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Diplomacy in Action

22. Health


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Significant progress was made during FY '01 toward protecting human health and reducing the global burden of disease, particularly the spread of infectious diseases.  The global fight against HIV/AIDS, tuberculosis, malaria, other infectious diseases, and emerging health threats continued as more countries followed the U.S. example and placed international health issues at the forefront of foreign policy efforts.  U.S. objectives and interests in establishing a healthier world community were advanced through diplomatic initiatives and undertakings.

Although advancements were made in international health, formidable challenges nonetheless remain.  Collectively, HIV/AIDS, tuberculosis, and malaria continue to account for one-fourth of all premature deaths worldwide.  The impact of HIV/AIDS, in particular, continued to grow: 40 million persons were living with HIV/AIDS at the end of 2001, including 2.7 million children under the age of 15.  Although fewer than in 2000, 5 million adults and children were newly infected with HIV in 2001; 3 million died of AIDS during that year.  Tuberculosis accounted for nearly 2 million deaths during the year, and malaria killed more than 1 million—mostly children in Africa.

A growing recognition of the extent and impact of infectious diseases, particularly HIV/AIDS, tuberculosis, and malaria, prompted calls for a new, global public-private partnership to strengthen cooperation, increase coordination, respect standards of protecting intellectual property, and provide greater investments aimed at these three deadly diseases, with an overarching goal of improving health globally.  In response, and to complement ongoing bilateral and multilateral initiatives, the Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) was established in recordbreaking speed during 2001, largely due to U.S. leadership.

The Global Fund will attract, manage, and disburse additional resources to heavily affected countries with the least resources to address these diseases, as well as to at-risk countries.  At the end of 2001, more than 30 governments, corporations, foundations, nonprofit organizations, and private individuals had pledged over $1.7 billion to the Fund.  In May 2001, President Bush was the first leader to pledge a Government contribution to the Fund, in the amount of $200 million. The Fund will make a sustainable and significant contribution to the reduction of infections, illness, and death.  Partnerships formed at the national and regional levels between governments, nongovernmental organizations, the private sector, foundations, and multilateral agencies will receive funding to enhance access to and integration of prevention, treatment, and care; boost training of health care professionals; and build community-based programs.

To further advance U.S. objectives and interests in establishing a healthier world community, during the year the Department created a new Office of International Health (OES/IHA) in the Bureau of Oceans and International Environmental and Scientific Affairs, headed by a new Deputy Assistant Secretary.  The new office, building on the efforts of the previous Office of Emerging Infectious Diseases (OES/EID), supports international health efforts to mobilize resources, galvanize national leaders toward more effective action, and garner public support for destigmatization and health investments.

In recognition of the importance of averting the HIV/AIDS pandemic in a large, strategic region such as Asia, in October 2001, the President announced an OES/IHA grant to the University of Washington to promote the establishment of a "network of networks" in disease alert and surveillance in Asia.  The network will enhance geographic coverage of communications about infectious diseases throughout Asia and will explore potential corporate partnerships in support of it.

Bilaterally, the United States continued to be the largest provider of direct assistance to developing countries in building the capability of public health systems and provided nearly half of all international HIV/AIDS funding.  Several agencies, including the U.S. Department of Health and Human Services (HHS), U.S. Agency for International Development (USAID), the U.S. Centers for Disease Control and Prevention (CDC), the U.S. National Institutes of Health (NIH), and the U.S. Department of Defense (DOD), support the international training of doctors, researchers, and health professionals, and provide technical assistance on establishing and maintaining health systems.

In June 2001, the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) provided a unique multilateral opportunity to boost the global fight against HIV/AIDS.  Represented at the UNGASS by Secretary of State Powell, the United States emerged in a strong leadership position on AIDS.  The UNGASS Declaration of Commitment emphasizes political leadership at the national level as the single most important factor in responding to the pandemic, and sets out a broad range of ambitious measures that nations must undertake to halt, and begin to reverse, the spread of HIV/AIDS. 

To further our efforts, throughout the course of the year, the Department also included health issues in key diplomatic venues such as the U.S.-European Union and the G-8 Summits, and actively participated in meetings of the UN, PAHO, WHO, APEC, ASEAN, SADC, and several others.  We have made a persuasive case to foreign leaders that the fight against infectious diseases, such as HIV/AIDS, is in their national interest, and that it supports security, stability, and the well-being of their citizens.  We have encouraged them to make commitments that seek to achieve their national health objectives, recognizing that the protection of intellectual property rights is consistent with this goal.  The role of U.S. diplomatic missions in these endeavors continued to be critical, and during the course of the year, two chiefs of mission conferences were held focused on HIV/AIDS—one in Zimbabwe and the other in Kenya.


No national or international campaign against infectious disease can succeed without the direct support of the general public.  A well-informed citizenry is the first line of defense against the spread of disease.  Citizens must know the steps they can take to lower their risk of getting infected or further spreading infection, and must understand how to dispel the fear and prejudices surrounding sickness, especially HIV/AIDS.  Throughout the course of the year, Department officials met and spoke with many individuals and groups concerned about global health issues, and heard new and compelling ideas on how the United States and the international community can advance nascent and well-established programs in global health.

