Donald Trump will take office at a pivotal time for the world's neediest.
The world's wealthy countries have, since 2000, been part of a historic partnership with poor countries to eliminate poverty and roll back diseases.
Over the past 16 years millions were given access to lifesaving HIV/AIDS and malaria treatments. From 1990 to 2015 the number of people living in extreme poverty dropped by more than half from 1.9 billion — or 47 percent of people in developing countries — to 836 million, or 14 percent. And last year, world leaders meeting at the United Nations committed to eliminating extreme poverty altogether by 2030.
Plenty of obstacles remain: the unprecedented migration crisis, the threat of global disease pandemics, and the long-term consequences of climate change, to name a few. Still, "the last decade has probably been the best in the history of mankind in terms of welfare benefits and reductions of poverty," says Todd Moss, chief operating officer at the Center for Global Development, a Washington think tank.
Will Donald Trump commit his administration to being part of this global effort?
Right now, "we know very little," says Moss. Trump barely mentioned the issue during the campaign. And until he fills key foreign policy jobs in his administration, "it's not clear who will be the people in positions of influence on this."
The stakes are high because the U.S. role in dealing with these health and development issues has been "outsized," says Raj Kumar, president and editor-in-chief of Devex, a news and jobs-listing website for international development professionals. No country donates more aid dollars, notes Kumar — with about $10 billion per year spent on global health programs alone. But it's more than that. U.S officials are also vigorously involved in setting the agenda on global health and development.
And this is all the product of a rare consensus that has coalesced in Washington around the value of foreign assistance and its centrality as a tool of foreign policy. As recently as the early 1990s, then-Republican Sen. Jesse Helms was opposing foreign aid on the grounds that much of it amounted to pouring money down "rat holes." Yet today, says Kumar, the foreign aid budget has emerged as one of the few areas of bipartisanship agreement in Congress. "It's kind of an amazing thing at a time when we think of nothing but gridlock. But Republicans and Democrats on the Hill have come together in amazing ways around foreign assistance."
Much of this dates to the administration of President George W. Bush, says Kumar. "He really ramped up American capabilities through massive new funding for foreign assistance." This included the President's Emergency Plan for AIDS Relief, or PEPFAR — which has provided HIV-AIDS drugs to millions of people in poor countries — and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Bush's push for sweeping efforts in this arena had the vigorous backing of religious conservative lawmakers such as Vice President-elect Mike Pence, who said in a 2008 speech that the United States had both a "moral obligation to lead the world in confronting the pandemic of HIV-AIDS" as well as a genuine security interest in doing so. "If not addressed," said Pence, "this plague will continue to undermine the stability of nations throughout the Third World, leaving behind collapsing economies and tragedy and desperation, a breeding ground for extremist violence."
Obama has built on those efforts still further, putting particular emphasis on preventing global disease pandemics in the aftermath of the 2014-2015 Ebola outbreak by, among other measures, working to strengthen health systems in poor countries. "Global health really became part of what the U.S. government did in development," says Jennifer Kates, vice president and director of Global Health & HIV Policy at the Kaiser Family Foundation.
And while spending on global health has not gone up considerably under Obama, says Kates, the fact that "it's been protected at a pretty constant level" in the midst of all the budget battles between Obama and Republican leaders of Congress speaks volumes. In the current environment, "if you can have flat funding for your program, that's often seen as a success," she says.
The overall foreign assistance budget — including programs to spur the economies of poor countries — has also generally fared well. And Obama's administrators of USAID, the agency housed within the State Department that's most prominently in charge of U.S. foreign aid programs, have enjoyed fairly smooth relations with congressional Republicans.
In short, concludes Moss, "I think there's pretty broad agreement that we cannot turn our backs on the world's most needy and desperate people — that that will only come back to bite us."
Of course it doesn't hurt that the amount of money involved is relatively small, accounting for roughly 1 percent of the total U.S. budget and thus reducing foreign aid's appeal as a target for budget-cutting.
