Science in the Triangle

At a global health conference in Chapel Hill, the tug-of-war over budget cuts on Capitol Hill landed smack-dab in North Carolina’s Research Triangle.

In 2010, foreign assistance accounted for 1 percent of all U.S. spending.

While Republicans and Democrats are negotiating about getting a handle on the federal deficit, concerns about proposed federal funding cuts are rising in states with global health research hubs, such as North Carolina, California and Washington.

House Republicans have proposed cutting international affairs and foreign assistance spending by a total of 44 percent over the next five years, including 29 percent in 2012. They’re also pushing for an 11 percent funding cut for global health programs during the remaining months of the current fiscal year, which would scale back malaria programs and reduce immunizations, the number of skilled birth attendants and other basic health services worldwide, Dr. Rajiv Shah, head of the U.S. Agency for International Development, told a House appropriations subcommittee.

At the conference, which took place April 1 at the University of North Carolina Friday Center in Chapel Hill, experts from USAID and the Center for Strategic and International Studies in Washington, D.C., and the Centers for Disease Control and Prevention in Atlanta addressed the future of global health and development.

Stephen Morrison

“We’re now in an era of austerity, uncertainty and flattening or declining budgets,” said Stephen Morrison, director of the CSIS Global Health Policy Center.

Morrison didn’t foresee a catastrophic collapse of global health budgets. But the days of double-digit annual increases are gone, he said.

From 1990 to 2010, international spending for global health rose from about $6 billion to an estimated $27 billion, according to a report by Chris Murray of the University of Washington Institute for Health Metrics and Evaluation. About one-third of last year’s funding came from the U.S.

U.S. spending on foreign aid and global health more than doubled in the past 10 years and the increase benefited Africa and parts of Asia.

The Bush administration started an initiative to battle HIV/AIDS in Africa, contributed to an International Monetary Fund effort aimed at boosting education, health status, nutrition and gender equality in poor countries and increased security-related assistance to Afghanistan and Pakistan.

Regional distribution of U.S. foreign aid in FY 2000 and FY2010

In fiscal year 2010, the U.S. spent $39.4 billion on foreign aid, according to a Congressional report. Nearly 90 percent of that money was funneled through USAID. Still, foreign aid accounted for only about 1 percent of all U.S. spending.

Domestically, the funding increases boosted grant revenue at research institutes and created jobs at universities.

In the Research Triangle, RTI International was one of the biggest beneficiaries. RTI increased funding from USAID from $165.9 million in 2006 to $265.4 million in 2010. Another local research institute that benefited was Family Health International. FHI’s annual revenue rose about 40 percent from $224 million in 2005 to $370 million in 2009. About 70 percent of the global health funding FHI secured in 2009 came from USAID.

The UNC Gillings School of Global Public Health and the Duke Global Health Institute trained the workforce needed to implement the new initiatives.

In 2009, a Duke University study determined that North Carolina’s global health sector supported more than 7,000 jobs and $508 million in annual salaries and wages. The sector’s impact on the state’s economy was nearly the same as the textile industry’s, according to the study.

Similar economic impact studies have been done in California, where global health supports about 350,000 jobs that generate $19.7 billion in annual salaries, wages and benefits, and in Washington state, where global health supports 13,700 jobs that generate $1.7 billion in annual salaries, wages and benefits.

At the conference, Morrison encouraged global health professionals in the audience to lobby their House representatives, but he was convinced that global health would take a disproportional hit no matter how the budget negotiations would turn out.

“This is a moment of wake-up for us,” he said.