KIN Global: Health and Wellness Prevention and Partnerships: What ...

KIN Global: Health and Wellness
Prevention and Partnerships:
What is the right mix for the next generation of health and wellness?
Hetal Desai, Jamie Jones, Shaina Morphew
Executive Summary
Global health efforts have traditionally focused on treatment of a disease state. However, as health issues become
increasingly complex and expensive to treat, preventing them becomes essential. Although the arguments in favor of
preventative medicine are intuitive, there are a number of roadblocks hindering funding allocation and public attention
to prevention programs, especially in the developing world. This project is meant to be a discussion of the opportunity
to expand global health efforts on programs promoting disease prevention and healthy lifestyles. The KIN working group
seeks input from the delegation on the following issues:
1. Currently funding is not channeled to prevention programs because it is inherently difficult to measure. What is
the right balance of measurement and who is responsible for its execution and funding?
2. The private sector can be a powerful mobilization force on social issues. What incentives can be used to promote
private sector involvement in prevention?
3. Partnerships have proven to be a successful model for addressing health issues in low and middle-income
countries. When should partnerships be used in prevention and what is the most effective model?
Health and Wellness
The study of health and wellness can be divided into three mutually-dependant segments: prevention, diagnosis and
treatment. Ideally, the first priority is to prevent a disease before it causes physical/mental distress or death. To do so,
there must be effective diagnostic tools that are readily available, accessible and affordable for all populations. If the
diagnosis is negative, preventative efforts are continued. If the diagnosis is positive, treatment ensues. Treatment not
only treats the infected, it often prevents further contamination. Due to the immediacy of infection and the ability to
measure results, treatment currently receives the most funding for research and development and implementation.
Although prevention provides an enormous opportunity to improve the health of populations, it does not receive
enough funding or implementation support. As a result, this project will focus specifically on prevention efforts.
Stakeholders
A pyramid of power can be used to describe the stakeholders in
the health system. In developing countries, governments and
funders have the greatest power to set health policy and
agendas. The patients comprise the bottom of the pyramid with
the least power and the greatest number of people. In the
middle tiers of the pyramid are the implementers, such as NGO’s,
and medical professionals, who are involved in executing health
programs. This project will focus specifically on developing
countries.
Why is prevention important?
Intuitively, prevention can be thought of as analogous to any process. If the front-end inputs are optimized, the backend
catch-up is minimized. It is proven that if a condom is used, it will prevent HIV. Likewise, if one abstains from
tobacco use, he/she is less likely to have lung cancer. It is not difficult to accept the simplicity of most preventative
efforts. Additionally, it makes sense from an economic standpoint. For example, since the eradication of smallpox in

1979, it is estimated that 30 million lives have been saved. The program cost $25M for 12 years, but it is estimated that
it has saved an additional $275 in direct costs every year since. Some global public goods should be understood not in
terms of their “cost” but in terms of the social and economic costs of delaying their eradication. 1
Why isn’t prevention a major focus in society today?
Given the aforementioned benefits of preventive efforts, why is it not at the forefront of the global health agenda
today? The success or failure of a prevention effort is inherently difficult to measure. The result of a specific effort either
occurs many years in the future or is based on the avoidance of a negative. Additionally, providing evidence for the
effectiveness of a drug, vaccine or biomedical prevention mechanism is much easier than for a behavioral or structural
prevention program which is usually a combination of several efforts. 2
Since measurement of prevention programs is difficult, governments and funders find it challenging to create a business
case for funding and implementing these initiatives. Governments hesitate to allocate funding to an effort that shows
little benefit to constituents in the near-term. Funders also often fail to provide resources to prevention programs as
they are not always proven, due to inherent measurement issues, to succeed. Additionally, they have thus far failed to
reach consensus on the appropriate mix of behavioral, biomedical and structural preventative efforts. Finally, funders
often fail to partner with the right organizations to achieve maximum results, burdening countries with parallel and
duplicative processes. 3 Both governments and funders fail to recognize the sustained effort necessary to wipe out a
disease or to continue to lower prevalence. Where polio has been eradicated in the developed world for 30 years, it is
now returning in several developing nations due to lack of continued funding. Finally, there is a lack of human and
physical infrastructure in developing countries to implement programs funded by international funders. To address the
aforementioned barriers, we will look to successful models in the treatment and diagnosis areas of health management.
Health Partnerships
Partnerships have become the prevailing model for addressing health problems for low and middle-income countries. 4
The partnership usually includes government, funders, NGOs and possibly the private sector. Collectively, the
partnership provides financial and non-financial resources, increased attention on the issue, increased attention on the
NGO and an opportunity to align the incentives of all stakeholders. There are many examples of partnerships in the
treatment arena and an increasing number of partnerships facilitating R&D for market-neglected diseases. However,
according to Julie Smith, CDC Foundation, little to no literature has been completed on best practices in health
partnerships. 5 Now that they have become the norm in developing world public health efforts, organizations must
decide when partnerships are necessary, choose the correct partners, and set up the most effective structure and
governance for the partnership. Can partnerships help to effectively increase the focus on prevention efforts?
1 Stansfield, Harper, Lamb, Lob-Levyt. “Innovative Financing of International Public Goods for Health,” CMH Working Paper Series,
Commission on Macroeconomics and Health, January, 2002.
2 Bertozzi, Stefano M., Laga, Marie, Baustista-Arredondo, Sergio, and Coutinho, Alex, “HIV Prevention 5: Making HIV prevention
programs work,” Lancet 2008: 372: 831-44.
3 Conway, Michael D., Gupta, Srishti, and Prakash Srividya, “Building Better Partnerships for Global Health,” The McKinsey Quarterly,
December 2006.
4 Ibid.
5 Smith, Julie. CDC Interview, 12 May, 2009.