Global health care feeling the Gates factor

The Swiss mountain resort of Davos


SCOTT JAGOW: They're still schmoozing and brainstorming at the World Economic Forum in Davos, Switzerland. This is a gathering of people with money and influence — people like Bill Gates. The Gates Foundation has given so much money to fight diseases in recent years, it has changed the dynamic of global health care. Laurie Garrett follows global health for the Council on Foreign Relations. Laurie, this sounds like a good thing. So what's the problem?

LAURIE GARRETT: The problem is that we're raising money in the wealthy world based on what the wealthy world is interested in — the fads, the concerns, what the rock stars say and the celebrities say and so on. We're looking at it disease by disease or problem by problem instead of seeing that what's missing here are entire systems of health.

JAGOW: Can you give me a specific example?

GARRETT: Sure, I was in Haiti about nine months ago. Here's this country that's been through hell and back, by every measure it is on a par with sub-Saharan Africa. And yet they've managed to get all of the HIV-positive people they can identify into treatment, they're receiving state-of-the-art HIV care and they're relatively healthy as a result. In the same time period that they've cut their new HIV infection rate in half, they have seen women dying in childbirth skyrocket, they have seen the deaths in children under five skyrocket, and life expectancy has collapsed by 10 years so I is now only an average of 51 years.

JAGOW: Hmm. So why is this happening?

GARRETT: We have a huge lobby of all sorts of people, including probably a lot of your listeners, who want to see a sort of social justice happen where people who have treatment for HIV want equivalent treatment to be available to the poor especially in Africa and I'm for that 100 percent, but where is the lobby for diarrhea in children? OK, there is none. But what's the No. 1 killer of children in Africa today? It's not HIV-AIDS, it's diarrheal diseases.

JAGOW: Well, it seems to me that one of the problems might be, you talk about a problem like global health, that's obviously a massive issue. Who's in charge of leading that effort?

GARRETT: Good question.

JAGOW: Anyone?

GARRETT: You know, I'm not being facetious. We actually have an enormous leadership gap. We have a new leader for the World Health Organization, Dr. Margaret Chan from Hong Kong, but WHO as an institution is rather weak. You know the core budget of WHO is far less than the annual budget for health for the city of New York.


GARRETT: Or for that matter for the city of Cincinnati.

JAGOW: So Laurie, in brief, what do you suggest we do, as a planet?

GARRETT: We actually want to stop the competition between philanthropies and donors and get us working for a common goal. Let's save millions of lives and close what is right now almost a 50-year gap in life expectancy between the longest-lived society, Japan, and the shortest-lived societies in West Africa.

JAGOW: Laurie, thanks so much for your time.

GARRETT: Thank you.

JAGOW: Laurie Garrett is a Senior Fellow for Global Health at the Council on Foreign Relations.


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