By former Sens. Tom Daschle (D-S.D.) and Bill Frist (R-Tenn.)
Feb. 29, 2016 | The Hill
As the 2016 primaries unfold, it’s time for candidates of both parties to focus on expanding the big-hearted policies that have made this nation so exceptional.
In recent years, the most effective of those policies has been global health — that is, putting U.S. resources to work saving lives in developing nations by spreading health treatments that work here at home. In a study for the Bipartisan Policy Center last November, we showed how the largest global health project in history, the President’s Emergency Plan for AIDS Relief (PEPFAR), has not only saved millions of lives but also improved America’s national security.
Under PEPFAR, launched under former President George W. Bush and enhanced under President Obama, with bipartisan support in Congress over more than a decade, 9.5 million men, women and children, mainly in Africa, are receiving lifesaving anti-retroviral drugs. Some 68 million have gotten HIV testing and counseling, 5.5 million orphans and vulnerable children have received care and support, and 190,000 new healthcare workers have been trained. In addition, our study found that in PEPFAR countries, political instability and violence have fallen 40 percent (compared to just 3 percent in equivalent non-PEPFAR countries), while economic growth has increased — and so has America’s reputation.
Now, a new survey by the Kaiser Family Foundation, released in January, has discovered that, while Americans are proud of the accomplishments of programs like PEPFAR, a majority (53 percent) believe we are already “doing enough to improve health in developing countries.” And a majority (55 percent) believe that “spending more money won’t make much difference in improving health in developing countries.”
Those are disturbing statistics. They stray far from reality. The truth is that the U.S. has the innovation and the resources to put an end to rampant deaths not only from AIDS but from such scourges as malaria, tuberculosis and hepatitis C. Based on the PEPFAR experience, we have proof that health will be improved dramatically — and Americans themselves will benefit.
The good news is that the Kaiser study provides important guidance on how to persuade Americans that our nation should do more. The starting point is better education about global health.
The public is woefully misinformed not just about the success of U.S. programs but about their cost. The Kaiser survey, taken in December, found that, on average, those polled believed that 31 percent of the federal budget is spent on foreign aid (including health programs). The actual figure is less than 1 percent (correctly estimated by just 3 percent of those polled). Researchers discovered that, when respondents were informed of the correct spending on foreign aid, their support of increased spending on global health improved significantly.
Actual spending on global health by the U.S. government has been steady at between $9.2 billion and $10.2 billion per year since 2009, with the exception of 2015, when an additional $3.7 billion was spent to stem the Ebola crisis that directly threatened the health of Americans. For 2016, global health represents just 0.2 percent of federal spending, or about $10 billion out of $4.1 trillion. Another way of saying this is that just $32 out of the average American’s tax bill will go to global health programs — with about $19 for fighting AIDS, $2 for malaria, $1 for tuberculosis and $2 for maternal and child health.
Kaiser’s national study also asked respondents to give the most important reason for spending U.S. tax dollars to improve global health. In first place, by far, was “because it’s the right thing to do,” chosen by 46 percent. That’s no surprise. This is the most benevolent country in the world. When our 43rd president announced PEPFAR in 2003, he said, “Seldom has history offered a greater opportunity to do so much for so many.”
Our humanitarian instincts are the bedrock of global health programs, but the Kaiser study also pointed to other strong reasons to spend federal money: “to improve our diplomatic relationships,” “to help ensure national security,” “to help the U.S. economy,” and “to improve the U.S.’s image around the world.” In total, these four justifications topped the list for 48 percent of respondents. Another practical reason to improve health abroad is to prevent diseases like Ebola and the Zika virus from spreading through our own population.
As the presidential campaign progresses, we believe that Americans will want to hear candidates appeal to what Abraham Lincoln referred to as “the better angels of our nature.” Wiping out diseases in poorer countries is simply the right thing to do. But Americans are pragmatic people, too, and, as the Kaiser research shows, we want our contributions to be both cost-effective and beneficial to our own nation as well.
As our research has shown, programs like PEPFAR meet all of those tests: humanitarian, practical and self-serving. In this election season, Americans must require candidates for public office who demonstrate the leadership we will need to ensure global — and national — health.
Daschle served in the Senate from 1987 to 2005 and as Senate majority leader from 2001 to 2003. Frist, a physician, served in the Senate from 1995 to 2007 and as Senate majority leader from 2003 to 2007.