The U.S. Government Engagement in Global Health: A Primer
Introduction
KFF. The U.S. Government’s Global Health Policy Architecture: Structure, Programs, and Funding, May 2011.
Report
Institute of Medicine. The U.S. Commitment to Global Health: Recommendations for the Public and Private Sectors. National Academies Press, Washington D.C., 2009.
Fineberg HV, Hunter DJ. A Global View of Health—An Unfolding Series. New England Journal of Medicine 2013;368:78-79. http://www.nejm.org/doi/full/10.1056/NEJMe1208801
Koplan JP, Bond C, Merson MH, et al. Towards a common definition of global health. Lancet 373:1993-1995, 2009.
Institute of Medicine. The U.S. Commitment to Global Health: Recommendations for the Public and Private Sectors. National Academies Press, Washington D.C., 2009.
Koplan JP, Bond C, Merson MH, et al. Towards a common definition of global health. Lancet 373:1993-1995, 2009.
Cohen M, et al. Prevention of HIV-1 Infection with Early Antiretroviral Therapy. NEJM; 2010 http://www.nejm.org/doi/full/10.1056/NEJMoa1105243.
UNAIDS. UNAIDS Explainer: Undetectable = untransmittable; July 2018.
UNAIDS. AIDSinfo website; accessed January 2019, available at: http://aidsinfo.unaids.org/.
BCG is recommended by WHO as a component of routine childhood immunization in countries with a high TB burden. See: “Implementing the End TB Strategy: The Essentials,” 2015, http://www.who.int/tb/publications/2015/The_Essentials_to_End_TB/en/.
WHO. Global Tuberculosis Report 2018, 2018. Available at: http://www.who.int/tb/publications/global_report/en/.
WHO. World Malaria Report 2018, 2018. Available at: https://www.who.int/malaria/publications/world-malaria-report-2018/en/.
Guidelines for the treatment of malaria, third edition, 2015. Available at: http://www.who.int/malaria/publications/atoz/9789241549127/en/.
WHO, Investing to Overcome the Global Impact of NTDs, 2015.
USAID, USAID Targeted Diseases webpage, https://www.neglecteddiseases.gov/usaid-target-diseases.
WHO, Family Planning website, http://who.int/reproductivehealth/topics/family_planning/en/.
WHO, Reproductive Health website, http://www.who.int/topics/reproductive_health/en/.
WHO. World Health Statistics 2014, 2014. Available at: http://www.who.int/gho/publications/world_health_statistics/2014/en/.
UN, World Family Planning 2017 Highlights, 2017. Available at: http://www.un.org/en/development/desa/population/publications/pdf/family/WFP2017_Highlights.pdf.
WHO, Trends in maternal mortality: 1990 to 2015, 2015.
UN IGME, Levels and Trends in Child Mortality Report 2018, 2018.
WHO, Global Health Observatory data: Maternal and reproductive health; http://www.who.int/gho/maternal_health/en/.
WHO, Global Health Observatory data: Child health; http://www.who.int/gho/child_health/en/.
WHO, Fact Sheet: Poliomyelitis; http://www.who.int/mediacentre/factsheets/fs114/en/.
WHO. Global Health Observatory data: Poliomyelitis (polio) immunization coverage; https://www.who.int/gho/immunization/poliomyelitis/en/.
UNICEF, The State of the World’s Children 2016, 2016.
FAO. The State of Food Insecurity and Nutrition in the World 2017. http://www.fao.org/state-of-food-security-nutrition/en/.
UNICEF. Coverage at a crossroads: New directions for vitamin A supplementation programmes, May 2018. https://data.unicef.org/resources/vitamin-a-coverage/.
UN. The Millennium Development Goals Report 2015, 2015.
WHO. Progress on drinking water, sanitation and hygiene 2017 update and SDG baselines, 2017. http://apps.who.int/iris/bitstream/10665/258617/1/9789241512893-eng.pdf?ua=1.
Institute for Health Metrics and Evaluation. Rethinking Development and Health: Findings from the Global Burden of Diseases Study, 2015. http://www.healthdata.org/policy-report/rethinking-development-and-health-findings-global-burden-disease-study.
WHO. Global status report on noncommunicable diseases 2014, http://www.who.int/nmh/publications/ncd-status-report-2014/en/.
WHO. Fact Sheet: Noncommunicable diseases, http://www.who.int/mediacentre/factsheets/fs355/en/index.html.
CDC. 2014-2016 Ebola Outbreak in West Africa, June 22, 2016.
