Global Health Initiatives: A Healthy Governance Response? - Innovation in Global Health Governance - page 290

alone each year (Sachs 2005, 196; rockefeller Foundation 2004, 5). Health simply
was not considered an integral component of the development agenda.
this lack of interest in health matters was due predominantly to the framing
of the role of the state in the development process in purely economic terms during
the 1980s and '90s. the world bank set the mark for this vision with its structural
adjustment programmes (SaPs). with SaPs it was expected that a low-income
country would become effective through a process of adjustments to the financial
and trade sectors of the country along neo-liberal lines. If the formula was adhered
to, it was assumed that economic growth would take hold in a country and public
services, such as a properly functioning health system, would automatically follow.
as some had noted throughout these years, this understanding of the poverty cycle
was too narrow. 3 Development agencies focussed too much on the economic aspects
of poverty alleviation, while leaving out many of the social factors that are attributable
to poverty and not encouraging investment into basic services to the population.
However, during this period, it was thought that these specialised agencies were
producing the best ideas for development strategies, based on the data available and
in-depth analysis. If health was not factored in, then it could not be perceived as a
problem. thus, as the spread of certain infectious diseases in the developing world
was growing into a crisis, the development agencies could not sense the looming
dangers and respond accordingly.
critical assessment among practitioners has now recognised that economic
growth is not a single-solution road out of poverty but rather that health is a major
determinant of economic growth and poverty alleviation. Macroeconomics and
Health: Investing in Health for Economic Development, the report produced by the
commission on Macroeconomics and Health (2001), explicitly made this point and
heralded the reversal of neo-liberal development policies focussed on economics. this
appreciation, combined with the fact that in 1999 the world finally began waking up
to the devastation of HIv/aIDS in africa, meant that efforts to improve health in the
developing world would need to make great leaps to catch up. Specialised responses
above and beyond oDa would likely have been necessary to take on most of the
growing health issues. but it was the failure to address HIv/aIDS in anything that
approached a timely fashion that ensured the focus would be on infectious diseases.
The first case of HIv/aIDS was diagnosed in 1981. but it was only in 1999
that the Un Security council (UnSc) held an unprecedented special session on
the matter and the world bank established a department to work on the problem.
even the wHo was slow to put the issue on its radar screen throughout the 1980s
(Mallaby 2004, 313-320). all international institutions and state-led development
agencies failed to identify and act reasonably before the HIv/aIDS problem grew
into what it is today. this incredibly slow response cemented the need to have a
mechanism and strategy to fight infectious disease that moved beyond the parameters
of development agencies and international institutions.
another consideration in the recent emergence of global health initiatives is the
link between the security and development agendas over the past few years (Un
2005a, 5-6). this convergence has turned the matter of infectious disease into