Public Good Perspective of Public Health

The debate on health as a public good, apparently settled in its favour in the 1970s, died a quiet death in national policy circles around the turn of the century with health sector reforms (HSR). It, however, re-emerged in another form at the global level when the Commission on Macroeconomics and Health (CMEH) of the World Health Organization (WHO) defined global public goods for health as programmes, policies, and services that have a truly global impact. In other words, health was not presented as a public good, but the focus was on selected public goods that benefit health. The working group 2 of the CMEH underlined that countries could benefit from working together as they—especially the underdeveloped nations—are becoming far more vulnerable in an interconnected world to health problems originating beyond their borders (WHO 2002). The examples were, however, tuberculosis (TB) or Ebola by which the West felt threatened. The working group proposed to utilise this growing interdependence to ­develop research networks, international public–private partnerships (PPPs) for new generation pharmaceuticals and diagnostics, formulate disease control campaigns and surveillance and establish treaties regulating cross-border movement of people, livestock and goods to minimise the health risks of globalisation (WHO 2002).

The concept of global public goods for health was pushed despite incomplete knowledge of the relationship between globalisation and health, the risks involved with increased interconnectedness from globalisation and its role in the processes that perpetuate poverty of the underdeveloped nations. The global public goods, it is argued, are not always pure public goods by being non-rivalrous (supply does not fall by use) and non-excludable (no discrimination in consumption); externalities, especially across borders, acquire importance and the ­impurity of most public goods (called common pool goods that are non-excludable but rivalrous) is managed by influencing and manipulating national policies. These key characters of global public goods for health set the stage for the need of ­cooperation and collaboration between nations to regulate positive and negative externalities across borders (WHO 2002). This argument, other than missing the context of countries’ strength, especially the underdeveloped ones, to demand a level playing field, also avoids debating the nature of public health itself. Its agenda includes technology, programmes, knowledge production and policy, but the sociopolitical relationships within nations remain untouched and so are allied services. It compels us to explore the changing conceptualisation of public health as a public good itself and to argue that such cooperation and collaboration is not possible without a strong public good perspective at the national level for public health.