BY JUDE ALAWA
In his 2018 budget, President Donald Trump called for a 24 percent reduction in spending on foreign assistance for global health. Though some of the greatest achievements in U.S. foreign policy history proceeded from global health investments- namely the President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. response to the 2014 Ebola outbreak- Trump has blatantly ignored humanitarian pleas for continued U.S. leadership in global health. He insists instead that these cuts “free up funding for critical priorities here at home and put America first.”
Trump is making a grave mistake: global health must be considered a matter of national security—instead of solely a humanitarian issue. This concern should compel Trump to reconsider his foreign policy agenda. Putting America first and protecting Americans at home requires foreign policy that prioritizes the strengthening of health systems across the world—something U.S. leadership has sought to do for the past two decades. Prioritizing global health protects Americans from the growing dangers of emerging infectious diseases, bolsters our economic productivity, and defends our security interests abroad.
Investments in global health have consistently captured bipartisan support, producing tangible economic, security, and humanitarian benefits across the globe. The United States has long been an advocate for global health, and in 2008, even Vice President Mike Pence demanded, “The United States has a moral obligation to lead the world in confronting the pandemic of HIV/AIDS.”
Largely due to United States involvement in global health, the past 15 years have witnessed the decline of global mortality rates from malaria and tuberculosis by 48 percent and 47 percent, respectively. The number of annual child deaths has been cut by more than one half, and more than 18.2 million people are now receiving life-saving antiretroviral treatment for HIV/AIDS through PEPFAR.
There is no question that the United States has increased standards of living across the world and decreased human suffering through its investments in global health. However, since these achievements do not convince Trump, maybe the following factors will.
The exponential growth of the global population, warming surface temperatures, urbanization, and the development of technology have made it easier to for people and diseases to travel across the world. Diseases don’t abide by borders. Scientists have tracked drug-resistant tuberculosis originating in eastern Europe, Asia, and Africa and their sudden appearance in patients in Western Europe and North America. Consider the devastation of the recent Ebola and Zika outbreaks that were due to a lack of international preparedness to effectively address pandemics.
Americans are at risk. Consistent and timely global support ensure that national health systems can effectively administer disease surveillance, medical treatment, and outbreak response, especially considering growing antimicrobial resistance. As they have in the past, infectious diseases will ravage Americans once they have crossed our borders and endanger U.S. citizens abroad, especially those in our armed forces. To truly fulfill his “America First” pledge, Trump must commit to global health investments to prevent deadly threats from spreading.
Although the primary goal of global health has traditionally been to alleviate human suffering, investing in health systems and epidemic prevention has substantial economic returns. For instance, if the U.S. simply maintains its current commitment to the Global Fund, it could spur at least $96.7 billion in global economic gains. In doing so, not only does the U.S. strengthen its allies and trading partners but also incentivizes them to take ownership of their disease programs and health system. In the past two decades, U.S. exports to developing countries have grown by more than 400 percent, and today, they total more than $600 billion annually. Population health status has consistently been linked to economic growth in every country. To bolster our economy, Trump should have a direct interest in strengthening health systems to combat disease.
Finally, and arguably most importantly, global health protects our security interests. In the same way that we bolster some regimes and tear down others, health has the power to improve or diminish governance and peacekeeping. Just as the HIV/AIDS epidemic in sub-Saharan Africa affected the most influential members of society, poor health can destroy leadership and discourage participation in civil society. With the positive socioeconomic benefits of good health, civilians are unlikely to become radicalized and will have less of a reason to evaluate the merits of violence. As Trump attempts to continue our battle against terror, he must consider the consequences of poor health—desperation, diminished economic productivity, and the erosion of social cohesion—as root causes of extremism that global health reform has the potential to address.
Following in the footsteps of pioneers of U.S. leadership in global health, Trump need not forget that U.S. investments in global health are not only some of the greatest humanitarian achievements of our time but also some of the best strategic ventures for American protection and prosperity.