The Business Case for Global Health in the Trump Administration

The following post was originally published at The Hill on January 5, 2017.

As President-elect Trump considers submitting a fiscal year 2018 budget request to Congress, scores of government funding issues will be intensely debated. America’s investment in global health is one area that should stand outside the political fray.

There are few issues that have won such consistent bipartisan support or, at a fraction of 1 percent of the federal budget, have produced such concrete economic, security and humanitarian gains for the country and the world.

Global health programming has expanded significantly over the last two decades, with the U.S. playing a leadership role. As Vice President-elect Pence said during the 2008 reauthorization of the U.S. global AIDS program:

“The United States has a moral obligation to lead the world in confronting the pandemic of HIV/AIDS.”

The impact of these investments has been startling. Since 1990, the number of annual child deaths has been cut by more than one half. More than 18.2 million people are now receiving life-saving AIDS treatment. The malaria death rate among children under age 5 is down 69 percent since 2000. Efforts to diagnose and treat tuberculosis (TB), a disease that has plagued humanity for centuries, have saved millions of lives in the same period.

This is an impressive track record, but the job is far from done. In fact, continued and increased investment in global health provides an important opportunity to build on bipartisan support, end major epidemics, and realize enormous humanitarian and economic benefits. There are four points to consider as the new President and Congress begin their work.

First, it is important to maintain the bipartisan support for global health established over eight Congresses and two presidential administrations.

Republican and Democratic policymakers agree that, together, investments in public-private partnerships like the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and bilateral programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI) are among our greatest foreign policy successes.

These programs reinforce each other’s work across the globe, achieving steadily increasing transparency and financial efficiency, scaling up effective programs and complementing each other’s efforts to ensure that U.S. resources are deployed for maximum impact.

Second, while the primary goal of global health programs is to save lives, investing in ending epidemics has considerable economic return on investment.

Malaria-free countries have five times greater economic growth than countries with malaria. Every dollar spent on TB generates $30 through improved health and increased productivity.

Just maintaining the current U.S. commitment to the Global Fund alone could support at least $96.7 billion in economic gains. U.S. investment in the Global Fund leverages resources — requiring a two-thirds match from other donors, and incentivizing countries receiving grants to increase ownership of their disease programs over time.

When people are healthy, they have more capacity to purchase American goods and services.

The 20 million people whose lives have been saved through Global Fund-supported programs live mainly in developing countries which are increasingly critical to the U.S. economy. U.S. exports to developing countries have grown by more than 400 percent over the last 20 years. Today, they total more than $600 billion annually and are greater than U.S. exports to China, Europe and Japan combined.

Third, we have been reminded repeatedly by outbreaks such as Zika and Ebola that disease knows no borders. Containment, prevention and evidence-based treatment of epidemics are national security matters that we cannot afford to underestimate or underfund. U.S. investments in disease programs support strengthened health infrastructure to help prevent future deadly threats from spreading.

Finally, investing in global health is an essential part of U.S. diplomacy and national security.

A 2015 Bipartisan Policy Center case study found that American efforts to support global health also have key secondary effects on state stability, public opinion of the U.S., and socio-economic development.

By helping to build more stable and capable partners, global health efforts in turn boost U.S. national security objectives. But our efforts against deadly epidemics remain underfunded. U.S. investment in global health represents just 0.25 percent of the federal budget, and has remained flat for four years.

Amid the many controversies today, global health investment stands alone. It saves the lives of millions of men, women and children every year, and is also one of the best strategic investments we can make in American security and prosperity.