	Introduction

The U.S. Centers for Disease Control and Prevention (CDC) plays a central role in shaping and implementing U.S. global health policy. CDC is also an implementing partner in three presidential initiatives that comprise the bulk of U.S. global health assistance: the President's Malaria Initiative (PMI) and the Neglected Tropical Diseases (NTD) Program, both of which are coordinated by USAID, and the President's Emergency Plan for AIDS Relief (PEPFAR), which is coordinated by the State Department. This report highlights the health-related activities conducted by CDC, outlines how much the agency has spent on such efforts from FY2001 to FY2011, and highlights FY2012 proposed funding levels. Today, CDC is a partner in a number of global disease control and prevention efforts, including those related to HIV/AIDS, influenza (flu), polio, malaria, measles, tuberculosis (TB), and emerging diseases. In addition, CDC's global health efforts aim to address other global health challenges, such as chronic disease, injury prevention, child and maternal health, and environmental health concerns. CDC's Global Health Programs

Congress appropriates funds to CDC for global health efforts through Labor, Health and Human Services, and Education (Labor-HHS) appropriations. The bulk of funds for CDC's global health programs are provided by Congress to the Center for Global Health, historically through five main budget lines: Global HIV/AIDS, Global Malaria, Global Disease Detection, Global Immunization, and Other Global Health. For example, CDC receives support transferred from the Office of the Global AIDS Coordinator (OGAC) at the U.S. Department of State, for the implementation of PEPFAR programs, and from USAID for its role in PMI and the NTD Program, among other programs. From FY2006 through FY2008, USAID transferred an estimated $25 million to CDC for global malaria programs. This figure includes funding for International Emergency and Refugee Health efforts. CDC also leverages other resources to respond to global requests for technical assistance related to disease outbreak response; prevention and control of injuries and chronic diseases; emergency assistance and disaster response; environmental health; reproductive health; and safe water, hygiene, and sanitation. Specifically, CDC supports global health programs aimed at TB, influenza, and neglected tropical diseases. In FY2005, Congress provided emergency supplemental funds for U.S. efforts related to global pandemic influenza preparedness and response. CDC Global Health Spending: FY2001-FY2012

From FY2001 to FY2011, Congress provided CDC roughly $3.5 billion for global health activities. The Administration requests that Congress provide about $381.2 million for CDC's global health programs in FY2012, some 10% more than FY2010 ( Table 1 ). The FY2012 budget request included several programmatic changes.
A number of U.S. agencies and departments implement U.S. government global health efforts. Overall, U.S. global health assistance is not always coordinated. Exceptions to this include U.S. international responses to key infectious diseases; for example, U.S. programs to address HIV/AIDS through the President's Emergency Plan for AIDS Relief (PEPFAR), malaria through the President's Malaria Initiative (PMI), and neglected tropical diseases through the Neglected Tropical Diseases (NTD) Program. Although several U.S. agencies and departments implement global health programs, this report focuses on funding for global health programs conducted by the U.S. Centers for Disease Control and Prevention (CDC), a key recipient of U.S. global health funding.
Congress appropriates funds to CDC for its global health efforts through five main budget lines: Global HIV/AIDS, Global Immunization, Global Disease Detection, Malaria, and Other Global Health. Although Congress provides funds for some of CDC's global health efforts through the above-mentioned budget lines, CDC does not, in practice, treat its domestic and global programs separately. Instead, the same experts are mostly used in domestic and global responses to health issues. As such, CDC often leverages its resources in response to global requests for technical assistance in a number of areas that also have domestic components, such as outbreak response; prevention and control of injuries and chronic diseases; emergency assistance and disaster response; environmental health; reproductive health; and safe water, hygiene, and sanitation.
CDC also partners in programs for which it does not have specific appropriations, such as efforts to address international tuberculosis (TB) and respond to pandemic influenza globally. Congress does, however, appropriate funds to CDC to address these diseases domestically. In addition, the State Department and the U.S. Agency for International Development (USAID) transfer funds to CDC for its role as an implementing partner in U.S. coordinated initiatives, including PEPFAR, PMI, and the NTD Program.
From FY2001 to FY2011, Congress provided CDC roughly $3.5 billion for global health activities, including $330.2 million in FY2011. The President requested that in FY2012, Congress appropriate $358.6 million to CDC for global health programs—an estimated 5% increase over FY2010-enacted levels.
There is a growing consensus that U.S. global health assistance needs to become more efficient and effective. There is some debate, however, on the best strategies. This report explains the role CDC plays in U.S. global health assistance, highlights how much the agency has spent on global health efforts from FY2001 to FY2011, and discusses the FY2012 budget proposal for CDC's global health programs. For more information on U.S. global health funding more broadly, see CRS Report R41851, U.S. Global Health Assistance: Background and Issues for the 112th Congress.