Reshaping Global Health Through Policy

According to the World Health Organization (WHO), the purpose of health policy is to outline a vision for the future of health by delineating priorities and expectations of key decision makers. Importantly, in their publication The US Commitment to Global Health, the Institute of Medicine published five recommendations for improved global health: (1) scale up existing interventions, (2) generate and share knowledge to address health problems endemic to the global poor, (3) invest in people, institutions, and capacity buildings with global partners, (4) increase US financial commitments to global health, and (5) set the example of engaging in respectful partnerships.   

I believe that policy can help achieve these goals by:

1. Developing standardized benchmarking of health reform

First, policies should require standardized benchmarking of healthcare reform as a means to measure what initiatives have been effective. Benchmarking would create accountability and shared responsibility. Daniel et al (2000) developed a benchmarking scale, ranging from -5 to 5, with 0 representing the status quo, to aid in measuring reform success. Their scale is based on nine predefined benchmarks: (1) intersectoral public health, (2) financial barriers to equitable access, (3) nonfinancial barriers to access, (4) comprehensiveness of benefits and tiering, (5) equitable financing, (6) efficacy, efficiency, and quality of healthcare, (7) administrative efficiency, (8) democratic accountability and empowerment, and (9) patient and provider autonomy.

2. Creating individualized plans most appropriate for the implementing country

Second, policies should support flexibility and customization of health initiatives. The initiatives should be defined by the unique needs of that population with the input of that country’s leaders, thinkers, and citizens.

3. Strengthening and integrating primary/general care

Next, broader health care access can be achieved by integrating primary, dental, and mental health care with a focus on geographically efficient distribution of facilities. In, 2008 the WHO published a global perspective paper urging policy makers to integrate these specialties. 

4. Increasing citizen’s access to health information

Improving access to health information empowers individuals to care for themselves and their families. Policy should support projects that promote universal access to the Internet such as Google’s Project Loon. Universal access to the Internet enhances global health not only by providing access to health information, but also by offering telecommunication infrastructure.  

5. Understanding and improving social determinants of health

Next, policies should attempt to prevent upstream effects on poor health by reducing a population’s exposure to risk factors. For example, the WHO calls for closing the health gap between countries within one generation by improving social determinates of health. Eloquently summarized by the WHO, “In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health. Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. Social injustice is killing people on a grand scale.” Policies could incentivize American business in undeveloped countries to invest in that countries public and environmental health. Policies could also require these American business to provide their workers with health insurance and free preventative services. 

6. Encouraging innovative solutions to promote global health  

Finally, policies should encourage innovative, out-of-the-box ideas for promoting global health and improving access to care. Policies for example can create “innovation funds” to support high risk projects. The Bill and Melinda Gates Foundation, for example, supports the Grand Challenges Explorations Initiative, which provide grants for bold, unorthodox ideas to overcoming challenges in global health.  Another unconventional solution, the Health Impact Fund, incentivizes the pharmaceutical industry to develop new medications for poor countries by rewarding them based on the actual impact of the drug while waving the cost for research and development. Thomas Pogge summarizes the Health Impact Fund and its goal to redistribute pharmaceuticals to the developing world in his  2011TED talk Reimagining Pharmaceutical Innovation.

Any other thoughts? Email me or comment below with your ideas.