ACE

Author: Kyle Rogers

  • The World Health Organization

    The World Health Organization

    The World Health Organization (WHO) was founded in 1948 as a UN specialized agency to direct and coordinate international health policy within the UN System with the goal of improving global health outcomes. The WHO would be created with the backing of 61 countries, including the United States, giving it legitimacy to steer the global health conversation as a major international actor. The WHO Constitution defines health as, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition expanded the concept of health to include not just medical interventions, but also the social determinants of health and healthcare access. Despite this robust definition of health, the WHO initially prioritized communicable disease, women and children’s health, nutrition, and sanitation as opposed to healthcare access or addressing the social structures impacting health. Over time, these facets of health would be more directly addressed by the agency.

    The WHO is headquartered in Geneva, Switzerland and has six regional and 149 country offices throughout the world. Delegates from the 194 member states compose the World Health Assembly, which sets WHO policy, approves and monitors budgets, and elects a director-general as a leader of the WHO for 5-year terms. Tedros Adhanom Ghebreyesus is the current director-general of the WHO after being elected to his first 5-year term in 2017. He is the first African in the organization’s history to occupy the post. The WHO is governed by the member states and must respect their sovereignty. Therefore, it cannot enter a country without their permission and a country does not have to follow the agency’s recommendations. The WHO also maintains an Executive Board that is comprised of 34 members who have technical qualifications in the field of health. They provide proposals, make recommendations to the director-general, and implement the agency’s work plan.

    The WHO rarely provides direct medical interventions or direct funding to implementors, but rather focuses on administrative, logistical, and advisory support for countries and other organizations. Core functions of the organization include partnership development, conducting research, setting global health morns, providing technical support, disease monitoring, and advocacy for global health initiatives. For example, guidelines regarding essential medicines, diagnostics, and medical practices are published by the WHO for countries to follow although they are not obliged to follow them. In addition, the WHO supports initiatives to control epidemic and endemic disease by promoting vaccination programs, the use of antibiotics and insecticides, the improvement of clinical facilities for early diagnosis and prevention, access to clean water and sanitation systems, and health education for rural communities. The final major function the agency has, is the ability to declare a Public Emergency of International Concern or a Pandemic. This function allows the WHO to draw attention to, and rally global resources against, emerging health threats or trends in an effort to address them.

    The WHO can direct the global health discussion through its World Health Report and other tools to influence global actions as well. This can be seen in its 2019 General Programme of Work, where the WHO identified three priorities it seeks to address in the coming years:

    1. Providing health coverage to one billion more people
    2. Protecting one billion more people from health emergencies such as epidemics; and
    3. Ensuring another one billion people enjoy better health and well-being, including protection from non-infectious diseases such as cancer.

    Since at least half of the world’s population does not currently have full coverage of essential health services, publishing this document allows the WHO to highlight a global health challenge and set a goal for the countries of the world to strive for.

    The WHO is funded through a combination of assessed contributions, which are calculated based on each member countries’ wealth and population, and voluntary contributions which are provided at the discretion of governments and private donors. Approximately 17 percent of the WHO’s budget comes from assessed contributions, with the rest coming from voluntary contributions. This has increasingly made the WHO dependent on voluntary contributions and placed pressure on the organization to align with the goals of their donors. This was seen in 2020 with President Trump’s plans to withdraw completely from the WHO and take U.S. funding with it due to his belief that the WHO was too deferential to China. Non-government donors also impact the WHO’s direction as seen when private donors make voluntary contributions with the understanding that the donors’ preferred projects will be addressed. One example includes the donations given to the WHO by the Bill & Melinda Gates Foundation. The Bill & Melinda Gates Foundation has prioritized the eradication of polio and the increased resources allocated to this cause by the WHO reflect the foundation’s priority. This has presented a growing challenge to the WHO as monetary contributions are increasingly becoming inflexible through donor restrictions. 93 percent of funds given to the WHO for its health programs is now earmarked and cannot be distributed to other projects that may have a greater need.

    The WHO has accomplished remarkable feats through its global leadership and coordination during multiple outbreaks, vaccination campaigns, and other global health initiatives. What many point to as the agency’s greatest achievement began in 1967 when the WHO started a smallpox vaccination campaign. By 1980, smallpox was eradicated due to the coordination and determination of the WHO’s staff and leadership. Similarly, the WHO’s role in the polio vaccination campaign has been highly lauded, with polio currently on the verge of eradication. The WHO’s handling of the SARS (severe acute respiratory syndrome) outbreak in 2003 was widely praised for the agency’s quick medical and travel guidance. The WHO’s decisive action and travel recommendations were crucial to the successful containment of what many feared could be a global health disaster. The impact of the outbreak was contained mostly to Asia and the death toll was quite low.

