PHM-Exch> Donors urged to tackle leading killer of under-fives (2)

[Claudio Schuftan]

 1.

We need to all join together and stand strongly against DIVISION of
health issues that are in reality both a right and indivisible one from
another...

One cannot have PHC without massive health work force investments,
and changes in IFI policy.

We need to grow a global movement for health care as a right...
We are meeting to discuss it...want to include all of
you and more

Joia S. Mukherjee, MD, MPH
Medical Director, Partners In Health

2.

I find this disturbing because the message that this sends in my view
is - AIDS, TB and malaria is getting too much money so let's move some
of it to address diarrheal diseases. It is true that AIDS has received
relatively more money than other health issues, but should we be
promoting what I interpret as the key msg in the articles the notion
that shifting money from one disease to another is the answer? This is
exactly the kind of divisive rhetoric that we should be resisting. So
we should move money away from AIDS, TB and malaria to focus on saving
children from diarrheal disease? You save a child's life from
diarrheal disease, but then the child dies of malaria because now the
pendulum of resources has swung the other way? We need to be working
towards messages of increasing money for everything instead of pitting
disease against disease, MDG against MDG and ultimately trading
deaths. I find this really not helpful.

Sue Perez

3.

I share Sue Perez's misgivings.  Claims that "too much" is being spent on
AIDS, or any other health issue, are the unfortunate but inevitable result
of counting DALYs and taking at face value the rhetoric of "scarce
resources."  As we know from recent experience, resources are not scarce
when needed to bail out mismanaged financial institutions ... and they are
never scarce for war-fighting.  Self-promotion it may be, but see my article
on this point at http://www.who.int/bulletin/volumes/86/8/08-050880.pdf.

Ted Schrecker



 4.

I agree with Sue's concern. I would also note that the actual reports are
calling for 'a comparable effort' to HIV for funding for diarrheal diseases,
not a trade-off.

The securitization of HIV (and pandemic influenza, the other massively
funded global disease) in UN resolutions; the prevalence of one and the
threat of the other in donor countries; and the existence of strong civil
society advocacy groups for one and a public health community for the other
created the momentum for public funding vastly disproportionate to funding
for other diseases. Understanding the history of how health funding became
skewed in this fashion is important if we are to develop strategies to argue
for needs-based alternatives which do not mean reducing funds for one to
compensate for lack of funds for another. That chronic disease has
supplanted communicable disease in all parts of the world except sub-Saharan
Africa (and receives virtually no donor funding) is slowly becoming a
higher-order topic of global health concern.

Unfortunately, HIV funding is the comparative lightening rod: witness the
recent World Bank internal evaluation report that found that as HIV funding
increased, consuming almost all of the resources for communicable diseases,
funding for family planning and reproductive health plummeted. Donor
agencies are triaging their resources in disease-specific ways that do not
reflect overall disease burdens.

To prevent the trading-off of one disease over another, we need, first, to
support the funding claims made by other groups -- in this case, agreeing
absolutely with the 'comparable effort' argument around water, sanitation
and diarrheal diseases in the two NGOs reports. Second, we can cite the
economic arguments and cost studies abound that show the affordability of
both and, as Ted has just posted, that decisions on where and how to invest
collective wealth is a matter of politics and policy, not of scarcity.
Third, we can argue that human rights treaties oblige wealthier nations to
assist.

Finally, we must always try to frame our health arguments around the
historic and contemporary practices of power and privilege that allocate
wealth and health to some, and poverty and disease to others. Regardless of
disease.

Ronald Labonté
Canada Research Chair, Globalization/Health Equity
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