Global Health in Transition

Cheryl Benton
Deputy Assistant Secretary, Bureau of Public Affairs
Lois Quam, Executive Director, Global Health Initiative; Jennifer Kates, Vice President & Director for Global Health & HIV Policy, Kaiser Family Foundation; and Carolyn Miles, President & CEO, Save the Children
Washington, DC
July 13, 2012

MS. BENTON: Hi. I’m Cheryl Benton, Deputy Assistant Secretary in the Bureau of Public Affairs, and I’d like to welcome you to Conversations with America. Today, we’re here to discuss Global Health in Transition. We’ll touch on some of the pressing issues such as maternal and child health, HIV/AIDS, and the new course of global health.

Now let’s introduce our experts. They will be joining us for this discussion, and we’re very privileged to have with us Lois Quam, Executive Director for the Global Health Initiative; Jennifer Kates, Vice President and Director of HIV policy at the Kaiser Family Foundation, and Carolyn Miles, President and CEO at Save the Children. Thank you so much for participating in this program.

America is the world leader in global health. Our investments abroad help protect Americans here at home from infectious diseases and help create stronger, more secure nations. In an age of fiscal austerity, the U.S. Government is rethinking how best to fulfill our high goals in health with constrained spending. The U.S. Government and the State Department are fully committed to improving existing health programs and empowering countries to improve the overall health of their citizens through country ownership.

Lois Quam, as the Executive Director of the Global Health Initiative, is leading this effort. Could you please start us off by just talking a little bit about your role in this important initiative?

MS. QUAM: Thank you. As you said, I work on the President’s Global Health Initiative. And we operate in a changing world, so we need to change the ways we work to be able to meet these high goals. Why do we do this work in global health? We do it because it reflects American values. We save lives around the world, and we do that because we can. We protect Americans from the threat of infectious disease, and we build stronger states. So I’m really glad to be with you here today, Cheryl.

MS. BENTON: Perfect. Thank you so much, Lois. And Jennifer, in your work at the Foundation, tell us about what you do.

MS. KATES: Sure. And it’s great to be here. Thank you.

MS. BENTON: Oh, of course.

MS. KATES: So I’m with the Kaiser Family Foundation, as you said, and we’re a nonprofit, private operating foundation, and our mission is to focus on health issues that face the United States. A lot of that work is focused on domestic health issues, which we all know quite a bit about, but we also have a mission to focus on U.S. global health policies. So what does the U.S. do around the world, including on HIV? And I oversee that work. We do policy analysis, research. And we’re – our goal really is to be a nonpartisan source of facts and information for different stakeholders. So we sort of watch what’s happening and reflect on it.

MS. BENTON: Great. Thank you. Carolyn, and tell us a little bit about your work at Save the Children.

MS. MILES: Sure. Thanks, Cheryl. And I’m the CEO and president of Save the Children, and we’re an international and domestic organization. We actually work here in the United States and in 120 countries around the world, both developed countries and developing. And our mission is really to make sure that kids survive and thrive. That’s really what we do, and a lot of our work is around health, so a lot of our work is making sure kids get to their fifth birthday.

MS. BENTON: Oh, perfect. Well, I’m so looking forward to our discussion.

Lois, can you tell us what the Department’s focus is surrounding global health? If you want to laser in on it, what would you say is what you’re focused on?

MS. QUAM: Well, we have really high goals. We want to work with others around the world to build the first AIDS-free generation. Secretary Clinton has highlighted that effort. We build on the work of previous administrations in doing that work.

We also, as Carolyn said – and her organization has played such an important role in helping children reach their fifth birthday. Ending preventable child deaths is a key goal of this Administration. Way too many kids die who could live.

And finally saving mothers and investing in women. Every day, about a thousand women die giving birth. Almost all of those deaths are preventable, and we want to make a difference there.

MS. BENTON: High goals.

MS. QUAM: High goals, indeed. (Laughter.)