The lasting need for strong public health interventions serves to confront HIV/AIDS and other debilitating diseases.  As the challenge grows in complexity and intensity, it is more evident than ever that diplomatic efforts are essential in assembling the resources, political support, and citizen recognition needed to make a tangible, sustainable impact.  The Department, as the lead U.S. foreign policy agency, is playing an increasingly important role in spurring action that is needs-based, forward-thinking, results-oriented, and grounded in best practices and sound science.


National Interest Global Issues Performance Goal # HE-01
Strategic Goal

Promote global health.

Outcome Desired

Reduced incidence of targeted diseases (includes both communicable, e.g., AIDS and polio, and noncommunicable, e.g., tobacco-related illnesses and malnutrition.)  Strengthened health care capabilities in targeted regions such as Africa, Asia/India, and the Caribbean.

Performance Goal
Protect the health of the American people and reduce the global burden of disease.

Performance Indicator

FY '99 Baseline

FY '00 Actual

FY '01 Target

FY '01 Actual

Disease incidence rates HIV/AIDS

HIV/AIDS: 5.4 million new infections worldwide.

HIV/AIDS: 5.3 million new infections.

Successful: decline in the number of new infections

Minimally effective: same number of new infections

Unsuccessful: increase in new infections

Globally, 5.0 million adults and children were newly infected in 2001 compared to 5.3 million new infections in 2000, representing a nearly 5.67 percent decline in the number of new infections in 2001 compared to 2000.

The greatest number of new infections in 2001 occurred in sub-Saharan Africa, with 3.4 million persons newly infected, although there was a nearly 10.5 percent decline in the number of new infections in the same region between 2000 and 2001.

Compared to 2000, new infections in 2001 rose by nearly 107.7 percent in East Asia and the Pacific, 2.5 percent in South and Southeast Asia, and declined by 13.3 percent in Latin America.  The level of new infections between 2000 and 2001 remained generally constant in North Africa and the Middle East, the Caribbean, Eastern Europe and central Asia, Western Europe, North America, and Australia and New Zealand.

Verification

Source:  UNAIDS AIDS Epidemic Update and CDC weekly reports

Storage:  Annual reports, WHO and CDC Web sites

Validation:  U.S. Government, United Nations, and other reliable indexes


Performance Indicator

FY '99 Baseline

FY '00 Actual

FY '01 Target

FY '01 Actual

Disease incidence rates for polio

Polio: 7,142 WHO-confirmed cases worldwide.

Approx. 2,000 projected polio cases

Successful:  drop in incidence; eradication

Minimally effective:  no change

Unsuccessful:  Increase in rates

Polio is 99 percent eradicated worldwide.  Globally, there were 521 confirmed cases of polio in 2001, representing an 82.5 percent reduction.

Intensive Global Polio Eradication Initiative continues, spearheaded by WHO,  to meet the goal of global polio-free certification by 2005.  Few remaining pockets of polio are found mainly in about 20 countries in Southeast Asia and Africa. 

In October 2000, China and the Western Pacific were certified as being polio free.

Verification

Source:  WHO, CDC

Storage:  Annual reports, data updates

Validation:  U.S. Government, United Nations, and other reliable indices

Performance Indicator

FY '99 Baseline

FY '00 Actual

FY '01 Target
FY '01 Actual

Number of partnerships

Level of international collaboration

Performance Indicator (cont'd)

Number of partnerships

Level of international collaboration (cont'd)

Raised global surveillance in international forums; development of TB research center in Baltics; increased international awareness of malaria and influenza vector control issues and WHO Rollback Malaria Program.

FY '99 Baseline

(cont'd)

More countries involved in developing alternative malaria and flu vector control methods.  Increased awareness of Rollback Malaria.

FY '00 Actual

(cont'd)

Successful: increased bilateral and multilateral collaboration on global surveillance and response efforts. Increased international support for TB research and programs, malaria and flu vector control strategies, and national malaria control efforts.

Unsuccessful:  lose support for efforts.

FY '01 Target

(cont'd)

  •          The level of bilateral and multilateral collaboration on global health surveillance and response efforts increased significantly during the year.
  •          At the end of 2001, negotiations had been concluded to establish the Global Fund To Fight AIDS, Tuberculosis, and Malaria; in April 2001, the UN Secretary-General had issued a call for the creation of the Global Fund.  At the end of the year, pledges to the Global Fund exceeded $1.7 billion; in May, the United States was the first Government to announce a pledge to the Global Fund, in the amount of $200 million.  The Global Fund embodies the principles of private-public partnerships between governments, the private sector, and nongovernmental organizations, including community-based groups

FY '01 Actual (cont'd)

  •       In June 2001, a Special Session of the UN General Assembly was convened on HIV/AIDS.  The session set in place a framework for national and international benchmark targets for prevention, care, support and treatment, and set a goal for financial commitments to the Global Fund.
  •       In April 2001, African leaders at the summit of the Organization of African Unity (OAU) committed their leadership to greater efforts to fight HIV/AIDS on the continent.  Leaders attending the G-8 Summit in July 2001 agreed to commit $1.3 billion to the Global Fund.
  •       In January 2001, the Stop TB Partnership's Global Drug Facility (GDF) became operational.  The aim of the GDF is to provide high-quality TB drugs for 10 million patients over 5 years, and to treat 45 million patients over 10 years.
  •       Partners in the GDF include governments, NGOs, foundations, and intergovernmental organizations.  In October 2001, Stop TB held its first Partners' Forum.
  •       In April 2001, Roll Back Malaria held its fourth Global Partners meeting to further achieve the global scale of action required for malaria control.  Roll Back Malaria reported progress between countries in further integrating separate, vertical malaria control operations, particularly in sub-Saharan Africa.

