Impact of Health Aid Investments on Public Opinion of the United States: Analysis of Global Attitude Surveys From 45 Countries, 2002-2016.

Objectives. To assess whether increasing health aid investments affected public opinion of the United States in recipient populations. Methods. We linked health aid data from the United States to nationally representative opinion poll surveys from 45 countries conducted between 2002 and 2016. We exploited the abrupt and substantial increase in health aid when the US President's Emergency Plan for AIDS Relief (PEPFAR) and President's Malaria Initiative (PMI) were launched to assess unique changes in opinions of the United States following program onset. We also ascertained increased exposure to health aid from the United States by systematically searching for mentions of US health aid programs in popular press. Results. Favorability ratings of the United States increased within countries in proportion to health aid and were significantly higher after implementation of PEPFAR and PMI. Higher US health aid was associated with more references to that aid in the popular press. Conclusions. Our study was the first, to our knowledge, to show that US investments in health aid improved the United States' image abroad. Public Health Implications. Sustained global health investments may offer important returns to the United States as well as to the recipient populations.