Trade, foreign policy, diplomacy and health

1. Global Public Goods and Health: concepts and issues

David Woodward, Richard D Smith

Vertical and Horizontal approaches

  • Vertical = traditional disease specific programmes are limited (they skew priorities towards dono concerns, divert resources from general health services and generate duplication between programmes)
  • Many GPGH cut across diseases, they are Horizontal (adequate health systems benefit many areas of communicable disease control).

The distinction between health as a GPG and GPG for health represents a distinction between ‘vertical’ and ‘horizontal’ GPGH.
‘Vertical’ GPGH may be considered to be disease-specific programmes, the ‘traditional’ means by which governments, NGO’s, international bodies and donors work in many countries, partly as a means of limiting the problems of working through under-resourced health systems.
While such programmes have saved many lives, they have also been seen as inefficient; giving rise, for example, to problems of co-ordination, skewing priorities from national towards donor concerns, diverting scarce human and other resources away from general health services, and generating costly duplication between parallel programmes.
These limitations arise primarily from the asymmetry in financing between these, relatively well-financed, vertical programmes and grossly under-resourced ‘horizontal’ health systems.
However, there are significant categories of potential GPG for health that cut across diseases. Adequate health systems, for example, would benefit many areas of communicable disease control, while modifications to international rules on pharmaceutical patents would apply to products across the spectrum of communicable diseases.
An advantage of the GPG approach is thus that horizontal and vertical approaches will be seen as complementary, rather than competitive, with a set of common horizontal GPGH creating the conditions in which disease-specific GPGs can then be provided more effectively, while a vertical programme co-ordinates the provision of inputs needed for each disease, or group of related diseases.