Global Health


It is still the case that the majority of casualties in war are civilians. The 5% formula would deliver an estimated $300 billion for international development in the first decade – that is $30 billion a year on average.

The WHO’s current biennium 2012-2013 budget is $3.9 billion (roughly $2 billion per year). It is proposed that from this redirected $30 billion, $1 billion – $2 billion of this could fund the WHO and enable it to remove its reliance on private interests and others74. This ‘new’ sustainable stream of public funding for WHO could ensure that it can again focus on its core missions and managing global health projects with the full involvement of the countries concerned both in both formulation and implementation level levels.

The WHO: An Underfunded Global Health System

In 2011 Sonia Shah wrote this telling piece for Foreign Affairs:

In 1950, the WHO’s budget derived from assessed dues on member nations. Over the past few decades, that financing stream has run dry. In reaction to the perceived politicization of UN organizations such as UNESCO and the WHO, major UN donors introduced a policy of zero real growth to the UN system’s budgets in 1980 and of zero nominal growth in 1993. Starved of public financing, the WHO has had to rely upon voluntary contributions from donor countries, private philanthropists, companies, and NGOs. By 2008, voluntary contributions from private interests and others[1] now bankroll four out of every five dollars (80%) of the WHO’s budget. Thus it is now the private donors, not the WHO, who can call the shots in Geneva, and thereby shape the global health agenda. Unlike funds from assessed dues, individual donors can earmark “extra-budgetary” monies for whatever specific purpose they like, thus circumventing WHO control.

Companies most active in global health projects today hail from a narrow range of industries[2], many of which are under fire for their negative impact on public health. These private firms are playing a double game: disrupting local communities with one hand and writing big cheques to ostensibly help them with the other. Often, their core financial interests are directly at odds with the business of improving the health of the poor, in ways that are distorting the global health agenda.

The private donors’ influence is clear. The WHO allocates its regular budget to the diseases that account for the most mortality around the world. Extra-budgetary funds, in contrast, support different interests. According to an analysis of the agency’s 2004-05 budget, 91 percent of the WHO’s extra-budgetary funds were earmarked for diseases that account for just 8 percent of global mortality. Given the dominance of extra-budgetary funds in the WHO’s overall expenditures, the WHO ended up spending 60 percent of its funds on illnesses that account for just 11 percent of global mortality. A substantial portion went toward developing vaccines for infectious diseases, which – many will argue – are in line with private industry’s general preference for expensive, high-tech research over cheap, low-tech prevention. It’s hard to see how such a misalignment between the needs of the world’s sick and the distribution of WHO’s funds helps the agency meet its core mission.

MEDACT : After Ebola – How To Save The World Health Organisation

We must hope that the international response works effectively and efficiently. Though many individuals and organisations are performing heroically, the international response has generally been slow and characterised by self-interest and bickering. The militarised nature of assistance provided by the US in particular may help build hospitals and establish command-and-control systems to help break disease transmission chains, but could also hinder the building of trust. The more developmental and social approach to disease control offered by the Cubans, which has received little attention in the mainstream media, possibly offers more hope. …

The Ebola crisis must also make it imperative for the global health community to find long-term and effective solutions to the problems of the World Health Organisation (WHO). We don’t need more fingers pointed at the financial, technical and management problems of WHO, particularly its regional office in Africa. These problems have been known for many years. What we need is a frank and independent enquiry that will highlight the role of specific actors in undermining the public health mandate and functions of WHO. There is culpability and there must be accountability. …

The global health community has tended to ignore such pathologies, but Ebola is both a call and an opportunity to change this. We can confront finance capitalists and multinational corporations as vectors of disease that bribe governments and extract wealth in ways that are unjust and ecologically destructive. We must describe bankers, lawyers and accountants who enable illicit trade, tax avoidance, theft and corruption as agents of poverty and illness. And we should view the arms trade as a pathogen that fuels violence and enables repression.

Global Health Spending trends

Laurie Garrett at the Council on Foreign Relations observes:

Global health programs now teeter on the edge of disaster. The world economic crisis and the politics of debt reduction are threatening everything from malaria control and AIDS treatment to well-baby programs and health-care worker training efforts. And even if the existing global public health architecture survives this time of parsimony and austerity, it will have been remodeled along the way.

As important as the totals is the shift in donor composition. The Gates Foundation, now combining the philanthropic assets of the Gates family and Warren Buffett, is responsible for 68 percent of all private giving for global health, dwarfing the efforts of even the largest public or international institutions. Power followed the money, and by 2005 the annual World Health Assembly, which governs WHO, was convening to listen to Gates’ suggestions, and today few policy initiatives or normative standards set by the WHO are announced before they have been casually, unofficially vetted by Gates Foundation staff.

In 1999, for example, total health spending in developing countries was about $5.6 billion, with the United States government providing roughly a third of that and U.S. private donors another tenth. In the spring of 2000, the Clinton administration officially defined HIV and emerging diseases as national security threats, which expanded U.S. grounds for engagement in global health. The call resonated with antipoverty activists, health advocacy groups such as Médecins Sans Frontiers, Partners in Health, and ACT UP; and institutions such as the World Health Organization, UNICEF, and the United Nations AIDS Program. Bill Gates and his wife, Melinda, stepped up their philanthropic efforts in global health through their Gates Foundation.

