How to Promote Global Health

A Foreign Affairs Roundtable

In this special Web feature, Paul Farmer, Jeffrey Sachs, Alex de Waal, Roger Bate & Kathryn Boateng, and Laurie Garrett discuss Garrett's essay "The Challenge of Global Health" and debate how best to help the world's poor and sick.

Round One: January 23, 2007

Paul Farmer
"The influx of AIDS funding can indeed strangle primary care, distort public health budgets, and contribute to brain drain. But these untoward or perverse effects are not inevitable; they occur only when programs are poorly designed. When programs are properly designed to reflect patients' needs rather than the wishes of donors, AIDS funding can strengthen primary care."

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Jeffrey D. Sachs
"Foreign aid is not a whim, a matter of dole, or a matter of avoidable dependency. It is the difference between life and death. It can also be used to do exactly what Garrett rightly wants: to build an effective health system. We have just started on the road to doing this, after decades of shocking neglect. Garrett is right to call for more coherence and better strategy, but the real answer to the problems she describes is a further scaling up of aid."

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Roger Bate and Kathryn Boateng
"Garrett hopes to 'witness spectacular improvements in the health of billions of people, driven by a grand public and private effort comparable to the Marshall Plan.' But given the poor track record of foreign aid in developing countries, one can predict that unless drastic changes are made, simply sending more aid would be counterproductive."

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Alex de Waal
"Garrett is enthusiastic in pursuit of her prey: how well-intentioned and well-funded stand-alone initiatives run the risk of undermining national priorities and setting up distorted and hence unsustainable health systems. And she makes a number of telling points. But her chase is not systematic, and so she doesn't catch her quarry."

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Round Two: January 24, 2007

Roger Bate and Kathryn Boateng
"Efforts to improve global health are often crippled by a state of denial. Failure to consider unfashionable modes of disease transmission or use proven but politically unpopular methods in disease prevention and control is illogical, dishonest, and should be exposed."

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Alex de Waal
"People who are poor often have much more insight into their plight than outsiders. Setting up channels through which the targets of aid can voice their concerns is not only a democratic imperative but will improve the quality of the assistance that is provided."

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Laurie Garrett Responds: January 24, 2007

Laurie Garrett
"The world's poor and sick do need help, and the world's rich should continue to give and even increase their giving. But they should do it in such as way as to produce the beneficial results everyone is eager to see."

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