D. Do States Perceive Global Health to be in Their National Interests?

Governments, therefore, have powerful reasons based on narrow or enlightened self-interest to ameliorate extreme health hazards beyond their borders. But do political leaders acknowledge, and act on, this evidence? The answer may be that States are beginning to understand, but their engagement in global health is relatively limited. And the sad truth is that the coincidence of interests is narrower than activists, and even scholars, have suggested. As U.K. Chancellor Gordon Brown said when launching the International Finance Facility for global health in 2003, rich countries “just don’t care enough.”

There is little doubt that developed countries are beginning to see global health as essential to their national interests. OECD countries have increased development assistance for global health over the last two decades, rising from nearly $2 billion in 1990 to $12 billion in 2004. At the same time, philanthropic organizations have devoted historic sums to global health. The Gates Foundation alone will donate up to $3 billion per year. This development assistance may appear substantial, but sits modestly beside the annual $1 trillion spent on military expenditure and $300 billion on agricultural subsides.

The increase in development assistance, moreover, is largely attributable to extensive resources devoted to a few high profile problems: AIDS, pandemic influenza, and the Asian tsunami. Even factoring in these new investments, most OECD countries have not come close to fulfilling their pledges of giving 0.7% of Gross National Income (GNI) per annum. OECD countries would have to invest an additional $100 billion by 2015 to close the vast investment gap. With these additional expenditures, WHO projects that tens of millions of lives would be saved every year.

Rather than a general commitment to global health, States often prefer “targeted engagements” to prevent only those hazards deemed most likely to affect their own citizens. National security assessments and international agreements offer relatively narrow justifications for State action on global health. Governments frame the problem as one of averting direct threats of infectious diseases reaching their borders, and not to reduce extremely poor health in impoverished countries.

In many respects, States may be correct that true global engagement does not serve their interests. Richer countries almost always have relative health advantages over poorer countries. The technological capacity to produce drugs and vaccines, the sophisticated health systems, and the simple fact that their populations generally are richer and healthier, means that developed countries usually can safeguard their citizens by looking inward. One need only examine the historical and current data on health disparities discussed next to understand that highly developed countries can, and will, maintain comparatively high levels of population health by focusing the bulk of their resources on domestic needs.