[Congressional Record Volume 155, Number 31 (Monday, February 23, 2009)]
[Senate]
[Pages S2361-S2362]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           GLOBAL HEALTH CARE

  Mr. FEINGOLD. Madam President, we have seen a historic and 
unprecedented expansion in United States leadership in global health 
over the last decade and especially over the last few years. I applaud 
the previous administration's work in this regard, and I was proud last 
July when we came together across party lines to authorize $48 billion 
to combat HIV/AIDS, tuberculosis, and malaria. That was a courageous 
commitment to save millions of lives, and it is critical that the 
United States deliver on our promises.
  I am sympathetic to those who ask how we can maintain such a high 
level of investment in health abroad at a time when we are facing 
widespread economic troubles here at home. Throughout my career, I have 
worked to try to bring fiscal responsibility to the Federal budget, and 
I am very concerned about the massive deficits we are running. This is 
a time when we must have priorities, and our first priority must be 
protecting and meeting the basic needs of the American people.
  However, this does not mean that the global health challenges of our 
time should be left unaddressed; indeed they too demand our continued 
and consistent engagement. Just last month,

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our Intelligence Community released an assessment of the connections 
between health and our national interests abroad. They found that 
infectious diseases--whether HIV/AIDS or SARS--as well as general 
maternal and child mortality and the availability of healthcare can 
have significant impacts on the economies, governments, and militaries 
of key countries and regions. Moreover, their assessment found that 
U.S. global health assistance provides substantial opportunities to 
advance diplomacy, support stabilization in Iraq and Afghanistan, 
engage constructively with the rising powers of China and India, and 
ease tensions within the developing world. I urge my colleagues to look 
at this report if they have not already.
  I have seen firsthand--as I know many Americans have--the tremendous 
good will generated for the United States by our leadership in global 
health. This has been especially true in sub-Saharan Africa. Just last 
December, I traveled to Tanzania and visited a health center funded by 
U.S. assistance that treats pregnant women and malaria patients. Over 
recent years, as we have tried to reverse a growing trend of anti-
Americanism around the world, our health assistance has been a critical 
tool toward that goal. New levels of U.S. engagement in global health 
have spurred thousands of Americans to become involved in service 
abroad and build cross-border relationships that foster mutual 
understanding. I strongly believe the power of citizen diplomacy cannot 
be understated in an increasingly interconnected world.
  For these reasons and more, I believe it is essential that we 
continue to lead in global health. It should not be a question of 
whether we do so, but a question of how we do so in a time of limited 
resources. We need an approach that maximizes efficiency, demonstrates 
real results, and fully leverages our programs toward our broader 
foreign policy objectives. American taxpayers should be confident that 
they are getting the most for their money. That is why I believe that, 
more than ever, we must develop a global health strategy that is all 
inclusive, integrated and sustainable.
  Let me explain what I mean when I say those three things: all-
inclusive, integrated and sustainable. First, all-inclusive. We all 
know that the current U.S. approach to global health has been focused 
on one disease, HIV. This is understandable, especially with tens of 
millions of people still affected and more being infected every day. 
Our efforts in this area must continue. However, a failure to 
simultaneously address other common infectious diseases can limit our 
progress toward combating the AIDS pandemic, as well as promoting 
overall health. This is especially the case with malaria, which 
continues to kill over a million people each year despite the fact that 
we have simple, affordable tools to prevent and treat it. I plan to 
work with my colleagues in Congress and the Obama administration to 
continue and build upon the efforts of President Bush's Malaria 
Initiative. At the same time, we cannot forget there is much work to be 
done to address tuberculosis and neglected tropical diseases, and we 
must not give up on the goal of eradicating polio. Our efforts in each 
of these areas should be brought together under a comprehensive vision 
that also incorporates the preventable and treatable illnesses that 
kill millions of men, women, and children each year. In fact, 
developing a plan to address the basic challenges to child and maternal 
health should be the foundation of our global health work, not a 
secondary initiative.
  By ``all inclusive,'' I am also talking about the means by which we 
seek to pursue our overall global health objectives. Too often, 
restrictions or requirements on U.S. health assistance have limited our 
flexibility to effectively balance prevention and treatment measures, 
or to pursue evidence-based approaches. This has especially been the 
case with regard to reproductive health and family planning 
initiatives, which I believe have an essential role to play if we are 
to stem the tide of HIV infections or reduce maternal mortality. To 
that end, I am pleased that President Obama recently overturned the 
Mexico City policy. I hope we can now move past the ideological 
divisions surrounding this policy as we develop and implement a truly 
comprehensive approach to advancing our global health objectives.
  It is not enough, though, to balance and bring all of our initiatives 
together under one umbrella; they must also be integrated. In many 
places, U.S. health programs remain fragmented on the ground and not 
well coordinated with each other. For example, we are funding some HIV/
AIDS clinics that do not provide testing for malaria or tuberculosis 
even though these diseases often co-exist. As another example, we 
support some programs to prevent mother-to-child transmission of HIV 
that are entirely disconnected from the provision of basic services in 
maternal and child health. This lack of integration is inefficient, 
places a great burden on patients, and can ultimately render our 
efforts ineffective. Just as it is important to have a comprehensive 
strategy, it is critical that its many parts are well coordinated. 
Greater integration can also ensure that our global health programs are 
working in support of, not against, building stronger health systems.
  This brings me to the third and what I believe is perhaps the most 
important point in developing a global health strategy: the need to 
place greater emphasis on sustainability. Perhaps the greatest 
challenge facing the global health community today is addressing the 
continuing weaknesses in health infrastructure around the world. I am 
concerned that our current programs have not done enough to address 
those infrastructure weaknesses, and in some cases may even be 
perpetuating them. We need to not only devote more resources and 
attention to strengthening indigenous health systems that can meet 
national and local needs, but we need to do so effectively by engaging 
with local communities and governments to understand where there are 
gaps and where the needs are greatest. Such a strategy includes help to 
recruit, train, and retain a new health workforce. Toward that goal, I 
was pleased to work with Senators Durbin and Coleman in the last 
Congress to introduce the Africa Health Care Capacity Act, and I hope 
to continue working on this issue in this new Congress. Until 
developing countries have the healthcare professionals and 
infrastructure they need, we will continue to fight an uphill battle 
for decades to come against HIV/AIDS and other global health 
challenges.
  The time is now to put in place an all-inclusive and robust strategy 
for global health. By doing so, we can help ensure that our leadership 
in global health is a good investment for the American taxpayer and 
that the world's sick and vulnerable can see the results so desperately 
needed. I look forward to working with the Obama administration and my 
colleagues on these issues this Congress.

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