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Summary
Global health is the goal of improving health for all people in all nations
by promoting wellness and eliminating avoidable disease, disability, and death.
It can be attained by combining population-based health promotion and disease
prevention measures with individual-level clinical care. This ambitious endeavor
calls for an understanding of health determinants, practices, and solutions, as well
as basic and applied research on risk factors, disease, and disability.
In the United States, an area of study, research, and practice has emerged to
contribute to the achievement of global health. The U.S. global health enterprise
involves many sectors (both governmental and nongovernmental) and disciplines
(within and beyond the health sciences) and is characterized by intersectoral,
interdisciplinary, and international collaboration. U.S. leadership in global health
reflects many motives: the national interest of protecting U.S. residents from
threats to their health; the humanitarian obligation to enable healthy individuals,
families, and communities everywhere to live more productive and fulfilling
lives; and the broader mission of U.S. foreign policy to reduce poverty, build
stronger economies, promote peace, increase national security, and strengthen
the image of the United States in the world.
The U.S. government, along with U.S.-based foundations, nongovernmental
organizations, universities, and commercial entities, can take immediate concrete
action to accelerate progress on the urgent task of improving health globally by
working with partners around the world to scale up existing interventions, gen -
erate and share knowledge, build human and institutional capacity, increase and
fulfill financial commitments, and establish respectful partnerships.
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THE U.S. COMMITMENT TO GLOBAL HEALTH
SCOPE OF THE REPORT
The Institute of Medicine (IOM)—with the support of four U.S. govern -
ment agencies and five private foundations—convened an expert committee to
investigate the U.S. commitment to global health and articulate a vision for future
U.S. investments and activities in this area. While global health encompasses the
health of everyone (including U.S. citizens) and is a shared global aspiration that
requires the work of many nations, this report focuses on the efforts of the United
States, both its governmental and its nongovernmental sectors, to help improve
health in low- and middle-income countries.
The committee examined whether the existing architecture, investments, and
activities of the U.S. global health enterprise are optimally geared to achieving
significant, sustainable, and measurable global health gains. This report commu -
nicates specific recommendations, not just for the U.S. government, but also for
several nongovernmental sectors, including foundations, universities, nonprofit
organizations, and commercial entities.
Because health is inextricably connected to the broader goals of hastening
development and reducing poverty, the committee recognizes that any action
taken by the United States to support global health should be tied directly to
broader discussions of U.S. commitments to global economic and human devel -
opment, as well as the environment. The committee also recognizes that while
the United States has the opportunity to support and advocate for a global plan
to improve health, ultimately individual countries—both governments and civil
society—are responsible for putting in place the social and economic policies that
protect the health of their populations.
U.S. CONTRIBUTION TO GLOBAL HEALTH IMPROVEMENTS
Health achievements in the last 50 years have been remarkable. Globally, life
expectancy has increased more in this period than in the preceding 5,000 years.
The creation, dissemination, and adoption of knowledge have been among the
main drivers of these health gains, delivering marked improvements in low- and
middle-income countries that have invested in sustainable and equitable systems
to deliver proven, cost-effective interventions.
Both governmental and nongovernmental sectors in the United States have
been an important source of global health knowledge, providing the scientific
basis for many health successes worldwide through their research and capacity
building efforts. The United States—in partnership with local communities, gov -
ernments, and international organizations—has also played a critical role in the
dissemination and adoption of knowledge by providing the financial and technical
resources to expand public health infrastructure and access to health interventions
in many countries, resulting in major public health achievements.
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SUMMARY
RECOMMENDATIONS FOR IMPROVED GLOBAL HEALTH
The United States now has an unprecedented opportunity to improve global
health. The promise of potential solutions to global health problems has captured
the interest of a new generation of philanthropists, students, scientists, healthcare
professionals, private sector leaders, and citizens—all eager to make a difference
in this interconnected world. At the same time, the U.S. government has made
record financial commitments to global health programming, for which the sup -
port of the American people has been crucial.
