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  • Informal dialogues can help drive global health policy


With the global community gearing up for World Health Day, informal dialogues can build partnerships to drive health policy.

I had the good fortune, last week, to attend a two-day colloquium in Geneva, Switzerland, jointly organised by the Council on Health Research for Development (COHRED) and the Lancet Commission on Investing in Health.

The purpose of the colloquium was to address the challenges involved in introducing innovative and practical initiatives to help low- and middle-income countries (LMICs) develop their own solutions for investing.

The event coincided with the twentieth anniversaries of both COHRED's launch and the publication of the World Development Report of 1993, 'Investing in Health', widely regarded as one of the most influential global health publications because it made the case that investing in health wasn't an economic drain but an investment in wellbeing and prosperity. [1]


  • 20 years after the 1993 World Development Report, experts meet to discuss health progress
  • Economists must wield their potent influence responsibly
  • A more nuanced understanding of local communities should also drive health policy

I spoke to Gavin Yamey, who leads the Evidence to Policy initiative of the Global Health Group at the University of California, United States, and also works as medical advisor and scientific writer for the Lancet Commission on Investing in Health.

Gavin was excited that now, twenty years after COHRED's launch, investment in research and development (R&D) is on the global health agenda once again.

'Improbable' partnerships

I mingled with the colloquium crowd and met Carel IJsselmuiden, executive director of COHRED. He introduced himself as someone for whom the idea of improving the health of a population was based not just on technical interventions such as new tools, toilets or through improved epidemiology, but also through political change.

The purpose of this colloquium, he told me, was to create opportunities in which to generate what he calls 'improbable partnerships for action'. The improbability of these partnerships, he says, is that they don't normally happen — that is, they don't automatically happen without a catalyst.

And so it was that I found myself huddled around flip charts, sticking up coloured post-it notes, and exchanging views, ideas and email addresses with a colloquium-full of 'improbable contacts'.

"You don't normally get private and public sectors, science and technology and health, ministers of finance and NGOs to sit in a room, and yet that is where large innovation happens," said IJsselmuiden. "The insecurity creates an openness to start accepting and talking about new ideas."

I heard success stories such as trachoma treatment among Australian Aborigines using the antibiotic azithromycin, an intiative by research-based pharmaceutical company Pfizer Inc being funded by profits from its sale for different diseases in developed markets. [2]

And I heard about failures, such as insect-impregnated malaria nets being used as fishing nets and wedding dresses.

I was also told about recent initiatives in medical ethics, including moves on the part of the EDCTP (European & Developing Countries Clinical Trials Partnership) to protect vulnerable communities in Botswana, who think that participation in research is equivalent to receiving medical treatment.

The good, the bad and the economist

On the first day, at the anniversary dinner, I was told a joke by one of the participants thatI'd like to share with our readers.

The joke goes something like this: during a grand military parade in an unspecified country we see ranks of marching soldiers, armoured vehicles of various kinds, followed by tanks and eventually trucks bearing the latest ballistic missiles. Behind these walks a figure, marching alone.

"Who's that behind those missiles?" asks an onlooker.

"Oh, that's an economist," comes the answer.

"That's weird," says the first onlooker; to which the other replies, "It's not weird at all. Have you got any idea of the destructive force of a single economist?!".

The joke made me chuckle. At the same time, it also made me reflect on the idea that economists can indeed be highly destructive through their influence on a country's policies and funding decisions, while conversely, in the right hands, they can represent a potent power for good, if they direct the flow of money to good use.

That morning, at the colloquium plenary session, we had seen a pre-recorded video message from Lawrence Henry "Larry" Summers, an American economist and Harvard Professor.

He spoke of his 'sense of kinship' with those at the colloquium, not least because as chief economist at the World Bank from 1991 to 1993, he was responsible for publishing the 1993 World Development Report.

Summers announced that he would also be chairing a new commission of 23 members, half from developing countries, who would be revisiting the case for investing in health, and who would publish their findings in The Lancet on 3 December this year.

If there was ever a force for good in global health, I thought, this economist must surely be at its epicentre.

A parade for good

The serendipity and potential for the unexpected that the Geneva colloquium established provides the kind of valuable context we need to help forge dialogues between people from diverse backgrounds, and encourage interdisciplinary and inter-sectoral ways of doing business.

This brings us back to our economist joke. Economists can indeed do great damage, if they don't work in an integrated way with other disciplines, and if they wield their power for advising on the use of money irresponsibly.

But they need to know what technical innovations are available before they can advise or plan for their potential impact.

And they need a better understanding of context. For example, predictions about human behaviour — such as the use of malaria nets — are often based on assumptions about motivations that are not driven by an understanding of local cultures.

Working responsibly means working together with natural scientists and local specialists from multiple disciplines.

As this year's World Health Day approaches, I would like to imagine a parade in an unspecified country — ranks of marching health workers, healthy mothers and children, former sufferers from malaria, tuberculosis and HIV, columns of life-saving technologies — behind which strides an economist.

And I would like to be able to answer the question, "Is this some kind of joke?" with the punchline, 'have you any idea how much an economist can do to champion world health?'

Kaz Janowski

Editor, SciDev.Net


[1] World Development Report 1993: Investing in Health (Oxford University Press, 1993)

[2] Elimination of Blinding Trachoma: Only 10 Years to Go (WHO, 2010)


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