Global Health and Its Congenital Discontents

This book is about the practice of global health in real life. Global health policy is at a crossroads, especially in the more resource-constrained low-income countries (LICs) and middle-income countries (MICs). It is on trial at the interface between the Global North and the Global South. There has been remarkable progress in multiple dimensions of health out-comes over the past century. Yet, countries face a complex landscape of lofty ambitions in the form of political commitments to universal health coverage (UHC), human capital, and global health security. These ambitions are tempered, implicitly if not explicitly, by severe resource constraints in LICs and MICs, weaknesses in the use of scientific evidence as the basis for rational policy decisions, gaps in the available science, modest-to-bleak prospects for increases in official development assistance (ODA) in general and development assistance for health (DAH) in particular, suboptimal dynamics of DAH, and ineffectual global health leadership — particularly for global health security. Current and potential investors in global health must navigate a minefield of remarkable but very uneven progress, great expectations, and denials of scientific evidence by entrenched interests. That terrain is further complicated by the hegemonic suppression of innovation that threatens the status quo and by self-perpetuating cycles of dependency of the Global South on the Global North.