1 November 2011


Simon Rushton

Dr Simon Rushton

Associate Fellow, Centre on Global Health Security


  • The recent rise of Health Systems Strengthening as a policy priority suggests that a move away from single-disease approaches to global health may be occurring.
  • As the largest attempt by far to tackle one disease, the global AIDS effort has acted as a lightning rod for criticisms of global health initiatives focused on single diseases.
  • Global AIDS institutions have sought to respond by broadening their mandates to incorporate some wider systemic interventions into their activities.
  • However, as the debate over addressing particular diseases or investing in health systems continues, five important underlying political and ethical questions are being neglected, including whether there is an ideal health system, the timescales involved, the definition of sustainability, governance/structural capacity and political will.
  • If a more sustained and coordinated effort to improve health outcomes is to become a reality, these difficult questions will need to be tackled.