In low-income countries, children are 12 times more likely to die before the age of five than they are in the United States, and women are 21 times more likely to die from childbirth complications. Harsh statistics like those are why high-income governments and private funders pour money into schemes such as free or low-cost vaccines and antiretroviral therapies. But exactly how much do we spend on health aid, and are we spending intelligently?
A new study, published this week in the Journal of the American Medical Association, begins to answer these important questions. Here are some highlights:
- In the last 25 years, governments and private funders have sent $458 billion in health aid to low-income countries. Since 1990, health funding has increased every year, though its climb has slowed since 2010, likely because of the 2008 worldwide financial crisis.
- Between 1990 and 2014, child health and HIV/AIDS treatment and prevention received the most money—combined, more than half of the world's health aid. In contrast, only 1.5 percent of worldwide health aid went to programs for treating and preventing chronic, non-infectious diseases, such as heart disease, cancer, and asthma. Funders spent only six percent on strengthening developing countries' health systems, even though better infrastructure theoretically helps prevent many diseases. For example, experts think the recent Ebola outbreak in West Africa would not have been as devastating had it occurred in countries with better hospitals, airports, and roads.
- The study authors, a team from the University of Washington, came up with a measure for comparing how much aid a specific health condition gets and how many people that condition severely affects. In other words, they found a way of measuring whether we're focusing our aid money in the places that need it most.
- Maternal health and HIV/AIDS get the most money, relative to the number of people it severely affects. Non-infectious diseases get the least. Child health gets a lot of money overall, but the need is also great, so it turns out its funding-per-need number is about one-tenth that of maternal health.
- The U.S. government is the world's largest health charity funder, giving $143.1 billion between 1990 and 2014. The second-largest funder: private organizations. Among private funders, the Bill and Melinda Gates Foundation is the top donor.
- The U.S. government has a big influence on what's funded and cured. For example, the major reason HIV/AIDS is the world's second-best funded health condition is a single U.S. program, the President's Emergency Plan for AIDS Relief (PEPFAR). That funding makes a difference—PEPFAR-funded countries have had steeper declines in AIDS-related deaths than countries without PEPFAR money.
So are American taxpayers and philanthropists spending their money on the right priorities? Answering that question requires much more than these data points. You could debate whether funders should focus on conditions that affect a lot of people, that are cheap to fix, or that the people themselves care about most. Nevertheless, these data are an important start.