A global health argument for for investing in the public sector while shrinking the private, non-government sector

The health of the world’s developing countries is increasingly at risk.  We present evidence that these health risks are as much (or more) the result of national and international financial systems as they are the consequence of pathogens. The 1980s “oil glut” led to a flood of poorly structured loans to low-income countries at exorbitant interest rates.  When leaders of poor countries (in the environment of Cold War politics) signed these loan instruments, they committed their governments to the requirements of payback policies imposed by the World Bank and the International Monetary Fund (among other financiers).  Further, these leaders often absconded with the spoils of those loans, leaving their impoverished populations to pay off (or re-negotiate the terms). To ensure inflation rates would be kept low, and exchange rates could support the value of the payback dollars, international financial institutions imposed “structural adjustment” terms that capped public spending on “non-productive” sectors of the economy, such as health and education.  As the public sector contracted, it was unable to respond to the simultaneous epidemic in HIV and its attendant opportunistic infections. In response, aid agencies (usually attached to the same forces that imposed the spending limits) declared the public sector “corrupt” and “non functional,” and re-directed their aid to private actors, often large international non-government organizations. We present evidence that the health of poor country populations requires redirection of donor resources back to the public sector.  Only governments have the responsibility and accountability to ensure public health systems are responsive to national and local priorities and accessible to all. As UN representative Paul Hunt says, "It is only through strengthening public health systems that it will be possible to secure sustainable development, poverty reduction, improved health for individuals and populations, (and) the right to the highest attainable standard of health."