[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 204 Introduced in House (IH)]

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118th CONGRESS
  1st Session
H. RES. 204

  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

                             March 7, 2023

   Ms. Schakowsky (for herself, Ms. Lee of California, Mr. Ruiz, Mr. 
  Blumenauer, Mr. Carson, Mr. Cohen, Mr. Doggett, Mr. Espaillat, Mr. 
  Garcia of Illinois, Ms. Jackson Lee, Ms. Jayapal, Ms. McCollum, Mr. 
McGovern, Mr. Moulton, Ms. Norton, Ms. Porter, Ms. Pressley, Ms. Ross, 
Mr. Soto, Ms. Tlaib, Mr. Trone, and Mrs. Watson Coleman) 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
            (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 decisionmaking 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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