BIG GUNS. MIXED BAGS. DEEP POCKETS. BROAD AUDIENCES. DEPENDABLE WING MEN. They are the ‘who’s who in global health,’ their more conventional names revealed shortly.

This young woman uses  a cigar-like filter to drink polluted water, a technical innovation designed by Inhabitat.

 WHEN HEALTH DETERMINANTS point to poor health–for example, poor sanitation, dirty water, limited medical services, or unreliable supplies of drugs– there’s a downward spiral leading toward diseases and illnesses such as diarrhea, malaria, pneumonia, tuberculosis, and more. It’s easy to fall into despair, even when individuals ultimately receive treatment.

Why? Underlying factors that created these health conditions in the first place are difficult to change without monetary aid, supplies, trained medical/health workers, and government and/or private interventions. These underlying factors— poverty, instability, access to education, cultural and gender disparities, job conditions, and more — are created, in part, from weak governments, interests of rich, land issues, loan debts, and structural adjustment programs (SAPs). This is where a ‘who’s who of global health’ takes the stage, from the World Health Organization to the Gates Foundation.

BREAKING IT DOWN…

The World Health Organization is the most recognized  multinational in global health.

 BIG GUNS: MULTILATERAL AND BILATERAL ORGANIZATIONS.  Multilateral organizations are a two-way street of money flowing between countries. In contrast, money from bilateral organizations usually originate in richer countries, with money flowing one-way to weaker countries.

Controversy: Since both types often focus on economic development and loans, critics say developing countries can become chronically dependent on such assistance.  Multilateral Examples: World Health Organization (WHO); International Monetary Fund (IMF);United Nations (UN); World Bank (WB). Bilateral Examples: United States Agency for International Development (USAID); Canadian International Development Agency (CIDA).

MIXED BAGS: NGOs–NON-GOVERNMENTAL ORGANIZATIONS. They’re every size and every agenda; many beneficial, others not-so-much. Their funding comes from donors, charities, and government agencies. Most NGOs can be broken down into geographically focused (Children of Chernobyl), religion-based (World Vision), demographically focused (Women’s Enterprises International); action-based (Nothing But Nets – malaria/bednets); or issues-based (Oxfam).

Controversy: Accountability, monitoring, and tracking can be murky –for example Greg Mortenson’s (Three Cups of Tea author) and his controversial misuse of funds with his Central Asia Institute. Another controversy is that some NGOs ‘parachute in’ with their solutions, funding, and staff and then leave when they declare success or run out of money. Africa is littered with good intentions: NGOs gone bad.

Brand-new Gates Foundation headquarters. (Seattle, June 2011)

 DEEP POCKETS: PRIVATE PHILANTHROPIC FOUNDATIONS. Living in Seattle with so much wealth poured into global health, you’d think there’s be no controversy. After all, global health philanthropy has literally changed the planet for better, whether it’s the mammoth Seattle-based Bill & Melinda Gates Foundation, or beyond the Northwest to the Kaiser Family,  Rockefeller, and Ford foundations; or beyond our borders to the United Kingdom’s Wellcome Trust.

Yet, there are controversies. Critics contend some foundations’ global health solutions are inserted ‘vertically’–that is, a specific solution to a specific disease/issue (vaccines, bednets) without considering the more complex ‘horizontal’ issues that create the global health problem in the first place (poverty, lack of education, war). It’s easy to measure progress and success with a singular vertical solution such as a polio vaccination program, but more difficult to track outcomes of gradual changes grafted ‘horizontally’ or ‘diagonally’ into a specific issue, or into an entire healthcare system. Other controversies include the reliance on foundations’ funds for continued progress; varying levels of transparency in accountability; and aid recipients’ fears that speaking candidly could cut off their funding.

BROAD AUDIENCES & DEPENDABLE WING MEN: GOVERNMENT ORGANIZATIONS. These ‘broad audiences’ come about thanks to government ministries of health, with their wide reach and considerable clout to carry out health campaigns such as National AIDS Awareness Day or World Malaria Day in a country. The ‘dependable wing men’ are governmental divisions that help carry out those far-reaching campaigns and ensure they’re on track to meet their goals; an example is the National Infant Immunization Week by the Center for Disease Control & Prevention (CDC).

Controversy: Stronger, richer governments can create campaigns and programs that benefit their own nations, while weaker/poorer neighboring countries are left languishing. This heightens disparities, akin to poorer neighbors looking across real and virtual fences, with national barriers preventing them from partaking of global health solutions–within sight, but just beyond their reach.

—Helen Holter

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Selective Resources: Who’s Who in Global Health

1. Major International Health Organizations: Solid explanations of global health’s ‘who’s who.’

2. Textbook of International Health: Global Health in a Dynamic World (3rd ed), by Anne-Emanuelle Birn, et al. Chapter 3 clearly explain international health agencies while chapter 4 focuses on the political economics of health.

3. Various lectures and publications by University of Washington global health professors Dr. Steve Gloyd and Dr. Matthew Sparke, and lectures by Dr. Jay McLean-Riggs. Thank you.

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