Global health is big business nowadays. The sums can be enormous, but the health problems in the developing world are even larger, often seeming intractable. Healthcare everywhere involves stark economic and political choices, but in the developing world these may involve such basic questions as whether to build a hospital or fund community health workers, but not both. Each constituency or group of workers sings its own song, competing fiercely for scarce donor funds.
Where do you put your money? Single-disease eradication was the traditional favourite, dating to the Rockefeller Foundation’s work beginning a century ago on hookworm, schistosomiasis, sleeping sickness, malaria, yellow fever and other diseases. The World Health Organization (WHO) campaign that eradicated smallpox in 1979 seemed to vindicate this single-disease, vertical approach, even as a WHO malaria programme was then ending in chaos.
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William Bynum is professor of the history of medicine at University College, London
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