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Maurice Middleberg is vice president for public policy at the Global Health Council.

What would you identify as the top “best buys” in global health today?

There are a handful of interventions that together could save millions of lives and enormously reduce suffering. There are the interventions that save children—immunization, preventing or treating diarrhea, pneumonia, and malaria and keeping newborns warm and clean. Family planning and having skilled birth attendants are the keys to protecting the health of women. The methods for preventing and treating HIV are known and more affordable. Detecting and treating tuberculosis through short-course therapy is highly cost-effective.

In the area of non-communicable diseases, the most important steps are taxing tobacco, promoting use of aspirin and inexpensive drugs for cardiovascular disease, and installing speed bumps to reduce the toll of traffic accidents.

Add to that list better nutrition for young children and pregnant women and you have an incredibly powerful set of affordable, effective interventions. Two good resources for best buys in global health include the Disease Control Priorities Project and the Global Health Council’s Global Health Opportunities Report.

Is too much attention being paid to emerging infectious diseases at the expense of other serious health threats?

Only if we spend the money foolishly and create false trade-offs. The threat of pandemics, such as avian influenza, is very important and highlights the interconnectedness of health around the globe. Although many are concerned about domestic preparedness, the reality is that a dangerous mutation of the disease would probably originate in a developing country that lacks surveillance to detect the disease early, or the health and communication systems to contain it.

It would be wiser to invest in health systems in developing countries so that we can both protect ourselves from a potential pandemic and help address current diseases, but without diverting money from the “best buys” noted above.

New medicines for treatment of many diseases (like HIV/AIDS) are priced out of reach for many, how do you see this changing?

The amount available for healthcare in poor countries is very low, or about $30 per person per year (compared to almost $6,000 per person in the U.S.) This small amount must cover drugs and all other healthcare costs. To change this reality, developing countries themselves must devote a greater percentage of their national income to health—it is now about five percent on average—and they must use effective approaches to health insurance and other ways of paying for healthcare.

The poorest countries, however, simply don’t have the money to provide essential healthcare. Countries such as Niger or Afghanistan, which have very low per capita incomes, only spend about $10 per person on healthcare. Hence, wealthy countries must make a long term commitment to helping with such care in these nations, including private philanthropy and a continuing commitment by pharmaceutical companies to make essential medicines available. And, resources must be used as efficiently as possible, which means focusing on making the best buys available to those most in need.

Are funding priorities in global health misplaced? If so, how?

© Global Health Council / Abigail MithoeferWe have seen very important increases in funding in the past years for specific diseases, including HIV/AIDS and malaria. However, U.S. investments in child health and family planning—two of the very “best buys” in global health—have remained stagnant and funding is at risk of being reduced.

Child health and family planning are two of the most successful programs in the history of public health, having triggered huge declines in infant mortality and birth rates. We need to look at past successes and invest in getting the programs that work to the people who need them the most. These investments should also build long term capacity. Almost one million additional health workers are needed in Africa to provide essential care, for example.

What is your perspective on the links between health and poverty?

Poverty means vulnerability. Illness can tip a poor family into disaster as the household loses income, depletes its meager savings, and borrows money to pay for care. Families end up making excruciatingly difficult choices about whether to eat, or to pay for drugs—unless there are effective health programs in place to buffer them from such financial crises.

Ill health means children do less well in school and adults are less productive. Besides poor health being a drag on economic growth, there’s also tremendous inequity in who gets health care. The poor simply don’t get their fair share. Poverty is often compounded by other forms of discrimination based on gender, ethnicity, or caste. So, it’s a challenge to make sure that health reaches those already most marginalized or deprived. Fortunately, there are lots of good examples of programs that reach the poor. Such programs are either specifically targeted at the disadvantaged, or seek universal coverage of very basic services that will most benefit the poor. Mexico, for example, subsidizes basic care for the poor.

What are some of the best local initiatives that you have seen and what innovations are you most excited about in 2006?

The most exciting work that I have seen is when communities—rural villages and poor urban neighborhoods—take responsibility for their own health and mobilize to secure the services they need. Good health isn’t given; it’s demanded and secured.

I have seen communities in places as diverse as India, Nepal, Uganda, and Guatemala organize to build on the resources they already have and negotiate with others to obtain what they lack. I have seen individuals and groups work incredibly hard to educate themselves and each other about how to protect their health. That’s real development work—not transferring a drug or a procedure.

What has inspired your own personal commitment to this work?

My parents are Holocaust survivors. They taught me at an early age that there is no “over there”; there’s only “over here.” They understood that the

Want to join in the fight for better health policies? The Global Health Council’s advocacy center can help you search past and current legislative efforts relevant to global health and alert you to key initiatives that need support.

world is a small place, although they never used the term “global village.” I always wanted to be part of that bigger world.

Once I became involved in global health I saw the astonishing resilience, creativity, and strength of communities and health workers coping with very scant resources. That has always been a humbling and inspiring experience and I feel privileged to be part of the process of making heath services available to all.

 NEXT “FRONTLINES” ARTICLE: The CORE Group on $4 Bednets to Fight Malaria

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