The Challenges of a Shifting Global Health System

For the average American, one who only listens to news headlines and glimpses at the front cover pictures on magazines and newspapers, it would seem like we are doing a decent job helping the world's sick and poor. We see stories about the Bill and Melinda Gates Foundation giving millions of dollars to this program or see pictures of Angelina Jolie in Africa feeding hungry children. However, buried beneath those headlines and pictures are major problems with our global health system that money and celebrity faces will not be able to fix. 

According to an editorial piece in the Lancet "Who run global health," the last 2 decades of global health has seen a shift from primarily government influence to donor-driven influence. On the surface, it seems as though these private foundations are providing billions of dollars, so we should all feel satisfied. Unfortunately, beneath the surface, there are many concerns about the future of global health due to the shifting influence. There is increasing inequality in services, reduced domestic spending, misalignment of health needs and the list goes on. In many cases, efforts are so focused on specific diseases that the population's general well-being is being overlooked. We are also fighting an aging society within developed countries, which is resulting in a shortage of health care workers.

Even though it seems like there is a huge flow of money between donor organizations and health programs, the burden of disease is much larger. For instance, it is estimated that over $300 million dollars were spent in 1999 on HIV/AIDS. That $300 million fell quite short of the $5 billion lost annually in medical care and productivity among African countries (Garrett, 2007). More money will not be the solution. Funding to poor countries comes with stipulations about how every dollar should be spent. So, countries walk away from it. Many times, the money gets stuck in banks or bureaucracies. Investing more would just mean a larger amount is stuck or misappropriated.   

As I read and learn about the challenges facing global health, I cannot help but think about America's current status. As the highest spender per person for healthcare in the world, we are achieving even higher scores in terms of patient dissatisfaction, reduced quality and uncoordinated care. In response to our unraveling healthcare system, the triple aim is focusing on changes such as improving care, lowering cost and improving overall health for Americans. But with such a hand in global matters, should America really be involved in fixing the face of global health when we cannot fix ourselves?

With each of these global challenges comes a slew of possible solutions- focus on reducing waste by coordinating key players, mobilize adequate and stable resources and implement exit strategies for health programs. Just as I have read about all of the possible solutions to helping America's healthcare system, it seems like everyone has their own ideas and agendas about what is best. It makes me question, how can we tackle a problem that is so vast and large? How do we bring together so many key players and agree on changes? How do we divert foundations away from their agendas and try to create just one?