Political pundits have interpreted Obama’s reelection in many ways. For some it was a referendum on Obamacare, for others, a mandate to raise taxes on the rich, and for others, a repudiation of the antiquated social views held by the GOP. Whatever the conclusion, there is little doubt that this election pivoted around domestic (and primarily economic) issues.
In this recent return to “it’s the economy, stupid,” we should not be so stupid as to think that it’s only the economy that will be affected. The global health agenda remains the purview of the President. In the coming weeks, as the media focuses on economic recovery and looming financial cliff, even in these austere times, President Obama must remember his commitment to global health.
The last four years…
In the last four years, the Obama administration took some interesting (if not entirely successful) steps to organize the US’s global health efforts. These fell under the auspices of the State department and the newly created “Global Health Initiative.” GHI sought to transition the global health agenda from that of disease-based approach (a la PEPFAR under the Bush administration) to an approach that would coordinate key US players (primarily USAID, PEPFAR and the CDC) and direct efforts towards the broad-based needs of developing health systems.
The principles of GHI were appropriate. It’s success, however, was limited. The original plan of consolidating GHI and other US global health efforts under USAID by 2012 fell apart and ultimately GHI closed its office in July of this year.
A slow (re)start
In its place, the Obama administration planned to open an Office of Global Health Diplomacy – also within the State department. The creation of this office has been slow (I would link to their website here… but it doesn’t yet exist) and five months after the closing of GHI there remains no publicly available plan for what its replacement will look like, let alone who will head this effort.
From what little we do know about GHD, its principles will appropriately reflect those of GHI. Global Health Diplomacy will continue to focus on gender equality, country ownership, and strengthening of health systems – all of which are important steps towards providing a broad base of services (including, yes, basic surgery). Further, GHD will work primarily through the embassies of 42 targeted countries. This approach will allow health initiatives to benefit from country-specific knowledge held by embassies, to utilize preexisting relationships that embassies have with in-country agencies, and will enhance in-country coordination of the various American players involved.
Unfortunately, what is lost in GHD, at least in the short term, is the goal of unifying global health programming under one agency. It remains likely that American agencies will continue to compete for instead of cooperating within global health space. Nevertheless, a newly created office of Global Health Diplomacy that continues to adhere to the sensible principles of GHI holds promise for improving American global health efforts.
Obama’s next move
Even in times of severe budget cuts, the Obama administration is not predestined to ignore global health. By focusing on high-efficacy projects targeted towards the specific needs of partnering countries, the Obama administration can stretch each global health dollar further. Coordination is not costly.
In the coming weeks, President Obama should move quickly to appoint an Ambassador of Global Health to head GHD. Global health can exist beyond the space of partisan bickering about tax-increases and “entitlement spending.” International aid occupies (sadly) less than 1% of the US budget and the current levels of global health spending is not the type of big-ticket item that must be loudly and lengthily debated on the House floor. The establishment of GHD can and should be fast-tracked.
Undoubtedly (and not incorrectly), American’s will continue to focus on domestic issues that affect the growing number of people in poverty within the US. In doing so, however, we must not forget the good-will and security that is fostered when the US helps develop infrastructure that provides immunizations, helps mothers in labor, and moves millions of people abroad closer to securing their right to health care. Despite the tough times within this country, the Obama administration can and should continue to support its global health efforts across borders. Making the Office of Global Health Diplomacy a reality is a good first step.