Exploring the US Health and Human Services' (HHS) Role in Global Health

Yesterday, the Henry J. Kaiser Family Foundation hosted a meeting in Washington, DC to discuss the role of the  US Department of Health and Human Services (HHS) in global health and to highlight the release of a new report on The Global Health Strategy of the HHS. To read this report, click here.  

HHS has about 1/4 of the total US government budget and is the agency responsible for a number of key health programs, including Medicare, Medicaid, the CDC, the NIH and the FDA.  While most of the HHS budget and agenda is focused on domestic health care issues, global health programs are an important priority, particularly through NIH, CDC and intra-agency initiatives with the Department of State (eg PEPFAR) and the Department of Defense.  The primary role of HHS is to optimize and protect the health of US citizens. In light of the global nature of diseases, the extent of international travel, as well as the close linkage between global health issues and global economic, development and security issues, HHS plays an important role in global health.  Therefore, the release of a new HHS Global Health Strategy has important potential impact.

The program was launched by a speech by Kathleen Sebelius (US Secretary of HHS). Click here to hear her comments.  The program also included comments from a number of global health leaders, including Nils Daulaire (HHS Director of Global Affairs and former Director of the Global Health Council), Harvey Fineberg (President, Institute of Medicine), Helene Gayle (CEO of CARE USA), Jennifer Kates (VP of Global Health for Kaiser), Kerri-Ann Jones (Dept of State) and Ariel Pablos-Mendez (USAID).  Click here to view the webcast of the meeting.    

Secretary Sebellius did a good job outlining the reasons why the US needs to be more engaged in global health and why this is important for the health of US citizens.  She also highlighted important strategic, economic, and morale reasons why the US needs to support global health programs.  However, it is also clear that the current budgetary challenges we face in the US will require HHS to pursue more strategic and innovative investments in global health. 

This is not a good time for global health initiatives that depend on support from HHS (eg CDC, NIH, PEPFAR).  Budgets are very tight or decreasing, creating competition for funds with other programs, particularly domestic initiatives.  This a particularly challenging issue for US universities engaged in global health.  US-based faculty are struggling to maintain support for their long-term partnerships overseas.   Funding for new innovative collaborative global health programs are limited.  In particular, career opportunities for US students interested in global health are very limited.  The irony is that despite great increases in US government funding over the past 2 decades, through programs like PEPFAR, as well as great increases in interest in global health from US universities and students, opportunities to engage in global health partnerships are decreasing.

The limited financial support for engagement of US in global health is due to stagnant NIH budgets.  It is also related to the well-intentioned objective to transfer ownership and capacity for US-funded global health programs to local, in-country partners, rather than rely on US citizens.   However, we still need US universities, particularly our students to be engaged in global health research and programs.  As noted in discussions yesterday in DC, there are tremendous benefits to US engagement in global health.  Insights about infectious diseases and chronic diseases, that could improve care in the US, are increasingly coming from research in other countries. 

We in the US have a lot to learn from our colleagues in other countries. While there are great benefits and there is a morale requirement to build capacity in other countries, we also need US students to stay engaged in global health.  Optimal care of patients and prevention of disease in the US requires more expertise in global health and more global health experts.  To limit engagement of US universities and students in collaborative global health learning and research is not in our best interest.  To optimize the impact of US investments in global health, US universities and US students need to be more engaged in collaborative international health programs and research, not less engaged.  Global health opportunities enrich the educational environment in US universities and stimulate innovation.  Global health training and experience creates better doctors, nurses and public health professionals.    Our domestic population is global.  Our health issues are global.  Our health professional students need to be global.