Health and Sustainable Development: America's Role in a New Era of Partnership

Over the past several years, we have realized that the world is a much smaller place than we once thought it was. What affects one nation has a direct impact on others, whether or not they share borders.

We have seen the outbreak of BSE and Hoof and Mouth disease in Europe and the panic it caused for the beef market all over the world. Avian influenza in Hong Kong had a similar effect on poultry markets. And the devastation of HIV/AIDS in Africa is now recognized as not only a threat to the national security of affected countries, but even to our own here in the United States.

Health issues are at the forefront of every nation’s foreign policy now, and in the new era of bioterrorism, protecting health will remain at the top of the list for every country’s national agenda.

Over the past several months, the schedules the Secretary and I have been keeping show that this is the case. The Secretary and I have met with Health Ministers from Europe, Asia, Africa, and Latin America. Last March in London, I attended the meeting of the Health Security Action Group, made up of the Health Ministers of the Group of Seven Industrialized Nations, or G-7, plus Mexico, to discuss cooperation in bioterrorism preparedness.

Much of our discussion there centered around smallpox. We know that if there is a smallpox outbreak anywhere in the world, no country is safe. While we are planning for a large enough stockpile of vaccine to immunize every American, we cannot forget about our neighbors. We have to work with other nations on a policy and a plan that the world can follow, and, as Secretary Thompson indicated in his address to the World Health Assembly last month, we are prepared to assist in the event of an outbreak.

Also stressing the importance of global health, we have seen recent high-profile United Nations (U.N.) events that address health issues directly. The U.N. General Assembly Special Session on HIV/AIDS in June of 2001, was the first U.N. General Assembly event addressing a health issue, and Secretary Thompson led the U.S. Delegation, on which I was privileged to participate.

Secretary Thompson also led the U.S. Delegation last month to the U.N. General Assembly Special Session on Children, at which we emphasized our commitment to strengthening families and preserving human dignity at home and abroad.

And of course, as we assist in the efforts to rebuild Afghanistan, establishing a sound public health infrastructure is of the utmost importance in that country to create a society that can develop and thrive on its own.

The United States is not only a superpower in terms of economics, defense, and technology, we are a leader in global health, and President Bush, Secretary Thompson, and Secretary Powell are providing important leadership in this area.

Our health efforts around the world involve at least three federal agency partners -- the Department of Health and Human Services (HHS), the State Department, and the United States Agency for International Development (USAID).

While the State Department has always been involved in the foreign policy aspects of health, the age of HIV/AIDS and bioterrorism has given health a more prominent role in U.S. foreign policy.

This new importance on health can be seen in several ways. Most notably, Secretary Thompson and Secretary Powell co-chair the President’s Cabinet Task Force on HIV/AIDS. Also, at the State Department, Dr. Jack Chow has been appointed as the Deputy Assistant Secretary for International Health and Science with the pending rank of Ambassador to represent Secretary Powell on issues like HIV/AIDS.

Through USAID at the State Department, the U.S. is the largest bilateral donor for health around the world -- $13.8 billion from FY 1985 through FY 2000. In FY 2002, we are spending over $1.6 billion for health programs such as child survival, HIV/AIDS and other infectious diseases, and environmental health.

At HHS, Secretary Thompson is providing global health leadership. He serves as the head of the U.S. Delegation to the World Health Assembly each year. Just last month, the Secretary joined with his counterparts from around the world in Geneva at the Assembly to discuss such issues as bioterrorism preparedness, HIV/AIDS, polio eradication, access to medicine, quality of care and patient safety, aging, mental health, and prevention strategies such as infant and child nutrition, diet, and physical activity.

Secretary Thompson is also the U.S. Representative on the Board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. In early April of this year he led a Presidential Mission to four countries in Sub-Saharan Africa, and later in the month he convened a Caribbean Conference on HIV/AIDS in Georgetown, Guyana.

Some of the global initiatives we are working on right now at HHS are polio eradication, child micronutrient programs, the normal work of the Food and Drug Administration (FDA) in protecting/regulating imported foods, medical devices, and biological and other health-related products, and HIV/AIDS research, prevention, and care.

