Now that we’ve finished salivating over the presidential pecs, [youtube][/youtube] it’s time to turn to more cerebral issues, like what might Barack Obama’s election mean for global health?

Two European public health experts – Bernd Rechel and Martin McKee from the London School of Hygiene and Tropical Medicine – ponder this question in an editorial in the British Medical Journal (5 Jan), and conclude it’s important for four reasons:

• In the short term, the greatest change may be in the ideological direction of US foreign assistance. Obama will likely change Bush administration policies blocking funds for needle or syringe exchange programmes, and putting an emphasis on abstinence only approaches to the prevention of HIV. He has called for a substantial increase in development aid and also advocated greater US support for the Global Fund to Fight AIDS, Tuberculosis and Malaria and for the UN Millennium Development Goals, and for 100% debt cancellation for the world’s heavily indebted poor countries.

• Given his vocal opposition to the war in Iraq and his commitment to the use of diplomacy and to bridge building with Europe, he may be in no rush to launch further military adventures, with obvious implications for global health.

• The new administration is likely to move quickly to restore the credibility of its science related policies, in contrast to the Bush administration which sought to impose its own ideology on science, restricting the subjects that could be researched with federal funds, using evidence selectively, and barring researchers whose findings challenged the ideology of advisory committees.

• The most important global health consequence is the adoption of a new position on climate change, now recognised as a major threat to health. Obama has advocated aggressive targets to cut greenhouse gas emissions.

Meanwhile, The Lancet (3 Jan) has summarised the US Institute of Medicine’s report on the incoming administration’s global health commitment. The report recommends:

• the new administration should highlight health as a pillar of US foreign policy

• a White House Interagency Committee on Global Health be formed and chaired by a White House global-health tsar serving as deputy assistant to the President

• a balanced aid portfolio should be created to cover diverse global-health issues including AIDS, malaria, tuberculosis, children’s and women’s health, nutrition, family planning and reproductive health, chronic and non-communicable disease, injury, and health systems

• the US Government should enhance partnerships with national governments, support the leadership of WHO, and fund research for health

• the budget for US global health assistance should be increased annually and doubled to $15 billion by 2012.

The IOM is due to release a second report on the US commitment to global health in April.

What’s the bet it doesn’t capture near as much attention as those pecs?

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