National Academies Press: OpenBook
« Previous: Front Matter
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

Summary

By investing in global health over the next 20 years, there is a chance to save the lives of millions of children and adults. Beyond these health benefits to individuals, global health is directly linked to economic productivity and growth worldwide. According to the Lancet Commission on Investing in Health, the return on investments in global health can be substantial—as the benefits can exceed the costs by a factor between 9 and 20, for low-income and lower middle-income countries, respectively. Worldwide, investing in core capacities to prevent, detect, and respond to infectious disease outbreaks through the development of multidisciplinary “One Health” systems focused on the interface of human and animal health can result in an estimated savings of $15 billion annually from the prevention of outbreaks alone. In light of these benefits, as well as the continual emergence and reemergence of infectious diseases and the growing threat of antimicrobial resistance, a sustainable commitment to global health security is an imperative for all nations.

The United States has long been a leader in global health, including through such high-profile programs as The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR); the President’s Malaria Initiative; the Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and more recently the Global Health Security Agenda. However, resources are not unlimited, and the case for continued commitment must be made. Against the backdrop of the influential legacy of the United States on the global health stage, the new administration is now faced with the choice of whether or not to ensure that gains in global health—won with billions of

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

U.S. dollars, years of dedication, and strong programs—are sustained and poised for further growth.

THE CASE FOR CONTINUED COMMITMENT TO GLOBAL HEALTH

The tremendous growth in international travel and trade that has occurred over the last several decades heightens the urgency of continued investments in global health. The resulting increased interconnectedness of the world and interdependency of countries, economies, and cultures have brought improved access to goods and services, but also a variety of health threats.

Foreign assistance is often considered a type of charity, or support for the less fortunate. Although this can be true for the poorest and most vulnerable populations, the majority of such aid, especially when directed toward health, is an investment in the health of the recipient country, as well as that of the United States and the world at large. This investment motivation for the United States is two-pronged—to secure protection against global health threats and to promote productivity and economic growth in other countries. While the burden of infectious diseases rests predominantly with low-income countries, these diseases represent global threats that could have dire consequences for any country, including the United States, in terms of both human and economic costs. Approximately 284,000 deaths were attributed to the 2009 H1N1 influenza outbreak, for example, and 2 million excess deaths are projected for a future moderate influenza pandemic. In only a few short months in 2003, the outbreak of severe acute respiratory syndrome (SARS) cost the world $40–$54 billion, while in 2014, the United States alone committed $5.4 billion in response to the Ebola outbreak, $119 million of which was spent on domestic screening and follow-up of airline passengers.

The increasing prevalence of noncommunicable diseases (NCDs) also has negatively affected global economies, threatening societal gains in life expectancy, productivity, and overall quality of life. The productivity losses associated with disability, unplanned absences from work, and increased accidents incur costs as much as 400 percent higher than the costs of treatment. Research also has shown that investors are less likely to enter markets where the labor force suffers a heavy disease burden. Thus, healthy populations are important on multiple levels. Investing in human capital contributes significantly to economic growth, prosperity, and stability in countries and creates more reliable and durable partners in the world. This strategy has proven successful, as evidenced by the fact that 11 of the top 15 trading partners of the United States are former recipients of foreign assistance.

In this context, the National Academies of Sciences, Engineering, and

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

TABLE S-1 Committee Recommendations and Corresponding Actions

Recommendation Actions

1

Improve international emergency response coordination.

2

Combat antimicrobial resistance.

3

Build public health capacity in low- and middle-income countries.

4

Envision the next generation of The U.S. President’s Emergency Plan for AIDS Relief.

5

Confront the threat of tuberculosis.

6

Sustain progress toward malaria elimination.

7

Improve survival in women and children.

8

Ensure healthy and productive lives for women and children.

9

Promote cardiovascular health and prevent cancer.

10

Accelerate the development of medical products.

11

Improve digital health infrastructure.

12

Transition investments toward global public goods.

13

Optimize resources through smart financing.

14

Commit to continued global health leadership.

