Building on America’s Leadership in Global Health

This essay is part of a new series of policy recommendations from the George W. Bush Institute. To read more, visit What’s Next: Policy Recommendations from the Bush Institute.
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The world has made significant progress in global health in the last several decades, and the United States can take credit for much of the success. Examples of achievements abound.

While an HIV infection can be a death sentence without access to antiretroviral treatment, the number of people accessing treatment has more than doubled in the past five years. The number has increased to 18.2 million as of June 2016, and AIDS-related deaths have fallen by 45% since the peak in 2005.

What’s more, the global under-five mortality rate declined by more than half between 1990 and 2015. The rate dropped from 90 to 43 deaths per 1,000 live births, and the maternal mortality ratio declined 45% in the same period. Global incidence of polio has decreased by 99% since 1988, and in 2016, fewer children (35) were paralyzed due to wild poliovirus than in any preceding year in history.

Each of these celebrated victories in global health is the result of coordinated, concerted efforts by leaders and funders around the world. Countries with high burdens of disease but little means to address health challenges have worked in partnership with donors that have extended funds and expertise to solve problems of scale and access. The United States’ leadership has been absolutely critical in making gains against ill health, and has galvanized and leveraged support from other sources as well. 

Among the donors to global health programs, the United States provides the largest level of support. Our assistance comprised 33.5% of the $22.8 billion in health overseas development assistance for global health in 2013.

But still, Americans have an appetite to do more. A clear majority believe that U.S. foreign assistance – including for global health – should be higher than the current one percent of the U.S. government’s $4 trillion budget. Global health programs are cost-effective investments, helping achieve U.S. goals abroad at lower cost (in lives and dollars) than using the military.  

Global health programs are important for many reasons. Measures of infections prevented and treated, deaths averted, and years of disability avoided demonstrate the value of the United States’ commitment. Yet the benefits of global health programs extend far beyond the good health of individuals:

• They protect Americans. Building strong health systems and epidemic surveillance systems protects everyone from the threat of epidemics such as Ebola.
• They build strong communities and countries. Healthy people are more likely to lead productive lives, and to stabilize and build their communities. Unhealthy people can destabilize economies, communities, and even countries.
• They nurture the next generation. Healthy children are able to learn more in school, and grow to be productive members of society.
• They build friendly relations. With small investments in health, the United States builds friends around the world, in countries where it is needed most. As an example, U.S. partnerships in health have helped to prevent the expansion of al Qaeda and al Shabab throughout Africa.

For all these reasons, the new administration should stay the course as a strong leader in global health. This is a bipartisan effort, as both sides of the aisle have agreed on the importance of health care investments through successive Congresses and administrations, reflecting the priorities of the American people.

As the new administration and new Congress evaluate their contributions to global health, we offer the following recommendations:

Continue to support PEPFAR and the Global Fund for HIV and AIDS prevention and treatment

The U.S. investment in HIV and AIDS is working. The epidemic is coming under control in key African countries, according to PEPFAR – the U.S. government’s HIV/AIDS program. Our investments are joined by those of other bilateral and multilateral partners, and increasingly shared by the countries where we work. We should continue to support PEPFAR, UNAIDS, and our country partners to prevent new infections and treat existing ones.

Integrate women’s health care by focusing on cervical and breast cancer, HIV and reproductive health – together

Women living with HIV are five times more likely to develop cervical cancer. President George W. Bush and Mrs. Laura Bush founded Pink Ribbon Red Ribbon to ensure that women put on lifesaving AIDS treatment don’t needlessly die of cancer. Cervical cancer is a completely preventable disease – preventable with access to the Human Papillomavirus (HPV) vaccine and by cost-effective “screen and treat” programs. These programs can easily be integrated into HIV testing and reproductive health programs, so that women are screened for cervical and breast cancer when they come to the health center for other health services – just like in the United States.

Focus on teens

Africa is facing a youth bulge; we need to prevent disease in these teenagers. Two of the best ways to do this are to provide vaccinations against HPV, the disease that causes cervical cancer, and ensure they do not contract HIV, with special HIV prevention programs to reach youth, and programs to reduce teenage girls’ exposure to sexual violence, which increases the rate of HIV transmission.

Prepare for new and emerging epidemics by investing in health systems

As we learned from Ebola and bird flu, the world is at risk of major epidemics. We have been lucky so far, with most epidemics remaining fairly localized, but the next epidemic could be worse. We need to invest in disease surveillance systems, strong health systems that can respond quickly at all levels to epidemics, and research and development capability that can quickly develop vaccines and medicines.

Prioritize the growing burden of non-communicable diseases

Non-communicable diseases (NCDs) are a fast-growing problem in low- and middle-income countries, and they affect people at younger ages than in high-income countries. Cancer, cardiovascular diseases, diabetes, and other NCDs are an increasing drain on scarce health care resources. They undermine the capacity of health systems to respond to other health challenges.

For a relatively modest cost, the United States could support countries with high NCD burdens to tackle risk factors and manage their NCD epidemics. This would protect our investment in addressing infectious diseases and outbreaks, and create more favorable environments for U.S. entities to pursue international trade and business opportunities. NCDs have not been a priority in the past for the United States and many other donors, so there is tremendous potential for a committed champion to make a big impact.

Increase commitments on global health innovation and access

Research to better understand human health and disease, and to create new tools and processes to support health in low-resource settings, is critical for ongoing global health progress. The research efforts of the U.S. National Institutes of Health, the U.S. Agency for International Development, and the U.S. Centers for Disease Control and Prevention have contributed significantly to the achievement of global health goals to date, and those efforts deserve greater investment.

The good news is that the U.S. doesn’t have to do this alone. We can work closely with our bilateral and multilateral partners. And the private sector can help. Pink Ribbon Red Ribbon was founded by the George W. Bush Institute, PEPFAR, Susan G. Komen and UNAIDS, and has grown to include over 30 private sector, non-profit, and international partners. Working together, we make more of a difference in the fight against cervical and breast cancer.

Celina Schocken is CEO of Pink Ribbon Red Ribbon, an organization affiliated with the George W. Bush Institute.