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Global Aid and the New President

President Obama at the State Department (Saul Loeb/AFP/Getty Images)As the new administration settles into the White House, global development and health experts are calling on President Obama and Congress to increase and refocus U.S. commitments to aid the world's poorest citizens.

In a New York Times op-ed today, World Bank president Robert Zoellick asked President Obama to use April's global summit meeting to call for developed countries to pledge 0.7 percent of their stimulus packages to a World Bank-managed "vulnerability fund for assisting developing countries that can't afford bailouts and deficits."

A World Bank spokesperson reached by ProPublica today said the vulnerability fund "is still at the concept stage," and it is unclear whether it would consist of grants, loans or a combination of both. Although the bank's plans remain vague, Zoellick's call to action emphasized that investing in health, education, nutrition, infrastructure and business development in poor countries can, as he wrote, "help limit the depth and length of the international downturn."

The U.S. currently contributes about 0.2 percent of its GDP for aid, well below the 0.7 percent target set by the European Union and United Nations. In a report released yesterday by the Council on Foreign Relations, global health expert Laurie Garrettargued (PDF) that despite the world's economic and financial crisis, it is in the U.S.'s interest to maintain or even increase its foreign assistance spending "for clear reasons of political influence, national security, global stability and humanitarian concern." Garrett called for a transformation of U.S. foreign assistance, including rewriting the "unwieldy" Foreign Assistance Act to improve coherence (the subject of a recent Foreign Affairsarticle by three former USAID administrators), doubling overseas development assistance, and supporting global health initiatives that are based on evidence and the needs of recipient countries.

The National Intelligence Council's recently released assessment on the strategic implications of global health emphasizes (PDF) that virulent infectious diseases "remain the most direct health-related threats to the United States." Other causes of widespread death and disability in low-income countries, including maternal mortality, malnutrition, chronic diseases and poor sanitation and access to clean water, also "affect the U.S. national interest through their impacts on the economies, governments, and militaries of key countries and regions."

U.S. global health assistance expanded dramatically under the presidency of George W. Bush, in particular through the President's Emergency Plan for AIDS Relief, which has provided life-extending anti-retroviral medication to more than 2 million people in developing countries. However, public health specialists have long chafed at requirements they considered ideological rather than scientific, such as a bias toward funding abstinence-focused HIV prevention programs. That is expected to change -- late yesterday news emerged that President Bush's Global AIDS Coordinator Dr. Mark Dybul, who had initially been asked to stay on during the Obama administration, would be replaced.

Today President Obama is also expected to lift the "global gag rule," which forbids federal funding for foreign organizations that provide abortions or counsel women about them. Global health advocates argue that the rule, also known as the Mexico City Policy and first imposed by President Ronald Reagan, has negatively impacted women's health programs worldwide.

It remains to be seen whether the new administration will respond to other items on global health advocates' agendas (PDF), including restoring funding for the United Nations Population Fund and instructing the Department of Health and Human Services to revise rules so that a Reagan-era U.S. travel ban on people living with HIV and AIDS can be lifted.

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