It's not clear that if we all beg for bigger slices, we'll just get more pie.
Alanna Shaikh rightly points out that, despite the incredible important of funding HIV/AIDS programmes, there are many health problems that are losing out in the fundraising arms race.
But here’s what I have figured out in the last decade: we can have more pie. Differently put, global health is not a zero-sum game. We can increase the funding that goes to it. In the last ten years, we have. The Global Fund and the Gates Foundation have radically increased the resources available to global health. The private sector has started funding global health, and government donors have increased their commitments.
There is nothing wrong with so much attention going to AIDS. HIV gets exactly as much attention as it deserved. It’s the second most terrifying pandemic of our time. (I really think first place belongs to MDR TB). About two million people a year die from AIDS, and there are about 33 million people currently infected with HIV. It is devastating to communities, families, and nations. It is worthy of every red ribbon, activist, and dollar of funding it receives.
What is wrong is that other health problems don’t get as much attention. And that’s not a problem we solve by ignoring HIV. It’s a problem we solve by bringing more attention to the rest of the world’s serious health problems. We should learn from the publicity for HIV, not complain about it. What we need is to get that kind of attention for everything that deserves it.
I am a little skeptical that the answer lies with more or better publicity for neglected health problems. I think it is unlikely that we are capable of increasing the volume of campaigning on some worthy causes while somehow avoiding crowding out others by increasing the overall pie. Owen Barder does a good job of dissecting some of the issues here.
For one, the more causes that potential donors get bombarded with, the less effective any of them will be. I should demonstrate this with some resounding empirical work, but I think this video of Robert Stack fending off a bunch of activists at LAX says it all:
So increasing overall noise by amplifying fragmented messages might not increase global giving and might even fatigue the entire process.
What about crowding out? We need to be more honest about how many messages we can take on board at once – our collective time thinking about global problems is rather limited. If someone tells me I should be thinking about neglected tropical diseases, that’s less time I’ll spend thinking about HIV/AIDS or education or conditional cash transfers or international trade.
