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Institute of Medicine (US) Committee on the US Commitment to Global Health. The US Commitment to Global Health: Recommendations for the New Administration. Washington (DC): National Academies Press (US); 2009.

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The US Commitment to Global Health: Recommendations for the New Administration.

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Summary

At this historic moment, the Obama administration and leaders of the U.S. Congress have the opportunity to advance the welfare and prosperity of people within and beyond the borders of the United States through intensified and sustained attention to better health. The promise of potential solutions in global health has captured the interest of a new generation of philanthropists, students, scientists, private industry leaders, and citizens, eager to make a difference in our interconnected world. During the last decade, the U.S. government has mirrored the American public’s interest with record expenditures on global health. By building on these commitments and deploying the full complement of U.S. assets to achieve global health, the United States can continue to improve the lives of millions around the world, while reflecting America’s values and protecting and promoting the nation’s interests.

The Institute of Medicine—with the support of four U.S. government agencies and five private foundations—formed an independent committee to examine the United States’ commitment to global health and articulate a vision for future U.S. investments and activities in this area. To coincide with the U.S. presidential transition, the committee prepared the following report outlining how the U.S. government can improve global health under the leadership of a new administration. A more complete exploration of this vision—including the role of the commercial sector, foundations, academia, and nongovernmental organizations—will be released in the spring of 2009.

Health is a highly valued, visible, and concrete investment that has the power to both save lives and enhance U.S. credibility in the eyes of the world. In today’s market crisis, the financial policies and practices of the most developed nations, including the United States, are seen as the cause of painful economic spillovers in low- and middle-income countries. During economic downturns, population health declines, especially among the poor in low-income countries, who pay a large portion of their health care costs out-of-pocket, without the benefit of social safety nets. It is crucial for the reputation of the United States that the nation live up to its humanitarian responsibilities, despite current pressures on the U.S. economy, and assist low-income countries in safeguarding the health of their poorest members.

The U.S. government can take this opportunity to demonstrate, through policies and actions, that this nation fundamentally believes in the value of better health for all. The committee is calling on the next President to highlight health as a pillar of U.S. foreign policy. This could be confirmed by a major speech early in his tenure, declaring that the United States has both the responsibility as a global citizen, and an opportunity as a global leader, to contribute to improved health around the world. The U.S. government should act in the global interest, recognizing that long-term diplomatic, economic, and security benefits for the United States will follow.

If health is to hold a more prominent position in U.S. foreign policy, the U.S. government will need to increase coordination among the multiple agencies and departments engaged in global health. A 1997 Institute of Medicine report, America’s Vital Interest in Global Health, called for the establishment of a government Interagency Task Force on Global Health, led by the U.S. Department of Health and Human Services. The committee supports this recommendation, but calls for the interagency group to be located more centrally, in the White House. Locating the effort in the White House, potentially within the National Security Council (NSC) and reporting to the President through the NSC Advisor, would give it convening authority among sometimes competing agencies and the ability to make policy recommendations directly to the President.

Within the first year of his administration, the committee recommends that the President create a White House Interagency Committee on Global Health to lead, plan, prioritize, and coordinate the budgeting for major U.S. government global health programs and activities. The Interagency Committee—consisting of heads of major U.S. departments and agencies involved in global health activities—should play the crucial role of ensuring that the U.S. government has a coherent strategy for ongoing investments in global health, and also that health is taken into account when setting U.S. foreign policy in other areas, such as trade, environment, and security.

The committee also calls on the President to designate a senior official at the White House (Executive Office of the President, potentially within the NSC) at the level of Deputy Assistant to the President for Global Health to chair the Interagency Committee. The Deputy for Global Health should serve as the primary adviser at the White House on global health, attend NSC meetings which deal in any way with global health issues, and work with the National Security Advisor, the Director of Management and Budget, and the President’s Science Advisor in carrying out his or her responsibilities.

The committee also asks that by the end of the administration’s term, the President and Congress double annual U.S. commitments to global health between 2008 ($7.5 billion) and 2012 ($15 billion). The committee recommends that the U.S. government commit to $13 billion for the health-related Millennium Development Goals (MDGs) and an additional $2 billion to address the challenges of noncommunicable diseases and injuries.

Meeting the globally recognized MDGs, adopted by the Member States of the United Nations (UN) in 2000, would require advanced economies to devote 0.54 percent of their gross national income (GNI) to overseas development assistance. Accordingly, the committee estimates that the U.S. contribution to the health-related MDGs (Goal 4: Reduce child mortality, Goal 5: Improve maternal health, and Goal 6: Combat HIV/AIDS, malaria and other diseases) would be $13 billion per year by 2012.

The allocation of this $13 billion per year should be balanced across the portfolio of global health spending to reflect the breadth of the health-related MDGs. The U.S. government should fulfill its implied commitments under the President’s Emergency Plan for AIDS Relief (PEPFAR) reauthorization to global AIDS programs ($7.8 billion per year), malaria ($1 billion per year), and tuberculosis ($800 million per year). The remaining $3.4 billion per year would double current levels of spending by the U.S. government for global programs in support of health systems strengthening, child and women’s health, nutrition, family planning and reproductive health, and neglected diseases of poverty, all of which have been severely under-resourced during the past decade.

Additional resources will be required to respond to the contemporary challenges of chronic and noncommunicable diseases and injuries, which are responsible for more than half of the deaths below age 70 in low- and middle-income countries, but are not captured in the health-related MDGs. Cost-effective strategies, such as tobacco control, have the promise of averting millions of premature deaths from noncommunicable diseases in low- and middle-income countries. The committee recommends $2 billion per year to expand the U.S. portfolio in support of these efforts, bringing the overall U.S. government commitment to global health to $15 billion by 2012.

Translating this commitment into sustained, significant, and measurable health outcomes in low- and middle-income countries requires a partnership between the United States and national governments; aid should therefore be allocated in support of technically and financially sound country-led health plans. Even disease- and intervention-specific programs should contribute to stronger health systems and a better trained, more productive health workforce. Congress and the administration should require that aid be accompanied by rigorous country- and program-level evaluations to measure the impact of global health investments in order to maximize their effectiveness.

America’s traditional strength in the global health field is its capacity to generate knowledge. The committee recommends that Congress continue to fund research in important areas—such as new interventions for the prevention and treatment of infectious diseases—but also allocate a portion of the funding levels recommended in this report to increase funds for three purposes: to study the basic mechanisms of diseases that disproportionately affect poor countries; to identify means to control noncommunicable diseases that are applicable in low-resource settings; and to conduct health systems research to improve the delivery of existing interventions.

While the U.S. government interacts with multiple UN agencies and other intergovernmental bodies, the committee believes that the United States has much to gain from supporting the World Health Organization (WHO) as this body has the unique mandate of setting evidence-based norms on technical and policy matters to improve global health. Many aspects of the WHO’s current structure and function, though, hinder its effectiveness. The United States, along with the international community, should support the WHO, but also request a rigorous external review of the organization to develop future-oriented recommendations.

The American public has strongly supported commitments to global health in the past. Repeated polls have shown that health now ranks among Americans’ top priorities for development assistance—not merely to protect U.S. interests, but also as a way of promoting human development worldwide. Working with partners around the world and building on previous commitments, the United States has the responsibility and chance to save and improve the lives of millions; this is an opportunity that the committee hopes the United States will seize.

Copyright © 2009, National Academy of Sciences.
Bookshelf ID: NBK32613

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