World Bank. Press release: Ebola: Most African Countries Avoid Major Economic Loss but Impact on Guinea, Liberia, Sierra Leone Remains Crippling, January 20, 2015.
Fidler D. The Globalization of Public Health: The First 100 years of international health diplomacy. Bulletin of the World Health Organization 2001. http://www.who.int/bulletin/archives/79(9)842.pdf.
Cohen J. The New World of Global Health. Science 311, 13 January 2006.
KFF. The Role of NGOs in the U.S. Global Health Response; 2015.
WHO. Global Health Histories: Origin and development of health cooperation, webpage, http://www.who.int/global_health_histories/background/en/; WHO. Declaration of Alma-Ata, September 1978.
Institute for Health Metrics and Evaluation. Financing Global Health Report 2015. http://www.healthdata.org/policy-report/financing-global-health-2015-development-assistance-steady-path-new-global-goals.
PolicyCures. G-FINDER Report 2011. http://www.policycures.org/downloads/G-FINDER_Year_3_media_release.pdf.
UN. MDG Gap Task Force Report 2012. http://www.un.org/en/development/desa/publications/mdggap2012.html.
Institute for Health Metrics and Evaluation. Financing Global Health 2011: Continued Growth as MDG Deadline Approaches. http://www.healthmetricsandevaluation.org/publications/policy-report/financing-global-health-2011-continued-growth-mdg-deadline-approaches.
KFF analysis of data obtained via online query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS), February 2018.
White House. National Security Strategy; December 2017. HHS. Global Strategy. https://www.hhs.gov/about/agencies/oga/about-oga/why-hhs-works-globally/hhs-global-strategy/index.html, USAID. Global Health Strategic Framework. https://www.usaid.gov/documents/1864/usaids-global-health-strategic-framework.
For more information about global health diplomacy, see KFF, Raising the Profile of Diplomacy in the U.S. Global Health Response, 2012, https://www.kff.org/global-health-policy/issue-brief/raising-the-profile-of-diplomacy-in-the/.
Specifically, the National Center for Immunization and Respiratory Diseases (NCIRD), the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), and the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).
FDA. FDA's International Posts: Improving the Safety of Imported Food and Medical Products. http://www.fda.gov/forconsumers/consumerupdates/ucm185769.htm
KFF. The U.S. Department of Defense and Global Health. https://www.kff.org/global-health-policy/report/the-u-s-department-of-defense-global/ .
U.S. Congress. Public Law No: 113-56; December 2, 2013.
White House. National Security Strategy; December 2017.
PEPFAR. Seventh Annual Report to Congress. http://www.pepfar.gov/documents/organization/166734.pdf
See, http://www.pepfar.gov/.
KFF. The U.S. President’s Emergency Plan for AIDS Relief Fact Sheet, https://www.kff.org/hivaids/fact-sheet/the-u-s-presidents-emergency-plan-for/.
U.S. Congress. Public Law No: 113-56; December 2, 2013.
U.S. Congress. Public Law No: 115-305; December 11, 2018.
Department of State, Fact Sheet: The Path to an AIDS-Free Generation, November 8, 2011.
PEPFAR, PEPFAR Blueprint: Creating an AIDS-free Generation, 2012. http://www.pepfar.gov/documents/organization/201386.pdf.
PEPFAR, PEPFAR 3.0 – Controlling the Epidemic: Delivering on the Promise of an AIDS-free Generation, 2014. http://www.pepfar.gov/about/strategy/.
PEPFAR. Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020); September 2017. https://www.pepfar.gov/documents/organization/274400.pdf.
USAID. Tuberculosis website. https://www.usaid.gov/what-we-do/global-health/tuberculosis. .
KFF. The Global Tuberculosis Epidemic Fact Sheet, https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-tuberculosis/.
USG, National Action Plan for Combating Multidrug-Resistant Tuberculosis, December 2015.
NIH/NIAID, NIAID Strategic Plan for Tuberculosis Research, September 2018.
U.S. Government, PMI website, http://www.pmi.gov/.
KFF, The President’s Malaria Initiative and Other U.S. Government Global Malaria Efforts Fact Sheet. https://www.kff.org/global-health-policy/fact-sheet/the-presidents-malaria-initiative/.
KFF. The President’s Malaria Initiative and Other U.S. Government Global Malaria Efforts Fact Sheet, https://www.kff.org/global-health-policy/fact-sheet/the-presidents-malaria-initiative/.
PMI, President’s Malaria Initiative Strategy 2015-2020, 2015.
KFF. The U.S. Government and Global Neglected Tropical Disease Efforts Fact Sheet, https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-neglected-tropical-diseases/.