Medicine were charged with conducting a consensus study to identify global health priorities in light of current and emerging global health threats and challenges and providing recommendations to the U.S. government and other stakeholders for increasing responsiveness, coordination, and efficiency in addressing these threats and challenges by establishing priorities and mobilizing resources. With support from a broad array of federal agencies, foundations, and private partners, an ad hoc 14-member committee was appointed to carry out this task over the course of 6 months.

RECOMMENDATIONS

Based on a rigorous and evidence-based consensus process, committee members formulated a set of 14 recommendations that, if implemented, will deliver a strong global health strategy and allow the United States to maintain its role as a global health leader (see Table S-1).1 The arguments supporting these recommendations are summarized in the section below on four priority areas for action.

___________________

1 The full text of these recommendations can be found in Chapter 10 of this report.

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

Priority Areas for Action

The landscape of global health is vast, and with new and sometimes disparate priorities across the health sector, considering each issue or disease in its own silo can be counterproductive. Such a narrow perspective hinders the ability to leverage investments in other programs and adapt resources from existing programs when a new threat arises. Thus, while prioritization of resources is necessary, it is also essential to embrace more holistic, system-focused concepts of integration, capacity building, and partnership to achieve results more comprehensively. With this understanding, the committee identified four priority areas for global health action that it believes, if addressed, will result in the greatest positive effect on global health.

  1. Achieve global health security

    In the last 10 years, outbreaks of potentially pandemic influenza, Middle East respiratory syndrome coronavirus (MERS-CoV), Ebola, and most recently Zika have threatened populations around the world. In each case, global and national responses, including those of the United States, have been reactionary, uncoordinated, ineffective, and highly costly. Absent the establishment of fundamental public health protections and preparedness capabilities at home and abroad, the world will never be ready to prevent, detect, and respond to such outbreaks. A solid commitment in the form of a sustainable mechanism for addressing these global threats is a critical need. The committee urges the administration to create a coordinating body within the U.S. government with the authority and budget to develop a proactive, cost-effective, and comprehensive approach to preparedness for and response to international public health emergencies. In addition, the committee calls for continued investments at the national level—and increased investments at the international level—to improve capabilities to confront the growing and alarming threat of antimicrobial resistance. Finally, the U.S. government should strengthen preparedness and response capacity in low- and middle-income countries through training and information exchange efforts (see Recommendations 1, 2, and 3).

  2. Maintain a sustained response to the continuous threats of communicable diseases

    Dedicated efforts of national governments, foundations, and the global community have resulted in millions of lives saved from AIDS, tuberculosis (TB), and malaria, yet all three diseases continue to pose immediate and longer-term threats to the health of populations around the world. More than 36 million people are living with HIV, with 2 million new infections occurring each year. TB disproportionately affects the

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×
  1. poorest populations of the world, killing 1.4 million each year, while dangerous resistant strains are becoming more prevalent and easily spread. The mortality rate due to malaria has decreased by more than 60 percent in the last 10 years, but those infected can lose 25 percent of their family’s income as a result of their lost productivity, affecting the prosperity of the society at large as well. The committee believes that a sustained focus on HIV/AIDS and malaria and a reevaluation of the commitment to fighting TB are imperative to prevent reversal of the gains achieved in the last few decades and avoid the further spread of resistant strains for all three diseases (see Recommendations 4, 5, and 6).

  2. Save and improve the lives of women and children

    Efforts to save the lives of women and children across the globe have historically been an important focus for the U.S. government. Although child and maternal mortality rates have decreased since 2000, each year nearly 6 million children die before their fifth birthday, and more than 300,000 women die from pregnancy- and childbirth-related causes. The vast majority of these deaths are preventable. The committee urges the U.S. government to continue its commitment to this survival agenda but also expand it to incorporate early childhood development as a key element. If current survival-focused programs can be complemented by a strong multisector focus on childhood development, the committee sees an opportunity to foster healthy families, resulting in turn in resilient societies and growing economies (see Recommendations 7 and 8).

