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Even Billions of Dollars Can't Solve Global Health Problems

The world's most deadly diseases are AIDS, malaria and tuberculosis. Together, they account for 6 million deaths each year, most of them in the developing world.

In recent years, multilateral institutions, governments and private foundations have responded to this global health challenge with billions of dollars in new funding. But some health advocates worry that these funds are too narrowly-targeted and that they are not meeting the basic health needs of millions of people.

In 2006, Warren Buffet, the world's second wealthiest man, contributed $30 billion of his personal fortune to the Bill and Melinda Gates Foundation, which itself has given away $6.6 billion over the past six years to support a broad array of global health initiatives. In 2003, the United States government made a five-year, $15 billion commitment to toward the President's Emergency Plan for HIV/AIDS Relief. Other large donations have come from wealthy countries and multilateral institutions.

All signs point to continued increases in this funding, according to Laurie Garrett, a senior fellow with the private Council on Foreign Relations. But she says the donations have grown at such a rapid pace that there is little time to reflect on how the money is being spent. "Are we doing the right things?" she asks. "Are we addressing the right problems and are we addressing them in the proper manner?" She says a larger issue is that the majority of the money is earmarked for very specific, narrow disease problems.

Garrett says efforts to fight disease must take account of local health care services, if such services are even available. She points to a worsening shortage of health care workers in sub-Saharan Africa, a deficit experts put at roughly one million people. It's due, in part, to the flight of trained professionals to wealthier countries, where the population is aging and more services are needed. Garrett says this 'brain drain' is complicated by the fact that many developing countries lack the basic infrastructure to support a health care system. In many poor countries, hospitals, clinics and laboratories have suffered decades of neglect.

Garrett advocates taking a more global, multi-system approach to public health, rather than focusing exclusively on single diseases. "Unless we do that," she warns, "we are going to see this whole moment of generosity turn into something sour, perhaps even claiming increased mortality."

Roger Bate, with the Washington-based American Enterprise Institute, says historically, poorer countries have not made health care a priority and money earmarked for health services has often gone elsewhere. He says these nations must rethink their priorities, adding, "we need to accept we have a role [in helping] these countries, but if they don't want to help themselves - and it is not just health spending, it is the other things that they are doing in the country - we will not make much of a difference."

Pressure from the United Nations, the World Health Organization and wealthy donors has begun to push governments in poor nations to spend more on health, according to Laurie Garrett. But she says it is still the killer diseases -- AIDS, malaria and tuberculosis -- that dominate the funding picture, even as greater numbers die from childbirth complications, childhood illnesses, respiratory and intestinal infections, and uncontrolled diarrhea. "The result is programs that don't have glamour here in the wealthy world, that don't have political constituencies fighting on their behalf, are losing personnel and therefore suffering, and in some countries we are already seeing the result."

Garrett would like to see the World Health Organization take the lead in coordinating the increasingly complex global health care initiatives. "[The WHO] can corral all the various forces to come together and create joint strategies and execute them in ways that actually result in sustainable health systems."

Roger Bate says that while the W-H-O plays a vital role in disseminating critical health information, it has been less successful in setting targets and coordinating aid response. "Of all of the targets they have ever set," he notes, "all of them have missed." He says the most egregious failure was the so-called '3x5 Campaign' to get 3 million people treated for HIV by the end of 2005. "Everyone knew that was impossible from the beginning and WHO, in trying to coordinate increases in spending for treatment on HIV, actually undermined some of the health systems in developing countries."

Roger Bate agrees with Laurie Garrett that unless drastic changes are made to improve the economies and health care infrastructure of developing countries, simply increasing aid will not improve global health.