Foreign Assistance in an Aging World

Susan Raymond

From Foreign Affairs, March/April 2003

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Summary:  Foreign aid has traditionally focused on communicable diseases and the needs of mothers and children. But now fertility rates are dropping throughout the world and populations are graying. Chronic ailments such as diabetes and heart disease will become far more widespread, placing great strain on health care budgets in developing countries. The focus of aid should change accordingly.

Susan Raymond is former Director of Policy Programs and Strategic Planning at the New York Academy of Sciences. She has also been a consultant to the U.S. Agency for International Development.

FROM MONTERREY TO MADRID

At the International Conference on Financing for Development held in Monterrey, Mexico, last March, the Bush administration promised it would request a $5 billion increase in the U.S. foreign assistance appropriations for those countries "making the strongest possible commitment to development." A month later, the UN Second World Assembly on Aging in Madrid, Spain, cast a spotlight on a global trend that has been accelerating for a decade: the graying of the world's population. Both a robust increase in money for development and an acknowledgement of what has long been the reality of population aging were major departures from past U.S. policy and recent global health priorities. Headlines did not link the two meetings, but they should have.

Fundamental changes in basic population trends and public health are transforming much of the developing world. Over the past four decades, discussions of health problems in developing nations have centered on communicable diseases and the needs of children and vulnerable women of childbearing age. Accordingly, these diseases and this limited population have been the focus of the health care programs supported by foreign assistance. But this focus needs to change. Over the next 20 years, fertility will drop sharply in the developing world, and the number of children under the age of five will decline both as a percentage of the population and in absolute numbers. Foreign assistance programs must recognize these new realities.

The growing challenge, in turn, will be managing adult health and the expanding ranks of the elderly. By 2020, there will be more people over 65 in the developing world than children under 5. Chronic conditions such as heart disease and diabetes, which are already more prevalent causes of disability and death than are communicable diseases in all regions except Africa, will become even more widespread. As this trend unfolds, the lifetime costs of treating these ailments will far outpace the costs of managing communicable diseases.

This changing pattern of disease and vulnerability will also make more obvious the intersection between health and the economic potential of the developing world. In the next several years, before the numbers of elderly start rising dramatically, falling birth rates will provide a window of opportunity for developing nations. Those economies will be responsible for fewer dependents, and health investments will potentially bear greater returns. Maintaining the health of working-age adults will therefore have a profound economic impact.

The implication for foreign assistance is clear. Donors must recast public health programs as part of an economic strategy targeted at the work force, not just as the provision of care to women and children. But implementing that shift will require both an expansion in the substance of health assistance and a more dramatic (and difficult) correction in the decades-old culture and traditions of foreign assistance itself.

INVESTMENT BEYOND CHARITY

The poor will always be with us, and disasters will always happen. The humanitarian impulse to help people must and will remain a core American value. But this discussion ...

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