On May 23, 2017, President Donald Trump released his FY 2018 budget request to Congress that includes approximately $2.5 billion in cuts to global health. These cuts had been foreshadowed in the administration’s earlier “Budget Blueprint,” which sought “deep cuts to foreign aid” to “free up funding for critical priorities here at home and put America first.”
Cuts to global health of this magnitude would be unprecedented and, while they already face opposition in Congress, provide a key statement of administration policy in an already constrained budget environment. In this post, we seek to assess what such a reduction by the United States might mean in the larger, global context of development assistance for health (DAH). To do this, we started with a recent Institute for Health Metrics and Evaluation (IHME) analysis that forecasted future DAH; the analysis, published in The Lancet, was based on historical trends and relationships with key covariates, such as gross domestic product, observed in data spanning from 1990 to 2016 (Note 1). The analysis projected increases in DAH from the US government and was used to assess how many resources would be available for health in each country well into the future.
For this post, we used the same modeling methods but assumed a one-year cut in the US global health budget of 24 percent, the reduction proposed by the president, followed by constant funding. We also modeled two more moderate cuts. We compared these results to the previous IHME forecast, focusing on the next 10 years (2018–27).
We found that a one-year cut in the US global health budget of the magnitude proposed by the president for 2018 would result in significantly less DAH over the next 10 years. Compared to the initial IHME forecast, such a cut would result in $9 billion less in 2027 and close to $68 billion less cumulatively over the full 10 years (Exhibit 1). Even under more moderate reduction scenarios, including flat funding over the period, US DAH would be several billion dollars less in 2027 compared to the previous IHME forecast.
Exhibit 1: Projected Global Health Funding Over 10 Years, Under Budget-Cut Scenarios
We also found that the US rank as a donor to global health, as measured by DAH as a share of gross domestic product (GDP), would fall from No. 5 (in 2016) to No. 10 under the administration’s proposed cut. If funding remained flat, the United States would rank No. 6 in 2027.
While future funding by the United States for global health remains unknown—already, Congress has pushed back on the administration’s proposed cuts, although downward pressure is likely to continue—our analysis finds that any cuts by the United States now would significantly reduce DAH going forward. These cuts, as demonstrated in other analyses, have significant impacts on health outcomes. They are also likely to have an outsized effect. Even though the United States does not rank at the top among donors as measured by DAH as a share of GDP, it is the single largest donor as measured in dollars and is a clear global health leader. Given broader global fiscal constraints on other donors, it is unclear if a gap left by the United States could be easily filled.
The analysis, which went through peer review before publication in The Lancet, applied ensemble modeling methodologies that draw on 14 individual models that each pass a complex set of inclusion criterion. These models are based on time-series modeling techniques and include covariates that consider the impact of country-specific changes in macroeconomic and demographic contexts. These models can be considered somewhat conservative because they treat the remarkable scale-up of development assistance for health (DAH) provided between 2000 and 2010 as a potential anomaly and not a trend that is guaranteed to persist. Had this previous analysis considered the remarkable growth in DAH provided between 2000 and 2010 to be representative of the future, the disparities measured here between the proposed cuts and previously predicted forecasts would be even greater.