The self-interest case for US global health cooperation

Abstract

While there is a great deal of talk in the US Congress about the importance of the global marketplace, as the world is now called in Washington, surprisingly little attention is being paid to global affairs. America seems to have turned inward, and leaders in Congress from both major parties seem to be thinking only of how they can cut not just the cost and size of the US government but also its power and influence. Given this atmosphere, there is a great danger that Congress will ignore the recent appeal by the Institute of Medicine's Board on International Health for a substantial expansion in US commitment to international efforts to improve world health. The IOM is an independent, non-profit organisation chartered by Congress to provide expert advice to the government on health policy. In a report entitled America's Vital Interest in Global Health, the IOM board points out that, despite the great wealth and scientific expertise of the USA, that country's involvement in efforts to improve international health is now at a low ebb. Not since 1950, the board notes, has the USA contributed such a small percentage of its gross domestic product to foreign assistance; the proportion is now smaller than that for any of the other top 20 industrialised nations. In 1995, for example, the USA spent just $7·3 billion on overseas assistance; in the same year Japan gave nearly twice that ($14·5 billion), France $8·4 billion, and the UK $3·2 billion. The USA has also been shirking its obligations to two international organisations that play an important role in improving world health-namely, the United Nations, to which it now owes $1·7 billion in past dues, and the World Health Organization, which is owed $145 million. Faced with such indifference, it is not surprising that the IOM board wastes little effort appealing to the humanitarian instincts of Congressional leaders. Instead, they argue that improving the health of the world is “enlightened self-interest”. The board warns, for example, that modern transportation now makes it possible for deadly pathogens anywhere in the world to reach the American heartland in less than a day. “From the standpoint of infectious diseases, we can consider no site remote, no person too removed to affect us, and no organism isolated anywhere.” Therefore, to protect its citizens at home the US government must fight diseases abroad. The surge in world trade also means that environmental hazards in distant countries can now threaten the health of people living in the United States, the board warns. Pesticides banned in the United States have been found on imported food and high levels of lead have been found in imported crayons from China, cosmetics from India, and canned food from Latin America. Only by helping developing nations identify and control their environmental hazards, the IOM board argues, can the US be sure its citizens are safe as well. The board, however, does not rely solely on fear to move Congress to act. It also appeals to another powerful motivation, greed: for developing nations to flourish and become markets for US goods, their populations must be healthy. Even training foreign health-providers can be seen as a good investment, the report points out, for it introduces them to US medical devices, pharmaceuticals, and services and thus should generate a demand for these and other US products. The board calls for an Interagency Task Force on Global Health to coordinate the efforts of the many different federal agencies that now work separately on international health issues, and it wants the US government to begin to work more closely with non-governmental organisations and corporations to develop effective global health programmes. The IOM report provides the US Congress with a needed reminder that global health is too important to ignore. How sad, though, that altruism, in this historically most generous of nations, carries so little weight these days. The trouble with the focus on US self-interest, enlightened or notcarries so little weight these days. The trouble with the focus on US self-interest, enlightened or not, is that some international partners may distrust US motives. One way for the USA to demonstrate its intent to work as an equal partner with its collaborators would be to follow another IOM board recommendation and quickly settle its debts to the UN and WHO.