Trump’s Funding Decisions and Global Health Impact

Mailing UNICEF cards for Christmas has become a widespread tradition in the US. However, President Trump submitted a budget to Congress for 2020 that eliminated all funding to UNICEF, as well other United Nations (UN) health-focused programs.1 Weakening of federal public health-related programs has also continued under Trump’s leadership.

Although Congress chose to sustain UNICEF’s federal funding mechanism, de-funding in 2018 of just one Trump-targeted agency resulted in 250 job cuts in that UN-administered relief agency.2 Since the health of international populations can affect public health (and infection transmission) in the US, Trump and Pence efforts to shrink international health-focused programs do not bode well for health emergency preparedness.

The negative impact of Trump Administration funding cuts on various global health-focused programs administered either by the UN and/or by the US government are described below. Some US-focused Trump policy decisions and Executive Orders undermining public health are described, as well.

Why the US Has a Monumental Impact on UN Healthcare Policies and Programs

The US is the UN’s largest single funder,3 contributing a total of $1 Billion in 2017 (corresponding to one-fifth of the UN’s collective budget4). Around $37.6 B was provided by high income nations and development agencies to promote improved health in low- and middle-income nations in 2016.5 In turn, funds enabling the hiring of physicians and public health staff in the recipient countries also aided their economic growth.

Despite the reliance of some major health-focused UN agencies (such as the World Health Organization [WHO]) on US financial support, Trump proposed a 24% decrease in UN funding for 2018.6

Consequent to the huge funding role of the US, the leverage that the US can apply to shaping the UN’s health-related program objectives is enormous – as well US leverage to discontinue any program in opposition to US policies under a given President.

Trump, UN HIV/AIDS Efforts, and George Bush’s HIV/AIDS Program in Africa (PEPFAR) 

The Joint UN Programme on HIV/AIDS (UNAIDS) unites the efforts of 11 UN organizations,7 and the majority were threatened by Trump’s attempted budget cuts. Additionally targeted for cuts by Trump was PEPFAR, a US federal initiative that commenced in 2003 under President Bush,8 which – by 2018 – had achieved the following:9

  • Supported HIV/AIDS testing services for at least 95 million people (across 50 countries9);
  • Supported treatment with antiretroviral dugs for at least 14.6 million people;
  • Prevented at least 2.4 million babies from being born with HIV;
  • Supported training for at least 270,000 new healthcare workers;
  • Provided care for at least 6.8 million orphans and vulnerable children

 Trump sought a $1 B cut in PEPFAR’s funding (out of the annual $4.5 B budget), and a reduced outreach to solely 13 of the customary 50 countries.10

UN’s World Food Programme, US Food Assistance Programs, and Public Health

 Nothing matters more to sustaining health than nutrition, because our bodies all require food. The UN’s World Food Programme serves around 80 million people annually with emergency food aid, and the US has provided $2 B each year as its largest funder.11 Yet, this was one of the UN programs targeted for de-funding by President Trump – albeit unsuccessfully – in 2017. A Trump appointee (David Beasley) is now the Executive Director of the World Food Programme.

According to the Kellogg Family Foundation, Trump rejected Beasley’s effort in 2018 to provide food aid to starving people in North Korea in 2018 due to sanctions imposed by the US on the North Korean government over its nuclear weapons program.12 Meanwhile, food aid under the aforementioned UN program to Palestinians in Gaza and the West Bank was all but eliminated due to US pressure (combined with Trump’s funding withdrawal totaling $500 Million in UN-administered aid to Palestinian food, health, and education programs).13

 In the US in October of 2019, the Dept. of Agriculture (under Trump-appointee Sonny Purdue) proposed a change to the way benefit dollars are calculated under the federal Supplemental Nutrition Assistance Program (SNAP) – anticipated to reduce federal SNAP expenditures by $4.5 B over 10 years.

This was on top of a proposed rule in 2018 tightening work requirements for SNAP enrollees. It was also on top of one proposed by the Dept. of Homeland Security (DHS) in 2019, whereby immigrant beneficiaries of federal assistance programs (e.g., SNAP) could automatically be disqualified from receiving a “Green Card” due to enrollment in a federal program such as SNAP.14

 Well-recognized is that poor nutrition is linked to preventable health disorders (e.g., iron-deficiency anemia) and cognitive dysfunction, and especially in children. Yet, an article in October 2019 in the Los Angeles Times noted that a Trump-proposed rule change would render at least 500,000 US children living in poverty ineligible for a free school lunch (or any free meal).15

Trump’s Blackmailing Strategy, the UN’s Population Fund, and Women’s Health

Trump halted in 2017 all US funding to the UN’s Population Fund (UNFPA), tasked with improving access to reproductive healthcare in impoverished global regions. This was especially a decision supported by Vice President Mike Pence due to his rigid (and extreme) position on abortion.

