{ "id": "R43115", "type": "CRS Report", "typeId": "REPORTS", "number": "R43115", "active": true, "source": "EveryCRSReport.com, University of North Texas Libraries Government Documents Department", "versions": [ { "source": "EveryCRSReport.com", "id": 582673, "date": "2018-07-09", "retrieved": "2018-07-10T20:01:48.710366", "title": "U.S. Global Health Assistance: FY2001-FY2019 Request", "summary": "Congressional interest in and support for global health programs has remained strong for several years. In FY2018, Congress provided $8.7 billion for global health programs through State, Foreign Operations appropriations and $488.6 million through Labor, Health and Human Services, and Education (Labor-HHS) appropriations. These funds are managed by several U.S. agencies and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)\u2014a multilateral organization aimed at combating the three diseases worldwide. Concern about infectious diseases, especially HIV/AIDS, tuberculosis, and malaria (HTAM), continues to drive budget growth. In FY2001, roughly 47% of the U.S. global health budget was aimed at these three diseases. By FY2018, almost 75% of U.S. global health funding was provided for fighting HTAM. The Appendix outlines U.S. funding for global health by agency and program. The 115th Congress may debate several pressing global health issues, including the following: \nStrengthening Health Systems. The global spread of recent disease outbreaks, including Ebola and Zika, has intensified debates about the advantages and disadvantages of disease-specific funding. Congressional interest in bolstering weak health systems was particularly strong during the Ebola outbreak. Congressional discussions about health system strengthening have been waning, though some interest remains, including in proposed legislation (see for example H.Res. 342, 115th Congress).\nBolstering Pandemic Preparedness. Since 1980, infectious diseases have caused outbreaks that have been occurring with greater frequency and have been leading to higher numbers of human infections. Outbreaks caused by diseases that were once concentrated in tropical regions, including Ebola and Zika, are spreading through international travel. At the same time, long-standing diseases like tuberculosis and malaria are becoming increasingly resistant to available drugs and also threaten global health. \nThe United States has been a key supporter in global efforts to bolster pandemic preparedness in low- and middle- income countries. It is unclear whether the 115th Congress will sustain high levels of supports, including through funding, for global health security efforts. In its report on H.R. 5515, National Defense Authorization Act for Fiscal Year 2019, the House Committee on Armed Services directed the Secretary of Defense, in coordination with the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, to develop an action plan to counter emerging infectious disease threats.\nConsidering the FY2019 Budget Request. The 115th Congress is considering the FY2019 budget request, which includes over $7 billion for global health assistance, roughly 24% less than FY2018 enacted levels. The Trump Administration proposes reducing the USAID global health budget by nearly 40% through the elimination of funding for global health security, vulnerable children, and HIV/AIDS programs and reductions to other health programs. The Trump Administration also recommended cuts for PEPFAR programs managed by the State Department (-11%), the Global Fund (-31%), and CDC global health programs (-16%). \nProtecting Life in Global Health Assistance. In 1984, former President Ronald Reagan issued what has become known as the \u201cMexico City policy,\" which required foreign nongovernmental organizations receiving USAID family planning assistance to certify that they would not perform or actively promote abortion as a method of family planning, even if such activities were conducted with non-U.S. funds. The policy has been rescinded and reinstituted across Administrations. Under the Trump Administration, the policy was reinstated, renamed to Protecting Life in Global Health Assistance (PLGHA), and expanded to apply to all global health programs. \nGlobal health experts are working to measure the impact of the PLGHA policy. Opponents maintain that the policy imperils all global health programs because some health providers may not be able to disentangle FP/RH, HIV/AIDS, and maternal and child health services from one another, particularly in areas with limited access to health workers and facilities. Supporters maintain that although existing laws ban U.S. funds from being used to perform or promote abortions abroad, money is fungible and the PLGHA policy closes loopholes. Since the Mexico City Policy was first established, Members on both sides of the issue have introduced legislation to permanently enact or repeal the policy (for example, see H.R. 671 and S. 210, Global Health, Empowerment, and Rights Act, 115th Congress).