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U.S. Cuts to Global Health Budget “Mass-scale Malpractice”

The impact of the budget cuts would be felt in communities around the world almost immediately. Credit: Fahim Siddiqi/IPS

WASHINGTON, Feb 26 2013 (IPS) - Public health workers, activists and policymakers are stepping up a last-minute campaign to highlight the global health impact of historic, sweeping cuts to the U.S. federal budget due to go into effect Friday if Congress doesn’t act.

While some are suggesting that the automatic reductions, known here as the “sequester”, could set back health-related research and outcomes by a generation, others are warning that NGOs and project implementers, long working on the assumption that the cutbacks would be averted, are now finding themselves massively underprepared for how to operate on slashed budgets.

“While these budget cuts would affect a huge number of national and international programmes, global health is one of the few in which people’s lives are actually at risk,” Ali Escalante, a volunteer with the ONE campaign, an advocacy group, told IPS.

This has caught academics and the intelligentsia by surprise, and by the time they woke up and understood, it was too late.

“Thanks to U.S. leadership, we’ve made huge advances in fighting poverty and preventable diseases over the past decade. But we’ve come too far to turn back now – risking that progress would be a tragedy for both the United States and the world.”

Along with around 150 concerned citizens from across the country, Escalante was in Washington on Tuesday to meet with members of Congress and underscore the sequester’s impact on global health.

The United States is currently by far the world’s largest supporter of global health research and interventions, a role that has only expanded since the 2008 global financial crisis led most other international donors to roll back their own foreign aid programmes.

Yet due to disagreements within the U.S. Congress over how to shrink the national debt, involuntary spending reductions are scheduled to go into effect on Mar. 1. Purposefully nonsensical, these would eliminate 85 billion dollars of federal spending this year and 1.2 trillion over the next decade, which some estimate could slash more than five percent from all federal programmes.

According to Escalante and others, the impact would be felt in communities around the world almost immediately.

“For instance, there are currently over eight million people being treated for AIDS, up from 200,000 just 10 years ago,” she says. “So we project out that if these cuts happen, 170,000 people would stop receiving U.S.-funded treatments. And we also know that those people will die.”

These reductions alone, she suggests, could directly lead to 37,000 AIDS-related deaths, many of parents who could leave behind upwards of 74,000 orphans.

And that’s just the AIDS-related impact. According to a new report released Tuesday by the Global Health Technologies Coalition (GHTC), a U.S. umbrella group, sequestration could shrink global health spending at the State Department and USAID (the country’s main foreign aid arm) by 484 million dollars this year.

Further, the National Institutes of Health, responsible for overseeing much of the country’s health-related research, could lose almost two billion dollars, on top of reductions to several other federally funded research programmes.

GHTC researchers suggest that these budget reductions could “jeopardise” up to 200 new global health tools that are currently in the research process. These include drugs, vaccines and other products to counteract HIV, tuberculosis, African sleeping sickness, dengue fever and others.

“The US commitment must be renewed,” the report states. “There is too much to lose if the United States pulls back from this legacy now, as US investment has driven the creation of the largest global health product development pipeline in history that is poised to become the next generation of lifesaving products.

Hundreds of thousands of lives

Amidst the confounding political spectacle of the U.S. debt negotiations leading up to the sequester, what has particularly frustrated many observers is the miniscule impact that foreign aid-related cutbacks would have on the United States’ broader deficit problems.

Contrary to the belief of many in the country, foreign spending makes up less than one percent of the national budget. Of that, just a tenth goes into health spending.

“We’re not talking about much money in terms of the country’s budget, but in terms of impact it’s enormous,” Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, a Washington think tank, told IPS.

“Further, in terms of public giving the United States is responsible for 52 percent of all global health support. There is just no one prepared to step into that breach.”

While it is unclear exactly how deeply programme heads would need to slice, estimates run anywhere from three to eight percent.

“At eight percent, now you’re talking about dead bodies,” Garrett says. “The way I look at it, that’s mass-scale medical malpractice. One thing a physician is trained to do is not to end treatment until a patient doesn’t need it any more. Cutting off this funding now means hundreds of thousands of lives.”

Previous attempts to roll back U.S.-funded AIDS medications saw almost immediate public demonstrations outside of U.S. embassies in Africa, and Garrett notes that similar reactions should be expected if the current reductions take place, as well.

Congress can still tweak or undo the sequester entirely, though President Barack Obama and Congressional Republicans remain firmly entrenched in their positions, with no public negotiations taking place whatsoever.

Regardless of the eventual timeframe, however, Garrett says that public health groups are notably unprepared for the impacts, whether long or short term.

“This has caught academics and the intelligentsia by surprise, and by the time they woke up and understood, it was too late – some health groups have only now started to ask what it will mean for their programme,” she says.

“The most important thing everyone can do right now is to start providing seriously reliable metrics that can show the impact of sequestration – not a lot of hand-waving and hysteria. Every group out there needs to take this as seriously as possible and be responsible about it. If actual lives are lost, this needs to be documented.”

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  • Chris Collins

    Also see amfAR’s analysis of the human impact of sequestration on global health programming at

  • lightweaver1213

    In the end, it is always the taxpayers and consumers who pay for the mistakes through the history of healthcare. There was a time that physicians and medical services for patient care became very very greedy by over-billing the insurance companies. Thus the insurance industry was forced to step into “managed care.”

    While it curbed the greed, medical insurance continued to escalate. We have come to this point with health benefits not being affordable, mainly because our economy has changed and the healthcare providers want more money from the employers with the employees losing out on benefits and thus is no longer affordable to the average worker. Either the deductibles are so high or the premiums out of reach to the average household.

    Then historically we can look back and see where our own government was stealing from the Social Security fund for years. Now that thievery has caught up and the government has no means to replace those funds for their intended purposes.

    In order to change healthcare coverage/premiums/deductibles, there has to be a driving force to achieve this. This means higher wages and lower prices on the consumption of goods. Someone has to pay the piper in order to have affordable healthcare, but it is not the general public who should take that on. Let our government take the fall for its own mistakes and quit using the public as a scapegoat. This whole situation only stands to get worse before it gets better. All things are relative either with the cause or the effect.