global health is an investment in developing countries’

It is easy to be discouraged about the state of international cooperation today, but global health remains an area in which the world has come together to do significant good. Over the last dozen years, international initiatives have delivered HIV/AIDS treatment to millions, expanded childhood immunization, and spurred a dramatic increase in global support for addressing other health challenges, from malaria to maternal health.
International support for global health is an investment in developing countries’ future prosperity and the wellbeing of their people. It is an investment that the world’s richest countries can well afford.
For example, the United States is the leading contributor of global health aid, which accounted for just 0.23% of US spending in 2013. The returns on that investment have been remarkable. Child mortality is plunging. Millions who would have otherwise perished from HIV/AIDS are still alive. Countries that were aid recipients are increasingly self-sufficient – and have become better trade and strategic partners as a result.
But the health needs of low- and middle-income countries are now shifting. Dramatic changes in urbanization, global trade, and consumer markets – which occurred over decades in wealthy countries – are happening at a faster rate, and at a much larger scale, in still-poor countries. These trends have brought substantial health benefits, such as better sanitation and increased food production, but have given rise to significant challenges as well.
Ebola is one high-profile example. Prior to this year, Ebola had killed fewer than 2,000 people, all in Central Africa, since it was first identified in 1976. The virus has killed more than three times that number in 2014, with enough cases spreading internationally to dominate nightly news broadcasts and spook voters in recent US state and local elections.
A major reason is the growth of small- and medium-size cities. Urbanization is increasing in West Africa at a rate of 3% per year (compared to 0.2% and 0.3%, respectively, in North America and Europe). The result has been the proliferation of settlements of a million people or fewer living with limited public-health infrastructure.
These cramped cities are ideal incubators for outbreaks of emerging infectious diseases like Ebola. With greater trade and travel to the region, outbreaks are likely to spread before international containment can coalesce.
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