Global aid cuts could reverse health gains in India: Lancet study

The Lancet Global Health published a new peer-reviewed study today by the Barcelona Institute for Global Health (ISGlobal), which warns that a precipitous drop in global aid could lead to 22.6 million additional deaths by 2030 across 93 low- and middle- income countries, including 5.4 million children under the age of five. With support from The Rockefeller Foundation in association with its public charity RF Catalytic Capital, the analysis demonstrates that Sub-Saharan Africa, which accounts for 38 of the 93 countries analysed, is particularly at risk, and with 21 of the countries in Asia, 12 in Latin America, 12 in the Middle East and North Africa, and 10 in Europe, including Ukraine, severe cuts to official development assistance (ODA) could be felt globally. ISGlobal’s research also reveals that over the course of 2002-2021, ODA helped reduce child mortality by 39 per cent; prevent HIV/AIDS deaths by 70 per cent, with a 56 per cent reduction in deaths from both malaria and nutritional deficiencies; and increased additional global health outcomes in these 93 countries, which are home to 75 per cent of the world’s population.

Dr Rajiv J. Shah, President of The Rockefeller Foundation in a Statement on the Human Cost of Foreign Aid Cuts said, “These findings are a warning of the profound moral cost of the zero-sum approach many political leaders are taking—and they are an urgent call to action to all of us to prevent this human suffering. The question before humanity today is whether we will accept a global retreat from commitments to feed the hungry, cure the sick, and lift up the most vulnerable define the future or whether we will come together to build new models of cooperation worthy of the tens of millions of people who could lose their lives if we do not.”

In 2024 international aid fell for the first time in six years, and the United States, United Kingdom, France, and Germany significantly reduced their ODA contributions for the first time in nearly 30 years. These deep cuts, along with projected cuts in 2025 and 2026, sparked the need to understand what this could mean at the human level for communities all over the world.

“Our analyses show that development assistance is among the most effective global health interventions available. Over the past two decades, it has saved an extraordinary number of lives and strengthened fragile welfare states and healthcare systems. Withdrawing this support now would not only reverse hard-won progress, but would translate directly into millions of preventable adult and child deaths in the coming years. Budget decisions made today in donor countries will have irreversible consequences for millions of people for years to come,” said Davide Rasella, Coordinator of the study, ICREA Research Professor at ISGlobal and at the Brazilian Institute of Collective Health.

As the world’s largest donors and other countries around the world continued to slash billions in assistance, the Organisation of Economic Cooperation and Development (OECD) is projecting that ODA could decline by 10%-18% from 2024 to 2025. In order to assess the realised impact of ODA in these countries and project what may happen if current aid cuts continue or worsen, ISGlobal, with funding from The Rockefeller Foundation in association with its RF Catalytic Capital, examined 20 years of development data between 2002 and 2021 in 93 countries that are home to 6.3 billion people.

“Asia’s scale means that when health systems fail, the human cost is immense, and in 21 countries across the region, decades of development gains are now at risk of being reversed,” said Deepali Khanna, Senior Vice President & Head of Asia, The Rockefeller Foundation. “Without sustained and smarter development assistance, hard-won progress against disease can disappear, health systems can weaken, and preventable loss of life can follow. These outcomes are not inevitable, but avoiding them requires country-led financing and resilient, self-reliant systems that can protect the most vulnerable and save lives.”

Peer reviewed and published by The Lancet Global Health, The Impact of Two Decades of Humanitarian and Development Assistance and the Projected Mortality Consequences of Current Defunding to 2030: Retrospective Evaluation and Forecasting Analysis, models two scenarios over the course of 2025-2030:

-Mild defunding scenario. With a 10.6 per cent yearly reduction (corresponding to the average reduction of the last two years, 2024–2025), these cuts could result in 9.4 million preventable deaths, including 2.5 million children younger than five years.

-Severe defunding scenario. Based on $32 billion (15.1 per cent) in ODA cuts from 2024 to 2025, with the funding cuts continuing and worsening through the end of this decade, this could cause 5.4 million children younger than age five years to die as part of more than 22.6 million additional deaths of all ages – Roughly equivalent to (1) the combined populations of greater Barcelona, Paris, and London; (2) more than the individual populations of Mexico City, Dhaka, Sao Paulo, Cairo, and Mumbai; (3) or the entire U.S. State of Florida perishing by 2030.

ISGlobal researchers applied a consistent methodological framework that integrates longitudinal panel data with validated country-level microsimulation models to quantify the health consequences of funding reductions across all OECD contributors. As result, the new study also demonstrates that higher global ODA levels in the 93 countries analysed between 2002 and 2021 contributed to:

• Decreasing all-cause mortality by 23 per cent
• Declining child mortality by 39 per cent
• Reducing deaths mortality rates from HIV/AIDS by 70 per cent, nutritional deficiencies by 56 per cent, malaria by 56 per cent, diarrheal diseases by 55 per cent, and neglected tropical diseases by 54 per cent
• Strengthening health systems and supporting disease control and eradication efforts
• Improving preparedness for outbreaks and epidemics

It also warns that at least three out of every four people on the planet live in countries where two decades of development gains could be reversed, where progress against diseases disappears, and where preventable loss of life could happen.

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