Whether the United States continues to be a leader in global health rests on the shoulders of the next president, panelists said on Wednesday at a Kaiser Family Foundation forum on the future of global health policy.
“Presidential leadership is sine qua non,” J. Stephen Morrison of the Center for Strategic and International Studies said. “It’s what we need to be targeting.” Had it not been for the leadership and commitment from Presidents Clinton, Bush and Obama, the over $10 billion yearly contribution from the U.S. government towards improving global health would not have been sustained, Morrison said.
Over the past four years, however, Congress has allocated more money for global health programs than the President’s request, Jen Kates of the Kaiser Family Foundation noted.
Still, presidential leadership has allowed for global health spending to jump from $5.2 billion in 2006 to $10.2 billion in 2016, as outlined by the Kaiser Family Foundation’s latest analysis of global health spending.
The Foundation has also released new polling data on how Americans view U.S. involvement in global health. While most Americans want the U.S. to play a major or leading role in world affairs, about half of Americans say the U.S. is contributing more than its fair share to improve global health. While 34 percent of Democrats say the U.S. contributes more than its fair share, 62 percent of Republicans think the U.S. is contributing more than its fair share. Twenty percent of Democrats believe the U.S. is spending too much on global health versus 40 percent of Republicans who think the U.S. is spending too much.
The danger is high right now, Morrison said, that the current “nihilist, anti-establishment sentiment” that’s present in the Republican party, especially around the presidential elections, “could disregard or actively eviscerate worthy programs nationally and internationally.”
“This is one of the biggest threats to bipartisan leadership around global health,” he said. “We need a functional Republican party that is coherent and committed.”
Disagreeing with Morrison, former Health and Humans Services Secretary Governor Tommy Thompson said Republicans are enthusiastic about global health issues, but they want a cause that has goals and accountability, citing the President’s Emergency Plan for AIDS Relief as one of those causes. Republicans look at development issues the way the business community looks at issues, Thompson said, desiring to see a beginning and an end and shaping a cause around that. He cited neglected tropical diseases and malaria as diseases that can be eliminated “if we really wanted to.”
This way of looking at global health issues as “something to be eliminated with a beginning and an end” isn’t conducive to setting up the proper infrastructure to really improve global health, Helene Gayle of the McKinsey Social Initiative, said.
If we continue to tackle disease after disease instead of building up health infrastructure, she said, there won’t be much of an improvement in global health ten years from now. “We need the health infrastructure in place to deal with the next crisis,” she said.
Strengthening that health infrastructure and addressing the social determinants of health is also key for tackling the biggest infectious disease killers, Global AIDS Coordinator Ambassador Deborah Birx said. While integration of health services as part of building health infrastructure is an important discussion to have, “there is nothing for young women to integrate into,” Birx said.
“There is no healthcare from the time you are five to the time you’re pregnant,” Birx said, adding that health looks even worse for young men and men in general who have no binding sites for healthcare at all unless they’re being treated for HIV.
The future of global health requires more integration into development, Gayle said. “How do we look at integrating health into the broader arena of development or community development, writ large,” she said. This includes looking at education and access to nutrition – which includes addressing agriculture – as well as financial inclusion, she said, in order to maintain the global health gains made.