A Marshall Plan for Global Health: Greater Power, Better Results
This article is part of the eJournal USA issue "A Healthy Future ."
By David Bangsberg, MD, MPH, and Vanessa Bradford Kerry, MD, MSc
David Bangsberg is the director of the Massachusetts General Hospital Center for Global Health, director of International Programs at the Ragon Institute, and director of the International Program of the Harvard University Center for AIDS Research.
Vanessa Bradford Kerry is the associate director of Partnerships and Global Initiatives at the Massachusetts General Hospital Center for Global Health and the head of the program in Global Public Policy and Social Change in the Department of Global Health and Social Medicine at Harvard Medical School.
Health is a global public good, capable of transcending borders and populations. Because ill citizens are less economically productive, poor health fuels economic and social inequity, while public health improvements correlate instead with economic gains. In short, the health of a country's population both reflects and contributes to its economic and social conditions.
HEALTH IS DEVELOPMENT
Failure to address poor health undermines economic development. For example:
.. Premature death from heart disease, stroke and diabetes reduces gross domestic product between 1 percent and 5 percent in low- and middle-income countries, according to the World Health Organization (WHO).
.. Two-thirds of Zambian households suffered devastating declines in economic, social and educational status when their breadwinners died of AIDS: 80 percent of families reported decrease in income, 61 percent moved to cheaper housing, 39 percent lost access to clean water, and 20 percent of children dropped out of school, according to the U.N. Development Programme.
.. The WHO calculates 3 percent economic growth when life expectancy increases by 10 years.
Strategies to improve health are integral to the success of economic aid and development programs, and modest investments can secure sustainable success against many of the world's most feared diseases. U.S. and international investments to improve health in developing countries already have eradicated smallpox, nearly ended the scourge of polio and prevented other diseases through vaccination. According to the Joint U.N. Programme on HIV/AIDS, more than seven million people have started HIV treatment worldwide, and antiretroviral therapy has helped decrease the number and rate of new infections compared with a decade ago.
However, the United States and its international partners can have an even greater impact by transitioning from short-term, disease-oriented approaches to more long-term, coordinated investments designed to bolster health systems and related human resources. For example, coordinated, sustained investments have enabled Rwanda to pay for approximately 50 percent of its own health expenditures since 2008.
REAPING REWARDS OF COOPERATIVE INVESTMENT
Though President Harry Truman committed $20 billion in long-term, low-interest loans to individual European countries at the end of World War II, this investment failed to reverse Europe's social and economic problems. In June 1947, Secretary of State George C. Marshall announced a new plan that required aid recipients to fashion multilateral solutions to their common problems. The coordinated Marshall Plan led to decades of economic development and political stability in Europe. A well-coordinated international health plan built on a similar principle - donors supplying aid that directly invests in programs developed and managed by our partner countries and recipients cooperating toward a mutual end - can help jump-start an era of improved health, prosperity and stability in sub-Saharan Africa and other vulnerable regions.
Such a health plan needs to focus on building health systems and infrastructure based on partner-country priorities and integrate prevention, diagnosis and treatment across diseases rather than selectively targeting specific diseases. Disease-focused approaches, which have dominated traditional public health efforts, often exacerbate existing distortions in weak and underfunded health systems. Maternal and child health, a major focus of the Millennium Development Goals, has been a casualty of this approach; 27 countries made little or no progress in reducing childhood deaths between 1990 and 2006.
A move to an integrated approach is increasingly important. Noncommunicable diseases such as cardiovascular disease and cancer are compounding the burden from infectious diseases such as AIDS, malaria or tuberculosis. Critically, 80 percent of deaths from chronic diseases including malignancies, chronic obstructive pulmonary disease, cardiovascular disease, diabetes and mental health disorders occur in developing countries. Emerging and under-recognized causes of morbidity and mortality, including trauma and environmental catastrophes, will also need attention.
An integrated approach would focus on increasing a country's capacity to deliver health care. For many countries, this strategy will require investing in human resources such as training doctors, nurses and other health care workers. Today, there is a shortage of approximately 2.4 million health professionals in 57 countries. Regions with the highest disease burden have the greatest need. Africa has 24 percent of the global disease burden, but only 3 percent of the global health care workforce, and only 1 percent of the world's health expenditure to rectify this imbalance. As the global HIV campaign has demonstrated, a strategic scale-up across health care systems from disease expertise to community support will be required.
More health care workers are needed, but also better trained ones. Donor countries can help by creating effective programs that invest in professional education and training designed to address the disease burdens of individual settings. Successful examples include:
.. The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) launched a Medical Education and Nursing Education Partnership Initiative to strengthen medical and nursing health skills in 13 PEPFAR countries.
.. Many academic medical centers such as the Massachusetts General Hospital or Brigham and Women's Hospital now partner with public-sector institutions in developing countries to help improve medical and public health education.
.. The proposed Global Health Service Corps would be a U.S.-funded program to support U.S. health professionals who teach and train health care workers in recipient nations and thus directly increase health capacity in those countries.
By strengthening the capacity of countries to deliver health care and invest in the next generation of health professionals, programs like these could yield significant health gains and promote sustainability for relatively little investment.
CONCLUSION
In our increasingly interconnected and interdependent world, no country can ignore the health problems of other countries. Because health and development are inextricably linked, failure to invest in health will fuel a vicious cycle of social instability, weak development, and lost economic productivity and growth. Coordinated, multilateral investment to build health care infrastructure in vulnerable countries can bolster health and economic development, and spark a cycle of health and progress that can be sustained over generations.
(This is a product of the Bureau of International Information Programs, U.S. Department of State.)
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