    Conversely, the most common criticism of the WHO comes in the form of mismanaged and slow responses due to poor coordination or political considerations. Political friction between WHO headquarters and the regional offices has been a hindrance to the agency’s efficiency, as many believe the regional offices have too much autonomy which leads to a lack of internal cooperation. During the 2014 Ebola outbreak, the WHO was criticized for waiting 5 months to declare a public health emergency despite the pleas of many organization such as Doctors Without Borders. More recently, many criticized the WHO’s response to COVID-19 as being too deferential to China. In particular, the Trump Administration believed the WHO accepted misinformation from China at face value due to the country’s political power within the agency. In general, critics believe the WHO should have been more forceful in its requests for accurate information at the start of the pandemic.

    The United States has played an outsized role in the WHO from its inception due to its monetary contributions and international political clout. The United States’ support for the creation of the United Nations (UN) following World War II was integral to the creation of the WHO as a UN specialized agency. Ever since the agency’s establishment, the United States has traditionally been the largest donor to the WHO. In 2019, the U.S. provided a of total $419 million through assessed and voluntary contributions of the WHO’s $5.624 billion budget. Additionally, The U.S. has been an active participant in WHO governance and provided technical support for health initiatives. This is seen in the country’s representation on the Executive Board along with U.S. government experts and resources being provided for research, laboratory work, and international outbreak response teams.

    As it relates to the current COVID-19 pandemic, the WHO responded with its coordination, technical support, and advisory expertise. On December 31st, 2019, China reported a cluster of unknown pneumonia cases to the WHO. One month later, before any deaths were reported outside of China but a sharp increase in cases was seen outside of the country, the WHO declared a Public Emergency of International Concern. By March of 2020, the agency declared it a Pandemic as cases spread around the world. Additionally, the WHO provided critical supplies such as diagnostic tests and personal protective equipment to member states and created online courses to train health care workers in diagnosis and treatment methods for COVID-19. Furthermore, the WHO is providing medical and technical guidance to countries as they continue to investigate the virus and its new variants. The agency has sent more than 70 teams of technical advisors to assist countries with their COVID-19 responses. 

  • Introduction to Global Health

    Introduction to Global Health

    Read this page as a PDF.

    Global health is defined as the study, research, and practices related to improving health and achieving health equity on a global scale. Global health focuses on health issues that are cross-cultural, cross-regional, or global in scope and local health issues that have transnational significance. It includes both population-based preventative measures along with individual-based clinical interventions. The major components of global health include disease monitoring, data gathering, direct medical interventions, addressing social and economic factors that impact health outcomes, and the coordination between international actors and implementors to fund and execute health solutions.

    Global Health can be broken down into three functions.

    1. The generation of knowledge regarding global health issues to develop global solutions.
    2. The distribution of knowledge through education, training, and publication of research.
    3. The application of global health knowledge and interventions to solve global health problems.

    The historical roots of global health can be traced back to the European colonial era. During the 16th and 17th centuries, as European powers started to explore and colonize new regions, they encountered new infectious diseases. As settlers and native populations suffered from contact with new diseases, colonial powers sought to study and negate the impact of infectious disease upon their settler population and military personnel. These international health measures taken by colonial nations and their colonies were referred to as tropical medicine.

    As the world became more interconnected over the course of the 18th century and international trade expanded, nations began to take greater notice of disease and its relationship with their global trade interests. This led to The International Sanitary Conference which was held between 11 European powers and Turkey in 1851 with the goal of standardizing quarantine regulations and preventing the importation of cholera, plague, and yellow fever through foreign trade. A total of 10 conferences would be held between 1851 and 1897 with little in the form of international agreements to show for them until the 1890’s, but a norm of international dialogue concerning international health was born. These conferences led to the International Sanitary Regulations (ISR) of 1903 which established a requirement for international disease reporting, initially only for cholera and plague outbreaks, to mitigate the impact of disease outbreaks on the commercial interests of industrialized countries while preventing the importation of diseases from developing countries. In 1907, the Office International d’Hygiene Publique was formed in Paris and began to monitor disease outbreaks throughout the world.

    Following the First World War, the League of Nations established a Health Committee with the aim of cooperating with new regional organizations, international organizations, and foundations. However, developments in global health were stalled by World War II and global health would not return to the forefront until the late 1940’s with the rise of the new liberal world order. In 1948, the World Health Organization (WHO) was created as a UN specialized agency and institutionalized the concept of global health. U.S. support for the UN was crucial, and the U.S. has historically provided more funds to the WHO than any other country.

