U.S. Should Bolster Funding to Improve Public Health

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To fulfill America's humanitarian obligations as a member of the international community and to invest in the nation's long-term health, economic interests, and national security, the United States should reaffirm and increase its commitment to improving the health of developing nations, says a new report from the Institute of Medicine. 

The United States should increase its funding for overseas disease prevention and treatment to $15 billion per year by 2012 to achieve this goal, said the committee that wrote the report. In addition, scale-up of existing preventive and therapeutic interventions and a boost in research on health problems that are endemic to low- and middle-income countries will be required. The U.S. government -- along with other nations, academia, nongovernmental organizations (NGOs), private foundations, and other partners -- should lead efforts to build the health care work forces and facilities in resource-limited countries; many have critical deficits that hamper delivery of care even when it is available. And public and private donors need to engage individuals and organizations in these nations as respected partners to ensure accountability and sustainability of aid initiatives, the report adds.

The committee supports President Obama's recent announcement of plans to make health a pillar of U.S. foreign policy, a recommendation the committee made in its interim report released in December. The president should underscore this commitment by creating a White House Interagency Committee on Global Health headed by a senior White House official to plan, prioritize, and coordinate budgeting for the nation's global health programs and activities, the new report says. 

"It is crucial for the reputation of the United States that we live up to our humanitarian responsibilities and assist low-income countries in safeguarding the health of their poorest citizens despite current pressures on our economy," said committee co-chair Thomas R. Pickering, vice chairman of Hills & Co. of Washington, D.C., and former undersecretary of state for political affairs.  "America should act in the global interest, recognizing that long-term diplomatic, economic, and security benefits will follow."

"The U.S. government and American foundations, companies, universities, and nongovernmental organizations together have an unprecedented opportunity to improve the health of millions," added co-chair Harold Varmus, president of Memorial Sloan-Kettering Cancer Center, New York City, and former director of the National Institutes of Health.  "Now more than ever, the knowledge and technologies to tackle the health problems of developing nations are within reach. A new generation of philanthropists, students, scientists, and business leaders is eager to make a difference in our global community. As the recent H1N1 influenza outbreak dramatically illustrated, health issues cross oceans as well as borders and require international cooperation and input."

The increase of U.S. funding for global health to $15 billion by 2012 should provide $13 billion per year for health-related millennium development goals -- including treatment and prevention of HIV/AIDS, malaria, and tuberculosis -- and an additional $2 billion to balance the portfolio by targeting the growing problem of injuries and noncommunicable diseases, such as heart disease. Of the $13 billion, $3.4 billion should support programs in areas that have been severely underfunded, including nutrition, family planning and reproductive health, and strengthening countries' healthcare systems. Scaling up such programs will require improving the delivery of existing health interventions and the development of new diagnostic, preventive, and treatment tools and services.

U.S. agencies and Congress should make government-funded health programs more flexible to permit funds to support not only specific interventions, but also to more broadly strengthen recipient nations' health systems. They should allow recipient nations to allocate funds as necessary to meet their particular needs. For example, funds targeted to providing malaria drugs to children could simultaneously support broader maternal and child health services.

In a recent nationwide poll, about two-thirds of Americans said they support U.S. efforts to improve health in poor countries.  The public's support is grounded in altruism, but also comes from a sense that a health crisis anywhere could impact Americans and the belief that health is an increasingly global issue, the poll showed. 

U.S. agencies, private institutions, universities, NGOs, and companies can help build the capacity of the health and research institutions in low- and middle-income nations by engaging them in long-term partnerships, the report says.  To deliver effective health services, countries require capable local leaders, researchers, and practitioners to identify problems and solutions that work and are sustainable in their own countries, but because these individuals are often not engaged in policy, they have been neglected by donors as potential partners. The U.S. research community should promote the global exchange of tools and information as a way to help resource-limited nations conduct research to improve the health of their own populations. 

The study was sponsored by the Bill & Melinda Gates Foundation, Burroughs Wellcome Fund, Google.org, Merck Company Foundation, Rockefeller Foundation, U.S. Department of Health and Human Services, U.S. Department of Homeland Security, and U.S. Department of State. 

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