Health and Human Rights at Stake in the US Election

Patty Skuster and Elisha Dunn-Georgiou

Since this blog was originally published on 16 July, President Joe Biden stepped down from the presidential race and Vice President Kamala Harris has become the presumptive Democratic nominee for president. We expect that Harris would remain just as committed to multilateralism as President Biden has been. Importantly, as a US Senator and Vice President, Harris has demonstrated her full-throated commitment to abortion access and reproductive rights.

The outcome of the US federal elections will impact the health and human rights of millions of people across the globe. The stakes are tremendous, amid growing threats from the health impacts of climate change, future pandemics, widespread displacement of people from natural and human-made disasters, and an anti-gender movement that seeks to deny the human rights of LGBTQI individuals. A US government that is fully committed to global health is needed to face these challenges and promote the health and human rights of all. Among many pressing areas where US engagement on health and human rights depend on  the outcome of the election, we focus on two: multilateralism and reproductive rights.

The United States is a global leader in supporting countries to improve the health and human rights of their citizens through bilateral and multilateral partnerships, which have contributed to global health progress over decades. An ongoing commitment by the United States is needed to ensure this progress continues and, furthermore, these investments protect the health of Americans by strengthening health security.

Strengthening multilateral organizations

International cooperation through multilateral organizations is critical to global health progress. The United States has long provided leadership and significant investment in multilaterals, including the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and the United Nations Population Program (UNFPA). These global organizations have been tackling pressing health challenges, for  example, UNICEF-procured vaccines save an estimated 2.5 million children annually. WHO provides technical assistance to coordinate global responses to public health emergencies such COVID-19, and UNFPA supports millions of women  yearly with sexual and reproductive health services, helping to fulfill their sexual and reproductive rights.

The role of the US Executive Branch is paramount in international relations and therefore the presidential election is consequential to US involvement in multilaterals. Members of congress also have power to shape foreign assistance, allocating funding to multilaterals, and they can limit the power of the president to make commitments to global cooperation through legislative policymaking.

The Trump administration in 2016-2020 was unwilling to partner with multilaterals, despite US leadership in their formation and growth, and their proven role in meeting global health goals.  At the onset of the COVID-19 pandemic, the Trump administration suspended financial support for WHO and took the unprecedented step of starting the process of withdrawing from it. Trump also sought to stop funding UNICEF and he discontinued funding for UNFPA.

In comparison, one of Biden’s first acts as president was to re-engage with WHO. Biden has committed to collaboration with WHO to address a range of global health challenges including childhood immunization, nutrition, polio eradication, strengthening the global health workforce, and tackling the health threats of climate change. Similarly he has commited to ongoing support for UNICEF and UNFPA.

Safeguarding reproductive rights

The US government has long supported health and human rights through funding to low- and middle-income governments and non-governmental organizations.  However, anti-abortion politicians have restricted reproductive rights through onerous restrictions on organizations and governments that receive US development assistance. In 1973, the US Congress enacted the Helms Amendment, which bans US foreign assistance from being used for abortion services or to promote access to abortion. In addition, anti-abortion presidents starting with President Regan have curbed reproductive rights through a Presidential Memorandum called the Mexico City Policy, referred to colloquially as the Global Gag Rule (GGR). The GGR stops NGOs that receive US global health assistance from providing abortion information, referrals, or services with their own funding. As the United States is the world’s largest bilateral donor to reproductive health, these policies can lead to violations of the reproductive health rights of millions of people globally.

As one of its first acts in 2017 the Trump administration re-imposed the GGR and expanded its reach to unprecedented scope. Previous Republican presidents had attached the policy to funding for reproductive health assistance (which has amounted to around half a billion US dollars annually). The Trump administration expanded the GGR to all global health assistance, amounting to around nine billion US dollars each year. The Trump Administration also widened GGR conditions to include organizations that received any funding from US-funded organizations, imposing the policy on a massive scale (beyond reproductive health care). It is expected that a future Trump adminstration would expand this even further.

In contrast, the Biden administration showed its commitment to promoting reproductive rights through both multilateral assistance to agencies such as UNFPA and bilateral assistance, and by rescinding the GGR in 2021.

This forthcoming US election is consequential for global health. Continued investment in multilaterals to improve global health and reproductive rights are vital to a vision of health and human rights for everyone.

Patty Skuster, Associate Director and Core Faculty, University of Pennsylvania MPH Program, United States

Elisha Dunn-Georgiou, President & CEO, Global Health Council, United States