Still, Kumar says, don't assume that the bipartisan consensus could never break down — or at least wobble — in the coming Trump era.
"Since [global health and development] has not been a priority for [Trump's] campaign and there are other priorities which are going to cost money like a tax cut, it's entirely possible that some foreign assistance programs will be on the chopping block," he says.
And at that point, he says, "these kinds of programs that have been bipartisan might no longer be."
A previous version of this story incorrectly stated the name of the Global Fund for Malaria. The organization is called the Global Fund to Fight AIDS, Tuberculosis and Malaria.
KELLY MCEVERS, HOST:
The Trump presidency could be a pivotal moment for the world's neediest people. For the last 15 years, the United States has been the biggest funder of an unprecedented effort to fight disease and lift incomes in poor countries. Now aid groups are asking what a Trump administration will mean for that effort. NPR's Nurith Aizenman reports.
NURITH AIZENMAN, BYLINE: Foreign aid has been a rare topic of agreement between President Obama and Republicans in Congress. It probably doesn't hurt that it only accounts for about 1 percent of the federal budget, but there's more to it than that, says Todd Moss of the Center for Global Development, a Washington think tank.
TODD MOSS: Since the end of the Cold War, we've really seen a consensus within the Republican Party. There's pretty broad agreement that we cannot turn our backs on the world's most needy and desperate people, that that will only come back to bite us.
AIZENMAN: This bipartisan consensus has been particularly strong when it comes to funding global health. Beginning with President George W. Bush, the United States massively ramped up programs to get people in poor countries treatments for HIV/AIDS and malaria. And Moss says that spending has been a key piece of a remarkably successful global effort to help the world's neediest.
MOSS: The last decade has been probably the best in the history of mankind in terms of welfare benefits and reductions of poverty.
AIZENMAN: Eighteen million lives have been saved from HIV/AIDS or malaria since 2000. The number of people in poor countries who live in extreme poverty has dropped by half since 1990. And last year, world leaders meeting at the United Nations vowed to completely eliminate extreme poverty by 2030. I ask Moss, will Donald Trump keep that commitment?
MOSS: Well, I actually think we know very little.
AIZENMAN: Trump barely mentioned foreign aid during the campaign except for comments that were pretty general, like last April when then-Fox News anchor Greta Van Susteren asked him what he'd do about countries that have deep needs.
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DONALD TRUMP: We just can't continue to keep giving, giving, giving. Now, there are countries that can do it.
GRETA VAN SUSTEREN: Would you cut out giving some of this humanitarian aid to these countries that are hurting?
TRUMP: I would try so hard to keep some of these countries going, but, Greta, we are a debtor nation.
AIZENMAN: And regardless of whether Trump downgrades the U.S.'s overall foreign aid contribution, advocates worry particular areas of spending could be vulnerable, like reproductive health. Alison Marshall is with International Planned Parenthood Federation which provides health care to millions of women in over 170 countries.
ALISON MARSHALL: It's become a political football.
AIZENMAN: See; U.S. law has long prohibited foreign aid money from paying for abortions overseas. But in 1984, then-President Reagan took that a step further by barring contributions to aid groups that, quote, "actively promote abortion." And that included giving referrals, advice.
MARSHALL: We'd have to stop counseling. We'd have to stop information provision. We'd have to stop telling women and girls when they came into our clinic what their options are, and we can't do that.
AIZENMAN: President Clinton reversed the policy when he came into office. President George W. Bush reinstated it, and President Obama reversed it again. Trump hasn't said he'd re-impose the ban, but his anti-abortion stance on domestic questions has advocates scared. Marshall says the last time around...
MARSHALL: Clinics had to be closed. Staff had to be laid off, and we just weren't able to offer the family planning services to the women and girls who needed them.
AIZENMAN: Advocates also wonder if Trump's more inward focus could mean his administration will step away from the very vigorous role the U.S. has been playing in putting the rights of women and girls on the international agenda. So far, it's not an issue Trump has really spoken about. Nurith Aizenman, NPR News. Transcript provided by NPR, Copyright NPR.