\nAuthorizing the extension of PEPFAR. Legislation that authorizes appropriations for PEPFAR and describes congressional priorities for the initiative expires September 30, 2018. PEPFAR continues to receive bipartisan support and is being maintained by the Trump Administration, though at lower levels than previous administrations. Following the release of the FY2018 budget and Strategy, some HIV/AIDS advocates and Members of Congress questioned the Administration\u2019s commitment to controlling the global AIDS epidemic and expressed concern about whether people on ART would lose coverage due to spending cuts. The Administration has pledged to maintain the current level of antiretroviral treatment provided through PEPFAR \nPlans to maintain treatment levels are a departure from the Bush and Obama Administrations, under which executive and legislative priorities for PEPFAR included steadily increasing the number of people receiving ART through PEPFAR programs. Some Members of Congress have challenged the Trump Administration\u2019s approach to PEPFAR, raising questions about whether executive and legislative consensus around broadening the reach of PEPFAR and advancing the global goal of achieving an AIDS-free generation is fraying.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43115", "sha1": "7b09329a0075b8a222e31a35cc4acd19a57455ec", "filename": "files/20180709_R43115_7b09329a0075b8a222e31a35cc4acd19a57455ec.html", "images": { "/products/Getimages/?directory=R/html/R43115_files&id=/1.png": "files/20180709_R43115_images_45bf21326b60241f8876833662b1933b250528e9.png", "/products/Getimages/?directory=R/html/R43115_files&id=/5.png": "files/20180709_R43115_images_eaca611823b279422f2e64c6a0469056b56db1c9.png", "/products/Getimages/?directory=R/html/R43115_files&id=/0.png": "files/20180709_R43115_images_679b5acbfe17650f6f9f6a2f532e62156ebd35e2.png", "/products/Getimages/?directory=R/html/R43115_files&id=/2.png": "files/20180709_R43115_images_0b163200742048dd211d111ec31190c5e81834b4.png", "/products/Getimages/?directory=R/html/R43115_files&id=/4.png": "files/20180709_R43115_images_2c13236617fad1513b009589fbbb26dcde74275b.png", "/products/Getimages/?directory=R/html/R43115_files&id=/3.png": "files/20180709_R43115_images_bd2f2fa237865b64366144ee233888dbbaa71468.png" } }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43115", "sha1": "b900ef3b9e8cd92cfd698ca719b48bb090630970", "filename": "files/20180709_R43115_b900ef3b9e8cd92cfd698ca719b48bb090630970.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4757, "name": "Foreign Assistance" }, { "source": "IBCList", "id": 4879, "name": "Sub-Saharan Africa" } ] }, { "source": "EveryCRSReport.com", "id": 582224, "date": "2018-06-22", "retrieved": "2018-06-25T13:08:57.311067", "title": "U.S. Global Health Assistance: FY2001-FY2019 Request", "summary": "Congressional interest in and support for global health programs has remained strong for several years. In FY2018, Congress provided $8.7 billion for global health programs through State, Foreign Operations appropriations and $488.6 million through Labor, Health and Human Services, and Education (Labor-HHS) appropriations. These funds are managed by several U.S. agencies and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)\u2014a multilateral organization aimed at combating the three diseases worldwide. Concern about infectious diseases, especially HIV/AIDS, tuberculosis, and malaria (HTAM), continues to drive budget growth. In FY2001, roughly 47% of the U.S. global health budget was aimed at these three diseases. By FY2018, almost 75% of U.S. global health funding was provided for fighting HTAM. The Appendix outlines U.S. funding for global health by agency and program. The 115th Congress may debate several pressing global health issues, including the following: \nStrengthening Health Systems. The global spread of recent disease outbreaks, including Ebola and Zika, has intensified debates about the advantages and disadvantages of disease-specific funding. Congressional interest in bolstering weak health systems was particularly strong during the Ebola outbreak. Congressional discussions about health system strengthening have been waning though some interest remains, including in proposed legislation (see for example H.Res. 342, 115th Congress).