18 December 2008
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Within the first year of his administration, the committee recommends that the President create a White House Interagency Committee on Global Health to lead, plan, prioritize, and coordinate the budgeting for major U.S. government global health programs and activities. The Interagency Committee--consisting of heads of major U.S. departments and agencies involved in global health activities--should play the crucial role of ensuring that the U.S. government has a coherent strategy for ongoing investments in global health, and also that health is taken into account when setting U.S. foreign policy in other areas, such as trade, environment, and security.
The committee also calls on the President to designate a senior official at the White House (Executive Office of the President, potentially within the National Security Council) at the level of Deputy Assistant to the President for Global Health to chair the Interagency Committee. The Deputy for Global Health should serve as the primary advisor at the White House on global health, attend National Security Council meetings which deal in any way with global health issues, and work with the National Security Advisor, the Director of Management and Budget, and the President's Science Advisor in carrying out his or her responsibilities.
The committee also asks that by the end of the administration's first term, the President and Congress double annual U.S.
commitments to global health between 2008 ($7.5 billion) and 2012 ($15 billion). The committee recommends that the U.S. government commit to $13 billion for the health-related Millennium Development Goals (MDGs) and an additional $2 billion to address the challenges of noncommunicable diseases and injuries.
Meeting the globally recognized MDGs, adopted by the Member States of the United Nations in 2000, would require advanced economies to devote 0.54 percent of their gross national income (GNI) to overseas development assistance. Accordingly, the committee estimates that the U.S. contribution to the health-related MDGs (Goal 4: Reduce child mortality, Goal 5: Improve maternal health, and Goal 6: Combat HIV/AIDS, malaria and other diseases) would be $13 billion per year by 2012.
The allocation of this $13 billion per year should be balanced across the portfolio of global health spending to reflect the breadth of the health-related MDGs. The U.S. government should fulfill its implied commitments under the President's Emergency Plan for AIDS Relief (PEPFAR) reauthorization to global AIDS programs ($7.8 billion per year), malaria ($1 billion per year), and tuberculosis ($800 million per year). The remaining $3.4 billion per year would double current levels of spending by the U.S. government for global programs in support of health system strengthening, child 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.
Additional resources will be required to respond to the contemporary challenges of chronic and noncommunicable diseases and injuries, which are responsible 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 strategies, such as tobacco control, have the promise of averting millions of premature deaths from noncommunicable diseases in lowand middleincome countries. The committee recommends $2 billion per year to expand the U.S. portfolio in support of these efforts, bringing the overall U.S. government commitment to global health to $15 billion by 2012.
Translating this commitment into sustained, significant, and measurable health outcomes in low- and middle-income countries requires a partnership between the United States and national governments; aid must therefore be allocated in support of technically and financially sound country-led health plans. Even disease- and intervention-specific programs should contribute to stronger health systems and a better trained, more productive health workforce. Congress and the administration should require that aid be accompanied by rigorous countryand program-level evaluations to measure the impact of global health investments in order to maximize their effectiveness. America's traditional strength in the global health field is its capacity to generate knowledge. The committee recommends that Congress continue to fund research in important areas--such as new interventions for the prevention and treatment of infectious diseases--but also allocate a portion of the funding levels recommended in this report to increase funds for three purposes: to study the basic mechanisms of diseases that disproportionately affect poor countries; to identify means to control noncommunicable diseases that are applicable in lowresource settings; and to conduct health systems research to improve the delivery of existing interventions.
While the U.S. government interacts with multiple UN agencies and other intergovernmental bodies, the committee believes that the United States has much to gain from supporting the World Health Organization (WHO) as this body has the unique mandate of setting evidence-based norms on technical and policy matters to improve global health. Many aspects of the WHO's current structure and function, though, hinder its effectiveness. The United States, along with the international community, should support the WHO, but also request a rigorous external review of the organization to develop future-oriented recommendations.
The American public has strongly supported commitments to global health in the past. Repeated polls have shown that health now ranks among Americans' top priorities for development assistance-- not merely to protect U.S. interests, but also as a way of promoting human development worldwide. Working with partners around the world and building on previous commitments, 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.
Committee on t he U.S. Commitment to Global Health
Thomas R. Pickering (Co-Chair), Vice Chairman, Hills & Company, International Consultants, Washington, DC; formerly, Under-Secretary of State for Political Affairs (retired)
Harold E. Varmus (Co-Chair), President and Chief Executive Officer, Memorial Sloan-Kettering Cancer Center, New York
Nancy Kassebaum Baker, Former U.S. Senator, Burdick, KS
Paulo Buss, President, Funda‡ o Oswaldo Cruz, Rio De Janeiro, Brazil
Haile T. Debas, Executive Director; Chancellor and Dean Emeritus, Global Health Sciences; University of California, San Francisco
Mohamed T. El-Ashry, Senior Fellow, United Nations Foundation, Washington, Dc
Maria Freire, President The Albert and Mary Lasker Foundation, New York
Helene D. Gayle, President and Chief Executive Officer, Care, Atlanta, GA
Margaret A. Hamburg, Senior Scientist, Nuclear Threat Initiative, Washington, DC
J. Bryan Hehir, Parker Gilbert Montgomery Professor of the Practice of Religion and Public Life, Hauser Center for Nonprofit Organizations, Kennedy School, Harvard University, Boston, MA
Prabhat Jha, Canada Research Chair in Health and Development, Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Canada
Roderick K. King, IOM Anniversary Fellow; Instructor of Medicine, Department of Global Health and Social Medicine, Harvard Medical School; Senior Faculty, Massachusetts General Hospital Disparities Solutions Center, Boston, MA
Jeffrey P. Koplan, Vice President, Academic Health Affairs, Emory University, Atlanta, GA
Ruth Levine, Vice President for Programs and Operations, Senior Fellow, Center for Global Development, Washington, DC Afaf I. Meleis, Professor of Nursing and Sociology, Margaret Bond Simon Dean of Nursing, School of Nursing, University of Pennsylvania, Philadelphia
Nelson Sewankambo, Dean, Faculty of Medicine, Makerere University, Kampala, Uganda
Bennett Shapiro, Chairman, DNDI-North America;partner, Puretech Ventures, New York; Formerly, Executive Vice-president, Merck Research Laboratories (Retired)
Marc Van Ameringen, Executive Director, Global Alliance for Improved Nutrition, Geneva, Switzerland
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