The influence of funding agencies on international health policy, research and programs.

Funding agencies, through the exercise of "strategic funding," are able to exert controlling influence in various fields of endeavor, and international health provides no exception to this general rule. A common way such control is exerted is to define the problem to be solved in a way that serves the vested interest of the funder. This is possible because the way a problem is defined determines the solution(s) to the problem. Currently, international health professionals are confronted with two contending definitions of health. The World Health Organization has defined health theoretically (to guide discussion) as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity." This definition reflects a health-oriented conceptualization of health as primarily a social product, and hence leads to social-oriented solutions to problems of ill health in society. On the other hand, funding agencies have defined health operationally (to guide activity) as "the absence of disease or illness." This definition reflects a disease-oriented conceptualization of health, which therefore leads to biotechnical, individual-oriented solutions to disease and illness in society. To choose between these two definitions is to choose between two quite different problems to be solved, two very different sets of solution strategies and two very different sets of value structures. This choice represents a particularly difficult dilemma to international health professionals who are dependent on external funding agencies for their support.