\nBolstering Pandemic Preparedness. Since 1980, infectious diseases have caused outbreaks that have been occurring with greater frequency and have been leading to higher numbers of human infections. Outbreaks caused by diseases that were once concentrated in tropical regions, including Ebola and Zika, are spreading through international travel. At the same time, long-standing diseases like tuberculosis and malaria are becoming increasingly resistant to available drugs and also threaten global health. \nThe United States has been a key supporter in global efforts to bolster pandemic preparedness in low- and middle- income countries. It is unclear whether the 115th Congress will sustain high levels of supports, including through funding, for global health security efforts. In its report on H.R. 5515, National Defense Authorization Act for Fiscal Year 2019, the House Committee on Armed Services directed the Secretary of Defense, in coordination with the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, to develop an action plan to counter emerging infectious disease threats.\nConsidering the FY2019 Budget Request. The 115th is considering the FY2019 budget request, which includes over $7 billion for global health assistance, roughly 24% less than FY2018 enacted levels. The Trump Administration proposes reducing the USAID global health budget by nearly 40% through the elimination of funding for global health security, vulnerable children, and HIV/AIDS programs and reductions to other health programs. The Trump Administration also recommended cuts for PEPFAR programs managed by the State Department (-11%), the Global Fund (-31%) and for CDC global health programs (-16%). \nProtecting Life in Global Health Assistance. In 1984, former President Ronald Reagan issued what has become known as the \u201cMexico City policy,\" which required foreign nongovernmental organizations receiving USAID family planning assistance to certify that they would not perform or actively promote abortion as a method of family planning, even if such activities were conducted with non-U.S. funds. The policy has been rescinded and reinstituted across Administrations. Under the Trump Administration, the policy was reinstated, renamed to Protecting Life in Global Health Assistance (PLGHA) and expanded to apply to all global health programs. \nGlobal health experts are working to measure the impact of the PLGHA policy. Opponents maintain that the policy imperils all global health programs because some health providers may not be able to disentangle FP/RH, HIV/AIDS, and maternal and child health services from one another, particularly in areas with limited access to health workers and facilities. Supporters maintain that although existing laws ban U.S. funds from being used to perform or promote abortions abroad, money is fungible and the PLGHA policy closes loopholes. Since the Mexico City Policy was first established, Members on both sides of the issue have introduced legislation to permanently enact or repeal the policy (for example, see H.R. 671 and S. 210, Global Health, Empowerment, and Rights Act, 115th Congress).\nAuthorizing the extension of PEPFAR. Legislation that authorizes appropriations for PEPFAR and describes congressional priorities for the initiative expires September 30, 2019. PEPFAR continues to receive bipartisan support and is being maintained by the Trump Administration, though at lower levels than previous administrations. Following the release of the FY2018 budget and Strategy, some HIV/AIDS advocates and Members of Congress questioned the Administration\u2019s commitment to controlling the global AIDS epidemic and expressed concern about whether people on ART would lose coverage due to spending cuts.11 The Administration has pledged to current level of antiretroviral treatment provided through PEPFAR \nPlans to maintain treatment levels is a departure from the Bush and Obama Administrations, under which executive and legislative priorities for PEPFAR included steadily increasing the number of people receiving ART through PEPFAR programs. Some Members of Congress have challenged the Trump Administration\u2019s approach to PEPFAR, raising questions about whether executive and legislative consensus around broadening the reach of PEPFAR and advancing the global goal of achieving an AIDS-free generation is