MS. BENTON: That’s right.

MS. QUAM: Yeah.

MS. BENTON: The Secretary believes mothers are at the heart of their families and central to societies.

(A clip of Secretary Clinton is played.)

SECRETARY CLINTON: And the key question comes down to if you really want to know how strong a country’s health system is, look at the well-being of its mothers. Because when a woman in labor experiences complications, it takes a strong system to keep her alive. It not only takes skilled doctors, midwives, and nurses. It takes reliable transportation, well-equipped clinics and hospitals that are open 24 hours a day. Where these elements are in place, more often than not, women will survive childbirth. When they aren’t, more often than not, they die or suffer life-changing traumatic injuries.

(Clip ends.)

MS. BENTON: To what extent is addressing maternal health linked to unlocking the potential of countries’ health systems? And I actually wanted to ask Jennifer if she could give us a bead in on that, and then Carolyn, if you could follow up with that.

MS. KATES: Sure. I actually think it goes back to what you were just saying. It’s about really investing in women and what happens when you invest in women. And that’s the first part, which is the idea – and the Secretary’s been a huge proponent of making this point – that if you invest in women you’re really investing in the country, you’re investing in that woman, her family, her community, and the ripple effects of that are pretty dramatic and can actually have benefits way beyond the community. So I think it’s from that perspective.

But also the interventions that we’re talking about, the very things that really are needed, many of them are low-cost and effective interventions that can save women’s lives, skilled birth attendants, et cetera. Those kinds of interventions build the systems as well, so they’re not always – they’re not one-off interventions; they really are part of building up the infrastructure needed to help have healthy communities.

MS. BENTON: Right. Something that we in America take for granted often.

MS. KATES: Definitely, definitely. I mean, obviously there are some communities that really suffer in America too, but not at the scale that we’re talking about, where there are so many preventable deaths among women, just basic things that are really just about the basic fabric of a health system that, if they’re in place, really could save – help save women’s lives.

MS. BENTON: Yes. And Carolyn, I assume you have a similar focus and perspective?

MS. MILES: We do. And to save a child, you really need to save moms as well. So a lot of our work is focused on mothers. And there’s a particular piece of the health system that we’ve been focusing on a lot, which is frontline health workers. Because if you look at the 7.5 million kids roughly that die of preventable disease every single year – that’s annually – those children are kind of at the end of the health system. So if you don’t have these skilled health workers that are available in their communities to actually deliver health interventions, these – that’s where kids and moms are both dying.

And so it’s things like pneumonia, diarrhea, totally treatable. And these are local women who don’t have hugely – their fourth of fifth grade education, but they can learn how to diagnose and treat these common killers of children. So it’s really important in the health system that you get it kind of all the way out to where lives are being lost.

MS. BENTON: And Lois, where does USG fit in it?

MS. QUAM: Well, we work in all these areas. We have a very important commitment around family planning so that families can decide when and how close together they want to have their children. And that makes a real difference for mothers.

We have a lot of important work to encourage young women to wait until they’re a bit older. When I was recently in Uganda, I was at a hospital and I asked about the last mother who died, and she was 14, just couldn’t give birth, way too young.

MS. BENTON: Yes. Yeah.

MS. QUAM: We also are working on that important 24 hours of labor and delivery. That’s when we lose about half of the mothers who die in pregnancy and about just under 50 percent of the infants. Because one of the things that happens, Cheryl, is that the healthcare delivery system has to work when a woman needs it. And if there isn’t a skilled person to help her when she gets to a facility, it doesn’t work.

MS. BENTON: It’s doesn’t work. Right.

MS. QUAM: Yeah. It doesn’t work. So we work across the whole spectrum to make sure that women can achieve their full potential.

MS. BENTON: Good. Hard stuff. So I wanted to ask you, Lois – and each of you please follow up – what are the key tactics for creating an AIDS-free generation? I know we’ve moved from moms and the birthing situation, but I think it’s all part of a continuum.

