Developing a Strategy for Global Health

By Elizabeth Scott and Prudence Ukwishwatse
posted on May 28, 2013 in Economics and Finance, Global Development

On May 16, Assistant Professor Jesse Bump, who teaches at Georgetown University’s Department of International Health, spoke to YPFP discussion groups (Public Health, Grand Strategy, and Africa) about grand strategies toward global public health and how they have evolved over time. Instead of focusing on specific health challenges, Bump spoke about the historical context of the idea, and how it originated from the colonization and expansion era to the industrial revolution and today’s globalized world. He explained that the idea of global health originated from rich, imperialist countries worried about their own security and economic stakes in their colonies. Bump believes that everything about global health is shaped by external environmental factors and inherent greed, such as using access to healthcare as a way to advance a countries’ foreign policy. Bump, stating that there is no universally agreed upon definition of global health, defines it as addressing "[health-related issues] in poor countries that are of interest to the rich world," for their political, economic, or moral importance. This informal definition, he reminds us, does not address all public health concerns; rather, rich countries are able to choose a subset of health concerns that are most important to them.

In an effort to explain the origins of public health and the relationship between poor and rich countries, Bump used the example of trade monopolies, such as the British East India Company and the Dutch East India Company, who were among the first multinational organizations in the 19th century. These companies were so powerful that they acted like states – treaties with other nations, waging war, claiming land, minting money, and lending money to other nations. Just like a monopoly does not care about the consumer, global public health efforts have not always served “the customers” who were the indigenous population in need of health services.

Bump used a business model framework to illustrate the global health system. He presented five forces that dictate public health policy: suppliers, new entrants, rivalries, substitutes, and buyers. From the mid-twentieth century onward, foreign donors dominated developing countries (buyers), which had few channels to express their actual healthcare interests. Today, developing states have much more leeway to set their own priorities as they have more foreign donors (suppliers) to choose from. Basically, as the supplier pool has grown, there has been an increased intensity and rivalry between the suppliers, which has granted more power to the buyers.

Bump also noted that there are new entrants into the public health supply pool with countries such as China, South Korea, Thailand, Brazil, and several Arab nations taking initiatives to provide public health services to developing nations.

Cooperation between all suppliers or large donor countries is essential to advancing global public health. Bump concluded by arguing state capacity and ownership will play an increasingly large role in ensuring beneficial outcomes, since the developing country's government is in the best position to know the needs and priorities of its citizens’ public health needs.