PHM-Exch> hillary-clinton-touts-global-health-initiative-as-key-foreign-policy tool

[Claudio Schuftan]

>From Vern Weitzel

http://www.politicsdaily.com/2010/08/17/hillary-clinton-touts-global-health-initiative-as-key-foreign-po/

   Hillary Clinton Touts Global Health Initiative as Key Foreign Policy Tool
 Sarah Wildman <http://www.politicsdaily.com/bloggers/sarah-wildman>
Foreign Policy Correspondent
  Posted:
 08/17/10
  "What exactly does maternal health or immunizations or the fight against
HIV and AIDS have to do with foreign policy?" Secretary of State Hillary
Rodham Clinton queried a packed
crowd<http://www.sais-jhu.edu/pressroom/press-releases/MA2010/clinton-live.htm>of
faculty and students at the Johns Hopkins School of Advance
International
Studies on Monday. "Well, my answer is 'everything.' "

With a careful nod to the Bush administration's major efforts in global
health – the President's Emergency Plan for AIDS Relief
(PEPFAR)<http://www.pepfar.gov/>and the President's
Malaria Initiative <http://www.fightingmalaria.gov/%20%20%E2%80%93> --
Clinton introduced what she called the "next chapter in America's work in
health care worldwide" and laid out the basic outline of the Global Health
Initiative (GHI) <http://www.pepfar.gov/ghi/index.htm>, a "new approach,
informed by new thinking and aimed at new goal: to save the greatest
possible number of lives, both by increasing our existing health programs
and building upon them to help countries develop their own capacity to
improve the health of their own people."

The GHI may be new, but it is not exactly news. Rolled out over the last few
months <http://www.usaid.gov/ghi/factsheet.html>, GHI will invest $63
billion over the next six years to help partner countries through integrated
health systems with a renewed focus on maternal and infant health. The
speech at SAIS was meant as a branding of sorts, a popularizing and
contextualizing of the massive project.

To do so, Clinton spent the better part of 90 minutes making the case for an
integrated, diplomatic approach to global health care policy and the impact
of international health on U.S. interests abroad. "From the very beginning
of my time as secretary of state," Clinton said during a Q&A session, "I've
talked about elevating diplomacy and development alongside defense -- the
three D's of 'smart power,' if you will."

Arguing that health is essential to bolstering fragile or failing states,
Clinton grounded the GHI in a larger nonpartisan context and the recent
history of U.S. global health policy.

"No nation in history has done more to improve global health. We have led
the way on some of the greatest health achievements in our time," she told
the audience, listing advancements ranging from eradicating smallpox in the
1960s and 1970s to addressing neglected tropical diseases, to preventing and
treating malaria.

Today, the secretary explained, "we provide nearly 60 percent -- *60 percent
* -- of the world's donor funding for HIV and AIDS. All told, 40 percent of
the total global funding for development assistance for health comes from
the United States. "

But she also made digs at her predecessors. "The United States was once at
the forefront of developing and delivering successful family planning
programs. But in recent years we have fallen behind. With the Global Health
Initiative, we are making up for lost time."

That was a nudge at the Mexico City
Policy<http://www.guardian.co.uk/commentisfree/2008/jul/21/usa.sexeducation>--
otherwise known as the global gag rule -- which forbade any U.S. funds
from going to a clinic or provider that mentioned abortion, a policy that
went above and beyond the Hyde Amendment, which assures no U.S. funds will
be used for abortions abroad. (By the summer of 2008, the policy had
undermined contraception distribution throughout the developing world.)

Clinton outlined a global-health-supports-security argument, a
global-health-as-compassionate-policy argument, and a
global-health-as-practical-solution argument.

"We're shifting focus from solving problems, one at a time, to serving
people, by considering more fully the circumstances of their lives and
ensuring they can get the care they need most over the course of their
lifetimes," Clinton explained, and then used an illustrative anecdote about
a theoretical rural village woman who can reach a clinic stocked with
anti-retroviral medication (to fight HIV) but cannot get antibiotics or
contraceptives -- nor can she give birth locally, should her birthing
process require intervention. Her children have been protected from malaria,
but they may die from dirty water. The moral of the story is one of
integrated services and of an assessment of needs on the ground.

"The list of diseases and deficiencies that threaten lives and livelihoods
across the world is nearly limitless," she said, "but our resources are not.
So therefore we must be strategic and make evidence-based decisions in
targeting the most dangerous threats."

Calling for integration, bundling of treatments and coordination, Clinton
decried the "vicissitudes of funding cycles and development trends." And,
perhaps to quell the concerns of
those<http://www.huffingtonpost.com/anand-reddi/truth-and-reconciliation_b_660586.html>who
fear the Global Health Initiative will negatively affect PEPFAR, she
used the latter as an example of why the GHI would be successful. "We are
raising our goal for prevention," she said. "We aim to prevent 12 million
new HIV infections. To do that we are embracing a more comprehensive
approach and expanding on what we know works. We are moving beyond ABC --
abstinence, be faithful, consistent and correct use of condoms," the phrase
is from the Bush era, "to an A to Z approach to prevention. . . . We know we
need to confront 2.7 million new infections every year. So in order to win
this war, we need better results in prevention. . . . So the immediate
impact for PEPFAR is clear. Its funding will increase, its impact will
increase, and its prevention strategies will be more comprehensive."

The twitter feed #saisevents was buzzing with commentators throughout and
after the event. Mostly positive, there were those, however, who feared
Clinton lost a chance for greater substance.

"After the secretary's speech, I have more questions than answers about the
Global Health Initiative," Jirair Ratevosian, deputy director of public
policy at amfAR, the Foundation for AIDS
Research<http://www.linkedin.com/companies/amfar-the-foundation-for-aids-research>,
tweeted (privately, not on behalf of amFAR) to Politics Daily after the
talk. "What are the tangible changes? Budget? Integration?" Agreed Nandini
Oomman, <http://www.cgdev.org/content/expert/detail/6727> director, HIV/AIDS
monitor at the Center for Global Development: "While it was encouraging to
hear about the US commitment to global health, the 'HOW' " -- as in how to
accomplish these goals -- "isn't being shared and it makes people wonder:
why?"

 Politics Daily <http://www.politicsdaily.com>
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