MS. QUAM: Yeah. It really is. It’s all about helping to make sure people can reach their full potential in life.


MS. QUAM: And part of it is about moms. Part of it is preventing people from getting AIDS of course. And we have big investments so that mothers who have – who are HIV positive don’t transmit HIV to their newborn babies.

MS. BENTON: Right, right.

MS. QUAM: We have another big investment in putting the best new research around HIV and AIDS into practice. We invest as the United States at the NIH and around our universities, and that research that shows how treatment can help people prevent the spread of AIDS, how circumcising adult men can help – voluntarily – can help treat – prevent the spread of AIDS. So it’s about putting that research into practice. And as the United States, you can feel so proud of the role your country has played in stemming this epidemic and in treating millions of people and stepping in boldly on an emergency basis to make a difference.

MS. BENTON: Very interesting. Very good. I’m curious how – what – how do you see creating an AIDS-free generation from the perspective of your organization?

MS. MILES: Yeah. Well, I think what’s important for children is actually that prevention early, so we do a lot of youth prevention work with girls and boys – how do you prevent AIDS, how do you – what are the transmission pathways, how do people actually – there’s a huge gap still on the education side. So a big piece of it is still educating young people about how AIDS is transmitted and how you can avoid getting AIDS.

We also work a lot on the transmission from mother to child. So if you’re going to have a generation that’s absolutely free of AIDS, you have to stop that transmission at every point that it’s going to occur. So that’s a lot of the work.

And unfortunately, right now, there are still a lot of kids that are living with HIV/AIDS, so we do a lot of work on the ground right now with – our strategy is very much about communities taking care of their own children. So we work with communities on how do they enable kids with HIV/AIDS or who are affected by HIV/AIDS to still go to school, for example, how do we make sure they still get an education, and really empowering those communities to take care of their own children. That’s a big part of what we do.

MS. BENTON: Right. Because unlike years ago, that’s not a death sentence, so you’ve got to figure out the ways to accommodate folks within society. I was curious, how does Kaiser fit into this whole paradigm?

MS. KATES: Actually, as you – as everyone was talking and you used the AIDS-free generation idea, Kaiser actually got into working on HIV and global health as one of our earliest areas that we took on when, in the late 80s or like 1990, deciding to look at HIV in the United States. And that kind of eventually progressed to looking at HIV outside and global health, so it’s a really core area of ours.

And if you had told me just maybe two or three years ago that we would be talking about an AIDS-free generation, as someone who’s been working in this field for a long time, I don't think everyone was there yet. And so, I mean, we’re really at a pivot point. And what’s – there’s – the big international conference is coming, which hopefully we’ll get a chance to talk about. But we’re at such a different point than we were because we have so much more evidence that the things that we know work, combined with new information around not just the power of treatment for keeping people alive, but the power of treatment for preventing infection, the O52 study. That I think is what prompted the Secretary to be able to say, if we put this all together, we can get there. So it’s a very unique time for HIV.

And to bring it full circle back to the mothers and – it’s about reaching kids and giving them the information they need to keep themselves uninfected, preventing babies from becoming infected, but also treating moms. Because if moms can live longer too, that’s going to keep the next generation healthier. So, I mean, it all does come together. But it’s really – it’s just a very exciting time in HIV right now.

MS. BENTON: Oh, yeah. It sounds like it. I’m going to put a pin on that AIDS conference for a minute, and I’m sure we’ll get to that. But I’m curious, how does one ensure that countries are able to sustain their global health programs? We’re in an era of constrained everything, particularly dollars, so how are countries able or expected to sustain their health programs?

MS. QUAM: Well, it relates a little bit to the discussion on saving mothers and the AIDS-free generation, because we’ve played an immense role in coming in and providing resources and providing technical assistance. But we can’t ever substitute for the local governments, for the national governments and the work that they can do on behalf of their communities and citizens. We can be their partner.

