Stop Fighting Viruses, Start Treating People

With the debate over health-care reform in the United States stretching into its second year, Americans are focusing intently on domestic rather than global health issues. But, since taking office, President Barack Obama has introduced a new vision of how to help other countries combat disease and health-care inequality.

On May 5, 2009, Obama unveiled a new global health initiative, dramatically broadening the scope, mission, and size of U.S. health-care initiatives abroad. The president asked Congress to increase global health funding nearly $500 million, to $8.6 billion per year. He also requested a six-year supplemental for the deadliest diseases and special programs, increased funds for U.S. Agency for International Development (USAID) programs, and the expansion of PEPFAR, the President’s Emergency Plan for AIDS Relief. In 2009, Washington upped its contributions to multilateral health institutions, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well. And in December, Obama committed to making the largest single contribution for global health ever: $1.05 billion to the Global Fund.

Many in the global health community are concerned that these budgetary requests are still not enough. The Global Fund remains short on cash. And Obama’s requests and allotments fall short of the amounts promised in his campaign: $1 billion in annual aid for PEPFAR and $50 billion in total aid by 2013. Still, given the magnitude of the recession and the cost of new health-care spending in the United States, it is an accomplishment.

But what is Obama’s new health-care philosophy? And does it really promise to work better?  

Previously, Washington focused its funding on individual diseases, such as AIDS. The Obama administration, in contrast, seeks to tackle broad-category initiatives, most importantly, child and maternal health, family planning, and often-neglected tropical diseases. He also seeks to help other countries strengthen their health-care systems and infrastructure. A May release stated: "We cannot simply confront individual preventable illnesses in isolation. The world is interconnected, and that demands an integrated approach to global health."

Obama’s top diplomat, Secretary of State Hillary Clinton, demonstrated this new focus — on populations like women and children, rather than on single viruses — when speaking on the 15th anniversary of the International Conference on Population and Development. She noted that women are disproportionately affected by HIV and lack access to contraceptives and family planning, and she discussed the high rates of maternal mortality in many countries. She said PEPFAR — which, when founded in 2003 during former President George W. Bush’s administration, focused exclusively on AIDS — will now tackle related problems. Clinton noted that investing in women and children is among the "smartest" moves government can make — as investing in women and the young often helps reduce poverty and foster development, in turn improving health outcomes.

When it came to shaping his outlook toward health-care policy in the United States and abroad, Obama cites personal experience as his inspiration. He has cited his mother, Stanley Ann Dunham, as crucial to his understanding of the importance of health. In a speech at the Clinton Global Initiative last September, Obama described her work as an anthropologist in rural Indonesia, providing microcredit to women and villagers via the Ford Foundation and USAID.

But the new approach also reflects the work of researchers and doctors. In 2008, before the announcement of the initiative, doctors Colleen Denny and Ezekiel Emanuel, a White House health-care advisor, wrote an article arguing, "In focusing so heavily on HIV/AIDS treatments, the United States misses huge opportunities. By extending funds to simple but more deadly diseases, such as respiratory and diarrheal illnesses, the U.S. government could save more lives — especially young lives — at substantially lower cost." The article advocated a more broad-based approach to reducing mortality in low-income countries.

No less an authority than the World Health Organization concurs. In a 2009 report on women’s health, the WHO argues for "Broader strategies, such as poverty reduction, increased access to literacy, training and education, and increased opportunities for women to participate in economic activities, will also contribute to making sustainable progress in women’s health. Experience suggests that this requires a gender equal­ity and rights-based approach that harnesses the energy of civil society and recognizes the need for political engagement."

Additionally, the president’s initiative reflects the need to help rejuvenate the United States’ reputation in and partnerships with other countries. Working closely with other nations to combat disease helps transform other countries’ perception of the United States — integral to what Clinton has called U.S. "smart power."

While Obama certainly faces challenges in implementing his new global health vision, such as the economy and a fragmented bureaucracy, the administration has introduced initiatives that are much needed and long overdue. The next — and hardest — step is putting them into action.