Debate Global public goods and the global health agenda : problems , priorities and potential Richard

The 'global public good' (GPG) concept has gained increasing attention, in health as well as development circles. However, it has suffered in finding currency as a general tool for global resource mobilisation, and is at risk of being attached to almost anything promoting development. This overstretches and devalues the validity and usefulness of the concept. This paper first defines GPGs and describes the policy challenge that they pose. Second, it identifies two key areas, health R&D and communicable disease control, in which the GPG concept is clearly relevant and considers the extent to which it has been applied. We point out that that, while there have been many new initiatives, it is not clear that additional resources from non-traditional sources have been forthcoming. Yet achieving this is, in effect, the entire purpose of applying the GPG concept in global health. Moreover, the proliferation of disease-specific programs associated with GPG reasoning has tended to promote vertical interventions at the expense of more general health sector strengthening. Third, we examine two major global health policy initiatives, the Global Fund against AIDS, Tuberculosis and Malaria (GFATM) and the bundling of long-standing international health goals in the form of Millennium Development Goals (MDG), asking how the GPG perspective has contributed to defining objectives and strategies. We conclude that both initiatives are best interpreted in the context of traditional development assistance and, one-world rhetoric aside, have little to do with the challenge posed by GPGs for health. The paper concludes by considering how the GPG concept can be more effectively used to promote global health. Background Although the health of the world's poor has been an apparent humanitarian concern of the world's rich for many years, results based on appeals to such 'humanity' have not been sufficient. Even recent high-profile engagements by the Global Fund Against AIDS, Tuberculosis, and Malaria (GFATM), the United States President's Emergency Plan for AIDS Relief (PEPFAR), the Bill and Melinda Gates Foundation, and WHO disease-targeted programs such as Stop TB and Roll Back Malaria have failed to bring us to the levels of assistance needed to achieve the healthrelated Millennium Development Goals (MDGs). Beginning in the late 1990s, the suggestion emerged to address this situation by encouraging policy makers in rich countries to view health assistance not only as humanitarian but as a selfish investment in protecting the health of their own populations. The key concept underlying this new interpretation is that of 'global public goods' (GPGs) [1]. Published: 22 September 2007 Globalization and Health 2007, 3:9 doi:10.1186/1744-8603-3-9 Received: 19 December 2006 Accepted: 22 September 2007 This article is available from: http://www.globalizationandhealth.com/content/3/1/9 © 2007 Smith and MacKellar; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.