“It is an affront to our common humanity, five years after the Millennium Summit, that 30,000 children die each day from easily preventable diseases, or that 100 million people go to bed hungry, or that 100 million children are not receiving a basic education.” 

This expression of Ireland’s commitment to the health and development needs of the poorest countries was made by former Taoiseach Bertie Ahern in his speech to the United Nations General Assembly in September 2005.

The current economic crisis has worsened the plight of these countries and threatens to reverse much of the progress made over recent decades.  UNESCO estimates that between 200,000 and 400,000 additional children are expected to die each year because of the economic crisis, which means the deaths of between 1.4 and 2.8 million children between now and 2015[1].  Urgent measures are needed to protect the poor and vulnerable.

Ireland’s aid budget was cut by €59 million in 2008 and by a further €195 million in 2009. This reduces Government spending on aid by €224 million from the 2008 level of €920 million to €696 million this year.  The McCarthy Report has recommended a further cut of €14.8 million and argues for suspending Ireland’s commitment to achieving the UN target of 0.7% of Gross National Product (GNP) on overseas aid.

Support for health is a vital part of Ireland’s overseas development programme and health-related programmes account for approximately 20% of total expenditure.  

Improving health is critical for development.  Three of the Millennium Development Goals are directly related to health (improving child health, improving maternal health, tackling HIV, malaria and other major diseases); and all of the others have impacts on the determinants of health. 

Reductions in development funding will undoubtedly have a negative impact on the health of people in the poorest countries.

Aid for health should be protected for a number of reasons:

1.    Ireland has a responsibility to help address the health needs of developing countries.  During the Celtic Tiger years health status steadily improved in Ireland, widening the gap between Ireland and the least developed countries.  Coming on top of a food crisis, the global economic downturn pushed more than 100 million people into chronic hunger and poverty in 2008: there are now more hungry people in the world than ever before.  The UN Food and Agriculture Organization (FAO) estimates that more than one billion people, almost a sixth of humanity, are now malnourished[2].   

Through trade and other policies, rich countries have contributed to the economic, food and climate crises that are hitting the health of the world’s poorest people.  With increasing globalisation, even positive actions in one country can have adverse effects elsewhere.   For example, the success of smoking cessation measures in Ireland and other countries has produced a shift by the tobacco industry to increase production and consumption in the less developed countries.   One hundred million people in China will be killed by tobacco in the first half of this century if current smoking trends continue[3].   Another example is the employment of health professionals from developing countries in Ireland.  They are a valuable asset to our health service, but the countries they come from may be desperately short of health workers.

2.    External aid for health has proven to be effective, and improvements in health can be directly attributable to aid.  

· The number of people receiving anti-retroviral treatment (ART) for HIV in low and middle-income countries increased 10 fold from 300 thousand in 2002 to 3 million in 2007.  The percentage of pregnant women living with HIV who received ART to prevent maternal to child transmission of HIV increased from 10% in 2004 to 33% in 2007[4].  These changes are mainly due to aid funding.

· The number of people who die from malaria in Ethiopia has been halved in just three years through the distribution of nearly 20 million insecticide-treated bed nets and widespread use of antimalaria drugs[5].  The dramatic fall in deaths from a disease that kills one in four people was made possible with Global Fund support, funded by donors including Ireland.  Similarly, reported malaria deaths have reduced by 66% in Zambia following the introduction of bed nets.

· In the 1980’s polio was present in 125 countries and caused paralysis in 350,000 thousand children every year.  Today the disease is nearly eradicated: there are only four countries in the world where polio is still endemic[6].  This remarkable achievement was only possible because of concerted efforts and funding from donor countries like Ireland.

3.    Aid for health is a sensible investment.  The WHO Commission on Macroeconomic and Health found that investing in essential health services in developing countries produces an economic return of up to 6 fold[7].  Sick people are a burden on society and tackling major diseases such as TB and malaria makes people healthier and more productive.   In Ireland we spend nearly €4,000 per person per year on our public health service.  This compares for example with Ethiopia which can afford less than €2 per person per year.  Developing countries need about $40 person per year to provide a basic package of essential services.  This is 1% of what we spend in Ireland, but still more than the poorest countries can afford.  Relatively small investments in health care can lead to direct benefits for poor people and poor communities.

4.    Developing countries are dependent on donor funding for investment to develop new technologies to prevent and treat the major diseases.  Vaccines are critically needed for malaria and HIV as are new drugs for TB and Ireland has been one of leading donors supporting their development.  However the return on these investments is longer term and they are particularly vulnerable to cutbacks in aid.  Delays in the development of new drugs and vaccines will be inevitable and the impact will be experienced most in the poorest countries.

5.    Sustainable long-term commitment by donors is necessary for aid to be effective.  It is difficult for recipient countries to plan and develop their health services if the level of aid is unpredictable.  Cuts in aid budgets reduce the predictability of funding flows to developing countries.  Governments will be unwilling to invest in health systems and services, such as recruiting new health workers and expanding immunisation programmes, because of uncertainties of how these will be financed in the future.   Delivery of health care will become less efficient and this will have adverse consequences on people’s health.

6.    It is in Ireland’s interest to provide aid for health.  Many of the health threats we face today are global in nature and protecting health in Ireland requires action across all countries.  One example that is in all of our interests is the threat of infectious diseases such as HIV, TB, SARS and pandemic influenza.

Ireland has developed a reputation internationally for its assistance to the underprivileged in developing countries – both historically because of religious and lay Irish working in such countries and because of non-aligned generous aid in more recent years.  We have shown leadership in development, globally and in Europe.  We have committed to increasing the aid budget to 0.7% of GNP by 2012.  Our reputation may be damaged by further reductions in aid. 

Speaking to CONCORD (European NGO Confederation for Relief and Development) In March 2009, European Commission President José Manuel Barroso said “The recession must not, cannot, will not be used as an excuse for going back on aid promises”.  Other European countries have found ways to protect their aid budgets, despite experiencing a severe recession.  In April 2009 the UK Government announced that it is keeping its promises to the world’s poorest people and will maintain its overseas aid at the level pledged and staying on track to deliver 0.7% of GNP in 2013.

Ireland must maintain its commitment to supporting the health needs of the poorest countries.  The Faculty of Public Health Medicine of the Royal College of Physicians of Ireland urges the Government not to cut the aid budget further and to keep its promise to increase aid to 0.7% of GNP by 2012.