Global Health and the Future Role of the United States, released in Spring 2017 by the National Academies of Sciences, Engineering, and Medicine, assesses U.S. investments in global health. Using the same rigor that the National Academies applied in advising U.S. policy for more than 150 years, a committee of experts from across the global health field reached consensus on why and how to continue America’s commitment to global health. The report culminates in 14 recommendations to guide action in improving the health of the world’s population.
The data show that foreign assistance directed toward health is a sound investment.
20x In addition to saving millions of lives, returns on investment in health can exceed costs by up to 20 times in some countries.
Investing in global health also serves to protect the American people from pandemics, and it can also spur economic growth in those countries, as shown by 11 of the top 15 U.S. trading partners being former recipients of foreign aid. This summary is a resource for policymakers and other critical stakeholders on areas to prioritize within global health and how to make investments that scale.
top U.S. trading partners are former recipients of foreign aid
The National Academies report recommendations are aimed at the following groups.
U.S. Centers for Disease Control and Prevention
U.S. Department of Health
and Human Services
U.S. Agency for
Office of Management
(U.S. Department of State)
U.S. Food and Drug Administration
Biomedical Advanced Research and Development Authority
U.S. Department of
In the last 10 years, outbreaks of potentially pandemic influenza, MERS-CoV, Ebola, and 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. Additionally, HIV/AIDS, tuberculosis (TB), and malaria continue to pose immediate and longer-term global health threats and require continued attention. 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.
The presidential administration should create a coordinating body for international public health emergency response that is accountable for international and domestic actions and oversees preparedness for and responses to global health security threats.
U.S. agencies had to wait for seven months for funding to respond to the Zika outbreak, threatening the safety of the American people and weakening other health capabilities.
Relevant agencies should continue to invest in national capabilities and accelerate the development of international capabilities to detect, monitor, report, and combat antibiotic resistance.
The current rate of antimicrobial resistance is projected to result in a loss of 10 million lives per year and a cumulative loss of $100 trillion in global economic output by 2050. Combating resistance could mitigate these losses, maintain the integrity of treatment, and protect the progress achieved in reducing the burden of critical infectious diseases.
Relevant agencies should expand training and information exchange efforts to increase the capacity of low- and middle-income countries to respond to both public health emergencies and acute mass casualty disasters.
The United States currently imports 75–80 percent of the raw materials for drugs meant for the U.S. domestic market, which increases susceptibility to the effects of a public health emergency should an outbreak occur in an exporting country.
Congress should fund the President’s Emergency Plan for AIDS Relief (PEPFAR) at current levels, and allow for more flexibility within the PEPFAR program by continuing to relax specific funding targets for all program areas.
13 percent higher employment rates were found among men in PEPFAR countries than in non-PEPFAR countries.
Relevant agencies should conduct a thorough global threat assessment of rising tuberculosis (TB) levels, including multi- drug-resistant TB and extensively drug-resistant TB. They should then execute a plan of action, including governance structure and priority activities, for developing and investing in new diagnostics, drugs, vaccines, and delivery systems.
Treating drug-resistant tuberculosis can be 100x more expensive than treating non-resistant tuberculosis.
Relevant agencies should continue their commitment to the fight against malaria through the President’s Malaria Initiative and collaborative work with all partners toward elimination of the disease.
Since its creation, the President's Malaria Initiative has reduced malaria mortality by 48% in focus countries.
The general health and well-being of other countries, including their burden of noncommunicable diseases such as cardiovascular disease and cancer, at first glance may not appear to be the top priority of donor countries such as the United States. However, investing in countries’ prosperity and stability can result in greater order and predictability in the world, as well as promote U.S. health and prosperity and create more reliable and durable global partners.
Congress should increase funding for USAID to augment the agency’s investments in ending preventable maternal and child mortality, defined as global maternal mortality rates of fewer than 70 deaths per 100,000 live births by 2020 and fewer than 25 child deaths per 1,000 live births by 2030.
More than 6 million children and 300,000 mothers die each year due to largely preventable causes.
Relevant agencies, their implementing partners, and other funders should support and incorporate proven, cost-effective interventions into their existing programs for ensuring that all children reach their developmental potential and become healthy, productive adults.
Early childhood interventions increase labor market participation, earnings, and economic growth, generating returns of up to 25 percent.
Relevant agencies, through their country offices, should provide seed funding to facilitate the mobilization and involvement of the private sector in addressing cardiovascular disease and cancer at the country level.
Investing in cancer care and control could result in millions of avoidable deaths, achieving between $100 and $200 billion in global economic savings.
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. Achieving true improvements in global health will require changing the way global health business is conducted to better enable innovation.
Relevant agencies should invest in a targeted effort to reduce the costs and risks of developing, licensing, and introducing vaccines, therapeutics, diagnostics, and devices needed to address global health priorities. This can be accomplished by enabling innovative approaches for trial design, streamlining regulation, ensuring production capacity, creating market incentives, and building international capacity for research and development.
The average time to develop a new drug and enter the market is 15 years and the average cost is $2.5 billion. Between 2000 and 2011, only 4% of new products were targeted at neglected diseases.
Relevant agencies of the U.S. government should convene an international group of public and private stakeholders to create a common digital health framework that addresses country-level needs ranging from integrated care to research and development.
In 2015, 25 percent of the people in Africa and 58 percent in Asia had an internet connection, along with even higher access to mobile phones, paving the way for a truly global digital health network.
Relevant agencies should systematically assess their approach to global health funding with an eye toward making long-term investments in high-impact, country-level programs.
US investments in the Global Polio Eradication Initiative are expected to generate returns of as much as $50 billion by 2035.
Relevant agencies should expand efforts to complement direct bilateral support for health with financing mechanisms that include results-based financing; risk sharing; and attracting funding from private investment, recipient governments, and other donors.
Investing in health makes business sense. A mining company in Ghana implemented malaria controls that led to a 72% decrease in disease burden, saving the company roughly $600,000 per year.
To protect itself from global threats, benefit from successes achieved in global health programs, and maintain a strong research and development pipeline, the United States should commit to maintaining its leadership in global health and actively participating in global health governance, coordination, and collaboration.
The United States needs a global health workforce. Because of system limitations there is a standing vacancy rate of more than 30% for overseas positions within the Department of Health and Human Services.
The health and well-being of other countries directly and indirectly affect the health, safety, and economic security of Americans. 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.
We hope that this interactive breakdown of the National Academies report serves as a useful resource for policymakers as they consider how best to make investments to safeguard the health and security of all U.S. citizens through ensuring a sustainable and thriving global population.
Download our full report on Global Health and the Future Role of the United States to learn more.