Global Health: What would Barack do?

Aug 25, 2008

As the American Presidential campaign heats up, it is good to see that candidates’ views on the US’s global health agenda is also getting some column space.

Unsurprisingly global health is nowhere near as prominent in the McCain campaign as it is for Obama. Apart from supporting PEPFAR, McCain has been vague on other global health issues.

In a recent CGD Policy Brief, health economist Ruth Levine sets out a systematic to-do list for Obama. Some of her key points are:

  • Work more closely with UN and other multilateral partners
  • Live up to your funding commitments, also smaller ones like those for malaria and child health
  • Make decisions based on scientific evidence, not political or narrow moral preferences
  • Find  a balance between AIDS and non-AIDS health spending (click here for more on this debate)
  • Establish exchange programs for training and research.

Obama’s campaign documents have made extensive commitments around expanding PEPFAR; taking on drug and insurance companies and supporting the Global fund and the MDGs. He has also made promises about adressing health infrastructure and the migration of health workers.

True to form, though, these campaign promises don’t explain how all these promises will be paid for or how  the strong interests that litter the health sector in the US and the rest of the world will be navigated. While Obama may attach more importance to questions of global  health, it only merits one paragraph in his 64 page ‘Blueprint for Change‘. It seems fairly clear therefore that he would only be able to move as far and as quickly on global health as his domestic constituency will let him.

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  2. While the US should definitely work more with the international community on various health issues, especially beyond HIV/AIDS and PEPFAR and honour its international commitments and it is good to know that Obama is concerned about these issues as well as insurance and drugs, he should also look more inwards into the US health system and its huge demands on funding which is more than two times as a ratio to GDP of any good universal healthcare system from other developed countries. The US needs to learn from its immediate neighbour Canada, that predominant public financing is critical to both lower and rational use of resources and that private insurance based startegies only drive healthcare costs one way, that is upwards. I know t is difficult ot change this trajectory given the powerful control by private insurance of the US health markets but if Obama can make US health policy move towards the Canadian trajectory it will not only benefit US health and healthcare but also global health because a number of coiuntries like India are trying to emulate the US health model. Only such a strategic change will really CHANGE the US health system and since Obama is all about change the ball is definitely in his court to impact both US and global health for the better.

  3. First, to my new friend and colleague, Ravi, I couldn’t agree with you more. We waste more money in the US health care system than most of the world spends on care combined, which hamstrings us even more than what we’re wasting in Iraq. And you’re right, some of the worst aspects of our “model” are being exported under wrong understandings (I just got an email from a new Ethiopian colleague asking for articles that describe the private sector in the US system, which he says is renowned as the best in the world … YIKES!).

    But, the original blog entry is right on, that Obama’s main audience is and must be domestic, and unfortunately Americans care little about global anything except when someone scares the bejeebies out of us for some lie. Neither he, much less McCain, is going to talk about the effects of agricultural subsidies on international development or suggest a more progressive approach to aid, like DFID’s, these points just have no value in the race. On the other hand, Obama has great potential to approach these various issues (including PEPFAR and how it affects a country’s capacity and decision making) in different ways, as long as he gathers around him people who are not so tied to the Washington consensus (writ broadly).

    Presidential campaigns are not won or lost nowadays based on specific policy proposals and leading in this fractured political system is much different than running a political campaign, so we can’t really evaluate what Obama might or will do based on what’s he’s said so far.

  4. Research!America, a non-profit alliance advocating for more funding for research to improve health, has expanded our efforts to include advocacy for global health research. Our position is that research to improve health globally saves lives and saves money. It’s the smart thing to do for America and the right thing to do for the world. And we hope that the next Administration and new Congress will take action on these fronts.

    We have sent statements to both parties regarding their platforms (see We also have asked the candidates (presidential and congressional) to go on the record and share their views on health and research, including a question about their views on global health research:

    How important would you say it is that the U.S. work to improve health globally? If important, please describe how you plan to increase our nation’s role in promoting and improving global health. If not, please explain why.

    See for more.

    I hope this information is helpful.

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