Former U.S. Senate Majority Leader William H. Frist, M.D.

Chairman, Save the Children’s Survive to 5 campaign

House Foreign Affairs Subcommittee on Africa and Global Health

March 13, 2008

Chairman Payne, Ranking Member Smith, distinguished committee members:

Thank you for holding this hearing and for your invitation to share my perspectives on a pressing global health matter. This is my first participation in an official Congressional activity since retiring as Senate Majority Leader, and I can think of no more important issue to address upon returning to Capitol Hill than renewing American leadership in saving millions of children throughout the world.

Why here? Why now? The answer is simple and compelling: We can save up to 10 million young lives throughout the world each year through inexpensive, well known, readily available health interventions. Today 27,000 newborns and children under the age of five will die from preventable and treatable causes. More than 2,000 of those innocent lives will be lost during this hearing alone.

The United States, governments in the developing world and other donors have the means to save these children. We know what to do, and we know how to do it. But we need the political will to achieve that goal. And we need to work with partners throughout the globe, just as we are doing to end the scourge of HIV/AIDS.

I know none of us gathered here today believes nearly 10 million children under the age of five dying every year is an acceptable reality. Each of these children, with access to appropriate care, can become a productive citizen in his or her country, helping those nations advance in health, education and economic development.

I come before you today as chairman of Save the Children’s Survive to 5 campaign to give voice to these children. The goal of our campaign is as simple as its name: helping those 10 million children who die each year reach their fifth birthday. Statistics clearly show that if these young people reach that milestone, the odds of them blossoming into happy, healthy, productive citizens – the dream we envision for our own children – are greatly enhanced.

For more than a decade I have participated in medical mission trips to Africa, and my firsthand experiences have led me to believe in the power of using medicine as a currency for peace. I have seen war-torn villages calmed and reunited through the establishment of health clinics. I have seen medicine dissolve hatred as hope filled voids long occupied by despair. And I have seen leery citizens in distant lands develop trust in America as our nation’s compassion and generosity provide a helping hand to those in need.

This last point has convinced me that increased support for global child and newborn health is more than a compelling moral or humanitarian issue. It is a national security issue. Health diplomacy undermines the ideological support of terror by shining through hate-filled propaganda to show America’s true face.  Medicine is truly a force that overpowers division and hatred because people do not go to war with those who have just saved their child.  We should harness those truths to strengthen our image abroad and bolster our security for generations to come.

Last summer, for example, I traveled to Bangladesh with Save the Children to work side-by-side with doctors and community health workers. We spent the vast majority of our time working to improve the health of newborns and young children. In a small village outside Sylhet I distributed vitamin A supplements and polio vaccine to dozens of babies, including the child of a young woman named Tahmina. Through the work of Save the Children and the support of USAID, Tahmina received prenatal counseling and continuing education regarding proper newborn care following her son's birth. As a result of that assistance, her child's chances of surviving to the age of five – and the odds he will lead a long, healthy life – have increased dramatically.

When I met with the Bangladeshi Minister of Health in Dhaka last summer, he offered his country’s profound thanks for U.S. assistance in reducing child mortality. But average citizens – not just government officials – have taken note of America’s support for Bangladesh. Stories such Tahmina’s are a driving force behind a recent Pew Global Attitudes survey that shows Bangladeshis have one of the most favorable views of the U.S. in the entire Muslim world. This support is due largely to the assistance we have provided Bangladesh since its independence – a relatively modest investment that continues to pay huge dividends by cementing a link with this moderate Muslim nation and building a bond between its citizens and Americans.

As a doctor, former legislator and now private citizen, I view our efforts to save these 10 million young lives through many lenses. I would like to speak briefly from three of those perspectives: public health, public policy and public opinion.

Public Health

In the developing world, the first few years of life are the most treacherous. Two million children die each year on the day they are born. Another two million die during the first month of life. In sub-Saharan Africa, one in every six children will die before their fifth birthday. That is the grim reality we face.

In America, pregnancy is a time of joy. Parents decide the name of their child before he or she is even born. In many developing countries, however, that joy is mixed with fear of adverse outcomes. In some countries, parents do not even give their child a name for the first six weeks of life. Try to imagine not naming your newborn because you fear he or she will not survive even six weeks. You have the power to help calm those mothers’ fears and provide hope for their children’s future.

It is important that we take a few moments to examine what is taking these young lives. The largest portion of preventable deaths is due to pneumonia, diarrhea and a variety of newborn complications related to suboptimal pregnancy and delivery care. Malnutrition is an underlying condition contributing to more than one-third of these deaths. And defying common misperceptions, HIV/AIDS is associated with only three percent of under-five deaths globally while malaria accounts for only another eight percent.

The health interventions to save these children are simple, inexpensive, well known and readily available. Supplements such as vitamin A can – for mere pennies – reduce micronutrient deficiency. A basic antibiotic that costs only 30 cents can treat pneumonia. Oral rehydration therapy can help save the two million children who otherwise perish from dehydrating diarrhea each year. And together with other interventions like immunizations, skilled care at delivery and simple knit caps, we could save most newborn lives.

These live-saving solutions do not require expensive investment in state of the art hospital facilities. They rely instead upon a network of community-level health services, an area in which U.S. government-supported programs can play a critical role in training and supporting community health workers to treat sick children and in teaching parents how to protect the health of their babies.

