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Health Affairs, 25, no. 2 (2006):
310-311
doi: 10.1377/hlthaff.25.2.310 © 2006 by Project HOPE |
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From the Editor |
Forging A New Path Down A Very Challenging Road
THE IMPLICATIONS OF globalization surround us in our everyday lives, be it through the food we eat, the trade deficit we shoulder, or the avian flu that could threaten our shores. These reverberations resonate often for Health Affairs because its publisher—Project HOPE—is an international health education and humanitarian organization that operates programs in thirty countries around the globe. These pursuits—undertaken initially by the teaching hospital ship, the S.S. HOPE, which sailed the world staffed by volunteer American physicians and nurses, and now carried on through land-based programs—were Project HOPE’s raison d’être in its early years and largely remain so today. But its nautical tradition was reenergized when, in an unprecedented humanitarian emergency, Project HOPE volunteers from thirty-seven states provided desperately needed health care aboard the U.S. Navy hospital ship Mercy in the wake of the tsunami on 26 December 2004. From February through May 2005, HOPE volunteers conducted some 50,000 outpatient visits, 48,000 ancillary services, and 500 surgeries. In the late 1970s, when the prospect of national health insurance was roiling the domestic dialogue, Project HOPE’s founder, the late William B. Walsh, M.D., concluded that HOPE should expand its horizons by publishing a health policy journal that focused on the already troubled U.S. health care system. Thus, the idea behind Health Affairs was born. I launched the journal in 1981 as a peer-reviewed publication focused largely on domestic issues. In Dr. Walsh’s Publisher’s Letter for Volume 1, Number 1, he said: "Health Affairs will not be a political instrument dedicated to one approach, but rather will publish views reflective of the broader body politic," a pledge to which I believe we have remained true.
As the journal has evolved through the years, I have always recognized that at its core, Project HOPE’s mission was to improve the lives of people in low- and middle-income countries through medical diplomacy. Now, as Health Affairs approaches its twenty-fifth anniversary, the journal has been given an opportunity to become a more active force in the dialogue around global health issues, thereby aligning our content more closely with HOPE’s international health mission. This opportunity was afforded through a five-year grant awarded by the Bill and Melinda Gates Foundation, which, since 1999, has pledged $6 billion to fight the scourges of HIV/AIDS, malaria, tuberculosis, and other diseases that are often neglected by the industrialized world. We hereby acknowledge with gratitude the support of the Gates Foundation and will work to become a more forceful presence in the global health debate, blending the domestic content, which we will continue to publish, with critical issues that face all nations. We also thank the Commonwealth Fund, which has steadfastly supported our efforts to cover international health policy. With help from the Commonwealth Fund, Health Affairs published six thematic issues between 1999 and 2004 devoted to international health policy, focusing mostly on the industrialized world. Since then, the journal has continued its collaboration with the Commonwealth Fund, but, to take advantage of the worldwide reach of the Internet, we have largely shifted this international content to our Web site. To emphasize the seriousness with which we take on this new international challenge, we plan to publish peer-reviewed global content through all three of our channels of dissemination: our bimonthly issues, on our Web site, and in three thematic issues that we will produce over the next five years.
This issue is a blend of the old and the new, covering topics that confront the industrialized and developing worlds. Seven feature papers have an international orientation: One considers drug review processes in four wealthy countries, while the other six deal with low- and middle-income countries. The two major emphases are drugs and vaccines, and private health insurance. Drugs and vaccines are often lacking where they are most needed, because development lags for drugs to treat diseases that afflict primarily poor countries; because drugs are misused or do not keep up with pathogen resistance; or because of fears about the cost of extending coverage. The good news is that there are opportunities to extend the reach of vaccines at below-average costs and that subsidizing new, more effective but more costly antimalarials could delay resistance and save many lives.
As for private voluntary insurance, it is almost nonexistent in countries where the need to pay for care out of pocket often threatens impoverishment or puts care out of reach. Welfare would clearly be improved if some of that spending were channeled through properly regulated insurance, even if total expenditure rose to cover administrative costs. Health insurance rules in rich countries that determine whether people can be reimbursed for care in other countries, and the emigration of health professionals from poor to rich countries, are two other issues with important implications for the global health economy.
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