USAID. Family Planning website. https://www.usaid.gov/what-we-do/global-health/family-planning. .
KFF. The U.S. Government and International Family Planning & Reproductive Health Fact Sheet. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-international-family-planning-and-reproductive-health/.
USAID. Maternal and Child Health website. https://www.usaid.gov/what-we-do/global-health/maternal-and-child-health.
KFF. The U.S. Government and Global Maternal & Child Health Efforts Fact Sheet, https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-maternal-and-child-health/.
USAID. Nutrition website. https://www.usaid.gov/what-we-do/global-health/nutrition.
U.S. Government. Feed the Future Guide; May 2010. https://feedthefuture.gov/resource/feed-future-guide.
USAID, USAID Multi-Sectoral Nutrition Strategy 2014-2025, 2014.
State Department. Paul Simon Water for the Poor Act Report to Congress, June 2010. https://www.state.gov/documents/organization/146141.pdf.
USAID. Water and Sanitation website. https://www.usaid.gov/what-we-do/water-and-sanitation.
Senator Paul Simon Water for the Poor Act of 2005 (P.L. 109-121); Senator Paul Simon Water for the World Act of 2014 (P.L. 113-289); State Department, Senator Paul Simon Water for the Poor Act: Report to Congress June 2010, https://www.state.gov/documents/organization/146141.pdf; USAID. Water and Sanitation website. http://www.usaid.gov/what-we-do/water-and-sanitation.
USAID. Water and Sanitation website. http://www.usaid.gov/what-we-do/water-and-sanitation; Senator Paul Simon Water for the World Act of 2014 (P.L. 113-289). USAID. U.S. Government Global Water Strategy, 2017.
WHO. United Nations high-level meeting on noncommunicable disease prevention and control. http://www.who.int/nmh/events/un_ncd_summit2011/en/.
KFF. The U.S. Government and Global Health Security. Nov 2017 https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-global-emerging-infectious-disease-preparedness-and-response/
KFFanalysis of data from the State Department, and U.S. Foreign Assistance Dashboard [website], available at: www.foreignassistance.gov; accessed October 2015. USAID, Countries Supported by USAID's NTD Program and Countries Supported by USAID’s Global Health Security Agenda Program, accessed June 2018.
Due to the unique nature of the program, funding provided through the Food for Peace (FFP) account at USAID is not included in this analysis. The U.S. Foreign Assistance Dashboard does not break out bilateral funding for NTDs and Global Health Security. As such, this analysis includes countries supported by USAID’s NTDs and Global Health Security Agenda programs as reported by USAID’s “Where we work” pages accessed https://www.neglecteddiseases.gov/where-we-work and https://www.usaid.gov/what-we-do/global-health/health-systems/countries.
KFF. Donor Funding For Health in Low-& Middle-Income Countries, 2002-2013. November 2015. https://www.kff.org/global-health-policy/report/donor-funding-for-health-in-low-middle-income-countries-2002-2013/.
Due to the unique nature of the program, funding provided through the Food for Peace (FFP) account at USAID is not included in this analysis.
Represents total known global health funding as specified by the Office of Management and Budget, Agency Congressional Budget Justifications and Operating Plans, Congressional Appropriations Bills, Press Releases, and Conference Reports; and U.S. Foreign Assistance Dashboard website, ForeignAssistance.gov. There is additional funding for global health activities that is determined at the agency level and is not specified by the Administration or in Congressional appropriations, and is therefore not included in the totals presented.
This amount includes specified U.S. contributions to the following multilateral institutions: the Global Fund, GAVI, , TB Global Drug Facility, UNAIDS, WHO, PAHO, UNICEF, and UNFPA.
Prior to FY10, nutrition funding was included as part of MCH.
HIV includes funding through State/OGAC, USAID, CDC, NIH, and DoD. MCH includes funding through USAID and CDC as well as contributions to UNICEF. Malaria includes funding through USAID, CDC, NIH, and DoD. FP/RH includes funding through USAID as well as contributions to UNFPA. TB, Nutrition, NTDs, and Vulnerable Children include funding through USAID. Global Health Security includes funding through USAID and CDC.
WHO. “Executive Board members” webpage, http://apps.who.int/gb/gov/executive-board-members.html.
White House, President Announces Proposal for Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis; May 11, 2001.
GAVI Alliance website. http://www.gavialliance.org/.
There have been several years, including FY 2017 and FY 2018, in which U.S. funding for UNFPA has been withheld due to Executive Branch determinations under the Kemp-Kasten Amendment. Please see the KFF fact sheet on UNFPA Funding & Kemp-Kasten: An Explainer.
