Health and development: toward a matrix approach
Editors: Anna Gatti & Andrea Boggio
Publisher: Palgrave Macmillan, Basingstoke, 2008
ISBN : 9781403947376; hardcover; 296 pages; £50.00
Interest in global health, the relationship between health and economic development, and the impact of globalization upon both of these, has risen rapidly up international and national agendas in recent years. This expansion of interest has both formal expression, such as the Millennium Development Goals, the Commission on Macroeconomics and Health, and the Framework Convention on Tobacco Control, and more informal expressions, through concerns and negotiations focusing upon pandemic influenza, the role of the food industry in nutrition-related chronic disease and the role of patent protection in access to essential medicines. These, and many other instances, serve to demonstrate that there is no such thing as national health or a national health system; in today’s world, all health is global health.
This has led to a welcome concomitant increase in funding allocated to global health, both through traditional aid routes and increasingly through new initiatives, most notable perhaps being the Global Fund to Fight AIDS, Tuberculosis and Malaria. However, this increase has not been universally applauded and there have been criticisms, mostly focused upon the reinforcement of the “vertical” approach, emphasizing a disease-specific approach to securing health improvement. This has come at a time when many in the international health community were feeling that there had finally been a breakthrough in securing recognition that health improvement can only be achieved through strengthening of health systems more generally; the so called “horizontal” approach. More recently a consensus may be emerging that both approaches have strengths and weaknesses, and that synergies may be capitalized upon if both are pursued in tandem; simultaneously strengthening the health system while focusing upon those diseases that are the major burden to a country.
It is this tandem, or “diagonal”, approach that Anna Gatti & Andrea Boggio emphasize in this book. In their introduction they emphasize this perspective and outline a matrix that seeks to combine both vertical and horizontal aspects to aid resource allocation. This is a novel and potentially illuminating means of categorizing interventions. The remainder of the book then comprises four sections written by a wide variety of authors internal and external to WHO. Part 1, on the global health arena, considers especially the role of WHO in global health. Part 2, on health and development looks in more detail at various perspectives on global health and development, including those of evolution, economics, law and ethics. Part 3, on global health and vulnerability, focuses on the experiences of the elderly, children and women. Part 4 considers the interrelation between specific disease and development, then shifts the focus to specific diseases of chronic illness, malaria, HIV/AIDS and tuberculosis. In the main, the book is relatively neutral in its presentation, provides a good deal of evidence – some of it new – and is authored by those with a good knowledge of their subjects. Certainly some of the perspectives by those working in or with international organizations provides interesting insights at times. The book is pervaded by the emphasis on building systems and capacities, rather than new technological discoveries, as the key to future health improvement. It is likely that readers interested in global health will find much that appeals and informs, and it is certainly a welcome addition to my bookshelf.
I read the book over a period of several weeks' travelling, something many readers may do, and the edited nature of the book lends itself very well to this style of reading as each chapter stands alone. However, once I had finished the final chapter, I found myself somewhat disappointed that there was no final section or chapter to turn to that deals with the performance of the matrix approach that was introduced at the beginning of the book. The book begins with the authors “propos[ing] a matrix as a tactical tool to be used to define optimal allocation of (scarce) resources” (p.xxiii). However, it is not made clear how the various chapters link to this, or how the analyses are informed by it, and the chapters themselves do not tend to make reference to this matrix. It is therefore disappointing to get to the end and find that there is no chapter to bring the book full circle and reflect upon the material in these chapters from this matrix perspective, or to offer a summary of the research and policy agenda’s arising from them. This lack of emphasis on the matrix makes one wonder at the appropriateness of the subtitle of the book as, apart from a brief discussion in the introduction, the matrix approach does not appear and the book then becomes another collection – albeit an interesting collection – of papers with some specific views and opinions on globalization, health and development.
A further feature to bear in mind is that 12 of the 16 authors are current or ex-WHO staff and this is reflected in an often uncritical reflection upon the role and activities of WHO (perhaps the best example being the discussion in chapter 2). Although there have clearly been considerable successes achieved by the Organization over the past 60 years, this uncritical reflection of its role in the current global environment is a weakness, as there is considerable debate – internal and external to WHO – about the role the Organization will play in the next 60 years; for example vis-à-vis other international organizations, such as the World Trade Organization, concerning issues of trade and health. This emphasis of the role WHO does and should play seems critical to any discussion of the links between health and development.
In summary, this is a useful and accessible book that offers much benefit for those interested in global health. This is especially true of those who are active in the field in research and policy but it may also be of some value to graduate students, probably as an optional reading or reading of selective chapters. I only wish that the editors had taken that final step to conclude with something more on their proposed matrix! ■
Richard Smith a
a. London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England.
Correspondence to Richard Smith (e-mail: Richard.Smith@lshtm.ac.uk).
Bulletin of the World Health Organization 2009;87:883-884. doi: 10.2471/BLT.09.064931