The UK’s cuts to development aid are morally repugnant

It’s hard to ignore Donald Trump and the deep harm he’s inflicting on health, both in the US and worldwide (doi:10.1136/bmj.r370 doi:10.1136/bmj.r357 doi:10.1136/bmj.r356 doi:10.1136/bmj.r279 doi:10.1136/bmj.r395 doi:10.1136/bmj.r288 doi:10.1136/bmj.r289).1234567 The assault is so multipronged that it’s mindboggling to fully identify, gauge, and respond to it. The US’s power and reach are such that science, medicine, and health are in unprecedented jeopardy. What we hear less of is that Trump has already earned negative opinion poll ratings in the US for his performance and for his much publicised policies.8 Yet, in its rush to meet Trump’s agenda, the UK government is damaging health too.

We know that the impact of policies that harm science and medicine extends beyond national borders and spreads quickly around the world. Trump cares for none of this in his manic pursuit of striking deals and cutting costs. One of his first acts in his second presidential term was to cut international aid. However, the world’s poorest people are being punished twice over: the UK government’s decision to cut its own development aid spending is a direct consequence of, albeit not excused by, Trump’s approach to geopolitics.

The UK cut its aid spending from 0.7% of gross national income (the United Nations target) to 0.5% in 2021. It also “phased out aid for 102 territories—nearly a quarter of which were fragile or in conflict” (doi:10.1136/bmj.p2075).9 External aid covers about a third of health spending in the world’s poorest countries. By some estimates, those cuts in UK aid led to 5.3 million women losing access to modern family planning methods, while 72 million people missed treatment for neglected tropical diseases in just one six month period. An analysis in 2021 calculated that defunding of immunisation programmes had contributed to 100 000 preventable deaths.

When further aid cuts were proposed for 2023, a parliamentary assessment of their impact made for “grim reading” (doi:10.1136/bmj.p1795).10 It predicted thousands more deaths in poor countries, particularly of women and children. There’s no reason to believe that the effects will be any less now—indeed, they will inevitably be greater. The arguments for the benefits of development aid are well known and are both moral and political (doi:10.1136/bmj.q1392).11 When the US, the UK, or any rich country cuts development aid it knows that this decision will be directly or indirectly responsible for plunging more people into poverty, more sickness, and more deaths. A small drop in a donor’s national budget will result in much greater damage to the recipients of aid.

Trump may not think too much about the harms of his self-serving agenda, but you might expect Keir Starmer and his cabinet colleagues in the UK to do so. Dropping development aid from 0.5% of gross national income to 0.3% will release £6bn (doi:10.1136/bmj.r410).12 This move was immediately condemned: the chief executive of Save the Children UK described it as a “betrayal of the world’s most vulnerable children and the UK’s national interest.”

The UK government’s desire to increase defence spending in the current geopolitical context may be understandable, but to finance it through a cut in development aid is morally repugnant.