People, Not Population

In a recent op-ed published by the New York Times international edition, Rachel Nugent discusses the United Nations’ new projections on population. The UN Population Division recently raised its estimate for global population to reach 10.1 billion by 2100—a steep increase from the previous projections which showed the world’s population leveling off at 9 billion by 2050. Rachel explains that the UN was too optimistic in its assumptions about how long it would take for many countries to reach replacement fertility. In her editorial, Rachel suggests that rather than thinking about “population,” we think about how fertility and mortality differentially affect population levels and growth rates, and how effective family planning policies can lead to lower fertility, which in turn, reduces child and maternal mortality. Focusing on overall population numbers doesn’t tell us how to bring about the desired changes.

Getting Better

In his book “Getting Better,” CGD's Charles Kenny shows that quality of life—as measured by health indicators such as life expectancy and child survival, among others—has improved dramatically over the last century. Further, using the health sector's numerous experimental evaluations, Charles describes the diffusion and democratization of inexpensive, cost-effective health technologies such as vaccines and oral rehydration as well as ideas such as conditional cash transfers and social marketing that have resulted in rapid improvements in the quality of life for the worst off. Last week at the World Health Assembly, Bill Gates said it best: "I hope this book gets the acclaim it deserves….We need the people who make funding decisions and set policy to understand the progress being achieved every day. I believe we have the opportunity to make even more progress, faster, for more people." Gates also reviewed Charles’ book in Saturday’s edition of The Wall Street Journal, explaining that “After years of doom and gloom on the subject of foreign aid, it is refreshing to find so thoughtful and contrarian an approach to the topic.”

Costing Antiretroviral Therapy

In a forthcoming editorial in the AIDS journal, Mead Over joins Stefano Bertozzi and Damian Walker of the Bill & Melinda Gates Foundation in welcoming a new article by PEPFAR staff and consultants in the same issue of AIDS (Menzies et al., already online for subscribers) which publishes the first official unit cost estimates of delivering ARTs. The PEPFAR Reauthorization Act of 2008 (H.R.5501 and S.2731) mandated PEPFAR provide these estimates to enable OGAC to set targets for the number of patients the U.S. will directly support on treatment. Mead and his co-authors point out that the work to date is insufficiently analytical or comprehensive to achieve that goal and call on PEPFAR and other researchers to follow this study by: 1) examining the reasons behind the wide variation in costs from site to site to identify channels to increase efficiency; 2) collecting data from a larger sample of treatment sites, including those supported by other donors, in order to compare their efficiency to that of PEPFAR-supported sites; and 3) including off-site costs, such as payments to prime-contractors, to calculate how total costs are affected by efforts to improve efficiency.

The GHI Turns 2…But What Are We Celebrating?

May 5th marked the end of the Global Health Initiative's second year. While the past months have seen a number of long-awaited releases from GHI—a website, final strategy, and GHI+ country strategies—two years in, we still lack specifics on how GHI is actually being implemented. While acknowledging that GHI is a huge undertaking, in a recent blog post, Nandini Oomman questions how GHI will deliver results and makes a request for GHI's third birthday: publicly share progress on GHI targets and learning on GHI principles and design. For more on GHI, listen to Nandini's CGD wonkcast.