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USA/Africa: Global Health Commitment
AfricaFocus Bulletin
Dec 18, 2008 (081218)
(Reposted from sources cited below)
Editor's Note
"The U.S. government [should] demonstrate, through policies and
actions, that this nation fundamentally believes in the value of
better health for all. The committee is calling on the next
President to highlight health as a pillar of U.S. foreign policy.
.. The U.S. government should act in the global interest,
recognizing that long-term diplomatic, economic, and security
benefits for the United States will follow." - The U.S.
Commitment to Global Health: Recommendations for the New
Administration from the Institute of Medicine, National Academy of
Sciences
In a report released on December 15, which received little coverage
in the U.S. or international press, a committee of the prestigious
Institute of Medicine released a study report calling for the U.S.
to double its budget for global health and make the commitment a
centerpiece of U.S. foreign policy. The committee's work was
sponsored by four U.S. government agencies and five private
foundations, and the 50-page report is available on-line for
download at http://www.iom.edu and
http://www.nap.edu/catalog/12506.html
The committee was co-chaired by former Under-Secretary of State
Thomas R. Pickering and by Harold E. Varmus, president of the
Memorial Sloan-Ketting Cancer Center, and included both American
and international experts on public health and related issues.
This AfricaFocus Bulletin contains the executive summary of the
report, which expresses an emerging bipartisan consensus that
consistent support for global health is both an international
obligation and in the national interest..
For previous AfricaFocus Bulletins on health, visit
http://www.africafocus.org/healthexp.php
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This issue will be the last issue of AfricaFocus Bulletin for 2008.
Regular publication will resume in mid-January, after the holidays.
News feeds and other features on http://www.africafocus.org will
continue to be updated regularly during the break.
Best wishes to our readers for the holidays and the new year.
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The U.S. Commitment to Global Health: Recommendations for the New
Administration
Institute of Medicine, National Academy of Sciences
Committee on the U.S. Commitment to Global Health, National
Research Council .
http://www.iom.edu
http://www.nap.edu/catalog/12506.html
[The National Academy of Sciences is a private, nonprofit,
self-perpetuating society of distinguished scholars engaged in
scientific and engineering research, dedicated to the furtherance
of science and technology and to their use for the general
welfare. Upon the authority of the charter granted to it by the
Congress in 1863, the Academy has a mandate that requires it to
advise the federal government on scientific and technical matters.
The Institute of Medicine was established in 1970 by the National
Academy of Sciences to secure the services of eminent members of
appropriate professions in the examination of policy matters
pertaining to the health of the public. The Institute acts under
the responsibility given to the National Academy of Sciences by its
congressional charter to be an adviser to the federal government
and, upon its own initiative, to identify issues of medical care,
research, and education.]
Executive Summary
At this historic moment, the Obama administration and leaders of
the U.S. Congress have the opportunity to advance the welfare and
prosperity of people within and beyond the borders of the United
States through intensified and sustained attention to better
health. The promise of potential solutions in global health has
captured the interest of a new generation of philanthropists,
students, scientists, private industry leaders, and citizens, eager
to make a difference in our interconnected world. Over the last
decade, the U.S. government has mirrored the American public's
interest with record expenditures on global health. By building on
these commitments and deploying the full complement of U.S. assets
to achieve global health, the United States can improve the lives
of millions around the world, while reflecting America's values
and protecting and promoting the nation's interests.
The Institute of Medicine--with the support of four U.S. government
agencies and five private foundations--formed an independent
committee to examine the United States' commitment to global
health and articulate a vision for future U.S. investments and
activities in this area. To coincide with the U.S. presidential
transition, the committee prepared the following report outlining
how the U.S. government can improve global health under the
leadership of a new administration. A more complete exploration of
this vision--including the role of the commercial sector,
foundations, academia, and nongovernmental organizations--will be
released in the spring of 2009. Health is a highly valued,
visible, and concrete investment that has the power to both save
lives and enhance U.S. credibility in the eyes of the world.
