In global health, knowing the solution to a problem often isn’t enough; the challenge is using that knowledge effectively. This “know–do” gap was one of the central puzzles that drew key leaders to HMS April 4 and 5 for a symposium titled “Global Health Delivery: Challenges and Opportunities for Advancing Excellence and Equity.”
“This is a moment to critically examine where we stand in generating and delivering the ideas, interventions and leadership that will advance global health equity—and to ask how we can do better,” said Paul Farmer, Kolokotrones University Professor and chair of the HMS Department of Global Health and Social Medicine (GHSM), which hosted the inaugural event for its Programs in Global Health and Social Change.
The Programs in Global Health and Social Change launched last year with a mission to advance the empirical evidence base for effective health care delivery in settings where inequitable access to health care, economic, technological, and social resources result in disease and poor health, and to link this research scholarship to medical education and practice.
The clinical focuses of the five programs correspond to major unmet burdens of disease in resource-poor settings: infectious disease, non-communicable disease, mental health, surgery and neonatal health.
“Right now, there is a remarkable amount of activity here at Harvard and across scores of universities and medical schools focused on what is loosely described as ‘global health’,” said Sadath Sayeed, director of the neonatal health program and, with colleague Vanessa Bradford Kerry, symposium co-chair. “Organizing this event, we were particularly interested in evaluating what it takes to equitably deliver excellent health care to the poorest populations, with an emphasis on the word ‘equity’.”
Keynote speaker Jeffrey Sachs, director of the Earth Institute and professor of health policy and management at Columbia University, told a rapt audience that the United States is no exception to inequity—“with the growing obesity epidemic, no access to care for the country’s poor, and a political system that is one of the most corrupt among high-income nations in the world.”
Sachs’ keynote was followed by a lively panel discussion titled, “Evidence to Policy: Translating Effective Delivery Strategies into Policy.” The panel comprised William Frist, former Senate majority leader and chairman of Hope Through Healing Hands; Rajiv Shah, administrator of the U.S. Agency for International Development; Agnes Binagwaho, permanent secretary of Rwanda’s health ministry and senior lecturer in GHSM; and John Ayanian, professor of medicine and health care policy at HMS and professor of health policy and management at Harvard School of Public Health.
Panelists offered an insider’s take on global health delivery. Frist, an HMS-trained physician and former Republican senator from Tennessee, told the audience that while research can sway lawmakers, it must reach decision makers in a way they can understand. Key, he said, are intermediaries such as think tanks and legislative staffers—and engagement with the public.
“You’ve got to get out where real people are,” he said, before offering a bitter pill to the experts assembled in the Joseph B. Martin Conference Center: “We’re not real people in this room. You think you are, but you’re not.”
Binagwaho, of Rwanda’s health ministry, prescribed a path for countries that receive aid. Develop a strategy that addresses your nation’s needs and ensure that donor aid serves that plan. If not, she said, “you’ll end up serving the money.”
USAID’s Shah detailed the agency’s priorities: maternal health, vaccines, malaria, tuberculosis and HIV/AIDS. “From a macro perspective,” he said, “that’s where the ‘best buys’ are in improving the state of the world in global health.”
For more on Programs in Global Health and Social Change, visit ghsm.hms.harvard.edu/about/programs.
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