fraying.14F", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43115", "sha1": "a85187bd5c51e42b0312c5dab1240d7c3ab7a60e", "filename": "files/20180622_R43115_a85187bd5c51e42b0312c5dab1240d7c3ab7a60e.html", "images": { "/products/Getimages/?directory=R/html/R43115_files&id=/1.png": "files/20180622_R43115_images_45bf21326b60241f8876833662b1933b250528e9.png", "/products/Getimages/?directory=R/html/R43115_files&id=/5.png": "files/20180622_R43115_images_eaca611823b279422f2e64c6a0469056b56db1c9.png", "/products/Getimages/?directory=R/html/R43115_files&id=/0.png": "files/20180622_R43115_images_679b5acbfe17650f6f9f6a2f532e62156ebd35e2.png", "/products/Getimages/?directory=R/html/R43115_files&id=/2.png": "files/20180622_R43115_images_0b163200742048dd211d111ec31190c5e81834b4.png", "/products/Getimages/?directory=R/html/R43115_files&id=/4.png": "files/20180622_R43115_images_2c13236617fad1513b009589fbbb26dcde74275b.png", "/products/Getimages/?directory=R/html/R43115_files&id=/3.png": "files/20180622_R43115_images_bd2f2fa237865b64366144ee233888dbbaa71468.png" } }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43115", "sha1": "0378cbd8124b155b08debcf94e68ad704e646637", "filename": "files/20180622_R43115_0378cbd8124b155b08debcf94e68ad704e646637.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4757, "name": "Foreign Assistance" }, { "source": "IBCList", "id": 4879, "name": "Sub-Saharan Africa" } ] }, { "source": "EveryCRSReport.com", "id": 573868, "date": "2017-10-06", "retrieved": "2017-10-10T17:07:58.054295", "title": "U.S. Global Health Assistance: FY2001-FY2018 Request", "summary": "Congressional interest in and support for global health programs has remained strong for several years. In FY2017, U.S. global health funding reached an estimated $9.6 billion. These funds are managed by several U.S. agencies and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)\u2014a multilateral organization aimed at combating the three diseases worldwide. Concern about infectious diseases, especially HIV/AIDS, tuberculosis, and malaria (HTAM), continues to drive budget growth. In FY2001, roughly 47% of the U.S. global health budget was aimed at these three diseases. By FY2017, roughly 73% of the U.S. global health budget was provided for fighting HTAM. The Appendix outlines U.S. funding for global health by agency and program. The 115th Congress may debate several pressing global health issues, including the following:\nFY2018 Budget Request. The FY2018 budget request includes almost $7 billion for global health assistance, roughly 30% less than the FY2017-enacted level. The budget request proposes halving the USAID global health budget through the elimination of funding for global health security, vulnerable children, and family planning and reproductive health. Budget reductions are also recommended for all other health programs. Additional budget cuts (-19%) are proposed for the U.S. Centers for Disease Control and Prevention (CDC) global health programs through the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor-HHS) appropriations. The bulk of the budgetary cuts through Labor-HHS appropriations is aimed at HIV/AIDS. For detailed information on global health programs funded through the Department of State, Foreign Operations, and Related Programs (SFOPs) and Labor-HHS appropriations, see Table A-2 and Table A-3, respectively. \nStrengthening Health Systems. The international community has coalesced around reducing maternal and mortality rates, as well as deaths caused by infectious diseases. While these efforts have improved health outcomes in these areas, this approach has left many countries ill-prepared to address other health issues, including disease outbreaks. The 2014 West Africa Ebola epidemic killed over 11,000 people and spread to 10 countries. The inability of the source countries to contain the outbreak and avert widespread death has prompted calls for investing in health systems to help countries withstand unanticipated health shocks, like disease outbreaks, but also to address other looming health issues such as noncommunicable diseases. Opponents are concerned, however, that such an approach is difficult to measure and oversee. \nThe Growing Influence of Nonstate Actors. Although the United States remains the largest donor for health assistance worldwide, some observers believe its influence is diminishing as nonstate actors play a greater role. In 2015, for example, spending on global health by the Bill & Melinda Gates Foundation was higher than all countries in the Development Assistance Community except the United States. Some groups are also concerned that the United States is minimizing its ability to protect its priorities as it channels more funds to multilateral actors like the Global Fund and the GAVI Alliance. Others counter that participation in these organizations enables the United States to attract additional resources for global health programs and reduce redundancies. \nIn addition to these issues, the 115th Congress may address other impending health challenges, such as pandemic threats from existing infectious diseases and novel diseases, as well as a growing global burden of noncommunicable diseases.