At What Cost? U.S. Leadership in Global Health in an Era of AusterityDr. J. Stephen Morrison

Senior Vice President;

Director, Global Health Policy Center

Center for Strategic and International Studies

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US Bilateral Global Health Financing: 1990-2011

1990199119921993199419951996199719981999200020012002200320042005200620072008200920102011 -

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Bil

lio

ns

of

2009

US

Do

llar

s

Source: IHME DAH Database 2011Note: 2010 and 2011 are preliminary estimates based on information from the above organizations, including budgets, appropriations, and correspondence

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Global Health Financing By Source: 1990-2011

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HIV/AIDS40.2%

Basic Health & Medical

Care14.8%

Management/ Workforce,

13.2%

FP/RH11.0%

Malaria8.7%

Other In-fectious Diseases

5.8%

TB4.3%

Nutrition2.0%

HIV/AIDS; 19.1%

Basic Health & Medical

Care; 19.3%

Management/Workforce;

26.4%

FP/RH; 19.4%

Malaria; 0.6%

Other Infec-tious Dis-

eases; 12.5%

TB; 0.3%

Nutrition; 2.4%

Total = $4.4 billion (USD) Total = $18.4 billion (USD)

SOURCE: Kaiser Family FoundationNote: Amounts in gross US$ disbursements. Health ODA combines data from three OECD CRS sub-sectors: (1) Health; (2) Population Policies/Programs and Reproductive Health (includes HIV/AIDS & STDs); and (3) Other Social Infrastructure and Services - Social Mitigation of HIV/AIDS Source: Analysis of data obtained via online query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS), November 7, 2012.

Donor Health Investments 2002 vs 2010

2002 2010

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Changing Global Burden of Disease:Changes in Cause of Death, 1990-2010

SOURCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2010, online

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CHART BY: Kaiser Family FoundationSOURCE: UNAIDS, Report on the Global AIDS Epidemic, 2012.

Millions

Global Estimates of People Living with HIV/AIDS 1990-2011

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HIV/AIDS Pandemic Overview (2011)HIV/AIDS remains a serious global threat:• 2.5 million new HIV infections worldwide• 1.7 million AIDS-related deaths

Progress is being made:• 8 million people (54 percent of eligible people) worldwide received

treatment with effective antiretroviral drugs• Between 2001 and 2011, the rate of new HIV infections has been reduced

by more than 50 percent among adults (15 to 49 years) in 25 countries• The number of people dying from AIDS-related causes in sub-Saharan

Africa declined by 32 percent, from 1.8 million to 1.2 million, between 2005 and 2011

Major challenges remain:• 6.8 million people remain eligible and waiting for treatment• Only 30% of treatment-eligible pregnant women living with HIV were

receiving ART.

Source: UNAIDS, “UNAIDS World AIDS Day Report 2012,” December 2012, online

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Global Deaths from HIV/AIDS: Regional Distribution (2011)

Source: UNAIDS, online

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Global Malaria Deaths: 2001-2010

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Reported Global Polio Cases: 2001-2012

Source: WHO AFP/Polio Database; communications with WHO

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US Priorities During the Second Obama Term

• Sustainability: partner country ownership & orderly transitions

• Ensure continuous high-level US leadership • Preserve broad American consensus • Consolidate reforms in face of recession• Clarify priorities and who is in charge

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Global Health Diplomacy

1. Preserve centrality of the Secretary of State

2. Better engage G-8 and emerging powers

3. Empower U.S. ambassadors

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HIV/AIDS

1. Maintain funding

2. Link U.S. programs with Global Fund

3. Implement AIDS-Free Generation

4. Manage transition challenges

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Malaria

1. Expand use of rapid diagnostics

2. Explore innovative finance

3. Focus upon rising resistance

4. Continue research investment

5. Control substandard products.

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Polio

1. Concentrate upon achieving eradication

2. Combine CDC and USAID contributions

3. Pakistan, Afghanistan, Nigeria: how reconcile global security versus global health?

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Women’s Global Health

1. Translate U.S. policies into action

2. Monitor progress in addressing inequality

3. Advance partnerships on cervical cancer, violence, safe motherhood

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Multilateral Partners

• Possess valuable assets• Of rising significance to U.S.

interests• Face funding replenishments and

continued pressures to reform

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Global Health Security

1. Diminished perceived threat

2. International Health Regulations: laboratories, surveillance, reporting, training.

3. Integration of public health with biosecurity

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Thank You!

Please register at www.SmartGlobalHealth.org to receive the CSIS volume Global Health Policy in the Second Obama Term, which will be available in late February.