This is an archived USAID document retained on this web site as a matter of public record.

Administrator J. Brian Atwood
National Council for International Health
Washington, D.C., June 12, 1997
U.S. Agency for International Development

I want to thank you for the opportunity to share my hopes and concerns with you at this important gathering. Over the next three days, you will hear about an array of issues relating to the state of global health and the role the United States can and should play in addressing them.

You will share valuable experiences and insights -- and participate in a two-way exchange that has the potential to benefit the people of the United States as much as those living in developing countries.

This is a time of great concern about international health issues. But it is also a time of opportunity if we work together. We can usher in a 21st century that is healthier, more peaceful and more prosperous than the century we are about to leave behind.

Let me give you some reasons to be optimistic:

--    Vitamin A research, supported consistently by USAID over the course of two decades, now provides humanity with a proven tool that can save a million children's lives a year at mere pennies a dose.

--    We have already eradicated polio from the Western Hemisphere. We can turn polio from a public menace into an obscure reference -- familiar only to trivia and history buffs.

--    We will eradicate guinea worm, which has been a huge drain on the productive capacity of many developing nations.

--    Perhaps we will find a cure for ebola or the AIDS virus if we continue to invest in research.

But you know that even these accomplishments are far from inevitable.

To secure advances of this scale, our nation must make sound, forward-looking public investments. Those who understand the challenges -- everyone in this room and your colleagues -- must convince the American public and decision makers that prevention is far cheaper than treatment once disease has struck.

I also want to encourage you to join in the effort to broaden support for sustainable development. The next time you hear someone question what Americans get out of foreign aid, point out USAID's role in eradicating polio throughout the world.

Tell them that, in addition to ending the suffering, crippling and lives lost to that terrible disease, Americans will save a lot of money. When polio is finally eradicated everywhere, the United States will save the $234 million a year which we currently spend to immunize our own children against polio.

These are not one-time savings -- they will continue forever, just as the savings on smallpox immunizations have continued since we eradicated that communicable disease in the 1970s.

The remarkable progress in spreading the benefits of health advances to the developing world has been possible because of the worldwide sharing of best practices, innovations and insights.

USAID also believes in sharing what we have learned abroad with communities in the United States which have similar problems, a philosophy I know NCIH has long embraced.

That philosophy is embodied in USAID's Lessons Without Borders program. Through it, Baltimore officials learned that 80 percent of Kenya's two-year-olds were immunized against childhood diseases, compared to 56 percent of Baltimore's.
Using methods city officials had observed in Kenya, Baltimore conducted a mass immunization program. Now, 96 percent of Baltimore's school-age children have documented immunizations.

Oral Rehydration Therapy (ORT) is another example of a health measure that can benefit Americans although it was designed to solve problems in developing countries. USAID supported the original research and development of ORT, which has saved millions of lives in developing countries. American pediatricians now recommend ORT's widespread use in this country to save millions of dollars and much needless hospitalization and suffering.

Global health problems cannot be solved by health research and programs alone, however. As Vice President Gore noted at NCIH last year, our world is interconnected in ways unimaginable just a short time ago.

An effective response to the challenges of improving the health of people around the world therefore demands U.S. action in areas not generally considered health related. Many of these issues will be discussed at the first session of this conference -- The U.S. Government's Role in Promoting Global Health -- coming up in a few minutes. Each of us brings something to the table:

--    The Centers for Disease Control and Prevention have special expertise in surveillance and outbreak response.

--    The National Institutes of Health have unique skills in researching diseases and therapies.

Both are essential to deal with diseases that could pose major threats to public health both at home and abroad. Yet, dramatic as the development of heart bypass, organ transplants and other medical miracles have been, it was not those high tech innovations that brought about the greatest increases in Americans' lifespans and health.

It was immunizations and basic health, together with clean water and public sanitation systems -- and the simple understanding of the importance of everybody, but especially doctors, washing their hands.

If something happened to disrupt America's water and sanitation systems, medical science could not keep up with the resulting havoc.

Clean water, sanitation and basic health are equally essential to conquering disease in developing countries. Ambulances and emergency rooms are the last steps, not the first, in dealing with health problems. You can't dial 911 to deal with root causes and prevention, or to affect early and cost-effective interventions.

Since 1961, developing countries have been able to call on our agency for help. USAID's unique role is to deal with the root causes of disease and prevent diseases from becoming imminent threats to the health of people around the world.

Many of you have experience with USAID's great strength -- our presence on the ground, working with host countries, other donors, and the private sector. This presence allows USAID to program health and population resources from a variety of places within a total development context. That strength, we believe, is critical to ensuring that host countries feel real ownership and are also able to sustain these activities within their own resources.

Development issues well beyond the realm of health systems, surveillance and response are fundamental to global health and to USAID's strategies in the developing world. They also play a crucial role in protecting the health of Americans.

When the Institute of Medicine expert committee released its seminal report on Emerging Infections in 1992, it did the world an immense service. The report highlighted a very important point: emerging infections are not driven by happenstance; they are precipitated by a clear set of underlying factors.