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43115", "sha1": "75b8b0b0570b32ea69c8e13ba1949312bc245748", "filename": "files/20171006_R43115_75b8b0b0570b32ea69c8e13ba1949312bc245748.html", "images": { "/products/Getimages/?directory=R/html/R43115_files&id=/1.png": "files/20171006_R43115_images_45bf21326b60241f8876833662b1933b250528e9.png", "/products/Getimages/?directory=R/html/R43115_files&id=/5.png": "files/20171006_R43115_images_80a56a24982f77c0ac7c83cbfe2dcd32d89ae44a.png", "/products/Getimages/?directory=R/html/R43115_files&id=/0.png": "files/20171006_R43115_images_7ab39517dfa6172fc5d756c8c0a62b54f5928a6a.png", "/products/Getimages/?directory=R/html/R43115_files&id=/2.png": "files/20171006_R43115_images_0b163200742048dd211d111ec31190c5e81834b4.png", "/products/Getimages/?directory=R/html/R43115_files&id=/6.png": "files/20171006_R43115_images_c9c2351afbb455d57f6a6f217d83a95b74289385.png", "/products/Getimages/?directory=R/html/R43115_files&id=/4.png": "files/20171006_R43115_images_7fdea0438a3ba66aa1e3b7a4be005d105f8635d7.png", "/products/Getimages/?directory=R/html/R43115_files&id=/3.png": "files/20171006_R43115_images_2acba0b96b025c2d923c739c1b1187880d923fa0.png" } }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43115", "sha1": "53403d3ef59f447fb97c494b20ce5a0334d471f2", "filename": "files/20171006_R43115_53403d3ef59f447fb97c494b20ce5a0334d471f2.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4757, "name": "Foreign Assistance" }, { "source": "IBCList", "id": 4879, "name": "Sub-Saharan Africa" } ] }, { "source": "EveryCRSReport.com", "id": 573591, "date": "2017-09-05", "retrieved": "2017-10-02T22:32:21.935115", "title": "U.S. Global Health Assistance: FY2001-FY2018 Request", "summary": "Congressional interest in and support for global health programs has remained strong for several years. In FY2017, U.S. global health funding reached an estimated $9.6 billion. These funds are managed by several U.S. agencies and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)\u2014a multilateral organization aimed at combating the three diseases worldwide. Concern about infectious diseases, especially HIV/AIDS, tuberculosis, and malaria (HTAM), continues to drive budget growth. In FY2001, roughly 47% of the U.S. global health budget was aimed at these three diseases. By FY2017, roughly 73% of the U.S. global health budget was provided for fighting HTAM. The Appendix outlines U.S. funding for global health by agency and program. The 115th Congress may debate several pressing global health issues, including the following:\nFY2018 Budget Request. The FY2018 budget request includes almost $7 billion for global health assistance, roughly 30% less than the FY2017-enacted level. The budget request proposes halving the USAID global health budget through the elimination of funding for global health security, vulnerable children, and family planning and reproductive health. Budget reductions are also recommended for all other health programs. Additional budget cuts (-19%) are proposed for the U.S. Centers for Disease Control and Prevention (CDC) global health programs through the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor-HHS) appropriations. The bulk of the budgetary cuts through Labor-HHS appropriations is aimed at HIV/AIDS. For detailed information on global health programs funded through the Department of State, Foreign Operations, and Related Programs (SFOPs) and Labor-HHS appropriations, see Table A-2 and Table A-3, respectively. \nStrengthening Health Systems. The international community has coalesced around reducing maternal and mortality rates, as well as deaths caused by infectious diseases. While these efforts have improved health outcomes in these areas, this approach has left many countries ill-prepared to address other health issues, including disease outbreaks. The 2014 West Africa Ebola epidemic killed over 11,000 people and spread to 10 countries. The inability of the