[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 1373 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. RES. 1373
Honoring the life of Dr. Paul Farmer by recognizing the duty of the
Federal Government to adopt a 21st-century global health solidarity
strategy and take actions to address past and ongoing harms that
undermine the health and well-being of people around the world.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 20, 2022
Ms. Schakowsky (for herself, Ms. Lee of California, Mr. Ruiz, Mr.
Doggett, Ms. Jackson Lee, Ms. Jayapal, Mr. Khanna, Mr. Lawson of
Florida, Mr. Levin of Michigan, Mrs. Carolyn B. Maloney of New York,
Ms. McCollum, Mr. McGovern, Mr. Moulton, Ms. Norton, Ms. Porter, Ms.
Pressley, Mr. Soto, Ms. Tlaib, Mrs. Watson Coleman, Ms. Adams, and Mr.
Blumenauer) submitted the following resolution; which was referred to
the Committee on Foreign Affairs, and in addition to the Committee on
the Judiciary, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
RESOLUTION
Honoring the life of Dr. Paul Farmer by recognizing the duty of the
Federal Government to adopt a 21st-century global health solidarity
strategy and take actions to address past and ongoing harms that
undermine the health and well-being of people around the world.
Whereas Dr. Paul Farmer, who pioneered novel community-based strategies for the
delivery of high-quality health care in impoverished settings, inspired
a paradigmatic shift in global health, including inspiring robust United
States leadership to address the global HIV/AIDS epidemic in the early
2000s via the United States President's Emergency Plan for AIDS Relief
(PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria;
Whereas in spite of this progress, weak health systems continue to cause
millions of people, primarily the global poor, to die tragic and
unnecessary deaths, including--
(1) annually, approximately--
G (A) 680,000 deaths from HIV/AIDS;
G (B) 1,500,000 deaths from tuberculosis;
G (C) 627,000 deaths from malaria;
G (D) 295,000 deaths of mothers during and following pregnancy and
childbirth;
G (E) 9,560,000 deaths among children under the age of 15; and
G (F) 560,000 deaths of children and young adults living among the
world's poorest billion people from noncommunicable diseases and injuries;
and
(2) a COVID-19 case-fatality rate up to 300 percent greater in low-
income countries than in high-income countries during the first two years
of the SARS-CoV-2 pandemic;
Whereas although progress against unnecessary deaths in impoverished countries
is being made, it is occurring so slowly that--
(1) based on present rates of decline, it will take approximately a
century for core mortality statistics in low-income countries to converge
with those of high-income countries, including--
G (A) 92 years for the tuberculosis death rate;
G (B) 109 years for the maternal mortality rate; and
G (C) 88 years for the under-15 child mortality rate; and
(2) the death rate in low- and middle-income countries from
noncommunicable diseases and injuries, which make up 40 to 60 percent of
the disease burden of these countries, will never converge with that of
high-income countries with present rates of reduction;
Whereas weak health systems that fail to prevent unnecessary deaths also lack
the staff, health facility infrastructure, and medical technologies
required for effective care delivery and thereby disease containment,
thus placing all countries at increased risk of pandemic disease;
Whereas essential medical technologies such as diagnostics, treatments, and
vaccines for diseases that affect the global poor are frequently
unavailable or inaccessible to health systems in developing countries
because--
(1) investing in research and development for technologies for diseases
that disproportionately affect the global poor is often unprofitable for
pharmaceutical corporations;
(2) high intellectual property licensing fees from originator companies
to generic manufacturers price the global poor out of access to medical
technologies; and
(3) originator technology companies refuse to share or license
intellectual property to generic manufacturers, which results in limited
supply and high prices, as in the case of COVID-19 vaccines;
Whereas the Lancet Commission on Investing in Health estimates the additional
annual spending required to prevent the vast majority of the millions of
unnecessary deaths and confer ``essential universal health coverage'' in
low- and lower-middle-income countries is $75,000,000,000 and
$293,000,000,000 (in 2016 United States dollars), respectively,
representing just--
(1) 1.6 percent of the United States gross domestic product (GDP) in
2021;
(2) 0.5 percent of G20 GDP in 2021; and
(3) 2.8 percent of the wealth possessed by the world's billionaires in
2021;
Whereas regular annual United States appropriations for global health have
increased by merely 10.6 percent to $11,300,000,000 since 2010, and have
been outpaced by both inflation and the United States economic growth;
Whereas relative to the size of the United States economy, the United States
official overseas development spending is low at 0.17 percent of gross
national income (GNI) in 2020, placing the United States 24th out of the
29 country members of the Organization for Economic Co-operation and
Development's Development Assistance Committee, and meeting just one-
fourth of the United Nations official development assistance target of
0.7 percent GNI;
Whereas dramatically increasing foreign aid may have voter support, given that
opinion polls consistently find that Americans believe United States
foreign aid should make up approximately 10 percent of the Federal
budget;
Whereas historically, United States and other global North-supported global
health programs have inadvertently entrenched standards of care in low-
income countries that would be unacceptable in rich countries by funding
