6. Public Health Infrastructure and Knowledge
John Powles, Flavio Comim
Production of knowledge
- Increased production achieved by government production, changes in taxes etc
- In addition, wider determinants of provision and consumption of public health infrastructures are:
- (primary) schooling
- International institutions have pivotal role as intermediaries in provision/finance of knowledge for many countries
Reductions in the price of knowledge could be funded either by taxes or by changes in the mark-ups of big producers of knowledge (their products are usually price-inelastic). This will not be adequate alone; final production will be determined by participatory and social processes that will point out the extent of their undersupply. Financing mechanisms and incentives should also be given at a local level where these GPG will be adapted, modified and used.
However, in addition to direct finance and production, there are wider determinants of the provision and consumption of public health infrastructures. Key amongst these are: (i) the very close link with poverty - programmes aimed at poverty reduction may strengthen the sense of empowerment and opportunity, and reduce the feeling of vulnerability, of the poor, contributing to the efficiency in the building of public health infrastructures in their communities; and (ii) the close link with schooling (especially primary schooling) - it is well known that the higher the levels of literacy of a population, the lower the levels of under-5 mortality rates.
Of special concern in the context of public health infrastructures are those areas of research need which lack commercial or institutional incentive for investigation - for example 'orphan diseases' affecting only the poor, who cannot be expected to pay prices (for example for drugs) that would be sufficient to re-imburse commercial research and development expenditures. International action is occurring to secure 'public-private partnerships' to fund work in these areas (eg Global Alliance for TB Drug Development). It is in this respect that international institutions have a pivotal role as intermediaries in the provision of knowledge for many countries.