Global Health Should be Key Component of U.S. Foreign Policy

The U.S. should significantly intensify its commitment to global health in the next four years by increasing funding and placing greater importance on health when setting overall U.S. foreign policy, says a new report from the Institute of Medicine written to inform the incoming administration's future policies. To achieve this level of commitment, a White House Interagency Committee on Global Health should be created early on in the new administration to coordinate U.S. global health activities. Improving health is the responsibility of the United States as a global leader, said the committee that wrote the report, and should be recognized as a goal with significant long-term diplomatic, economic, and security benefits for the U.S.

"The financial commitment that we are asking from the new administration and Congress is not trivial, but neither are the potential benefits from such a commitment," said Harold Varmus, president and chief executive officer of MemorialSloan-KetteringCancerCenter, former director of the National Institutes of Health, and co-chair of the committee that wrote the report. "Investments guided by a coherent vision for U.S. engagement in global health can avert millions of premature deaths, foster economic development, and strengthen our international relationships. Making such investments is especially important when a global financial crisis threatens the health of the world's poorest and most vulnerable populations."

A key aspect of U.S. global health funding should be producing a balanced portfolio of aid. Over the past decade, the U.S. government's annual overseas development assistance for health has increased, reaching an all-time high of $7.5 billion in 2008. To date, between PEPFAR -- the President's Emergency Plan for AIDS Relief -- and contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the U.S. government has spent over $18 billion combating AIDS. These health initiatives are lauded achievements that have brought life-saving drugs and HIV prevention strategies to millions. However, between 2004 and 2008, over 70 percent of U.S. global health funds were allocated to AIDS programs, while funds for chronic disease programs were virtually nonexistent, despite the fact that chronic, noncommunicable diseases now account for more than half of all deaths in low- and middle-income countries.

To ensure balanced and strategic U.S. global health efforts, the report recommends creation of a White House Interagency Committee on Global Health -- composed of heads of major federal departments and agencies involved in global health -- and designation of a senior White House official at the level of deputy assistant to the president to chair the Interagency Committee. The deputy assistant should serve as the primary White House adviser on setting U.S. global health policy and should work with the national security adviser, the director of management and budget, and the president's science adviser.

"An authentic, committed investment in the future of those around the world -- especially the poor -- is an investment in our own future," said Ambassador Thomas Pickering, vice chairman of Hills and Co., International Consultants, former U.S. undersecretary of state for political affairs, U.S. ambassador to the Russian Federation, India, Israel, El Salvador, Nigeria, and Jordan, U.S. ambassador and representative to the United Nations, and co-chair of the committee that wrote the report. "The incoming administration has the opportunity to demonstrate clearly that the United States is fully committed to human development and improved health for all."

Public support for global health initiatives has increased as philanthropists, students, scientists, private industry leaders, and citizens commit time and resources to respond to worldwide health challenges. Despite recent increases in global health funding, however, the U.S. commitment to development assistance for health abroad still remains below that needed to meet the United Nations Millennium Development Goals, a list of eight goals aimed at reducing poverty, hunger, and disease worldwide by 2015 that were adopted by U.N. members, including the United States, in 2000. As such, the report recommends that the U.S. strive to meet these internationally acknowledged goals -- as well as respond to emerging health challenges not captured in the Millennium Development Goals -- by increasing annual global health assistance to $15 billion by 2012. These funds should be spread across a breadth of global health issues including: treating and preventing AIDS, malaria, and tuberculosis; improving health systems, children's and women's health, nutrition, family planning, and reproductive health; and combating the emerging global health challenges of chronic, noncommunicable disease and injury.

According to the report, the U.S. should also ensure that as global health funding levels increase, the quality of global health programs increase as well. This requires improved evaluation to know which interventions are working and which are not. To have sustainable impacts, the U.S. should partner with national governments, coordinate global health efforts with the health priorities of countries receiving aid, and strengthen local health systems and work forces. In addition, the U.S. should work with the rest of the global health community and support the independence and leadership of the World Health Organization, which is uniquely positioned to set global, evidence-based norms on technical and policy matters. Increased research devoted to health problems specific to poor populations could provide new tools for use in global health programs, such as a vaccine for malaria. Improving deployment of existing technologies, however, even those as simple as insecticide-treated bed nets, could also have a large impact.

This report will be followed by a second report in the spring of 2009, which will contain more detailed recommendations on what government, foundations, academia, nongovernmental organizations, and the commercial sector can do to further the U.S. commitment to global health.

This study was sponsored by the Bill & Melinda Gates Foundation; Burroughs Wellcome Fund; Centers for Disease Control and Prevention;; Merck Company Foundation; Rockefeller Foundation; U.S. Department of Homeland Security's Office of International Affairs and Global Health Security, Office of the Assistant Secretary for Health Affairs; U.S. National Institutes of Health; and the U.S. State Department's Bureau of International Security and Nonproliferation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.