"Governments of the world's richest nations have launched significant responses to the rampant health crises of those living in the poorest nations," Boston Globe columnist James Carroll writes in an opinion piece. He adds that "wealthy individuals, like Bill and Melinda Gates, are also making extraordinary interventions" and that President Bush's "request for a reauthorization of the President's Emergency Plan for AIDS Relief solidifies what will likely be regarded as the Bush administration's finest act."

However, global health and development issues are so complex that "even these proposals spark controversy," Carroll writes, adding that some advocates say that the "entire 'disease-specific' approach ... is equally misguided." According to these advocates, "donors should be shoring up health infrastructures, not targeting particular diseases," Carroll says. "What the past five years" of PEPFAR illustrate, however, is that "disease-specific strategies do create systemwide collateral benefits, making the dichotomy false," Carroll writes, adding, "The point is now for planners and politicians to make a conscious effort to enhance that pattern." According to Carroll, opportunities "must be seized to expand in-country work forces of health professionals." He adds that the "focus on particular prevention programs must simultaneously broaden to encourage in ordinary people the fuller health consciousness on which systems depend."

The "demands of multiple health crises must not be reduced to a zero-sum game, with care for malaria or preparation for Avian flu set against the needs of those" living with HIV/AIDS, Carroll writes, adding, "By doubling the American dollar commitment to" the disease in Africa, Bush "gave an example of what is needed -- which is a drastic expansion of financial support for the health of people living in poorer nations." Expanding the global "response to this disease can prompt a needed expansion of our responses to the others," Carroll writes, concluding, "And responding with focus to each disease can help the broader health systems of the world become what they must be" (Carroll, Boston Globe, 2/11).