Earlier this month, the Lancet published two studies clarifying some long-standing questions about global health financing and the effectiveness of health programs. One of the studies, funded by the Bill and Melinda Gates Foundation, provided a comprehensive list of sources of public health funding, including—for the first time—non-governmental organizations in the U.S that offer ‘development assistance’ overseas.
The findings mark an interesting tipping point in public health: as the United Nations struggles to find monetary support during this recession, private donors are becoming the major players in monetary assistance. Seven researchers at the University of Washington’s Institute for Health Metrics and Evaluation led the study, providing much-needed information on the changing landscape of organizations involved in public health.
How startling, then, that so few media outlets covered the report.
Besides a blog post at The Wall Street Journal, the Seattle Times and the Associated Press were apparently the only general interest outlets that reported the story. A few outlets like the San Francisco Chronicle and the Miami Herald picked up the AP story. The lack of coverage is both an unfortunate side effect of journalists’ current focus on healthcare reform within the U.S., and a result of the cutbacks that science and health departments are facing in newsrooms across America. Yet readers should be aware of the widespread role non-governmental organizations are playing in financing public health projects around the world, and how these organizations might complicate international health goals.
According to an article in Forbes magazine:
[The study is] a “critical piece of work” says Jennifer Kates, vice president of the healthcare policy nonprofit Kaiser Family Foundation, because it’s the first time researchers compiled a comprehensive list of the sources and cumulative amount of global health financing. A major obstacle to improved efficiency, she says, is the lack of coordination between donors. Without a central, public database for aid, donors often don’t realize similar programs are funded in the same country.
Mounting a coordinated effort is not the only concern. An article in the AFP quoted Dr. Christopher Murray, lead author of the Gates study:
“It is good that we have a more diverse set of actors and institutions in global health – we would not have seen a growth of 22 billion dollars if it was all flowing through the UN system,” Murray said. “But there are certain core functions that only the United Nations – especially the WHO [World Health Organization] – can fulfill. The risk is that these functions may get neglected and underfunded.”
This point is especially timely. With the recent declaration of the H1N1 flu pandemic, the WHO has been a leader in communicating and delegating health information and policy. An article in The Seattle Times mentions what might happen if the United Nations, administers of the WHO, loses its dominance:
Though international organizations like the WHO and UNICEF have long been criticized for rigid bureaucracies that stifled innovation, their declining role may harm efforts to improve health around the world, the researchers say.
When those organizations are forced to compete for funding, they lose their status as “trusted neutral brokers between the scientific and technical communities on the one hand, and governments of developing countries on the other hand.”
Achieving a coordinated, properly balanced global health effort among all actors is important, because the current situation is far from ideal. Case in point: in addition to providing a list of global health financiers, the Gates study focused on whether low- and middle-income nations were receiving development assistance for health proportionate to their need. In many cases, there seemed to be a discrepancy between the level of funding a country received and the level of assistance the people there needed. Take, for example, a few snippets from the press.
From Scientific American:
Niger is one of 12 countries on the list of the 30 most burdened by disease that are not also among the 30 receiving the most health aid.
Brazil, China and Russia also rank in the top 10 countries with the highest burden but receive disproportionately less funding.
From the Associated Press:
Murray and colleagues also found AIDS gets at least 23 cents of every health dollar going to poor countries. Globally, AIDS causes fewer than 4 percent of deaths.
It’s not surprising that the Seattle Times covered this story—after all, the Gates Foundation is based in Seattle. And the Associated Press is known for its ubiquitous coverage. But why did most of the major press outlets skip covering this?
Perhaps because the Bill and Melinda Gates Foundation not only funded the study, but is itself a significant financier of global health projects—making up nearly four percent of total funds for international healthcare assistance in 2007. And while the researchers were transparent about their funding, there is a possibility that the Gates-backed study put the Gates foundation in a positive light— à la a certain statin study from last fall.
But, still, the purpose of the study was not to promote non-governmental organizations for their increase of contributions, or to chide the UN for not providing enough money. Researchers explored whether low and middle income countries were getting enough funding for their health programs—having a comprehensive list of organizations that assist was part of the methods, and a side result.
Journalists may also have not been so quick to report on the study because of an additional issue with the methods. Researchers did not include non-governmental, non-U.S. organizations when calculating contributions. So there could be an international foundation that donates more money than the Bill and Melinda Gates Foundation. Or international donors could be assisting countries that receive, according to the study, a disproportionately low level of development assistance for health.
Even with these issues, more reporters should have covered this story. The lack of attention from the press is just another example of the decline in global health coverage at US media outlets. Too bad, because international media like the Guardian and the AFP picked up the story. Not covering the results might make it harder for journalists to explain why UN programs might not work in the future. When we’re not seeing results/better quality of health after throwing millions of dollars to dubious projects, in say, India, journalists are going to have to go back and explain.
The Lancet study provided one of those rare, opportune moments to help news readers, according to an editorial in the Lancet, understand “quantitatively what many observers have seen qualitatively.” By not educating the public on the shifting landscape of organizations’ assistance, we risk a future where the WHO won’t be the predominant authority in promoting global health. Whether that’s a good or bad thing is up to the public to decide, but right now newsreaders are in the dark. We wish journalists spread the word a little bit more.