(The Week, April 24, 2012)

By Bill Frist, M.D.

America’s national debt is ballooning at a worryingly rapid pace. But some programs ought to be spared the chopping block.

Government spending is about to get chopped — no matter who wins the next presidential election. President Obama and his GOP challenger Mitt Romney have both prioritized deficit reduction, which, of course, is a worthy goal. However, not all cuts are created equal. And many surveys put global health at the top of the list of things to slash. That’s a mistake, and here’s why.

1. Global health initiatives save lives abroad
Investments in global health pay off a lot more quickly and dramatically that you might think. PEPFAR, initiated by President George W. Bush and strongly embraced and expanded by Obama, was the largest direct investment any country has made in defeating a single virus (HIV) or disease. Our taxpayers’ leadership has provided 7.2 million people with access to lifesaving, anti-retroviral therapy for HIV/AIDS, 8.6 million with treatment for tuberculosis, and more than 260 million — mostly kids — with anti-malarial resources. This U.S.-led historic initiative to prevent and fight disease has directly saved millions of lives, put kids back in school, and helped rescue entire societies from collapse over the past eight years.

Lifting others up no matter where they live is part of what makes us American.

Saving lives and societies leads to better and stronger relationships for trade, enterprise, and foreign investments. It enables economic growth, democracy, accountability, and transparency in these countries.

2.Global health initiatives protect U.S. families
Deadly microbes know no borders. They are just one plane ride away. HIV did not exist in the U.S. when I was a surgical trainee in 1981. But since then, it has killed more than 600,000 individuals here (and 25 million globally) and infects another 54,000 U.S. citizens each year. It arrived here from Haiti, migrating there from Africa.

Imagine the devastation avoided if we had identified HIV and our National Institutes of Health had figured out how to treat the virus a decade before it arrived on our shores. Our current global surveillance and engagement system might have done just that.

3.Global health initiatives enhance national security
A hopeful people are a people who shun terrorism. And nothing destroys hope more than a society without a future, hollowed out by diseases that decimate middle-aged civil servants, police, doctors, and teachers. A bleak and nonproductive future for an individual sets the stage for societal discontent and chaos.

Our investments in public health reverse these tragedies, and fuel the smart power of health diplomacy. Kaiser Family Foundation surveys have repeatedly revealed that more than half the public thinks U.S. spending on health in developing countries is helpful for U.S. diplomacy (59 percent) and for improving America’s image in the countries receiving aid (56 percent).

4.Global health initiatives are a bargain
Treating HIV costs a tenth of what it did a decade ago, and the costs continue to plummet. Globally, of the 8 million children under 5 years old who will die this year, half could be treated and cured with a low-cost intervention. Pneumonia, the number one killer of young children in the world, is easily treated for less than a dollar! And the No. 2 killer, diarrhea, can be prevented by increasing access to clean water. The price? For $20, we can provide clean water to a family for 20 years. For $14, we can fully vaccinate a child.

5.Global health initiatives are simply the right thing to do
I was born in Nashville by the luck of the draw. It could just as well have been South Africa, where life expectancy is only 49 years. We are all the same. Lifting others up no matter where they live is part of what makes us American. It’s what we do. Americans overwhelmingly say the U.S. should spend money on improving health for people in developing countries “because it’s the right thing to do.” Nearly half (46 percent) say this is the most important reason for the U.S. to invest in global health.

Yes, out of control entitlement spending and a deep recession have put everything on the chopping block. But let’s be smart about where we cut and where we don’t.

This article was originally featured in The Week http://theweek.com/article/index/227117/5-reasons-deficit-hawks-should-lay-off-global-health-initiatives