A Foreign Affairs Roundtable – Round One: January 23, 2007

In this special Web feature, Foreign Affairs has convened some of the world’s top experts — Paul Farmer, Jeffrey Sachs, Alex de Waal, Roger Bate & Kathryn Boateng, and Laurie Garrett to discuss Garrett’s essay “The Challenge of Global Health” debate how best to help the world’s poor and sick; and to debate her thesis and suggest where global public health efforts should go next.

Laurie Garrett’s article “The Challenge of Global Health” argued that the money flowing toward the world’s poor and sick might produce fewer benefits than people expect because aid is often directed at narrow, disease-specific problems rather than public health in general.


From “Marvelous Momentum” to Health Care for All

Paul Farmer is associate chief of the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital; Presley Professor of Medical Anthropology at Harvard Medical School; and a founding director of Partners In Health, an international charity that provides health care to and undertakes research and advocacy on behalf of the sick and poor.

“The influx of AIDS funding can indeed strangle primary care, distort public health budgets, and contribute to brain drain. But these untoward or perverse effects are not inevitable; they occur only when programs are poorly designed. When programs are properly designed to reflect patients’ needs rather than the wishes of donors, AIDS funding can strengthen primary care.” . . .http://www.foreignaffairs.org/special/global_health/farmer

Beware False Tradeoffs

Jeffrey D. Sachs is Director of the Earth Institute, Quetelet Professor of Sustainable Development, and Professor of Health Policy and Management at Columbia University.

“Foreign aid is not a whim, a matter of dole, or a matter of avoidable dependency. It is the difference between life and death. It can also be used to do exactly what Garrett rightly wants: to build an effective health system. We have just started on the road to doing this, after decades of shocking neglect. Garrett is right to call for more coherence and better strategy, but the real answer to the problems she describes is a further scaling up of aid.” . . .

Reality Check

Roger Bate is a Resident Fellow and Kathryn Boateng is a Research Assistant at the American Enterprise Institute in Washington, D.C.

“Garrett hopes to ‘witness spectacular improvements in the health of billions of people, driven by a grand public and private effort comparable to the Marshall Plan.’ But given the poor track record of foreign aid in developing countries, one can predict that unless drastic changes are made, simply sending more aid would be counterproductive.” . . .http://www.foreignaffairs.org/special/global_health/bate_boateng

Major Challenge, Minor Response

Alex de Waal, is program director at the Social Science Research Council and working group co-chair of the Joint Learning Initiative on Children and AIDS.

“Garrett is enthusiastic in pursuit of her prey: how well-intentioned and well-funded stand-alone initiatives run the risk of undermining national priorities and setting up distorted and hence unsustainable health systems. And she makes a number of telling points. But her chase is not systematic, and so she doesn’t catch her quarry.” . . .http://www.foreignaffairs.org/special/global_health/dewaal

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