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3
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Attitudes Toward U.S. Foreign Assistance:
Perception and Reality
The industrialized nations' traditional contribution to improving global health
has been in the form of foreign aid donations. As the previous chapter indicated,
however, our nation's stake in global health goes far beyond the giving of foreign
aid and is likely to increasingly involve other activities, such as research into health
problems of global significance. Nevertheless, within that component of global
health that does require foreign aid, public misperceptions within the United States
have been a significant barrier to positive action that would benefit the nation, as
this chapter shows.
In 1995 the United States spent about 0.1 percent of its gross national product
(GNP) on foreign assistance, a lower percentage than any of the other members of
the Organization for Economic Cooperation and Development's (OECD)
Development Assistance Committee. Yet nationwide surveys indicate that the
American public vastly overestimates U.S. spending on global health assistance.
These same polls also indicate that when informed of the current limited U.S.
participation in global health activities, Americans strongly endorse spending levels
above those currently budgeted, and that they do so based on both traditional
humanitarian values and enlightened self-interest.
SURVEY FINDINGS
The arrival of the 104th Congress in November 1994 provoked extensive
reexamination of U.S. federal spending, including expenditures for global health
assistance and development. Congressional criticism of foreign assistance focused
on its perceived inefficiencies and on bipartisan concern that foreign assistance has
traditionally followed the whims of shifting political alliances. A belief was also
voiced that the American public feels that foreign aid provides no benefit to the
United States and is akin to pouring money down a drain. A poll to test these
assumptions was conducted in January 1995 by the Program on International
Policy Attitudes, a joint program of the Center for the Study of Policy Attitudes
(CSPA) and the Center for International and Security Studies at Maryland of the
University of Maryland's School of Public Affairs.
The study results were surprising. Far from opposing foreign assistance, the
Americans polled both Republicans and Democrats-overwhelmingly supported
the principle of giving foreign assistance, provided that it is directed toward
19
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20
MECCA 'S VITAL INTE=STIN GLOBAL HEALTH
helping the needy rather than merely funding political allies; promotes self-reliance
rather than relief; ensures that the money goes to the individuals In need rather than
to corrupt governments; and places a high priority on democratic governance and
respect for human rights. Another striking lesson from this poll was that Americans
erroneously believe that the United States is spending far more on foreign aid than
it is, and it is this misperception that underlies the public's opposition to foreign
aid.
. .
Far from opposing foreign assistance, the Americans
polled both Republicans and Democrats~verwhelm-
ingly support the principle of giving foreign assistance.
A second recent poll of 1,514 randomly selected adult Americans conducted
by the Washington Post, the Henry J. Kaiser Family Foundation, and Harvard
University indicated that nearly 6 in 10 people believe that the United States spends
more on foreign aid than on Medicare. When asked to guess, 58 percent of the
Americans polled believed the United States spent more on foreign aid, while only
27 percent of those polled believed more money was spent on Medicare. When
asked what an "appropriate" amount of foreign aid would be, the median level
proposed by those polled by CSPA was 15 percent of the federal budget, an
amount 15 times greater than the amount actually spent. Medicare, for
comparison, accounts for about 13 percent of federal spending (Washington Post et
al., 1996~. Overall, those who voiced the greatest opposition to foreign assistance
were the respondents who believed the amount to be higher than it is (CSPA,
19953.
Americans erroneously believe that the United States is
spending vastly more on foreign aid than it is.
.
Until the early 1990s, when the United States slipped behind Japan, America
was the world's largest foreign aid donor. In 1995, for the first time, Japan ($14.5
billion), France ($8.4 billion), and Germany ($7.5 billion) each provided more
overseas assistance than the United States ($7.3 billion) (OECD, 1996~. As Figure
3-1 starkly demonstrates, some members of the OECD Development Assistance
Committee, such as Ireland, Spain, and Portugal, contribute proportionately more
generously to overseas assistance than the United States, and do so with
considerably smaller economies (OECD, 19969. In 1994, while the United States
expended more than $900 billion on domestic health care, it spent $9.9 billion
(0.14 percent) of its GNP on overseas assistance (OECD, 1996~. Of this $9.9
billion, only $1 billion (10 percent) was earmarked for health, primarily child
survival and AIDS (U.S. Congress, 1994~. Thus, U.S. expenditures on global
health assistance in 1994 represented only 0.010 percent of GNP.
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22
AMERICA 'S VITAL INTERESTIN GLOBAL HEALTH
Last year, for the first time, Japan ($14.5 billion), France
($8.4 billion), and Germany ($7.5 billion) each provided
more overseas assistance than the United States.
The CSPA poll generated two other findings of note. First, support for
spending on behalf of poor countries stems from the belief that the world is now so
interconnected that it is in the economic interest of the United States to promote
development of the neediest countries. Second, Americans support foreign
assistance based on their belief that the United States has a moral obligation to help
nations in need; an overwhelming majority rejected the notion that the United
States should give aid only when it promotes U.S. national interests.
The findings of this poll and others (~Washington Post, et al., 1996) provide
strong evidence that the American public, when accurately informed of the limited
U.S. participation in global health activities and the opportunities available to shape
future directions, will endorse spending levels above those currently budgeted, and
will do so based on both traditional humanitarian values and enlightened self-
interest. Beyond the value implicit in humanitarian assistance, the Americans
polled understood that the globalization of health requires active U.S. engagement
in international health activities to protect the health, economy, and security of the
United States and its people. The following three chapters argue that support for
global health is justified on these rationales, and would provide an enduring global
good that would benefit the U.S. directly, even in the absence of an established
foreign aid program.
Representative terms from entire chapter:
global health