One of the things the Secretary has asked me to undertake at HHS is a management review of the HIV/AIDS programs throughout the Department. We want to make sure that the money we are spending is following the disease and that we are funding programs that work.

This is important as we begin to expand our efforts worldwide in an aggressive fight against HIV/AIDS. We want to make sure that the programs and policies we have here in the United States and are sharing with other countries work -- that they are showing measurable results in reducing infections and deaths.

It is estimated that 40 million people worldwide are living with HIV/AIDS, and over 22 million have already died of the disease. More than 70 percent of people living with AIDS (28.1 million) are in Sub-Saharan Africa, and more than 15 percent (6.1 million) live in South and Southeast Asia.

Africa, of course, is the most troubling. When 25-40 percent of the adult populations of entire nations are infected, the stability of those nations is in jeopardy. Again, it is a risk to our own national security.

HIV/AIDS in Africa is important to me particularly, as I am a board member of the Africa Development Foundation (ADF), which is a public corporation to foster economic growth on the continent of Africa. I was on the Board prior to joining the Federal government, and one of the things I began to stress when I joined was the importance that ADF must place on HIV/AIDS.

I am pleased to say that a significant portion of ADF’s resources go toward HIV/AIDS programs in Africa. The simple reason for this is that Africa will not survive unless drastic measures are taken to curb the epidemic of HIV/AIDS. The development and future of the continent is dependent on ending the spread of this deadly disease.

As many of you know, when you go into government service, you are asked usually to resign from the various boards and councils upon which you serve. However, rather than resigning from the ADF board, the Administration saw my presence there as an important tool in an effort to create a consistent policy across government and business in our efforts to assist African nations in fighting HIV/AIDS.

As we work to build strong families and communities that can support themselves, we have to stress the importance of public health and responsible behavior.

At the Department, the President’s budget for FY 2003 calls for $222 million for the National Institutes of Health (NIH) to conduct international AIDS research in more than 50 countries in Africa, Asia, Europe, Latin America, and the Caribbean.

The Centers for Disease Control and Prevention (CDC) will dedicate $144 million this year to promote prevention strategies and programs in 25 countries across the globe. This will include expanded efforts in Africa, Asia, and the Americas, under the HHS Global AIDS Program (GAP), with another $144 million in Fiscal Year 2003.

The programs in some of these countries will include AIDS treatment and care, with important technical assistance coming from the Health Resources and Services Administration (HRSA).

As we look at our efforts, it is important that we realize we do not have all the answers here in the United States. We need to look at the successes of other nations, and I want to discuss the one country in Africa where life expectancy has increased. That country is Uganda.

Uganda is a shining example of what can happen when people work together. Uganda has turned a major epidemic around and has inititated a national mobilization that has pushed the adult HIV prevalence rate down from around 14% in the early 1990s to 8% in 2000.

I have had the privilege of spending some time with Uganda’s First Lady, Janet Museveni, and she has a tremendous burden and heart for this issue -- and in particular for youth. She has brought all parts of the nation together to sit down and have very open and frank dialogue about HIV/AIDS. When you have entire communities, the national government, churches, and missions organizations coming together, change happens.

She has led conferences over the past 10 years reaching tens of thousands of children with a clear message that the safest sex is no sex. Her message and commitment to abstinence until marriage is clear, and it resonates with the youth in Uganda.

By stressing the imporance of family, sexual purity, and strong communities, Uganda is making a difference in the fight against HIV/AIDS.

Fostering economic growth and sustainable development and fighting HIV/AIDS in Africa go hand in hand. Indeed, one cannot happen without the other.

Later this Summer, heads of states and delegations from countries around the world will convene in Johannesburg for the World Summit on Sustainable Development. The Summit is the ten-year follow-up to the 1992 "Earth Summit" in Rio de Janeiro. This year’s Summit, however, will encompass a broader orientation than simply the environment.