only health services narrowly defined as ``sustainable'', ``cost-
effective'', or ``appropriate'' in poor settings;
Whereas the effectiveness and efficiency of current United States overseas
development assistance for health is often undermined by--
(1) misalignment with countries' national health plans;
(2) bypassing delivery systems with parallel inputs, leading to
fragmentation of care delivery, poor donor coordination across partners,
and weak health systems;
(3) favoring technical assistance from consultants from high-income
countries, especially the United States, over funding health service
delivery in beneficiary countries; and
(4) promoting privatization of health services, thereby undermining
public system strengthening, health care access, health equity, and
financial risk protection;
Whereas 98 percent of the annual $1,500,000,000,000 in health spending in aid-
eligible low- and middle-income countries is mobilized domestically by
these countries themselves, and only 2 percent of this spending comes
from overseas development assistance for health;
Whereas many of the poorest developing countries presently lack the tax capacity
to mobilize the necessary resources to close the universal health
coverage financing gap, meaning unnecessary deaths will continue in
these settings for the foreseeable future without external donor
financing or dramatic increases in domestic tax capacity;
Whereas the inability of many of the poorest developing countries to fully close
the financing gap for universal health coverage and the provision of
numerous other public goods and services is in part due to the intimate
economic links between these countries and high-income countries,
including the United States, which have been marked throughout history
by acts of violence and coercion, including, but not limited to--
(1) the fundamental injustice, cruelty, brutality, and inhumanity of
colonization and slavery;
(2) the overthrow of governments and backing of dictatorships in the
postcolonial era;
(3) the imposition of structural adjustment programs by international
financial institutions controlled by high-income countries, which forced
austerity, privatization, and liberalization on developing countries,
resulting in an estimated loss of $480,000,000,000 per year in potential
GDP during the 1980s and 1990s, nearly 5 times more than aid provided
during the same period;
(4) the loss of economic sovereignty imposed by fundamentally
undemocratic global governance institutions, such as the International
Monetary Fund, the World Bank, and the World Trade Organization, at which
decisions that shape the unequal terms of the global economic system and
determine countries' abilities to finance health systems are made;
(5) capital flight from developing countries consisting of mostly
illegal financial flows, estimated by Global Financial Integrity to total
approximately $1,700,000,000,000 each year, including--
G (A) $700,000,000,000 from deliberate trade misinvoicing; and
G (B) $261,000,000,000 from hot money narrow outflows; and
(6) external debt repayments, often undemocratically and unjustly
imposed, commonly sold by corrupt lenders, regularly accumulated by
dictators without a democratic mandate, and exacerbated by compound
interest as a result of United States interest rate increases;
Whereas the harms have entrenched a global economic architecture of upward
wealth redistribution that has resulted in--
(1) depressed workers' wages and artificially low prices of natural
resources in developing countries to serve consumption in rich countries,
amounting to an appropriation of tens of billions of tons of raw materials
and hundreds of billions of hours of human labor, estimated to value over
$10,000,000,000,000 in losses through unequal exchange annually;
(2) 3,500,000,000 people living under the poverty line of $5.50, which
according to the World Bank is a poverty headcount that has ``barely
changed in the last 30 years'', even as global GDP has more than tripled in
size during this time;
(3) more financial resources flowing out of developing countries than
into them each year, estimated by Global Financial Integrity to total net
negative $2,000,000,000,000 annually in 2012, meaning poorer countries are
developing richer countries rather than the other way around; and
(4) developing countries bearing 98 percent of deaths and 80 to 90
percent of economic losses attributable to climate change, despite rich
countries bearing 92 percent of the responsibility for climate change due
to carbon emissions in excess of safe planetary boundaries, meaning those
who suffer the most from climate change are least responsible for the
crisis;
Whereas the United States leadership to close the financing gaps for essential
universal health coverage in low- and lower-middle-income countries
could precipitate increased global health financing from other donor
partners as evidenced by United States leadership to address the HIV/
AIDS epidemic in the early 2000s, spurring a 100-percent increase in
global overseas development assistance among all donor partners from
2000 to 2006;
Whereas official United States development assistance to low- and lower-middle-
income countries are not a supplement for United States action to stop
ongoing structural violence and economic injustices preventing countries
from financing and delivering universal health care and other social
services for their populations; and
Whereas it is the view of the House of Representatives that creating a decent,
humane world without tragic, unnecessary deaths requires both a modest
but meaningful increase in global health aid funding and a meaningful
effort to stop the economic abuse of low- and middle-income countries:
Now, therefore, be it
Resolved, That it is the sense of the House of Representatives
that--
(1) the Federal Government should adopt a new, 21st-century
