“Gets AIDS and Survive”: Are we making things worse by “doing good”?

The “business” of global health regularly ignores community input and primary care, causing huge disparities in health care. For instance, in some countries, AIDs patients are guaranteed primary care due to international funding while impoverished malnourished children remain unattended; therefore, although the mortality rate for AIDs patients often decreases, others are dying from inadequate care. Furthermore, much health aid advances the private interests of large corporations like pharmaceutical and device manufacturers. Capitalism is the driving force behind the current global health aid system, resulting in vertical, disease-specific interventions. We will discuss the reason why criticisms of this system have been ignored and describe the negative consequences of vertical medical interventions in developing countries. We propose that health aid must fit within a horizontal framework, centered on public health interventions, in order to maximize aid efficiency, thereby saving more lives with the available funding. Relying on data that reveals the major causes of morbidity and mortality in developing countries, we suggest that health aid must address the social and environmental determinants of health including: water, sanitation, food security, and the education and empowerment of girls and the communities in which they live. Furthermore, we believe that “medical care,” centered on drugs and surgery, has become the dominant hegemonic construct for addressing health while social and environmental public health interventions have received limited or no funding. Global health initiatives thus require a redefinition of medicine, health care and the role of the physician in order to advance necessary improvements to global health.