Ask Dr. Arun Gupta, a paediatrician based in the New Delhi, what makes a sound investment in global health, and his answer may surprise you.
The co-founder and central coordinator of the Breastfeeding Promotion Network of India is now member of the Prime Minister's National Council on India's Nutrition Challenges, and serves as regional coordinator of the International Baby Food Action Network in Asia.
We spoke with Gupta about the role of the public and private sectors in advancing global health.
What do you see as the biggest global health challenge today?
Isn’t it surprising? Much of the world is either obese or undernourished. It has a lot to do with the market, and we continue to find solutions that are market- led.
What, to you, are the characteristics of a sound investment in global health?
An investment that balances both preventive and curative services.
What do you see as the next big "best buy" in global health?
Reaching everyone with an investment policy that addresses both prevention and cure! Can we say goodbye to inequity?
Do restrictive regulatory policies represent a major barrier to developing innovative global health solutions?
I don’t understand why developing countries are under pressure to improve their policy environment, when improvement means either deregulation or weakening regulations to give free trade a go over health.
The state is the primary duty bearer of the human right to health, and it has to put this duty before all else. Policy must ensure that health reaches everyone, which means that the state has to regulate on anything that violates or negatively impacts the attainment or enjoyment of this right. The private sector, for example, has the primary duty to earn profits for its shareholders, putting it in direct confrontation with human rights in several cases. In such cases, the state will need to regulate the private sector. The policy environment of countries, particularly developing countries, needs to reflect this.
Our survey of global health professionals suggests that public-private partnerships are seen as important to the success of global health interventions. Your take?
I don’t agree on the face of it. Last year, The Lancet presented an analysis, saying: “Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.”
In the current geopolitical situation, there is a role for the private sector in health care. However, as the main focus of the private sector is to earn profits, rather than put people’s health first, it is essential that decision-making processes, including the generation of evidence for interventions, are free from their influence. The private sector can provide the services required, once decisions on the interventions are taken independently and policy development is kept free from conflict of interests. I think the survey you mention may show this as a perception but studies do not suggest this.
One of the most interesting finding of our survey was that health systems strengthening beats R&D as the most critical investment area in global health. In other words, innovation is seen as less important than more traditional interventions. What's your take on this?
My take on this is system strengthening is a way to go any day for any country to achieve its goal for health for all. It does not mean innovation should not be there, it could be needs-based.
Take, for instance, diarrhea. There is enough evidence in the world that optimal breastfeeding and preventing dehydration is both the primary protection and treatment for diarrhea in infants. However, there is little investment in improving breastfeeding policies or they have remained static for decades, or of improving access to oral rehydration solutions. According to WHO, “In fact, an estimated 88 percent of diarrheal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene.”
Still, we continue to find clinical solutions. Instead, millions of dollars are spent in trying to find a vaccine that could prevent a percentage of these deaths. Training lactation counselors, preventing the promotion of manufactured baby milks for infants, and universalizing access to ORS strengthens the health system as well as saves lives. Such health system strengthening is imperative.
I hope this example explains what can be achieved. I am not saying vaccines are not needed at all but there is a need to calculate real efficacy at the community level through absolute risk reduction studies.
This story is part of Best Buys in Global Health, a campaign by PSI, PATH and Devex to highlight sound investments in global health. Find out more.