Neither the U.S. government nor any one U.S. organization can achieve
global health by acting alone. Progress toward this goal requires the collabora -
tion of all countries, donors, and recipients of aid to develop, finance, and deliver
essential and cost-effective health interventions. The United States can, however,
lead by setting an example of meaningful financial commitments, technical excel-
lence, and respectful partnership.
The committee examined many ways in which the United States, includ-
ing the U.S. government and the nongovernmental sector, could contribute to
advances in global health. The committee pursued those areas that draw on U.S.
technical and scientific capabilities to generate knowledge; maximize growing
involvement by the U.S. government, universities, foundations, and commercial
entities; and address a significant deficiency in advancing global health. The com -
mittee identified five areas for action by the U.S. global health enterprise:
1. Scale up existing interventions to achieve significant health gains.
2. Generate and share knowledge to address health problems endemic to the
global poor.
3. Invest in people, institutions, and capacity building with global partners.
4. Increase U.S. financial commitments to global health.
5. Set the example of engaging in respectful partnerships.
SCALE UP ExISTING INTERVENTIONS TO
ACHIEVE SIGNIFICANT HEALTH GAINS
The global health community has reached a critical juncture. The knowledge,
innovative technologies, and proven tools to help millions of people in need
are within reach. Yet even with demonstrated success in tackling certain health
issues, a wide gap remains between what can be done with existing knowledge
and what is actually being done. Existing interventions are not widely used even
though many are inexpensive and easy to administer.
Support the Millennium Development Goals by 2015
The globally recognized Millennium Development Goals (MDGs) were
adopted by the Member States of the United Nations (UN) in 2000 to achieve
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THE U.S. COMMITMENT TO GLOBAL HEALTH
demonstrable reductions in poverty and improve specific health and social out -
comes by 2015. Three of the eight goals pertain directly to health (Goal 4:
Reduce child mortality; Goal 5: Improve maternal health; and Goal 6: Combat
HIV/AIDS, malaria, and other diseases) and the other five, indirectly. While prog -
ress has been made, the MDG targets remain a distant goal for many countries,
particularly in sub-Saharan Africa and parts of South Asia.
Recommendation 2-1. As part of a comprehensive approach to develop-
ment and poverty reduction, the United States, both its governmental and its
nongovernmental sectors, should support the UN’s Millennium Development
Goals. In particular, the United States should partner with countries to pro -
mote and finance the application of existing knowledge and tools to achieve
the health-related MDGs by 2015 with special attention to areas that are
lagging behind. (See Recommendation 5-1 for funding proposal.)
Prepare for Emerging Challenges of the Twenty-first Century
The timeless health problems associated with poverty are now coupled with
new challenges. Infectious diseases are emerging at the historically unprecedented
rate of one per year. With airlines now carrying more than 2 billion passengers
annually and systems of trade more interconnected than in any time in human
history, opportunities for the rapid international spread of infectious agents and
their vectors have vastly increased. The recent spread of H1N1 influenza (swine
flu) to more than 20 countries in the span of a few weeks highlights the speed at
which new threats can travel. The rising tide of chronic diseases and injuries in
low- and middle-income countries, where 80 percent of the world’s deaths from
chronic, noninfectious diseases now occur, also cannot be ignored.
Recommendation 2-2. The United States should partner with the global
community to prepare for emerging challenges of the twenty-first century
by increasing attention to pandemic infectious threats, noncommunicable
diseases, and injuries. The U.S. government should demonstrate leadership in
this area by adopting clear goals—such as improving global disease surveil -
lance, decreasing deaths from tobacco-related illnesses, and reducing injuries
from accidents—to guide U.S. global health investments. (See Recommenda-
tion 5-1 for a detailed funding proposal.)
Address Neglected Health Systems
The drive to produce results for the MDGs and other health goals has led
many donors to focus on specific disease outcomes. Yet undermining all efforts to
reduce disease burden is the stress on health systems in low- and middle-income
countries. Functional health systems—including access to adequate financing;
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SUMMARY
public health infrastructure and programming; essential medical products, vac -
cines, and technologies; a well-performing health workforce; reliable and timely
health information; and strategic policy frameworks to provide effective analysis,
oversight, management, and governance—are sorely lacking in most low-income
countries.
