Rollout of the Smart Global Health Policy's Final Report

Jacob J. Lew
Deputy Secretary for Management and Resources 
Remarks at the Center for Strategic and International Studies
Washington, DC
March 18, 2010

It’s a pleasure to be here this afternoon among friends, colleagues, and partners to discuss an issue of critical importance to our nation and world: global health.

I’d like to thank Helene Gayle, both for that introduction and for her leadership. In her work at the CDC, the Gates Foundation, and CARE, and as the co-chair of this commission, she has played an integral role in shaping our nation’s approach to improving health here at home and around the world.

I also want to thank Admiral Fallon. After a highly distinguished military career, he has turned his sights on the national and global security threat posed by the world’s many inadequate health systems. The world is coming to realize what Admiral Fallon has long known: when people’s lives and livelihoods are at risk, their communities are insecure—and that insecurity can spread across borders and oceans and affect us all.

And I want to thank everyone who served on the CSIS Commission on Smart Global Health Policy. They represent a range of expertise and viewpoints—from friends and former colleagues Donna Shalala, Bob Rubin and Senator Frist, who recently returned from doing heroic work caring for the victims of the earthquake in Haiti, to John Hamre and his outstanding team here at CSIS -- Lisa Carty and Steve Morrison. As a group, these commissioners remind us that saving lives and preventing disease are shared goals that transcend political differences and draw on the deepest of American values. This report reflects their broad knowledge, experience, and dedication. It is full of innovative thinking and persuasive arguments for how our country can get better results from our work to improve health worldwide. And I join you in looking forward to seeing these ideas take root in policies and programs worldwide.

I also bring congratulations from the Secretary of State, who is in Moscow to represent the United States at a meeting with Russia, the EU, and the UN to make progress on resolving the Israeli-Palestinian conflict. She sends her thanks to all of you for the work you are doing to foster peace through health.

I’ll begin today by asking you to imagine two women who live not far from each other on the other side of the world.

Both have just given birth. Like most women worldwide, they did not deliver their babies in a hospital but at home with the help of family members and perhaps a midwife. And they both experienced a not uncommon consequence of childbirth—post-partum hemorrhage. The first woman lives in a village with a small health clinic that has a trained nurse and is stocked with oxytocin, an inexpensive drug that can stop the bleeding. The second woman does not. The first woman lives. The second woman dies. And her children lose their mother and provider.

It is clear how the absence of a simple intervention devastated this one woman’s family. What may be less clear is why her life and her family’s health matter to us. That’s what I’d like to discuss today—how the health of people on the other side of the planet affects the lives of people everywhere, including in the United States—and how, as a result, the Obama Administration is working to improve global health in a new way with a new commitment.

When people think of global health threats, they often think of pandemics—and it is true that diseases in one country can quickly spread to another, as we saw last year with the H1N1 virus, which swept the globe in a matter of weeks.

But the impact of poor health care goes beyond the spread of disease. Poor health prolongs poverty; when people are sick, injured, or underfed, their ability to work or attend school declines. Health crises foster political instability, as we have seen in countries ravaged by AIDS; when millions of adults disappear, states shut down or fall apart. Disease fuels famine; when farmers grow too sick to work, their crops die, and the widespread hunger that results can spark violence; there have been riots over food in more than 60 countries since 2007, because when people can’t feed themselves or their children, anger rises. And disease and under-nutrition sustain the social and economic divides that prevent billions of people from participating in the life of their communities, contributing to broader progress, and pursuing their own dreams and aspirations.

In other words, a health crisis is more than a health crisis. It is a political crisis, an economic crisis, a social crisis, and a security crisis. And in our interconnected world, crises that start in other countries rarely stay there.

But this is only half of the story. Just as poor health has a broad impact, promoting better health can have a broad impact. When health improves, economies grow, opportunities rise, trust in government increases, societies flourish, and life becomes more stable and secure.

Furthermore, as the story of the two women illustrates, life-saving interventions are often inexpensive and easy to administer. A dose of nevirapine costs less than five dollars, a shot of the measles vaccine costs less than a quarter, and a dose of oral rehydration therapy costs about a dime. Yet every year, more than 400,000 babies are infected with HIV, about 3 million children die from vaccine-preventable diseases, and 1.5 million children die from diarrheal disease.

For these reasons—the strong connection between health and broader progress, and the potential for investments in health to have a significant impact across many lives—the Obama Administration has made global health a central priority of U.S. foreign policy.

We are investing in health to save lives and alleviate needless human suffering. We are also doing it as a means of protecting our citizens, supporting our partners, and making headway across a range of issues. Improving global health accords with both our values and our interests. It is an urgent national and global need that we cannot underestimate or overlook.

Last May, President Obama announced the launch of the Global Health Initiative, a $63 billion commitment over six years to improve health outcomes, with a particular focus on improving the health of women, newborns and children.

