Implementing Global Health Interventions

At last night’s dinner, we questioned how we will pursue global health efforts and equality of health for all. Lobbying policy makers, leading large activist groups, and publishing our findings were some ways we discussed about addressing various issues. Simply being active in efforts to achieve global health will begin the process.

It seems that our president, Mitch Daniels, is also pursuing global health efforts. He currently co-chairs the Council on Foreign Relations’ Independent Task Force on Noncommunicable Diseases, according to this article in the Exponent:

http://www.purdueexponent.org/campus/article_c2fe035b-2d02-5f0a-a120-2d4f827a89e2.html

First of all, I applaud President Daniels on addressing global health, especially noncommunicable diseases, which receive such little attention on a global scale. Daniels says in the article “While we don’t prescribe any level of this or that, we do point out the rather stunning opportunity that’s here in a situation in which the U.S., which is only spending 0.2 percent of its budget on the whole global health picture, is only spending a little over 0.1 percent of that on NCDs.” The article also mentions that Daniels believes that U.S. international aid should be increased. While I agree with him, I was surprised that a conservative like himself who focuses on cutting costs would support increasing costs. How great is it that he believes in reducing the cost of tuition for higher education and promotes spending on issues such as global health?

However, I would also like to critique one aspect of President Daniels views. He believes in implementing cost-effective interventions in low-infrastructure settings. While this may be helpful in the short term, these sorts of interventions will not be sustainable in the long term. Focus must be concentrated on improving infrastructure. This could be done in the diagonal approach, as described in our RIG text, where disease states are targeted, which ultimately strengthens health infrastructure. However, Mitch Daniels seems to be in a neo-liberal mindset. He speaks of “$21.3 trillion loss in developing countries over the next two decades.” In addition to cost-effective interventions, this is not the mindset that should be used in expanding global health resources.

On the other hand, President Daniels suggested in the article to improve infrastructure in ways that it has already been improved relating to diseases such as AIDS. This seems to be similar to the diagonal approach that is described in our RIG text (Farmer, 2013, p. 304). President Daniels’ talk of cost-effectiveness seems to conflict with his ideas of improving infrastructure. In a way, I do not think that this is wrong. He is promoting expanding resources for global health and is trying to get the most out of the resources that are available. However, it has also been noted that “When global health is understood as a zero-sum game—when practitioners and policymakers are socialized for scarcity—some priority always loses when another wins” (Farmer, 2013, p. 336). Because of this, I struggle with President Daniels’ conflicting views of increasing equity by expanding resources and using cost-effectiveness strategies to implement global health interventions.

Farmer, P., Kim, J. Y., Kleinman, A., & Basilico, M.  (2013). Reimagining global health an

            introduction. Berkeley: University of California Press.