The 2018 federal budget battle has barely begun and already critics – including myself – are questioning the wisdom of Trump’s proposal to drastically cut key agencies like the US Department of State, Health and Human Services, and the Environmental Protection Agency in order to build a wall that no one wants, to buy fighter jets that no one needs, and to give tax breaks that no one earned.
The Trump Administration claims that the President’s proposal will make Americans safer, healthier, and wealthier, but the unprecedented cuts and reallocations in this budget are likely to make us poorer, sicker, and endangered. They are also likely to do irreparable harm to America’s image overseas. Although Ronald Reagan famously described America as “a shining city upon a hill whose beacon light guides freedom-loving people everywhere," we will soon be seen as the exact opposite as the very programs that save lives, promote equality, combat poverty, and advance human rights – the very values and ideals that Americans cherish – are dismantled.
Consider, for example, Trump’s plan to cut funding from a program that provides life-saving treatment to those living with HIV/AIDS across the globe. Known as the President's Emergency Plan for AIDS Relief (PEPFAR), that program was created in 2003 by then President George W. Bush. It would not be hyperbole to describe PEPFAR as President Bush’s greatest legacy, redeeming an otherwise disastrous administration best known for embroiling America in an unjust and seemingly unending war in the Middle East and for trigger the worst financial disaster since the Great Depression.
PEPFAR was created at a time when over 30 million people globally were living with HIV/AIDS. As it still true today, most of those people lived in the developing world where access to treatment and care for HIV was unavailable, unattainable, or simply too expensive to buy. Of the 20 million in sub-Saharan Africa who were living with AIDS at the time, less than 50,000 of those had access to antiretroviral drugs to manage the disease and prevent its spread.
PEPFAR changed all that. The program now provides antiretroviral treatment for over 11.5 million people living with HIV/AIDS, at an individual cost of less than $0.40 per day. Not only do these drugs extend the lives of those living infected with HIV, it also reduces the likelihood that they will transmit the disease to others. As a result, the rate of new infections has dropped by two-thirds or more in many African countries.
PEPFAR has also provided HIV testing and counseling to hundreds of millions of people, including over 10 million pregnant women. In doing so, by identifying HIV-positive women and getting them on treatment, it has prevented nearly two million babies from being born with HIV.
This program has been so effective that death rates have actually dropped in many African countries; one study found that adults overall were 16 percent less likely to die simply by living in a country that had a PEPFAR-funded program. Despite this, the Trump administration wants to cut PEPFAR funding by almost $300 million, reducing the number of newly infected patients put on antiretroviral treatment and eliminating many of PEPFAR’s existing HIV prevention programs. We will thus condemn tens of thousands of people to die of HIV/AIDS, but at least we will save enough money to buy approximately three F-22 fighter jets.
President Trump has also cut all funding to the United Nations Population Fund (UNFPA), which provides reproductive health care and family planning services to women in more than 150 countries. This is not the first time that a Republican-run administration has cut the UNFPA’s funding. Upon taking office in 2001, President Bush similarly withheld funding by citing the Kemp-Kasten Amendment, a 1985 policy that prohibits giving money to organizations involved in abortion or involuntary sterilization. Because UNFPA works with China’s national family planning agency, critics argue, it supports that country’s coercive population control laws.
The Kemp-Kasten Amendment was specifically adopted in response to China’s “One Child Policy,” which called for Chinese couples to have only one child each in order to curb that country’s surging population; according to some reports, Chinese officials sometimes enforced the policy through involuntary sterilization or abortion. However, the “One Child Policy” was rescinded in 2015 and there is no evidence that the UNFPA worked with Chinese officials to enact the policy. In fact, the situation is the exact opposite: the UNFPA only works in regions of China where local governments have agreed to eliminate birth targets and quotas.
Trump’s claims about the UNFPA are thus as erroneous as the GOP’s allegations against Planned Parenthood, and will likely be as deadly. According to the United Nations, in 2016 the US provided $32 million to support UNFPA programs. This money was used to save 2,500 women from dying during childbirth, and prevented nearly a million unintended pregnancies and 300,000 unsafe abortions. By cancelling our 2017 contribution to the United Nations Population Fund we will save enough money to pay for six months’ worth of Trump outings to his Mar-a-Largo estate, but sentence thousands of families to a life of abject misery and poverty. Moreover, the pro-life values used to justify this decision will result in more rather than fewer abortions.
My late grandmother was very fond of using the cliché “penny-wise and pound-foolish” to describe those who worry about little expenses while over looking large expenditures. I only wish that that were the case here. Rather, the Trump Administration is being penny-foolish, cutting the very programs that give the US its best return on investment. Through the sheer number of lives saved and families helped, programs like PEPFAR and UNFPA embody the very values and ideals that Americans cherish. To cut them now in order to fund the expansion of the US military does little more than tarnish the shining city’s walls and dim its beacon light.
A public health researcher and ethicist by training, Dr. Sean Philpott-Jones is Director of Research Ethics for the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of the Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.
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