In today's market crisis, the financial policies and practices of
the most developed nations, including the United States, are seen
as the cause of painful economic spillovers in low- and
middle-income countries. During economic downturns, population
health declines, especially among the poor in low-income
countries, who pay a large portion of their health care costs
out-of-pocket, without the benefit of social safety nets. It is
crucial for the reputation of the United States that the nation
live up to its humanitarian responsibilities, despite current
pressures on the U.S. economy, and assist lowincome countries in
safeguarding the health of their poorest members. The U.S.
government can take this opportunity to demonstrate, through
policies and actions, that this nation fundamentally believes in
the value of better health for all. The committee is calling on
the next President to highlight health as a pillar of U.S. foreign
policy.
This could be confirmed by a major speech early in his tenure,
declaring that the United States has both the responsibility as a
global citizen, and an opportunity as a global leader, to
contribute to improved health around the world. The U.S.
government should act in the global interest, recognizing that
long-term diplomatic, economic, and security benefits for the
United States will follow.
If health is to hold a more prominent position in U.S. foreign
policy, the U.S. government will need to increase coordination
among the multiple agencies and departments engaged in global
health. A 1997 Institute of Medicine report, America's Vital
Interest in Global Health, called for the establishment of a
government Interagency Task Force on Global Health, led by the
U.S. Department of Health and Human Services. The committee
supports this recommendation, but calls for the interagency group
to be located more centrally, in the White House. Locating the
effort in the White House, potentially within the National Security
Council (NSC) and reporting to the President through the NSC
Advisor, would give it convening authority among sometimes
competing agencies and the ability to make policy recommendations
directly to the President.
Within the first year of his administration, the committee
recommends that the President create a White House Interagency
Committee on Global Health to lead, plan, prioritize, and
coordinate the budgeting for major U.S. government global health
programs and activities. The Interagency Committee--consisting of
heads of major U.S. departments and agencies involved in global
health activities--should play the crucial role of ensuring that
the U.S. government has a coherent strategy for ongoing
investments in global health, and also that health is taken into
account when setting U.S. foreign policy in other areas, such as
trade, environment, and security.
The committee also calls on the President to designate a senior
official at the White House (Executive Office of the President,
potentially within the National Security Council) at the level of
Deputy Assistant to the President for Global Health to chair the
Interagency Committee. The Deputy for Global Health should serve
as the primary advisor at the White House on global health, attend
National Security Council meetings which deal in any way with
global health issues, and work with the National Security Advisor,
the Director of Management and Budget, and the President's Science
Advisor in carrying out his or her responsibilities.
The committee also asks that by the end of the administration's
first term, the President and Congress double annual U.S.
commitments to global health between 2008 ($7.5 billion) and 2012
($15 billion). The committee recommends that the U.S. government
commit to $13 billion for the health-related Millennium
Development Goals (MDGs) and an additional $2 billion to address
the challenges of noncommunicable diseases and injuries.
Meeting the globally recognized MDGs, adopted by the Member States
of the United Nations in 2000, would require advanced economies to
devote 0.54 percent of their gross national income (GNI) to
overseas development assistance. Accordingly, the committee
estimates that the U.S. contribution to the health-related MDGs
(Goal 4: Reduce child mortality, Goal 5: Improve maternal health,
and Goal 6: Combat HIV/AIDS, malaria and other diseases) would be
$13 billion per year by 2012.
The allocation of this $13 billion per year should be balanced
across the portfolio of global health spending to reflect the
breadth of the health-related MDGs. The U.S. government should
fulfill its implied commitments under the President's Emergency
Plan for AIDS Relief (PEPFAR) reauthorization to global AIDS
programs ($7.8 billion per year), malaria ($1 billion per year),
and tuberculosis ($800 million per year). The remaining $3.4
billion per year would double current levels of spending by the
U.S. government for global programs in support of health system
strengthening, child and women's health, nutrition, family planning
and reproductive health, and neglected diseases of poverty, all of
which have been severely underresourced during the past decade.
Additional resources will be required to respond to the
contemporary challenges of chronic and noncommunicable diseases
and injuries, which are responsible for more than half of the
deaths below age 70 in low- and middle-income countries, but are
not captured in the health-related MDGs. Cost-effective
strategies, such as tobacco control, have the promise of averting
millions of premature deaths from noncommunicable diseases in lowand
middleincome countries. The committee recommends $2 billion
per year to expand the U.S. portfolio in support of these efforts,
bringing the overall U.S. government commitment to global health to
$15 billion by 2012.
