Of course, the LA Times report on the contradictions of the Gates Foundation is not to be ignored. But the contradictions which come from ignoring a holistic approach to public health in the developing world are exposed much more forcefully by Laurie Garrett’s excellent, thoroughly-researched essay in Foreign Affairs. Garrett’s conclusions reach way beyond Gates’ false steps, in fact, and assess the deeply entangled structural problems at the heart of failure. NGOs frequently overlap, and are also prone to take local populations as objects of salvation rather than agents (a point Paul Farmer has been making for a while, and again recently). Aims are too often driven by novelty and issue-based shock among Western givers, rather than addressing the structures which perpetuate inequality. Perhaps topping all of this, however, is the lethal effect of the “brain drain” of qualified medical practitioners. Garrett has the figures, and they suck.
The point here is not that everything is bad and we’re all doomed — there are some reasons to be cheerful, not least the impressive, multicentric increases in both donation and action — but that a combination of selfish health policy on the part of states, wrongheaded “intervention” on the part of NGOs and narrowmindedness on the part of donors congeal to stunt the very processes which would effect a radical and lasting transformation of health inequalities. And really, anything less than the latter is unacceptable.
In short, it’s all well worth a read.