Four Pillars Part 4: U.S. Global Health Leadership
Last year, I wrote about the four pillars of GHC’s work. I wrote about global health security, multilateral support, and health equity but never got around to the 4th pillar: U.S. global health leadership.
This month has been especially busy for global health and for showcasing the impact of what a difference U.S. global health leadership can make in the world. The U.S. has a long history of global health leadership. It has played a critical role in fighting diseases, developing effective programs, and building health systems worldwide. In March, we celebrated the 20th anniversary of the President’s Emergency Plan for AIDS Relief (PEPFAR). We marked the 10th anniversary of the Child Survival Call to Action- two visionary actions and investments from the US that have saved and improved millions of lives worldwide. Since its launch in 200, PEPFAR has saved an estimated 25 million lives and improved health outcomes—including maternal and child health—in more than 50 countries. And in the past ten years, USAID has helped save the lives of more than 9.3 million children and 340,000 women.
These are amazing achievements, and they deserve to be celebrated. But we cannot let celebration equal complacency, as the need for US leadership is far from over. The past several years of COVID-19, conflicts, and the detrimental effects of climate change have severely eroded our gains in global health. As Dr. Atul Gawande reminded us, Assistant Administrator for Global Health at USAID, at our recent Hill reception to mark the anniversary of the Child Survival Call to Action, the global human lifespan has declined for the first time since World War II. We still have 300,000 women and girls dying from pregnancy and childbirth-related complications each year- the vast majority of these deaths happening in Low and middle-income countries. As for children, malnutrition is the underlying cause of at least half of child deaths. Likewise, HIV, TB, and Malaria testing, prevention, and treatment sharply declined during COVID-19.
We are at a critical point if we want to continue to make significant progress in global health and building on the legacy of U.S. leadership is important now more than ever. As the largest donor to global health programs, the U.S. is crucial to ushering in a new era of investments, transforming the current system, and ensuring a safer, healthier future. We had hoped to see this vision and commitment reflected in the President’s FY24 Budget Request released earlier this month. Unfortunately, that budget request fell short and did not go far enough to meet the pressing needs in global health. This is disappointing because investing in health yields dividends far beyond the health sector. When people are healthy, communities are healthier, and economies can prosper. Investments in health- particularly for women and children- are among the best buys for the United States, supporting the well-being and economic security of generations.
The U.S. has a unique opportunity to elevate its global health leadership. Effectively addressing today’s challenges and preparing for new global health threats requires well-resourced, operationally sound institutions that can develop and implement effective, equitable programs.
However, In order to do that, however, several challenges need to be addressed:
- Funding. U.S. investments in global health, which have remained stagnant over the last decade, must be scaled up. The way funding is delivered must also be reimagined in order to be fit for purpose. Static investment, spread thinly across multiple agencies and organizations will not adequately address global health challenges.
- Coordination. U.S. health and development programs must take a whole-of-government approach. Traditionally, U.S. health and development programs are spread across more than 20 agencies, operating separately, each with distinct goals, funding streams, expertise, and fragmented congressional authority and oversight.
- Thinking more broadly. Vertical global health funding and programming must evolve to become more integrated and health systems strengthening-focused. The COVID-19 pandemic has shown us that we can’t divert all resources to address one disease only to backslide in others. The current state also undermines commitments to health system strengthening and does not reflect countries’ needs and priorities.
Over the coming months – and with our recently released 2023 Global Health Briefing Book in hand- GHC will be advocating for U.S. budget and policy leadership that does, in fact, meet the moment. We hope you will join us!