I quote:
Global health funding at the World Health Organisation (WHO) is skewed towards infectious diseases and does not reflect the actual health needs of recipient countries, say researchers in The Lancet this month (1 November)......Comment: The title is misleading. The allocation of WHO resources to disease categories is governed by the member states of the organization through a complex and effective organization and process. It makes no more sense to complain that that allocation does not mirror the Disability Adjusted Life Years (DALYs) lost to different classes of disease than to complain that WHO does not do much to promote Democracy and fine art. The organization tries to do what it is told to do.
They found consistent evidence that funding is skewed towards infectious diseases. In 2006–07, for example, infectious diseases, non-communicable diseases and injury received 87, 12 and one per cent of funds respectively. This skew was even more extreme in the extra-budgetary funds.
More fundamentally, the burden of disease is only one factor that should be used in determining the optimum allocation of health resources. We know that health deteriorates with old age, but it would not make much sense to accuse WHO to fail to devote adequate resources to keeping people from getting older. WHO allocation decisions should include also a consideration of the impact that the resources can have in reducing the burden of disease.
It should also be noted that there are decreasing returns to investments directed toward different diseases. The private sector, under the influence of profit maximization, allocates large amounts of resources to diseases, especially to the diseases afflicting people who can pay for health goods and services. WHO can do more to reduce the global burden of disease allocating its scarce resources to public health services in poor countries, since they are comparatively underfunded (especially as compared with services for chronic disease in rich countries).
Health planners also are concerned with the "transcendence" of the burdens of different diseases. While DALYs are useful indicators of the need for health interventions, they don't tell the whole story. If that were not true, we would not see the huge expenditures in many nations on cosmetic surgery for people who are perfectly presentable even prior to their interventions. Charitable donations for health are directed in significant part toward the diseases that seem to the donors as especially worthy of their support.
Of course, scientists should study the burden of disease, and it is quite proper for The Lancet to publish comparisons of the burden of disease with the resource allocations of WHO or of other organizations or sectors. That information should be very useful to decision makers and policy wonks. I am simply pointing out that it does not tell the whole story. JAD
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