With the surge in public support for global health came increased attention from private individuals, corporations, and foundations, leading some to call the decade “the age of generosity.” By 2008, global health enjoyed an estimated $16 billion pot of public-funding gold — and with private funding and poor countries’ own increased health spending included, the total spent on public health for the world’s poor reached about $27 billion.

But then the global financial crisis hit and as Europe’s economic situation worsened, the region reduced its overseas commitment-to-disbursements ratio. Italy, which donated nearly $1 billion annually from 2001 to 2008, gave nothing in 2009 and has given almost nothing since. Greece provided more than $50 million in global health assistance in 2007 and now gives nothing. Iceland stopped making commitments and contributions in 2008, Portugal in 2009, and Spain in 2010. In 2009, 94 percent of all global health promises made by the European Union and its member countries were actually disbursed, but by the end of 2010 only 78 percent were, and the gap appears to have widened further in 2011.

Total estimated expenditures worldwide on health care in 2010, meanwhile, hit $5.3 trillion, with U.S. domestic spending accounting for nearly half of that. Even at its recent peak, the amount of money spent on the health of the world’s poorest people, who suffer most of humanity’s infectious and preventable diseases, represented merely .0005 percent of worldwide health spending.

Militarizing public health

High military spending becomes ‘normalised ’ in part through the ever greater effort to ‘recruit the nation’ (Ben Griffin Veterans for Peace UK). Especially for countries with a professional army (ie small percentage of the population).

This is done  through the armed forces ever-growing presence in schools (funding events through to recruitment) and through Public Relations (eg UK Armed Forces Day and revamped Poppy Day).This in turn enables acceptance of a ‘perpetual war machine’ – convenient for a seemingly never-ending  ‘war on terror’.

Other aspects of civilian life in Western countries have been gradually militarised such as mass surveillance in the UK or militarized policing in the USA, where routine police operations are carried out by SWAT teams armed as military special forces.

This ever-present ’militarisation’ of public life is now being turned to health and emergency disaster responses. The army is now often flagged as the first responder rather than the medics. In anticipation of disasters unfolding with the deepening of the climate change crisis, this will become more and more the norm as no opportunity will be wasted to militarise the response to a public health or natural disaster emergency.

This is worryingly authoritarian, bad for public health, and strategically counterproductive. Despite its impressive logistics, the army makes only a marginal contribution to international disaster relief—and often makes things worse. Nor do soldiers “fight” pathogens—and the language of warfare risks turning infected people and their caretakers into objects of fear and stigma. But, because of America’s politics of public finance, the army is the only tool we have. If civilian health programs were properly funded, they could have prevented the disaster. …

But this expert consensus is not reflected in federal spending priorities. Global public health is small change: $7.4 billion last year, down from $8.3 billion in 2011, with global health research and surveillance budgets at the Centers for Disease Control and the National Institute of Health of just $464 million and $527 million, respectively. By contrast, as the size and power of the Department of Defense have grown, so too has its involvement in global public health. According to a thorough review of its labyrinthine $650 billion budget, the “DoD dedicated no less than $579.7 million in identifiable funding to global health-related activities” in 2012, plus considerable other monies in other accounts. …

The only rationale for sending the troops is that they and their equipment are available and already paid for, and would be doing nothing of significance otherwise. And, as a supplementary justification, that the U.S. Congress and taxpayers are ready to spend vast amounts of money on the military over modest amounts on global health.

This argument has a dreadful circularity; we are in this trap because we have paid for a bloated military and a threadbare global health system. It would be sickeningly wrong for the army’s role in responding to Ebola—inefficient, largely ineffective, but nonetheless better than nothing—to become a justification for why the Pentagon should continue to consume limitless resources. Soldiers can perform some useful tasks in West Africa. But their role should be brief, limited, barely visible, and subordinate to civilian control.

Militarizing public health is a strategic error. Security and public health experts know this and have tried to steer global health and security policies in a direction that is informed by the best evidence and analysis. But somehow, the beguiling metaphor of sending soldiers to fight pathogens still wins out, fueled by our deepest fears of disease, and by our uncritical acclaim for soldiery. It is time to discard misleading military metaphors and spend real money on real global public health.

Alex de Waal is Executive Director of the World Peace Foundation,

HOW BRITISH AEROSPACE drained money from South African development

To see how BAE impacted on development in South Africa under Thabo Mbeki, watch Andrew Feinstein’s talk​ (9mins)​

Andrew Feinstein is the author of The Shadow World: Inside the Global Arms Trade .  H​e served as an African National Congress (ANC) Member of Parliament in South Africa for over seven years and resigned in 2001 in protest at the ANC’s refusal to allow an independent and comprehensive inquiry into a multi-billion dollar arms deal which was tainted by allegations of high level corruption.