source countries to contain the outbreak and avert widespread death has prompted calls for investing in health systems to help countries withstand unanticipated health shocks, like disease outbreaks, but also to address other looming health issues such as noncommunicable diseases. Opponents are concerned, however, that such an approach is difficult to measure and oversee. \nThe Growing Influence of Nonstate Actors. Although the United States remains the largest donor for health assistance worldwide, some observers believe its influence is diminishing as nonstate actors play a greater role. In 2015, for example, spending on global health by the Bill & Melinda Gates Foundation was higher than all countries in the Development Assistance Community except the United States. Some groups are also concerned that the United States is minimizing its ability to protect its priorities as it channels more funds to multilateral actors like the Global Fund and the GAVI Alliance. Others counter that participation in these organizations enables the United States to attract additional resources for global health programs and reduce redundancies. \nIn addition to these issues, the 115th Congress may address other impending health challenges, such as pandemic threats from existing infectious diseases and novel diseases, as well as a growing global burden of noncommunicable diseases.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43115", "sha1": "33594bef0f831e551b51977f94a16f73ec9d2886", "filename": "files/20170905_R43115_33594bef0f831e551b51977f94a16f73ec9d2886.html", "images": { "/products/Getimages/?directory=R/html/R43115_files&id=/1.png": "files/20170905_R43115_images_45bf21326b60241f8876833662b1933b250528e9.png", "/products/Getimages/?directory=R/html/R43115_files&id=/5.png": "files/20170905_R43115_images_80a56a24982f77c0ac7c83cbfe2dcd32d89ae44a.png", "/products/Getimages/?directory=R/html/R43115_files&id=/0.png": "files/20170905_R43115_images_19b25c4726516ae2293b37cf25bcd6faafde779d.png", "/products/Getimages/?directory=R/html/R43115_files&id=/2.png": "files/20170905_R43115_images_2ee4cfd3a6f1350f2db6bea2b8e0a44242195391.png", "/products/Getimages/?directory=R/html/R43115_files&id=/6.png": "files/20170905_R43115_images_c9c2351afbb455d57f6a6f217d83a95b74289385.png", "/products/Getimages/?directory=R/html/R43115_files&id=/4.png": "files/20170905_R43115_images_7fdea0438a3ba66aa1e3b7a4be005d105f8635d7.png", "/products/Getimages/?directory=R/html/R43115_files&id=/3.png": "files/20170905_R43115_images_2acba0b96b025c2d923c739c1b1187880d923fa0.png" } }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43115", "sha1": "987993af4cb8a6dc02572134e7a833777dafd9a8", "filename": "files/20170905_R43115_987993af4cb8a6dc02572134e7a833777dafd9a8.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4757, "name": "Foreign Assistance" }, { "source": "IBCList", "id": 4879, "name": "Sub-Saharan Africa" } ] }, { "source": "EveryCRSReport.com", "id": 441260, "date": "2015-05-11", "retrieved": "2016-04-06T19:06:00.337819", "title": "U.S. Global Health Assistance: FY2001-FY2016", "summary": "Congressional support for global health programs has remained strong for several years. U.S. global health funding rose from $1.7 billion in FY2001 to $9.3 billion in FY2015. These funds are managed by several U.S. agencies and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)\u2014a multilateral organization aimed at fighting the three diseases worldwide. Concern about infectious diseases, especially HIV/AIDS, tuberculosis, and malaria (HTAM), continues to drive budget growth. In FY2001, roughly 47% of the U.S. global health budget was aimed at these three diseases. By FY2015, roughly 70% of the U.S. global health budget was provided for fighting HTAM. The Appendix outlines U.S. funding for global health by agency and program. The 114th Congress may debate several pressing global health issues, including the folloring.