Laurie Garrett talks with
ScienceWatch.com and answers a few questions about
this month's New Hot Paper in the field of Social Sciences,
Article Title: The challenge of global
Journal: FOREIGN AFF
Year: JAN-FEB 2007
Listen to a podcast about this paper
recorded in July 2008 (added Dec. 2008).
Why do you think your paper is highly
The paper brought together several streams of thinking at a critical time,
offering a perspective that was controversial for some, and applauded by
many. Timing was the key. The paper garnered widespread attention at a
critical moment in global health efforts.
Does it describe a new discovery,
methodology, or synthesis of knowledge?
The paper's ideas, individually, were not new. However, bringing many
streams of thought together in a single coherent analysis was new.
Would you summarize the significance of your
paper in layman's terms?
It is not enough to simply throw more money at a problem in poor
countries—there must also be a framework in place for spending that
money properly. In the absence of such a framework, money from taxpayers
and donors in the wealthier parts of the world may end up yielding
disturbing outcomes in poorer countries.
In particular, in the richer parts of the world, public opinion has been
captured by a handful of terrible diseases—chiefly AIDS, malaria, and
tuberculosis. The overwhelming funding priorities in health have followed
that public enthusiasm. And it is a good thing—billions of dollars
are now on the table to fight those diseases. But in most poor and
middle-income countries the scarcity of skilled health workers is so
severe, and the facilities at their disposal so dismal, that well-intended
donor financing can easily skew all health prevention and treatment efforts
toward a finite set of diseases, leaving all other health problems grossly
The paper calls for a systemic view of health, featuring greater support
for public health prevention, medical systems, and training of healthcare
workers, especially those who can fill the lower rungs of the system.
How did you become involved in this
research, and were there any problems along the way?
I have written about public health and medical care of people in poor
countries most of my adult life, including two books: The Coming Plague:
Newly Emerging Diseases in a World Out of Balance (Farrar, Straus,
and Giroux, 1994) and Betrayal of Trust: The Collapse of Global Public
Health (Hyperion Press, 2000).
Where do you see your research leading in
There have already been some wonderful changes in the global health picture
since publication of my paper. Within the UN system the H-8 has formed,
bringing greater coherence to the health-related efforts of several UN
agencies plus the Global Fund and the Global Alliance for Vaccines and
The UK government has spearheaded the International Health Partnership,
which aims to push health infrastructure programs with decade-long grants.
The Norwegian government launched a one billion dollar campaign in support
of infant and maternal survival during and immediately after childbirth.
The Global Fund announced that some 20% of its grants will now go for
health systems support. Only the US government remains committed to
disease-specific programs as its top foreign-aid health missions.
Do you foresee any social or political
implications for your research?
I certainly hope so!
Senior Fellow for Global Health
Council on Foreign Relations
New York, NY, USA
Keywords: global health, money, poorer countries, AIDS,
malaria, tuberculosis, scarcity of skilled health workers, public health
prevention, medical systems, UN, H-8, Global Fund, Global Alliance for
Vaccines and Immunization, GAVI, International Health