Given the emergency conditions prompting the initial global response to
AIDS, for example, it is not surprising that donors chose to circumvent exist -
ing weak components of national health systems to set up programs devoted to
immediate and demonstrable results. While this focus on specific diseases has
led to significant health outcomes related to these diseases, the programs have
sacrificed opportunities to strengthen local health systems.
Recommendation 2-3. When delivering health assistance, federal executive
branch agencies and departments should work with Congress to make U.S.
government global health programs less formulaic and more performance-
based, to permit resources to be used more easily within unique national health
systems with the explicit objective of promoting stronger national health sys-
tems and a better trained, more productive health workforce.
GENERATE AND SHARE KNOWLEDGE TO ADDRESS
HEALTH PROBLEMS ENDEMIC TO THE GLOBAL POOR
One of the greatest contributions the United States can offer to the global
campaign to improve health is to share America’s traditional strength—the cre -
ation of knowledge—for the benefit of the global poor. The United States has a
distinguished record in the generation of knowledge, spending more in this area
than any other country. The United States and other wealthy nations focus the
majority of their research resources on conditions that affect people within their
own borders. As a result, diseases or conditions that are overwhelmingly or exclu-
sively incident in low- and middle-income countries are often neglected.
While the U.S. research community—comprised of the U.S. government,
universities, commercial entities, public-private partnerships, and other non-
profit organizations—has increased its research contributions to benefit global
health (especially to combat AIDS, malaria, and tuberculosis), it is not currently
mobilized to reach its full potential. The growing number of public-private part -
nerships and university-based collaborative research models devoted to global
health demonstrates the growing interest and untapped demand within the U.S.
research community to engage with partners in addressing the health needs of
the global poor.
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THE U.S. COMMITMENT TO GLOBAL HEALTH
Strengthen Knowledge on the Adoption and
Dissemination of Existing Interventions
The systemic bottlenecks in the health systems of low- and middle-income
countries (such as poor surveillance systems, bottlenecks in drug supply pipe -
lines, and chronic deficits in the health workforce) prevent the full benefits of
existing public health knowledge and technologies from being realized. Research
on healthcare systems is required to mitigate these effects. Currently, few pro -
grams that deliver specific health interventions undergo rigorous evaluation. If
U.S. efforts are to achieve sustainable and far-reaching outcomes, the importance
of knowing what works is critical.
Recommendation 3-1. The U.S. research community should increase
research and evaluation efforts to address the systemic bottlenecks in health
systems in low- and middle-income countries that keep the full benefits of
existing medical and public health knowledge and technologies from being
completely realized.
(A) The U.S. research community should expand its research efforts
through increased attention to health systems research (both for studies
that can be generalized across countries and for operational and imple -
mentation studies that are culturally and contextually relevant).
(B) In addition to measuring inputs (such as dollars spent) and out-
puts (such as drugs delivered), Congress and other global health funders
should require that efforts to deliver health interventions be accompanied
by rigorous country- and program-level evaluations to measure the effect
of global health programs on saving lives and improving health.
Continue Research to Develop Novel Health Technologies and Interventions
Global health would greatly benefit from developing and disseminating a
variety of novel behavioral and biomedical prevention strategies to combat infec -
tious diseases. Antiquated diagnostics and treatments also need to be improved
to achieve sustainable results in the management and control of disease and to
reduce drug resistance that results from misdiagnosis or poor adherence to treat -
ment regimens.
One of the most promising approaches to bridge the enormous and widening
gap in the availability of drugs, vaccines, and diagnostics to deal with the global
disease burden is the advent of public-private product development partnerships
(PDPs). This novel approach, coupled with U.S. expertise in science and bio -
medical research, strong U.S. financial commitments (through funding from the
National Institutes of Health [NIH] and the U.S. biomedical and pharmaceutical
industry), and the synergies that exist when the government works in partnership
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SUMMARY
with the nongovernmental sector, can yield technologies and interventions to
revolutionize global health.
Recommendation 3-2. The U.S. research community, in collaboration with
global partners, should leverage its scientific and technical capabilities to
conduct research using state-of-the-art technology and innovative strategies
to address health problems endemic to low- and middle-income countries.
