Brexit Is a Global Health Risk

New waves of nationalism in the U.K., U.S., and Europe could threaten the financing of programs that have saved millions of lives around the world.

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When Theresa May takes the reins of power in London this week, it’s almost certain she’ll execute policies that are to David Cameron’s political right and will likely (and swiftly) invoke Article 50 of the Lisbon Treaty, thereby officially commencing Britain’s exit from the European Union — the so-called Brexit. Many British citizens who voted in favor of Brexit on June 23 were of the impression that the money sent to Brussels for EU programs would now remain in London, to be used on health care, roads, schools, and other public goods in England, Wales, Scotland, and Northern Ireland. The nationalism behind the Brexit vote has its roots in a long list of woes inside the United Kingdom and also reflects a larger trend seen all over the world toward retrenchment and a general push to move away from globalization.

This new sense of nationalism that fueled Brexit, or, to coin a mouthful of a term, anti-globalizationism, poses an existential threat to an array of initiatives that have saved millions of lives, mostly in poor or war-torn regions of the world.

While it is certainly true that financial empires and multinational corporations have benefited from globalization to the tune of trillions of dollars over the last 25 years, great humanitarian dreams have also been constructed in this new world, with lowered borders, more open trade, cyber-connectedness, and a sense of responsibility by wealthy nations toward middle- and lower-income states. Retreat behind traditional national borders, both physically and metaphorically, directly challenges the furtherance of all of the great 21st-century dreams.

It almost seems quaint today to recall the late 1990s and the establishment of the Millennium Development Goals — eight targets set by the U.N. for combating poverty and disease that engaged the wealthy world in the business of financing grand schemes, transferring billions of euros, pounds, dollars, yen, and other currencies to such entities as the Global Fund to Fight AIDS, Tuberculosis, and Malaria in order fulfill a collective dream of a world with less suffering, premature death, and inequality. During the Bill Clinton and Kofi Annan era of the 1990s, there was a collective imagining, from the halls of the U.N. General Assembly all the way down to grassroots community organizers the world over, of the significance of the dawn of a new millennium as a time for profound global change. Grand schemes, fueled by cash from wealthy countries and philanthropists, were conceived of as transformative, spawning an Age of Globalization that brought not only great wealth to multinational corporations and financial institutions, but also tackled grinding poverty and disease, climate change, and famine. Gatherings of the G-8 leaders during the first decade of this century consistently featured lists of commitments, with the richest countries vowing grand support of ventures to improve humanity’s lot in life.

But Brexit is the more extreme example of a political momentum that threatens to end that group imagining, that way of thinking, which pushed aside old Westphalian ideals of home improvement, strict boundaries, and loss of citizens’ respect in favor of institutions and dreams of globalism.

Concerns and howls are rising across the globe over the future of climate change negotiations and the carbon dioxide reductions agreed upon at the U.N. climate conference last year. The World Food Program, OCHA (the U.N. office for humanitarian affairs), and UNHCR (the U.N. refugee agency) were already overwhelmed with 63 million refugees and record numbers of disasters worldwide before the Brexit vote. (According to OCHA, there were more natural and man-made major disasters requiring U.N. assistance in 2014, 2015, and now 2016 than ever before in world history, including massive storms, hurricanes, earthquakes, typhoons, refugee catastrophes, El Niño-created famines, etc. The list goes on and on and on.) Owen Barder of the Center for Global Development argues that even if the new leaders of the U.K. decide to maintain some scale of financial commitment to development programs in poor countries, the financial pie that they can cut from — the British economy — will suffer from EU withdrawal and so London will have less cash to spread around the planet. About $3 trillion disappeared from global markets in the first four days post-Brexit, with a trillion of that returning within days to New York stock markets, leaving the U.K. teetering today somewhere between a recession and chaos.

