A New Health Opportunity
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Development. Copyright © 2001 The Society for International Development. SAGE Publications (London, Thousand Oaks, CA and New Delhi), 1011-6370 (200103) 44:1; 36–43; 016554.
Health and Poverty in a Social Context
A New Health Opportunity D AV I D E . B L O O M A N D D AV I D CANNING1
ABSTRACT David E. Bloom and David Canning argue that there are three types of justification for improving health: health is a human right, it is a vital social goal, and it is important to economic success. An exploration of each of these areas indicates that health improvements rely on social choices and political priorities. Investment in health, especially when targeted at the poor, can stimulate virtuous cycles of development. More attention must be given to the reform process and to setting priorities for investment in health. Implementation and management of change is at least as important as the content of a health reform initiative. KEYWORDS Alma-Ata declaration; growth; health sector reform; institutional change; poverty
Health for all In 1978, the Declaration of Alma-Ata committed the world community to achieving health for all by 2000. Twenty-two years later, the world’s health has improved, with increases in life expectancy in 163 of 184 countries for which data are available (between 1975 and 1995).2 However, massive disparities in health status remain. In the 24 most healthy countries, a child born in 1999 can look forward to more than 70 years of healthy life (measured in disabilityadjusted life expectancy or DALE). In the 51 least healthy, he or she can expect to live less than 50 healthy years, with three countries – Malawi, Niger and Sierra Leone – having DALEs of less than 30 years. Especially worrying is the fact that standards of health are now deteriorating in some countries. In many republics of the former Soviet Union, life expectancies have been in long-term decline since the 1950s (Becker and Bloom, 1998), while HIV/AIDS is having a devastating and worsening effect on health in many countries in sub-Saharan Africa (Bloom et al., 2000: 26–37). By challenging the presumption that people will inevitably become healthier over time, recent health reversals have pushed global health up the international political agenda, after a period of stagnation and neglect. In January
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Bloom and Canning: A New Health Opportunity 2000, the UN Security Council held a debate on the impact of AIDS on peace and security in Africa. It was the first time in 50 years that a health issue had been considered as a matter of international security. In July 2000, leaders of the Group of Eight (G8) signed up to new disease targets, pledging to cut deaths from tuberculosis (TB) by 50 percent, the burden of disease associated with malaria by 50 percent, and the number of young people with HIV by 25 percent – all by 2010 (Tett, 2000). This article looks beyond the failure to achieve AlmaAta’s ambitious goals and directs attention to these new signs of promise.3 It argues th
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