Foreign aid, particularly global health assistance, is not a charitable endeavor—it is a strategic investment in the well-being, stability, and security of the United States. While public discourse around foreign assistance often gets mired in partisan debates or misleading fiscal rhetoric, the reality is more complex and far more urgent. In an era defined by pandemics, climate-related disasters, and geopolitical fragmentation, America’s engagement in global health is a barometer of our global leadership, economic foresight, and moral identity1.

As a healthcare provider and nurse leader, I understand how quickly a localized health crisis can metastasize into a global emergency. The tools we use to manage outbreaks, build trust in public health systems, and contain diseases do not exist in silos—they are deeply interdependent. The U.S. has more to gain from strategic international health engagement than most of its citizens realize.

Global Health as a National Security Priority

Health instability is both a symptom and a driver of national fragility. When disease overwhelms healthcare systems in low-income or post-conflict states, the cascading effects include political unrest, mass migration, supply chain disruption, and the erosion of state legitimacy1. In these vacuums, extremist ideologies often thrive, regional conflicts erupt, and foreign actors seeking to undermine liberal democracies gain traction.

U.S. foreign health assistance has played a unique role in mitigating these risks. Programs like PEPFAR and the Global Health Security Agenda have done more than save lives—they’ve helped build the scaffolding for sustainable governance and rule of law in regions that might otherwise slide into chaos2. Countries that have received sustained U.S. health aid are demonstrably more stable, and their populations are less susceptible to the appeal of insurgency or authoritarianism.

Moreover, health diplomacy has become an arena of geopolitical competition. When the U.S. fails to engage, adversaries like China and Russia step in, providing health infrastructure support with conditions that further their political agendas. That aid often comes with fewer quality safeguards and little concern for democratic institution-building. America’s retreat from global health spaces cedes influence and credibility in regions critical to our long-term strategic interests3.

The False Economy of Cutting Aid

Despite persistent public misperceptions, foreign aid comprises less than 1% of the U.S. federal budget4. Of that, global health programs represent just a subset. And yet, these programs yield massive downstream economic savings.

The COVID-19 pandemic highlighted the economic damage caused by vulnerabilities in the global health system. Investing in early detection systems, ensuring vaccine equity, and promoting international cooperation is an investment that costs significantly less than the costs of our response to address the crisis in the United States5. Public health infrastructure abroad is a form of early-warning system—one that enables the U.S. to anticipate, prepare for, and sometimes entirely avoid health threats that might otherwise reach our shores6.

Economists estimate that for every $1 invested in pandemic preparedness and global health surveillance, up to $10 in economic losses can be prevented5. The return on investment is not speculation—it is historical precedent supported by longitudinal studies in public health and development economics.

Moreover, global economic stability is closely linked to health. When nations are affected by disease, their workforce suffers, production decreases, and demand for exports—including American goods—declines6. The ripple effects of unmitigated health crises abroad are measurable in our Gross Domestic Product (GDP). That foreign aid supports economic resilience overseas is not merely a benefit—it’s a necessity for U.S. prosperity.

Why Global Health Means Domestic Health

The idea that U.S. public health operates in isolation is outdated and dangerous. Diseases are transboundary by nature. The air travel revolution, the globalized food supply, and international migration patterns all ensure that an outbreak anywhere can become a global pandemic in a matter of days.

U.S. global health programs are essential components of numerous surveillance points worldwide. These networks allow us to track emerging infectious diseases before they gain international momentum7. They enable scientists to collaborate in real time, share genomic data, and update diagnostic and treatment protocols in synchrony. Research emerging from global clinical trials often informs our standards of care.

Equally important is the role of global partnerships in scientific advancement8. Scientists in the U.S. and international teams collaborated over decades to develop the mRNA vaccine platforms that became central to the COVID-19 response9. Breakthroughs that save American lives, from polio to HIV and influenza, often stem from multinational cooperation.

