International budgets: health, representation, politics, and globalization

With a packed room of more than 300 people, the 9th annual Western Regional Health Conference kicked off its second day on Saturday morning, with a subject that normally puts most people to sleep: budgets. But with lively questions from dozens of audience members, and practical honest answers from the speakers, global health funding seemed to keep the attendees very much awake.

The three speakers were all doctors, and shared the belief that we must move to a mentality where we rid ourselves of “us vs. them,” and instead “embrace a global community.” Despite the similar nature of their opening remarks, the speakers’ responses to audience questions showed where their views differed.

An undergraduate student, Dean Chahim, asked the panel how they reconcile the needs of powerful donors with what their goals are as doctors and people who actually work in development–as people who know the complexities and gritty realities of health in developing countries.

One speaker, Dr. Jaime Sepulveda, responded to Chahim’s question by announcing his own bias as an affiliate of The Gates foundation, and called himself “a strong believer in private philanthropy.”

“Not everyone agrees with the Gate’s foundation approach and [it's] emphasis on technology, but I think that is changing, and it’s one of the most evolving and revised strategies, to see the impact on developing countries,” he said. “We really focus on the delivery. And it think it sets an important example for other wealthy people.”

More independent from donors, another speaker, Dr. Judith Wasserheit, said ”You need to know when you should walk away from the donor, when your own integrity and values won’t permit you to go there.”

All the speakers touched on economics. They echoed similar beliefs that inequity–social difference– is different from inequality– inequity structured by avoidable social determinants.  Their definition seemed heavily influenced by Dr. Paul Farmer’s ideas about structural violence–that poverty is enforced upon people by political and economic systems, whether they be local or global.

Wasserheit said she is hopeful of large institutions such as the World Bank because they can provide “comparative evidence to show how countries are doing.”

“They thus are providing peer pressure, and a more transparent ability for other countries to pressure [each other] along the way. Having said that, it’s very challenging to work with a country that does not have good leadership, that’s filled with corruption, and that has repeated states of conflict going on.”

She said a country’s leadership is intertwined with many factors, including governance,  conflict, and the overall economic starting point for development.

Dr. Timothy Brewer, the third speaker on the panel, said he believes all fields of health-tropical diseases, mental, infectious diseases, and others– need to be supported, but that it’s difficult to emphasize the interconnectedness of health to donors.

“At the end of our day, we all push our agendas. All of these are critically important, and I don’t see much value in trying to rank one over the other, because at the end of the day, we got problems, and we need to deal with them.”

“ The practical answer [to working with donors], is this:  you need to understand what do the people with the money want to do, and figure out how to do it so that it suits your way too.”

An audience member pointed out the lack of representation of people from developing countries in leadership positions in the Global Health field. Sepulveda, originally from Mexico, responded by saying he will always advocate for better representation, but that he first values competency.

“It takes two to tango and it takes a mutual accountability…..Still, I think this will be the last time we see an American appointed to the World Bank and a European appointed to the IMF.”

The room’s conversation all revolved around the undeniable process of globalization, and both Sepulveda and Brewer echoed Wasserheit’s comments that globalization is not inherently bad.

Wasserheit cautioned everyone to be weary of how we view globalization, that “there’s some things that can be very bad, at the infectious and communicable disease level, at the shared negative health behavior level, and at the economic level.”

“We need to remember that it’s not globalization itself that’s bad,  but it’s the way we allow globalization to go.”

By Katherine McKeon  Twitter: @kleemckeon




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