Trade, foreign policy, diplomacy and health

1. Global Public Goods and Health: concepts and issues

David Woodward, Richard D Smith

GPG status of the control of major communicable disease

Diseases considered to be GPGs:

  • Tuberculosis (especially drug-resistant TB)
  • Eradicable disease (e.g. polio)
  • Anti-Microbial Resistant disease

Diseases considered not to be GPGs:

  • Malaria (regional public good)
  • Acute Respiratory Infection (poverty)
  • Diarrhoea (analogous to ARI)
  • Vaccine Preventable diseases (e.g. mumps).

    For this sub-set of diseases whose control can be considered a GPG, it is also important to distinguish between control within a country or region, to limit the global ‘stock’ of disease which may be disseminated (e.g. polio eradication), and control of cross-border transmission (e.g. through International Health Regulations). These two approaches have very different implications, particularly for the distribution of benefits. Since transmission is predominantly from countries with a high incidence of disease to those with a low incidence, the benefit of limiting cross-border transmission is greatest where incidence is lowest. By contrast, programmes based on in-country control focus on countries with high incidence, which therefore benefit most. Since the incidence of communicable diseases is generally lower in richer than in poorer countries, the approach chosen thus has important implications for equity.