1. Public Health in the News

2. Global Health Organizations and Movements Matthew L. Boulton, MD, MPH December 7, 2015 PUBHLTH 350

3. Outline Who pays for public health? Types of global health programs Implementing programs Challenges of global health organizations

4. Paying for Public Health Global public health is funded by a variety of contributors –Not just global rich aiding the global poor Global health funding aims to address shared health concerns and achieve mutual goals Jacobsen chapter 12. Global health payers and players.

5. Government Funds The majority of public health initiatives around the world are funded by the governments providing those services Ex. Public Health Foundation of India Jacobsen chapter 12. Global health payers and players.

7. Bilateral Aid Bilateral aid: money given directly from one country to another Major donor nations (>$10 billion each in 2010): United States, United Kingdom, France, Germany, Japan Major donor nations as % GNI (>0.8%): Norway, Luxembourg, Sweden, Denmark, Netherlands –United States: <0.2% GNI Jacobsen chapter 12. Global health payers and players.

11. The World Bank & IMF Multilateral aid: money pooled from many donors and given as loans that have to be repaid or as grants (gifts) World Bank: makes loans to developing countries, usually for infrastructure projects IMF (International Monetary Fund): makes loans to any country that could not otherwise pay the interest on their other loans Heavily Indebted Poor Countries (HIPC) Initiative aims to forgive some loans Jacobsen chapter 12. Global health payers and players.

12. Private Foundations Private foundations are making an increasingly significant contribution to spending on global public health Example: The Bill & Melinda Gates Foundation provides more than $1 billion each year to support health technologies Jacobsen chapter 12. Global health payers and players.

13. Businesses Pharmaceutical companies donate >$1 billion in products each year Other companies make in-kind and monetary donations as part of their corporate social responsibility plans Jacobsen chapter 12. Global health payers and players.

14. Personal Donations Millions of individuals make donations each year Americans donated nearly $300 billion to charity in 2011 –73% from individuals rather than foundations or corporations –Represents about 2% of disposable income Jacobsen chapter 12. Global health payers and players.

16. Types of Global Health Programs 1.Research and education 2.Clinical services 3.Relief 4.Community development 5.Advocacy 6.Logistics Jacobsen chapter 12. Global health payers and players.

17. Implementing Programs Thousands of governmental, corporate, and nonprofit groups implement global and local public health projects and programs Jacobsen chapter 12. Global health payers and players.

18. Governments National governments provide the bulk of health services and payment for health Other roles –Create and enforce health and safety guidelines and regulations –Sponsor health research –Shape public policies to address health disparities –Oversee projects sponsored by outside organizations Jacobsen chapter 12. Global health payers and players.

19. United Nations Agencies The United Nations has 193 member nations The World Health Organization (WHO) is the primary UN health agency Examples of other UN agencies –UNICEF –World Food Programme –UNIAIDS Jacobsen chapter 12. Global health payers and players.

21. International Cooperation Most developed countries have a governmental division dedicated to working with developing countries USAID (U.S. Agency for International Development) focuses work on 3 areas –Democracy, conflict prevention, humanitarian aid –Economic growth, agriculture, trade –Global health Jacobsen chapter 12. Global health payers and players.

23. Partnerships Nonprofit public-private partnerships (PPPs) are working to set and accomplish goals for a variety of global health issues Many PPPs focus on technology development Jacobsen chapter 12. Global health payers and players.

25. NGOs Nongovernmental organizations (NGOs) are privately managed and receive at least part of their funding from private sources Challenges: Directed donations, Autonomy for local workers, politics, and neutrality Benefits: ability to do important on-the- ground public health work, especially in the neediest areas Jacobsen chapter 12. Global health payers and players.

26. International Red Cross The ICRC (International Committee of the Red Cross) provides humanitarian aid to people affected by war and other armed conflicts Sanctioned under international law to provide certain services like visiting prisoners of war (POWs) National Red Cross and Red Crescent societies are autonomous from the ICRC Jacobsen chapter 12. Global health payers and players.

27. International Businesses Some businesses receive contracts from governments and foundations to implement global health programs All businesses can contribute to public health by facilitating the health and safety of employees and their families and communities Jacobsen chapter 12. Global health payers and players.

28. “The Challenge of Global Health” --Laurie Garrett Large rise in public and private giving to combat health challenges Much of the money is used without results –Most successful programs from local NGOs Still need for sufficient health care workers in country –Preventing brain drain in countries Garrett L. The challenge of global health. Foreign Affairs. 2007;86(1);14-38.

29. From “Marvelous Momentum” to “Health Care for All” -- Paul Farmer A commitment to social justice is necessary to understand the global health outcome gap –Why did it happen? Why does it continue to worsen even with efforts to improve? Though Garrett’s critique offers valid points, we should re-examine the badly designed programs –Good results can be achieved Farmer P. From "marvelous momentum" to health care for all. Foreign Affairs. 2007;86(2):155-161.

30. Question of the day There are over 2000 NGOs operating in Haiti addressing health, human rights, labor, housing, nutrition, and myriad other issues. Despite this, Haiti continues to have significant challenges to successfully developing and maintaining sustainable infrastructure to address these very problems. What can we learn from the Haiti experience?