This initiative continues a strong tradition of U.S. support for global health. The United States is the world’s leading contributor to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. We are the largest donor country to the GAVI Alliance. And we have had great success in fighting AIDS through PEPFAR. Since President Bush launched PEPFAR in 2003, it has delivered life-saving antiretroviral medicine to more than 2.4 million people, provided care to nearly 11 million, and prevented almost 350,000 cases of mother-to-child transmission of the virus. And now PEPFAR will be a cornerstone of the Global Health Initiative; our budget request for 2011 represents the largest commitment the United States has ever made toward fighting AIDS.

So with the Global Health Initiative, we’re building on years of experience and commitment—much of it done with the support of many here today. But this initiative is not simply a continuation of past practices. It represents a new business model—one that emphasizes integration and coordination across the health spectrum, rather than addressing single diseases in isolation; one that leverages our existing investments for broader impact; and one that is built upon the principle of partnership, so the countries we work with can, in time, provide care to their citizens without relying on us or other donor countries to fill critical gaps.

We are reaffirming our commitment to the core services that have saved countless lives and served as the hallmark of our global health efforts. The United States will continue to deliver drugs and vaccines and bed nets and birthing kits to people worldwide.

But we all know this model of aid cannot be sustained indefinitely. That’s why we are working to take our health programs to the next level by helping our partners expand and strengthen their health systems—for example, by establishing better supply chains, so local clinics have enough frontline drugs and basic supplies to serve their communities; and by building on existing clinics, so a woman gains access to HIV counseling, prenatal care, delivery care, and family planning, all at one location.

We also hope to help countries provide not only treatment for those who are sick but preventative care to protect people from getting sick in the first place. It is not self evident to place prevention as a top priority when the needs of the sick are so great. But that is when prevention is even more critical, to stop the spread of illness and lessen a given disease’s long-term impact. For example, for every two people we put on AIDS treatment today, five more are infected – and we continue to lose ground against this and other epidemics. In many places today, local health workers are too overwhelmed by patients with urgent needs to focus on prevention and wellness; by expanding their capacity, we hope to change that.

We are doing our work with an eye toward innovation. The United States has a strong tradition of funding, developing, and implementing health innovations, and that tradition must continue across the board—from the pursuit of new vaccines to the use of new diagnostic technologies to the development of innovative financing mechanisms.

We’re calling on our ambassadors to play a new coordinating role; as our chiefs of mission, they are the best-positioned to bring everyone together around one table and harmonize their efforts—not only in health but in our work on climate change and food security as well.

And we are embracing a new commitment to results, rather than measuring our success by how many programs we run or dollars we spend. We are investing in monitoring and evaluating our work, so we can track our progress and learn from both our mistakes and best practices.

There are a few specific health issues we are focusing on immediately, including nutrition, safe water, and neglected tropical diseases. But there is one area in particular I want to address, and that is maternal and child health.

Because of the central role they play in caring for others, the health of women is critical to the health of children, families, and communities. When mothers are sick, their children suffer—and when mothers die, their children are more likely to die. This has broad implications; in fact, one of the most constant predictors for political upheaval is the rate of infant mortality, because in places where infant mortality is high, the quality of life is often low.

Yet despite the importance of women’s and children’s health to larger progress, they are particularly vulnerable to poor health—in part because of entrenched attitudes about whether women and children, particularly girls, should receive care as a priority. As a result, childbirth continues to be one of the leading causes of death for women in low-income countries, and nearly 9 million children under the age of five die every year, most of them from preventable causes. This issue features prominently and persuasively in your report; it is a priority we share.

Some of the changes to U.S. policy I've discussed today are already underway; others will be implemented in the months ahead. All are addressed in this Commission’s important work we are here today to celebrate.

Together, they represent a new approach and new commitment to improving the health of people worldwide. This work won’t be finished in a year. But the United States is invested in it for the long-term. We are committed to see it through. And we are committed to tying our programmatic efforts with a renewed emphasis on global health diplomacy—to raise health issues not only in the context of development but also the democracy and security of nations and institutions worldwide.

The people in this room represent our country’s top talent in the field of global health. We are counting on each of you, and the organizations and institutions you represent, to help. Your experience and dedication could make the difference in our work worldwide. We need your ideas. We invite your critiques. And we ask for your support.

The road ahead is sure to be full of obstacles. There will be times that we try something new—and fail. We will grapple with tangled bureaucracies and struggle to maintain momentum. This will not be easy; indeed, it’s one of the most ambitious projects we’ve ever embarked upon.

But we must always remember the future we are working to achieve.

It’s a future where parents line up outside clinics on Vaccination Day—and there are always enough shots for every child. Where mothers receive competent and compassionate care as they bring new life into the world. Where pharmacies are fully stocked with the essentials, so no one has to die for want of a simple cure. And where people everywhere have the chance to live safe, healthy, and productive lives, no matter where they live or what their income.

This is the future we hope to achieve, and the foundation of stability, prosperity, and peace, for our country and for the world.

Thank you.