The following are listed on the UNFPA website as three women’s healthcare outcomes targeted in 2018: 1) ending unmet need for family planning; 2) ending preventable maternal death; 3) ending gender-based violence and harmful practices.16

The US-stated reason for cutting all funding of the UNFPA was that the UNFPA continues to partner with China’s National Health and Family Planning Commission which promotes abortion.17 Yet, cutting all funding to this critical program endangers fetuses and adult women – especially in Africa and Southeast Asia – by reducing their access to prenatal and postnatal care (as well as contraceptives and condoms to prevent HIV transmission). For example, UNFPA in 2016 enabled at least 800,000 adults in 150 different countries to obtain contraception.18

The punitive action on the part of the Trump Administration toward the UNFPA for refusing to cease providing pregnant patients with abortion safety information also promotes the further skewing of the total population in impoverished nations toward youth under age 10 – which, in turn, will place a likely burden on these nations’ economic capacity to provide food, education, and healthcare to these children.

Trump’s Proposed Cuts to the Centers for Disease Control (CDC)

Trump’s proposed budget for 2020 included a 10 percent funding “cut” to the Centers for Disease Control (CDC) (equivalent to a loss of $750 M) – and including a National Institute for Occupational Safety and Health (NIOSH) cut of $145 M; chronic disease prevention and health promotion cut of $236 M; and $102 M cut to emerging and zoonotic diseases.19

Besides an overall budget cut to NIOSH, Trump sought to halt direct federal funding for academic salaries, stipends, and tuition/fee reimbursements for occupational health professionals at universities.20 This is in alignment with Trump’s other attempts to weaken occupational health protections for workers in the US and globally.

Trump’s Proposed Cuts to the National Science Foundation (NSF)

According to an article in Nature in 2019, Trump’s proposed 12 percent “cut” to the National Science Foundation (NSF) chiefly targeted research in the Arctic and Antarctic regions (which have shown the most visible alterations due to climate change), earth science research, and math/physical science research – which this article aptly described as “derailing science”.21

Trump’s expressed disdain for the Environmental Protection Agency (EPA), refusal to acknowledge the existence of climate change and de-regulation of environmental pollutants (and curbing of the ability of academic scientists to perform scientific research) all align with his lack of concern for the planet’s future. His proposed funding cut in 2020 of $52 M for CDC environmental health activities is further evidence of a failure of to grasp the importance of the environment to people’s health.22

Since science is well-recognized as the underpinning of public health, Trump has positioned himself as a power-broker in world affairs with a viewpoint clearly destructive of public health – not to mention the Earth itself.

Scapegoating as Public Policy – Refugees, Asylum-Seekers, and Immigrants

 A recent article in the Washington Post – titled Trump Administration Slashes Refugee Limit for the Third Consecutive Year to a Historic Low of 18,000 – noted that this ceiling established for 2020 represents a 40 percent decrease from 2019, and is the lowest in the US in 40 years.23 In addition, an Executive Order issued by President Trump will allow local municipalities beginning in 2020 to decide whether resettlement of refugees into their communities will be allowed.24

This xenophobic policy toward refugees of certain ethnicities has also played out in Trump’s policies toward Mexican/Central Americans seeking asylum in the US – with fleeing gang violence, fear of lifetime imprisonment due to a LGBT identity, and domestic violence no longer considered valid reasons for granting asylum in the US. Meanwhile, Trump has sought to deport around 300,000 immigrants living legally in the US through revoking their “Temporary Protected Status”.25

In 2018, the UN accused the US of human rights violations for separating migrant families detained at the US-Mexico border (and the US is the only country not to have signed the UN Conventions on the Rights of the Child).26 Meanwhile, at least 47,000 migrant families legally requesting asylum in the US have been sent back across the Mexican border to await asylum hearings under a new DHS policy.27

In June 2018, the US withdrew from the UN Human Rights Council (joining Iran, North Korea, and Eritrea as the only nations refusing to participate in this Council).28 Likewise, all funding was cut by the US to this entity of the Office of the High Commissioner on Human Rights (OHCHR),29 as well as an additional $16 M in discretionary funding to the OHCHR.30

The UN Refugee Agency (UNHCR) in 2018 documented 25.9 M global refugees, 41.3 M internally-displaced people, and 3.5 M global asylum-seekers.31 Global public health leaders have recognized for at least 40 years that displaced people and refugees are far more likely to become the victims of human trafficking and poor overall health.

President Trump has not only consistently scapegoated refugees and immigrants to the US as the cause of all societal problems in the US (e.g., crime). He has reversed the usual position of the US as a global leader of human rights through his cruel policies aimed at the weak and vulnerable, and his expressed support of various white supremacist political leaders across the globe.