(A) The U.S. research community should continue to examine new inter-
ventions for the prevention and treatment of global infectious diseases.
(B) The U.S. research community should expand its research efforts in
global health with heightened attention to two purposes: (1) to study the
basic mechanisms of diseases that disproportionately affect the global
poor, and (2) to identify means to control communicable and noncom -
municable diseases by adapting existing knowledge for low- and middle-
income countries.
Share Knowledge that Enables Local Problem Solvers
Research on global health involves not only generating knowledge rel-
evant to the context of low- and middle-income countries, but also effectively
transferring such knowledge and technologies to these settings and ensuring
that its intended beneficiaries can apply it on a sustained basis. With research
increasingly conducted globally through virtual communities of geographically
dispersed scientists, it is critically important that information exchange promote
sustainable cross-country research partnerships and enable the timely dissemina -
tion of best practices.
Recommendation 3-3. The U.S. research community should promote
global knowledge networks and the open exchange of information and tools
that enable local problem solvers to conduct research to improve the health
of their own populations.
(A) Funders of global health research should require that all work sup-
ported by them will appear in public digital libraries, preferably at the time
of publication and without constraints of copyright (through open access
publishing), but no later than six months after publication in traditional
subscription-based journals. Universities and other research institutions
should foster compliance with such policies from funding agencies and
supplement those policies with institution-based repositories of publica -
tions and databases.
(B) The U.S. government, universities, and other research institutions
should develop new methods—such as simplified web-based procedures
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THE U.S. COMMITMENT TO GLOBAL HEALTH
for executing agreements like materials transfer and nondisclosure
agreements—to expedite the sharing of information and research materials
with researchers in low- and middle-income countries.
(C) Scientists, clinicians, advocates, and other personnel involved in
defined areas of global health should develop trustworthy websites that
aggregate published literature, incorporate unpublished databases or clini-
cal trial information, promote digital collaboration, and disseminate news
and other information about common interests.
(D) Universities and other research institutions that receive federal and
philanthropic funding to conduct research should adopt patent policies
and licensing practices that enable and encourage the development of
technologies to create products for which traditional market forces are not
sufficient, such as medicines, diagnostics, and therapeutics that primarily
affect populations in low- and middle-income countries.
INVEST IN PEOPLE, INSTITUTIONS, AND CAPACITY
BUILDING WITH GLOBAL PARTNERS
Although the United States can offer partial solutions to help resolve the
challenges that low- and middle-income countries face in delivering basic health
services, these countries require capable local leaders, analysts, researchers, and
practitioners to identify problems and solutions that work and are sustainable in
their own countries. Unlike the United States, where academia, nonprofit orga -
nizations, and commercial entities play an important advisory role in domestic
U.S. healthcare policy, in low- and middle-income countries, universities, science
academies, and the research community are often absent from policy engagement.
As a result, this community has been neglected as a partner by many external
donors.
Expand Commitment to Institutional Capacity Building
The United States has an opportunity to address the neglect of universities
and the research community in low- and middle-income countries by leveraging
the growing involvement of U.S.-based universities, corporate entities, and foun -
dations in global health by supporting institutional partnerships across nations.
Such collaboration will not only strengthen capacity in leadership, research,
teaching, and patient care for all the institutions involved, it will also create incen-
tives for researchers and practitioners to stay in their home countries, by produc -
ing a workplace environment conducive to continuing education and enhanced
career opportunities.
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SUMMARY
Recommendation 4-1. Federal executive branch agencies, along with U.S.
private institutions, universities, nongovernmental organizations, and com -
mercial entities, should provide financial support and engage in long-term
and mutually advantageous partnerships with institutions—universities,
public health and research institutes, and healthcare systems—in low- and
middle-income countries with the goal of improving institutional capacity.
These partnerships should enable local and global problem solving and
policy engagement by
• Investing in training,
• Creating an enabling institutional environment,
• Funding a steady stream of diverse research grants,
• Generating demand for scientific and analytical work that influences
public policy, and
• Contributing to the control of real and immediate health problems.