  3. Promote cardiovascular health and prevent cancer

    Infectious diseases often captivate the media, but an equally important concern is rising rates of NCDs, such as cardiovascular disease (CVD) and cancer, in countries around the world, regardless of income level. The costs of managing these diseases are rising as well. CVD alone is projected to cost the world $1 trillion annually in treatment costs and productivity losses by 2030. However, because of their historical focus on infectious diseases, many health systems in low- and middle-income countries are not adequately equipped to care for patients with NCDs. The need to fill these gaps often goes unmet because of other priorities, but their prevention and treatment can be built into existing platforms for other areas, such as HIV/AIDS or maternal and child health. The committee calls for improved mobilization and coordination of private partners at the country level and across the U.S. interagency community to implement strategies proven to ensure the highest impact. These strategies include targeting CVD risk factors, early detection and treat-

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

ment of hypertension and cervical cancer, and immunization against vaccine-preventable cancers (see Recommendation 9).

Maximizing Returns on Investments in Global Health

To have the greatest effect in the above priority areas, the committee identified three cross-cutting areas for action to maximize the returns on investments, achieve better health outcomes, and use funding more effectively: (1) catalyze innovation through both the accelerated development of medical products and integrated digital health infrastructure; (2) employ more nimble and flexible financing mechanisms to leverage new partners and funders in global health; and (3) maintain U.S. status and influence as a world leader in global health while adhering to evidence-based science and economics, measurement, and accountability (see Recommendations 10 through 14). Achieving true improvements in global health will require changing the way global health business is conducted to better enable innovation. Adequately protecting U.S. citizens at home and abroad necessitates not only investment in U.S. infrastructure, but also continued awareness of global issues and active engagement in the international global health arena. Many of the events and elements of the changing global health landscape described throughout this report have created an environment for a centralized and comprehensive strategy for U.S. global health diplomacy. To these ends, a change in approach and long-term visioning across the various U.S. agencies involved in global health will be necessary, with an emphasis on integration and partnership.

The committee wishes to emphasize that strong collaboration and cooperation among donors, national governments, nongovernmental organizations, and private companies will be essential to achieving the proposed global health goals. Health effects extend far beyond the health sector, and addressing them will therefore require cross-sectoral interaction and synergy. While existing multilateral institutions continue to be crucial, engaging in new and more productive partnerships with other donor governments and the private sector can augment multilateral networks and lead to more successful outcomes moving forward. These joint investments should be geared toward harmonized approaches to global public goods and general global health goals shared by all countries. Finally, to have the greatest effect, all global health work should incorporate essential principles of community inclusion and cultural competency.

CONCLUSION

The United States cannot ignore the reality that the health and well-being of other countries affect both directly and indirectly the health, safety,

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

and economic security of Americans. For many years, strong bipartisanship has backed U.S. engagement in global health, with active support from the faith community, private industry, foundations, and civil society. To sustain the proud U.S. legacy in global health, the committee encourages the administration to focus on the above key areas and cross-cutting opportunities and to implement the recommendations set forth in this report. The committee believes that implementing evidence-based interventions, modifying country engagement strategies, exploring new investment mechanisms, and taking a more proactive and systematic approach to global health priorities will make the U.S. government’s current efforts in global health more efficient and cost-effective. The United States must preserve and extend its legacy as a global leader, partner, and innovator in global health through forward-looking policies, a long-term vision, country and international partnerships, and, most importantly, continued investment. Doing so will not only lead to improved health and security for all U.S. citizens but also ensure the sustainable thriving of the global population.

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

This page intentionally left blank.

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×
Page 1
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×
Page 2
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×
Page 3
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×
Page 4
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×
Page 5
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×
Page 6
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×
Page 7
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×
Page 8
Next: 1 Introduction »
Global Health and the Future Role of the United States Get This Book
×
Buy Paperback | $78.00 Buy Ebook | $64.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

While much progress has been made on achieving the Millenium Development Goals over the last decade, the number and complexity of global health challenges has persisted. Growing forces for globalization have increased the interconnectedness of the world and our interdependency on other countries, economies, and cultures. Monumental growth in international travel and trade have brought improved access to goods and services for many, but also carry ongoing and ever-present threats of zoonotic spillover and infectious disease outbreaks that threaten all.

Global Health and the Future Role of the United States identifies global health priorities in light of current and emerging world threats. This report assesses the current global health landscape and how challenges, actions, and players have evolved over the last decade across a wide range of issues, and provides recommendations on how to increase responsiveness, coordination, and efficiency – both within the U.S. government and across the global health field.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!