22 May 2012

Building American Support for Global Health Spending

A version of this post appeared in the PSI blog.

What do Americans think about the role of the US in global health? A Kaiser Family Foundation survey released today sought to answer that question.

As you may already know, Americans are terrible at guessing how much of the US budget is spent on foreign assistance. Previous surveys put the estimates of Americans into the 10 to 20 percent range. The latest from KFF shows an even higher average with people surveyed estimating 27% of the federal budget is spent on foreign aid.

As the chart illustrates, the reality of foreign aid spending is vastly different than its perception. Recent studies show the impact that 1% of the US budget has in developing countries. A  Stanford University School of Medicine study determined that PEPFAR saved 740,000 lives between 2004 and 2008. Also, an analysis by the Guttmacher Institute uncovered dramatic changes for every $10 million less spent on international family planning assistance. Despite representing a small sliver of the federal budget, foreign aid does a lot of good and it is especially true in the area of public health.

When people are explained how much is actually spent on foreign aid and the impact it has, attitudes quickly swing towards support.

The number of people who thought too little was spent on foreign aid doubled when learning that only 1% of the federal budget is spent on foreign aid. Looking into global health questions, the survey shows the potential for building greater support in this area as opposed to foreign aid in general.

One of the most interesting findings is where people think money should be allocated. Multi-partner organizations such as the WHO and the Global Fund receive the most support while the governments in developing countries and faith-based organizations are groups that should not be given money.

There are strong concerns about corruption. "On average, Americans believe just 23 cents of every tax dollar the U.S. spends on improving health in developing countries ends up reaching people who really need it. The public believes twice as much money—47 cents of every tax dollar spent on these efforts—is lost through corruption," says the survey.

Finally, the study shows a strong correlation between support and age, political party affiliation, and understanding of foreign assistance. Support comes from younger people, those who estimate a lower percentage of the US budget is spent on foreign assistance, Democrats, and individuals who have previously traveled to a developing country.

KFF President and CEO Drew Altman, Ph.D sums up the findings from the survey:
The message here is threefold.  First, global health aid has the potential to be relatively popular even if foreign aid is not.  It may not move votes in an election as issues like jobs and the economy can, but it could be a plus instead of a minus for elected officials.  Second, information and public education — to counter misperception — can matter to the level of public support.  But third, whether for foreign aid generally or global health more specifically, the ultimate obstacle to greater public support is the need to make the case effectively that aid is not ripped off and makes a difference.
Overall, the survey findings are very positive. It illuminates the need for more work to be done, but shows that people are generally supportive of global health. That support increases with more information about how the money is spent.  The majority of people surveyed understand that reducing global health spending will have a negative effect and  they understand that the decrease in funding will not likely be filled by other donors. However, the US public are skeptical of the impact of increased spending and fear that a large portion of money is lost to corruption.

Taken together, the survey suggests that a case can be made for increased development spending, and the audience is receptive. The challenge is reaching Americans to build a broad-based level of support. Results from the survey seem to point towards it being possible.

It is then followed by the very important question of the role the US can play in the global health space. Hopefully understanding about aid will grow as the result of building a constituency to support US foreign assistance spending. Doing it well matters as much as having the money.