In short, we know how to deliver these life-saving solutions. The challenge is to scale up our efforts in coordination with other donor nations and enlist the commitment of developing countries to ensure these proven, low-cost health interventions reach every village and each child in need.

Public Policy

As someone who served in Congress and wrestled with the broad range of policy and funding questions you face, I know these global health issues seem daunting. But Americans are a generous and compassionate people, a truth our nation has demonstrated time after time.

It is a credit to Congress and this Administration that the U.S has made great efforts in recent years to tackle HIV/AIDS, malaria and tuberculosis. As Majority Leader, I – like many of you – devoted significant time and energy to making these initiatives a reality, and I appreciate this committee’s many contributions to combating these challenges. Yet as much as we have done, tough battles remain.

If a child in Haiti, for example, escapes infection from HIV thanks to PEPFAR relief but loses her life to pneumonia or diarrhea, should we be satisfied? Can we declare success? Even with the important work this committee has done to reauthorize PEPFAR, our assistance will not help most of the 10 million forgotten children we are discussing today. Saving those young lives requires additional leadership and investment through an integrated package of basic, cost-efficient health interventions addressing the leading causes of illness and death.

The good news, as I noted earlier, is that we know what needs to be done and how to do it. This challenge, as compared to many others facing Congress, is neither intensely complicated nor all that expensive.

The programs I have described during the course of this testimony work. UNICEF’s recent State of the World’s Children report makes clear that progress has been achieved: the global mortality rate for children under five was cut in half between 1960 and today. And countries need not be flush with cash in order to succeed. Bangladesh and Egypt, for example, have made great gains in recent years thanks to the commitment of their national leaders to make this a priority. Bangladesh reduced under-five child mortality from 149 deaths per thousand live births in 1990 to 73 in 2005. Egypt reduced its figure from 104 in 1990 to 33 in 2005. Even Nepal, a country torn by conflict, has succeeded in reducing child mortality from 145 in 1990 to 74 in 2005.

Nonetheless, reducing the rate by 50 percent over the past half century still means that almost 10 million children die each year of preventable causes. Clearly much work remains to be done. Ninety-four percent of the nearly 10 million children who die each year of preventable causes live in just 60 developing countries, and we need to mount a targeted effort that focuses resources on these high priority countries.

The U.S. Commitment to Global Child Survival Act (H.R. 2266/S. 1418), introduced by Representatives Betty McCollum and Chris Shays in the House and Senators Chris Dodd and Gordon Smith in the Senate, will help advance this cause. This bipartisan legislation, cosponsored by more than 80 House members and more than 20 senators, renews U.S. leadership for child and newborn health programs in developing countries while ensuring greater coordination and accountability in the delivery of these services.

But why should the House Foreign Affairs Committee and Congress take up this issue now?

When children die needlessly, we have a moral and humanitarian imperative to act. For Republicans and Democrats alike, that imperative has long stood as a principle guiding America’s role in the world. It is an impulse that springs from our conscience and represents our highest ideals. Our nation has always adopted the common cause of those in need, and at a time when we have the tools and the knowledge to save millions of young lives each year, we should do so with greater urgency and commitment.

But American leadership on child survival does more than convey our humanitarian values. Scaling up our child survival programs and leading other nations to follow suit also serves our national security interest. The investment in saving young lives protects our security by ameliorating conditions that breed extremism and enhancing our standing in the world. When we know basic health care can help bring stability and serve as a currency for peace, we cannot afford to stand pat.

The 9/11 Commission concluded, “[W]hen people lose hope, when societies break down, when countries fragment, the breeding grounds for terrorism are created.” Many countries with high child mortality rates are also fragile states, affected by (or recently emerging from) conflicts with the potential to spawn instability and threaten our security. These are precisely the countries where, from the perspective of our national security strategy, we need to engage in a proactive effort to stem extremism and shore up stability. Increased child survival programming can serve as an important component of such an effort.

Although a moral imperative and improved national security are sound reasons for greater U.S. leadership in child survival, responsibility to save these children does not rest with America alone. Other governments such as Norway have undertaken major initiatives to reduce child mortality. The Japanese government has also placed global health on this July’s G8 summit agenda, a forum providing a great opportunity for the United States, Japan and other G8 partners to pledge an all-out effort to accelerate the reduction of child mortality and boost international investment in these programs.

Public Opinion

I would like to close my opening remarks by speaking to you as a private citizen who has traveled throughout our great country and the world. Ours is a tremendous nation, one much admired overseas but often misunderstood. I strongly believe every U.S. effort – public or private, at home or abroad – to ensure each child has an opportunity to achieve his or her potential helps reduce that misunderstanding. And I am pleased to say I do not stand alone.

A survey last fall by the U.S. Coalition for Child Survival showed that 93 percent of all Americans believe saving the 27,000 children who die every day should be a government priority. Many have expressed themselves through organizations such as the ONE Campaign, a grassroots movement of more than 2.4 million Americans seeking to raise awareness of extreme poverty and global disease. ONE members have sent more than 200,000 letters to members of Congress urging support for H.R. 2266, the lifesaving legislation I discussed earlier, and I urge the committee to make this critical bill a priority this session.

Approving the U.S. Commitment to Global Child Survival Act and supporting the appropriation of the funds required to achieve its goals is the right thing to do for children at risk. It is the moral thing to do under America’s humanitarian ideals. And it is the smart thing to do for our nation’s long-term security interests. I look forward to working together to renew our nation’s leadership in the fight to save millions of young lives each year.