annual report

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WHO report highlights chronic diseases & lack of global health strategy

Flickr, Erebos

Analysis

The World Health Organization has published its annual health report for 2012 and this year decided to “put the spotlight on the growing problem of non-communicable diseases.

Here are some of the news stories spawned by the WHO report:

Reuters/MSNBC Heart disease, diabetes spreading to poor regions

AP/Washington Post Diseases of affluence are spreading worldwide

Voice of America Non-communicable diseases cause most deaths worldwide

UN Dispatch The Good, Bad and Mixed News in World Health Statistics

This focus on the NCDs, (non-communicable diseases) is certainly legitimate since they are, as a general category, major contributors to the global burden of disease. But another way to look at this, of course, is that the WHO report has turned the spotlight away from other diseases.

Why the focus this year on diabetes, heart disease and other chronic illnesses? Why has the attention been shifted away from the still-expanding HIV-AIDS pandemic, the threat of drug-resistant tuberculosis or malaria?

One easy answer is that the WHO annual statistics report always picks a theme and this year’s flavor is chronic disease.

Before, it was AIDS. Another year, it was TB or malaria. To WHO’s credit, one year the organization focused the attention on the much-neglected problem of mental illness worldwide. Another time, the spotlight was on deaths from accidents (which is a much bigger contributor to global mortality than you might think).

All of these are legitimate health concerns. But the nagging suspicion — or perhaps just inkling — you get from all this is that the shifting spotlight indicates no real strategy for global health.

I’ve long been disturbed by the lack of a clear, comprehensive strategy in global health — as well as the lack of a clear definition of what the hell we even mean by global health. Many tell me to lighten up, that the diversity of opinion and a de-centralized approach to the fight against disease is actually a good thing.

I’m not so sure, and I’m not alone in my uncertainty. See this post from the Center for Global Development’s Amanda Glassman and Kate McQueston Making Priority Setting a Priority for Global Health, which offers links to other related posts.

Update: Here is Amanda’s more recent perspective published in the British Medical Journal.

Kate Kelland of Reuters earlier this week also did a great report on the ‘squishiness’ of the WHO health statistics and the debate over how best to measure the burden of disease globally. It’s worth a read and mentions a group of Seattle number-crunchers, at the UW’s Institute for Health Metrics and Evaluation (e.g. a recent report on malaria) who are trying to bring more reliability and perhaps order to all this.

But, clearly, it’s not just a matter of improving the numbers. The international community has no consensus on what we mean by global health, let alone consensus on which problems deserve the most attention and resources.

 

Gates Foundation shrinks report, chronic(les) failure to communicate

Tom Paulson

As noted yesterday, the Bill & Melinda Gates Foundation released its annual report for 2010 and, once again, promised to do a better job of communicating and improving on transparency.

Upon further scrutiny of the report, I noticed two trends:

  • First, the Gates Foundation annual report is getting shorter every year. This year’s report is eight pages long, last year’s was 16 pages, the 2008 report was 23 pages, in 2007 it was 49 pages … and so on. This may be due to the fact that much of the information is on the web, but I thought this was curious.
  • Secondly, the admission of having a problem communicating with grantees and the outside world seems to go back even further than I initially thought. See below how this theme has repeated itself for years in the annual report.

For the basics on the report — program areas, achievements and financials — you can read the annual report yourself or the Seattle Times’ summary of it.

The basics: They gave out $2.5 billion, accomplished some good things (such as PATH’s meningitis vaccine project and other initiatives I’ve reported on), tripled staffing to nearly 1,000 people and are working on improving in certain areas. Below is the BMGF’s pie chart showing the distribution of funds.

Gates Foundation

BMGF funding by program area

And below is my timeline of Gates Foundation CEO references to the problem the world’s biggest philanthropy seems to have with communicating to grantees and the outside world. To their credit, I have to say, they are at least being very open and honest about the problem. But one has to wonder why it has become so chronic:

I noted yesterday (and in the first link above) what Jeff Raikes, CEO of the Gates Foundation, said in this year’s (2010) annual report about the need for improving communication.

Here’s what Raikes said in the 2009 annual report:

Last year I announced that the foundation would be commissioning a Grantee Perception Report, and I promised that I’d report back about our findings.
They were sobering. We received below-average ratings on many aspects of the grantee experience. We take this feedback very seriously, because we understand that some of these barriers are preventing us and our grantees from maximizing our impact. We don’t see our work as a popularity contest—there is bound to be some tension in even the most productive relationships—but we know that we must do everything we can to make sure that we and our grantees can have the maximum possible impact. We spent much of the past year digesting the results and developing a plan to address them.

In the 2008 annual report, Raikes said much the same thing after noting that his first priority coming in as the new CEO was to improve “internal processes” at the philanthropy:

My second priority is to improve the quality of our external partnerships, which are our lifeblood. I know we are not doing as good a job as we can in this area. Starting with me, everybody at the foundation needs to make a concerted effort to listen more carefully to what our partners in the field have to tell us.

To that end, we are working with the Center for Effective Philanthropy to survey all of our active grantees this fall. In the past, we’ve received some feedback from our grantees that pointed out areas where they thought we were doing well and other areas, particularly with respect to how we interact with them, where we had room to improve.

In 2007, then-CEO Patty Stonesifer also said in the annual report that the Gates Foundation needs to do a better job of communicating — especially listening — with grantees and outsiders:

First: Listen to your partners…. working with partners requires, more than anything, listening hard to what they have to say. While you’re listening, make sure you’re hearing the full story. The danger isn’t in what people do tell you—it’s in what they don’t.

It’s amazing what people won’t tell you when you have billions of dollars to give away.

It’s also kind of amazing how long the Gates Foundation has been struggling with this problem — of encouraging an open and honest dialogue with those outside the philanthropy.

Perhaps the reason this issue has become such a chronic refrain isn’t due to the lack of coming up with some new plan, or timeline or committee-designed set of principles, as it is about developing a new mindset.

As a journalist who’s been covering the Gates Foundation for more than a decade, I’ve seen it evolve from an upstart start-up philanthropy run by just a handful of people — who were actually pretty bold, outspoken and perhaps even a bit reckless — into a massive, fairly bureaucratic and apparently risk-averse organization.

Fling open the doors, I say. Let us all in on your arguments, your admissions of failure and frustrations. We know you’re trying to make the world a better place. We’d like to help.