Why do you think your paper is highly cited?

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 underserved.

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 the future?

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 Immunization (GAVI).

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!

Laurie Garrett
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 Partnership.