Global public health notes

These are some notes on global public health as part of a larger project. The final results will likely not be published here (but I will try to link to them from here when they’re done), but this is the most convenient place for notes.

What exactly has happened in global health and what’s in store for the future?

New question as of December 2016. HT Vipul Naik.

Global health as a success story

Part of my interest in global health comes from the view that global health is seen as a success story in philanthropy. To use the language of cause prioritization, global health is a successful and “safe” cause. This section collects information on to what extent this is true.

From “Philanthropy’s success stories” on the GiveWell blog:

Philanthropy has some extremely impressive accomplishments. Among other things, foundations have been (in my view) reasonably credited for leading the way on building schools and hospitals in the rural Southern U.S., piloting the shoulder line on U.S. roads, successfully advocating for federal legislation in areas including health care for the homeless and nuclear deproliferation, the research that led to the Green Revolution, and many major advances in medical research (including the first combination drug therapy for AIDS and the development of the pap smear). There are many other projects that sound like they may have been impactful, but which the Casebook doesn’t give enough context on for me to have a strong view.

[…]

The most impressive achievements (in my view) are concentrated in the sectors of research (particularly medical research) and health care.

Global health as a “boring” cause

This section considers whether global health has become successful to the point where it is considered “boring”.

One evidence is the existence of donor fatigue.

James Grant also often refers to a “silent emergency” (e.g. here).

When and how did global health become a movement?

Some relevant Quora questions I’ve asked that might spring up useful information:

Initial hypotheses (after reading the Wikipedia section):

It’s important to distinguish between government interest and public interest in global health. It seems that government interest came first, followed by public interest. There is also “philanthropic interest” from individuals with a lot of money.

This page provides an outline of how government bodies formed, but not a lot of underlying motivation.

The World Health Organization and the Transition From “International” to “Global” Public Health’:

“International health” was already a term of considerable currency in the late 19th and early 20th century, when it referred primarily to a focus on the control of epidemics across the boundaries between nations (i.e., “international”). […] “Global health,” in general, implies consideration of the health needs of the people of the whole planet above the concerns of particular nations. The term “global” is also associated with the growing importance of actors beyond governmental or intergovernmental organizations and agencies—for example, the media, internationally influential foundations, nongovernmental organizations, and transnational corporations.

On potential motivations for countries like the US:

In 1955, Candau was charged with overseeing WHO’s campaign of malaria eradication, approved that year by the World Health Assembly. The ambitious goal of malaria eradication had been conceived and promoted in the context of great enthusiasm and optimism about the ability of widespread DDT spraying to kill mosquitoes. As Randall Packard has argued, the United States and its allies believed that global malaria eradication would usher in economic growth and create overseas markets for US technology and manufactured goods. It would build support for local governments and their US supporters and help win “hearts and minds” in the battle against Communism. Mirroring then-current development theories, the campaign promoted technologies brought in from outside and made no attempt to enlist the participation of local populations in planning or implementation. This model of development assistance fit neatly into US Cold War efforts to promote modernization with limited social reform.

Interesting note on WHO’s funding:

Another symptom of WHO’s problems in the late 1980s was the growth of “extrabudgetary” funding. As Gill Walt of the London School of Hygiene and Tropical Medicine noted, there was a crucial shift from predominant reliance on WHO’s “regular budget”—drawn from member states’ contributions on the basis of population size and gross national product—to greatly increased dependence on extrabudgetary funding coming from donations by multilateral agencies or “donor” nations. By the period 1986–1987, extrabudgetary funds of $437 million had almost caught up with the regular budget of $543 million. By the beginning of the 1990s, extra-budgetary funding had overtaken the regular budget by $21 million, contributing 54% of WHO’s overall budget.

1990s:

Best-selling books and news magazines were full of stories about Ebola and West Nile virus, resurgent tuberculosis, and the threat of bioterrorism. The message was clear: there was a palpable global disease threat.

This Harvard course spends quite a bit of time on the role of missionaries. I’m not sure if it’s worth looking into.

From this chapter:

From “The Great Dispensary in the Sky: Missionary Medicine” by Vaughan:

Throughout most of the colonial period and throughout most of Africa, Christian missions of one sort or another provided vastly more medical care for African communities than did colonial states. It was not until the 1930s, and in many places until the 1950s and 1960s, that secular medicine reached rural communities in any form other than the ‘great campaigns’ against epidemic disease which I have described in the last chapter. It was missionaries who in East and Central African from the late nineteenth century pioneered the setting up of rural hospitals and rural clinics, who trained African medical personnel, who introduced ‘western’ midwifery and childcare practices, and who dealt with chronic and endemic disease. […]

If it is true that, for most Africans before the Second World War, any prolonged encounter with biomedicine came in the form of an experience of mission medicine, it is also true that for church-going Britons of this period one of the most popular representations of Africa and of Africans came via the accounts in missionary journals of the woes of the ‘sick continent’, and the trials, tribulations, and triumphs of heroic medical missionaries.

From A Mighty Purpose (a book about James Grant) by Adam Fifield:

From the opening of Portfolios of the Poor:

Public awareness of global inequality has been heightened by outraged citizens’ groups, journalists, politicians, international organizations, and pop stars. Newspapers report regularly on trends in worldwide poverty rates and on global campaigns aimed at halving those rates. A daily income of less than two dollars per person has become a widely recognized benchmark for defining the world’s poor.

What does the success of global health tell us about other movements?

Specifically, I’m interested in anti-aging.

Some parts of early history of philanthropy are less relevant. For instance, the way in which nonprofits became codified in US law was important the first time around (i.e. for currently-existing philanthropy), but is less relevant for newer developments like anti-aging, since these laws are already in place.

More questions

See also


  1. This quote in particular seems to provide evidence for this position:

    The palpable tension, between managing episodic, acute, frightening, deadly and dramatic pandemics and the arduous path to ameliorating the chronic maladies and social conditions that kill many more people but in far less dramatic ways, has always shaped the agenda of the World Health Organization. Yet the historical record amply demonstrates how international efforts to control infectious disease, beginning in the mid-nineteenth century and extending to the present, have dominated global health policies, regulations, agendas and budgets, often at the expense of addressing more chronic health and environmental concerns. 5,6 How these challenges have affected present circumstances and created demands for an entirely new conception and execution of 21st century global health efforts will be the focus of this paper.