26 Feb, 09 | by BMJ Group
On Monday I was at a meeting with Bill Clinton and Ban Ki-moon, illustrating my global significance. I’d better make clear, however, that 500 other people were also present, and neither Bill nor Ban would have had any idea that I was there.
Held at the United Nations building in New York, the meeting was intended to encourage philanthropists to continue to contribute to achieving the Millennium Development Goals, particularly those related to reducing maternal mortality and the harm from neglected tropical diseases. These two MDGs are not on track to be achieved.
Half a million women die in childbirth every year, 99% of them in developing countries. A woman in Niger has a one in seven chance of dying in childbirth, whereas a woman in Ireland (the safest country in which to give birth) has a one in 48 000 chance of dying. Fifty million women a year give birth without a skilled attendant being present.
Maternal mortality could be cut substantially by a triad of having a skilled attendant present at every birth, providing access to emergency obstetric care, and giving access to family planning. Improving the human rights of women and girls is also important. Yet a 2008 review showed that few developing countries are making progress in reducing maternal mortality.
One billion people are affected by the 13 major parasitic and bacterial infections that constitute the neglected tropical diseases, and 500 000 people die from them each year. But they debilitate, deform, and blind more than they kill, and they account for more DALYs than either TB or malaria. Neglected tropical diseases are controllable and possibly eradicable by treatments already available. Yet little has been done about them, largely because of lack of awareness of their impact.
As Bill Clinton said, the big question for the 21st century is “how.” For all of his political life, he said, he’d been concerned with two questions: what to do and how to pay for it? But the how is more important.
Part of the how is partnership, one of the great themes of the meeting. The meeting was organized by the Economic and Social Council (ECOSOC), which is charged with implementing the MDGs. It discharges this responsibility primarily through its Annual Ministerial Review each July, and the New York meeting was preparation for the review. It was only the second time that ECOSOC had held a meeting with global philanthropists.
Sylvie Lucas, the president of ECOSOC, said: “Partnerships are the cornerstone for advancing the MDGs, and there is no doubt that these will not be reached by 2015 if we do not work together for their realization…I am encouraged by the presence of representatives of the philanthropic community and by their willingness to engage more actively in the work of the Council. This kind of collaborative response has become a new paradigm of international cooperation in tackling global challenges, including public health.” Ban Ki-moon said: “We need the innovative spirit of the private sector.”
This may all sound a bit odd in Britain, which is possibly the country in the world where there is the most suspicion of profit and private companies. I find it strange that Brits, who invented the industrial revolution and grew rich through trade across the world, should be so suspicious, and, as I’ve written and said before, I blame the Romantic poets (whom I much admire) and snobbishness: “I hear that his father was in trade.”
A second major theme was whether philanthropy would collapse in the financial crisis. Clinton pointed out that 30 trillion dollars (twice the US GDP and around half of world GDP) has disappeared. But, he argued, philanthropy must continue because there is no investment that gives a better return than investing in the health of people in poor countries. It is also essential to make every dollar count. We should redouble our efforts not walk away from our commitment. Working in poor countries is the least expensive thing we can do to fulfill our obligations.
But innovative ways of financing are needed, and there was much talk of GAVI (Global Alliance for Vaccines and Immunisation), which has developed at least two innovative financial instruments. With the International Finance Facility for Immunisation governments make legally binding 10-20 year commitments to funding. GAVI can then borrow from capital markets against these commitments. Another innovation is the Advanced Market Commitment, whereby countries commit money to guarantee the price of vaccines once they are developed. Gordon Brown is currently co-chairing the High Level Task Force on Innovative Financing for Health Systems.
Clinton also referred to innovative financing and thought that the future might be—as with recent political campaigns in the US – small amounts of money coming from the many rather than large amounts from the few.
The need for strong health systems was another major theme of the conference — because without them nothing. Bill Clinton urged investment in building out health networks, and, he argued, once a network has been built to test for and treat HIV it can be extended to treat other problems. Nobody is dying now simply because they can’t get drugs, but they are, he said, dying because they can’t engage with any health system.
A final theme of the meeting was the need for global coalitions to reduce maternal deaths and promote treatment of neglected tropical diseases — along the lines of the Global Fund for AIDS, TB, and Malaria. We now have what is needed for effective global coalitions in these areas: clear targets, evidence on policies that will work, high level political commitment, and a communication and marketing strategy.
Perhaps it was the influence of New York but the mood of the meeting was optimistic and can do rather than depressed and defeatist. Klaus Leisinger, president and CEO of the Novartis Foundation for Sustainable Development, emphasized in his keynote address that for the first time in history we have the skills, knowledge, resources, and technology to solve these global health problems. We must now make it happen.
Competing interest: Richard Smith directs the UnitedHealth Chronic Disease Initiative, which is funding and partnering with centres in low and middle income countries to counter chronic disease. The company paid his expenses in attending the meeting. He travelled economy and stayed in one of New York’s cheaper hotels but did have an excellent steak at Peter Luger’s Brooklyn steakhouse and got to see the Pierre Bonnard late paintings of interiors, which were a revelation of colour and light, at the Metropolitan.