Global Futures Initiative

Director-General Margaret Chan identified the lack of health systems as a major player in the Ebola epidemic, harkening others’ calls for mobilization of “stuff, staff, and systems."  But the call for investment in health systems is not a new one – it is resounding a cry for health equity from the Director-General Halfdan Mahler who led the WHO from 1973-1988 and the signing of the Alma Ata Declaration (1978). 

Many have argued that this call for building health systems – envisioned through the elevation of primary health care – failed because it lacked a financing vision.  In the past decades a robust field of health policy and research has responded with innovative possibilities.  One solution is investing in national health systems to strengthen governments’ capabilities of delivering healthcare not only to the wealthy but also the poor.  This may be strengthened further with some imagination not only about what governments can do but also with regard to what the U.S. government can do with funds already committed to global health.   

For the past decade the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), to which we recommitted just months ago, has paid for the delivery of the majority of the world’s anti-retroviral therapy (ART).  With new commitments to PEPFAR and the delivery of ART, there is a need to be more imaginative about health systems.  Indeed, it is imperative that comprehensive healthcare incorporates those with malaria, heart disease, depression, diabetes, anxiety, chronic lung disease, and others.  

This is not a call for dismantling the incredible work done through PEPFAR—indeed PEPFAR and others, including the Global Fund and Bill and Melinda Gates Foundation – have transformed global health through the delivery of ART.  But it is time to recognize, as a recent report by the Council on Foreign Relations did (December 2014), the growing threat to economies as well as the poor of the “silent killers” (non-communicable diseases, such as diabetes, cancer, depression, anxiety, and others).  

To address this less visible threat, it is important to use AIDS money in a more sustainable way.  Indeed, treating the myriad diseases people who are HIV-infected face is a start.  Also, treating loved ones of people and communities afflicted by HIV/AIDS (those who are HIV-affected) is an even better beginning.  But what is sure – and something that Director-General Chan touched on briefly, is that non-communicable diseases, including mental and neurological disorders, are often overlooked, underfunded, and deprioritized in global health.  These silent killers – although yet to be viewed as “emergencies” – have definitely emerged among low-income populations around the world and require attention on the global stage.   

Emily Mendenhall is an assistant professor of Global Health in the Science, Technology, and International Affairs Program in the School of Foreign Service.