So it’s important that we work with local partners so we understand how to be most effective, and it’s important that countries increase the level of responsibility they take for their healthcare, provide more funding to it. Because we have high goals, and to reach these goals, like an AIDS-free generation, the United States can’t do it alone. It’s going to take the Government of Botswana, the Government of Rwanda, all of our partner countries and other donors like the United Kingdom and Norway, who have stepped up so boldly.

MS. BENTON: Oh, good. Good, good. Tying into the country-led solutions, how does your organization work around it? Because civil society has to play a role, and I would expect that that comes into play with your organization.

MS. MILES: Absolutely. I think Save the Children’s whole ethos in terms of the way we work – and a lot of organizations like ours – really look at the community, again, as the real key. And I think Lois mentioned partnership. That is really the way in which we’re going to solve – whether it’s ending the preventable child deaths in our lifetime or whether it’s an AIDS-free generation, it really is about partnerships that bring together donor governments, local governments, nonprofit organizations like Save the Children, community leaders, and then the private sector, which is another, I think, important partner in all of this that can really add a lot to making sure that these are sustainable, things that are really sustained.

So I think to me, it’s about, as we’re doing now, getting everybody to understand what are the facts, what’s happening with children, what’s happening with HIV/AIDS, and then saying who can do what about those issues, and everybody getting together and saying I can do this part, you can do that part, we can do that part. But it has to be happening at the country level. If it doesn’t happen at the country level, we’re never going to get to the point where we have children not dying of preventable deaths or an AIDS-free generation. It’s just not going to happen. So it really is about identifying what each person can do and then making sure that the countries and the governments, all the way from kind of the national down to the local, are very involved in those, in those interventions and in those – and they’re the ones who are putting together what am I going to do in my country to stop my kids from dying.

MS. BENTON: Gosh. You’re our private sector entity at the table. What do you hope for the new course for global health?

MS. KATES: Well, actually, I’m an optimist, so reflecting on some of the things that you were saying earlier around the economic austerity and sort of where we are, and I remember thinking back to 2009. There was some new excitement around global health. There was some new energy. And I think that ran up against this recognition of the fiscal realities.

But in the last – I mean, I think this last year has been a very interesting one, and there’s some real new energetic moments that are happening that to me provide some real excitement, hope, things to look for.

I mean, I was thinking it connects to the country ownership in the transition. But the Child Survival Summit that’s coming up and the call to action that just happened – what was so interesting to me about the call to action on – which was just sponsored by the U.S. Government, is that the other co-sponsors were the Governments of Ethiopia and India. And it was really a statement about what does it mean to lead a response to problems in country. It has to have those countries with donors and others as partners. So that, to me, was a real, very important thing to see.

And then the conference itself, which is the AIDS conference coming back to the United States for the first time in 22 years, there will be 30,000 more people in the city in about a week.

MS. BENTON: Amazing.

MS. MILES: And just bringing all that energy and attention to dealing with this epidemic from so many different perspectives and 100 countries will be an amazing thing.

And so there is momentum. And hopefully, that can be picked up and we can start thinking about all these challenges but from a real proactive way.

MS. BENTON: Very good.

MS. QUAM: If I can jump in here, one of the things I’m so pleased about is we announced last week that for the first time ever, we’re going to have a Global Health Diplomacy Office at the State Department. And that put’s global health --

MS. BENTON: That’s huge.

MS. QUAM: -- at the heart of what we do here at the State Department, which is about taking the energy of the United States into this space. So our ambassadors and our diplomatic leadership at the State Department will now, in the future, with the support of this office, engage in global health diplomacy in a new way. That’s important for us to be successful in this changing world, where we’ve got constrained resources, but we need to bring more resources to this fight. Diplomacy is a key tool, and we’re going to organize for it in a powerful way.

