A busy decade for global health

It’s that time o’ year. Time for rankings, lists, and summaries of all that’s happened in the past year. Except this year, we’re also staring at the end of an entire decade! Yeah, some say the decade ends next year, but heck, a lot’s happened since Y2K! Inspired by Newsweek’s recap of the “decade in 7 minutes“, I figure all of us motivated by global health equity could also all use a bit of reflection this time of year.

It’s been a busy busy decade, with tons of developments. Here are a few to chew on. This list is by no means comprehensive….so throw out other moments, people, and events that you think shaped global health over the past decade.

1. The launch of PEPFAR and the Global Fund to Fight HIV/AIDS, TB, and Malaria: Since 2003 and 2002, respectively, these two financing/aid programs represent major scale-ups in the pool of resources available for global health. They’ve provided much needed hope to millions across the world, from the destitute sick to those working on their behalf. While both programs have faced criticism and challenges in disbursing their funds, they signify the prominence that global health, often driven by HIV/AIDS, has gained on the world stage.

2. The emergence of the Gates Foundation as a major global health player: Since they first stepped up their efforts in global health around the turn of the century, the Bill and Melinda Gates Foundation has become a major influence on global health. On an annual level, their budget for global health now mirrors that of the World Health Organization! Their philanthropy has added a significant boost to research efforts for diseases that affect the poor around the world, though some are wary of accountability and transparency issues. Nonetheless, Bill and Melinda Gates hold major clout, and are trying to use that clout to attract more and more attention to global health, recently even taking time to lobby Washington officials to sustain high levels of foreign aid and also appealing to the American public through an appearance on Meet the Press.

3. University students get active: Student activism and engagement around global health played critical roles in increasing political will for addressing HIV/AIDS at the turn of the century, and a proliferation of new groups during this decade, such as GlobeMed and FACEAIDS, promises to sustain student energy for years to come. With more young people realizing that the challenges of global health demand their attention and present opportunities for action (certainly one book about a doc’s work in Haiti had some thing to do with this), a new generation of young leaders will surely change the landscape of the ways in which organizations – from universities, businesses, governments, to NGOs – respond to global health inequity. This 00s will be remembered as a decade when this energy fomented on college campuses.

4. The health MDGs - In 2001, the global community rallied around the Millenium Development Goals - targets around key development metrics that the world has promised to realize by 2015. While global goals by nature are challenging tools to use, the health MDGs (focused on reducing child mortality, maternal mortality, and HIV/AIDS) laid a foundation around which many programs and initiatives mobilized political will and support for global health.

5. Who rules in global health? - As this decade draws to a close, the debates around governance in global health – who makes decisions and how – are under increasing scrutiny. With the proliferation of new initiatives and organizations, it’s often confusing as to how the global health agenda and priorities are set. Debates about whether we should move away from disease-specific funding, increase investment in prevention versus treatment, etc seem to have a chaotic way of being addressed, with many global health actors flocking in the direction of the crowd. The heightened importance of these debates signifies, however, the ways in which global health has ascended as a political priority in the course of the decade. To get a snapshot, see the Foreign Affairs debate that Laurie Garrett kicked off in 2007.

These are just a few of the major things that have emerged and happened over the past 10 years in global health. Coming from the 90s, when global health policy-makers often spent most of their time arguing how to ‘manage’ health systems on pennies, the 00s saw a paradigm shift towards arguing instead about how a new infusion of resources could be best used to tackle major global health emergencies, like the AIDS pandemic. With so many grave health inequities continuing to plague our world, the focus on effective health delivery is certainly welcome, but maintaining high(er) levels of commitment will still be a necessary challenge into the coming decade.

In a busy, busy 10 years however, there are plenty more developments I’m missing on this short list. Throw ‘em out there for discussion!