Concluding Thoughts

Hate crimes in the US increased by 226 percent in areas where Trump held presidential rallies in 2016,32 and the number of hate groups operating in the US has increased by 30 percent since Donald Trump’s inauguration.33 Likewise, mass shootings of people in schools, shopping centers, and houses of worship have increased under Trump’s presidency.34 Not only is this bad for public health, but it is horrific for our society as a whole.

Throughout history, dictators and tyrants have utilized fear-mongering, scapegoating, and increased economic inequality to consolidate their power. President Trump has praised dictators in his tweets (such as Vladimir Putin and Kim Jong-un). This has also encouraged dictators globally to increase inflicting human rights abuses on their own people (such as Saudi Arabia’s imprisonment of female human rights advocates, and Egypt’s imprisonment of journalists).

In conjunction with Trump’s refusal to support US or global efforts to curb greenhouse gas emissions, preserve nuclear arms treaties, and/or engage in worldwide collaborations to promote global peace, many of his pronouncements and policies utterly undermine both US and global public health.

Trump needs to be ousted from his position as President in the voting booth in November 2020. Nothing less than the survival of our entire planet is at stake. We can’t afford another four years of Trump. It really is that simple.

References:

  1. Goldberg, Mark L. (March 12, 2019). The White House Seeks to Eliminate Funding for UNICEF. UN Dispatch Webpage: https://www.undispatch.com/the-white-house-seeks-to-eliminate-funding-for-unicef/
  2. Amr, Hady. (September 7, 2018). In one move, Trump eliminated US funding for UNRWA and the US role as Mideast peacemaker. Brookings Institute Webpage: https://www.brookings.edu/blog/order-from-chaos/2018/09/07/in-one-move-trump-eliminated-us-funding-for-unrwa-and-the-us-role-as-mideast-peacemaker/
  3. Better World Campaign. U.S. Funding for the UN. Webpage: https://betterworldcampaign.org/us-un-partnership/us-funding-for-the-un/
  4. Hillard L, and Shendruk A. (April 2, 2019). Funding the United Nations: What Impact Do U.S. Contributions Have on UN Agencies and Programs? Council on Foreign Relations Webpage: https://www.cfr.org/article/funding-united-nations-what-impact-do-us-contributions-have-un-agencies-and-programs
  5. Micah AE, Zlavog B, Friedman S, et al. (December, 2017). The US Provided $13 Billion In Development Assistance For Health In 2016, Less Per Person Than Many Peer Nations. Health Affairs 36(12). Webpage: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1055
  6. Micah AE, Zlavog B, Friedman S, et al. (December, 2017). The US Provided $13 Billion In Development Assistance For Health In 2016, Less Per Person Than Many Peer Nations. Health Affairs 36(12). Webpage: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1055
  7. Joint UN Programme on HIV/AIDS (UNAIDS). Home page. Webpage: https://www.unaids.org/en
  8. U.S President’s Emergency Plan for AIDS Relief (PEPFAR). What is PEPFAR? HIV.gov Webpage: https://www.hiv.gov/federal-response/pepfar-global-aids/pepfar
  9. Kellogg Family Foundation (KFF). (August 2, 2019) Global Health Policy – The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Webpage: https://www.kff.org/global-health-policy/fact-sheet/the-u-s-presidents-emergency-plan-for/
  10. Beaubien, Jason. (July 25, 2018). Praise For The Global HIV Program That Trump Wants To Cut. National Public Radio (NPR) Webpage: https://www.npr.org/sections/goatsandsoda/2018/07/25/632395250/praise-for-the-u-s-hiv-program-that-trump-wants-to-cut
  11. Hensch, Mark. (April 3, 2017). UN World Food Programme head rips Trump budget. The Hill Webpage: https://thehill.com/policy/international/un-treaties/327065-un-food-program-head-rips-trump-budget
  12. Kellogg Family Foundation (KFF). (May 17, 2018). Trump Administration Rejects WFP Appeal For Food Aid Funding For North Korea. Webpage: https://www.kff.org/news-summary/trump-administration-rejects-wfp-appeal-for-food-aid-funding-for-north-korea/
  13. The Times of Israel. (January 13, 2019). Funding shortage leads to cuts in UN food aid to Palestinians. Webpage: https://www.timesofisrael.com/funding-shortage-leads-to-cuts-in-un-food-aid-to-palestinians/
  14. Brown, H. Claire. (October 3, 2019). The new plan could save $4.5 billion, while taking SNAP from 8,000 families. New Food Economy Webpage: https://newfoodeconomy.org/usda-snap-food-stamps-policy-change-utility-deduction/
