improve public health in the developing world. And because decades of neglect there have rendered local hospitals, clinics, laboratories, medical schools, and health talent dangerously deficient, much of the cash now flooding the field is leaking away without result. Moreover, in all too many cases, aid is tied to short-term numerical targets such as increasing the number of people receiving specific drugs, decreasing the number of pregnant women diagnosed with HIV (the virus that causes AIDS), or increasing the quantity of bed nets handed out to children to block disease-carrying mosquitoes. Few donors seem to understand that it will take at least a full generation (if not two or three) to substantially improve public health -- and that efforts should focus less on particular diseases than on broad measures that affect populations' general well-being. The fact that the world is now short well over four million health-care workers, moreover, is all too often ignored. As the populations of the developed countries are aging and coming to require ever more medical attention, they are sucking away local health talent from developing countries. Already, one out of five practicing physicians in the United States is foreign-trained, and a study recently published in JAMA: The Journal of the American Medical Association estimated that if current trends continue, by 2020 the United States could face a shortage of up to 800,000 nurses and 200,000 doctors. Unless it and other wealthy nations radically increase salaries and domestic training programs for physicians and nurses, it is likely that within 15 years the majority of workers staffing their hospitals will have been born and trained in poor and middle-income countries. As such workers flood to the West, the developing world will grow even more desperate. Yet the visionary leadership required to tackle such problems is sadly lacking. Over the last year, every major leadership position on the global health landscape has turned over, creating an unprecedented moment of strategic uncertainty. The untimely death last May of Dr. Lee Jong-wook, director general of the World Health Organization (WHO), forced a novel election process for his successor, prompting health advocates worldwide to ask critical, long-ignored questions, such as, Who should lead the fight against disease? Who should pay for it? And what are the best strategies and tactics to adopt? The answers have not been easy to come by. In November, China's Dr. Margaret Chan was elected as Lee's successor. As Hong Kong's health director, Chan had led her territory's responses to SARS and bird flu; later she took the helm of the WHO's communicable diseases division. But in statements following her election, Chan acknowledged that her organization now faces serious competition and novel challenges. And as of this writing, the Global Fund to Fight AIDS, Tuberculosis, and Malaria remained without a new leader following a months-long selection process that saw more than 300 candidates vie for the post and the organization's board get mired in squabbles over the fund's mission and future direction. Few of the newly funded global health projects, meanwhile, have built-in methods of assessing their efficacy or sustainability. Fewer still have ever scaled up beyond initial pilot stages. And nearly all have been designed, managed, and executed by residents of the wealthy world (albeit in cooperation with local personnel and agencies). Many of the most successful programs are executed by foreign NGOs and academic groups, operating with almost no government interference inside weak or failed states. Virtually no provisions exist to allow the world's poor to say what they want, decide which projects serve their nee[...]