[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. Res. 95 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
S. RES. 95

  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 SENATE OF THE UNITED STATES

                             March 7, 2023

   Mr. Brown (for himself, Ms. Warren, and Mr. Markey) submitted the 
 following resolution; which was referred to the Committee on Foreign 
                               Relations

_______________________________________________________________________

                               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 through the United States President's Emergency Plan for AIDS 
        Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria;
Whereas, in spite of progress made in global health, 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 
poorest billion people in the world, from non-communicable diseases and 
injuries; and

    (2) a SARS-CoV-2 case-fatality rate of up to 300 percent greater in 
low-income countries than in high-income countries during the first 2 years 
of the COVID-19 pandemic;

Whereas progress against unnecessary deaths in impoverished countries is being 
        made, but progress is occurring so slowly that--

    (1) based on rates of decline from 2013 to 2022, 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 non-
communicable diseases and injuries, which make up 40 to 60 percent of the 
disease burden of those countries, will never converge with that of high-
income countries based on rates of reduction from 2013 to 2022;

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 disease containment, 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 of technologies for diseases 
that disproportionately affect the global poor is often unprofitable for 
pharmaceutical corporations;

    (2) costly intellectual property licensing fees from originator 
companies to generic manufacturers frequently leave the global poor unable 
to purchase or access medical technologies; and

    (3) originator technology companies often refuse to share or license 
intellectual property to generic manufacturers, which results in limited 
supply and high prices, as was the case with the COVID-19 vaccine;

Whereas, according to the Lancet Commission on Investing in Health, preventing 
        most avertable deaths and conferring ``essential universal health 
        coverage'' in low- and lower-middle income countries requires an 
        increase in annual health systems resources in those countries of 
        $75,000,000,000 and $293,000,000,000 (in United States dollars as of 
        2016), respectively;
Whereas, historically, the 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 the national health plans of the host country;

    (2) bypassing delivery systems with parallel inputs, leading to--

    G    (A) fragmentation of care delivery;

    G    (B) poor donor coordination across partners; and

    G    (C) 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, which weakens--

    G    (A) the public health system;

    G    (B) health care access;

    G    (C) health equity; and

    G    (D) 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 
        the countries themselves, and only 2 percent of this spending comes from 
        overseas development assistance for health;
Whereas many of the poorest developing countries lack the tax capacity to 
        mobilize the necessary resources to close the universal health coverage 
        financing gap, meaning unnecessary deaths will continue in the poorest 
        developing countries 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 those countries and high-income countries, 
        including the United States, which have been marked throughout history 
        by acts of violence and coercion;
Whereas these harms have entrenched a global economic architecture of upward 
        wealth redistribution that has resulted in--

    (1) depressed wages of workers and artificially low prices of natural 
resources in developing countries, amounting to an appropriation of tens of 
billions of tons of raw materials and hundreds of billions of hours of 
human labor through unequal exchange;

    (2) 3,500,000,000 people living under the poverty line of $5.50 from 
1993 to 2023, even as global gross domestic product has more than tripled 
in size during this time;

    (3) more financial resources flowing out of developing countries than 
into developing countries each year, estimated by Global Financial 
Integrity to total a net negative of $2,000,000,000,000 annually in 2012; 
and

    (4) developing countries bearing nearly all deaths and the vast 
majority of economic losses attributable to climate change, despite rich 
countries bearing 92 percent of the responsibility for climate change;

Whereas leadership from the United States 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 that addressed 
        the HIV/AIDS epidemic in the early 2000s, which spurred a 100-percent 
        increase in global overseas development assistance among all donor 
        partners from 2000 to 2006;
Whereas official United States development assistance to lower-middle income 
        countries is 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 Senate 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 Senate that--
            (1) the Federal Government should adopt a new, 21st century 
        global health solidarity strategy to end medically unnecessary 
        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 Dr. Paul 
                Farmer called the ``Five S's'', which refers to--
                            (i) staff, meaning 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 worker 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, meaning 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, meaning the tools and 
                        resources necessary for high-quality care 
                        provision, including medical supplies, 
                        technologies, and equipment;
                            (iv) systems, meaning 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, meaning the resources 
                        needed, beyond the direct delivery of health 
                        care, to ensure effective care; and
                    (B) financing the discovery and development of new, 
                urgently needed 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 of adopting a 21st century global health 
        solidarity strategy to end medically unnecessary deaths and 
        responding to the full burden of disease in poor countries will 
        require--
                    (A) increasing annual global health spending to 
                $125,000,000,000, sufficient--
                            (i) for the first time, to 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) to close over 100 percent of the 
                        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;
                    (B) optimizing global health delivery spending by--
                            (i) introducing a new form of coordinated, 
                        multilateral fiscal cooperation for global 
                        public investment that--
                                    (I) ensures increased and ongoing 
                                global public funding of common goods 
                                for health; and
                                    (II) exhibits 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; and
                            (ii) ensuring funding directly supports 
                        national health plans, public institutions, 
                        local priorities, and donor coordination, 
                        practices aligned with what Dr. Paul Farmer 
                        called ``accompaniment'';
                    (C) focusing on health service delivery for 
                vulnerable populations, such as--
                            (i) people living in poverty;
                            (ii) women; and
                            (iii) children; and
                    (D) 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 
        developing countries that deplete impoverished countries of the 
        resources required to provide health and social services for 
        their populations by--
                    (A) supporting debt cancellation initiatives for 
                low- and middle-income countries, particularly 
                countries in need of debt cancellation, across 
                bilateral, multilateral, and private creditors;
                    (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 non-repetition of harms, for--
                    (A) the institution of slavery, the subsequent 
                racial and economic discrimination against African 
                Americans that resulted from the institution of 
                slavery, and the impact of these forces on living 
                African Americans, following the establishment of a 
                commission substantively similar to the commission 
                established under the Commission to Study Reparation 
                Proposals for African Americans Act, H.R. 40, as 
                introduced on January 4, 2021;
                    (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 post-colonial eras; and
                    (C) the disproportionate responsibility of the 
                Federal Government for climate breakdown, the burden of 
                which unjustly and overwhelmingly falls on the global 
                South.
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