At the G8 summit in France, David Cameron put the case forward for continuing aid to some of the world's most impoverished people. The magic number seems to be set at 0.7% of GDP, and in these straitened times even that seems to be up for debate. David Cameron has made a good case for aid in general, commendable when other countries are failing to live up to promises made.
What we read less about, though it is undeniable, is the correlation between poverty and disease. The impact of disease – particularly neglected tropical diseases or NTDs – on the world's poorest billion in terms of development is often undersold. With the exception of the US, the UK and Japan, other G8 countries have ignored this serious problem.
Putting poor people with disease before Britain's economic interests is a task that is easier said than done. At a time when the Foreign and Commonwealth Office (FCO) is expected to take the lead on Africa in place of the Department for International Development (DfID), it raises the question of where the separation between development and national policy lies. As a recent Chatham House paper put it
"This reflects an important, and growing, recognition that development objectives can best be pursued with reference to UK interests in Africa, but also an extremely strong, and potentially controversial, focus on boosting UK trade."
So how much of that 0.7% would go to fight the diseases that cause the vicious cycle of poverty?
As with all things that are policy-driven, numbers and metrics dictate where aid money goes. People need to be convinced that aid isn't simply going down a theoretical black hole. The case for targeting diseases in aid programmes is simple; there is a clear and measurable cost-effective gain. Vaccines represent the single most cost-effective health-protection measure. Mass drug administration for NTDs provide some of the highest rates of economic return of any public health programme.
The global health landscape has become increasingly fragmented over the past decade, with a variety of vertical funds with specific targets, such as the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM) and the Global Alliance for Vaccines and Immunisation (GAVI), and it is these funds that are targeting the poorest countries. At all stages of the aid-giving process, targeting disease and increasing health makes the most sense. DfID's recent multilateral aid review placed the global funds in the top ten multilateral development organisations in terms of their focus on poor countries.
It is clear that an evidence-based approach is what is needed for aid, ensuring value for money and maximum impact for people, regions and nations. Health impacts all other strands of the poverty trap – infrastructure, agriculture and education. Blindness, resulting from trachoma or onchocerciasis, destroys agricultural workers' productivity. Child infections, as a result of soil-transmitted helminths and schistosomes, leads to a reduction in school attendance and performance. Trypanosomiasis kills if untreated. Buruli ulcers deform. The list goes on.
A pro-poor aid agenda aimed at tackling health provides stunning economic rates of return. For every $1 invested in control of Chagas disease in Brazil, $7 is returned. Lymphatic filariasis control in China produces a 15-fold return. Guinea worm eradication has been calculated to produce an economic rate of return of 29%. All of this without even mentioning the most important return – the life saved.
Health is important. Simple income growth is not the only way to a healthier society. With the clear benefits in targeting health in aid programmes, the time has come to recognise the importance of tackling the diseases that affect the poorest of the poor.