I wanted to bring these issues to the Kossack community, since I haven't seen any coverage here about how US global health funding is changing under the Obama Administration.
BTW, this is timely because there have been a lot of recent news articles about Obama's proposed Global Health Initiative, since the budget proposal was released on February 1st.
First off, here's a light-hearted 90 second video made by summer interns at Physicians for Human Rights.
This video basically sums up what's happening. As people likely know, the US has provided lots of money to global HIV/AIDS programs.
There have been productive debates about the success of our HIV/AIDS programs (and I think these types of debate are critically important. For example, we know that abstinence-only-until-marriage programs are counterproductive for HIV prevention, and we also know that it is important to provide funding to syringe exchange programs for injection drug users, as the US can now begin doing.).
In addition, though, some people have decided to criticize the very idea of specifically funding global HIV/AIDS programs. Of course, other people have then defended HIV/AIDS funding.
In response to the situation, during mid-2009, global civil society organizations organized an international Declaration of Solidarity for a Unified Movement for the Right to Health, which says many things including that there is sufficient money in the world to meet the universal right to health*, and that money should not be taken from one cause (i.e. HIV/AIDS) to pay for another health issue.
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Now, the important thing here is that some global health activists are upset that the Obama Administration is not allocating the money needed in order to meet the HIV/AIDS funding targets in an important US global health bill, which Obama co-sponsored in 2008 [for example: a, b, c, d]
Other people have argued, though, that the increases Obama has requested for global health are commendable, considering the state of the economy. While I tend to also agree with this latter argument, I want to point out that the Obama Administration has also been influenced by the above mentioned debates... that is to say, that people who have the Administration's ear are advocating to hold HIV/AIDS spending where it is, and instead increase funds for other programs. (I think that that would be unacceptable, and I strongly believe that we can and should increase our global health spending, including the funding that goes for HIV/AIDS.)
According to a NYT article on December 8,
AIDS advocates complained bitterly that they had been betrayed and that the Bush administration’s best legacy was being gutted — and they blame a doctor and budget adviser who is also the brother of the White House chief of staff
Rahm Emanuel's brother, Ezekiel, has argued in the Journal of the American Medical Association [restricted access], among other places, in favor of maintaining "PEPFAR [global AIDS] programs at their current high level while using the newly committed funding to launch a more cost-effective program targeting basic health problems."
According to a recent press release by the Treatment Action Campaign of South Africa, this type of argument fails to consider "the massive negative impact of the HIV epidemic on life-expectancy and the economic potential of young adults in Sub-Saharan Africa".
Later, JAMA published a letter critical of Emanuel and published his response [summaries of letters].
Here's some of the criticism:
the answer is not to scale back PEPFAR, which has a much broader impact than these comments acknowledge, but to greatly increase the overall amount of U.S. foreign assistance so that all effective programs, including essential maternal and child health programs, are appropriately funded
The reason that Zeke Emanuel has been accused of wanting to scale-back (or gut) PEPFAR, when IMHO he argues to "simply" maintain current funding, is because HIV/AIDS, malaria and TB funding is supposed to dramatically increase, but he wants to maintain current levels, in effect cutting the promised funding increases.
Anyways, here's Emanuel's response to the critical letter:
three "principles should determine which programs receive priority" -- the first being which programs "save the most lives," the second being which programs "save children's lives," and the third being which programs "achieve these goals in a cost-effective manner.
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UPDATE
since this diary should not have been focused on one person, i think it is important to point out that several people such as Daniel Halperin (ex) and Roger England (ex) have made similar arguments as Emanuel.
And therefore, I changed the title from "US global AIDS policy (and Zeke Emanuel)"
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So, basically, I wanted to bring some more attention to these debates and to say the following:
* RE: the declaration's claim that there can be sufficient money for health
There are sufficient resources in the world to meet all internationally agreed upon health goals, but insufficient resources have been committed to address health and its social determinants. The necessary resources must be provided in full. We reject the notion that increased funding of one area of health must come at the expense of another.
[snip]
countries in the global South and North must live up to their commitments, including UN covenants and the Abuja Declaration commitment of African Union countries to spend at least 15% of their budgets (excluding aid) on the health sector and the commitment of wealthy nations to spend at least 0.7% of their gross national income on Official Development Assistance, with an adequate portion directed towards health.
In the U.S., discussion about the level of official development assistance (ODA) has been on the back-burner for far too long. The U.S. allocates 00.19% of its gross national income to ODA (that's 19 cents out of every $100), the lowest relative level amongst rich countries, AND that includes our development aid to Iraq and Afghanistan (source)! The United Kingdom, for example, gives 00.43%, and along with the original members of the European Union, the UK has committed to reaching the 00.7% goal by 2015 or before. But the U.S. currently has no such goal (...that is if you ignore the 2002 Monterrey Consensus and multiple UN General Assembly resolutions since 1970)...
Of the 22 member countries on the OECD Development Assistance Committee (the major donors and richest countries in the world), only 5 countries have not setup a timetable to reach this 00.7% goal: Australia, Canada, Japan, Switzerland and the United States.
FURTHER READING:
NYT. As Donors Focus on AIDS, Child Illnesses Languish. 10/29/2009.
Letter to Obama on Global Health and AIDS from Medical School/Public Health Deans. 11/18/2009.
TIME. Is Obama Scaling Back Bush's AIDS Initiative? 12/2/2009.
NYT. Obama Is Criticized on AIDS Program. 12/8/2009.
Foreign Policy. Stop Fighting Viruses, Start Treating People: The Obama administration's broad vision of global health. 1/27/2010.
WSJ. War on AIDS Hangs in Balance as U.S. Curbs Help for Africa. 1/30/2010.
US Dept of State. Implementation of the Global Health Initiative: Consultation Document. 2/1/2010. [20 page document available in PDF]
Sarah Boseley's blog. Guardian. Obama gets brickbats and plaudits over global health budget. 2/4/2010.