Stop Trump's War on Global Health

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Global health is one of the few issues that has long commanded widespread bipartisan support, with numerous politicians on both sides of the aisle working to improve the health of people in some of the world’s most impoverished locales.

Perhaps the most visible U.S. global health success was President George W. Bush’s 2003 commitment to fight HIV through the President’s Emergency Plan for AIDS Relief (PEPFAR). Now, PEPFAR supports 11.5 million people worldwide with antiretroviral therapy for HIV, treatment that requires lifelong access to medication to prevent the deadly progression from HIV to AIDS. Throughout his administration, President Barack Obama also supported this important effort by sending billions of federal dollars to various government and nongovernment health organizations.

Bucking this established tradition of helping those most in need, President Donald Trump’s administration is dismantling U.S. global health commitments — a decision that could have dangerous consequences abroad.

The president’s position has been no secret. From the beginning of his administration, Trump pushed for massive cuts to global aid in his “America First Budget.” Among the cuts Trump proposed was a 28 percent reduction to the budgets of the Department of State and the U.S. Agency for International Development (USAID). He also pledged to decrease the funding sent to the United Nations and its affiliated agencies, including U.N. peacekeeping efforts, as well as other international organizations.

Fortunately, Congress has thus far rejected many of these cuts. But it seems that has not deterred Trump, who has persisted in cutting health development funding for the disenfranchised. For instance, in his proposed fiscal year 2019 budget, Trump plans to cut global health funding from 10.7 billion to 8.3 billion, a 23 percent reduction. If Trump gets his way, global health funding will be at its lowest point since 2008, and, at the very least, hundreds of thousands of people will suffer as a result.

Trump’s proposed budget is predicted to result in as many as 200,000 new cases of HIV and 31,000 new cases of TB. Up to 31,300 mothers, children, and newborns will die. Many of those who have been started on lifelong PEPFAR-funded antiretroviral therapy will be unable to afford treatment. Their HIV infections will progress to AIDS, and they will die, too.

Foreign policy and global health expertsincluding Bill Gates, believe that these large and sudden changes could disrupt fragile states, reversing decades of U.S.-led stability efforts. This is an important and often overlooked consideration. Investments can deter violent conflict and prevent the spread of infectious diseases, which have in the past posed significant danger to even the wealthiest countries, including the United States. We have seen firsthand that diseases such as Ebola and SARS do not respect national borders.

Additionally, military and civil conflicts can arise when significant disease outbreaks occur in destabilized regions, a problem that has in the past drawn American military, aid organizations, and resources away from our own domestic policy problems.

In addition to his attempted cuts to global health funding, Trump’s presence in office has also been harmful to global health because of various policy reforms. Perhaps the best-known example is his reinstatement of the Mexico City Policy, which essentially prevents foreign non-governmental organizations (NGOs) from receiving any U.S. funds if they actively promote or perform abortions. While there is controversy about the ethics of abortion, withholding aid to these NGOs impacts their ability to perform all services, including vital ones such as family planning, maternal and reproductive health, and antenatal care. Moreover, according to an analysis by the Kaiser Family Foundation, Trump’s broad application of the Mexican City Policy has affected funding related to the treatment and prevention of diseases that aren’t directly related to maternal and child health care, including HIV, malaria, and malnutrition. Because of Trump’s Mexico City Policy, as many as 1,275 foreign NGOs are at risk of losing much-needed funding.

Global health isn’t and shouldn’t be a partisan issue. More than two-thirds of Americans agree that our country should have a role in improving health in developing countries. It is an injustice for people to suffer and die because they cannot access or afford care, an injustice with a direct impact on our own safety. With the November midterm elections just around the corner, it is time for voters, health-care professionals, and policymakers to be advocates for equity by electing only those politicians who agree to continue supporting U.S. global health efforts. 

Americans must band together to block a Trump agenda that will reverse decades of progress in global health. If we fail, a global health catastrophe is inevitable.

Jacquelyn Corley, M.D., (jacquelyn.corley@duke.edu) is a neurological surgery resident at Duke University Medical Center, Paul Farmer Research Fellow at Harvard’s Program for Global Surgery and Social Change (@HarvardPGSSC), and a human rights journalist focusing on health-care-related topics. Follow her on twitter @JacquelynCorley.

Rolvix Patterson, B.A., (rolvix.patterson@tufts.edu) is a medical and public health student at Tufts University School of Medicine and a Research Associate at Harvard’s Program for Global Surgery and Social Change. Follow him on twitter @RolvixPatterson.

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