NCPA - National Center for Policy Analysis

World Bank Focusing On Health

March 29, 1999

"The World Bank is the new 800 lb. gorilla in world health care," says a senior World Health Organization (WHO) representative. The bank has displaced WHO as the major player and funder in international health, reports the British Medical Journal.

The World Bank originally focused on building dams, roads and railroads, but over the past decade, President James D. Wolfensohn has steered it toward international health efforts through its Health, Nutrition and Population (HNP) sector.

  • In fact, the bank only made its first HNP loan in 1970, and lent a total of $13.5 billion for HNP programs by 1996.
  • From 1995 to 1996, yearly HNP lending more than doubled from $1.16 billion to $2.35 billion -- 11 percent of total bank lending.
  • Wolfensohn reportedly would like to increase the proportion of HNP lending to 45 percent of the bank's total -- or more than $9 billion annually.
  • By comparison, WHO grants have stagnated at around $900 million a year.

An impetus toward new priorities came with the bank's 1993 report, "Investing in Health," which estimated the global disease burden was unevenly spread -- measured in disability adjusted life years, 93 percent is concentrated in low income and middle income countries, with sub-Saharan Africa, China and India accounting for 60 percent.

Furthermore, data from 1990 showed that of the $1.7 trillion the world spent on health, high income countries accounted for 90 percent -- spending $1,500 per person, compared with an average of $41 per person in low income countries.

The report's most controversial recommendation was that poor and middle income countries "promote diversity and competition" through private or public insurance programs, and foster competition in the delivery of health services.

Source: Kamran Abbasi, "The World Bank and World Health: Changing Sides," British Medical Journal, March 27, 1999.


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