Commentary: False dichotomy hinders global healthBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5458 (Published 25 September 2014) Cite this as: BMJ 2014;349:g5458
- Gavin Yamey, evidence to policy initiative lead
- 1Global Health Group, University of California San Francisco, San Francisco, CA 94105, USA
Global health in recent years has been characterised by bitter debates, with each side marshalling a mixture of evidence and moral arguments to prove that their approach is the one that will save more lives. Witness, for example, the never ending disputes over whether the best way to reduce avertable deaths is through strengthening health delivery systems (a “horizontal” approach) or targeting individual diseases like HIV/AIDS or malaria (a “vertical” approach).1 Or take the rancorous debate over whether the private sector should be engaged or marginalised when it comes to tackling health challenges in low and middle income countries.2 Now Jocalyn Clark sets up yet another binary view of global health, arguing that a focus on biomedical approaches limits success; what we need, she says, is to follow social and political pathways to improve the health of the world’s poor.
However, the complexity of the challenges in global health—and their multifactorial origins in poverty, inequity, and lack of access to health services, education, and safe and …