9. Global Public Goods for Health: Use and Limitations
Richard D Smith, David Woodward
Correct identification of a GPGH
- Identification of possible GPGH critical, yet open to ‘interpretation’
- Could lead to GPGH concept being over-exposed or abused, and thus devalued
- Balance: robustness vs scope of application
- Framework to identify possible GPGH more systematically required
The identification of a possible GPGH is critical, yet the core characteristics of non-rivalry and non-excludability are somewhat 'elastic'. There are very few 'pure' GPGH (some communicable disease control/eradication and some environmental preservation). Knowledge and international legislation are important 'intermediate' GPG, and health systems a key 'access good'.
If the GPG concept is seen as a means to secure/protect funding, then the temptation to use this 'elasticity' may over-expose/abuse the concept (similar to 'public-private partnerships'), leading to the concept becoming devalued.
This highlights the fundamental dilemma faced by GPGH as an advocacy tool. If used strictly, it will be robust and convincing, but of limited scope. If the definition is more ‘relaxed’, to be inclusive, it loses its effectiveness.
A framework is thus needed to identify possible GPGs more systematically. A useful starting point for this may be to distinguish between problems conducive to GPG-type solutions, and GPG-based means of resolving problems. This suggests viewing possible GPGH in two dimensions: (i) the type of problem they address; (ii) the type of solution they offer. GPG-type solutions include those in the areas of global governance (international institutions and rules); knowledge (basic epidemiological research, the development of medical technologies, and dissemination of information); and interventions (international support for specific national health programs). This category might also include national access goods (eg national health systems).
Problems conducive to such solutions address within-country health problems with cross-country externalities (eg CDC) or cross-border transmission of factors influencing health risks (such as tobacco marketing).