MS. BENTON: Yeah, that’s great. I hadn’t known about that, but I think that is a demonstration of the way this Administration and leadership of Secretary Clinton has changed the way we do foreign policy. To place that high of emphasis and importance on this, it’s phenomenal.

MS. MILES: I mean, I think it also highlights – we were talking about the fiscal issues. And I think the fiscal issues are important and you do have to put resources behind these programs. But a lot of these solutions are not expensive. And I’ll give you an example which we use to save newborn lives all the time, which is something called kangaroo mother care, which is, you put babies onto a mom’s chest and you wrap them with a scarf, and it takes the place of an incubator. It doesn’t cost anything to do that. What it costs is political will to make sure that countries believe that they can actually save their babies in this way and training people how to do it.

But I think it’s that political will piece that’s really important in this initiative of kind of putting real emphasis at the country level to drive political will inside the countries as well as the diplomacy to do it amongst donor countries. That’s going to really make a difference, because the solutions are not the things that are really expensive to do. Again, you still need resources, but you need to get the resources behind mobilizing people to really do the work that has to be done at the end of that delivery.

MS. KATES: Right. You want to have sustainable response. I mean, that’s the only way to get the sustainability.

MS. BENTON: That’s great.

MS. QUAM: And you’re right about that. And it makes – I’ve seen the difference it makes when the U.S. Ambassador goes in and meets with a head of state and says we’re very concerned with the number of women who are bleeding to death in labor in your hospitals, we’re very concerned about the number of infants who don’t get any of the kind of care that they can get. And because it is about political will and to have that discussion, not just as a technical healthcare discussion. But as a discussion where we’re saying the United States, the Secretary of State, the President of the United States, is concerned about this and believes it’s important, that expresses our values in a powerful way. So for the first time ever, we’re going to have a Global Health Diplomacy Office at the State Department.

MS. BENTON: That’s pretty neat. I like that. I like that a lot. So I wanted to go to our questions, because we’ve gotten in a lot from – actually all around the world. Kermit in California writes: Are we making adequate progress on vaccines for disease epidemics in less developed countries? I know the Naval Medical Research Center has candidate vaccines for malaria and dengue fever in various trials. But how much would such vaccines improve life for adults and for children? And how would widespread vaccination in – if these trials are successful, be implemented? I want to ask Jennifer to jump in on that.

MS. KATES: Yeah. I think the question is both, a little bit about what’s in development, but really about – let’s say we get something tomorrow. What does that really mean in practice? And there are some really great, promising research into vaccines on the horizon, particularly for malaria. I mean, we’re on the cusp of getting a malaria vaccine. And I think everyone’s very excited about that, but of course just getting a solution is not the solution. It’s getting it to people who need it. And so – and we know from history that that’s where we often lose, right?

So I think there – that – there are, fortunately, organizations and efforts already in place that are trying to mobilize around building networks, building support, to get access in advance of new vaccines as well as for current vaccines. A Decade of Vaccines Collaboration, for example, that I know we’re somewhat connected to – you are as well too – that the Gates Foundation spearheaded is really – and (inaudible) is a big part of it – the access part, the access point, which is not just develop new vaccines that will save – and the malaria vaccine, for example, will be tremendous in changing many things. The dengue vaccine’s a little further. There are some candidates. But still, I mean, getting – they would always become an essential tool in the tool kit, but getting it to where it’s needed – if we can’t get a basic no-cost solution (inaudible). (Laughter.)

And so I mean, I think it’s – we have to – we can’t forget that part. And I think that this often – that’s where we fall down. But there are – there’s optimism and there’s organizations that are trying to make sure that that stays as high on the agenda as getting the products.

MS. QUAM: And go ahead --

MS. MILES: There’s also – actually, the number one killer of kids under the age of five is pneumonia. And there’s also work on a pneumonia vaccine as well, which again, I think it just reinforces Jennifer’s point. There’s lots of great research going on, but countries, again, really need to buy into those immunization campaigns and they need to be strongly supporting them.

