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March 10, 2017

Responding To: Global Health and Migration

The Changing Paradigm of Global Health

Professor Rebecca Katz, Georgetown University

We are at the cusp of a major shift in global health. With the introduction of new actors, drivers and frameworks, we anticipate shifts in approaches to global health assistance, cooperation and outcomes. The field of global health assistance is already crowded. The amount of funding for global health has increased five fold since 1990, and there are now a wide range of donors and channels of assistance, including bilateral donors, public private partnership and philanthropic organizations. Most of this assistance is driven by development, and much of this assistance is for vertical programs focused on a single disease, like HIV/AIDS.

China’s interest in global health has been focused primarily in Asia and Africa, emerging as one of the top ten donors for health assistance in Sub-Saharan Africa. China’s approach to global health- particularly in Africa, however, has taken a different path from most other donors. Instead of being driven by a development agenda, China’s aid to Africa is managed by the Ministry of Commerce, with input from the Ministry of Foreign Affairs. As such, assistance has often been tied to business interests or diplomatic engagements.

China, though, has recently added global health to its development agenda, and has prompted a rapid scale up in assistance to developing countries. China has ambitious goals: it has established a Center for Global Health within the Chinese Centers for Disease Control. This new Center only has a handful of employees, but plans to hire a few hundred, and is now starting the process of defining its global health strategy. In parallel, prominent Chinese universities have established the Chinese Consortium for Universities of Global Health (CCUGH), modeled after the primarily U.S.-based Consortium for Universities of Global Health (CUGH), and are beginning to explore a cohesive research and educational agenda. Our Chinese colleagues are exploring how this new age of global health in China might be influenced by the country’s recent history of being a recipient nation, and how “South-South” cooperation may create new types of relationships in global health. All of these activities have the potential to shift traditional approaches to global health, and potentially influence the actions and methods of other bilateral donors, philanthrocapitalists, and development organizations.

We should mark 2017 as the start of a new decade in global health. It is unclear if the Trump Administration in the United States will continue its commitment to global health activities. With changing geopolitical environments, global health assistance may become more explicitly tied to diplomatic relationships. New roles for development banks and other institutions working on financing global health may result in changing priorities, as may assistance managed by commerce as opposed to development agendas. And the increase in “South-South” cooperation may shift the relationships between donors and recipients. With all of these uncertainties and changing priorities and actors, it is possible that we will see major shifts in global health.

The global academic community must carefully watch these potential changes and monitor the global health actions, strategies and engagements as they are developed and initiated. Metrics and areas for monitoring, evaluation and analysis should be developed to enable us to identify real shifts in global health and related policy recommendations for decision makers around the world.

It is an exciting, but uncertain time in global health, and China will no doubt contribute to a new paradigm in global health, with impacts on population health, disease spread, foreign policy, trade and security.

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