[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
ACHIEVING THE UNITED NATIONS MILLENNIUM
DEVELOPMENT GOALS: PROGRESS THROUGH
PARTNERSHIPS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON INTERNATIONAL ORGANIZATIONS, HUMAN RIGHTS AND OVERSIGHT
OF THE
COMMITTEE ON FOREIGN AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
JULY 27, 2010
__________
Serial No. 111-121
__________
Printed for the use of the Committee on Foreign Affairs
Available via the World Wide Web: http://www.foreignaffairs.house.gov/
______
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COMMITTEE ON FOREIGN AFFAIRS
HOWARD L. BERMAN, California, Chairman
GARY L. ACKERMAN, New York ILEANA ROS-LEHTINEN, Florida
ENI F.H. FALEOMAVAEGA, American CHRISTOPHER H. SMITH, New Jersey
Samoa DAN BURTON, Indiana
DONALD M. PAYNE, New Jersey ELTON GALLEGLY, California
BRAD SHERMAN, California DANA ROHRABACHER, California
ELIOT L. ENGEL, New York DONALD A. MANZULLO, Illinois
BILL DELAHUNT, Massachusetts EDWARD R. ROYCE, California
GREGORY W. MEEKS, New York RON PAUL, Texas
DIANE E. WATSON, California JEFF FLAKE, Arizona
RUSS CARNAHAN, Missouri MIKE PENCE, Indiana
ALBIO SIRES, New Jersey JOE WILSON, South Carolina
GERALD E. CONNOLLY, Virginia JOHN BOOZMAN, Arkansas
MICHAEL E. McMAHON, New York J. GRESHAM BARRETT, South Carolina
THEODORE E. DEUTCH, CONNIE MACK, Florida
FloridaAs of 5/6/ JEFF FORTENBERRY, Nebraska
10 deg. MICHAEL T. McCAUL, Texas
JOHN S. TANNER, Tennessee TED POE, Texas
GENE GREEN, Texas BOB INGLIS, South Carolina
LYNN WOOLSEY, California GUS BILIRAKIS, Florida
SHEILA JACKSON LEE, Texas
BARBARA LEE, California
SHELLEY BERKLEY, Nevada
JOSEPH CROWLEY, New York
MIKE ROSS, Arkansas
BRAD MILLER, North Carolina
DAVID SCOTT, Georgia
JIM COSTA, California
KEITH ELLISON, Minnesota
GABRIELLE GIFFORDS, Arizona
RON KLEIN, Florida
Richard J. Kessler, Staff Director
Yleem Poblete, Republican Staff Director
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Subcommittee on International Organizations,
Human Rights and Oversight
RUSS CARNAHAN, Missouri, Chairman
BILL DELAHUNT, Massachusetts DANA ROHRABACHER, California
KEITH ELLISON, Minnesota RON PAUL, Texas
DONALD M. PAYNE, New Jersey TED POE, Texas
THEODORE E. DEUTCH, Florida
C O N T E N T S
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Page
WITNESSES
Ms. Kathy Calvin, Chief Executive Officer, United Nations
Foundation..................................................... 7
John McArthur, Ph.D., Chief Executive Officer, Millennium Promise 16
Scott C. Ratzan, M.D., Vice President, Global Health, Government
Affairs and Policy, Johnson & Johnson.......................... 26
Mr. James Roberts, Research Fellow for Economic Freedom and
Growth, The Heritage Foundation................................ 34
LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING
The Honorable Russ Carnahan, a Representative in Congress from
the State of Missouri, and Chairman, Subcommittee on
International Organizations, Human Rights and Oversight:
Prepared statement............................................. 3
Ms. Kathy Calvin: Prepared statement............................. 11
John McArthur, Ph.D.: Prepared statement......................... 20
Scott C. Ratzan, M.D.: Prepared statement........................ 30
Mr. James Roberts: Prepared statement............................ 37
APPENDIX
Hearing notice................................................... 62
Hearing minutes.................................................. 63
The Honorable Russ Carnahan: Material submitted for the record... 64
ACHIEVING THE UNITED NATIONS MILLENNIUM DEVELOPMENT GOALS: PROGRESS
THROUGH PARTNERSHIPS
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TUESDAY, JULY 27, 2010
House of Representatives,
Subcommittee on International Organizations,
Human Rights and Oversight,
Committee on Foreign Affairs,
Washington, DC.
