Although funding for global health priorities like HIV/AIDS and malaria has enjoyed great support among US lawmakers in recent years, the global financial crisis—and the US Government’s US$700 billion bailout package aimed at shoring up credit markets—may change that. With the days ticking down to the presidential election, the US foreign assistance budget is increasingly being mentioned as a spending area that will have to be scaled back—and that means funding for global health priorities.Senator Barack Obama, for instance, has long pledged a doubling of foreign assistance in his first term. But campaign officials are already signaling that such a goal may be unrealistic in the face of new budget pressures, and Obama’s running mate, Joe Biden, specifically singled out foreign assistance as a funding item that may have to slow. The McCain campaign has also said foreign assistance may feel downward budget pressure.

Although the large increases of recent years may be slowed, what this ultimately means for overseas funding aimed at combating HIV/AIDS, malaria, tuberculosis, and other health issues remains unclear.

Both McCain and Obama support continuing and expanding the President’s Emergency Plan for AIDS Relief (PEPFAR)—the primary vehicle for US HIV/AIDS funding overseas, the majority of which is spent in Africa. Obama wants the US Government to increase its focus on addressing health care infrastructure and health care worker training in African countries, and also appears to favor a stronger, more streamlined US Agency for International Development—the agency responsible for carrying out most PEPFAR-funded programmes.

With congressional Democrats pledging to pass a second package of spending and tax breaks to stimulate the recession-bound American economy in a post-election “lame duck” session in November, additional funding for cash-strapped US states struggling to meet health care costs may be back on the table.

As part of an economic stimulus package passed in September, House Democrats proposed providing billions of dollars funding to help states with their funding for Medicaid—the US Government health care programme for low-income individuals and families. The bill died in the Senate, but could be revived, and expanded, if lawmakers return to Washington, DC after the election.

As part of a larger economic stimulus plan announced Oct 13, Obama signalled he would support federal aid to states and cities to support cash-strapped health care programmes. “And for all those cities and small towns that are facing a choice between cutting services like health care and education or raising property taxes, we will provide the funding to prevent those tax hikes from happening”, Obama said in Toledo, Ohio.

The tumultuous debate over a $700 billion economic bailout plan signed into law by President Bush 2 weeks ago brought with it an unexpected victory for advocates of greater funding for mental-health care. As congressional leaders sought to win support for the bailout, they attached it to legislation that requiring private health insurance companies to offer mental health benefits equivalent on par with traditional medical benefits. The bill’s passage was a victory for long time advocates like Democratic Senator Edward M Kennedy.

 Joseph Schatz

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