Opening Remarks at the Institute of Medicine's Public Meeting of the Committee on Transforming the Case for U.S. Commitment to Global Health

Your task to establish a strategic vision for U.S. investment in health is an important one. The Committee’s first report, “America’s Vital Interest in Health,” identified three key reasons why America would benefit from using foreign policy and national resources to promote health abroad: to protect our people, to enhance our economy, and to advance our international interests.

Importance of Global Health

These findings from 10 years ago remain just as relevant today. Recognizing this, the United States, under the Bush Administration, has led the global effort to promote health. A few key examples include:

The President’s Emergency Plan for AIDS Relief, known as PEPFAR, has provided over $18 billion to support international HIV/AIDS programs. The President has announced his intention to double the initial U.S. commitment, and Congress is currently considering his request.

In 2005, President Bush challenged the world to reduce dramatically the burden of malaria - a major killer of children in Sub-Saharan Africa. The U.S. has committed to spending $1.2 billion over five years to fund malaria prevention and treatment. In less than two years, over six million Africans have already benefited from this program.

Just last month, President Bush announced a $350 million initiative to combat neglected tropical diseases such as hookworm and river blindness.

Protecting our People

At any given moment, health events can unfold with the potential to affect not only the areas in which they originate, but also countries around the globe. A world of people and goods in constant motion means that, in terms of disease, nothing remains isolated for long. There has been West Nile Virus in Cairo and Colorado, drug-resistant tuberculosis in Azerbaijan and Atlanta, and poliovirus in Nigeria and New York City.

More specifically, we know the world will face another influenza pandemic. It may come from the current strain of highly pathogenic bird flu, or from another source. Depending on its severity, tens of thousands to millions of Americans could die during such a pandemic. In response to the risk the U.S., and all nations face, the President launched the International Partnership for Avian and Pandemic Influenza in 2005. This diplomatic partnership among countries is dedicated to protecting human and animal health and preparing for this threat.

Much of the nearly $629 million the U.S. has invested internationally for avian and pandemic influenza is strengthening basic health systems by increasing health worker skills, improving laboratory capacity, and educating populations in proper hygiene. This work enables nations to better handle avian flu - and many other diseases as well. Our investment also makes the U.S. better prepared to protect our own citizens. A more effective health system in Egypt, for example, will not only save Egyptian lives but will help to slow the spread of a pandemic, and save lives here at home.

Not all health threats are natural or unintentional. Over the past ten years, we have gained a heightened awareness of the potential for bioterrorism. We continue to utilize foreign policy resources to strengthen international biodefense and health security capabilities, in part, by increasing global cooperation on bioterrorism preparedness and response.

Enhancing the Economy

Investing in health also promotes economic growth. In the past ten years, evidence has accumulated that verifies what was intuitively obvious – that disease damages economies and slows national and international growth. Reduced global economic activity hurts American trade and exacerbates poverty. Rampant disease has undercut productivity in Sub-Saharan Africa. Treating HIV-related illnesses in South Africa alone is expected to cost over $500 million annually by the end of the decade. Similarly, malaria costs Africa an estimated 2 billion dollars in lost productivity each year.

During the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, twenty-nine countries were affected, 774 people were killed, and the outbreak cost an estimated $10-20 billion in lost economic activity in East Asia. Many U.S. companies discovered the hard way that their supply lines were affected by a disease outbreak half way around the globe.

Building on the lessons from SARS, we are reaching out to the private sector to encourage planning for continuity of operations in the event of a pandemic. We are also working with our partners in government to address contingencies for transportation, travel, trade, and agriculture – all to help minimize the economic fallout of a major outbreak.

Advancing our International Interests

Health promotion can also be an effective public diplomacy tool. Every mother and father cares about the health of his or her children. This universal concern can be the vehicle for interaction among adversaries– offering ways to bring people together to discuss critical issues of common interest and establish common goals. For example, diplomats from many nations have worked to create “days of tranquility” in conflict zones so that health workers can safely deliver polio vaccines to children. These efforts have not only improved the health of children, but have occasionally led to broader ceasefires and greater stability.

U.S. leadership in reducing the spread of infectious diseases, or lowering infant mortality, can shape a positive public opinion of the United States even in areas where the overall image of the U.S. is less than positive. We saw this dramatic effect in Indonesia after the 2004 Tsunami. A public opinion poll conducted after the high profile U.S. relief efforts found that opposition to U.S. anti-terrorism efforts had decreased from 72 percent to 36 percent. Similarly, support for the U.S. increased in Pakistan when suffering villagers saw that U.S. helicopters were the only vehicles delivering relief following the terrible earthquake there in 2006.

According to another recent poll by the Pew Research Center for People and the Press, eight of the top ten countries giving America the highest approval rating were African. This fact was not lost on commentators during the President’s recent trip to Africa, in which many speculated that the use of “soft power” diplomacy such as health promotion had helped boost the U.S. image.

National Interest and American Values

There is, finally, a moral imperative that is advanced through our health policies. The 2006 National Security Strategy issued by the White House captures this well when it states that:

“America’s national interests and moral values drive us in the same direction: to assist the world’s poor.

Secretary of State Condoleezza Rice noted similarly in a speech just this month that:

‘We lead the fight against disease for a more compelling reason and that’s because it’s the right thing to do and because as America we can. In the face of such cruel and needless suffering, we are blessed with power and plenty and we have a moral responsibility to act.”

It is crucial to note that our investments in health will not reap the additional benefits to national security without being also based on a moral imperative. If we choose to pursue global health only because it is in our strategic interest to do so, others will perceive our efforts not as generous, but rather as self-serving. I believe the American people support our health initiatives because they, too, recognize that it is the right thing to do. Moreover, I believe the global community recognizes and appreciates that our efforts are based on more than strategic interests – as important as those interests may be.

Conclusion

As the next Administration takes office, let us hope they build on the success of the last ten years, and heed the guidance of groups such as this Committee to strengthen further the U.S. commitment to global health.

Thank you for your dedication to this important cause.