The subcommittee met, pursuant to notice, at 9:35 a.m., in
room 2172, Rayburn House Office Building, Hon. Russ Carnahan
(chairman of the subcommittee) presiding.
Mr. Carnahan. Good morning. I want to call the Subcommittee
on International Organizations, Human Rights and Oversight to
order this morning and kick off our hearing this morning on
``Achieving the United Nations Millennium Development Goals:
Progress Through Partnerships.''
And I will begin with an opening statement. After that, I
will turn it over to others here for opening remarks and look
forward to introducing our panel.
Ten years have passed since 192 nations and multilateral
organizations set eight international development targets,
which became known as the Millennium Development Goals, or
MDGs, representing a collective international effort toward
improving the lives of those living in developing countries.
The goals include: The eradication of extreme poverty and
hunger; achievement of universal primary education; promotion
of gender equality and empowerment of women; reduction of child
mortality; improvement of maternal health; halting and
reversing the spread of HIV/AIDS, malaria, and other diseases;
environmental sustainability; and creation of a global
partnership for development.
At last year's U.N. General Assembly, President Obama
stated, ``We will support the Millennium Development Goals and
approach next year's summit with the goal to make them a
reality.'' It is in the interest of the U.S. to stick to this
commitment. We must use this strategy to take a leadership role
at the United Nations high-level review of the Millennium
Development Goals, which takes place on September 20th through
the 22nd in New York City. I look forward to receiving the
administration's MDG strategy in the coming days.
As we recover from an economic recession, it is important
to keep in mind that the MDG goals are not only a moral
commitment of U.S. and universal values, but they are also
vital to our security and economic prosperity. Fighting
poverty, hunger, the lack of access to education and health
care helps reduce unrest and extremism, which can contribute to
hatred and violence.
The MDGs also help to leverage U.S. aid, bringing in
contributions from other countries, the private sector, and
civil society. Collectively, our investment helps to reduce
extreme poverty and build a growing middle class abroad, which
will ultimately buy U.S. products. Achieving MDGs helps the
world's most needy, but it also is good for America's producers
and consumers.
Since 2000, the global community moved steadily toward
achieving many of these goals. In developing regions, net
enrollment in primary education increased by 5 percent between
2000 and 2007. Globally, the new HIV infection rate decreased
from an estimated peak of 3.5 million in 1996 down to 2.7
million in 2008. And as we heard last month at this
subcommittee's hearing on women as agents of change, women's
share of national parliamentary seats has increased from 6
percent to 19 percent in the last 10 years.
Unfortunately, progress has stagnated in other areas. The
mortality rate for children under 5 is still well under the
target of a two-thirds reduction. And we have seen an increase
in poverty rates over the last year. Finally, as we heard last
week at our hearing on the administration's Feed the Future
Initiative, the number of hungry people increased from 842
million in the early 1990s to over 1 billion people in 2009.
In order to address these critical challenges, we must
adhere to a strategy that is cost-effective, invests wisely in
the developing world, and works with our national security
strategy. The U.S. Government has played and will continue to
play a vital role in this effort.
However, we need to ensure that we do so in a collaborative
manner that leverages all available resources. The private
sector is in a unique position to contribute their expertise,
resources, and innovative techniques toward this global effort.
Targeted public-private intervention programs have already
proven successful. For example, the incidence of polio has
plummeted by more than 99 percent since 1988, when Rotary
International partnered with the WHO, CDC, and UNICEF to launch
the Global Polio Eradication Initiative.
Another project, Millennium Villages, supports social and
business development services for more than 400,000 people in
rural communities across 10 countries in Africa. Finally, there
are many microfinance programs that serve as examples of
successful public-private initiatives that have helped to
reduce poverty and empower women.
I look forward to hearing from our witnesses today about
lessons learned from their public-private partnerships and what
initiatives can be scaled up to meet MDGs.
I will now recognize our ranking member, Representative
Rohrabacher of California, for his opening statement.
[The prepared statement of Mr. Carnahan follows:]
Mr. Rohrabacher. Thank you very much, Mr. Chairman.
While I am here to listen to what you have to say, you have
a skeptic here, obviously. You know, when you got $1.5 trillion
more going out than you got coming in, pretty soon, if we don't
change that--you know, last year it was $1.5 trillion deficit,
this year it is $1.5 trillion--that is not billion-dollar
deficit, this is trillions--within a short period of time, our
country is going to turn around and our economy will have
totally collapsed.
