|January 14, 2002
for Financial Support for Global Health
Extending the coverage of crucial
health services to the world's poor could save millions of lives a year, reduce poverty,
spur economic development and promote global security, according to a new report by
economists, political leaders, health specialists and policy experts.
Richard Feachem, director of the UCSF Institute for Global Health, was one of 18
distinguished individuals appointed to the Commission on Macroeconomics and Health (CMH),
which conducted the two-year study and presented findings to the World Health Organization
(WHO) on Dec. 20.
In fact, experts say, a $66 billion annual increase in investment in global health
could save at least 8 million lives each year by the end of this decade, generate at least
$360 billion annually, and give more than 50 of the poorest countries a real chance of
In the most economically depressed countries, about $13 is spent per person per year on
health care. The report concludes that spending must rise to about $38 per person by 2015
to allow those countries to adequately treat health crises like malaria, tuberculosis,
AIDS, childhood infections, as well as offer immunizations, prenatal care and other
preventive services. Industrialized world per capita spending on health runs about $2,000
a year. In the United States, it is $4,500, more than twice that of some European
Industrialized countries spend about $7 billion a year to fund health and medical
programs in the least developed countries. That figure will need to rise to $27 billion a
year by 2007 and $38 billion a year by 2015 to achieve the health goals set by the
Commission members emphasize that additional investments in health - requiring donor
countries to give roughly one-tenth of one percent of their national income - would be
repaid many times over.
"With bold decisions in 2002, the world could initiate a partnership of rich and
poor of unrivaled significance, offering the gift of life itself to millions of the
world's dispossessed and proving to all doubters that globalization can indeed work to the
benefit of all humankind," the Commissioners wrote.
According to the report, the main causes of avoidable deaths in the low-income
countries are HIV/AIDS, malaria, tuberculosis, childhood infectious diseases, maternal and
perinatal conditions, nutrient deficiencies, and tobacco-related illnesses. If these
conditions were controlled, impoverished families could not only enjoy longer and
healthier lives, but they could also choose to have fewer children (secure in the
knowledge that their children would survive) and could invest more in the education and
health of each child. The improvements in health would translate into higher incomes,
higher economic growth, and reduced population growth, they said. Non-communicable
diseases also are of significance for developing countries, according to the report.
Cardiovascular disease, diabetes, mental illnesses, and cancers can be effectively
addressed by relatively low-cost interventions - especially using preventive actions
relating to diet, smoking and lifestyle, according to the commissioners.
The report strongly argues that improved health is not a natural or automatic byproduct
of economic growth. Some countries, such as oil-rich Middle Eastern countries, have become
wealthy while allowing their health status to lag behind, said Feachem. He explained that
other countries, through investment in health, have not only improved the well being of
their populations, but also provided the conditions necessary for economic growth. China
is a striking example of this phenomenon, according to Feachem.
In addition, Commission members noted that high disease burden is not merely a product
of corrupt and broken health systems in poorly governed low-income countries. In fact, the
vast majority of the excess disease burden is the result of a relatively small number of
clearly identifiable conditions - each with a set of interventions that can dramatically
improve health and reduce the deaths associated with these conditions.
"The problem is that these interventions don't reach the poor because the poor
lack the financial resources to implement these interventions, as do their
governments," said Feachem. "If we want a stable, secure and prosperous world,
we have to invest in human health." This case is even stronger since the events of
September 11, 2001, he added.
In addition to Feachem, other University of California leaders (former and current)
participated in the two-year project of the CMH. Laura Tyson, now dean of the London
Business School, was dean of the Walter A. Haas School of Business at UC Berkeley when she
served as a Commissioner. Dean T. Jamison is the director of UCLA's Program on Global
Health and Education. Harold Varmus, until recently director of the National Institutes of
Health, is a former UCSF professor and Nobel laureate.
These leaders joined forces with such individuals as Manmohan Singh, the leader of the
opposition of the Upper House of the Indian Parliament and former Minister of Finance and
Supachai Panitchpakdi, former deputy prime minister of Thailand and now director-general
designate of the World Trade Organization.
The CMH, established in January 2000 by Gro Harlem Brundtland, the director-general of
the WHO, was asked to look at the relationship between investing in health, economic
development and poverty reduction.
The full report of this two-year project, titled, "Macroeconomics and Health:
Investing in Health for Economic Development," is available online here.
UCSF's Institute for Global Health (IGH) played a key role in the work of the CMH. In
addition to being a commissioner, Feachem co-chaired a working group (one of six) that
focused on global public goods for health. The product of the working group will be
published by Oxford University Press this year.