Research & Service

In the opening editorial “A Plea for Cost-Effectiveness, or at Least Avoiding Public Health Malpractice” in the September issue of the American Journal of Public Health, Leslie Roberts, PhD, associate clinical professor of Population and Family Health, illustrates the tension between medical versus public health approaches to providing healthcare and how those differing philosophies impact the effectiveness of international aid.

The question of economic efficiency lies behind the conflict between these two approaches as the medical establishment concentrates on the care for the individual while public health seeks to provide the most equitable care for society-at-large. That some diseases, like HIV/AIDS, strike a chord in donor countries more so than meningitis, for example, has resulted in a somewhat lopsided dispersal of international aid as large sums are spent to provide antiretroviral therapy to some, while funds are scarce for significantly less expensive treatments for other common diseases.

Dr. Roberts questions the effectiveness and sustainability of such an approach especially if such interventions do not produce a population-based benefit. While in wealthier countries, the medical establishment often has the luxury of being able to provide the necessary expensive care to treat a sick patient, is that an unrealistic, unsustainable, and potentially ethically problematic standard for the developing world where funds are tight and the needs are many?

By looking back to the Alma Ata Declaration and the successes and failures that followed, Dr. Roberts provides a trenchant historical context for rethinking the motivations, actions, and goals of international aid policy.