Rectify the Health Workforce Crisis
Institutional partnerships between organizations in low- and middle-income
countries and the United States provide an opportunity to address the critical
workforce deficits that hinder the achievement of health-related MDGs. Beyond
the shortage of health workers, public health systems in these countries also lack
capacity due to weak civil service and absenteeism, with limited incentives for
good performance (including low salaries that lead to income supplementation
strategies such as informal payments and dual-practice in the private sector).
Underperforming market systems also typically have weak government capacity
to regulate the quality of providers, leading to particularly insidious outcomes,
such as price gouging and unnecessary or harmful care.
The same poor working conditions that have created disincentives for health
workers to perform at the highest level have also pushed many health profession -
als in low- and middle-income countries out of the public sector. Many choose
to emigrate to high-income countries that are experiencing a health workforce
shortage. However, the committee finds that global migration is neither the main
cause of, nor would its reduction be the main solution to, the worldwide human
resource crisis in health. Attempts to merely increase the supply of workers by
restricting emigration visas or reversing migration might have a modest effect on
the numbers, but would not solve the problem and would put unnecessary restric-
tions on the right of workers to migrate.
National health resource plans that go beyond simply increasing the number
of health workers and endeavor to understand and improve the dynamics of the
labor market have been successful in stemming the tide of workforce migration
and in recruiting and retaining labor for underserved areas. While such plans
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0 THE U.S. COMMITMENT TO GLOBAL HEALTH
require commitments by governments to construct and finance sound human
resource plans, the success of these plans is often dependent upon external donor
assistance and cooperation.
Recommendation 4-2. Federal executive branch agencies and departments,
nongovernmental organizations, universities, and other U.S.-based organiza-
tions that conduct health programs in low-income countries should align
assistance with the priorities of the national health sector human resource
plans and should commit and sustain funding in support of these plans.
Recommendation 4-3. Congress should work with federal executive branch
agencies and departments and U.S. universities to explore opportunities to
leverage the U.S. workforce to contribute to solutions that partially address
health workforce deficits in low- and middle-income countries. This explora-
tion should include an inquiry into the willingness of Americans to partici -
pate in a global health service corps; a determination of whether this kind of
assistance would be well received by recipient countries; and an examination
of whether specific opportunities exist to help migrants from low-income
countries return home to work temporarily or permanently.
INCREASE U.S. FINANCIAL COMMITMENTS TO GLOBAL HEALTH
Given the severe resource constraints in low-income countries, their progress
toward meeting the MDGs by 2015 will require increased and sustained foreign
assistance for health care from the advanced economies. Over the last decade, the
U.S. government has made record commitments to global health. Between 2001
and 2008, global health programming through the U.S. Agency for International
Development (USAID) and the State Department grew by nearly 350 percent.
As a result, health now makes up a significantly larger portion of both the U.S.
foreign affairs budget and the overall overseas development assistance (ODA)
budget. The extraordinary increase in the percentage of U.S. aid for health was
driven mostly by new models of assistance, such as the Global Fund to fight
AIDS, Tuberculosis, and Malaria; the President’s Emergency Plan for AIDS
Relief (PEPFAR); and the President’s Malaria Initiative.
In May 2009, President Obama announced the Global Health Initiative and
requested that Congress provide $63 billion in appropriations for global health
over the next six years (2009-2014). The proposal calls for an increase in funding
from $8.186 billion in FY 2009 to $8.645 billion in FY 2010.
Meet Existing International Aid Commitments
The committee commends the increased U.S. spending on global health. The
U.S. commitment to overall ODA, however, is less impressive. It is less than the
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SUMMARY
efforts of other high-income countries in relative terms and is among the lowest
levels of net ODA as a percentage of gross national income (GNI). Even when
private giving is included, per capita spending by the United States does not
approach the level of most other wealthy nations.
Meeting the MDGs would require advanced economies to devote 0.54 per-
cent of their GNI to ODA, as determined by the UN Millennium Project. Accord -
ingly, the committee estimates that the U.S. contribution to the health-related
MDGs would be $13 billion per year by 2012. This level of spending, although
still below the capacity of the United States and the overall resources needed for
health, is justified on the basis of international norms and commitments.
