Sarah awoke in pain again, alone on the mat, still reeking from the night before. She had not dreamed, not for months, that she could remember. Just waking with the pain inside her, the knowledge of her abandonment in the crowded house, and the emptiness that had been her future.
When the school closed ‘because of Covid’, Sarah’s father said it would just be a week, and she could help with the harvest. The fruit must be picked, anyway. When the harvest was coming in, the markets closed and it rotted in the store at the back of the house. The broker had forwarded the costs of her little brother’s medicines when he went to hospital three months earlier, and they were to pay him with the crop. Sarah’s father explained that college was no longer an option, and she did what she had to do. The man was old and she hated the smell and sight of him, but he had paid off the broker, and now Sarah owed him.
About 20 years ago, increased funding began flowing into international public health. This came mainly from a few private sources, people who had grown up in wealthy countries and made their fortunes from computer software. Their investment levered further funding from corporations and governments through ‘public-private partnerships’, adding public taxes to the private funder’s priorities. New foundations and non-government organisations paid people in poor countries to work on areas of public health that interested wealthy people. The World Health Organisation (WHO), formerly funded by countries as a technical agency, gained new ‘specified’ funding from these sources, co-opting the WHO’s vast network and influence to further the priorities of investors.
This new funding was a win-win for international public health (or ‘global health’). We got larger salaries and lots of travel, leading wealthier and more interesting lives. Improved resources for disease programs such as malaria and tuberculosis reduced avoidable sickness and death. Behind this, a few very rich people were deciding the health priorities of billions. They were not enabled by those whose health was at stake, but by those whose careers were at stake. Supporting the centralisation of public health has become standard, whilst simultaneously arguing for its decentralisation. Job security can paper over a lot of ills.
Private sponsors, and the pharma companies in whom they invest, give money for a reason. Corporations have a responsibility to their shareholders to maximise profits. Investors look to increase their own wealth. Where health outcomes seem more measurable, such as X number of vaccines saving Y number of children’s lives, media and public attention also helps build a positive image. Improved sanitation and community health worker support may be a better way to stop children dying, but the public don’t get excited by clinics and toilets.
