U.S. less generous than European nations with development assistance

The U.S. contributes more than any other nation in development assistance for health to low- and middle-income countries, but its generosity falls short when compared in terms of size and wealth, a new study found, Reuters Health reports.

Norway, Denmark, Luxembourg and the UK each provided substantially more assistance for health relative to the size of their populations, their public spending and their economies, the Health Affairs study shows.

Each resident of Norway provided $149 in annual assistance for health to low- and middle-income nations, while each resident of the U.S. provided $41 in recent years, the analysis found.

“The study shows that the U.S. has been quite generous in its support of global health, which has saved millions of lives,” said Jen Kates, vice president and director of global health and HIV policy for the Kaiser Family Foundation in Washington, DC.

“But it also may help to show that, despite concerns about the U.S. spending ‘too much,’ it really depends on how that is measured,” Kates, who was not involved with the study, said in an email.

Senior author Joseph Dieleman analyzed 23 countries’ donations from 2014 through 2016 in an effort to gauge the relative charity of the U.S. in light of concerns about the impact of a Trump administration proposal to cut nearly one-quarter of the development-assistance budget.

“These cuts have very real consequences,” said Dieleman, a health economist and professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

U.S. global health assistance has been spent on maternal, newborn and child health and to combat tuberculosis and HIV. Much of U.S. development assistance has been used to prevent, diagnose and treat HIV infections and to attack emerging epidemics like Zika and Ebola, Dieleman said in a phone interview.

“HIV is one of the amazing stories,” he said. “Mortality rates in the 1990s and early 2000s in developing countries, some of the poorest countries in the world, were double what they are now.”

“As soon as you start taking away money, there could be increases in incidences and the mortality rates could climb,” he said. Likewise, if developing nations are unable to contain emerging epidemics, local epidemics are more likely to turn into global epidemics, he said.

Kates and her colleagues have predicted the proposed U.S. cuts could lead to as many as another 198,700 HIV infections and 31,100 tuberculosis infections.

More than 87 percent of global disease burden was in low- and middle-income countries, while only 35 percent of global health dollars were spent in those countries.

Norway, Denmark, Luxembourg and the UK were the most generous providers of development assistance for health, with each country contributing more than $1,500 for every $1 million in national income, the study found. By the same metric, the U.S. was the seventh most generous contributor, spending $714 for every $1 million in national income.

Norwegians and Luxembourgers each contributed nearly 50 percent more than citizens of any other country and more than 200 percent of what Americans contribute, the study found.

Norway spent 2.3 percent of its health spending on international health, compared to the U.S., which spent 0.4 percent.

“The U.S. has the largest footprint in global health in the world,” Kates said. “A reduction of U.S. support would have an outsized effect on the health of those in low- and middle-income countries.”