Carrots, Sticks, and Systems Change: Financing the Shift to Preventive Health [Guest Essay]

Newsletter Edition #286 [The Files In-Depth]

Hi,

Profound changes underway in global health are raising fundamental questions about the way the field is run and governed.

In our guest essay today, experts from Rypple, an organization working on improving health systems, argue that global healthcare is overwhelmingly "wired for treatment, not prevention". They question whether, in the context of the current fiscal crisis in global health (not just at the United Nations), such a model of emphasizing treatment more than prevention is sustainable at all.

Even as policy choices are in a flux with unprecedented uncertainty, the authors call for precision for any future strategies that governments and leaders may consider.

We hope you appreciate the diverse range of perspectives we bring you through our guest contributions. Write to us with feedback.

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More soon!

Best,

Priti

Feel free to write to us: patnaik.reporting@gmail.com or Follow us on Twitter: @filesgeneva

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Illustration Credit: Amy Clarke, Chembe Collaborative

I. GUEST ESSAY

Carrots, Sticks, and Systems Change: Financing the Shift to Preventive Health

Ash Norman (Co-Founder & CPO, Rypple – ash@rypple.org); Ushma Issar (Co-Founder & CEO, Rypple – ushma@rypple.org) [www.rypple.org]

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Global health is at a critical juncture now, at a time when the sector has been deeply affected by funding gaps even as preventable diseases continue to spread rapidly through the world’s most vulnerable communities.

The need for future-proof, innovative policy solutions has never been more urgent - solutions that transcend short political cycles and deliver lasting, measurable relief to the mounting pressures on global healthcare.

World Health Organization’s (WHO) renewed guidance on sin taxes (1) cannot be more timely. This underscores a broader crisis regarding health financing and the urgent need for long-term, prevention focused policies and programs.

WHO is advising countries to introduce "sin taxes" on products like tobacco and alcohol to generate domestic resources. This advice comes in the wake of severe cuts to official development assistance (known as ODA), highlighted by the US President's formal request to Congress to rescind $9.4 billion in global health funds (1). Such cuts threaten to unravel years of progress, leading to and already seen treatment interruptions, clinic closures, and job losses for health workers across Africa and other regions of the world, impacting programs for tuberculosis, malaria, HIV, vaccinations, and maternal and child health.

This advice is in line with the WHO’s 2017 “Best Buys” for noncommunicable disease prevention (2), which identify excise‐tax increases on tobacco, alcohol and sugar‐sweetened beverages as among the most cost-effective and time efficient interventions.

This fiscal strain lays bare a more profound systemic flaw: global healthcare is overwhelmingly "wired for treatment, not prevention". The cost of delivering treatment worldwide is already unsustainable and it is only escalating. This fundamental design flaw fuels over-medicalization, perpetuates inequitable access, and drives spiraling costs, with financial incentives predominantly rewarding disease management while prevention and “health” remains critically underfunded and underutilized.