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Editorial: Can global health be good business?

A lavishly sponsored Global Health Summit conference in New York organized in early November by Time magazine included a panel discussion on the pertinent issue of whether global health can be good for business, and in the process highlighted many of the contradictions confronting health care providers, policy makers and planners the world over. Attempts to graft compassion onto the root stock of global capitalism have been only partially successful, if at all. Certainly none of the big players in the $3 trillion plus health care industry – whether they be pharmaceutical corporations, equipment manufacturers, hospital chains or health insurers – has been able to demonstrate any long term or sustained commitment to the delivery of health care services to the billions of people in low income countries who currently lack access to them. Many of the ‘Global Public Private Partnerships’ favoured by the WHO (Buse & Waxman 2001) appear to serve largely as public relations campaigns for the private sector ‘partners’ and also as a means to help them to secure and potentially expand their longer-term market for drugs and vaccines (Hardon 2000; Global Forum for Health Research 2002, 2004). Meanwhile some of the largest donors supporting such partnerships come from outside of the health care industry altogether – most notably Bill and Melinda Gates, whose benevolent billions also help make Microsoft’s cosmic profits seem more socially acceptable. Among those at the Time summit arguing that global health is, in fact, good business was Sir Richard Branson, chairman of another company outside of health care – the Virgin Group. He selected the example of yet another nonhealth business, Anglo-American, supplying anti-retroviral drugs to their staff in South Africa. As a result, instead of losing 25% of their staff from AIDS ‘they have got that 25% back in the mines, working and healthy’. Against the Branson approach, Prof. CK Prahalad from the University of Michigan argued that philanthropy can never ensure a sustainable future for health care systems, and that health care must develop as a business, down to the principle of charging even the poorest person for each item of treatment they receive. In one sense, Prof. Prahalad is obviously right: benevolence alone is not enough. Branson’s view of business supplying health care to ensure the continued productivity of its own direct workforce – similar to the US model in which General Motors is the country’s largest private health care purchaser (Lazarus 2005) – may, as Branson argues, be well in advance of the attitude of the majority of companies. But it offers only limited benefits in many of the poorest countries, where there are few if any wealthy companies able to make such choices, but where a large population of unemployed and desperately poor people stand outside the formal economy. Even in South Africa, a continental centre for global investment, half the population is poor, and 40% of the workforce is unemployed, and 60% of the unemployed have never worked. While some employers may be convinced to invest in their own workforce, there is little evidence that many companies can be persuaded to take an equivalent interest in the wider population, few of whom will be earning enough even to be potential customers. While the good intentions of a handful of benevolent and highly successful capitalists such as Branson and Gates are welcome, the capitalist system as a whole exists not to distribute goods or services to the needy, but to accumulate profit for proprietors and shareholders. The difficulty in translating this into the provision of global health care is that as a general rule those with the greatest health needs are poor people, who are least likely to be able to afford an economic price for their treatment. In other words, as even the World Bank’s researchers have concluded (Dunlop & Martins 1996), the laws of the market – which ensure that there is sufficient investment to present an abundance of consumer goods and services in the wealthier countries – collapse when applied to health care nationally and internationally. There is no mistaking the huge potential demand for health services, especially in the developing countries – but no section of the global