Foreign Affairs
http://www.foreignaffairs.com/articles/137312/laurie-garrett/money-or-die?page=4

Money or Die: A Watershed Moment for Global Public Health
Laurie Garrett
March 6, 2012

Extract (first paragraphs)
Over the last three decades, public funding for global health organizations has dried up. Private companies are writing checks to fill the gap, and, accordingly, they are bending the agenda toward their interests. Realigning priorities, however, will mean getting more private firms involved, not less.

In relative terms, the funds required are not large. Combined charitable giving for all causes by individuals in the United States and the United Kingdom hit $300 billion in 2011, but the bulk of this giving goes to domestic issues, and what goes to foreign causes is often dominated by surges of support for relief efforts for shocking natural disasters. Total estimated expenditures worldwide on health care in 2010, meanwhile, hit $5.3 trillion, with U.S. domestic spending accounting for nearly half of that. Even at its recent peak, the amount of money spent on the health of the world’s poorest people, who suffer most of humanity’s infectious and preventable diseases, represented merely .0005 percent of worldwide health spending.

Like it or not, the burden of reducing suffering and increasing the health of the world’s poor now falls largely on the backs of the two Washingtons. The Gates Foundation is doing extraordinary work, but it operates without accountability or transparency and needs competition. Bill Gates has admitted as much himself in multiple interviews, acknowledging that his efforts wield an uncomfortably large amount of unchallenged power over global health. So far, Congress has spared global health drastic budget cuts, but the White House 2013 budget request signals that pressure for reductions is building. It would be a catastrophe were the “age of generosity” to end so soon after it began, leaving millions without life-sparing medicines and tools they have come to rely upon….