In the summer of 2003, at yet another symposium dedicated to struggling with the reality of the tenacious poverty and diseases of the millennia, the Bellagio Study Group on Child Survival estimated that each year, 6 million children in 42 countries where 90% of child deaths occurred in 2000 could be saved; if only 23 proven health interventions for common ailments and diseases were deployed.
But this month, as pleas for more aid echo throughout the world, the UN reports that the basic development goals are still not being met:
"Slow economic growth, poor trade performance, continuing environmental degradation, debilitating HIV/AIDS pandemic, discouraging foreign direct investment and unmet ODA (overseas development assistance) commitments, compounded by a host of new challenges in a globalizing world make the development tasks of these countries extremely difficult," UN Under-Secretary-General Anwarul K. Chowdhury told a symposium on the global development agenda at UN Headquarters [June 1, 2005].
But while at the UN and conferences like Bellagio see the feasibility of improving childhood morbidity and mortality, not everyone's so sure. "Can the world afford to save the lives of 6 million children each year?", the medical journal Lancet (subscription) asks in a follow-up to the Bellagio study in their June 25th issue. And what's the cost to developed countries?
"US$5.1 billion in new resources is needed annually to save [the] 6 million child lives in the 42 countries [of the Bellagio Report]. This cost represents $1.23 per head in these countries, or an average cost per child life saved of $887. Sensitivity analyses for salary levels for community delivery agents, drug costs, and coverage rates for 2000 were used to develop uncertainty estimates around the US$5.1 billion annual price tag that range from about $3.1 billion to $8.0 billion."
$887 cost per child life saved. The article assesses the Millenium Development Goals (MDG) of (among other things) reducing child mortality by two-thirds by 2015, and determines that "child survival is affordable for donors and developing countries". The hurdles will be the "lack of funds" and "scaling up health delivery".
In related news, The Ellison Medical Foundation has been announcing that they will give $100 million dollars to Harvard University to start a global monitoring research center, which will independently measure global health expenditures, delivery of services, and the impact on population health.
The Ellison Foundation was dedicated to aging and global infectious diseases however they have dropped the global infectious diseases focus to target areas that are 'less well-funded'. [Headline philanthropy may be even more competitive than the software industry].
There have always been debates about aid for development and disagreements about the ideal aid mechanism. For now, aid and global health initiatives are routinely justified via different sorts of cost-benefit analyses. Unfortunately the models, though necessary, are sometimes necessarily limited -- a vaccinated child does not only save himself, for instance, but the costs of care for those he may infect if unvaccinated.
Even more ponderous then methodological questions are the ethical considerations of this type of economics. For example, within the apparently burgeoning cost-benefit analysis industry, how are the cut offs discerned? At what point is a certain life, to some, just not worth donating to? Perhaps it's not the $887 determined by the Lancet study, but something more - $889? - or less? - Despite proclamations about a culture of life? Or will we be consoled by ever more precisely balancing the cost of others lives- in order to ever so quietly bear with poverty and death on other continents? Do the goals behind the millions that will be spent for cost benefit analyses dare to propose to change anything?