    The WHO sought to bring disease outbreak monitoring and technical assistance to developing countries to mitigate infectious disease outbreaks. In addition, WHO guidelines and statistics are used by countries from across the income spectrum to make informed decisions on health policy. The WHO Constitution defined health as, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, thus providing a robust definition for the global health agenda that did not limit health to clinical parameters but expanded it to include social determinants and healthcare access too.

    Following the end of the Cold War, leading nations in global health, like the United States and United Kingdom, grew concerned that direct aid to developing countries contributed to corruption by local governments. Additionally, many believed the WHO was focusing too much on preventing infectious diseases to the detriment of basic healthcare. This presented an opportunity for NGOs and other philanthropic organizations to play a role in global health as implementers who specialized in addressing specific regions, diseases, or health challenges in partnership with donors (Governments, Development Banks, etc.). NGOs filled the gaps which the WHO was not addressing while reducing corruption as they were more accountable to donors than sovereign states. NGOs now play a significant role in implementing global health initiatives for the U.S. In 2014, USAID disbursed 41% of its global health activities budget to NGOs.

    During the 1990’s, the HIV/AIDS crisis spurred an increased interest in international cooperation on global health between governments, inter-governmental organizations (IGOs), and NGOs. In addition, a growing recognition formed that the vast growth in human contact facilitated by increased trade and travel could lead to the increased transmission of infectious diseases between countries. In short, diseases do not respect national borders. 

    In 2000, the WHO released eight Millennium Development Goals (MDGs) to establish a global health agenda for the 21st century.

    1. Eradicate extreme poverty and hunger
    2. Provide universal primary education
    3. Improve gender equity and empowerment of women
    4. Reduce childhood mortality
    5. Improve maternal health
    6. Combat HIV/ AIDS, malaria, and other diseases
    7. Promote environmental sustainability
    8. Develop global partnerships for development

    These goals highlight the evolution of global health from its initial focus on infectious disease intervention to also address socio-economic factors that limit healthcare delivery. This modern vision of global health has corresponded to increased investments in global health development. Spending on development assistance for health (DAH) increased from $7.1 billion USD in 1990 to $37.6 billion USD in 2016.

    Traditionally, the U.S. has been a leader in global health efforts as the largest funder in the world. The U.S. motivations for funding global health initiatives coincide with its larger international development goals. These goals include the promotion of democratic stability, fostering diplomatic relations, promoting economic development, and preventing disease outbreaks that could threaten U.S. citizens. Under the Trump administration, this leadership role was called into question as plans were made to withdraw from the WHO and reduce global health funding for FY 2020. However, the U.S. seems poised to rebound in its leadership role as Dr. Anthony Fauci, Chief Medical Advisor to President Biden, advised the WHO in January 2021. The meeting pledged a recommitment to U.S. leadership on global health security, HIV/AIDS, malaria, women’s health, and epidemic preparedness initiatives.

    Global health faces enormous challenges due to the COVID-19 pandemic. Not only does the COVID-19 pandemic constitute a serious global health crisis in its own right, but it also threatens to set back decades of progress as COVID-19 takes precedence over other global health initiatives such as measles and polio vaccine campaigns. In addition, experts are worried about increased malnutrition in children and increased infectious disease rates due to resource diversion to COVID-19 activities. Global health faces one of its greatest challenges yet and rebuilding the capacity of global health systems in a post-pandemic world will be just the beginning.

  • Kyle Rogers, University of Albany

    Kyle Rogers, University of Albany

    Senior Fellow; Leader of Public Health

    Linkedin

    Kyle is a second-year master’s student studying Public Administration with a concentration in Global Affairs at the Rockefeller College of Public Affairs and Policy at the University at Albany. He is originally from Syracuse, New York and attended St. John Fisher College in Rochester, NY where he obtained his undergraduate degree in History while minoring in French and International Studies. These studies have shaped his interest in international relations and specifically international development. The international development of public health has become an area of keen interest to him that he looks forward to exploring as part of his research.

    Kyle has worked for 5 years in the logistics industry as a Logistics Coordinator at Transaver
    where he worked to facilitate the logistical needs for the company’s clients including one of their largest clients from Quebec. This allowed him to hone his French language skills in a professional environment. In his free time, he enjoys gaming, spending time outdoors, traveling, reading, and hanging out with his friends. For the spring semester, he is excited to be working with ACE and looks forward to providing research to those interested in international public health and international health development initiatives.

