Meier 10 – Asst. Professor of Global Health Policy @ UNC Chapel Hill (Benjamin Mason, The Obama Administration’s Global Health Initiative: Public Health Law, U.S. Foreign Policy & Universal Human Rights, Public Health Law, 2010)
Global health is fast becoming an explicit goal of U.S. policy – with legislation, regulations, and policy statements guiding our funding, activities, and programs to address public health abroad. At the intersection of foreign policy and health policy, this global health imperative for public health law is poised to grow under the Obama Administration’s Global Health Initiative. With contemporary institutions of global health governance now over 60 years old, the nature of the global health architecture has changed considerably as the United States has shifted its global health priorities.[i] As a leading progenitor of the global health governance framework, the United States has long sought a place for global health policy to alleviate suffering in an increasingly interconnected world. However, with U.S. policymakers harboring suspicions that global governance would advance “socialized medicine” in the midst of the Cold War, the United States constrained international organizations to medical “impact projects” that would advance U.S. foreign policy interests.[ii] Despite fleeting U.S. support for global health policy in the 1970s,[iii] the 1980 election of President Reagan—and with it, principled opposition to international organizations—would limit opportunities for global health governance.[iv] Given a growing leadership vacuum in global health, the global health architecture began to shift toward greater U.S. hegemony in global health policy, with scholars increasingly noting that “the U.S. domestic agenda is driving the global agenda.”[v] Moving away from a model of working through international institutions for global health governance, the United States is bypassing multilateral organizations and pursuing a herculean expansion in bilateral health assistance, increasingly making U.S. foreign policy a singular force for global health.[vi] As the largest donor to global health—in absolute dollars, albeit less committed relative to GDP—foreign health assistance is fast becoming an anchor of U.S. soft power – answering the call for global health leadership in a post-Cold War world.[vii] Where once this role was defined by uncoordinated medical approaches to select high-profile diseases, the United States is moving toward coordinated foreign assistance to public health systems. With U.S. health diplomacy once grounded solely in the containment of the Cold War—to combat the “unsatisfactory living conditions on which Communism feeds,” influencing minds as much as bodies[viii]—the 1961 establishment of the U.S. Agency for International Development (USAID) galvanized foreign assistance for public health, administering technical and economic assistance for the provision of health services.[ix] However, even as extended by President Bush’s 2003 Emergency Plan for AIDS Relief (PEPFAR), these ambitious global health commitments would be criticized for excessive reliance on medical services and for “crowding out” public health systems in the developing world.[x] In spite of burgeoning efforts to address HIV, malaria, and tuberculosis, these fragmented U.S. efforts continued to lack coordination across government agencies, attention to health systems, and strategy for foreign assistance. But as ethical claims and human rights have renewed attention to the plight of the world’s poor,[xi] the United States has moved to coordinate foreign assistance for global health. Given the need for a comprehensive strategy to govern U.S. engagement with global health[xii]—a need that grew dire as the global financial crisis decimated global health[xiii]—the Institute of Medicine (IOM) recommended that the United States engage more deliberately in global health leadership.[xiv] To reshape foreign health assistance across U.S. agencies, programs, and partners, the Obama Administration’s Global Health Initiative (GHI) seeks to develop a unified global health strategy to integrate and organize U.S. global health efforts. Focusing on public health systems (specifically health financing, information management, and workforce capacity-building institutions)—adding onto existing disease-specific efforts (with 70% of funds earmarked for PEPFAR, notwithstanding a stabilization in HIV funding)—the GHI seeks to shape how the U.S. government coordinates its resources across global health activities and engages with developing countries in meeting nine targets for global health (delineated in figure 1), achieving these targets through seven key principles (delineated in figure 2).[xv] While it is unclear to what extent this foreign policy effort will meet its targets and principles for health system strengthening, preliminary coordination among agencies has begun to identify areas in which the United States could have the greatest sustainable impact on public health outcomes.[xvi] With $63 billion requested for this Initiative over a six year period, the GHI will seek to prioritize country-led efforts to reach the most effective and efficient improvements for public health systems. These changes in U.S. policy will greatly influence disease prevention and health promotion throughout the world, with public health lawyers holding key positions in shaping this policy. With an imperative to create policy frameworks to guide our innovative programs in global health, the need has never been greater to rethink how we in public health law endeavor to meet global health needs – viewing ourselves as key actors in the global health architecture and viewing our work as medicine on a global scale.