Who knows best: The affected country or the rest of the world?

Global health has become more of a priority than ever. It’s on agendas across the world—included in the aims of the Millennium Development Goals, on the U.S. President’s desk, at the World Health Organization, the Bill and Melinda Gates Foundation, and the list goes on…

But who’s to say that these individuals or organizations know what’s best for the people of India? Or those suffering in Ethiopia? Or the poor people of Nicaragua?

Too often global health priorities are set by those who are unaffected, who are far away from disease, who don’t experience its pain and suffering. People with big money or big power want to make a big difference. That’s wonderful, but are they doing it effectively?

Across the board, international actors are fighting the same, major health concerns, leaving much to be desired by the developing countries not affected by these priorities.

Three of the eight Millennium Development Goals focus on global health, or more specifically, they work to reduce child mortality rates, improve maternal health, and fight HIV/AIDS, malaria and other diseases. These global priorities have set precedence for other international organizations that have adopted these struggles as their priorities as well.

The World Health Organization, for example, has refocused its efforts to more effectively address the MDGs, most notably the goal concerning HIV/AIDS, turning their attention away from their initial, more inclusive mandate as the normative health organization.

In 2000 and 2001, the G8, the World Economic Forum, the World Bank and the European Commission all made commitments to address HIV/AIDS, tuberculosis and malaria. In 2002, USAID allocated its population, health and nutrition funding to HIV/AIDS, family planning/reproductive health, child survival/maternal health, and infectious diseases.[1] Even private foundations, like the Bill and Melinda Gates Foundation, share these priorities.

While the health concerns in the MDGs are certainly significant and warrant a great deal of attention, they have steered international actors toward narrow agendas that work to achieve these goals almost exclusively. This makes sense and will help the world reach our targets sooner, but it also leaves few agendas that address other, unfortunate diseases, like lower respiratory infections. Neglected, these diseases will creep up behind us before we know it.

International priorities have geared the world toward vertical approaches that produce disease-specific programs, which are beneficial, but which can’t act alone. Horizontal, more broad approaches to global health are also needed to maintain the progress we’ve made so far, to avoid the spread of other disease and to benefit developing countries not significantly affected by the disease-specific programs. While the major priorities addressed tackle the majority of health concerns in sub-Saharan Africa, they don’t necessarily represent the concerns of the rest of the world.[2] So these “global” health efforts can’t be all that “global” if they’re not accurately and directly addressing concerns that affect the entire world.

International actors play a huge role in global health, providing $22 billion a year in financing for global health programs. Because of this large sum of money, most of which is allocated to specific causes, international priorities are dictating national priorities. Twenty-two billion dollars could go a long way, but it can go even farther if we more appropriately consider the individual needs of specific countries or regions. This would not be easy, but it would make for a lot more value for the international buck. People with big money or big power would be making a bigger difference. And while those contributing the money certainly have the right to recommend where the money should be allocated, at the end of the day, the country knows best.




[1] USAID: Total population, health and nutrition funding. 2002.

[2] World Health Organization. World Health Report 2002. Reducing risks, promoting healthy life. Geneva. 2002.


One response to “Who knows best: The affected country or the rest of the world?

  1. this is the second post I’ve read that seems to speak to a recent paper I’ve written (actually, a chapter from my dissertation that is my job market paper). I’ve been presenting the findings from the paper (essentially that rural Malawians don’t prioritize HIV/AIDS) and am constantly asked whether I think Malawians are rational in their low prioritization of HIV/AIDS.

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