global health solidarity strategy to end medically avertable
deaths and respond to the full burden of disease in poor
countries by--
(A) supporting developing countries to meet the
material needs of their health systems by localizing
investments in support of national public sector and
local priorities, referred to as ``accompaniment'' by
Dr. Paul Farmer and delivered through what he called
the ``Five S's'', which include--
(i) staff, the human resources necessary
for high-quality service delivery, including
clinical staff, transportation teams, and
community health workers, especially by--
(I) supporting long-term training
and education systems, including
medical schools and teaching hospitals
to train the health workforce and
improve the quality of care across
diseases; and
(II) supporting professionalized
community health workers programs
whereby community health workers are
recruited, adequately compensated,
comprehensively trained, supported for
long-term retention, positioned as
bridges to care, and tasked with
undertaking community work with
appropriate patient ratios and a
manageable scope of work;
(ii) space, the infrastructure needed for
service delivery at primary, secondary, and
tertiary levels to deliver safe and high-
quality care to meet all health care needs;
(iii) stuff, the tools and resources
necessary for high-quality care provision,
including medical supplies, technologies, and
equipment;
(iv) systems, the leadership and
governance, health information systems, supply
chain systems, logistics, laboratory capacity,
and referral pathways required to meet the
health needs of the population; and
(v) social support, the necessary resources
needed, beyond the direct delivery of health
care, to ensure effective care; and
(B) financing the discovery and development of
urgently needed new health technologies such as
diagnostics, treatments, and vaccines, particularly for
neglected diseases of poverty, and ensuring their
availability as global public goods;
(2) the objectives described in paragraph (1) will
require--
(A) increased United States investment in
development assistance over the coming years,
sufficient to--
(i) for the first time, meet the United
Nations development assistance target of
spending the equivalent of 0.7 percent gross
national income on development assistance,
which 6 other countries have previously met;
and
(ii) close over 100 percent of the
previously described essential universal health
coverage financing gap for low-income
countries, and 30 percent of the overall
financing gap for low- and lower-middle-income
countries, by dedicating $125,000,000,000 per
year for global health investment;
(B) optimizing global health delivery spending by--
(i) introducing a new form of coordinated
multilateral fiscal cooperation for global
public investment that ensures increased and
ongoing global public funding of common goods
for health, exhibiting shared governance with
global South governments and meaningful
participation of civil society, which is also
essential for addressing intersectional crises
of social inequalities including the climate
crisis;
(ii) ensuring funding directly supports
national health plans, public institutions,
local priorities, and donor coordination,
practices aligned with what Dr. Paul Farmer
called ``accompaniment''; and
(iii) focusing on health service delivery
for vulnerable populations, such as people
living in poverty, women, and children; and
(C) optimizing research and development spending
for neglected diseases of poverty by ensuring the
knowledge and technology produced by these efforts
remains accessible to all as global public goods;
(3) the Federal Government should pass and enforce laws and
use its diplomatic influence to stop ongoing economic harms to
the global South that deplete impoverished countries of the
resources required to provide health and social services for
their populations by--
(A) canceling debt for all low- and middle-income
countries in need of debt cancellation, and supporting
debt cancellation initiatives across all creditors:
bilateral, multilateral, and private;
(B) democratizing institutions of global
governance, such as the International Monetary Fund,
the World Bank, and the World Trade Organization, to
ensure fair and equal representation among member
countries so that low- and middle-income countries can
have greater decision-making power in the creation of
policies that affect them;
(C) supporting a United Nations Convention on Tax
and other measures to dramatically reduce tax
avoidance, tax evasion, and other forms of harmful
licit and illicit financial flows from developing
countries through fundamental reform of international
tax cooperation;
(D) supporting global labor rights and living
wages, such as a global minimum wage set at local
living-income thresholds; and
(E) adopting new indicators of progress that
measure social and ecological health and abandon gross
domestic product as a measure of progress; and
(4) it is the duty of the Federal Government to issue
reparations, containing multiple elements including apology,
award, and guarantees of nonrepetition of harms, for--
(A) the institution of slavery, its subsequent
racial and economic discrimination against African
Americans, and the impact of these forces on living
African Americans, following the establishment of a
commission as per the ``Commission and Develop to Study
Reparation Proposals for African Americans Act'' (H.R.
40 of the 117th Congress);
(B) the harms of colonialism and subsequent forms
of imperialism, which have undermined sovereignty,
democracy, self-determination, social and economic
rights, and human and ecological well-being in both the
colonial and postcolonial eras; and
(C) its disproportionate responsibility for climate
breakdown, the burden of which unjustly and
overwhelmingly falls on the global South.
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