Trade, foreign policy, diplomacy and health

6. Public Health Infrastructure and Knowledge

John Powles, Flavio Comim


  • Global public health largely ‘vertical’ - disease oriented
  • Public health infrastructures ‘horizontal’ - used across a number of diseases
  • GPGH useful in clarifying why rich should support public health infrastructures for poor
  • Future work should focus on international mechanisms for finance and support of public health infrastructure

Global public health to date has largely been ‘vertical’ - dedicated to specified objectives in relation to specific diseases. Eg smallpox, malaria, HIV/AIDS. Public health infrasturutres are more ‘horizontal’, of use across a number of objectives/diseases. Current concentration on vertical programmes is unwise. It cannot compensate for neglect of public investment in local ‘horizontal’ public health infrastructures. Care should therefore be taken to ensure that resources for vertical programmes are not at the expense of the development of 'horizontal' programmes, which are most likely to achieve further health gains.

The GPGH lens may have heuristic value in helping to clarify why it is in the interest of rich countries to strengthen public health infrastructures globally. However, there is the danger (even though not instrinsic to the concept) that the analytic device of regarding public health infrastructures as 'goods' - or as the means of access to such goods - can encourage the false idea that decisions can readily be made to 'produce' more of them or not, depending mainly on the availability of vertically commandable resources. In contrast, the connections of such infrastructure to an array of social institutions must first be understood.

Future work on the importance and impact of public health infra-structures in the provision of GPGH should therefore focus on international transmission mechanisms that may allow the financing and support of these goods. Emphasis should be given to the international coordination problems that would need to be overcome in order to produce coherent, efficient and equitable patterns of provision and distribution of infra-strcutures. A more comprehensive assessment of the impacts of health improvements in poor countries would also deserve further scrutiny.