Verification

Source:  OES, U.S. Agency for International Development, HHS, UNAIDS, WHO

Storage:  Annual reports, Issue Briefs, Situation analyses, cables

Validation:  U.S. Government, United Nations, and other reliable indexes


Performance Indicator

FY '99 Baseline

FY '00 Actual

FY '01 Target
FY '01 Actual

Nations in targeted regions and donor partners appoint executive-level AIDS envoys to engage on HIV/AIDS issues at the head-of-state level

About 8

8

Successful:  20 appointed; 15 representing targeted countries

Minimally effective: 10 appointed; 7 representing targeted countries.

Unsuccessful:  none appointed

International cooperation and commitment is increasing at the executive level, although numbers of executive-level AIDS envoys may not be the most accurate way to measure this increase.  Many developing countries consider HIV/AIDS to be among their highest priorities, but they do not have sufficient capacity to dedicate a public servant solely to the issue. 

With this in mind, international commitments, led by the United States., have yielded the Global Fund To Fight AIDS, Tuberculosis, and Malaria to pursue an integrated and balanced approach covering prevention, treatment, and care and support in dealing with the three diseases. 

Along with the Fund, high-level bilateral and multilateral engagement led by the United States on HIV/AIDS did indeed increase in FY '01.  Among other country representatives, approximately 24 heads of state attended the United Nations General Assembly's Special Session on HIV/AIDS in late June 2001.  UNAIDS has appointed five international Ambassadors, four of which are from targeted countries.  These Ambassadors will have the authority to negotiate at the Ministerial level and higher.  Also, 28 countries and the European Commission took part in the Global Fund's Transitional Working Group, including 11 from targeted regions.

Verification

Source:  State, White House, U.S. Missions

Storage:  OES


Performance Indicator

FY '99 Baseline

FY '00 Actual

FY '01 Target

FY '01 Actual

Long-term trend in national health expenditures/

responsiveness (e.g., WHO index on system responsiveness, percentage of GDP spent on health) of countries in targeted regions

For WHO Country Health System Responsiveness Index: Baseline year for the number of countries in targeted regions.

From 1997 to 1998 (the years for which the most recent data is available), the number of countries in which total expenditure on health as a percentage of GDP increased was 95 (50.26%), while there was a decrease in 64 (33.86%) countries, and no change in 30 (15.87%) countries.

Successful: A net increase in the number of low-income countries demonstrates enhanced responsiveness.

Minimally effective: same levels

Unsuccessful: A net increase in number of countries shows a decline in responsiveness.

See FY '00.  The WHO index on system responsiveness has been discontinued, and we are currently researching an appropriate alternate indicator.

Verification

Source:  WHO Annual Health Report, Statistical Annex on Country Health System Responsiveness (Table 6 -now discontinued)

Storage:  Annual reports, WHO Web site         Validation:  U.S. Government, United Nations, and other reliable indexes


Performance Indicator

FY '99 Baseline

FY '00 Actual

FY '01 Target

FY '01 Actual

Number of HIPC countries committing to increase social and health spending

No data available

Ten countries receive HIPC debt relief, based on their commitments.

The majority of remaining countries eligible for HIPC receive debt relief.

In FY '01, 13 more countries received HIPC debt relief based upon their commitments.  Eleven of these countries are in Africa.

Fourteen countries are yet to be considered.  It is unlikely that these countries will receive HIPC relief until they demonstrate they can support sound economic policies.


Verification

Source:  World Bank, IMF, other development banks

Storage:  Maintained at World Bank, Department of State /EB, OMA

Validation:  U.S. Government, international financial institutes, and other reliable indexes


Countries

Africa, East Asia/India, Caribbean, Russia and the New Independent States, major industrial nations, and economically disadvantaged nations


Complementary U.S. Government Activities

(Non-Department of State)

Agencies of the U.S. Department of Health and Human Services:  Office of the Secretary; National Institutes of Health, Centers for Disease Control and Prevention, Food and Drug Administration, U.S. Agency for International Development; U.S. Department of Agriculture; Central Intelligence Agency; Department of Defense; White House; U.S. Department of Treasury, U.S. Trade Representative

Lead Agency

Department of State, U.S. Agency for International Development

Partners

State bureaus:  AF, EAP, EB, ECA, EUR, G, IIP, IO, NEA, OES, USUN, WHA, SA, INR, U.S. Missions overseas

Outside institutions:  World Bank, WHO (including UNAIDS, PAHO), nongovernmental organizations, private sector



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