Development Assistance for Health: Going Beyond Recipient Country Needs to Donor Country Benefits

The start of the 21st century ushered in a golden age in global health.¹ During this period, development assistance provided to low- and middle-income countries from major development agencies for health grew by 10% annually. More recently, growth in development assistance for health has stagnated, and some health focus areas, such as HIV/AIDS, have seen decreases in funding. Although advocates for development assistance for health point to the difference this assistance makes in recipient countries through reduced incidence and burden of disease, providing justification for development assistance through benefits to citizens in donor countries can be more daunting. Nonetheless, in this issue of AJPH, Jakubowski et al. (p. 1034) provide new evidence that highlights some national benefit that may result from the provision of development assistance for health by donor countries.

STUDY FINDINGS AND VALUE PROPOSITION

Jakubowski et al. used data on public opinion and health aid in 45 countries around the world and found that “US investments in health aid improved the United States’ image abroad.” Their analyses relied on nationally representative surveys on public opinion conducted for multiple years by the Pew Research Center and official estimates of US development assistance for health from Foreign Aid Explorer, a US government Web site (https://explorer.usaid.gov) with curated data on foreign aid transfers. Their results show that important benefits accrue to US citizens from development assistance for health provision. This finding is important because even though this benefit from development assistance has been known anecdotally for many years, this is one of the few studies that provides supporting empirical evidence. Furthermore, these findings broaden the discourse around the value of US development assistance at a time when the provision of global development assistance is being questioned and the growth rate in assistance has stagnated for almost a decade.²

Jakubowski et al. also indicate that their results suggest that development assistance for health presents good value for money given that the share of total US development assistance for health contributions relative to national income is small. In other words, in aggregate the United States provides the majority of development assistance for health contributions globally, but US contributions relative to the size of the population or size of the economy are actually modest. Between 2014 and 2016, the average assistance as a share of national income was less than 0.08%.³

OTHER DEVELOPMENT ASSISTANCE BENEFITS

Development assistance for health provided by the US government benefits Americans in other ways. By funding global public goods, development assistance for health also provides valuable returns to citizens of donor countries. Global public goods are goods that have benefits that can extend broadly, with the benefits not being limited to a single group of individuals. Examples include research activities that develop new tools for health, facilitate the generation of knowledge, or address the threat of antimicrobial resistance or pandemics.

The Ebola epidemic in 2014 presented a preview of the global exposure to such infectious diseases and the chaos that can result during a very short time from such outbreaks. According to an analysis by the Commission on a Global Health Risk Framework for the Future, which was instituted soon after the Ebola epidemic, economic losses of about $60 billion annually could be expected from potential future pandemics, whereas the implementation of its recommendations—such as enhancing public health systems in low- and middle-income countries and investing in research and development—aimed at preventing such pandemics would cost only $4.5 billion annually.⁴ The cost of prevention activities outweighs the losses that potential outbreaks present.

In an increasingly interconnected world, another avenue through which US development assistance for health may provide value to domestic citizens is through improved global health security. The provision of transnational goods has become an important component of efforts to maintain stability in the global landscape.

CURRENT/FUTURE DEVELOPMENT ASSISTANCE

Figure 1 highlights contributions of development assistance for health from all the major donors worldwide in aggregate. From 1990 to 2018, US government contributions were substantial. Cumulatively, the US government contributed $213.2 billion, 30.3% of all development assistance for health. After major increases in development assistance in the first decade of the millennium, the amount of development assistance for health provided each year since 2010 has been approximately the same.

FIGURE 1—

Worldwide Development Assistance for Health, by Source of Funding: 1990–2018

Note. IBRD = International Bank for Reconstruction and Development. The 2018 estimates are preliminary.

Although future growth in development assistance for health remains uncertain, the global community has coalesced around the new and more expansive Sustainable Development Goals.⁵ These goals aim to achieve even more than the world was able to achieve during the Millennium Development Goals⁶ era, although this will be possible only with strong global leadership, including leadership from the United States. Ultimately, development assistance for health also can be used as a catalyst for more domestic health spending in low- and middle-income countries and the greater good. A more secure and healthy world benefits all.