Disaster Response And European Health Insurance: Ensuring Continuity Of Care – U.S. global health efforts aim to help improve the health of people in developing countries while contributing to broader U.S. global development goals (eg, promoting a free, peaceful, and prosperous world), foreign policy priorities ( (eg, promoting democratic institutions, upholding universal values, and promoting human dignity) and national security concerns (eg, protecting Americans from external threats, maintaining a stable and open international system).1 For these reasons, the government of the United States has been engaged in international health activities for more than a century and today is the largest funder and implementer of global health programs in the world. The U.S. Global Health Response—a key component of the U.S. international development portfolio, accounting for approximately 19% of the international affairs budget2—is a multibillion-dollar, multifaceted investment that targets a myriad of global health challenges, countries, and stakeholders. The effort involves many different US government departments and agencies, congressional committees, and funding streams.
US engagement in global health is largely carried out by executive branch departments and agencies (see organizational chart below), but the legislative branch also plays an important role.
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Day-to-day US global health activities are administered primarily through the State Department’s Office of the Global AIDS and Health Diplomacy Coordinator (OGAC), which oversees US global HIV efforts and also provides diplomatic support (through US ambassadors and others) in implementing of US global health efforts; United States Agency for International Development (USAID); and operating departments of the Department of Health and Human Services (HHS), particularly the Centers for Disease Control and Prevention (CDC). Additionally, the HHS Office of Global Affairs leads the department’s engagement with bilateral and multilateral partners.
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Congress introduces, reviews, and passes global health-related legislation; oversees global health efforts; authorizes and appropriates funding; and confirms presidential appointees to key positions in US global health. See the primer on Congress and global health.
The US government supports a wide range of bilateral and multilateral global health efforts in countries around the world:
U.S. bilateral (bilateral; country-to-country; U.S. support that benefits another country and is provided to a government, non-governmental organization, or other group for this purpose) programs provide direct support to approximately 70 low- and middle-income countries. revenues and typically operate in a specific set of countries with their own budgets, staffing, strategies, objectives, and monitoring and evaluation practices; they often involve multiple US agencies/departments.4 See “What are the major programs?” below.
U.S. support for multilateral (multiple countries, usually through an international organization involving or supported by multiple governments; U.S. support provided to a multilateral organization is channeled to support programs in or benefit other countries) global health efforts includes:
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While the United States first provided funds to address the emerging global HIV epidemic in 1986, funding and attention have increased significantly in the last decade, particularly after President Bush announced the Emergency Plan for AIDS Relief (PEPFAR) in 2003. The launch of PEPFAR led to a major increase in US support for HIV prevention, treatment and care efforts, as well as contributions to the Global Fund, the Joint United Nations Program on HIV/AIDS (UNAIDS) and the International AIDS Vaccine Initiative (IAVI). . ). The State Department’s US Global AIDS Coordinator oversees this whole-of-government effort, which is being implemented by USAID, CDC and other agencies. fact sheet on the US and the Global Fund.
USAID launched its global TB control program in 1998, and since then, the US response has grown, especially expanding after 2003 when the US government’s commitment to TB control was highlighted as part of PEPFAR. Today, led by USAID and implemented by and involving several agencies, US TB efforts focus on the diagnosis, treatment, and control of TB (including multidrug-resistant and extensively drug-resistant TB (MDR/XDR TB)) and research. The United States is also a donor to the Global Medicines Fund of the Partnership to Stop Tuberculosis, a global network of public and private entities working to eliminate TB. 6 See the fact sheet on US TB efforts.
Engaged in malaria work since the 1950s, the US supports malaria efforts through the President’s Malaria Initiative (PMI, launched in 2005) as well as other activities, including research. PMI programs, overseen by USAID’s US Global Malaria Coordinator and implemented by USAID and CDC, focus on expanding coverage of six key high-impact interventions: malaria diagnosis and treatment with artemisinin-based combination therapies (ACTs), entomological monitoring, intermittent preventive treatment in pregnancy (IPTp), indoor residual spraying (IRS), insecticide treated mosquito nets (ITN) and seasonal malaria chemoprevention (SMC). See fact sheet on PMI and other US malaria efforts.