I think this is another place where community health workers can help in terms of mobilizing communities, not always in administering the vaccines. Sometimes they could probably do that as well, but really in mobilizing, educating mothers, what is this vaccine about, what is it going to prevent in your child, why should it – why is it important that you take your child to this place where they’re going to be giving these vaccines next week.

MS. BENTON: You got to get the bus.

MS. MILES: You’ve got to get the (inaudible), and you’ve got to get the kids there. (Laughter.) I mean, so you have to get the kids there.

MS. BENTON: Good deal.

MS. QUAM: And it relates to our goals around protecting Americans. Measles – we’ve had a vaccine for a long time --

MS. BENTON: Yes. I was just thinking about that. Yeah.

MS. QUAM: -- is such a contagious disease. When we have epidemics in other parts of the world, somebody picks it up and flies into this country and then we get an epidemic here.

MS. BENTON: Right.

MS. QUAM: And in my hometown of Minneapolis, we had an epidemic earlier this year that came that way. So we’re all connected and doing the research and then getting it out there and then making sure people get it protects us all.

MS. BENTON: Yes. That’s very, very true. We have another question from Australia. Georg writes and he asks: Slowly, but surely, kids, teenage, young adults, obesity and type II diabetes becomes a global problem. Should we reassess our standards of health and treat obesity as a chronic disease? I want to go to you first because you’re working with children, and we really want to look at where that is happening right there.

MS. MILES: Yeah. So for us, this is actually a big issue. We actually – this is one of our major programs in the United States with poor rural families in the U.S. and the poorest kids are the ones most affected by obesity. So this is a big problem in the U.S. for poor children and poor families. And it’s about access to healthy food. It’s about education of what caloric intake looks like. It’s about access to physical activity, which a lot of these kids don’t have. There’s no more gym programs in schools in (inaudible).

MS. BENTON: Right. Absolutely, yeah.

MS. MILES: So there’s a huge issue in the United States. But what we’re also finding is now there’s this, what we’re calling, dual burden in a lot of countries. India’s probably the best example, where, as you get a growing middle class, you have still tremendous malnutrition and under-nutrition in a place like India. Millions of kids are dying from malnutrition. But you also have, at the same time, this growing middle class with a growing obesity rate.

So these countries have this dual burden of obesity and all the issues that come with obesity like Type 2 diabetes, and they have the issue of malnutrition at the same time. So it really is looking at nutrition. It’s looking at this issue of nutrition and saying how are we going to solve this issue of nutrition for children and families so that they’re all getting the right kinds of food, the right amounts of food, and the foods that they need to eat to stay healthy.

MS. BENTON: Very interesting. Do you have any research on that or any data that you’ve seen at the Kaiser Foundation?

MS. KATES: We haven’t looked too much at the – there’s actually not as much globally as there is in the U.S. but I think there – as Carolyn said – there’s growing recognition – not just of – I mean, sort of the problems that are more middle income country problems that are starting to affect the same countries that are still struggling with the disease of poverty.

And so I think there’s a bigger issue around how do we, as a global community, address noncommunicable diseases, how do we address other challenges that are more – that are affecting communities all around the world like obesity. So they’re global problems in a different kind of way and require some of the same approaches, but also they’ve been really challenging, I think, to take on.

MS. MILES: I read a stat the other day that was the – used to be that the number of malnourished children was much higher than the number – the percentage of obese. Now those are becoming equal.


MS. MILES: So you have as many people globally who are obese as are malnourished.

MS. BENTON: Oh my god, that’s devastating.

MS. MILES: So that’s a really telling statistic. And I think one of the challenges that comes up too is there’s already – donors are already starting to level off their, collectively, funding for global health issues, just in the current environment. And so if we’re trying to now take on big problems that we haven’t tackled in the U.S., it’s what’s the best way to do it? And for the U.S. perspective, I think – even though you could speak to it better than I – what – the U.S. brings a lot of technical expertise to that discussion, which I know the U.S. Government is involved in. So it’s how do we – how do you best leverage all of that to really impact this?

