Privatizing Global Health

There’s an interesting new article in Globalization and Health about the privatization of global health policy that’s well worth highlighting. The story here starts in the late 1980s, when UN agencies began collaborating with private financial institutions on health funding and policy-setting, in part because these agencies were getting less and less aid from developed countries, and in part due to a fear that the UN needed to work more closely with the private sector lest it become irrelevant. At any rate, global health spending now comes increasingly from private organizations like the Bill and Melinda Gates Foundation, whereas multilateral agencies themselves contribute only about one third of all global health funding.

Now the article notes that this turn for privatization has also come with a shift in actual health policy—including a sharp focus on communicable and infectious diseases, AIDS and malaria especially, along with malnutrition, maternal health, and child mortality. Similar priorities are set by the UN’s Millenium Project, directed by Jeffrey Sachs. This is all genuinely important—and these organizations are doing a lot of good—but one should also note that infectious diseases aren’t the main health priority in any region other than sub-Saharan Africa, and altogether represent “less than a third of global ill-health.”

Nevertheless, it seems that private organizations have kept the focus on infectious diseases partly because many of these battles are high-profile—especially the battle over AIDS—and partly because it’s easier to show results here than it is with, say, non-communicable diseases, or the mundane-but-important task of developing health infrastructure. As well, global health policy is increasingly aligning itself with trade and industrial interests, which often tends to weaken the efforts of health agencies to combat non-communicable diseases by regulating, say, tobacco and alcohol use. At any rate, it’s not an easy topic to sort out, and it’s not like no one has ever thought about market failures before, but it’s still reason to question the increasing role of private firms in setting global policy.