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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.

funding, is not one of the biggest causes of child mortality. Instead, the top causes are neo-natal deaths (largely due to lack of access to health care), malaria, pneumonia, and diarrhea. The problem, say child health advocates, is not that HIV/AIDS get too much, but that everything else gets too little.

While the Obama budget keeps funding for popular disease programs like AIDS (with relatively small cuts) and malaria (with a marginal increase), it proposes a 19 percent cut in the budget for tuberculosis (TB), a less well known, but still devastating disease that kills 1.4 million people per year. About 15 percent of TB cases are estimated to affect children. A letter from a bipartisan group of members of Congress to the House appropriations committee asked for funds to be reinstated, noting that one-in-four AIDS deaths are associated with TB co-infection. The members, echoing a broad consensus of public health experts, argue that insufficient funding can both undermine the gains made by PEPFAR as more people suffer TB, and that insufficient treatment programs have resulted in more than 300,000 cases per year of potentially devastating multidrug-resistant strains of the airborne disease.

"The lobby for tuberculosis is far weaker than HIV and, remarkably, malaria,"  said Roger Bate of the American Enterprise Institute, who himself has been one of the prime advocates for increasing support to the US malaria program. TB, he says, "is a real threat, it's expanding, and it deserves more money — and yet the budget is cut."

Advocacy groups recognize that the Obama administration has prioritized select global health efforts in its 2014 budget, such as international health initiatives like the Global Fund, which provides funding for HIV/AIDS, TB, and malaria, in line with USAID’s overall goal to maximize aid effectiveness, particularly in a tight fiscal climate. But they share concerns that potentially deeper cuts to the overall international affairs budget will compromise existing progress.

Rep. Gerry Connolly (D-VA) dismisses the claim that cutting foreign aid for health is good for cost savings: “It’s always their applause line. Of course you are talking than less than one percent  of the foreign budget – I mean it doesn’t balance anything.  And it’s cheap at the price, if you think about it as a powerful, diplomatic tool that allows us to do all kind of things without having to put troops on the ground,” said Connolly, himself a former congressional staffer who helped write the foreign aid legislation. “We lack a national consensus about what we should do. And that flows from our long time ambivalence about our role in the world.”

Food Fight

By far, the most controversial budget fight in global health is the Obama administration’s attempt at significantly reforming the way the US gives international food aid. The current system, which numerous reports have found to be highly wasteful, has the support of powerful vested interests in the shipping and agricultural industries, according to a review of advocacy documents.

This is not the first attempt at such reforms. The Bush administration tried to make a similar change, and was met with strident opposition from US agricultural and shipping interests, which have always successfully shot down past proposals, and had mobilized to oppose the current reform attempt even before it was officially announced.

Hunger is an underlying cause of child mortality in more than one-third of all child deaths, according to the WHO. While there have been strides made at a global level, in sub-Saharan Africa there has been barely been any progress on chronic childhood malnutrition, which only dropped from 43 percent in 1990 to 41 percent in 2010, according to the United Nations Development Programme.

The US is by far the world’s largest food donor, spending about $1.5 billion sending food to hungry people around the world. The changes, which would allow relief organizations to purchase more food locally rather than waiting it for it be shipped from the US, would save up to 50 percent of costs, reach 2 to 4 million more people, and save months of transport time, according to administration estimates. Advocates of reform point out that the US is the only major food donor in the world that still uses this system, and that other countries simply give cash to aid