Heather Ignatius, a senior policy and advocacy officer with PATH’s Advocacy and Public Policy team in Washington, DC, recently wrote about her thoughts on global health and development priorities for the second-term Obama administration and the 113th Congress. Thanks to PATH for allowing us to share her piece.

As President Barack Obama was sworn in for his second term yesterday, I wondered: will he return to the idealism of his early presidency? Or will the nation’s challenging fiscal and political climate dampen his aspirations for improving the health of people in impoverished countries?

Four years ago, I was optimistic that nearly a decade of strong bipartisan support for global health programs would continue. President Obama came out of the gate fast, launching the Global Health Initiative (GHI) within months of his inauguration. The GHI made some notable progress. It encouraged planning led by the countries it was formed to help, improved the health status of women and girls, and promoted changes to integrate health programs and strengthen capacity within those countries.

But Congress has paid out only a little more than half of the funds needed to achieve the program’s bold goals. This has forced the administration to lower its targets, jeopardizing the future of global health programming and overall health gains.

A good sign: secretary of state

We need strong leadership to meet US global health commitments, and one thing that bodes well for global health is the likely confirmation of Senator John Kerry as secretary of state. As chair of the Senate Foreign Relations Committee, Kerry argued that global health programs advance US national interests abroad. The veteran lawmaker cosponsored important legislation that increased US support for work addressing AIDS, tuberculosis, and malaria.

Outgoing secretary Hillary Clinton’s unremitting emphasis on women and girls will be hard to match. To meet the administration’s targets, Kerry, like Clinton, will have to manage competing interests to maintain focus on global health and development goals.

A role for US embassies

If confirmed, Kerry will supervise a new Office of Global Health Diplomacy at the State Department. The office will supplement the Global Health Initiative’s work by using US embassies to coordinate donors. Embassy staff also will be charged with encouraging countries that receive aid to contribute more of their own fiscal and human resources to their health systems—contributions that are essential to building skills and achieving long-term success.

The office’s success relies on how well it works with the US Agency for International Development (USAID) and other global health agencies.

Open question: Congress

The ability of the administration to achieve its global health goals rests on the work of US global health agencies—primarily USAID, the National Institutes of Health, and the Centers for Disease Control and Prevention—and the will of Congress to cooperate in the budget-making process to fund their work.

Nearly half of lawmakers in the 113th Congress weren’t in office five years ago, when groundbreaking global health legislation was passed. It’s hard to predict how strong their support for global health will be, but many of them campaigned on domestic issues, with international issues low on their agendas.

These policymakers have some critical choices ahead of them. The foreign assistance decisions that a nation makes when its economy and the well-being of its citizens are challenged is the true test of its resolve. Will our elected officials consider the health of people around the world who are at risk of preventable death and disability as they look for ways to cut costs? Will they continue to dream big, or will they let political gridlock curtail the ability of the United States to improve health around the world?