Toward a Golden Age: Reflections on Global Health and Social Justice

Article excerpt

We are living in a time of unprecedented opportunity in global health. The past decade has seen bold health-related commitments from political leaders, such as the Millennium Development Goals and the 2005 pledge by heads of state and government to press toward universal access to HIV/AIDS treatment. Substantial new resources are flowing into the global health field. Between 2003 and 2005 alone, global spending on HIV/AIDS almost doubled, from US$4.2 to US$8.3 billion. Effective strategies have been developed to treat and prevent many of the greatest contributors to the global burden of disease. Investment in medical research by governments and donors like the Bill and Melinda Gates Foundation brings the promise of a new generation of products that, within eight to ten years, may dramatically bolster the world's arsenal in the fight against disease. At the same time, broad public interest in the health and well-being of poor and marginalized people in the developing world has exploded. Bill Foege, former Director of the US Centers for Disease Control and Prevention, has referred to this current period as the "golden age of global health" that he predicts will last at least until 2025.

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While all these developments are encouraging, there is an enormous gap between this growing political concern for global health and the actual health outcomes of vulnerable groups. The persistence of poor outcomes for so many in the face of huge new investments in global health is an ongoing tragedy. What is especially tragic is that, in many parts of the world, we are failing to intervene and save lives from conditions that could be prevented or remedied with existing--and often relatively simple--interventions. The World Health Organization (WHO) Commission on Macroeconomics and Health estimated that over eight million deaths per year could be averted with the effective delivery of proven health care services to affected populations. For these eight million souls, our inability to deliver costs them their lives. If we can find a way to export FedEx packages and cold Coca Cola to every corner of the world, surely we can find a way to dramatically improve our capacity to implement critical and often simple interventions.

Universities--as laboratories for ideas and training grounds for tomorrow's leaders--can play a major role in bridging this "delivery gap." But what have they been doing to help? Are there groups of scholars who, working together, might develop new insights, models of delivery, training materials and most importantly, mentor the next cadre of global health leaders who will become masters in global health delivery? Unfortunately, universities have not given high priority to healthcare delivery for predictable reasons. The gritty business of delivering health interventions has not attracted great interest in academic circles despite its inherent complexity and importance to the health of people everywhere, including wealthy countries. More to the point, the governmental institutions that could support scholars working on problems of global health delivery are woefully underfunded.

Now, as complex diseases that were once thought to be universally fatal in poor countries are beginning to be treated with an influx of significant new resources, our "failure to deliver" becomes even more problematic. In the case of drug resistant strains of tuberculosis that have been labeled "extensively drug-resistant tuberculosis" or "XDR-TB," both the moral imperative to treat those who are ill and enlightened self interest to protect citizens of developed countries has led to important gains in both financing and attention to the problem. In the realm of HIV treatment, we have swiftly moved from conventional wisdom that stated that treatment in resource-poor settings is not cost-effective or possible, to scaling up treatment for millions of HIV patients in low-and middle-income countries. …

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