Newsday - December 20, 2001
Laurie Garrett, Staff Writer

The seemingly costly package of health interventions would end up fueling broad economic growth internationally and would slow the population explosion in poor countries, the WHO commission said. By 2015 the 48 poorest nations in the world would collectively gain $360 billion a year in economic expansion. Per capita income in the next- poorest tier would rise by about 10 percent by 2020.

The six-volume "Macroeconomics of Health: Investing in Health for Economic Development" offers a game plan for reducing inequities in life expectancy, infant mortality and disease. The WHO report argues global economies will improve as a direct result.

WHO Director-General Gro Harlem Bruntdland set up the commission two years ago with Harvard economist Jeffrey Sachs as chairman. It has been more than two decades since any international body has tried to create a worldwide plan for achieving specific targets in reducing death, disease and resultant poverty.

Gordon Brown, chancellor of the exchequer for Britain and chairman of the International Monetary Fund's Guidance Committee, likened the initiative to the Marshall Plan, under which the United States spent the equivalent of $88 billion in today's currency to rebuild Europe after World War II - an investment that paid off many times over for U.S. corporations and average citizens by creating strong European economies that purchase U.S. goods.

"The U.S. gave two percent of GNP [gross national product] per year between 1948 to 1951 in the Marshall Plan," Sachs said in a recent speech at Cornell University's Weill Medical College in Manhattan. "It was the most unselfish act in history, and it was a stunning success. I'm talking about one-twentieth of that for health. A mere one penny of every $10 of rich world income would save eight million lives a year."

According to the report, many of the world's poorest nations are stuck in poverty because their burden of disease - most of it preventable - is so high that they cannot build industrial societies.

The commission's solutions include:

Create national health programs in every country that determine the primary disease trends of the nation and lay out strategies for their mitigation.

Create fully accountable programs nation by nation for implementation of such strategies - such as building water filter systems to reduce diarrheal disease and improving vaccine campaigns.

Set up an international research enterprise to fund studies of the diseases of the poor, such as tuberculosis and malaria, with the goals of finding new cures and vaccines.

Push all nations, rich and very poor alike - to spend 5 percent or more of their GNP on health. The United States spends three times that domestically, but many poor nations spend less than 3 percent of GNP on health.

To offset the funding gap that would still be in place because of the extreme poverty of most of the world's nations, international donor commitment from the rich world would be necessary, to the tune of 0.7 percent of the GNP of each wealthy nation being donated for improving the health of the poor.

Dr. Harold Varmus, who served on the commission and who is director of Memorial Sloan-Kettering Cancer Center in Manhattan, says the thing that "most astounded" him during the commission investigation was learning how little the United States spends directly on the health of the world's poor.

Sachs said the United States donates 0.1 percent of its GNP to the poorest nations. In contrast, many European nations donate more than 0.5 percent of their GNP.

The report now becomes fodder for debate and negotiation both between and within governments in a process that will undoubtedly last through 2002.

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