WHO reforms: on course What have economists but core functions still ever done for global require reliable support health? In 2010, WHO’s financial difficulties came to a head, prompting its Director-General Margaret Chan to instigate organisational reforms that are now in their final phase. As part of the process, Member States, donors, and partners have participated fully in setting the priorities that have shaped the WHO’s General Program of Work 2014–19. This week (May 19–24, 2014), Member States meet for the annual World Health Assembly, where they will take stock of the present situation, not least of the financial realities of an agenda that includes welcome new medicine-related resolutions and commitments. Many of these relate to the availability and affordability of essential medicines and other health products. Yet the financing of WHO’s work in support of essential medicines is still a cause for concern. In particular, assurances are still lacking for the norms, standards, policy and pricing guidance, and mechanisms that will support Member States struggling to secure affordable supplies of appropriate medicines. Non-governmental organisations, including Oxfam, have highlighted the impact of underfunding on WHO’s work on medicines, which cuts across almost every component of health services, and upon which health agencies such as UNITAID, the Global Fund, GAVI, and many others depend. Member States now need to ensure that WHO has the necessary resources to effectively build the foundations needed to support universal health coverage and complex and expanded global health needs. We declare no competing interests.
Philippa Saunders, *Mohga Kamal-Yanni [email protected] Oxfam GB, Oxford OX4 2JY, UK
www.thelancet.com Vol 383 May 24, 2014
In response to The Lancet’s persistent attack on economics and economists,1,2 we offer the view that the lack of progress in addressing the global epidemic of chronic diseases is largely failure to recognise it as mainly an economic problem. We would contend that a major reason for little progress in addressing chronic illness is that not enough economics has been involved in the development of interventions and, instead, such tasks have hitherto been taken over by narrow medical and public health perspectives. Solutions proposed for chronic disease, when based on medical treatments or conventional public health programmes such as diet and exercise, are focused on simply mitigating the consequences of a bigger problem. Amid pervasive controversies such as those about the effectiveness of preventative programmes, the role of individual risk factors, and the inability to ensure adherence to programmes that have some promise of efficacy, one of the few solid facts that exist is the gradient between socio-economic status and illness.3 Our view is that the poor progress in addressing the chronic disease epidemic is potentially due to lack of attention given to its economic antecedents. Given the known relationship between illness and socioeconomic status, it would follow that measures to promote social mobility are an effective route to reduce the disease burden. Why then is there little discussion about the role of job creation schemes, income support, economic empowerment, and income redistribution through taxation as measures to combat chronic disease? Where are the trials of such programmes and why is the link between measures to address social mobility almost never evaluated with a health focus?
The likelihood is that such measures cross disciplinary barriers and enter political arenas that public health and medical professionals and researchers see as a step too far. The solution therefore lies in a greater role for economics and economists in the design and evaluation of chronic disease programmes and in doing so, employing measures that incorporate health and economic outcomes. At present, the role of health economics tends to be confined largely to evaluating cost-effectiveness, eliciting consumer preferences, and the secondary analyses of datasets. Contrary to Richard Horton’s recent Offline,2 we believe substantial gains in health and wellbeing can be achieved by putting economics at the front and centre of deliberations about solutions to our major health problems.
AFP/Getty Images
Correspondence
Published Online May 19, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60840-0
We declare no competing interests.
*Stephen Jan, Virginia Wiseman [email protected] The George Institute for Global Health, Sydney, NSW 2050, Australia (SJ); University of New South Wales, Kensington, NSW, Australia; and the London School of Hygiene & Tropical Medicine, London, UK (VW) 1
2
3
Parkin D, Appleby J, Maynard A. Economics: the biggest fraud ever perpetrated on the world? Lancet 2013; 382: e11–15. Horton R. Offline: What have economists ever done for global health? Lancet 2014; 383: 1024. Wilkinson R, Marmot M. Social determinants of health: the solid facts. WHO, 2003. http:// www.euro.who.int/__data/assets/pdf_ file/0005/98438/e81384.pdf (accessed May 5, 2014).
Adding the doctor’s voice to the global health agenda There is an increasing desire for UK medical students and doctors to receive more global health training for the benefit of patients at home and overseas.1 The Commission on education of health professionals for the 21st century stated that all “should be educated to mobilise knowledge
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
1801
Philippa Saunders, *Mohga Kamal-Yanni [email protected] Oxfam GB, Oxford OX4 2JY, UK
www.thelancet.com Vol 383 May 24, 2014
In response to The Lancet’s persistent attack on economics and economists,1,2 we offer the view that the lack of progress in addressing the global epidemic of chronic diseases is largely failure to recognise it as mainly an economic problem. We would contend that a major reason for little progress in addressing chronic illness is that not enough economics has been involved in the development of interventions and, instead, such tasks have hitherto been taken over by narrow medical and public health perspectives. Solutions proposed for chronic disease, when based on medical treatments or conventional public health programmes such as diet and exercise, are focused on simply mitigating the consequences of a bigger problem. Amid pervasive controversies such as those about the effectiveness of preventative programmes, the role of individual risk factors, and the inability to ensure adherence to programmes that have some promise of efficacy, one of the few solid facts that exist is the gradient between socio-economic status and illness.3 Our view is that the poor progress in addressing the chronic disease epidemic is potentially due to lack of attention given to its economic antecedents. Given the known relationship between illness and socioeconomic status, it would follow that measures to promote social mobility are an effective route to reduce the disease burden. Why then is there little discussion about the role of job creation schemes, income support, economic empowerment, and income redistribution through taxation as measures to combat chronic disease? Where are the trials of such programmes and why is the link between measures to address social mobility almost never evaluated with a health focus?
The likelihood is that such measures cross disciplinary barriers and enter political arenas that public health and medical professionals and researchers see as a step too far. The solution therefore lies in a greater role for economics and economists in the design and evaluation of chronic disease programmes and in doing so, employing measures that incorporate health and economic outcomes. At present, the role of health economics tends to be confined largely to evaluating cost-effectiveness, eliciting consumer preferences, and the secondary analyses of datasets. Contrary to Richard Horton’s recent Offline,2 we believe substantial gains in health and wellbeing can be achieved by putting economics at the front and centre of deliberations about solutions to our major health problems.
AFP/Getty Images
Correspondence
Published Online May 19, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60840-0
We declare no competing interests.
*Stephen Jan, Virginia Wiseman [email protected] The George Institute for Global Health, Sydney, NSW 2050, Australia (SJ); University of New South Wales, Kensington, NSW, Australia; and the London School of Hygiene & Tropical Medicine, London, UK (VW) 1
2
3
Parkin D, Appleby J, Maynard A. Economics: the biggest fraud ever perpetrated on the world? Lancet 2013; 382: e11–15. Horton R. Offline: What have economists ever done for global health? Lancet 2014; 383: 1024. Wilkinson R, Marmot M. Social determinants of health: the solid facts. WHO, 2003. http:// www.euro.who.int/__data/assets/pdf_ file/0005/98438/e81384.pdf (accessed May 5, 2014).
Adding the doctor’s voice to the global health agenda There is an increasing desire for UK medical students and doctors to receive more global health training for the benefit of patients at home and overseas.1 The Commission on education of health professionals for the 21st century stated that all “should be educated to mobilise knowledge
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
1801