MS KATES: What we’ve learned here.

MS. BENTON: Yeah. Is that what you find, too?

MS. QUAM: Yeah. The Centers for Disease Control – CDC – does a tremendous amount of research in this area, and we need to do a lot of work. And it relates to how nutrition and healthcare work together, but I’m glad that the questioner asked this because it hasn’t been focused on enough. I hadn’t heard that. That’s quite a fact.

MS. BENTON: It’s stunning.

MS. MILES: It’s a stunning fact.

MS. QUAM: And if we look back on why do we do this work, it’s so that all people in the world can reach their full potential. All this is a risk and so we need to pay attention to it.

MS. BENTON: Right. Oh my god, we’re wading into some waters that just – you’re shocked when you hear the statistics and obesity versus malnutrition. That’s just stunning. But we have a question from Guyana. Reza C. : How can educational healthcare institutions get involved in the Global Health Initiative with USAID?

MS. QUAM: Well, the universities in this country provide so much of the energy for our work in global health, students, professors, the research that’s done, so there’s so many ways for universities to get involved, to participate in the implementation of programs that USAID does, to do the research that allows us to make the next step forward, and to do the kind of volunteer work, not only that supports the work that we do in global health, the work that the Peace Corps does, there’s a way for everybody to get involved.

MS. BENTON: I would think so. I would think so. You think (inaudible)?

MS. MILES: I think the whole idea of there’s a way for everybody to get involved is a real key here. And I think the American public also has to think about how they get involved, as well. So in addition to universities and institutions – I mean, organizations like mine are very much supported by the general American public, and so they need to look for who is it that’s working on these global health issues and how do I get involved.

MS. BENTON: Yeah, that’s very good. I seem to remember that there’s some legislation that maybe Representative Nita Lowey is introducing on global health, and from my understanding it’s going to go a long way if we can get the momentum, get it passed and signed, to addressing some of these very vexing issues.

MS. QUAM: Well, Representative Lowey and so many other members of Congress – Representative Granger, also in the House – have played such an important leadership role. This has been an area of bipartisan --

MS. BENTON: Yay! (Laughter.)

MS. QUAM: -- progress. We’ve been great stewards of the programs that President Bush started like PEPFAR --

MS. BENTON: Right. Exactly.

MS. QUAM: -- and we’re very fortunate to have a wonderful set of great Congressional leaders.

MS. BENTON: Yeah, that’s good. I think we can’t say highly enough how good PEPFAR has been and what its impact has been around the globe.

MS. QUAM: Yeah.

MS. BENTON: I think it’s been pretty amazing.

MS. QUAM: Yeah, it’s made a real difference. And we find that in the other – I was – earlier today, I was looking at USAID’s programs in malaria – the President’s Malaria Initiative – unbelievable results. So we have a lot be proud of. Americans can be proud of their country and now – but what we have to do is we can never rest on our laurels, and that’s why we’re setting up this Global Health Diplomacy Office to sort of push forward so that we can succeed in a changing world.

MS. BENTON: Yeah. Absolutely.

MS. KATES: And one of the things I wanted to add because Carolyn mentioned if briefly, is the American public and sort of how we’re actually talking to the public. One of the things we do at Kaiser is survey the American public. We think it’s really important. We do this on domestic health issues as well as global health: What does the public think? What do they know? Where do they place priorities? And we asked – and we just put – came out with one in May, so it’s very recent. We asked if the American public felt the U.S. Government should be involved in fighting global health problems around the world and many Americans say yes. And smaller groups say it should be a main priority – strong priority. But many Americans say it should be an important priority of the United States Government.

