Global Public Goods: A Framework for Advancing Public Health Outcomes

Abstract

Global health is at the precipice of a new era. The world faces a multitude of complex challenges, including rising disease burden and reproductive health problems. These threats are evolving within the context of an increasingly multifaceted and interconnected global landscape, exacerbated by inequalities in the distribution of health risks and resources to address them. A robust response to these challenges necessitates improved coordination of international health organizations, developing countries, and their partners at a global level. As a recent Lancet Report puts it, the world needs a “new framework for international cooperation to deal with global threats and to promote global public goods that serve our common interest.” These global public goods (GPGs) include objectives such as reducing barriers to R&D information sharing and containing communicable diseases. This paper posits that the concept of global public goods, specifically with regards to health, is both a valid and effective means of promoting global health outcomes. Advocating for increased usage of the GPG framework presupposes that investing in health is a beneficial activity, both in and of itself (i.e., good health is intrinsically valuable) and as measured through economic terms. Empirical evidence suggests that investments in health are a critical driver of economic growth and further, that good health itself is a valued commodity. Communicable disease control, especially through immunization, is one way to improve public health outcomes worldwide. It can also be classified as a GPG because it fulfills the two basic criteria of a public good: nonexcludability and non-rivalry. The GAVI Alliance, a global public-private partnership, is one example of how collective action is used in order to deliver the GPG of immunization. GAVI has immunized 440 million children since 2000, and its vaccination programs will avert nearly 4 million deaths over the next three years. In a way, GAVI acts as hypothetical “world government” for overcoming the collective action problem associated with the provision of immunization. It marshals various donors and technical partners together, acts as a conduit for funds, creates rules and regulations for the dissemination of those funds, and ultimately, purchases high-value vaccines that increase access to vaccination in developing countries. Adopting a GPG perspective has allowed the GAVI Alliance to mobilize innovative sources of finance through collective action. GAVI utilizes financial engineering tools such as a Finance Facility to frontload donor commitments or Advance Purchase Commitments to encourage the development of new vaccines in order to further the GPG of immunization. This is one of the most important aspects of GAVI—and more generally, collective action to produce GPGs—that it taps into sources of funding that would not have been possible without its presence. GAVI provides proof that collective action can be used to further global public goods like immunization. The value of the concept of GPGs is its recognition of the interdependency of national health and health systems, as well as its focus on international collective action to achieve optimal health outcomes. Because it operates from an assumption of self-interest, the GPG framework is an intuitively appealing perspective for developed and developing countries alike. It offers a rational reason for why developed countries take an interest in and invest in the health problems and health systems of developing nations.