This article makes three points regarding international assistance in health, AIDS, and population. First, despite growing attention in the development policy dialogue, the share of health (broadly considered) in total assistance is actually declining, not increasing, if assistance for the HIV/AIDS crisis is taken out of the picture. Second, interventions financed by international health assistance do not closely correspond to the burden of disease as conventionally calculated. HIV/AIDS receives a share of assistance in excess of its contribution to the global burden of disease, and reasons for this are adduced. Third, despite the emphasis on aligning international assistance to country priorities, a comparison of how health is treated in poverty‐reduction strategies and the nature of health assistance reveals no clear relationship between the two. This suggests that there may be room for improvement in the process of preparing such strategies, the allocation of health assistance, or both.
The 'global public good' (GPG) concept has gained increasing attention, in health as well as development circles. However, it has suffered in finding currency as a general tool for global resource mobilisation, and is at risk of being attached to almost anything promoting development. This overstretches and devalues the validity and usefulness of the concept. This paper first defines GPGs and describes the policy challenge that they pose. Second, it identifies two key areas, health R&D and communicable disease control, in which the GPG concept is clearly relevant and considers the extent to which it has been applied. We point out that that, while there have been many new initiatives, it is not clear that additional resources from non-traditional sources have been forthcoming. Yet achieving this is, in effect, the entire purpose of applying the GPG concept in global health. Moreover, the proliferation of disease-specific programs associated with GPG reasoning has tended to promote vertical interventions at the expense of more general health sector strengthening. Third, we examine two major global health policy initiatives, the Global Fund against AIDS, Tuberculosis and Malaria (GFATM) and the bundling of long-standing international health goals in the form of Millennium Development Goals (MDG), asking how the GPG perspective has contributed to defining objectives and strategies. We conclude that both initiatives are best interpreted in the context of traditional development assistance and, one-world rhetoric aside, have little to do with the challenge posed by GPGs for health. The paper concludes by considering how the GPG concept can be more effectively used to promote global health.
This essay, written ten years after the first human death from avian influenza, reviews scientific, social, and policy aspects of pandemic influenza, and asks whether the near‐crisis level of concern is justified. That there will be another influenza pandemic is certain, and a number of factors suggest it will occur sooner rather than later. It is impossible, however, to predict two of the pandemic's crucial characteristics—its pathogenicity and the age‐attack curve. The scientific arsenal has never been stronger, yet gaps in the availability of antiviral drugs and vaccines are inevitable, and the world is poorly prepared to cope with the politics of drug shortage. Some studies suggest emergent pandemics can be “ring‐fenced,” but these studies are not broadly accepted. Assuming that they cannot, rapid and global deployment of a range of responses, including social distancing, travel limitations, and prophylactic/curative application of antiviral drugs such as Tamiflu, can limit impacts. However, the impacts are bound to be significant if not severe. Overall health‐sector strengthening, rural development (particularly in the area of veterinary health), and addressing the local, national, and international governance issues that cut across all aspects of infectious disease are more likely to bear fruit, especially in the developing world, than the pandemic preparedness planning now in vogue.
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