All these young people you see in the audience, it is going
to be a disaster for their lives. You know, already they are
going to be on the hook for hundreds of billions of dollars
that is going to be taxed from them every year in order just to
provide the interest on what we are doing in the last 2 years.
So, yeah, we need to care about people around the world who
are in need, but we got to put our own house in order. And if
trying to take care of people across the ocean and in different
places where people are in need and horrible situations, if by
trying to care of them we exacerbate our problem at home and
dump our own future generations into poverty, we will have
sinned against our own people.
So I want to know why this is a good idea. If you want to
spend more money on it, I want to know why it is a good idea
for those young people and their future, and how it will affect
this $1.5 trillion worth of debt that we are putting ourselves
into every year. It makes no sense.
We learned from some papers that were leaked--and I thought
the person who leaked those papers did a good job for the
people of the world--we learned that Pakistan has continued all
of these years in supporting the Taliban, while we give, Mr.
Chairman, what, a $7 billion package to Pakistan to help them
build their economy, at a time when we just find out through
these leaked documents that Pakistan has been helping the
Taliban the whole time. Does that make any sense? That makes no
sense at all.
Borrowing money from China in order to give to Pakistan,
China's ally, in order to help the Taliban, while the Taliban
are fighting the United States? Well, this is about as much
sense as a lot of these programs that I have been looking at
over these years make--you know, when you look back on it,
makes no sense at all, most of these things. So, now that we
are in a crisis, maybe we can ask some very fundamental
questions.
So I am looking forward to your testimony. I am going to
listen, so we will see what happens.
Mr. Carnahan. Thank you.
I now want to yield 5 minutes for an opening statement to
Mr. Smith of New Jersey.
Mr. Smith. Thank you very much, Mr. Chairman. And I thank
you for convening this very important hearing on the Millennium
Development Goals. As you know, the outcome documents of the
high-level summit on the Millennium Development Goals continues
to be negotiated at the U.N. this week. It will be an important
roadmap for the next steps to be taken.
I wanted to take this opportunity to focus our conversation
and efforts on achieving MDGs 4 and 5 jointly. We must keep in
mind that to achieve MDGs 4 and 5, reducing child mortality and
maternal mortality, both mother and unborn child must be
treated as co-patients in need of care, compassion and, when
sick, either patient or both patients, in need of timely
interventions. We must strive to save and to affirm both.
The April 2010 Lancet medical journal published a
groundbreaking study funded by the Bill and Melinda Gates
Foundation that shows that worldwide maternal mortality has
been decreasing since 1980. Progress is being made by many
countries, and the successful policies must continue.
The study analyzed volumes of studies and data, including
WHO maternal mortality data. And, using statistical methods now
available through advanced computer technology, the study found
that the number of maternal deaths per year as of 2008 is
342,900. That is down from 526,300 in 1980, about a 40-percent
drop. The study notes that if the world wasn't suffering from
the HIV/AIDS pandemic, the total number would be 281,500,
almost 50 percent down from the 1980 levels.
While still too high, this landmark report is encouraging
to governments who have been seriously addressing maternal
mortality in their countries by increasing the number of
skilled birth attendants.
I would note parenthetically that I hosted a group of OB-
GYNs who talked about their work in Africa, and they said,
``100 years ago we realized how to reduce maternal mortality.
You need a skilled birth attendant, the capability to do a C-
section when there is an obstructed delivery, and you need to
have the ability to provide safe blood so that that woman can
get a transfusion, if necessary.'' Education of women is also
important.
I actually chaired a hearing on safe blood, Mr. Chairman,
and the WHO rep at that particular hearing said if women in
Africa had access to safe blood, maternal mortality would drop
by 44 percent. Unfortunately, for so many, that blood is simply
not there.
And, of course, economic development and the education of
women is also very important, as well. And there are others.
Many of these countries with very low maternal mortality
rates have laws, however, that restrict abortion. The inclusion
of legalized abortion, or so-called reproductive health
services defined as abortion in the outcome document, I believe
would be unjust, intellectually dishonest, and
counterproductive to the littlest humans and efforts to provide
successful efforts for the MDGs.
