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National Academies Report Makes Strong Case For US Involvement In Global Health

Calling on the new Trump administration to extend the proud legacy of US involvement and achievement in global public health, a panel from the National Academies has identified four priority areas and made 14 recommendations to guide the future role of the United States in global health.

Why Global Health and Why Now?

Before presenting its recommendations, the NAS report seeks to make the case for why supporting global health initiatives is important to the United States. Several rationales are offered by the committee in the statement released by the NAS.

·         The increased interdependency of countries, economies, and cultures resulting from tremendous growth in international travel and trade over the last several decades has brought improved access to goods and services, but also a variety of health threats…

·         By investing in global health over the next 20 years, there is a chance to save the lives of millions of children and adults…

·         The health and well-being of other countries both directly and indirectly affect the health, safety, and economic security of Americans. 

·         The U.S. government should maintain its leadership position in global health as a matter of urgent national interest and as a global public benefit that enhances America’s international standing.

The four priority areas containing 14 specific and cross-cutting recommendations included in the NAS statement and report are listed below:

I. 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.

Recommendation 1: Improve international emergency response coordination.

Recommendation 2: Combat antimicrobial resistance.

Recommendation 3
: Build public health capacity in low- and middle-income countries.

Included on the NAS panel were at least two epidemiologists, the University of Minnesota’s Michael Osterholm and Duke University's Michael Merson who have both had a career focus on global health issues and threats. In an op-ed essay in the New York Times last March, Osterholm and a colleague stated “While the Trump administration is proposing significantly increased military spending to enhance our national security, it seems to have lost sight of the greatest national security threat of all: our fight against infectious disease. We already spend far more on our military than any other country in the world. To help pay for the increases, President Trump wants to cut back many federal programs, including those that prepare us to wage war against microbes, the greatest and most lethal enemy we are ever likely to face. This is  where ‘defense spending’ needs to increase, significantly.”

II. 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 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.

Recommendation 4:  Envision the next generation of the President’s Emergency Plan for AIDS Relief.

Recommendation 5: Confront the threat of tuberculosis.

Recommendation 6: Sustain progress toward malaria elimination.

III.  Save and improve the lives of children

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.

Recommendation 7: Improve survival in women and children.

Recommendation 8: Ensure healthy and productive lives for women and children.


IV. 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.

Recommendation 9: Promote cardiovascular health and prevent cancer

Cross-cutting topic areas

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:

Recommendation 10: Accelerate the development of medical products.

Recommendation 11: Improve digital health infrastructure.

Recommendation 12: Transition investments toward global public goods.

Recommendation 13:
 Optimize resources through smart financing.

Recommendation 14: Commit to continued global health leadership

To obtain a copy of the NAS report, visit :

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