\nFY2016 Budget Request. The FY2016 budget request includes more than $9 billion for global health programs, roughly 2% less than in FY2015. The Administration proposes significant cuts through State-Foreign Operations for vulnerable children (-34%), global health security (-31%), tuberculosis (-19%), the Global Fund (-18%), neglected tropical diseases (-14%), and nutrition (-12%). The President is seeking a 5% increase for global health programs funded through the Labor-HHS appropriations. Some observers have questioned why the Administration has requested lower spending levels for programs aimed at advancing global health security and addressing infectious disease through State-Foreign Operations appropriations, while seeking an increase for similar programs through Labor-HHS Appropriations. \nCoordinating Bilateral Health Programs. In his first term, President Obama announced the Global Health Initiative (GHI) to coordinate U.S. bilateral health programs. After having established interagency GHI task forces and developed interagency country health plans for 28 countries, the initiative appears to have stalled. The Administration has not nominated a GHI Coordinator and the interagency teams have largely disbanded. Some advocates assert that GHI was a good model and that global health programs need to be coordinated. Supporters of this idea assert that coordinated health programs are more cost-efficient, can have greater impact, and can advance country ownership. Detractors argue that this approach adds bureaucracy and could exacerbate interagency tensions. Concerns about disparate legislative oversight authorities have also been raised. \nStrengthening Health Systems. The international community has coalesced around reducing maternal and mortality rates, as well as deaths caused infectious diseases. While these efforts have improved health outcomes in these areas, this approach has left many countries ill-prepared to address other health issues like disease outbreaks. The Ebola epidemic has prompted calls for investing in health systems to help countries withstand unanticipated health shocks, like disease outbreaks, but also to address looming health issues like noncommunicable disease. Opponents are concerned, however, that such an approach is difficult to measure and oversee. \nThe Growing Influence of Non-State Actors. Although the United States remains the largest donor for health assistance worldwide, some observers believe its influence is diminishing as non-state actors play a greater role. In 2013, for example, spending on global health by the Bill & Melinda Gates Foundation was higher than all countries in the Development Assistance Community except the United States. Some groups are also concerned that the United States is minimizing its ability to protect its priorities as it channels more funds to multilateral actors like the Global Fund and the GAVI Alliance. Others counter, however, that participation in these organizations enables the United States to attract additional resources for global health programs and reduce redundancies. Supporters also point out that the United States plays a leading role in most multilateral health programs. For example, Ambassador Mark Dybul (the former PEPFAR Coordinator) is the Executive Director of the Global Fund, and U.S. officials sit on several influential Global Fund boards. \nIn addition to these issues, the 114th Congress may also discuss how to address other impending health challenges, such as rising noncommunicable disease prevalence, emerging diseases, and pandemic threats.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R43115", "sha1": "5573d81a0c2f79b1949b338f42e1682fdc08f817", "filename": "files/20150511_R43115_5573d81a0c2f79b1949b338f42e1682fdc08f817.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R43115", "sha1": "ba0326d0d7a8165a23e28340e40389fc536c1ed2", "filename": "files/20150511_R43115_ba0326d0d7a8165a23e28340e40389fc536c1ed2.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 276, "name": "Sub-Saharan Africa" }, { "source": "IBCList", "id": 3241, "name": "Global Health, Human Rights, and Humanitarian Policy" }, { "source": "IBCList", "id": 3467, "name": "Foreign Aid" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc227874/", "id": "R43115_2013Jun21", "date": "2013-07-21", "retrieved": "2013-11-05T18:07:05", "title": "U.S. Global Health Assistance: Background and Issues for the 113th Congress", "summary": "Report that discusses the role and efficacy of U.S. foreign aid, including global health programs, the U.S. global health programs, global health funding, and global health initiative.", "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20130721_R43115_887cd9370ac64bfc16713cf92fa2150ffce4a014.pdf" }, { "format": "HTML", "filename": "files/20130721_R43115_887cd9370ac64bfc16713cf92fa2150ffce4a014.html" } ], "topics": [ { "source": "LIV", "id": "Health care industry", "name": "Health care industry" }, { "source": "LIV", "id": "Global budgets", "name": "Global budgets" }, { "source": "LIV", "id": "Health promotion", "name": "Health promotion" } ] } ], "topics": [ "Appropriations", "Foreign Affairs", "Health Policy", "National Defense" ] }