The U.S. Global Health Policy Agenda: Where Are We Headed?

For more than a century, the United States has supported health initiatives oversees as an element of its foreign aid and international development assistance portfolio. It also remains the largest funder and implementer of global health programs worldwide.[1] America’s long track record of foreign aid provisions (PEPFAR, the Global Fund) highlights the country’s leadership in the worldwide effort to combat disease and epidemics. However, America’s funding pledges have ebbed and flowed in tune with the changes in the political and economic landscape. Under the Obama administration, support for global health has continued but budgetary restraints and political jockeying continue to hinder the process of sustained and coordinated efforts to stamp out preventable disease and death. And now with a new conservative-led Congress, what can the U.S. expect to see in global health policy?

The Ebola outbreak that began in West Africa in early 2014 struck new chords with Americans, especially since it spread at an unprecedented rate, spilling over to neighboring countries and affecting health care workers from all over the world. As of February 8, there have been a total of 9,177 reported deaths in six different countries: Liberia, Guinea, Sierra Leone, Nigeria, United States, and Mali[2]. Experts cite that the lack of global investment in health systems particularly in highly affected areas was the main driver of Ebola’s astonishing scope and persistence[3]. It is important to recognize that a country’s capacity for preventing, detecting, and responding to emerging health threats are hinged on the availability of resources. For instance, health care worker support, improved holistic infrastructure (paved roads, larger hospitals) and urban clinic catchment areas, an increase in rural clinics, pharmaceuticals, and expanded health education and communication all require persistent funding to build up the health system infrastructure in low- and middle-income countries. Will global health funding increase in order to stem future global health threats in light of the Ebola outbreak?

For the most part, the FY 2016 Presidential Budget varies little from last fiscal year in the amount it requests for global health funding and development assistance. Within a fixed budget, current priorities often have to compete with one another, likely leading to budget stalemates. And with a new Congress at the helm, there will likely be even more reluctance to maintain funding for development assistance programs, let alone create new or expand on existing programs. Indeed, many critics of current funding levels to global health programs argue that more and more countries are transitioning out of their “developing” status and moving up the fiscal ladder (i.e. “we are creating, if not exacerbating, aid dependence”). Furthermore, federal agencies are struggling with these new trends and the political language that comes with it, in spite of the fact that hundreds of millions of people around the world are still at risk of contracting HIV, being bit by malaria-carrying parasites, and succumbing to heart disease and other non-communicable diseases that are preventable. So what is the trajectory of the United States’ stance on global health? It will require advocates like us to stay abreast of future budget negotiations, the stability of the global economy, and ultimately the winner of the 2016 Presidential Election.