After years of prioritizing diseases such as HIV and malaria, the UN has finally realized that “non-communicable diseases” such as cancer, diabetes and heart disease are now the biggest health problem facing developing countries. This will be the topic of a major UN summit in New York this week, where governments will agree a global plan for tackling these diseases. This is not the first time the UN has proposed a grand initiative to tackle disease. Although they are fading from public consciousness, in 2000 the UN created the Millennium Development Goals (MDGs), a series of global targets to reduce disease and poverty. Over a decade on, what lessons do the MDGs hold? Those trying to influence the New York summit are convinced of the utility of measurable targets. "Without global goals or targets, this is not going to fly. What gets measured gets done," Margaret Chan, Director-General of the World Health Organization said in April. The WHO wants the UN to agree to a target of 25 percent fewer preventable deaths by 2025, and detailed targets covering everything from salt consumption to breast cancer screening. The MDGs show the difficulty of applying targets to developing countries. In most such countries, the quality of health data is patchy. Causes of death are rarely registered, and the incidence of diseases such as malaria is only vaguely understood. This paucity of data made the MDGs meaningless from the outset, and a poor mechanism with which to track progress. Unfortunately, the same gaps in data exist for non-communicable diseases, forcing public health specialists to rely on estimates, which give only a vague indication of the reality on the ground — hardly a sound basis from which to mobilize hundreds of millions of dollars. Second, politicians too often succumb to the temptation to sign up to targets that sound good, but have little chance of actually being achieved. The MDGs fall into that category, with 48 of the world's poorest countries off-track as the 2015 deadline approaches. Other failed health plans include the Roll Back Malaria target of reducing malaria deaths by 50 percent by 2010, and the WHO ‘3 by 5' target of putting 3 million people on AIDS treatment by 2005. These kind of catchy targets offer no real accountability, as there are no sanctions for failure — the health agencies simply move on, setting up a new target for a new problem. But continually missed targets can breed cynicism, undermining public support for global efforts to tackle poverty and disease. Money is not necessarily the issue, either. Foreign aid for health has more than tripled over the last decade, rising from $7.6 billion in 2001 to $26.4 billion in 2008. Sadly, much has been wasted. A 2009 study by the WHO attempted to gauge the impact of the last 20 years of aid spending. While it listed some successes, such as increased diagnosis of tuberculosis and higher vaccination rates, it also found some UN programs were counterproductive because they undermined basic services and resulted in falls in domestic health spending. Corruption remains a major problem: The Global Fund for Aids recently announced it could stop funding for Nigeria over apparent fraud worth $474.6 million. Even now, less than 50 percent of people have access to basic medicines in many parts of Africa, as public health systems creak under the weight of corruption, mismanagement and staff shortages. The West is facing a massive debt crisis. As such, is it feasible to continue the old way of handing money to health ministries in developing countries in the hope that public health infrastructure will improve? Instead, why not try to harness the private sector, which already provides the majority of healthcare throughout Africa and Asia? Experiments have long been taking place using public money to provide access to quality private sector healthcare for the poor, via methods such as contracting and franchising. Framed correctly, these partnerships can improve the quality health services, something that will be vital as the numbers of people suffering from non-communicable diseases grows. Without such thinking, the UN summit risks becoming yet another historical footnote. Philip Stevens is a Senior Fellow at the Center for Medicine in the Public Interest, New York. Thompson Ayodele is the Director of Initiative for Public Policy Analysis, Lagos, Nigeria
