Millions Saved: Proven Successes in Global Health

Journal of Public Health Policy,  2005  by Bilchik, Brian

• E-mail
• Print
• Link

Ruth Levine and the What Works Working Group, Millions Saved: Proven Successes in Global Health. Washington: Center for Global Development, 2004 180 pp. in paper cover (available at www.cdgev.org).

"AIDS, malaria, and tuberculosis kill 6 million people each year in developing countries, and another 7 million children die of infectious diseases that have long been forgotten in the rich world... Does anything really work to solve profound health problems that face poor countries? Does development assistance from rich countries make any difference at all?" So asks Nancy Birdsall, the President of the Center for Global Development, in her preface to Millions Saved: Proven Successes in Global Health. The answer, 17 times over, is a resounding, yes.

Millions Saved chronicles 17 successful public health initiatives from all over the globe. The book, a publication from the Center for Global Development, is authored by Ruth Levine and the "What Works Working Group" (a panel of 15 experts in global health, public policy and development economics). While each chapter tells a compelling story, equally compelling is the work and intellectual capital of the "What Works Working Group." This book and their work holds promise for political leaders, policy-makers, practitioners, and millions of people's lives all over the globe.

To find these large-scale successes in international health, the CGD collaborated with the Disease Control Priorities Project at the National Institutes of Health. The programs selected for inclusion met the following criteria: they had to be ambitious in scale nationwide or larger; they had to have had a major positive impact on health; the improvement clearly had to be due to the public-health intervention; they had to produce strong results for at least 5 years; and they had to be cost-effective.

Levine and her colleagues present each case study in a separate chapter but they also tease out the common threads of success. Each study also provides a "behind the scenes" glimpse at the players, personalities, and complexities of these large scale, mostly multipartner initiatives.

Fittingly, the book launches with the story of the eradication of small pox - arguably one of the greatest achievements of humankind and public health. The scope of the 17 studies range from preventing river blindness in n countries in sub-Saharan Africa, to controlling trachoma in Morocco, to reducing fertility in Bangladesh, to the almost complete elimination of measles in southern Africa.

A government sponsored "100% Condom Program" in Thailand, targeting commercial sex workers is one of the book's many innovative programs. This effort prevented the spread of HIV/AIDS relatively early in the course of the epidemic. Thailand had 80 percent fewer new cases of HIV in 2001 than in 1991 and has averted nearly 200,000 new cases. An epidemiologist in Thailand's Ratchaburi province, Dr. Wiwat Rojanapithayakorn, devised the program. "It was not possible to stop people from having sex with sex workers, so the most important thing was to make sure that sex is safe."

Other studies highlighted in the book include: controlling tuberculosis in China; eliminating polio in Latin America and the Caribbean; preventing infant deaths from diarrheal disease in Egypt; improving health in Mexico; reducing guinea worm disease in Africa and Asia; and curbing tobacco use in Poland. This last program started in the early 1990s when the transition to a more open society paved the way for health advocates to implement strong tobacco controls in Poland, which had the highest rates of tobacco consumption in the world. Poland's lung-cancer rate among men is down 30 percent, preventing some 10,000 tobacco-linked deaths a year and adding 4 years to the life expectancy of Polish men.

Each chapter tells a particular story - the health conditions addressed and interventions used are very different and particular to time and place. While there emerges no single recipe for success, a consistent list of ingredients contribute to success - political leadership and champions; technological innovation; expert consensus around the approach; effective use of information by management; strong management on the ground; and adequate and sustained funding.

If any is read in isolation - "100 percent condom program" in Thailand or reducing fertility in Bangladesh - the successful threads seem germane to that particular project: extraordinary individuals, passionate policy makers, and innovative politicians. Read together, these threads merge into recurring patterns - successful components of success - reinforced 17 times over.

The book counteracts criticisms of large-scale public health initiatives. From the outset the authors challenge a prevailing notion that nothing works and that global health challenges are insurmountable. They counteract the widely held belief that international public health programs are a waste of money; the prevailing scientific wisdom that programs cannot be scaled up effectively. In reflecting on this difficulty, renowned social policy analyst in 1996, Lisbeth Schorr, noted "...we have learned to create the small exceptions that can change the lives of hundreds. But we have not learned how to make the exceptions the rule, to change the lives of millions." Millions Saved does just that.