In Horton’s 2014 Editorial Comment in the Lancet he summarises his arguments from a recent conference debate in an attempt to affirm the proposition that global health investments benefit countries of the Global North more than those of the Global South. He begins with an admission of playing devil’s advocate and is consequently pleased his opponent, Prof. Sewankambo, won the debate.
Amongst a number of claims, Horton posits that Global Health is the tool of ‘an increasingly toxic network of sinister alliances’ used not only for political influence but also for corporate propaganda. Despite a potential lack of faith in his arguments, Horton touched on the cornerstone of global health’s ineffectiveness; unfounded interventions designed to foster a sense of achievement in developed countries. It is not a stretch to conclude that profound levels of funding going to interventions so discordant to the ethos of global health spell its death.
The most prominent way in which the Global North’s self-aggrandizement damages global health is through squandering funds on health interventions that lack impact. For example, one of the most ambitious forays into global health in recent times, the Grand Challenges in Global Health initiative was started by the Gates Foundation in 2003. None of the 16 challenge areas funded under the initiative have produced any interventions capable of dealing with the problems identified and aren’t expected to for another decade; this is despite funding of US$1 billion. But the research commissioned allows the Gates Foundation, USAID and other contributing bodies in western nations to ‘pat themselves on the back’ for doing their bit. Numerous criticisms have been levelled against the Foundation’s drive for complex technological solutions to problems more easily tackled through a social determinants of health approach. But even within the research community, prominent academics have decried the way in which the Foundation’s considerable spending power warps research priorities and keeps the best scientists “locked up in a cartel”. Additionally, the funding doesn’t even contribute to alleviating poverty indirectly through economic flow-on effects as, like Horton noted, the bulk of funding goes to developed nations.
Another example of squandered funds and poor accountability to those most in need were the recent failings of the WHO to adequately respond to the Ebola outbreak in West Africa. The WHO was criticised for improper resource distribution, country preparedness and delaying the declaration of a Public Health Emergency of International Concern. In part the WHO attributes its difficulties to underfunding by member nations. In the past, some have estimated it operates at 10% of the funding required. In response, member nations are reluctant to contribute more due to bureaucratic and political concerns.
While member nations begrudge their contributions to the WHO, it’s important to note that despite US$6.5 trillion being spent on health around the world, 84% of this is within OECD countries. Further, while US$227.9 billion has been spent on global health projects in lower socio-economic countries since 2000, Qatar is set to spend US$200 billion on the 2022 FIFA World Cup preparations. This demonstrates the blatant hypocrisy of developed nations in pledging support to a movement that claims to promote health equity within developing countries.
It’s clear to see that Global Health is at a crisis point. Errors such as those made during the Ebola outbreak are set to become more regular with the increasing risk of future outbreaks and chronic underfunding of the WHO. Continued investment in interventions based not in evidence but that provide the Global North with a sense of accomplishment impede practical change. It’s only by divesting ourselves of this need to feel validated that we can successfully resuscitate Global Health.