Grand Challenges in Global Health—a critique

Bill Snyder
Published: July, 2006

Like any ambitious endeavor, the Grand Challenges in Global Health initiative has its share of skeptics.

In a column published in 2005 in The Lancet, Anne-Emanuelle Birn, Sc.D., associate professor of Public Health Sciences at the University of Toronto, criticized the initiative for its “narrowly conceived understanding of health as the product of technical interventions divorced from economic, social and political contexts.”

“Global health,” she wrote, “might be better served through political support for universal, accessible and comprehensive public-health systems… in the context of overall improvements in living and working conditions.”

“I believe the approach is wrong,” added David McCoy, B.Med., DrPH, managing editor of Global Health Watch, in a story published in 2005 in RealHealthNews.

“They will develop vertical programs from which some people will benefit,” McCoy said, “but I doubt that there will be anything sustainable. I doubt if they will build the health care infrastructure for the poor countries.”

Microsoft Chairman Bill Gates, in a speech to the World Health Assembly in Geneva in 2005, defended the initiative’s emphasis on research.

"Some point to the better health in the developed world and say that we can only improve health when we eliminate poverty. And eliminating poverty is an important goal,” Gates said. “But the world didn't have to eliminate poverty in order to eliminate smallpox—and we don't have to eliminate poverty before we reduce malaria.

“We do need to produce and deliver a vaccine—and the vaccine will save lives, improve health and reduce poverty,” he continued. “… When health improves, life improves by every measure.”

Ann Marie Kimball, M.D., MPH, professor of Epidemiology at the University of Washington, told the Seattle Post-Intelligencer that Gates’ approach certainly can be debated, but "the fact that these investments are being made is extraordinarily important."

Since 1995, the Bill & Melinda Gates Foundation has awarded nearly $6 billion in grants to support global health services and research.

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