Every day I’m tempted to apply lessons from global health successes to other domains of development, like education and governance. It’s a temptation I’ve got to fight.
You can see the appeal. The world has seen many great successes in public health in poor countries, from eradicating small pox to reducing child mortality to extending the lives of people with HIV and AIDS – and those successes have been due in large measure to a combination of good science and generous aid. The global health sector, for all its flaws, has demonstrated an ability to set shared goals, build and sustain organizations like GAVI and the Global Fund to Fight AIDS, Tuberculosis and Malaria, use reasonably good data to make decisions, and transfer knowledge about what works in one country to inform practice in others. Most other pieces of the development puzzle have had considerably less success than global health as they’ve tried to raise money, build institution, and create a body of evidence at the global level to serve local decision makers.
Why can’t global health successes go viral? I think it’s because global health is simply more, well, global than most other domains of development. It’s more global because infectious diseases don’t respect borders, and when one country is healthier so are its neighbors. It’s more global because health products and health workers, in different ways, trade on international markets, and when vaccines, drugs, and interventions are tested in one country chances are pretty good they will work in others.
The “globalness” of global health has contributed in fundamental ways to the successes in the field. It’s what’s made it possible, for example, for medical doctors and nurses from the U.S., Canada, Western Europe, and Cuba to help so much and so quickly in both humanitarian crises and in the ongoing development of health systems that provide Western-style care. It’s what’s permitted huge volumes of drugs and vaccines to be purchased at relatively affordable prices, so they can then be made available to every country.
In contrast, look at education: Resources can be pooled and coordinated at the international level, as they are by the Global Partnership for Education, and it’s possible to create standards for collection of data. But the “globalness” story in education is quite thin. Teachers and schoolbooks from one country are rarely useful in others. And the jury is still out on whether teaching-learning tools developed in one setting will work as well in others.
Or look at governance: International norms around public financial management and transparency are useful to raise the bar, but governance and public sector management problems have to be solved in creative, often unpredictable, ways within the historical and cultural contexts in which they occur. They may be able to draw ideas from other settings, but do not benefit from a “corruption vaccine” with the power to stamp out graft around the world.
Pick a sector and try to figure out the “globalness” story. I’ll be there are very few, if any, that have a much that’s global as global health.
What global health does offer to other development challenges, I think, is the inspiration that comes with making a real, measurable difference in people’s lives. We can and should seek that sort of positive impact regardless of the sector in which we’re working. But increasingly I’m seeing that to make that difference means adopting different models than what’s worked in global health.