The health of others is, by design, linked to our own. Infectious diseases, antimicrobial resistance, vector-borne illnesses, and bioterrorism threats all flourish when international health systems are weak. We have a vested interest in strengthening them not just for ethical reasons—but for the protection of our citizens.

Reframing Aid as Nonpartisan Public Policy

Foreign health aid should not be a wedge issue. Its success has depended on support from both Republican and Democratic administrations, with rationales ranging from faith-based service to national security imperatives8. Yet, in recent years, foreign assistance has been increasingly politicized, often mischaracterized as a drain on domestic resources rather than the deeply reciprocal investment it is.

This is where nurses and healthcare leaders must step forward. We are among the most trusted professionals in the country. We are skilled in assessing risk, managing systems, and coordinating across specialties—abilities that directly apply to the policy arena. And we have unique insight into the long-term impacts of health instability, both globally and locally.

As a nurse practitioner who has led health services and taught emerging clinicians, I know that prevention is always more cost-effective and humane than intervention. My fellow nurses, over five million strong in the United States, know this, too. We also know the consequences of tunnel vision and short-sightedness. It can cost people their lives. Foreign aid, when executed with accountability and transparency, is the ultimate preventive strategy. It is the inoculation we can offer against both suffering and systemic breakdown.

Looking Ahead: A Strategic Reinvestment

As we face a century defined by climate-driven migration, novel pathogens, and increasing polarization, the United States must reestablish its leadership in global health, not just rhetorically but materially. We need to recalibrate foreign aid narratives—from viewing it as charity to seeing it as strategy, from considering it a cost to recognizing it as an investment, and from adopting isolationism to embracing mutual resilience.

Aligning foreign health assistance with our national security strategy and increasing funding for global health surveillance are essential steps forward. By prioritizing partnerships in our diplomatic efforts and effectively communicating the importance of foreign health aid, we can ensure these initiatives are critical in safeguarding both global and domestic health.

In doing so, we not only save lives—we safeguard our values, our stability, and our place in the world.

References

1. Garrett, L. (2007). The Challenge of Global Health. Foreign Affairs, 86(1), 14–38.

2. Goosby E, Von Zinkernagel D, Holmes C, Haroz D, Walsh T. Raising the bar: PEPFAR and new paradigms for global health. J Acquir Immune Defic Syndr. 2012 Aug 15;60 Suppl 3:S158-62. doi: 10.1097/QAI.0b013e31825d057c. PMID: 22797738.

3. Katz R, Sorrell EM, Kornblet SA, Fischer JE. Global health security agenda and the international health regulations: moving forward. Biosecur Bioterror. 2014 Sep-Oct;12(5):231-8. doi: 10.1089/bsp.2014.0038. PMID: 25254911.

4. McCabe, E. M., & Brown, N. M. (2022). Foreign assistance: An introduction to U.S. programs and policy (CRS Report No. R40213).

5. Cutler, D. M., & Summers, L. H. (2020). The COVID-19 pandemic and the $16 trillion virus. JAMA, 324(15), 1495–1496. doi:10.1001/jama.2020.19759 

6. Sands P, Mundaca-Shah C, Dzau VJ. The Neglected Dimension of Global Security--A Framework for Countering Infectious-Disease Crises. N Engl J Med. 2016 Mar 31;374(13):1281-7. doi: 10.1056/NEJMsr1600236. Epub 2016 Jan 13. PMID: 26761419.

7. Jamison, Dean T.; Gelband, Hellen; Horton, Susan; Jha, Prabhat; Laxminarayan, Ramanan; Mock, Charles N.; Nugent, Rachel. 2017. Disease Control Priorities, Third Edition: Volume 9. Improving Health and Reducing Poverty. © World Bank.

8. Morens, D. M., & Fauci, A. S. (2013). Emerging infectious diseases: threats to human health and global stability. PLoS pathogens, 9(7), e1003467. https://doi.org/10.1371/journal.ppat.1003467