Global Health - Where Are We?
I’ve been thinking recently about where we are in global health. Since the pandemic ended, it has been back to business for most. But so much has changed in the past few years that I wonder if we know where we are.
Why does it matter? Afterall, most of us know the destination we’re aiming for. We’re (hopefully) working to some defined organisational goals, and are measuring progress from time to time.
It matters because our work isn’t achieved in a vacuum, and our strategies don’t succeed or fail based solely on whether they are ‘good’ or are ‘implemented well’. Everything we do exists in a wider environment. It sits within the framework of a world that is always changing - sometimes imperceptibly, and sometimes quite visibly.
So from time to time, it’s important to look around and see what is happening in the world, and try to relate those observations to the work you’re doing – you might call it ‘understanding the times’.
Working out where we are is hard: especially in global health, where politics, economics, society, technology and the environment interact to create a complex and complicated reality.
A useful starting place can be to look at the ‘big picture’. What trends can we observe? What signals are we picking up? And then each of us will want to drill down in more detail in the specific areas we’re working on.
To get you started, here are four themes that keep coming up in conversations I’ve had with people across the global health community. How might you internalise these in your organisation’s plans for the future?:
Health needs have shifted – this much is obvious. Over the next decade, significant changes to health ‘priorities’ at national, regional and global levels will take place. The re-ordering of priorities will require adjustments in the distribution of financing among these priorities, and ongoing dialogue between stakeholders at all levels so there is a shared understanding of where, together, they can have the greatest health impact. The question of which priorities are best tackled (and paid for) at the country level, coordinated through the regions, or led at the global level is going to be critical.
Money is tight – traditional sources of financing for health cannot meet the growing cost of delivering health. Many in the sector are starting to acknowledge that we’ve probably passed the point of peak donor financing. Ensuring that the available funding has the greatest impact will need new approaches to resource distribution, but equally important will be efforts to identify new sources of financing. In the end, for many health priorities, our goal should be domestic financing. But this takes time and may need some radical thinking to speed up this financing transition.
New approaches are needed – take the case of antibiotics. The decline in investment for developing new antibiotics is well documented. Life science companies have understandably moved their R&D assets into other therapeutic classes where the return on investment looks more promising. At the same time, we’ve seen through the pandemic what it can look like when the world relies on too few suppliers of a scarce product. Creating new business models to incentivise R&D for critical diseases is something that needs to a lot more attention and energy. , We are a long way from the sort of healthy, sustainable business models that are required to reinvigorate some fields of R&D, but credit goes to those who have been calling for this for a long time, and are trying some innovative pilots.
Stronger regional institutions – are emerging. This is excellent and will accelerate the process of global institutions reimagining their relationships with regional and national stakeholders. It will give countries a stronger voice as well as the collective capacities and capabilities to determine their own approaches and positions on issues that are globally significant.
These are just four macro observations that came to mind: I’m sure you can think of plenty of others, like the emergence of promising new technologies, or the inequity that remains in access to healthcare around the world.
I’m interested to hear what you think about where we are in global health.
There’s a lot of change taking place. Do you think we’ve reached an inflection point in global health? Or is it more akin to a slow metamorphosis of the sector?
In a future blog I’ll offer some thoughts about how to respond to the changing winds in global health.