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From Iowa: The US elections and global health

At the beginning of January, US presidential candidate Mitt Romney narrowly beat out Rick Santorum in the Iowa Republican Caucuses—the first of a series of caucuses and primary elections that will eventually choose the Republican candidate for the US elections in November. This week we focus on the implications of these elections on US foreign policy for health and development more generally.

The USA contributes about 22 per cent of the regular budget of the World Health Organization (WHO)—more than any other country. And depending on how the data is cut, the OECD estimates that the US is responsible for about 20 per cent of overseas development aid (ODA). This means that although the USA has not met United Nations targets in terms of ODA spending as a percentage of gross national income, it is still providing more aid than any other country. What happens in the next election affects the world.  


Santorum versus Romney

According to Rick Santorum, 'we need to keep and expand our commitment to humanitarian aid, especially in Africa'. However, he plans to:

  • 'Cut in half the number of State Department USAID employees and US funding for United Nations programmes; and
  • Eliminate funding for United Nations’ agencies which oppose America’s interests and promote abortion and cut the US contribution to the UN in half'.

Mitt Romney is more of a centrist. He talks about the problems of 'poverty, disease, internal strife, refugees, drugs, and crime' in failed states and discusses the importance of US leadership:

As the world’s greatest power, the United States will strive to set the international policy agenda, create a predictable economic and security environment that enables other countries to develop policies that are in conformity with our own … American leadership will also focus multilateral institutions like the United Nations on achieving the substantive goals of democracy and human rights enshrined in their charters.


This leaves a few unanswered questions

If Santorum is committed to aid, then why is he intending to cut USAID funding?  And UN funding? And does he plan on cutting funding to the WHO, United Nations Population Fund (UNFPA) and United Nations International Children’s Emergency Fund (UNICEF)? These institutions want to reduce abortion rates through proper family planning, but also recognise the dangers of illegal abortions.

Romney wishes to work within the UN system. But there are concerns with both candidates over the influence that US domestic policy could have in development and multilateral forum. Santorum plans to repeal the mandate that contraception is covered in US health plans. And all the Republican candidates call for a repeal of Obamacare and for “market-based solutions” in health care. When your blogger was a student at the London School of Economics, it was constantly emphasises that that health care systems do not operate like a “normal” market and health cannot be handled as a “normal” commodity. This is basic health economics.

If, as Romney put it, the US will be enabling “other countries to develop policies that are in conformity with our own…,” does that mean under Santorum, family planning would be greatly hindered?  And does it mean that, with any of the Republican candidates, aid money will promote the privatisation of health care.  This is dangerous.

And what if the US cut funding to UN agencies? Arguably, the UN would probably work more effectively if the US cooperated better. In global health specifically, the US is not always the favourite member of the community (it was the only delegation not invited to the Brazilian Mission’s party at the 63th World Health Assembly). Diplomatic popularity contests aside, it is one of the few countries not to have ratified the Framework Convention on Tobacco Control, has been criticised for its approach to family planning in development context and is usually in favour of patent protection on pharmaceuticals even, arguably, to the detriment of public health (this said, the US has been much more cooperative under Obama).

Many of these institutions would also have more freedom without the ties that come with American money. However, this is something that they, and the people who need development aid the most, probably can’t afford.