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IOM to Obama: Get Your Act Together on Global Health

A new Institute of Medicine report released today by a prominent group of scientists and former public officials on a global health committee has a message for President-Elect Barack Obama: Give us some of that change you've promised.

The committee, co-chaired by Harold Varmus, head of the Memorial Sloan-Kettering Cancer Center, and Thomas Pickering, retired Under Secretary of State for Political Affairs, urges Obama to make "a major speech early in his tenure" that declares that the United States sees global health as "an essential component of U.S. foreign policy." In the eyes of the committee, a more substantial investment in global health will yield diplomatic, economic, and security returns. Specifically, they call on the administration to double its commitment from $7.5 billion to $15 billion by 2012. They suggest that $13 billion should go toward health-related Millennium Development Goals, and another $2 billion toward noncommunicable diseases and injury.

Although the committee commended the United States for making "dramatic increases" in global health during the past decade, it noted that the U.S. "does not come close" to the spending on development aid made by most other rich countries. Denmark, one of the most generous countries, spends $1.07 per day per person, while U.S. public and private contributions only amount to 35¢, for example. In terms of gross national income, the U.S. spends 0.16%, while several Scandinavian countries contribute more than 0.8% (see graph). "Overall as a percentage we're still battling with Greece at the bottom of the pile," Varmus, who also is on Obama's transition team, told ScienceInsider. "We ought to get the level up."

But is it realistic to call for a doubling of funding during the current economic crisis? "We're talking about spending a lot of money on the stimulus package, but a relatively small investment in healthcare," says Varmus, a Nobel laureate who formerly headed the U.S. National Institutes of Health. "We have to recognize we have a lot at stake here."

More from the committee, including a blistering passage, after the jump.

Aside from calling for an increase in funding, the committee wants the U.S. government to more carefully assess how it spends the money and what it buys. Funding has been "heavily skewed" toward HIV/AIDS, the committee stressed, noting that it received 70% of the country's global health aid in 2008. The Obama Administration and Congress should "create balance in the traditional portfolio of global health aid," the report recommends.

In one of its most blistering passages, the committee complained that the government doesn't have a good handle on who is doing what. "To date, the committee is not aware of any efforts to broadly coordinate and quantify U.S. actions in global health across even the major government agencies," the report states. "The tools available to track U.S. government global health funding are limited, and their results are often piecemeal, subject to double counting, and not inclusive of all agencies' work. As a result, the total U.S. government commitment to global health is not known with any certainty; the United States can neither measure the positive impacts nor justify the level of its investments in global health."

To better coordinate the U.S. government's global health effort, the report recommends that Obama create a White House-level interagency committee, chaired by a senior White House official, "to lead, plan, prioritize, and coordinate" budgeting. The report also urges Congress and the White House to require more rigorous evaluation of global health funding.

In April, the committee plans to issue a more complete report that Varmus says will "dot all the i's and cross all the t's," dealing with such complex issues as helping developing countries strengthen their healthcare delivery and the roles of nongovernmental organizations, academia, and the private sector. "This is a 'letter report' designed to attract the interest of the new administration and hopefully put these into place in short order," he says. Varmus would not discuss whether he might have a role in the Obama Administration or the transition team's reaction to the report.