By Marilyn Heymann
Poor economic times have never favoured good health. The economic downturns of the 1930’s and 1980’s and, more recently, the world food crisis have shown how vulnerable a population’s health really is to economic fluctuations. As the financial world readjusts after the recent collapse, governments, organizations and industry are restructuring programs, cutting budgets and altering the flows of funds across the world.
The various impacts of the collapse are becoming increasingly apparent. In particular, it is expected that the financial crisis will have a profoundly negative effect on issues relating to health for people all around the globe. Whose health will suffer most from this economic climate? The world’s poorest and most vulnerable populations. While higher-income countries are putting together stimulus packages for their economies, low-income countries are facing an increasing burden on their health care systems, drastic cuts in international aid, and a reduced capacity to address urgent health needs.
International aid is said to be pro-cyclical, meaning that having less national revenue available often results in reductions in international aid. Recently, some governments have started to retract funds and many NGO’s have closed their operations, calling into question how global health efforts will be able to maintain their promises and their funding under the harsher economic climate. According to the World Health Organization, countries within the European Union and the Organization for Economic Cooperation and Development have declared that they will provide previously pledged funding for international aid, but the United States and other G8 countries are already falling behind on promised funds. After the past decade of increased attention and funding devoted to global health, this financial crisis provides a reminder that global health is not a populist cause. Rather, global health efforts require sustained commitments, clear priorities and well-directed resources to stabilize and address varied health care needs.
Many low-income countries rely on international funding for the delivery of basic health care services. For these nations, cutting international aid can have a direct effect on the delivery of health care to the majority of the population. Furthermore, experts predict that the burden on these increasingly resource-poor health care systems will only augment in the coming years. In low-income countries, a large percentage of health care spending comes from private, out-of-pocket payments. Rising costs for food and medical supplies will render it impossible for many individuals to afford medical services on their own, resulting in an increased reliance on already weak and overburdened public health systems. Thus, in addition to the higher demand on formal health care systems, low-income countries also face a reduced capacity to address health needs. In the longer term, lack of investment will further weaken health systems and reduce future capacity to take on escalating health challenges.
How then, can the global community mitigate the negative impacts of the financial crisis on health? In a report published in January 2009, the World Health Organization identifies the need to increase efforts to monitor the emergence and indicators of disease, stabilize and protect health sectors, and raise public and political support for global health. Moreover, global health needs to be on the agenda for policy, research, and public advocacy. Framing the financial collapse as an “economic crisis” isolates the problem as strictly economic, but the impact on health reminds us of the inherently human nature of this crisis, as well as the acute and urgent need to address global health issues.
It follows that action is needed, and there is optimism to be found in the momentum of the global health community. There are more funding mechanisms available and more attention being given to global health now than ever before. Health priorities, targets and goals have been established in the form of Millennium Development Goals, and the global health community is continuing to mobilize and evolve. The financial crisis will certainly set back the Millennium Development Goals and other global health agendas, but this only goes to show that development and global health goals are moving targets that require evaluation and adjustments. We can therefore hope that this financial crisis will force us to evaluate existing efforts and will serve to mobilize and prioritize global health efforts as a response to the financial crisis.
