How Politics Influence Global Health

Public health has a long history: from inoculation practices in early India, to aqueduct sanitation systems in ancient Rome, to the sprawling public hospital systems we think of today. Since its early days, the field of public health has evolved alongside the governments that help establish public health policies.

In the modern world, global governments influence health care by setting goals and standards, enforcing laws, contributing resources, providing services, building infrastructure, and involving the public in decision-making processes regarding health care. This influence is part of the reason Partners In Health (PIH) works so closely with local governments to help improve health systems and expand health programs globally.

Despite governments globally contributing to global health policies and dictating local health care services, some of the largest influences in health care around the world lie in one country. The U.S. government is the world's largest donor to global health, providing $12.3 billion in funding for global health in 2024. However, while the U.S. may lead in the overall dollar amount, the country's relative contributions to global health are some of the lowest when considering overall national income-meaning that the U.S. has the capacity, and the responsibility, to increase its global health spending. Many different U.S. government departments and agencies, congressional committees, and funding streams are involved in shaping global health policy.

U.S. Government Shaping Global Health Policy and Programming

Take tuberculosis (TB) for example. The executive branch takes the lead on programming and budgeting. The White House sets the agenda by appointing agency leaders, and by suggesting budget amounts to Congress with the combined President's Budget Request each spring, which is released with the annual State of the Union address. Through the State Department, the bilateral country-to-country funding of the President's Emergency Plan for AIDS Relief and the U.S. contribution to the multilateral Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund) support a significant proportion of global HIV-TB and TB programs. Through the U.S. Agency for International Development (USAID), the U.S. government funds global TB efforts, as well as malaria, maternal and child health, vaccines, nutrition, and other specific disease areas. The Centers for Disease Control and Prevention (CDC) has a global TB program, and the National Institutes of Health (NIH) is the world's largest single funder of TB research.

The House and Senate of Congress are also responsible for allocating funding to TB programs through the annual discretionary appropriations process. For example, the State, Foreign Operations, and Related Programs appropriations subcommittee allocates funding to the TB programs under USAID and the Global Fund. Equally important are the House Foreign Affairs Committee and the Senate Foreign Relations Committee, which have jurisdiction over the policy guidelines and goals for global TB programs-for example, the End TB Now Act. All members of Congress have an opportunity to weigh in on the appropriations process, including how much funding is allocated to TB programs. Funding for domestic TB work, including through the CDC and NIH, is allocated by another appropriations subcommittee, and governed by separate authorizing committees. It's worth noting, however, that mental health, surgery, and non-communicable diseases like cancer and diabetes receive little or no funding, and PIH is continually working to change this.

While the U.S. government may hold the purse strings to help advance health policy, PIH recognizes that partnering with local governments to implement health programs is vital to their sustainability and success.

PIH and Government Accompaniment

Since the beginning, PIH leaders knew that real advancement toward a universal right to health would only be possible through strong partnerships. Our goal is not to expand across the globe, but to partner with governments and organizations who invite us to work together. PIH's collaboration with national governments, local districts, organizations in the private and public sectors, and civil societies helps drive all our health system strengthening work, everywhere.

"What makes PIH unique is that we provide clinical care and provide evidence to the Ministry [of Health] of our impact through a system strengthening model," Danielle Sharp, director of policy and partnerships, said. "And through that accompaniment model, [we] are then able to transform the health system."

PIH's approach to accompaniment includes working side-by-side with our friends and colleagues at all levels, whether they are community-based, state health authorities, or global health advocates, to deliver the highest quality care. We call on those in power, from local legislators to world leaders, to advance equitable health care.

"Health care is a human right and a public good that is best designed and delivered at scale through government," Dr. Maxo Luma, executive director of PIH Liberia, said.

Through accompaniment, PIH teams around the world aim to influence legislation, funding, and programmatic decisions to support the movement for global health equity.

Advocating for Public Health Advancements

In both the U.S. and globally, PIH works to improve health equity and address disparities by improving public policy. Through coalition and grassroots advocacy, PIH has successfully co-authored and spurred the introduction of important new legislation-such as the Community Health Worker Access Act-and opened new financing at the state and federal levels.

"We work daily to grow a foundation of strong bipartisan and bicameral congressional and agency support for critical global and domestic health programs, regardless of who may be in elected or appointed roles at a given time," Vincent Lin, associate director of health policy and advocacy, said.

Thinking again of TB, the PIH advocacy team worked with Congressional leadership to integrate lessons from PIH's care delivery work across sites and lay out an ambitious strategy for ending TB in the End TB Now Act.

As a result of this dedicated advocacy focused on global health funding, the U.S. has continually increased funding for global health programs. PIH's grassroots network of volunteer organizers, known as PIH Engage, has contributed to this national movement through more than 1,500 meetings, calls, and letters to elected policymakers over the last year. PIH supporters far and wide have taken action from all 50 states and Washington D.C., with more than 40,000 calls made and letters written to Congress on important health access topics from addressing Tribal health disparities to TB spending.

The Public's Role in Influencing Global Health

Each year, executive and congressional staff seek input from the public. By design, congress is responsive to the desires of their constituents. For example, congressional staff will meet face-to-face with constituents, take phone calls, read emails and handwritten letters, and hold town halls to better understand the interests of the communities they serve.

Aside from engaging with their representatives, another way constituents have power to influence the public health priorities of our government is through voting. During an election year, the phrase "healthy voter turnout" takes on a new meaning when we view voting as a public health priority. According to the Health & Democracy Index, communities with higher voter turnout rates have better health outcomes. Voters also have the power to influence policy decisions that impact health care, both locally and globally.

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