The Revolution in Global Public Health

The world of global public health has changed dramatically in the past decade. For long-time practitioners and advocates, the field is almost unrecognizable.

Consider: in the years 1990 to 1992 only 10 articles in The New York Times mentioned malaria and most of these were advisories in the travel section. In 2006, the newspaper published 169 articles citing the disease.

Political partisanship used to bedevil the entire United States debate on foreign assistance. Those favoring more funding for neglected diseases regularly found themselves lumped together with a host of advocates for domestic social spending programs that fiscal conservatives viewed as unnecessary.

Funding Increase for Health Programs Pays Off
But by 1999, policymakers could see the increase in funding for research and development in the fight against AIDS during the decade had paid off royally. Death rates from HIV plummeted in industrialized countries and prevention efforts and biomedical advances were hailed as superb returns on investment. Partisanship dissipated. Budget constraints eased. Advocates, industry representatives and governments started working toward the same goals instead of squaring off against each other.

A new energy, spurred by the power of globalization and the information age, has helped to discredit the view that ancient diseases, long forgotten in developed countries, are an inevitable fact of life for poor countries.

Combating Neglected Diseases
Thanks in part to a great influx of resources from the Bill & Melinda Gates Foundation and the remains of earlier unspent aid budgets in many donor countries, advocates no longer have to chase scarce foreign assistance dollars. Their cause has also been helped by growing awareness of the potential global economic impact of epidemics and by the development of a public-private partnership model in which industry representatives and advocates cooperate on clearly defined terms.

Commitments to fight neglected diseases have multiplied in the past 10 years:

•    The Global Fund to Fight Aids, Tuberculosis and Malaria was established after the 2000 G8 summit in Okinawa (the first to engage African leaders in dialogue).
•    In 2002, 191 nations signed the UN Millennium Development Goals, which included reversing the spread of HIV/AIDS, tuberculosis and malaria by 2015.
•    In 2002, the World Economic Forum launched its Global Health Initiative, now a driving force behind the public-private sector partnerships.
•    The Global Business Coalition on HIV/AIDS has expanded its portfolio to include malaria and tuberculosis.
•    In 2005, President Bush announced his US$1 billion Presidential Initiative on Malaria.
•    The G8 2005 summit in Gleneagles resolved to “take action to combat HIV/AIDS, malaria, tuberculosis and other killer diseases.”
•    The European Union’s Directorate-General for Research has increased the amount allocated to neglected diseases from €109 million in 1999 to about €400 million today.
•    Canada, Ireland, the Netherlands, Norway, Sweden and the UK are all earmarking more of their international aid budgets to fight disease.

Increased commitments by donor countries have raised transparency and governance issues, but corruption, patronage and public sector inefficiency still plague countries burdened by disease. However, the past 10 years have shown that change is possible, if not inevitable, in the governance of developing countries.

In 2001, African leaders adopted the Abuja Declaration, pledging to dedicate increased amounts of their own budgets to improve health care infrastructure and significantly reduce mortality due to HIV/AIDS, tuberculosis, malaria and other diseases.

Importance of Accountability
Accountability is growing too, as evidenced by China’s minister of health, who lost his job for covering up the earliest days of the SARS epidemic – previously standard practice in developing countries. Most significantly, there have been important scientific advances that give the world hope for new and improved drugs and therapies – even vaccines against HIV and malaria. But with rising hopes come rising expectations.

With additional funding comes additional pressure to succeed. With greater attention comes greater cost of failure.

For all these reasons, advocacy and communication strategies that were appropriate for 1990, or even 1999, will no longer work in today’s environment. Developing countries require effective and targeted strategies if they are to reap the benefits of the additional funding and policy changes planted in the last years of the 20th century. To achieve them, solid relations with their governments and media will be vital.

Despite budget deficits and the distractions of war, donor countries have not reneged on their commitments to fight neglected diseases; however, priorities can change quickly and are susceptible to many external influences. In particular, an influenza pandemic that directly threatens the health of donor nations could deflect resources and force policy changes.

This article was written by Jim Jones, senior vice president in APCO Worldwide's Washington, D.C., office. It was excerpted from the PR News Guide to Best Practices in Corporate Social Responsibility, Volume 2. To order a copy, visit the