Translating this commitment into sustained, significant, and
measurable health outcomes in low- and middle-income countries
requires a partnership between the United States and national
governments; aid must therefore be allocated in support of
technically and financially sound country-led health plans. Even
disease- and intervention-specific programs should contribute to
stronger health systems and a better trained, more productive
health workforce. Congress and the administration should require
that aid be accompanied by rigorous countryand program-level
evaluations to measure the impact of global health investments in
order to maximize their effectiveness. America's traditional
strength in the global health field is its capacity to generate
knowledge. The committee recommends that Congress continue to fund
research in important areas--such as new interventions for the
prevention and treatment of infectious diseases--but also allocate
a portion of the funding levels recommended in this report to
increase funds for three purposes: to study the basic mechanisms
of diseases that disproportionately affect poor countries; to
identify means to control noncommunicable diseases that are
applicable in lowresource settings; and to conduct health systems
research to improve the delivery of existing interventions.
While the U.S. government interacts with multiple UN agencies and
other intergovernmental bodies, the committee believes that the
United States has much to gain from supporting the World Health
Organization (WHO) as this body has the unique mandate of setting
evidence-based norms on technical and policy matters to improve
global health. Many aspects of the WHO's current structure and
function, though, hinder its effectiveness. The United States,
along with the international community, should support the WHO, but
also request a rigorous external review of the organization to
develop future-oriented recommendations.
The American public has strongly supported commitments to global
health in the past. Repeated polls have shown that health now
ranks among Americans' top priorities for development assistance--
not merely to protect U.S. interests, but also as a way of
promoting human development worldwide. Working with partners
around the world and building on previous commitments, the United
States has the responsibility and chance to save and improve the
lives of millions; this is an opportunity that the committee hopes
the United States will seize.
Committee on t he U.S. Commitment to Global Health
Thomas R. Pickering (Co-Chair), Vice Chairman, Hills & Company,
International Consultants, Washington, DC; formerly,
Under-Secretary of State for Political Affairs (retired)
Harold E. Varmus (Co-Chair), President and Chief Executive Officer,
Memorial Sloan-Kettering Cancer Center, New York
Nancy Kassebaum Baker, Former U.S. Senator, Burdick, KS
Paulo Buss, President, Funda� o Oswaldo Cruz, Rio De Janeiro,
Brazil
Haile T. Debas, Executive Director; Chancellor and Dean Emeritus,
Global Health Sciences; University of California, San Francisco
Mohamed T. El-Ashry, Senior Fellow, United Nations Foundation,
Washington, Dc
Maria Freire, President The Albert and Mary Lasker Foundation, New
York
Helene D. Gayle, President and Chief Executive Officer, Care,
Atlanta, GA
Margaret A. Hamburg, Senior Scientist, Nuclear Threat
Initiative, Washington, DC
J. Bryan Hehir, Parker Gilbert Montgomery Professor of the Practice
of Religion and Public Life, Hauser Center for Nonprofit
Organizations, Kennedy School, Harvard University, Boston, MA
Prabhat Jha, Canada Research Chair in Health and Development,
Centre for Global Health Research, St. Michael's Hospital,
University of Toronto, Canada
Roderick K. King, IOM Anniversary Fellow; Instructor of Medicine,
Department of Global Health and Social Medicine, Harvard Medical
School; Senior Faculty, Massachusetts General Hospital Disparities
Solutions Center, Boston, MA
Jeffrey P. Koplan, Vice President, Academic Health Affairs, Emory
University, Atlanta, GA
Ruth Levine, Vice President for Programs and Operations, Senior
Fellow, Center for Global Development, Washington, DC
Afaf I. Meleis, Professor of Nursing and Sociology, Margaret Bond
Simon Dean of Nursing, School of Nursing, University of
Pennsylvania, Philadelphia
Nelson Sewankambo, Dean, Faculty of Medicine, Makerere University,
Kampala, Uganda
Bennett Shapiro, Chairman, DNDI-North America;partner, Puretech
Ventures, New York; Formerly, Executive Vice-president, Merck
Research Laboratories (Retired)
Marc Van Ameringen, Executive Director, Global Alliance for
Improved Nutrition, Geneva, Switzerland
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providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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