Having historically engaged in NTD efforts through research and surveillance, the US expanded its response by launching the USAID NTD Program in 2006, which aimed to reduce the prevalence of seven NTDs through integrated treatment programs using mass administration of drugs (MDA) and the US NTD Initiative in 2008, which aimed to intensify efforts and increase funding for activities across the US government. The effort is led by USAID and includes the CDC, the National Institutes of Health (NIH), and other agencies. See fact sheet on US NTD efforts.
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The United States has been engaged in international research on FP and population issues, as well as other FP/RH efforts, including the purchase and distribution of contraceptives in developing countries, since the 1960s. Today, led by USAID and involving several agencies, US FP/RH activities are designed to reduce the risk of unintended pregnancy and maternal and child mortality through effective interventions, including contraception, counseling, and postabortion care. See the fact sheet on US FP/RH efforts and the fact sheet on legal requirements and policies related to these efforts.
The US has been involved in efforts to improve MCH since the 1960s. Today, led by USAID and involving several agencies, US MCH activities aim to: improve equitable access to and use of services by vulnerable populations; scale up a range of high-impact interventions that reduce maternal, infant and under-five mortality; preventing and addressing the indirect causes of such deaths (such as HIV, TB and malaria); strengthening the integration of health services for mothers with FP; and strengthening health systems. In addition, some water, sanitation, and hygiene (WASH) activities are part of the environmental health efforts of USAID’s MCH program. The US is also a donor to global organizations dealing with MCH, such as Gavi; UNICEF; and the Global Polio Eradication Initiative (GPEI). See the US MCH Effort Fact Sheet, the US Polio Effort Fact Sheet, and the US and Gavi Fact Sheet.
For more than 40 years, USAID has been involved in nutrition efforts to prevent undernutrition through interventions such as nutrition education, nutrition during pregnancy, exclusive breastfeeding, and micronutrient supplementation. FtF, launched in 2009), which aims to address global hunger and food security and is led by USAID and the US Department of Agriculture. See fact sheet on US MCH efforts (which includes US nutrition efforts).
While the US government has supported the work of Global Health Security (GHS) for more than two decades, its involvement has expanded over time, with attention to these efforts growing significantly due to the COVID-19 pandemic. Aiming to reduce the threat of emerging and re-emerging diseases by supporting preparedness, detection, and response capabilities worldwide, US GHS efforts are primarily led by USAID, CDC, the Department of Defense (DoD), and the Department of State. The United States also played a key role in the development of the Global Health Security Agenda (GHSA), an international partnership launched in 2014 that now includes more than 70 countries and international organizations. Through GHSA, US government agencies work with host governments and partners to help countries make measurable improvements in their capabilities to detect and respond to disease outbreak events and achieve global health security goals. See the brief on US GHS efforts.
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US global health efforts are implemented in approximately 70 countries (mostly in sub-Saharan Africa, but also in South and Central Asia, the Middle East and North Africa, East Asia and Oceania, the Western Hemisphere, and Europe and Eurasia; see Table 1 ) through bilateral support to countries or through regional programs.8 Additional countries are reached indirectly through US contributions to multilateral organizations. The United States typically operates multiple global health programs in most countries.
SOURCE: State Department analysis of data, Foreign Assistance Dashboard [website], available at: http://www.foreignassistance.gov; accessed July 2022. USAID, Countries Supported by the USAID NTD Program, available at: https://www.neglecteddiseases.gov/where-we-work accessed January 2022. CDC.
While more support is generally directed to countries facing higher disease burdens, other factors influencing where US health assistance is targeted include the presence of willing and able partner governments; a history of positive relations and goodwill with host countries; strategic and national security priorities; financing; and staff availability.9
The United States is the largest global health donor in the world, and its investment in global health has increased significantly over time
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