10 Key Facts About the U.S. Global Health Response

The U.S. has been involved in efforts to improve the health of those living in low- and middle-income countries for decades and has been the largest donor to global health in the world. Starting on January 20, 2025, as part of a larger foreign aid review, the Trump administration began to take several steps to defund and dismantle most of the U.S. global health response, rendering its future uncertain. To better understand the U.S. global health response, as it was before this date, here are key facts to know (also see 10 Things to Know About U.S. Funding for Global Health):

1. What have been the goals of U.S. global health efforts?

U.S. global health efforts aim to help improve the health of people in developing countries while also contributing to broader U.S. global development goals (e.g., advancing a free, peaceful, and prosperous world), foreign policy priorities (e.g., promoting democratic institutions, upholding universal values, and promoting human dignity), and national security concerns (e.g., protecting Americans from external threats, sustaining a stable and open international system).¹

2. How long has the U.S. been involved in global health?

The U.S. government (U.S.) has been engaged in international health activities for more than a century beginning with efforts in the late 1800s to join with other nations to form the first international health organizations, standards, and treaties designed to promote growing international trade and travel while protecting borders from external disease threats. Since then, U.S. engagement in global health has grown considerably, particularly after the launch of USAID in 1961, the U.S. international development agency, but most markedly in the last two decades with the creation of PEPFAR and other signature U.S. global health efforts. Heightened engagement has been driven by factors such as globalization, the growing recognition that infectious disease threats – including the emergence of new infectious diseases such as HIV, SARS, avian influenza, and COVID-19 – are threats to national security in the U.S. as well as abroad, as well as demonstrated success in addressing global health challenges, such as polio.

3. How much global health funding does the U.S. provide?

In FY 2024, the U.S. provided $12.4 billion to global health. Most funding (81%) was provided bilaterally (provided to or on behalf of other countries or regions), reaching almost 80 low- and middle-income countries, primarily in sub-Saharan Africa. The remaining share was provided to multilateral institutions (where it is pooled with funding from other donors and, in turn, disbursed to countries and programs by the multilateral institution). U.S. funding for global health, however, represents a very small share of the federal budget (<.1%). See Figure 1.

4. How does the U.S. rank as a global health donor?

The U.S. government has been the largest donor to health in low- and middle-income countries. The U.S. provided 42% of all international health assistance from major donor governments in 2023 (see Figure 2), the largest of any donor. In addition, the U.S. has historically devoted a larger share of its foreign assistance to health than other donor governments; global health accounted for almost 30% of U.S. foreign assistance in 2023 (all other donor governments devoted less than 20% of their foreign aid budget to global health).

5. What are the main U.S. bilateral global health programs and priorities?

The U.S. has focused its global health work on several main areas and programs, including establishing major initiatives such as PEPFAR, its signature global HIV/AIDS program. These programs include (see Figure 3 for funding amounts):

• President’s Emergency Plan for AIDS Relief (PEPFAR)
• President’s Malaria Initiative (PMI)
• Tuberculosis
• Maternal and Child Health
• Nutrition and Feed the Future
• Family Planning/Reproductive Health
• Neglected Tropical Diseases
• Global Health Security

6. What are the main multilateral health organizations supported by the U.S.?

The U.S. government has been a major donor to several multilateral organizations, including those that are United Nations (U.N.) entities as well as independent, public/private partnerships:

U.N. entities:

• U.N. Children’s Fund (UNICEF)
• World Health Organization (WHO)
• Pan American Health Organization (PAHO)
• Joint United Nations Programme on HIV/AIDS (UNAIDS)
• U.N. Population Fund (UNFPA)

Independent entities:

• Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)
• Gavi, the Vaccine Alliance
• TB Global Drug Facility of the Stop TB Partnership
• Global Polio Eradication Initiative (GPEI)
• Pandemic Fund

7. How does the U.S. carry out its global health efforts?

The U.S. government’s engagement in global health is carried out and overseen by multiple executive branch departments and agencies and the legislative branch. The main federal agencies include:

• the National Security Council (NSC), within the White House, which is responsible for coordinating and reviewing the U.S. strategy and activities, particularly for GHS;
• the Department of State, including the Bureau of Global Health Security and Diplomacy (GHSD);
• USAID (although its future is uncertain);
• the Millennium Challenge Corporation (MCC);
• the Department of Health and Human Services (HHS), including the Office of Global Affairs (OGA), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Food & Drug Administration (FDA); and
• the Department of Defense (DoD).

To implement health programs, the U.S. government partners with many organizations, ranging from non-profit and private sector organizations to foreign governments and international and multilateral organizations. In FY 2022, of the $10.6 billion in U.S. global health funding obligated to non-U.S. government recipients, the largest share (45%) went to U.S. NGOs, followed by multilateral organizations (34%), foreign NGOs (17%), and foreign governments (3%).

8. What do we know about the effectiveness of U.S. global health efforts?

U.S. global health programs have been shown to have significant impact. For example, PEPFAR is estimated to have saved 26 million lives (in addition to positive effects on health outcomes beyond HIV mortality, as well as impacts in the area of maternal and child health, along with significant, positive economic and educational spillover effects). Likewise, MCH efforts have supported a 55% decline in under-five mortality and a 42% drop in maternal deaths since 2000, while malaria efforts under PMI since 2006 have supported a 28.7% decline in malaria case rates and a 48.2% decline in malaria death rates.

9. What does the American public think about the U.S. involvement in global health?

Overall, there is broad support for the U.S. playing a role in improving the health for people in developing countries, although support is split along party lines, with the share of Republicans saying the U.S. should play a major role in this area declining since 2016. Half of the public says the U.S. should take a leading or major role in improving health for people in developing countries, while about one-third (36%) say the U.S. should take a “minor role.” Just over half the public says that before Trump took office this year, the U.S. was spending too little (19%) or about the right amount (37%) on these efforts. The public continues to recognize a benefit of spending money on global health. A large majority say that spending money on improving health in developing countries helps protect the health of Americans by preventing the spread of infectious diseases, although support is split along party lines, with most Democrats (86%) and many independents (67%) but fewer Republicans (49%) saying this spending helps Americans in this way.

10. What has the Trump administration done to affect the U.S. global health response?

Starting on January 20, 2025, the first day of his second term, President Trump began to announce numerous executive actions, several of which directly address or affect U.S. global health efforts. These have included a foreign aid freeze and “stop-work order”, cancelling the vast majority of foreign aid grants and contracts, and moving to dismantle USAID (the main implementing agency of U.S. global health efforts). As a result, many U.S. global health programs have been effectively shuttered. This situation presents considerable risks to the health of millions of people in low- and middle-income countries. Multiple lawsuits have been filed challenging these actions and litigation is ongoing.

KFF Resources

• Health Policy 101: The U.S. Government and Global Health
• KFF Global Health Fact Sheets on U.S. Global Health Policy and Programs
• KFF Global Health Budget Tracker
• KFF Breaking Down the Budget by Program Area
• KFF Overview of President Trump’s Executive Actions on Global Health Tracker