[Congressional Record Volume 169, Number 43 (Tuesday, March 7, 2023)]
[Senate]
[Pages S672-S673]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         SUBMITTED RESOLUTIONS

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     SENATE RESOLUTION 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

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

                               S. Res. 95

       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--
          (A) 680,000 deaths from HIV/AIDS;
          (B) 1,500,000 deaths from tuberculosis;
          (C) 627,000 deaths from malaria;
          (D) 295,000 deaths of mothers during and following 
     pregnancy and childbirth;
          (E) 9,560,000 deaths among children under the age of 15; 
     and
          (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--
          (A) 92 years for the tuberculosis death rate;
          (B) 109 years for the maternal mortality rate; and
          (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--
          (A) fragmentation of care delivery;
          (B) poor donor coordination across partners; and
          (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--
          (A) the public health system;
          (B) health care access;
          (C) health equity; and
          (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;
       (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

[[Page S673]]

     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 is it 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 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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