The Administration has proposed reducing U.S. contributions to a number of multilateral organizations, including Gavi, the Vaccine Alliance and UNFPA in the FY 2019 budget request. KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, Congressional Appropriations Bills, and the U.S. Foreign Assistance Dashboard website, www.foreignassistance.gov.
Appendices
Parascandola JL, “Public Health Service”, pp. 487-93 in ed. George Thomas Kurian, A Historical Guide to the U.S. Government, New york: Oxford university Press, 1998. http://lhncbc.nlm.nih.gov/apdb/phsHistory/resources/phs_hist/pub_phs01.html.
See, http://www.archives.gov/research/guide-fed-records/groups/166.html
See, http://uscode.house.gov/browse/prelim@title42&edition=prelim
See, https://www.usaid.gov/what-we-do/agriculture-and-food-security/food-assistance/programs
See, http://uscode.house.gov/browse/prelim@title42&edition=prelim.
Joint Committee Print, House Committee on Foreign Affairs and Senate Committee on Foreign Relations, Legislation on Foreign Relations, Available at, https://foreignaffairs.house.gov/legislation-on-foreign-relations/ .
See, https://www.usaid.gov/who-we-are/usaid-history. Joint Committee Print, House Committee on Foreign Affairs and Senate Committee on Foreign Relations, Legislation on Foreign Relations, Available at, https://foreignaffairs.house.gov/legislation-on-foreign-relations/.
White House, Presidential Memorandum Regarding the Mexico City Policy, January 23, 2017, available at https://www.whitehouse.gov/the-press-office/2017/01/23/presidential-memorandum-regarding-mexico-city-policy; KFF, The Mexico City Policy: An Explainer, available at https://www.kff.org/global-health-policy/fact-sheet/mexico-city-policy-explainer/.
See, http://www.law.cornell.edu/uscode/html/uscode07/usc_sec_07_00001736---o000-.html
See, http://www4.law.cornell.edu/uscode/uscode10/usc_sup_01_10_10_A_20_I_30_20.html
Department of State. Humanitarian Operations. http://www.state.gov/t/pm/iso/c21542.htm
See, http://hdl.loc.gov/loc.uscongress/legislation.106hr3194
See, https://www.gpo.gov/fdsys/pkg/PPP-2000-book2/pdf/PPP-2000-book2-doc-pg1667.pdf.
See, http://hdl.loc.gov/loc.uscongress/legislation.106hr3519
White House, Office of the Press Secretary, President Promotes New Mother and Child HIV Prevention Initiative, June 19, 2002, Available at, http://georgewbush-whitehouse.archives.gov/news/releases/2002/06/20020619-3.html.
See, http://hdl.loc.gov/loc.uscongress/legislation.106hr4577
See, http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1466&context=globaldocs.
See, http://www.nationalaglawcenter.org/farmbills/. See, http://hdl.loc.gov/loc.uscongress/legislation.107hr2646
See, http://hdl.loc.gov/loc.uscongress/legislation.108hr1298
FDA, Regulatory Information, “Fixed Dose Combination and Co-Packaged Drug Products for Treatment of HIV”, Available at, http://www.fda.gov/RegulatoryInformation/Guidances/ucm125278.htm.
See, http://hdl.loc.gov/loc.uscongress/legislation.108hr2673
U.S. Government, PMI website, http://www.pmi.gov/.
See, http://hdl.loc.gov/loc.uscongress/legislation.109hr1268
See, http://hdl.loc.gov/loc.uscongress/legislation.109hr4939
See, http://www.dtic.mil/whs/directives/corres/pdf/648502e.pdf
See, http://www.nationalaglawcenter.org/farmbills/. See, http://hdl.loc.gov/loc.uscongress/legislation.110hr6124
See, http://hdl.loc.gov/loc.uscongress/legislation.110hr5501
U.S. Congress. Public Law No: 113-56; December 2, 2013.
U.S. Congress. Public Law No: 114-195; July 20, 2016.
White House. Executive Order -- Advancing the Global Health Security Agenda to Achieve a World Safe and Secure from Infectious Disease Threats, November 4, 2016.
White House, Presidential Memorandum Regarding the Mexico City Policy, January 23, 2017, available at https://www.whitehouse.gov/the-press-office/2017/01/23/presidential-memorandum-regarding-mexico-city-policy; KFF, The Mexico City Policy: An Explainer, available at https://www.kff.org/global-health-policy/fact-sheet/mexico-city-policy-explainer/.
U.S. Congress. Public Law No: 115-305; December 11, 2018.