Kaiser Family Foundation Report Highlights U.S. Engagement in Global Health: A NewPublicHealth Q&A with Josh Michaud

Mar 6, 2013, 11:06 AM

The increasing globalization of the world circles back to health as well. That’s a key tenet in a new report, The U.S. Government Engagement in Global Health: A Primer, from the Kaiser Family Foundation. The report describes the U.S. agencies and programs involved in global health and the federal budget supporting these efforts. Following the release of the primer, NewPublicHealth spoke with Josh Michaud, a Principal Policy Analyst at the Kaiser Family Foundation focused on the U.S. government’s role in global health.

NewPublicHealth: Why did the Kaiser Family Foundation create the global health primer?

Josh Michaud: The Kaiser Family Foundation has produced primers for other health issues on which we work, including Medicare and Medicaid. We felt that global health was an area in which we’ve built up some good data and analysis and we wanted to put it together in a format accessible to as wide an audience as possible. There has also been a growing interest at universities among young people in global issues, in particular global health issues.

Another critical reason to produce the primer is to set out a baseline for discussions, whether it is for different sides of a policy debate, student’s writing papers or people just getting started in the field. We don’t come at this with a particular recommendation, it really is meant to be a portrait of all the different parts of the U.S. government that are involved in global health. In the final section of the primer, we pulled together some policy issues that are of particular importance right now.

NPH: What trends or changes does the report note?

Michaud: The major trends have been increased levels of funding and an engagement by many different parts of the U.S. government in global health. The budget has increased significantly. In fiscal year 2001 the global health budget was about $1.5 billion. In fiscal year 2012 it was $8.8 billion. And while the United States is the most important and largest donor to global health, contributions from other governments have also grown significantly.

Much of the increased funding has been driven by increases for HIV/AIDS programs worldwide, and in particular, the PEPFAR program that the United States funds, as well as U.S. funding in support of Malaria. Earlier in the decade, there were significant increases year by year. That’s now leveled off and we don’t know what will happen in the future.

NPH: Do we see any benefits from this funding coming back to the United States?

Michaud: Yes, we do. There’s been increasing interest in a return on investment that would have a benefit to domestic healthcare for the health problems we’re tackling globally. Some examples of that would include lessons learned from the PEPFAR program; some of the staff that have been working overseas in Africa and other locations have come back and taken positions working on the domestic HIV problem which is very important. The United States has had a stagnant rate of HIV, and it remains stubbornly resistant to efforts. There’s a sense that there are lessons that could be applied from what are seen as highly successful programs in many African countries to some of the areas in the United States which are most heavily impacted by HIV. Washington, D.C., for example, has one of the highest HIV/AIDS prevalence rates in the country. Higher, in fact, than many African countries.

A key idea learned overseas that has been successfully translated locally is the importance of having a national plan. This was emphasized overseas by PEPFAR and other donors and partners to have a plan to tackle the HIV epidemic that is tailored to the country specifics. The United States didn’t have a national plan for responding to HIV/AIDS until 2010, and a lot of the support leading up to that was from the lessons learned and the impact that was seen from having a strategic plan in other countries.

There are other examples such as program integration learned overseas in low resource environments or otherwise difficult environments. More broadly, outside of the HIV/AIDS arena, one of the important justifications given by many government officials—including the Secretary of Health and Human Services, the Secretary of State and the White House in national security strategy documents and other national strategy documents—is that investments in overseas health programs also defend U.S. citizens. If you build up the surveillance systems and the ability to respond to epidemics and pandemics overseas, there’s likely to be a lesser impact here in the United States. That’s crystalized, for example, in the Department of Health and Human Services’ global health strategic plan released last year.

NPH: What has the interest level been for the primer?

Michaud: It has generated a significant amount of interest including, from members of Congress and Congressional staff. We hope to make it a living document, rather than just a single annual report. It will be more of a resource which will be continually updated.


>> Bonus Links:

  • Read a NewPublicHealth post on the dedication of two new public health buildings in Haiti by the CDC Foundation with other foundation and corporate partners.
  • The Global Health Corps (GHC) pairs young professionals from diverse backgrounds, who possess a variety of skill sets, with health organizations for a yearlong fellowship to serve poor communities in 12 countries, including the United States. The fellows work with organizations such as Partners in Health, which helps provide medical care to the poor, and The Access Project, which supports health systems in developing countries. In Newark, New Jersey, where 15 percent of African American mothers give birth prematurely, resulting in serious health risks for the newborns and their mothers, fellows share health information with expectant mothers to help reduce those numbers. Barbara Bush, daughter of former president George W. Bush, is the CEO and co-founder of the program. Since GHC began four years ago, most of the fellows who have completed the program have continued to work in public health in the United States and abroad.

This commentary originally appeared on the RWJF New Public Health blog.