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Obama’s Global Health Plan’s Missing the Money

Yesterday President Obama announced a new "Global Health Initiative." Gayle Smith from the National Security Council and Dr. Ezekiel J. Emanuel, the chief of staff's brother, summoned a number of my colleagues to the Old Executive Office building early yesterday to announce this new initiative with great excitement.

Should we all be excited?

The good news: Many of us have been waiting to see just what President Obama and his team would do with global health--the area of our foreign aid that has arguably seen the biggest and clearest results. It is good to see the Administration taking global AIDS seriously since it continues to be the leading cause of death in Africa--killing millions of mothers, brothers, and children. The administration also this week announced the appointment of Dr. Eric Goosby to be Global AIDS Coordinator and Ambassador, a very good sign that Secretary of State Clinton is emphasizing this post and looking for leaders close to her. Meanwhile this Administration is finally paying attention to programs like family planning, which the right wing so vociferously undermined in the last eight years. This is great news for women, youth, and people around the world.

The bad news: Looking at this announcement, though, I'm very worried that the administration is falling into a very scary trap of pitting funding for HIV/AIDS against other funding. The reason why AIDS, TB, and malaria programs have been prioritized is that they're the major infectious killers in Africa--if we can get ahead of them, we can save lives now and prevent new infections for the future. What we've seen is that these programs are also really good building blocks for other health services--like the family planning programs Republicans were so against in the last administration.

What would make a lot of sense--and what's implied by the President's announcement--would be to increase support to other areas like reproductive health and child and maternal health. These essential areas could build off the success of AIDS programs and bolster the lives of people living in poverty.

Doing so, though, will require increased investments... and that leads us to the worse news:

The worse news: This big new announcement does not actually include an increase in funding for global health and, in fact, it suggests a decrease in planned AIDS funding. As this chart from RESULTS shows, the administration is trying to get away with adding new priorities without new money by promising a six-year project instead of five and moving money around. If the very AIDS, TB, and malaria programs that Obama, Clinton, and Biden co-sponsored are fully funded (for six instead of five years) and all other programs got no boost then we would expect a total of $64 billion--$1 billion more than Obama's "new" initiative.

This is not worthy of Obama--who has promised to get rid of Bush's slights of hand in the budget process that hide the true costs of programs.

Meanwhile, while the announcement of a $63 billion initiative sounds big--this year sees essentially flat funding on almost all global health accounts (save malaria). Not an auspicious start.

A number of activists and advocacy groups have already come out with worried statements--and tomorrow when the budget comes out there is likely to be very bad news. The Global Fund to Fight AIDS, TB, and Malaria--whose board is meeting now in Geneva--is going to face the first crisis. We've all been hoping the Obama administration would reverse Bush's position of undermining and underfunding the Global Fund (because it wasn't US controlled and supports scary programs like needle exchange and sex-worker programs). The Fund faces a $4-$5 billion gap between life-saving programs planned for approval in the next year or so and what donors have pledged and will face a major crisis without renewed support from the US.

Global health programs are massively smart investments: healthy people build healthy economies and strong communities. It's some of the best spending to lift people out of poverty and stabilize societies in crisis (Afghanistan and Pakistan have two of the worst TB epidemics around which sucks lives and jobs!).

But Obama does not deserve credit for taking from one planned program--that we know has been successful and saved millions of lives already--and put it into another. Doing so only changes who will die from what cause. People around the world deserve better.