The London-based Overseas Development Institute reckons the British pound’s decline in value, even without any change in U.K. policies regarding foreign aid, will effectively remove $4 billion from developing economies due to a drop in remittances (in real currency value) sent to home countries by U.K.-based immigrants and to the roughly 3 percent decline in GDP. The World Health Organization (WHO) and hundreds of other health and development agencies and groups use GDP in their algorithms for computing how much money the U.K. is expected to give.

For example, the Joint U.N. Program on HIV/AIDS (UNAIDS) has for some time received 15 million pounds annually from the United Kingdom to support its Geneva-based program. Leaders at UNAIDS think the U.K. will maintain that level of support, but its value has plummeted. Before Brexit, 15 million pounds equaled $22.2 million; today, it’s only worth $19.5 million. So while the same amount of money is leaving London, its value in dollars has so plummeted that UNAIDS will be forced to tighten its belt, possibly laying off personnel, to accommodate a $2.7 million loss.

The England-based relief organization Oxfam, which garners much of its support for development activities around the world from the U.K. government and now fears a dramatic reduction in U.K. commitments to fighting global challenges, such as disease, poverty, and climate-caused damage. In agreement with Barder, Oxfam notes that Parliament passed a law in 2015 committing the U.K. to donating 0.7 percent of its annual gross national income (GNI) to overseas health, development, and humanitarian programs — a lofty goal, yet of shriveling significance as the British pound’s value declines and the national economy shrinks. British author Duncan Green says by mid-2015, the U.K. accounted for one out of every $7 in official development assistance (ODA) in the world and was the only wealthy country to elevate foreign aid to a cabinet-level position. That unique high-level commitment could now be imperiled by a rightward trend in the government, threatening to sever ties with a vast array of multilateral institutions, country programs, and a robust development industry, which employs hundreds of British aid workers and consultants.

The picture grows stranger when the unraveling of the U.K.’s financial entanglements with the EU is considered. For example, 10 percent of Oxfam’s budget comes from the EU — a relationship that may well die alongside U.K. withdrawal. (In 2014, the U.K. got back 1.1 billion pounds from the EU, via the European Regional Development Fund.) The U.K. also contributes to EU aid, which comprises a number of programs that distribute about 11.3 billion euros in ODA annually (or about $12.5 billion), including funds for the European Development Fund, which largely targets sub-Saharan Africa. Fifteen percent of that program’s support comes from the U.K.

Another fund likely to feel immediate pain is the EU’s emergency aid department, or ECHO, which provides millions of dollars annually for refugees, natural disaster responses, and other crises. In 2015, U.K.-based nonprofits received 145 million euros from ECHO — funds likely to disappear when Article 50 is invoked. If London doesn’t swiftly offset the losses by directly underwriting the 25 ECHO-recipient nonprofits through added funds to the Department for International Development (DFID), their programs — especially those for refugees and immigrants — are likely to suffer severe cutbacks. In the current political climate in much of the U.K., a loss of support for refugees and immigrants might well be cheered.

Let’s do the math: For fiscal year 2011-2012, Parliament gave DFID a budget of 7.72 billion pounds (or $11.1 billion in 2012 currency value), 20 percent of which went into the EU aid system. The pound has fallen so much in value since the Brexit vote that 7.72 billion pounds today equals only $9.96 billion. In 2015, the budget for DFID rose to 11.1 billion pounds overall, which today equals $14.7 billion — but was valued at $17.2 billion a year ago, before the pound fell in value post-Brexit.

So that indicates how much less funding the U.K. will be able to provide for ODA, simply due to the national economic impact of Brexit.

The next question: How much, if any, of the U.K. contribution to EU aid will continue to support ODA, perhaps in the form of direct DFID programs? In 2015, adjusted for current currency value, the U.K. allotted $2.86 billion to EU aid — does that sum now remain in the DFID budget and continue to support such things as WHO’s anti-epidemic efforts, the purchase of millions of malaria bed nets for kids, low-carbon-dioxide-emitting fuels for poor people, and African health care workers’ training programs? Or in the atmosphere of this new nationalism, will the money be absorbed into the general U.K. domestic budget?

