Emanuel Offers Some Details of Administration's Global Health Initiative

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This post is by Center Director Christine Lubinski, who attended today’s meeting at the NIH of the Consortium of Universities for Global Health.

 The Obama Administration’s Global Health Initiative has been the subject of intense debate and scrutiny since the White House first unveiled the proposal, with few details, in May.

Today, at a meeting of leading academics involved in global health programs, Dr. Ezekiel Emanuel, a special advisor to the White House on health policy, talked a bit about the substance and the process behind the GHI. For starters, he said he has had extensive discussions with Dr. Francis Collins, the new NIH director, about the GHI.

One of Dr. Emanuel’s early slides focused on health conditions that take a heavy toll from the perspective of disability adjusted life years lost or saved—DALYS.  The top conditions are pneumonia/meningitis, diarrhea, HIV/AIDS, tuberculosis, malaria, and worms.

In terms of lives lost, he highlighted—in this order—pneumonia, HIV, diarrhea, malaria, and tuberculosis–as an explanation for why the Obama Administration was making global health a priority.

“Every day, 26,000 children die of preventable conditions, and that should not be acceptable to any of us,” said Dr. Emanuel.

He identified US government assistance to global health as $7.31 billion in 2008 and pointed out that PEPFAR has proved to the world what could be done with concerted attention and money.  But he also pointed out that there were significant problems with PEPFAR, and with US global health spending generally, that the GHI would be fashioned to address—too much stove piping, too much emergency emphasis, and too much emphasis on process-oriented goals as opposed to outcome measures.  The hope is to build programs in a much more sustainable manner, based on solid outcomes.

Key components of the GHI will be promoting program integration, developing sustainable infrastructure, placing a strong emphasis on maternal-child health, requiring hard outcomes and prioritizing cost-effective interventions.  Another aim is to integrate global health programs with development programs and food assistance. Dr. Emanuel highlighted cost-effectiveness as an ethical imperative, not simply a financial imperative, since if we waste money or spend too much, someone else is essentially being denied an intervention.

He outlined the following primary goals of the President’s GHI:

*Prevent millions of new HIV infections

*Reduce mortality of mothers

*Reduce mortality of children under 5

*Avert millions of unintended pregnancies

*Reduce burden of neglected tropical diseases

Dr. Emanuel indicated that that the Administration was committed to putting real resources into the GHI.  According to him, the US government spent $27 billion from 2003 to 2008, and President Obama was committed to spending $61 billion between 2009 and 2014.  Some of us wondered what had happened to the $63 billion initiative we have been hearing about since early spring.

Seventy-five percent of the resources will go to PEPFAR, which presumably includes tuberculosis and malaria.  Family planning would garner $475 million, while child health would receive $525 million.

The GHI will transform US government programs by promoting  more integration between PEPFAR and other GHI activities,  and highlighting the importance of women and mothers in particular, Dr. Emanuel said.

Dr. Emanuel called for an emphasis on diseases with high DALYS, which can be easily and cheaply be cured, and those that affect children.

He pointed out his own special interest in neglected tropical diseases that do not have high mortality but have very high morbidity.  In this regard, in highlighted the need for research and development as well as programming, since new drugs are urgently needed for a variety of these conditions.

He ended his talk by underscoring a commitment to be data driven and outcomes focused, but expressed frustration that the data is not always available and it is challenging to identify an outcome measure or progress for sustainable infrastructure, for example.  He called on the members of the academic community present to assist with this.

He also pointed out that the US can’t address global health alone and that the Obama Administration would be placing additional emphasis on partnerships with other entities and governments.

During a brief question and answer session, Emanuel was asked about the timeline for the GHI process currently under way. Emanuel described it as involving every single government agency with any stake in global health and said he expected substantive announcements about the GHI by year’s end.

In response to an audience query, Emanuel indicated that the Administration is also looking to integrate health with development and food assistance. 

Former Congressman John Porter and current board member of Research America described Dr. Emanuel as the true “architect” of the Global Health Initiative.

In a later talk, Steve Morrison, Ph.D., from the Center for Strategic and International Studies (CSIS),  told meeting participants that the Obama Administration is poised to announce a 5-year, $15 billion food security initiative for developing countries.

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