Nicholas Kristof’s op-ed in the New York Times today, Congress to America: Drop Dead, laments Congress’ inaction on appropriating funding requested by the White House for proactive public health measures intended to stem the expected spread of the Zika virus in the United States. In April, I raised similar concerns here on the Duck, Chasing our Tails, where I asked:
It is puzzling why Zika has not garnered the same policy attention from Congress as the Ebola outbreak. Viewed through a security lens, the Zika outbreak more readily meets the attributes of a “threat” in its proximity to the U.S., in its pervasiveness, and in the fact that it poses a high risk for global transmission. Moreover, mobilization in response to humanitarian crises is generally more likely to occur when it strikes communities in close proximity to us (i.e. South America) or with whom we can identify (i.e. Americans).
[The fact that my blog post preceded Kristof’s by almost three weeks is particularly satisfying given Kristof’s frequent critiques that political scientists do not anticipate or contribute to real-world policy problems. Checkmate!]
The larger mistake is that budget cutters have systematically cut public health budgets that address Zika, Ebola and other ailments. The best bargain in government may be public health, and Republicans have slashed funding for it while Democrats have shrugged.
Research in political science largely supports this claim. Today in the Washington Post fellow duck Josh Busby along with his co-authors, Karen Grépin and Jeremy Youde describe the paradoxes of public health funding where cuts to public spending have led to the increase of private money often focused on disease-specific programs rather than health systems.
New actors and sources of finance such as the Gates Foundation have created a more diffuse global health landscape. Spending on global health increased dramatically since 2000, but much of the funds were channeled through new entities such as the Global Fund to Fight AIDS, Tuberculosis and Malaria — not the WHO.
The increase in private spending is particularly problematic for global public health given that the
WHO relies overwhelmingly on voluntary contributions from countries, often for specific projects and priorities that leave core WHO functions such as surveillance under-resourced. Donors have been unwilling to raise the level of assessed dues and invest in the organization.
Busby, Grépin and Youde, promote a special issue of Global Health Governance (full disclosure: including an article of mine) that examines the implications of the Ebola crisis for the future of global health governance. My article in that volume conceptualizes national vs. human security approaches to global public health crises like the Ebola and Zika outbreaks. A human security approach requires the types of far-sighted planning and policy that Kristof urges Congress to adopt. Specifically,
A human security approach to global public health crises requires a systems-level response which coordinates the efforts—particularly information sharing, project planning, and needs assessment—of multiple actors based on actual human needs and human rights; encourages consideration and protection of the most vulnerable parts of the population—women, children, the disabled and the elderly—and emphasizes empowerment, which suggests a bottom-up approach that enables people and communities to act on their own behalf.
At present, public health systems in the U.S. and globally are not equipped to put into place farsighted human security approaches that address the root causes of health crises. Continued stalling by Congress will perpetuate the cycle of reacting to rather than preventing disease spread.