Nobody knows.

One more point: The U.K. has benefited from a double whammy of influence and leverage over global health and development programs while in the EU. Because it maintained a separate DFID stream, the U.K. had a special impact on institutions to which it was a top bilateral donor, such as the global vaccine alliance Gavi, which is responsible for most of the world’s vaccinations. And as a member of a 28-nation bloc of donors, the U.K. shared a platform with the largest development donor in the world — EU aid. By leaving the EU, the U.K. loses that second leverage, which allowed a collective voice over health and development efforts that rivaled the United States and Bill & Melinda Gates Foundation. As a unilateral player, the country can only maintain as much influence and leverage over worldwide dreams of health and poverty eradication as its national pocketbook manages to buy. What that will look like is uncertain right now, as it depends on decisions the May government will have to reach regarding its ongoing commitment to the 0.7 percent of GNI pledge, how it will use the funds once sent to EU aid and ECHO, and to what degree the far right of the Conservative Party-led Parliament feels the U.K. is responsible for the health and welfare of refugees, victims of natural disasters, epidemic responses, and combating global poverty.

Given the political uncertainties in London, including when and under what conditions new Prime Minister May will invoke Article 50, formally withdrawing from the EU, none of the organizations dedicated to global health and humanitarian responses are willing to discuss pending details in their budgets and the likely impact EU withdrawal, coupled with the falling British pound value, will have. But they are extremely worried — every single one of them. Privately, key global health leaders tell me they expect losses to exceed anything they experienced as a result of the 2008 financial crisis.

The United Kingdom is hardly the only European country wrestling with dueling tensions of globalization and nationalist interests, and any spirit of “exit” from the EU below the English Channel will only exacerbate international health, humanitarian, and development problems. But Britain’s special commitment to such global dreams, especially in its former African colonies, has spawned some panic in the sub-Saharan region. African pundits are already warning people to brace for a new era of lowered aid commitments, increasing self-reliance, and longer time horizons for realizing collective dreams of rising wealth and receding disease. Impoverished households all over the world that depend on a family member living in the U.K. for monthly stipends, or remittances, are already feeling the pain as the value of British money declines, and there is great fear that anti-immigrant sentiments will spread like contagion, forcing individuals out of Britain and European countries, thus removing remittance currency (of any monetary value) from economies across Asia and Africa. The perception that some percentage of the Brexit vote was inspired by racism directed at immigrants, refugees, and foreigners has struck a nerve across the Commonwealth of former British colonies — with the exception of India, where a faltering English economy is seen as a golden opportunity for subcontinent businesses and investors.

As institutions like WHO, UNICEF, and Gavi tremble with nervous anticipation of London’s ultimate decisions about DFID and foreign aid and humanitarian relief, anxiety over the U.S. presidential election is rising. In particular, there is great concern about America’s multibillion-dollar annual commitment to programs that provide drugs for HIV patients, bed nets to protect children from malaria, food to famine-struck regions, that mobilize the U.S. Navy to scenes of typhoons, and back hundreds of other global health and relief efforts.

The United States’ commitments to overseas partners are the largest, in absolute terms, of any government but have always been hamstrung by Congress. For example, legislators have, for decades, protected American farmers and shipping companies by insisting that U.S. food relief, even in dire famines, be shipped all the way on U.S. private carriers — a grossly inefficient and costly way to bail people thousands of miles away out of starvation. Congress has also long insisted that the U.S. government’s programs through the State Department or other agencies be direct and bilateral and never pooled with other donors’ efforts. The only exceptions have been U.S. donations to U.N. agencies and a handful of multilateral organizations like the Global Fund. As a result, the sorts of complications seen in parsing the U.K. direct DFID commitments from those passed through the EU are not an issue for America. Most U.S. efforts, such as the Millennium Challenge Corporation or the U.S. Agency for International Development, are directly administered from Washington in coordination with the local recipient government and overseen by the U.S. ambassador.

