The presidential election and global health

Before the primaries, the presidential debate often focused on US health care. With the primaries behind us, the world and the media are beginning to look at how our two candidates, Barack Obama and John McCain, will impact US Government (USG) Foreign Assistance and global health policies. Nellie Bristol’s article in the August 16, 2008 issue of the Lancet is a great starting point for people to start comparing these two candidates’ views on global health (http://www.thelancet.com/journals/lancet/article/PIIS0140673608612167/fulltext).

Elections are never decided on health issues, but health is a growing concern among Americans. Additionally, there is a growing investment and awareness in the US that the health of the world will impact our health directly and indirectly. Despite the shortcomings of the current administration, they have increased the US presence both financially and technical in the field of global health. With the restructuring of PEFPAR, the launching of the President’s Malaria Initiative (PMI), and continued support to multilateral organizations, global health has evolved into a crucial component of the US Foreign Assistance strategy and the USG overseas investment. The US Foreign Assistance goal of “Investing in People” demonstrates the importance and revamping of the current administration’s thinking on global health. Health is no longer on the sidelines in policy but on center stage. As a result, we need to continue this momentum forward. We need a leader who will understand and work to create rationale polices and programs.

In evaluating these two candidates solely on their global health views and strategies, who would you vote for and who would you like to see elected? Both candidates have pledged to make substantial commitments to global health. Who will lead our country down the right path? What should the role of the United States be for global health? As current and future global health practitioners, we need to analyze in a deeper way the speeches and broad PR promises of these two candidates and look at the facts.

In my view, there is a clear lack of understanding and one dimensional policies of the McCain campaign. McCain supports PEPFAR and pledges more money for PMI. However, the depth in Obama’s global health stance is a bit more reassuring and demonstrates a deeper understanding of the intricacies of our past global health failures and successes.

Critics speak of Obama’s lack of foreign policy experience. However, in global health, Obama does not show the understanding of a novice, but the thoughtfulness of a seasoned global health practitioner. He understands that we cannot do it alone. His support for other multilateral programs and the UN Millennium Development Goals demonstrates a perhaps pivotal change in US foreign policy. Additionally, he is committed to increasing US Foreign Assistance to $50 billion by 2012 and also seeks to expand the scope of activities to focus on more regions and to address fundamental cross-cutting areas such as education and health infrastructure. In the era of giant vertically-funded disease initiatives such as the Global Fund to Fight AIDS, TB and Malaria, PMI and PEPFAR, it is important that we reposition the focus of global health also to maternal and child health, family planning, and chronic diseases. I think that Obama, the candidate, understands this imperative.

Refreshing again is Obama’s stance on supporting the rights of sovereign nations to ensure access to quality-commodities, which is quite different from McCain’s rhetoric on the campaign trail. In a GOP Debate in Michigan Jan 10, 2000, McCain argues that he will do anything to stop HIV. However, he has publicly stated that he will not work with corrupt governments. Before committing US taxpayers’ money, he needs assurance that the resources will go to the people. This is well intended. But under his criteria, he believes that “in a lot of parts of Africa today, I do not have that confidence” that the money will reach the people. Without a plan on how to improve anti-corruption, this stance will leave many countries without suitable resources to address the health needs of their people.

Is personal passion and investment a benchmark for success? It is evident that Obama’s passion for global health has positively influenced his stance on global health and his understanding of the issues and needs. The silence and lack of a formal plans or strategies from McCain is deafening. His support of PEPFAR and "League of Democracies" is laudable, but it is the lack of depth that is a bit disconcerting.

Will passion be enough? It may not be, but it is always a good start. I suspect that most of you in our global health class are there because you are passionate about social justice and health for all. There are many important reasons we should care about this election, and global health is at the top of the list.