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US budget negotiations threaten global health spending

Millions of the world’s poorest people, especially children, could feel the pain of America’s belt-tightening.

20130423 paul ryan budget cutsEnlarge
Committee chairman U.S. Rep. Paul Ryan (R-WI) (L) speaks as ranking member Rep. Chris Van Hollen (D-MD) (R) listens during a hearing before the House Budget Committee April 16, 2013 on Capitol Hill in Washington, DC. (Alex Wong/Getty Images)

EDITOR’S NOTE: This article is part of a GlobalPost Special Report titled “The Seven Million,” about the many challenges faced worldwide in an effort to reduce child mortality. The project is supported through a partnership with the Henry J. Kaiser Family Foundation as part of its U.S. Global Health Policy program. In the coming months, GlobalPost will examine this issue around the world. In this first of a continuing series of articles, Global Health Correspondent Sam Loewenberg and Global Health Reporting Fellow Marissa Miley reported from Washington, DC and Cambridge, Mass.


WASHINGTON – Many in Congress compare the budget process to balancing one’s checkbook at home. Now, as Congress braces for an historic struggle over the Obama administration’s proposed budget for fiscal year 2014, one of the biggest potential impacts of sought-after cuts will not be at home, but abroad, as millions of the world’s poorest people, especially children, could feel the pain of America’s belt-tightening.

The unfolding prelude to the budget fight, illustrated by a trove of correspondence to Congress reviewed by GlobalPost, illustrates the power that well organized lobbying has on influencing public policy. While the administration has pledged to focus its global health resources on the estimated seven million children who die every year, mostly from preventable causes, those efforts could be undercut by lawmakers eager to reduce government spending.

In testimony scheduled for Wednesday and Thursday, U.S. Agency for International Development (USAID) Administrator Rajiv Shah will make the case for the Obama administration’s global health budget. In its spending proposal, the administration has largely protected existing programs and has even increased budgets in some areas, including in maternal and child health, malaria, and vaccines, as well as funding for multilateral health programs.

The austerity budget put out by the Republican-controlled House of Representatives could significantly impact some of these programs that affect children, according to aid groups. The House plan, sponsored by Budget Committee Chairman Paul Ryan (R-Wisc.), would cut the base international affairs budget by 5.6 percent from levels already reduced from sequestration, according to the US Global Leadership Coalition, a foreign aid advocacy organization. Overall, the organization estimates this allocation is 25 percent less than what the base international affairs budget was four years ago.

“Given our debt crisis, the bar for justifying foreign aid is higher than ever. Wasteful spending on ineffective and unsustainable programs will not be tolerated,” said House Foreign Affairs Committee Chairman Ed Royce (R-Calif.), in an opening salvo on the committee’s website in anticipation of Thursday’s testimony by Shah.

Newly appointed Secretary of State John Kerry, in testimony before Congress last week, defended strong foreign assistance funding, declaring, “development is not charity. It’s an investment in a strong America and a free world.”

Even if the administration succeeds in preserving the current level of funding, public health experts warn that the global health budget is far too low to meet current needs. Of the 75 countries that account for nearly all of the world’s preventable child deaths, less than one-third are on track to meet the Millennium Development Goal on child mortality, according to the aid monitoring group Countdown to 2015. Thirteen countries have made little or no progress.

Prioritizing Health

A review of the correspondence to Congress obtained by GlobalPost provides insight into the behind the scenes battles that will determine how the United States will continue to support global health. Some of the letters are from members of Congress themselves, as they try to convince their colleagues to maintain or reform current programs. Tellingly, the letter with by far the most signatures — more than 100 — is for maintaining funding for the global HIV/AIDS program, known as PEPFAR (the President’s Emergency Plan for AIDS Relief). The program, which was started under the George W. Bush administration, has long had broad bipartisan support in Congress. In contrast with nearly every other disease that affects people in developing countries, HIV/AIDS has also had a profound impact on the US population, and thus resonates with voter-conscious lawmakers.

HIV/AIDS receives about two-thirds of the total US global health budget. The rest is divided between all other diseases, nutrition, and integrated health programs. It is these funds that are most at risk of getting cut in the ongoing budget negotiations. HIV/AIDS, despite its massive