Additional resources will be required to respond to the contemporary chal -
lenges of chronic and noncommunicable diseases and injuries, which are respon -
sible 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 strate -
gies, such as tobacco control, hold the promise of averting millions of premature
deaths in these countries.
Recommendation 5-1. The President and Congress should commit to invest-
ing $15 billion in global health by 2012, with $13 billion of this directed to
the health-related MDGs and an additional $2 billion to the challenges of
noncommunicable diseases and injuries. (See Chapter 5 for more detailed
recommendations.)
(A) While pursuing the goal of $13 billion per year for the health-related
MDGs, federal executive branch agencies should work with Congress to
create balance in the traditional portfolio of global health spending that
reflects the breadth of the health-related MDGs.
(1) Congress should fulfill its implied commitments under PEPFAR reau-
thorization to global AIDS programs ($7.8 billion per year), malaria
($1 billion per year), and tuberculosis ($800 million per year).
(2) The U.S. government should use the remaining $3.4 billion per year to
support programs such as health systems strengthening, children 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.
(3) Given concerns that PEPFAR costs could crowd out other equally
important global health initiatives, the U.S. government should main-
tain funding for ARV treatment for individuals already supported by
PEPFAR but should also act diligently to ensure that the program
prevents as many HIV infections as possible.
(B) Federal executive branch agencies and departments—particularly
the Centers for Disease Control and Prevention, the NIH, and USAID—
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THE U.S. COMMITMENT TO GLOBAL HEALTH
should work with Congress to identify specific ways to respond to the
contemporary challenges of noncommunicable diseases and injuries and
should commit to investing $2 billion for this purpose by 2012.
Continue Strong U.S. Commitment to Fund Global Health Research
The appropriate mix of health spending for care delivery and for research
should be weighed against the requirements of combating a particular disease and
the unique health needs of a local population. However, including research in health
assistance can only increase its effectiveness. In the spirit of the 2008 Bamako Call
to Action on Research for Health (which urged international development agencies
and major funders to allocate 5 percent of global health development assistance
for health research), the committee recommends that aid be flexible and allow for
the funding of research to be conducted through the foreign affairs budget as it
supports improvements to health in low- and middle-income countries.
Recommendation 5-2. Federal executive branch agencies and departments
should work with Congress to design a coordinated approach to funding
global health research that leverages research subsidies through the Depart -
ment of Health and Human Services budget and innovative funding mech-
anisms for novel vaccine, drug, and diagnostic procurement through the
foreign affairs budget.
SET THE ExAMPLE OF ENGAGING IN RESPECTFUL PARTNERSHIP
The U.S. government—the largest funder of many international organiza-
tions and a significant donor of bilateral aid in some countries—carries consider-
able influence in shaping the global health environment. While the global health
community faces many complex questions about governance that will not be
resolved by any one country acting alone, many opportunities exist for the United
States to be an effectual leader, respectful partner, and good steward for health at
both the national and the global levels.
Support and Collaborate with WHO
The flourishing global health community is vast and diverse and is greatly
in need of effective leadership. While the proliferation of new participants in this
field, such as PDPs and foundations, is a welcome development that brings with
it fresh resources and innovation, global health activities will remain ad hoc,
duplicative, and highly fragmented unless the different initiatives and agendas
are coordinated through effective leadership.
With so many committed partners based in different countries dedicated to
improving global health, leadership would ideally be provided through a single
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organization with a mandate for setting evidence-based norms on health-related
technical and policy matters. Although not perfect, the World Health Organization
(WHO) is such an organization, and if it did not exist, a similar one would have
to be created—to lead a coordinated response to epidemic influenza, for example.
The committee finds that the United States has much to gain from supporting
WHO, despite the fact that many aspects of its current structure and function
hinder its effectiveness.
Recommendation 6-1. The U.S. government should support WHO as a
leader in global health by paying its fair share of the organization’s budget
and providing technical expertise to WHO, as requested. However, it should
also request a rigorous external review of the organization to develop future-
oriented recommendations that maximize its effectiveness. (See Chapter 6
for more detailed recommendations.)
