A Healthy Dose of Skepticism

Global health is big business in Seattle—which means it may be in danger of forgetting the billions of people it set out to help.

By Tom Paulson June 23, 2009 Published in the July 2009 issue of Seattle Met

BACK IN THE GLORY DAYS of the British Empire, it was called “tropical medicine.” As the sun dipped on the imperial Brits, it became “international health,” the province of health activists, religious do-gooders, Peace Corps types, and scruffy scientists studying obscure diseases. Now it is “global health,” and Seattle, the home of the Bill and Melinda Gates Foundation, is one of its epicenters, on par with Geneva (home of the World Health Organization) and Atlanta (the U.S. Centers for Disease Control and Prevention, or CDC).

As a consequence, global health is now widely hailed as a local growth business. Last October participants at the Greater Seattle Chamber of Commerce’s annual leadership conference celebrated it as an important “emerging industry” with huge growth potential for the Puget Sound region. In 2007 a University of Washington economic analysis found that global health already supported 44,000 jobs at nearly 200 organizations and brought more than $4 billion in “business activities” to the region. At the annual meeting of the Washington, DC–based Global Health Council in May, Seattle’s leadership role was as visible as Microsoft’s presence is at a consumer electronics conference.

PATH and the Seattle Biomedical Research Institute, two formerly tiny, little-known research organizations that started here in the late 1970s, struggled for years to survive. Now they’re megaplayers in the field. Massive cash infusions from the Gates Foundation have made SBRI a world leader in malaria research. PATH, which develops sustainable health technologies and strategies for the developing world, has received nearly 50 grants totaling about $1 billion from the Gates Foundation.

For those working in the field, this is a thrilling moment loaded with immense promise and big challenges. Perhaps no one brings more hard-won frontline experience to those challenges than two local global-health heroes, William Foege and Stephen Gloyd. Both are physicians who cut their professional teeth in remote African villages. Each has dedicated nearly a half century to improving the health of the world’s poorest people.

Dr. William Foege, a Lutheran minister’s son from Colville, Washington, started out as a medical missionary in a church-sponsored health program in eastern Nigeria. The CDC enlisted him to work there as part of a worldwide campaign to eradicate smallpox. The experience transformed Foege, who’d originally set out to treat the sick, into a renowned disease-prevention advocate. He wound up as lead field strategist in the successful smallpox effort—the only campaign so far that has rid the world of a disease. Today he is a senior adviser to the Gates Foundation.

Stephen Gloyd, a doctor’s son, grew up on the nonview side of Seattle’s View Ridge neighborhood, just across the rise from Bill Gates’s childhood home. The Vietnam-era draft convinced him to postpone his intended career as a rock musician and pursue a medical degree at the University of Chicago. Gloyd returned to Seattle for a medical residency in 1973. It was a progressive time in the city, the heyday of the “health for all” community clinic movement and of international solidarity groups supporting democratic efforts overseas. Gloyd worked in the free clinics and got involved in social justice issues. He got back into music and played marimba to raise money for medical assistance in southern Africa. That was how he learned of an urgent need for doctors in newly independent Mozambique.

{page break}

Gloyd arrived in Mozambique in 1979, one year into a civil war fueled, with U.S. support, by two neighboring regimes, white-ruled Rhodesia (today’s Zimbabwe) and apartheid South Africa. He witnessed the war’s toll firsthand—massacres, the bombing of cities, an estimated 900,000 people killed. “It was a life—changing experience for me.”

Upon his return, Gloyd started the -Mozambique Health Committee, now Health Alliance International, a Seattle-based nonprofit with more than 1,000 employees working to improve care systems in -Mozambique, East Timor, Côte d’Ivoire, and Sudan. He and his wife, the Côte d’Ivoire–born public health lawyer Ahoua Koné, have continued working in Mozambique and other poor countries for more than two decades. He recently became associate chair of the University of Washington’s new global health department.

PATH has received about $1 billion from Gates to develop health solutions for the developing world.

Gloyd finds it encouraging that global health attracts so many more resources today, but he worries when he hears it characterized as an emerging industry and a boon to this region. “This isn’t supposed to be about us,” he says. “For me, global health is about making sure everyone everywhere has the same opportunity to be healthy.” And he sees that focus getting lost in the rush to cash in.

Bill Foege, the physician credited with devising the strategy that rid the world of smallpox, shares some of Gloyd’s concern about losing focus. Nevertheless, he says, “I’m not too worried about people referring to global health as an industry.” After decades of wishing the rich world would pay attention, using any lingo at all, to the health needs of the developing world, he’s happy to see the “industry” stimulating so much excitement and interest.

“We do need to get the vision right and not lose sight of the real objective,” says Foege. But as he points out, the fact that some of the world’s richest people have made global health their personal cause (and made Seattle the base for this altruistic enterprise) has already changed the world for the better. Thanks in large part to the Gates Foundation, Foege notes, other long-neglected ills of the developing world—malaria, tuberculosis, vaccine—preventable childhood diseases—have come to the fore.

Diseases such as AIDS, SARS, West Nile virus, and the so-called swine flu remind us that health has indeed become global. “These diseases tie the fears of the rich world to the needs of the poor,” says Foege. When the world comes together to fight them, everyone benefits. “But I agree with Steve that we do need to work to stay on track. Or else we will instead just tie the needs of the rich to the fears of the poor.”

Gloyd, upon reflection, thinks all the “industry” hype may actually help the global health cause stay on track. “Maybe it’s okay to call it an industry,” he muses. “Maybe using the word will shock people into recognizing that when a local biotech firm says it is working on a vaccine to help people in Africa, some will see it is actually just trying to make a few people in Seattle rich.” And, he hopes, we will be able to distinguish between serving the needy and serving ourselves.

Filed under
Show Comments