Despite its stand-alone approach, the United States is the major player in overseas development and, especially, global health. Will programs such as the President’s Emergency Plan for AIDS Relief, launched by President George W. Bush and responsible for keeping more than 12 million people alive on anti-HIV drugs, survive in a Donald Trump presidency? Presumptive Democratic nominee Hillary Clinton has a long track record of supporting global health and development programs, both as a senator and secretary of state, and it is generally believed that she would, as president, provide continuity for the Obama administration’s efforts. In 2009, as the newly appointed secretary of state, Clinton ordered a review of all ODA programs in a monthslong thrashing at odds with the National Security Council, resulting in a formal policy guidance that became the backbone of all Obama administration nonmilitary overseas aid programs.

Trump’s views of overseas aid are largely unknown. In reference to his formal national security speech last month, Trump’s top foreign-policy advisor, Walid Phares, said, “At the moment, the top two priorities are how to deal with issues of nuclear proliferation and how to completely destroy Islamic jihadist organizations, including and especially ISIS,” using a common acronym for the Islamic State. Neither Trump nor his policy advisors have addressed global health issues or foreign aid. Since Trump’s candidacy has come to dominate the Republican race, many of his foreign-policy views have appeared isolationist, sporting an “America First” view that might, by inference, indicate a loss of interest in foreign aid spending.

In his April 27 foreign-policy speech, Trump vowed, “We will no longer surrender this country, or its people, to the false song of globalism. The nation-state remains the true foundation for happiness and harmony. I am skeptical of international unions that tie us up and bring America down and will never enter America into any agreement that reduces our ability to control our own affairs.” The “unions” Trump referred to, based on subsequent lines in his address, are trade pacts, yet these words seem similar to sentiments espoused by Brexit leaders, assuming the word “American” is replaced by the word “British”:

“Under a Trump administration, no American citizen will ever again feel that their needs come second to the citizens of foreign countries. I will view the world through the clear lens of American interests. We will always help to save lives and, indeed, humanity itself. But to play that role, we must make America strong again.”

The European Union and the U.S. government are the financial pillars upon which the 21st-century dreams of globalized caring and concern about the health, wealth, and safety of all of humanity rest. The stability of one of those pillars is now in question, amid fears that London’s Brexit will lead not only to withdrawal from the EU, but from loftier, even altruistic, collective dreams. The second American pillar seems to rest on uncertain ground, pending the results of the November presidential election. It is a sorry reality that food for starving children in Yemen, medicines for tuberculosis patients in Malawi, and outbreak responses to combat the spread of Zika and yellow fever depend more on the voters of York in the United Kingdom and New York in the United States than perhaps any other factors on Earth. It is not just, but it is true, that voters in Kansas and Wales have more say about such matters than nearly any other group of citizens on the planet; though they seem to be unaware of their influence.

Globalization has become a dirty word in many political circles around the world, for different reasons. Sen. Bernie Sanders, Clinton’s former rival, and the Labour Party’s Jeremy Corbyn blame globalization for the world’s wealth gap, giving increasing riches and power to an ever-shrinking elite. On the right, the U.K.’s Brexit backers and Trump blame globalization for violating the independence and sovereignty of nations, creating immigration, refugee, and terrorism crises. Almost absent from the public discourse in Europe and North America has been the great dream of globalization spawned in the 1990s and echoed in the United Nations’ Sustainable Development Goals for transforming the world by 2030. Amid the shouting about building walls, respecting boundaries, eliminating trade agreements, national pride, and fiscal crisis, the advocates for a world without extreme poverty, famine, epidemics, climate-related disasters, and disease are drowned out.

The great danger of this moment in history is a retrenchment behind the walls and ideals of me-first nationalism and the death of dreams of a better, safer, wealthier world for all of humanity.

Photo credit: MARCO SECCHI/Getty Images

Laurie Garrett is a former senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer. Twitter: @Laurie_Garrett

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