[Updated: 7:05 pm Eastern]
Wealthy donors like the Bill & Melinda Gates Foundation have helped spark a movement that has almost quadrupled financial support for global health in the past two decades, yet much of the world’s financial support is being spread unevenly, and isn’t always getting to the poorest people in the neediest countries, according to a new study by researchers at the University of Washington and Harvard University.
It might sound surprising, but the people who produced this edgy piece of research, which claims to be the first ever comprehensive look at funding for global health projects, are sponsored by the Gates Foundation. The study, being published in The Lancet, is co-authored by Christopher Murray and six colleagues, including Catherine Michaud of the Harvard Initiative for Global Health. Murray is the former Harvard University professor recruited to the UW two years ago with a $105 million donation by the Gates Foundation to establish the Institute for Health Metrics and Evaluation (IHME).
The report—written without input from the Gates Foundation—is loaded with financial detail, which will certainly be required reading for those who argue that powerful private donors aren’t being transparent enough about what they do. The report found that financial support for global health has climbed from $5.6 billion in 1990 to about $21.8 billion in 2007. This field that attempts to reduce health disparities around the world, used to be primarily the responsibility of international organizations like the World Bank and the United Nations, but now gets almost one-third of its total funding from private sources, according to the study.
Yet even as all this money has flowed in for help, 12 of the 30 countries with the highest burden of disease in the world weren’t getting as much aid as people in healthier, and in some cases, wealthier, countries, according to the study. Angola, Ukraine, and Thailand were among the neediest countries that haven’t been getting their share of health aid.
“The size and scale of it all was surprising,” Murray says. “We all knew the money was going up, but it was much a bigger increase than we thought we’d see. ”
Since no one organization has done a comprehensive analysis of how much money is going to global health, which countries get the money, and which disease categories receive the most, the findings are likely to spark a lot of conversation in global health circles about how to better allocate resources.
“Everyone’s watching,” Murray says.
Some small island nations like Micronesia and the Solomon Islands receive more health aid per capita than countries with higher rates of illness—like Niger and Burkina Faso, according to the study. Mali and Colombia have about the same level of sickness, yet Colombia receives triple the health funding, researchers said. Researchers said they don’t know exactly why that is, although many of the countries with great health needs, and that lack support, are French-speaking former colonies in central and western Africa, Murray says.
“It appears to be part of the colonial legacy,” Murray says.
This study was released as many world leaders in global health gather in Seattle for the Pacific Health Summit. The summit’s focus this year was on the threat of multidrug resistant tuberculosis, which kills an estimated 1.7 million people each year, but rarely makes the headlines or evening news like HIV does. When I left the Summit around noon today, there was a fair bit of grumbling about how there are a lot of people talking (some might say whining) about it, yet there’s not enough people taking groundbreaking action to do the basic research and development needed to create new drugs, diagnostics, and vaccines.
Part of the problem is that money tends to follow attention from society—which was reflected in the global health financial analysis. HIV—even though it’s not a bigger cause of suffering and death than TB and malaria—grabbed the lion’s share of resources, with $5.1 billion in support, according to the study. That compares with $800 million for malaria, and $700 million for tuberculosis. Another $900 million goes to financing new clinics, doctor training, and prevention programs—the all-around systemic improvements that many experts say are needed to make a dent in these diseases.
One last fact I found extremely interesting: If you were to poll people on the street in Seattle and ask “Who pays for global health?” I bet most would say the Bill & Melinda Gates Foundation and stop there. But that’s only part of the story. Seattle’s most famous couple actually write smaller checks than U.S. taxpayers like you and me. The U.S. government provided one-fourth of the world’s global health budget in 2007, or $5.7 billion, while just 4 percent of the total pie came from the Gates Foundation ($1.1 billion). The U.S. as a whole, when adding up public and private money, pays for more than half of all global health aid.
“It’s surprising that the U.S. is such a dominant force in global health spending, because so many people like to cast the U.S. as being miserly, at least for health,” Murray says. “It’s not really true.”
But Murray and his co-authors agreed, after looking through the financial data, that it was also surprising that this field involves so many more players than just a few committed philanthropists and public health officials.
“Although, the scale-up of global health resources from the Bill & Melinda Gates Foundation is striking, the magnitude of resources that U.S. non-governmental organizations mobilized from other private philanthropy was greater,” the researchers said in The Lancet. “Corporate drug and equipment donations have expanded substantially.”
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