How The President is Doing

May 14th, 2009 10:00 AM UTC
By Lisa.Fleisher

This afternoon, I watched a webcast on the global health component of President Obama’s proposed budget for 2010 hosted by the Kaiser Family Foundation. ONE’s Senior Director for U.S. Government Relations, Tom Hart, sat on the panel which included distinguished guests such as Zeke Emanuel from the Office of Management and Budget, Tim Westmoreland from Georgetown Law and the House Committee on Energy and Commerce, and Allen Moore of the Stimson Center.

Here are some highlights:

Zeke Emanuel: President Obama’s commitment of $63 billion to global health over the next six years represents a major mark for what he hopes to accomplish during his Administration. The themes underlying the new Global Health Initiative indicate that health cannot be addressed one disease at a time, especially in the developing world. Thinking holistically about health means that maternal and child health, neglected tropical diseases, and health system infrastructure needs to be considered in an integrated manner parallel to interventions for HIV/AIDS, malaria, and tuberculosis. This does not mean that priority diseases are no longer a concern of the Administration – HIV/AIDS is not disappearing off the map. Nearly 75% of the proposed 2010 budget for global health goes to PEPFAR and as the Global Health Initiative progresses, the PEPFAR program will have 70% of the total. While it is not possible to solve all health problems at once, health problems have effects on the entire system. This must be kept in mind as the response to health crises in developing countries shifts from emergency to sustainability. An inter-agency task force is meeting to discuss how best to coordinate the U.S. agenda on global health, and Congress has requested a strategic plan for PEPFAR which will be released in October.

Tim Westmoreland: This budget year is unlike any other because of the financial crisis. While the total federal budget will be approximately $3.5 trillion, a lot of this is already claimed for mandatory programs like insurance. There is about $1.2 trillion available for discretionary spending programs, and global health might be about one half of one percent of this piece of the budget pie. However, Congress has already called for significant cuts to discretionary spending, so it will be hard to find additional money for global health. The President’s budget proposal calls for growth in the resources available for global health. However, even this will fall behind the growth in diseases, and what is needed to address them. It’s the role of advocates not to accept what has been laid out and to talk about what the need is. Percentage growth over an inadequate base is not a good place to start. “Bankers aren’t censoring themselves and advocates shouldn’t either.”

Tom Hart: While the proposal is not enough, in the context of the financial crisis, President Obama’s announcement of the Global Health Initiative was welcome. Over a six year timeframe, it looks possible to achieve good progress with a more comprehensive global health approach, even though some details have yet to be fleshed out. However, it is more sobering for 2010. ONE is looking forward to working with Congress to improve the funding levels in 2010 for PEPFAR and Global Fund as well as to realize the proposals made for the coming six years. When we do this, we need to be politically shrewd and keep the discussions vibrant, and interesting. PEPFAR focused on real goals (treat 2 million people, prevent 7 million infections, and care for 10 million people infected with HIV). ONE encourages the Administration to do the same with this $63b health initiative because otherwise the funding numbers become the end in themselves. Also, the link to national security is a powerful one, and Secretary Gates has been one of the biggest advocates of this.

Allen Moore: The unique economic environment puts even more pressure than normal on increasing foreign assistance. Members of Congress and Senators have to respond to priorities of people back home – spending overseas appears as not focusing on home priorities. All these factors are exacerbated now. As Congress heads into Appropriations, it is clear there is a relatively small amount of money that will go into subcommittees. These subcommittees will pay attention to Obama’s priorities but also have their own priorities to be responsive to constituents. Advocates have to know the facts to be effective in calling for increases for global health.

-Lisa Fleisher

TAGS: Barack Obama, HIV/AIDS, Uncategorized