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Jump to Chapter 3 Sections:
>> Health, development and aid >> Broad progress, startling changes, persistent quandaries >> Health indicators: advances and obstacles >> Health systems and services >> To review the bidding >> Implications of trends for future directions >> Implications for the philosophy and pursuit of "foreign assistance" >> Notes >> Background paper >> References
When it comes to health, developing countries fall into two groups. In most, health care has improved dramatically in recent decades, raising life expectancies, expanding workforces, and reducing deaths from communicable diseases. As a result, by 2020 these countries are expected to achieve international objectives for basic health indicators. They will have smaller populations under 5, and their median ages will approach those in industrial countries today. Moreover, noncommunicable disease will be the leading cause of death. But these countries will still have subpopulations with health profiles similar to those in least developed economies. Further, there may be unexpected shocks that could cause countries to regress, such as the HIV/AIDS epidemic, social upheaval, and natural disasters.
In a second, smaller group of developing countries which includes badly managed or conflicttorn
economies that have seen little or no growth in recent years health indicators have stagnated
or worsened. Fertility and infant mortality rates are high. Life expectancies are low. And infectious diseases, including HIV/AIDS, are widespread. Though some of these countries are seeing slight improvements in demographics and mortality rates, they will not approach the levels of today’s industrial countries by 2020.
These features offer opportunities and create challenges. In addition to maintaining basic public health services, the first group of countries must decide how to meet the challenges of changing health patterns. Global health programs can shift their focus from women of reproductive age and children under 5 to entire families, including income earners and elderly dependents. Better health outcomes will require better management of chronic diseases, from prevention through treatment. Sustainable progress in health will require health care institutions with both capital and recurrent financing. And systems will need to respond to rising expectations for health care and to the dominance of private flows in its funding.
In the second group of countries public health interventions will have to remain focused on
reproductive and maternal and child health, but must examine the strategies to do so. By 2020
nearly 9 out of 10 people in this group of countries will be African.1 Global health programs will
need to evolve to produce more effective results.
In addition, consideration must be given to external concerns that affect health outcomes including
income growth, education, water, sanitation, and good governance. What do these issues mean for foreign assistance?
- Health interventions must encompass a wide range of new approaches and actors. Dealing with local financing institutions, employer benefit plans, and telecommunication networks may be just as important as ministries of health.
- The increase in noncommunicable diseases will be permanent, making health care more expensive. Donors and developing countries must make complementary investments involving all parties public and private with vested interests in a country’s long-term health status, ultimately aiming for selfreliance.
- Given the rapid and diverse changes in many developing countries, donors must be flexible.
Efforts to accelerate the progress of countries suffering from traditional health and disease problems must be combined with programs to help other countries address new challenges.
- Despite 40 years of effort, many countries have extremely high infant mortality and low
life expectancy, now affected by high HIV/AIDS rates-suggesting a need to carefully evaluate past public health investments, develop new approaches, and better define the role of the private sector.
The changing profile of disease is affecting the economies of developing countries. Moreover, in
many newly democratic countries, people are demanding better health care. U.S. medical and health care organizations have the expertise and experience to help solve many of their problems. All these points suggest that U.S. efforts to improve health care overseas must continue to evolve to benefit both the public and private sectors and the citizens of all the countries involved.
Health, development and aid
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