When it comes to global health, how much are we spending?

When it comes to global health, how much are we spending?

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What we spend money on reflects what we care about. Every year, for example, Americans spend over $100 billion on fast food and $250 billion on clothes and accessories. Even Qatar, with a GDP one-eighth the size of that of the US, is expected to spend roughly $200 billion on preparations to host the 2022 World Cup. Now consider global health: over the last 15 years, the total amount of money donors spent on global health efforts in poor countries nears $230 billion—a pretty hefty sum by any measure.

But as it turns out, donors’ contributions (defined as development assistance for health, or DAH) have actually plateaued in recent years. According to a new report from the Institute for Health Metrics and Evaluation (IHME), the total amount of DAH disbursed to poor countries has hovered around $30-35 billion since 2010 (almost 50% less than what French consumers spend on alcohol and cigarettes). And in fact, in 2014, overall DAH declined by 1.6% from 2013 levels.

IHME-1

Sources of Development Assistance for Health (1990-2014)

It may come as even more of a surprise that this stagnation persisted during a year that saw the onset of the Ebola crisis, for which over $650 million in additional funds were channeled to Western Africa as DAH. It would appear that funding for Ebola was then not secured by reaching deeper into donor pockets in a time of crisis, but instead by reallocating or displacing money that had already been committed for other health priorities.

The reason for this slump, you might ask? The global financial crisis, for one, has played a part in forcing countries to construct stricter budgetary environments, especially in Europe. As part of their austerity efforts, for example, Portugal, Austria, and Italy have decreased their bilateral DAH contributions by an average of almost 40% since 2010.

But financial mayhem cannot be the only answer—indeed, we must also understand changes in what policymakers and citizens care about. Fifteen years ago, the international community put health at the forefront of the Millennium Development Goals (MDGS), setting out to reduce child mortality by two-thirds, maternal mortality by 75%, and the spread of major infectious diseases. The related growth in financing for global health efforts that followed in the early 2000s was unprecedented.

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Millennium Development Goals

But if we interpret more recent spending trends as a proxy for country priorities, the change in DAH since 2010 would imply that global health isn’t as hot as it used to be. In the first decade of the MDG era, for instance, Canadian DAH increased by an average of 55% per year. Yet between 2010 and 2014, that annualized average was reduced to a meager 1%. Since 2010, these same patterns have been observed in other high-income donors like Germany and the US.

As emphasized in the report, nevertheless, not all changes to DAH since 2000 have been negative. During the so-called slump period, funding from the UK has actually increased by nearly 50%, and the Bill & Melinda Gates Foundation increased their DAH by 61%. And funding for Gavi has increased by over 100% in the last five years—a jump supported in part by advocacy campaigns from ONE members like you and our partners.

So which diseases have been the winners and the losers over the past 15 years? Since 2000, both malaria and TB have seen over 800% increases in DAH, while HIV/AIDS, which began occupying only 12% of total DAH in 2000, saw its piece of the pie shoot up to 30%, representing $57.5 billion in cumulative disbursements by 2010.

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% of DAH allocated to health focus (2000, 2010, and 2014)

 Between 2010 and 2014, however, DAH for HIV/AIDS increased by only 3%, recently leveling off at $10.9 billion per year. According to UNAIDS, this is at least $3-5 billion short of global need.

Despite the recent sluggish trends for AIDS, not all health-area funding has stagnated since 2010. In just the past five years, DAH for maternal and child health has respectively increased by 18% and 32%. In the last five years, the DAH targeted towards non-communicable diseases (NCDs), the largest contributor to mortality both globally and in the majority of low- and middle-income countries (LMICs), has also increased by nearly 30%.

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Change (%) in DAH health focus areas (2010-2014)

Flattened donor financing for health presents a real and dangerous threat as the international community prepares to evaluate the MDGs and set new goals for the post-2015 era. While it is important for leaders to consider countries’ own domestic resources as a crucial source of additional health spending alongside DAH, the world’s least-developed countries and their current health programs are by no means self-sustaining. Flat-funding will not help us secure our goal reducing the disease burden unfairly shouldered by the world’s poorest—and in fact, we risk compromising the progress we have made thus far, allowing for diseases to emerge or rebound. IHME’s report, then, is a stark reminder about financing and prioritizing—a clear wake up call to the world’s health donors that the status quo is not enough.

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