Is the Global Health System Broken?

AuthorJoe Cerrell/Helene Gayle/Tore Godal
PositionDirector, Global Health Policy & Advocacy, Bill & Melinda Gates Foundation/President, CARE J. Stephen Morrison, Director, Africa Program, Center for Strategic and International Studies/Special Advisor to the Norwegian Prime Minister and founding Executive Secretary of GAVI
Pages36-38

Page 36

Three points of view on how the global health system can be improved

In September 2000, the global community committed with great fanfare to meet a set of eight Millennium Development Goals by 2015-three of which center on health: reducing child mortality by two-thirds; reducing maternal mortality by three-fourths; and halting and beginning to reverse the spread of HIV/AIDS, malaria, and other major diseases. With eight years left, how are we doing? The answer is not good; in fact, the world looks set to miss all three of these goals. Could the problem be that the global health system is now outdated and badly in need of an overhaul? F&D asked a few key health players for their insights.

Making Markets Work

The current global health system has achieved stunning, lifesaving successes-from the global eradication of smallpox to smaller daily victories, such as delivering healthy babies in refugee camps in the most war-torn parts of the world. And yet the system also fails. It fails the 2 million children who die each year of vaccine-preventable disease; it fails the millions who die of malaria, tuberculosis, and AIDS; and it fails to mobilize the financial and scientific resources to give every child born in this world an equal chance at a healthy life.

But declaring that the global health system is "broken" suggests a sense of hopelessness, perhaps even defeat. In fact, the global health system is not beyond repair. With increased resources, improved policies, and greater political will, it is possible to transform health conditions in developing countries and save millions of lives. And, as traditional geographic boundaries blur and the fates of nations intertwine, improving global health is not only the moral thing to do: it is essential to the strategic interests of all countries, both rich and poor.

Moreover, the notion that a global health system per se is responsible for health outcomes removes personal and organizational accountability from the equation. everyone involved in global health has a responsibility to help make the system function better, including developed countries, multilaterals, developing country governments, and civil society organizations, including foundations.

Many strategies are needed to help repair the global health system. One strategy that has tremendous potential, but has been largely neglected until recent years, is to take greater advantage of market dynamics.

Markets-from local craft markets to global markets- have been central to the increase in standards of living for millions in the developed world and are transforming the global economic landscape. But sometimes markets need some scaffolding to function effectively: recently, the Nobel Prize in economics was awarded to three deserving individuals for their work in explaining how incentives, information, and structures affect the functioning of markets, to "distinguish situations in which markets work well from those in which they do not." Influencing market dynamics related to global health can bring about a transformation similar to the one we have seen in developed countries.

Some of the greatest inequities in global health result from markets that are not structured to...

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