They get that global health’s an important thing for our country and for different institutions, private and public, to address. And most of them say it’s because it’s the right thing to do. They have other reasons too, but the self-interest reason doesn’t really – it’s not as important to at least what they say is, really it’s the right thing to do, is to help fix the problems that others have around the world.

MS. BENTON: Very good. Well, we’re coming to a part in the show that I really hate. We have to close now. But I wanted to have each of our guests share your final thoughts, and we’ll go around and do that and then we’ll bid adieu to our audience and to you. Lois, if you could start us off.

MS. QUAM: Well, we invest in global health because we save lives. And we bring the energy and ingenuity of the United States to that work. And we do it because we can. And when we do that, we also protect Americans from the spread of disease, and we build stronger nations who can be our partners. We’re committed to that work. We’re going to keep developing and changing how we engage in that work so we can be effective. And I look forward to a future program on global health diplomacy at the State Department --

MS. BENTON: Yes, yes. (Laughter.)

MS. QUAM: Yeah.

MS. BENTON: Now are you going to be involved in the AIDS conference that’s coming up?

MS. QUAM: I am looking – yeah. I’m looking forward to that. That is going to be big, and Jen has been playing a huge role there.

MS. BENTON: Right. So Jen, will you give us your final thoughts and make sure you tell us about the AIDS conference?

MS. KATES: Sure, sure. So I’m going to stick with my optimistic theme. I am optimistic, and I think that there’s a lot that we can all look to and say that there’s a lot of movement. There’s a lot of things that are happening, there’s always a lot of challenges. So it’s what can we can we really grasp on to?

We talked about the work that the U.S. Government and other – and Ethiopia and India were involved with – the call to action and soon will be a follow-up summit on child survival. There was just a family planning summit in London, the AIDS conference in a week, I mean, so these are all – yeah, they’re meetings, they’re summits, but they all mark a way to come together with difference sectors and really focus on some of our key challenges.

And so I look forward to especially the AIDS conference. And just to say a word about that, again, it’s the 19th International AIDS Conference, first one back in the U.S. after 22 years because of the lifting of the entry ban – entry immigration ban against HIV-positive people. So it’s a big deal. The U.S. helped start the conference, so it’s a big milestone, and I just think it’s a really critical time to bring governments and the private sector and communities affected by HIV together to talk about – the theme is Turning the Tide Together. So it’s how do we turn the tide together?

But then beyond that, I think figuring out how to harness all of what they things that we talked about and really get to a new place with tackling some of these problems. And we’re on the cusp in a lot of ways.

MS. BENTON: Good deal. Carolyn?

MS. MILES: Yeah, I would just echo the theme of optimism and a new day and all of those things. I mean, I do think it’s important for the U.S. to remain a leader in this area of global health. I mean, the United States has been the leader in the world in pushing global health, and I think we have to remain a leader. It’s a different kind of leadership that’s not maybe exactly the same kind as before because it’s really now about this idea of partnership, but I do think it’s really important that the U.S. continues to lead.

And I think for us at Save the Children, we’ve been working on this issue of child survival forever. So to have people really all get excited about it is just, for us, such a wonderful thing because it’s the thing that we’ve really been working on for so many years. And to see the energy that people can bring and to actually say we can end preventable child deaths in our lifetime, I mean that’s a huge thing.

MS. BENTON: That’s huge.

MS. MILES: And it means 7.5 million children every single year won’t die of preventable deaths. So that is just – that’s big.

MS. BENTON: Well, I feel comforted by the fact that I’ve sat here with three wonderful women leaders and we have had a great conversation and it’s nice to know that women with this – of this quality are leading these efforts. So I want to thank Lois Quam, Jennifer Kates, and Carolyn Miles for sharing your work and your knowledge with us. I’d also like to thank each of you for joining us today. We hope that Conversations with America will continue to inform citizens about the Administration’s effort to address the challenges of the 21st century. We look forward to engaging with you again soon. Thank you.