While lawmakers have indicated they may reject cuts to U.S. global health funding, the Trump Administration’s proposed cuts to the U.S. Agency for International Development and the National Institutes for Health, among other agencies, “should be looked at as a clear direction of where U.S. policy towards global health is going,” Jen Kates of the Kaiser Family Foundation said at a panel discussion on the future of global health funding last month. Even the suggestion of cuts, she said, could have “dramatic and permanent global implications.”
The Trump administration’s proposed cuts come at a time when, globally, development assistance for health is at an all-time low since the rise of that funding began. Then, Joseph Dieleman of the Institute for Health Metrics and Evaluation said, the annual growth rate for global health funding was 5 percent. Between 2000 and 2010, that rate jumped to an 11 percent increase every year for global health assistance. Now, annual growth is just 2 percent.
Already, the IHME’s latest global health funding report, estimates international HIV funding has decreased by $100 million per year since 2010. Maternal and child health are the only global health areas that have seen funding increases in recent years.
While donor funding is decreasing, Tim Evans of the World Bank said, healthcare costs are increasing at an exponential rate. “The global healthcare economy will more than double from $9 trillion today to $24 trillion by 2040,” he said. Most of that spending, however, will occur in high- and middle-income countries, he said, while the poorest countries will not be able to keep up. In fact, he said, health spending in low- and middle-income countries is likely to decrease.
Currently, only 0.6 percent of healthcare spending globally is development assistance, but that assistance accounts for 36 percent of health spending in low-income countries, according to the IHME’s report on rising disparities in global healthcare.
“Now there’s a very real potential for a decrease in development assistance for health, unlike ever before,” Christopher Murray of the IHME said.
A “pretty dystopian vision” lies ahead for three-quarters of a billion people who will reside in low-income countries by 2040, Steve Morrison of the Center for Strategic and International Studies said, if development assistance for health further decreases. As healthcare costs rise and global health assistance falls, people in low-income countries will increasingly have to pay out-of-pocket for healthcare, which, Evans said, will only buy them inadequate and poor services.
Now, with the “dramatic populist assault on USAID and the value of foreign assistance,” Morrison said, “even if half of the cuts proposed are accomplished and continued as a yearly impulse and logic, that leaves very little” for the people who most need assistance.
“There is no substitute for sustained U.S. leadership in global health,” Morrison said. “No one else, including the private sector, can fill the gap if the U.S. contracts.”