  • U.S Role in International Development

    U.S Role in International Development

    Read this brief as a PDF

    International development encompasses the knowledge, resources, and financial assistance employed by various international actors to improve economic, educational, health, and human rights conditions in developing countries. These actors include states, non-governmental organizations (NGOs), international governmental organizations (IGOs), philanthropists, foundations, and even individual donors. International development assistance comes in the form of direct bilateral payments between states and recipients, multilateral payments between IGOs and recipients, loans, material resources, technical assistance, information sharing, and training.

    Following the end of World War II, the United States has played a leading role in the inception and advancement of international development. In 1948, the first large scale international development initiative was enacted by President Truman to provide technical and financial assistance to Europe in order to rebuild the continent’s economy, infrastructure, and governmental capacities. This initiative was known as the Marshall Plan, named after then Secretary of State, George C. Marshall. At the same time, the United States would play a lead role in the creation and promotion of IGOs, none more important than the United Nations (UN). The UN would go on to develop their own international development programs through offices such as the United Nations Development Programme (UNDP) and World Health Organization (WHO).

    President Truman saw international development as a means of effectuating the foreign policy agenda of the United States. In 1949, he proposed a foreign aid program that would become the 1950 Point Four Program to support technical assistance and capital projects abroad. This program had two strategic goals:

    • The creation of economic opportunity for the United States by opening markets in developing countries through poverty reduction and economic development initiatives
    • Limiting the influence of communism by promoting capitalism in developing countries through economic incentives

    Thus, President Truman saw international development as a long-term investment to boost global economic opportunities, while also holding the United States’ geopolitical rival, the Soviet Union, at bay. 

    In 1961, President John F. Kennedy signed the Foreign Assistance Act into law, creating USAID via executive order. This act introduced USAID as an autonomous federal agency that could implement international development assistance as its sole directive. The USAID Administrator would lead the agency, a position that is still appointed by the President and confirmed by the Senate, although it is not a cabinet-level position. President Kennedy institutionalized international development as he believed it was vital to the United States’ foreign policy objectives. In this way, USAID could advance the moral, economic, and strategic considerations of the United States as a bulwark against totalitarianism and instability around the world.

    During the 1970’s, USAID began to shift focus from technical and capital assistance programs towards programs that focused on basic human needs. These basic needs can be characterized as food and nutrition, population planning, health, education, and human resources. Today, this is referred to as human capital development. By adding this facet to its strategy, USAID widened the scope of what was considered part of international development. Thus, giving us the more comprehensive definition of international development, we have today.

    The 1980’s would largely see the United States retain its strategy of using international development to encourage economic growth and combat the influence of communism. With the dissolution of the Soviet Union in 1991, one of the major motivators of U.S. foreign aid would cease to exist. During the Presidency of Bill Clinton, foreign aid was viewed as an unpopular political topic that left USAID and the funding of international development in limbo. 

    The events of September 11th and the subsequent wars in Afghanistan and Iraq would see the U.S. invest heavily in the rebuilding of those two countries and the resurgence of international development. U.S. international development is now seen as focusing on four main areas: long-term development aid, military and security aid, humanitarian aid, and political aid. These areas of focus highlight the areas the U.S. believes it must invest, to tackle the political and economic challenges of the future.

    The federal budget request for USAID is combined with the U.S. State Department within the federal budget. On a year to year basis, the United States has provided more foreign assistance than any other country in terms of a total dollar amount but falls short of other countries as a percentage of its gross national income. Foreign assistance is generally about 1% of federal budgets, although the public believes it to be much higher. Historically, the public has also believed foreign assistance is favored more by the Democratic Party, but this too is a misconception. Both Republican and Democratic administrations have shown strong support for foreign assistance with some of the most rapid increases in such aid occurring under Ronald Regan and George W. Bush. It is worth noting that the Trump administration broke this bipartisan trend of favorability towards foreign assistance. The administration threatened to cut budgets on multiple occasions which would have abandoned programs in up to 27 countries. This was highly irregular compared to past Republican and Democratic administrations. 

    As the United States looks to the future, the influence of China in the international development sector will be one of the most important factors in our approach to foreign assistance. International development has become a larger part of Chinese policy in recent years as strategies like the Belt and Road Initiative seek to fund infrastructure projects in developing countries to spread China’s influence. In this way, international development as part of U.S. policy will again be a response to a geopolitical rival like it was during the Cold War. As we look to the future of the United States’ role in international development, the two main goals that drove its creation, opening economic markets and containing the political influence of a geopolitical rival, have returned to the forefront.