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January 14, 2002

Leaders Call 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 escaping poverty.

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 countries.

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.

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.


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