Obama's Global Health Budget

The global health world has been abuzz this week about President Obama's budget proposal, which includes $63 billion over six years on global health (White House Press Release). By "abuzz" I mean mostly angry and indignant. In fact, when Bono came out and praised "Doctor Obama" for the budget, the Global AIDS Alliance' Executive Director wrote a passive-aggressive open letter to him, "In the future, I would humbly recommend that you do not try to broker any half-step deals behind the back of people living with HIV/AIDS." Yikes.

What's behind this exasperation? Below, I have summed up the major criticisms of Obama's Global Health Budget from RESULTS, The Global AIDS Alliance, The Global Health Council, Physicians for Human Rights, and The Center for Global Health Policy:

Broken Campaign Promises. During the campaign, Obama made several campaign promises that contradict his current budget proposal:

1) Fully fund the President's Emergency Plan For AIDS Relief (PEPFAR), and expand it by $1 billion a year in new money for five years.

2) Make fair-share contributions to the Global Fund to Fight AIDS, TB, and Malaria

3) Provide at least $2 billion to a Global Fund for Education

4) Double foreign assistance by 2012

5) Support needle exchange programs

To give him credit, Obama's plan does increase spending from the FY 2009 budget, but not up to the level that the US has already pledged, and certainly not to the levels that he promised. Read on for more on each point.

A numbers game; Downsizing PEPFAR? Rather than increasing total global health funding, Obama has shifted money around, and changed the time commitment. Obama's budget proposes $51 billion on PEPFAR over six years (FY 2009 - 2014). In fact, Congress has already approved $48 billion for PEPFAR over the five years (FY 2009 - 2013). Extrapolating to six years would come to $57.6 billion. In other words, Obama's plan would not fully fund PEPFAR, let alone introduce $1 billion per year in new funds he promised.

Flat-lining of support for the Global Fund. The Global Fund for AIDS, TB and Malaria currently has a funding gap of at least $4-5 billion, and based on the size of the US economy, our fair share is $2.7 billion.  However, Obama's plan flat-lines the US support at $900 million. That's $1.8 billion short. The Global Fund's effectiveness is known and proven. When money is given, lives are saved. Over 3.5 million lives have been saved since 2002 through HIV/AIDS and TB treatment and bed net distribution.

Slow on Global Education. The budget commits $981 million for global basic education, not the $2 billion Obama promised (~$1.0 billion short). Why does education matter to health? For a girl in a poor country, every year of education beyond 3rd or 4th grade means her children will be 10 percent less likely to die of preventable causes.

(Non)-Doubling of Foreign Assistance. If the US increases spending by only $4.4 billion each year (as outlined in his budget), doubling will not be reached until at least FY2017 (a year after his possible second term).

Ban on Needle Exchange Programs Remains. There is a decade-old ban on federal funding for syringe exchange programs, which are critical to stopping the transmission of HIV among drug users. While Obama pledged support of such programs during his campaign and even after becoming president, his current budget includes language that bans it. In fact, a page on civil rights on the White House website changed from April to May 2009, removing evidence of the President's support of needle exchange programs

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Of course, we must remember that Obama's budget is just a proposal. The ultimate spending will depend on what Congress approves, and Congress only approves the budget on a year-by-year basis. Nevertheless, it is understandable why the nonprofit world is upset at President Obama for not being more ambitious, for not being more of a champion for the poor.

I want to believe this administration is more than just eloquent prose, and that there is funding to turn lofty ideals into reality. I feel like we are being a bit hard on him, but considering how many lives are on the line, I think it is appropriate for us to hold him to high standards. I leave you with these words Obama said in his inaugural address:

"To the people of poor nations, we pledge to work alongside you to make your farms flourish and let clean waters flow; to nourish starved bodies and feed hungry minds. And to those nations like ours that enjoy relative plenty, we say we can no longer afford indifference to suffering outside our borders; nor can we consume the world's resources without regard to effect. For the world has changed, and we must change with it."

For Further Reading:

(White House)  Statement by the President on Global Health Initiative

(US Department of State) International Affairs - FY 2010 Budget

(PEPFAR) A Commitment Renewed (Information on what PEPFAR includes)

(BarackObama.com) A Statement from Barack on Global AIDS Day (What candidate Obama promised)

(CQ Politics) Global Health Plan: Breaking New Ground or a Campaign Promise?

(RESULTS)  Analysis of the Administration's Global Health Budget (Chart, pdf)

(Global AIDS Alliance) President Obama's FY10 Budget Breaks His Campaign Promises on Global Issues

(ONE Campaign) ONE's Issues Report Card on President's FY2010 Budget

(ONE Campaign) Bono & ONE Applaud President Obama's Boost to Global Health Spending

(Center for Global Health Policy) Global HIV/AIDS & TB Experts Disappointed with Obama Budget

(Global Health Council) Council Looks for Details on President Obama's Global Health Budget

(Physicians for Human Rights) Obama Administration Shows Disappointing Inaction on Syringe Exchange Funding

(Huffington Post) Obama Budget Bans Federal Funding For Needle Exchange, Breaking Campaign Pledge