Report of the WHO Commission on Macroeconomics and Health: a critique.

The World Health Organization has been able to interest some of the world's top economists in joining the Commission on Macroeconomics and Health, to study macroeconomics of health services for the poor peoples of the world. The commission has been ahistorical, apolitical, and atheoretical. It has adopted a selective approach to conform to a preconceived ideology. It has ignored earlier work done in this field. And it has pointedly ignored such major developments in the health services as the Alma-Ata Declaration. These failings have brought the quality of the scholastic work to an almost rock-bottom level. The commission's tunnel vision in its recommendations on so important a subject is not surprising. Its emphatic recommendations for perpetuating vertical programs against major communicable diseases (tuberculosis, AIDS, and malaria) on the grounds that such programs have proved convenient to "donors" reveals the real motivations for an almost openly ideology-driven agenda. This is a serious danger signal for scholars who wish to take a scientific attitude toward program formulations for the poor that provide maximum returns from limited resources. The concept of DALYs (disability adjusted life years) is bristling with gross infirmities. The WHO-generated data used for DALY calculations, converted into dollar terms, are patently invalid, unreliable, and not comparable between and even within countries.