The United States must scale up its foreign health assistance and shift toward proactive aid rather than emergency response to address the health risks connected to global climate-driven displacement, a report GW researchers released late last month found.
The working paper — authored by experts from GW’s Redstone Global Center for Prevention and Wellness and the CORE Group, a D.C-based convener of practitioners and public health professionals — found that if the United States increased foreign health assistance for displaced people in countries subject to extreme weather events, mainly in the Global South, the country would be able to prevent deaths and promote safety and security. Timothy Holtz, chair and director of the Redstone Center and co-author of the report, said in an email that U.S. foreign aid would provide flexible funding, technical expertise and early-warning systems to help communities in developing countries prepare for climate hazards, reducing health risks and limiting further forced displacement.
“Health assistance for, and empowerment of, displaced populations — including women, children, older adults and people living in poverty — aligns with core American values of helping the most at-risk populations, averting deaths and alleviating human suffering,” Holtz said in an email.
Researchers developed many of the report’s proposals during a June roundtable convened by the Redstone Center and CORE group at the Milken Institute School of Public Health, which brought together a group of experts across academia, policy and research organizations. Participants shared insights on trends in health issues over the last two decades caused by environmentally induced displacement and strategies for the U.S. government to effectively channel resources.
Since taking office in January, President Donald Trump has targeted foreign aid through a series of rollback efforts, beginning with a January executive order that froze funding for 90 days — a move that experts and aid organizations say disrupted supply chains and continues to delay assistance. That same month, Trump and Secretary of State Marco Rubio began dismantling the United States Agency for International Development, the country’s primary foreign aid provider, which officially ceased operations in July. Late last month, the Supreme Court ruled that Trump could withhold $4 billion in foreign aid previously approved by Congress.
The roundtable discussions reflected on recent trends of climate and conflict-induced migration, like the 120 million people currently displaced because of conflict, urbanization and environmental hazards, such as heat waves, extreme weather and rising sea levels, the working paper said. The study specifies that nearly half of displaced people are hosted in countries exposed to extreme weather, like Myanmar and Niger.
The paper warns that forced and environmentally induced migration increases the risk of a wide range of health challenges, like measles, uncontrolled diabetes, injuries, maternal health hazards and mental health issues, as migrants are often subject to crowded conditions and lack access to care while moving from place to place. The health challenges mean the United States must invest in solutions, like community-led, locally focused interventions as well as disease prevention and adaptation efforts in order to address not only immediate needs but also the longer-term resilience of vulnerable populations, the researchers found.
Steven Hansch, an adjunct faculty member at Milken and co-author of the paper, said the roundtable’s discussions of displacement and climate change, which he said were two of the biggest pressing issues facing the world, will allow the Redstone Center to connect NGOs with each other to facilitate communication to become more forward-planning and address these issues proactively before environmental disasters strike.
“Relief is always too late, responding to problems after they’ve already killed people, which is how things normally go,” Hansch said.
The report highlights U.S. technical expertise, ranging from data science and health information systems to early warning systems for natural disasters, which positions the country uniquely to develop preventative solutions for displacement. Hansch said that while any country can provide financial aid, the U.S.’s technological capabilities enable proactive intervention.
Hansch also said the aid community, including NGOs and donors, needs to focus on long-term solutions. He used Bangladesh as an example of how donors and governments fail to plan for the future. Despite being home to almost 175 million people, he said the country faces the prospect of disappearing underwater due to rising sea levels and does not have concrete plans for where those millions will go.
“Frankly, a lot of governments around the world don’t think about long-term,” Hansch said. “A lot of governments, frankly, are in denial about it.”
He said there are organizations that are thinking about long-term solutions, but they tend to be more research-based and don’t have enough funding to actively make change.
Despite the need for proactive strategies, Hansch said recent developments in U.S. foreign health assistance, particularly given cuts in the USAID, show a counterproductive trajectory. He said even though the U.S. government is still funding humanitarian aid, it has pulled back from almost all of its health funding.
The report states global humanitarian efforts are losing “technical capacity” due to a decline in U.S. foreign assistance stemming from Trump’s cuts to USAID and other forms of federal aid. The U.S. is losing its “credibility” in the foreign aid system due to the cuts, which means the country needs to shift its resources to assisting international actors that are continuing to provide aid, according to the report.
“A lot of people feel like we just lost leadership,” Hansch said. “We’ve lost a lot of good programs. We’ve lost a lot of good research. We’ve lost a lot of good networks.”
Gavin Yamey, a professor of global health and public policy at Duke University, said the ethical and practical consequences of reducing aid include disease resurgence, lack of vaccinations and death and warned of the dangers of abrupt aid withdrawal with no future planning in place. He pointed to a database developed in March by a researcher at Boston University that attempts to estimate the number of deaths that have stemmed from USAID and Medicaid cuts under the Trump administration, which as of Sunday estimates over 170,000 adult deaths and over 350,000 child deaths caused by funding discontinuation.
“Ending aid overnight is immoral and catastrophic,” Yamey said. “When the Global Fund left Romania suddenly, for example, HIV prevalence in injection drug users in Budapest went from under 1 percent to over 50 percent very quickly.”
Yamey also said global health challenges require multilateral cooperation between countries, reinforcing the report’s recommendation that U.S. assistance should adopt a holistic and integrated approach to forced displacement in the context of environmental change.
“We have so many global health challenges that transcend the boundaries of individual nation states that are going to require multilateral cooperation,” he said.
Nancy Reynolds, a professor and associate dean at Johns Hopkins School of Nursing, said cross-country data systems can be useful to track the spread of diseases, citing a dashboard developed by a Johns Hopkins investigator to monitor COVID-19 globally.
“I think there’s a lot of opportunity like that to sort of be picking up on trends very early on and then with AI, mass cross-country data,” she said. “I think it could be very, very powerful.”