Foreign Policy Blogs

Equality and Efficiency

As the inaugural post to ‘Global Health’, I thought I’d start with a bit of philosophy.  A colleague of mine, with a career in the public sector, who at the time was pursuing his MBA, once remarked to me: “I’ve been pursuing equality my entire career; I decided now it was time to take a closer look at efficiency.” 

As someone with a business career who had recently transitioned to a nonprofit in the public health space, this comment struck me as pretty potent.  My experience had been the opposite: I was taught (indoctrinated?) that efficiency was the goal and that equality, while possibly desirable, was not always feasible.  To pursue both simultaneously was not an option.

As a discipline, I believe global health sits squarely at the juncture of equality and efficiency.  We take for granted that as a global community, we now seek healthy outcomes for the entire international community.  But once upon a time–in fact less than a century ago–global health was barely on the radar screen.  Two of the biggest global health milestones have been in the last couple of generations: the creation of the WHO in 1948 and the Declaration of Alma Ata in 1978, which promoted the concept of universal primary health care.

As a globe, we are still in relatively virgin territory when it comes to promoting the idea of “the attainment by all people of the highest possible level of health”.  (And making significant progress, as reported by the world’s most famous Bills – Bill Clinton & Bill Gates – earlier this month.)

Furthermore, and excitingly, ‘the highest possible level of health’ is a moving target.  In most areas of the world, Africa being a glaring exception, life expectancy has increased significantly in the last century.  And the quality of that life is increasing too.  Our ability to positively influence the duration and quality of the human experience has been largely successful.  But in no way is it inevitable.  Recent developments–HIV/AIDS, climate change and Type II diabetes being a few–threaten to reverse our upward trend.  And equality still remains an enigma in many ways. 

This blog will attempt to document, interpret and promote developments in the field of global health, paying attention to both equality and efficiency, as well as their counterparts efficacy and effectiveness.  I promise, starting next week, to philosophize a bit less and report a bit more – in the meantime, have a great weekend.



Cynthia Schweer Rayner

Cynthia Schweer Rayner is an independent consultant and philanthropy advisor specializing in public health, social entrepreneurship and scalable business models for positive social change. As a recovering management consultant, she spent several months living in South Africa, and later co-founded the US branch of an organization providing support to orphaned and vulnerable children. In 2009, she was an LGT Venture Philanthropy Fellow, working with mothers2mothers (m2m), a multinational non-profit organization employing mothers living with HIV as peer educators to positive pregnant women. She currently works with individuals, companies and nonprofits to finance and develop models for positive change. Cynthia has an MBA from INSEAD and a BA in English Literature from Georgetown University. She currently lives in Cape Town and visits New York frequently, where she co-owns a Manhattan-based yoga studio, mang'Oh yoga (