Prioritizing Health: Who Gets to Decide?

Every year, millions of dollars are poured into campaigns designed to fight HIV/AIDS in Africa. Thousands of bed nets are bought through funds raised by Westerners to help eradicate malaria in developing countries. The health needs of children in Malawi must be addressed immediately, and then it’s teenage girls in India. Who is deciding where the greatest need is? What does this decision process look like? Often it feels that the answers to these questions lie in celebrity endorsements, documentary filmmakers and funding from the Gates Foundation or the Clinton Global Initiative, rather than national and local governments, global health experts, and the poor themselves.

Jeremy Shiffman speaks to this issue particularly well, in his piece on global health issues. He reminds the reader that much like any other issue, health policy is crafted and formed through the actors engaged in agenda setting, the narrative of the problem, and the current political climate. Should this be the way that the health of a population is decided? Can we take the politics out of health policy? If we can (and I know that we can’t) should we? Is health policy and service delivery different than, let’s say, education or tax policy?

I am not naïve enough to think that policymaking can be tailored to specific issues, but how then, as a global community, can we address the (truly) most pressing health issues in a given place? Should this power really be placed in the hands of those with the most money and the best marketing scheme? To the people with a more influential Rolodex? I agree with Shiffman, I do not think that we can take the “social constructionism” out of policy making, but I have to believe that there is a more responsible, equitable, and efficient way to prioritize global health issues. Policymakers need to look at all available data, they need to analyze and reanalyze it. They must listen to experts on the issue, and they must understand the specific context in which the policy will be implemented. Cost of an intervention should play a role, but it should not be a final determinant. Health is complicated and intricate, and so to is forming the policies that address it. These more nuanced actions must take precedence over a check, photo, and handshake with a former president, a business mogul, or a celebrity; the health of the world depends on it.

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