Among the key determinants cited in this report were two groups of factors I want to highlight: first, human demographics and behavior; and second, economic development and land use. These factors can feed broad social and political decay, systemic underdevelopment and foster emerging infections.

USAID programs that help prevent conflict, environmental degradation and rapid population increases directly tackle the root conditions that allow a society's health to deteriorate.

As the Institute of Medicine report pointed out, rapidly growing populations and increasing population density in today's "megacities" provide a fertile breeding ground for new and reemerging organisms.

That is one of the reasons why USAID's thirty-year commitment to voluntary family planning remains crucial both to development and to combatting major public health threats.

This year, as we observe the 10th anniversary of the Safe Motherhood Initiative, we are reminded that the health and survival of mothers is central to the well-being of children.

Where USAID has family planning programs, women bear an average of three children instead of six. Both mothers and children are healthier and survive longer where there are sufficient intervals between births.

Smaller families are better cared for, better educated, have better nutrition, are more productive economically, and are less vulnerable to everything from diarrheal diseases to dengue fever.

Within our broad commitment to reproductive health, family planning is an integral part of USAID efforts to assist in improving health for people around the world.

We cannot assure the health of children by focusing on childhood diseases alone. It is not enough even when we broaden the focus to other diseases which have a major impact on children, such as malaria and HIV/AIDS, important as they are.

Conflicts that produce massive and sudden migrations of entire populations, such as we have seen in Rwanda, also trigger epidemics.

Our programs dealing with democracy and governance and with economic growth provide an important bulwark against the failure of states and imploding of societies that have contributed so much to disease, malnutrition and death in the developing world.

The rapid changes underway in the global economy pose risks as well as opportunities never before faced. This is why our economic development programs are increasingly tied to our health concerns.

A dam that would allow expansion of irrigation and power generation might once have been seen only as good. It may not be a sound investment, however, if its creation changes the flow of a river and thereby spreads disease vectors such as snails that carry schistosomiasis.

Logging and rapid deforestation may provide a quick profit for the few. But the longer term cost could be catastrophic for the many who would come in contact with previously unknown organisms -- such as ebola or, prior to that, HIV.

We all know that microbes and disease are not stopped by national borders -- the hard-won lessons of experience should not be either. To be effective in combatting a new generation of diseases, our approaches and solutions must be transnational.

Global warming and climate change may introduce disease carrying vectors to new areas where millions may be at risk. Much of the discussion about climate change has centered on food supplies and the potential disappearance of beaches and low-lying cities like Miami and New York.

You in this room also understand that global warming could expand the territories of many deadly and disabling diseases now endemic only in tropical areas of developing countries. Diseases like malaria and yellow fever could become endemic in what are now the temperate zones of the United States and Europe.

You here today are uniquely qualified and positioned to make these relationships clear to the public and decision-makers.

USAID should not have to defend our programs in family planning, the environment, economic growth and democracy against people concerned solely about child survival and infectious disease. Cutting funds for other development programs on which child survival and infectious disease control also depend makes little sense.

I recognize that those of you in this audience have a particular commitment to health and to health systems. We share that commitment. We will continue our longstanding efforts to strengthen these systems, and to build local capacity and the commitment of our development partners to manage these systems for the long haul. These efforts are at the heart of our strategy of sustainability.

In the worst of all possible worlds, USAID's various committed constituencies could be reduced to competing for priority and attention. I know that your common commitment is to help the people of the developing world, rather than to attack in isolation any particular symptom of poverty and underdevelopment.

As we celebrate the 50th anniversary of the Marshall Plan which helped rebuild Europe after World War II, General George Marshall's words in announcing that proposal still resonate today:

"Our policy is directed not against any country or doctrine, but against hunger, poverty, desperation and chaos. Its purpose should be the revival of a working economy in the world so as to permit the emergence of political and social conditions in which free institutions can exist."

As we prepare for a new century, USAID fights hunger, poverty, desperation and chaos to help developing countries build working economies that permit the emergence of political and social conditions in which free institutions can exist. But today we do not fight alone. The nations the United States helped half a century ago are now are strong partners in the fight.

To achieve our mutual goals we must strengthen these strategic alliances and multilateral coalitions. We must bring together community, private and public agencies, NGOs, public health professionals and volunteers -- the bedrock of international development.

Together we can find common ways to overcome obstacles, and focus the attention of Americans on all the good bought by their foreign aid dollars.

We must make our common case with passion and commitment. We must help the American people and their legislators -- some of them coming here tomorrow morning -- understand how important our work beyond our own borders has become to this nation.

Again, I congratulate NCIH on all you have done to spread this critical message.

Together, we can make sure that those most at risk share the benefits of both past and future advances. Together, we can build the systems that will hold back new disease threats.

We have no time to lose.

I pledge to you my best efforts in our mutual cause of combatting illness and human suffering around the world. I know I can count on yours.

Thank you.

This is an archived USAID document retained on this web site as a matter of public record.

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