Align Aid with Country-Led Health Plans
The effects of the proliferation of new participants in global health are
perhaps most acutely seen at the national level. Low-income countries typically
receive aid from multiple global agencies, resulting in overburdened health
ministries. Given that a majority of investments are delivered and managed
through local nongovernmental organizations operating outside the recipient
government’s budgeting system, many countries struggle to maintain control of
their own health priorities. Countries with weak control of their health systems
lose the incentive and ability to create and support their own sustainable plans.
Recommendation 6-2. To ensure that countries retain ownership and
accountability for the health of their populations and to promote long-term
sustainability, donors should support recipient countries in developing results-
focused, country-led agreements that rally all development partners around
one country-led health plan, one monitoring and evaluation framework, and
a unified review process. Donors should also aim to build local capacity to
regulate and integrate local private sector participants in the government’s
health plan.
Recommendation 6-3. To reduce the burden on countries in coordinating
donor efforts around a basic health plan, all funders of global health should
strive to deliver a greater proportion of aid in support of technically and
financially sound country-led health plans provided on the premise that the
recipient government implements agreed-upon strategies in a transparent
fashion.
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THE U.S. COMMITMENT TO GLOBAL HEALTH
CALL TO ACTION
At this historic moment, the United States has the opportunity to advance the
welfare and prosperity of people within and beyond its borders through intensi -
fied and sustained attention to better health. Even as the U.S. economy is under
pressure, attention to global health remains essential. The financial policies and
practices of the wealthiest nations, including the United States, are having painful
consequences in low- and middle-income countries. During economic downturns,
the health of a country’s population worsens due to lowered household income
and reduced access to health care. Moreover, the poor in low- and middle-income
countries are most affected because they pay a large portion of their healthcare
costs out-of-pocket, without the benefit of social safety nets. It is therefore crucial
for the reputation of the United States that the nation live up to its humanitar-
ian responsibilities, despite current pressures on the U.S. economy, and partner
with low- and middle-income countries in safeguarding the health of their most
vulnerable members.
Global Health Is a Responsibility and an Opportunity to Be Seized
Health is a highly valued, visible, and concrete investment that has the
power to both save lives and enhance the image of the United States in the eyes
of the world. Through its policies and actions, the United States can take this
opportunity to demonstrate that it fundamentally believes in the value of better
health for all.
Recommendation 7-1. The President should 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. Priorities should be established on the basis of
achieving sustained health gains most effectively, rather than on short-term
strategic or tactical U.S. interests.
Need for Coherent Strategy for U.S. Government
Involvement in Global Health
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. The 1997 IOM report America’s Vital
Interest in Global Health called for the establishment of a government Inter-
agency Task Force on Global Health, led by the U.S. Department of Health and
Human Services. The committee supports this recommendation in principle, but
recommends that the interagency group be located more centrally, in the White
House. Locating the effort in the White House, potentially within the National
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SUMMARY
Security Council (NSC) and reporting to the President through the NSC adviser,
would give it convening authority among sometimes competing agencies and the
ability to make policy recommendations directly to the President.
Recommendation 7-2. Within the first year of his administration, the Presi-
dent should create a White House Interagency Committee on Global Health
to lead, plan, prioritize, and coordinate the budgeting for major U.S. govern -
ment global health programs and activities. The President should also desig -
nate a senior official at the White House (Executive Office of the President,
potentially within the NSC) at the level of deputy assistant to the President
for global health to chair this interagency committee.
Call for Summit to Highlight U.S. Commitment to Global Health
Working with partners around the world and building on previous commit-
ments, 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.
Recommendation 7-3. In recognition of the partnership needed to achieve
global health, the President should call together world leaders for a summit
meeting at the UN General Assembly General Debate and the meeting of the
G20 in September 2009 to announce a commitment to the overall funding
levels recommended in this report ($15 billion spent annually by 2012) and
to emphasize the importance of the closely related issues of food and water
security. In the interest of sovereignty and sustainability, the President should
also ask low- and middle-income countries to commit publicly to providing
additional resources by 2012 to finance their own health initiatives.
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