"Sustainable Development" is based on three mutually-supporting pillars: Economic growth, social development, and environmental protection. Health, along with education, is one of the key components under the social pillar of sustainable development.

Health has emerged as a prominent priority for the Summit, not only within the U.S. Government, but at the level of the U.N. Secretary General and in the planning documents.

The vision of the United States for this summit is "Working Together to Build Prosperity." We must determine how we can work together with our international partners to implement activities, including health activities and programs, which contribute toward sustainable development around the world.

Our vision includes investing in basic health, increasing the percentage of people with access to safe drinking water, fighting the pandemic of HIV/AIDS, and reducing the incidence of tuberculosis and malaria dramatically.

The United States has been preparing for this summit for nearly two years with agencies and departments across the federal government and with a broad range of other countries and institutional partners.

Entire generations are dying in places like Africa, and we must work together to save the next generation by controlling infectious diseases such as HIV/AIDS, tuberculosis, and malaria, and by safeguarding child health and environmental health.

We have to do this by working with key partners across public and private sectors. We must invest in research, using evidence- and scientific- based approaches for policy and program development. We must invest in human resources and capacity for the provision of health and medical services, support the use of appropriate technologies, and exchange successful best practice models, such as the efforts in Uganda to curb HIV/AIDS.

The governments of developing countries also have a responsibility to devote more of their own national budgets to health, especially to preventing and treating HIV/AIDS.

One of the ways the United States is doing this already is through the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The Global Fund is a new initiative that has been conceived and brought into being over a record short time. Standing with U.N. Secretary General Kofi Annan in the Rose Garden just over a year ago, President Bush announced the world’s first national pledge in the amount of $200 million as an initial investment in the proposed fund.

In making his announcement, the President stressed the need for partnerships across borders and among both the public and private sectors; an integrated approach that emphasizes prevention as well as treatment and care; concentrating efforts on programs that work, based on proven best practices; a review of proposals by medical and public health experts to ensure effectiveness and technical soundness; and, respect for intellectual property rights, as an incentive for vital research and development.

Total pledges from countries and private partners to the Fund now amount to close to $2 billion, including an additional $300 million pledge by President Bush for a total U.S. commitment of $500 million, making the United States the largest single contributor.

Secretary Thompson serves as the U.S. Representative on the Fund’s Board, and the first awards from the Fund were announced at its second Board meeting this past April. Over 60 proposals totaling more than $616 million have been approved. And what is interesting is that three projects involve multi-national proposals, which reveals the spirit of partnership that we were hoping for within the Fund.

Of course, there is still a large number of issues to be worked out, including ensuring financial accountability among grantees, that projects are monitored and evaluated appropriately, and that intellectual property rights and other guidelines and obligations are respected.

But the Fund reflects some of the most important principles of global health in the new millennium -- investment and partnership across the public and private sectors. Perhaps some of you want to learn more about the Global Fund and explore ways that you can get involved personally or institutionally. I invite each of you to join us in trying to make a difference in creating a better world through the control of these three deadly diseases.

One of the lessons we have learned about global health in recent years is the important role of leaders outside the health sector in making the case for health. Individuals from all walks of life can help us address health problems through their own disciplines and institutions.

Investing in global health will bring a substantial return on investment in humanitarian, economic, and political terms -- the crux of sustainable development. We spend billions of dollars in foreign aid each year to fight diseases that could be prevented easily with the availability of clean water, inexpensive life-saving medications, a better diet, or simple behavior changes.

Our support for the important new Global Fund to Fight AIDS, Tuberculosis and Malaria is an example of such an investment, and as our world continues to become a much smaller place, the importance of investing in public health throughout the world will continue to grow.

Strong partnerships are an important cornerstone to successful and long-lasting change -- and sustainable development. We invite interested partners to join us and others in the individual efforts that will bring about such change, and a better world for this generation and generations to come.

These are the messages we will deliver to the rest of the world in Johannesburg later this summer, and my hope is that you will stand with us as we work with nations around the world to invest in sound, principled public health policy.

Thank you for allowing me to be with you this evening.