  15. Hiltzik, Michael. (October 21, 2019). Column: Trump proposes denying free school meals to half a million children. Los Angeles Times Webpage: https://www.latimes.com/business/story/2019-10-21/hiltzik-trump-school-lunch
  16. United Nations Population Fund (UNFPA). About Us. Webpage: https://www.unfpa.org/about-us
  17. Jones, Nicola. (April 7, 2017). President Trump, the facts show that defunding the UN Population Fund won’t work. ODI.org Webpage: https://www.odi.org/blogs/10508-president-trump-facts-defunding-un-population-fund-unfpa-wont-work
  18. Center for Reproductive Rights. (April 4, 2017). Trump Administration Guts Funding to United Nations Population Fund. Webpage: https://reproductiverights.org/press-room/trump-administration-guts-funding-to-united-nations-population-fund
  19. American Public Health Association (APHA). (May, 2019). President’s budget would hinder US public health progress: Huge cuts proposed. The Nation’s Health 49(3): 1-14. Webpage: http://thenationshealth.aphapublications.org/content/49/3/1.2
  20. American Industrial Hygiene Association (AIHA). Newswatch – President Trump Proposes to Consolidate NIOSH Activities, Research within NIH. The Synergist Webpage: https://synergist.aiha.org/201804-trump-proposes-to-consolidate-niosh
  21. Leford H, Rodriguez Mega E, Reardon S, et al. (March 18, 2019). Trump proposes slashing science spending at the NSF. Nature Webpage: https://www.nature.com/articles/d41586-019-00851-1
  22. American Public Health Association (APHA). (May, 2019). President’s budget would hinder US public health progress: Huge cuts proposed. The Nation’s Health 49(3): 1-14. Webpage: http://thenationshealth.aphapublications.org/content/49/3/1.2
  23. Nakamura D, Sacchetti M, and Kim SM. (September 26, 2019). Trump administration slashes refugee limit for the third consecutive year to a historic low of 18,000. The Washington Post Webpage: https://www.washingtonpost.com/politics/trump-administration-proposes-slashing-refugee-limit-for-the-third-consecutive-year-to-a-historic-low-of-18000/2019/09/26/3a554a60-e0a4-11e9-be96-6adb81821e90_story.html
  24. Anderson, Stuart. (October 1, 2019). Trump Order May Give Veto To People Who Hate Or Fear Refugees. Forbes Magazine Webpage: https://www.forbes.com/sites/stuartanderson/2019/10/01/trump-order-may-give-veto-to-people-who-hate-or-fear-refugees/#44a018052be8
  25. Johnson K, and Ibe P. (November 7, 2019). Trump has ended Temporary Protected Status for hundreds of thousands of immigrants. Here’s what you need to know. American Friends Service Committee (AFSC) Webpage: https://www.afsc.org/blogs/news-and-commentary/trump-has-ended-temporary-protected-status-hundreds-thousands-immigrants
  26. GlobalCitizen.org. Citizenship – UN Accuses US of Human Rights Violations for Separating Migrant Families. Webpage: https://www.globalcitizen.org/en/content/un-us-human-rights-abuses-child-migrants/
  27. Hackman, Michelle. (September 23, 2019). U.S. Seeks to Send More Migrant Families to Mexico to Await Asylum Hearings. Wall Street Journal Webpage: https://www.wsj.com/articles/u-s-seeks-to-send-more-migrant-families-to-mexico-to-await-asylum-hearings-11569290834
  28. Harris, Gardiner. (June 19, 2018). Trump Administration Withdraws U.S. From U.N. Human Rights Council. New York Times Webpage: https://www.nytimes.com/2018/06/19/us/politics/trump-israel-palestinians-human-rights.html
  29. US New and World Report. (August 23, 2018). AP Exclusive: US to Cut Funding for UN Human Rights Office. Webpage: https://www.usnews.com/news/world/articles/2018-08-23/ap-exclusive-us-to-cut-funding-for-un-human-rights-office
  30. CommonDreams.org. (August 26, 2019). Trump Has Done Incalculable Damage to Humanity by Backing Out of UN Programs. Webpage: https://www.commondreams.org/views/2019/08/26/trump-has-done-incalculable-damage-humanity-backing-out-un-programs
  31. UN Refugee Agency (UNHCR). 2018 in Review: Trends at a Glance. Webpage: https://www.unhcr.org/globaltrends2018/
  32. Choi, David. (March 23, 2019). Hate crimes increased 226% in places Trump held a campaign rally in 2016, study claims. Business Insider Webpage: https://www.businessinsider.com/trump-campaign-rally-hate-crimes-study-maga-2019-3
  33. Southern Poverty Law Center. (February 19, 2019). Hate Groups Reach Record High. Webpage: https://www.splcenter.org/news/2019/02/19/hate-groups-reach-record-high
  34. Silverstein, Jason. (September 1, 2019). There have been more mass shootings than days this year. CBS News Webpage: https://www.cbsnews.com/news/mass-shootings-2019-more-mass-shootings-than-days-so-far-this-year/