In fact--and this is largely under-known and under-focused-
upon--abortion can have a negative effect on the reproductive
health of the mother as well as the health of her subsequent
children. At least 113 studies show a significant association
between abortion and subsequent premature and low-birth-weight
births. For example, a study in the International Journal of
Obstetrics and Gynecology showed a 36-percent increased risk
for a preterm birth after one abortion and a staggering 93-
percent increased risk after two. Similarly, the risk of
subsequent children being born with low birth weight increased
by 35 percent after one and 72 percent after two or more
abortions. Another study showed the risk increases nine times
after a woman has had three abortions.
What does this mean for her children? Preterm birth is the
leading cause of infant mortality in the United States and
causes one-fourth of infant mortality in the world. Preterm
infants have a greater risk of suffering from chronic lung
disease, sensory deficits, cerebral palsy, cognitive
impairments, and behavioral problem. Low birth weight is
similarly associated with neonatal mortality and morbidity.
Abortion hurts both mother and child and can cause sickness,
even death, in future children.
I would also point out to my colleagues that abortion is
child mortality for the child who is actually aborted. And,
again, the mortality and morbidity of future children is at
risk. Abortion methods chemically poison, dismember, induce
premature labor, or starve to death the fragile life of an
unborn child. So terms like ``safe abortion,'' which is thrown
around very loosely, is, at best, misleading. ``Safe abortion''
is never safe for the baby.
Another cause of infant mortality should be addressed in
the outcome document, and it is birth asphyxia, which kills 1
million newborns each year--more than malaria and five times
more than AIDS. There is much we can do, even in resource-
limited situations, to ensure that babies take their first
breath in that golden minute right after birth. Skilled
attendants, again, at birth; temperature support and
stimulation to breathe; and assisted ventilation through the
use of low-cost resuscitators are interventions we can and
should be making available to achieve MDG 4.
The MDG document will be very important for guiding our
steps as an international community over the next 5 years.
Every step counts. And I hope that our panelists will use all
of their influence to ensure that the outcome document keeps us
on the path of saving both mother and child.
Again, I thank you, Mr. Chairman.
Mr. Carnahan. Thank you.
And now I want to turn to our panel.
And let me start to my left with Ms. Kathy Calvin. She is
the chief executive officer at the United Nations Foundation.
The foundation was created in 1998 with Ted Turner's $1 billion
gift to support U.N. activities. Prior to joining the U.N.
Foundation, Ms. Calvin served as president of AOL-Time Warner
Foundation. She has also worked at Hill and Knowlton, as well
as U.S. News and World Report. From 1976 to 1984, she served as
Senator Gary Hart's press secretary in his Senate office and on
his 1984 Presidential campaign. She is a graduate of Purdue
University.
Next, Dr. John McArthur. He is chief executive officer of
Millennium Promise, a nonprofit organization committed to
supporting the achievement of the Millennium Development Goals.
He is also research associate at the Earth Institute at
Columbia University and teaches at Columbia School of
International and Public Affairs. Previously, he served as the
deputy director and manager of the U.N. Millennium Project. He
completed his bachelor of arts at the University of British
Columbia, a master's in public policy at Harvard's Kennedy
School of Government, and a master's and doctorate in economics
at Oxford University, which he attended as a Rhodes Scholar.
Next, Dr. Scott Ratzan. He serves as vice president for
global health, government affairs, and policy at Johnson &
Johnson. He is co-chair of the U.N. Secretary-General's Joint
Action Plan on Women and Children's Health Innovation Working
Group. Previously, he served as senior technical adviser in the
Bureau of Global Health at the USAID, where he developed the
global health communication strategy for U.S.-funded efforts in
65 countries. He received his MD from the University of
Southern California, MPA from Harvard University's Kennedy
School of Government, and MA from Emerson College.
And, finally, Mr. James Roberts. He is the research fellow
in economic freedom and growth at the Heritage Foundation
Center for International Trade and Economics. His primary
responsibility is to produce the ``Index of Economic Freedom,''
an annual analysis of the economic climate of countries
throughout the world. Before joining Heritage, Mr. Roberts
worked for the U.S. State Department for 25 years, serving in
Mexico, Portugal, France, Panama, and Haiti. He also served as
an intelligence officer in the U.S. Navy Reserve. He has a
master's degree in international development and economics from
Yale, an MBA from the University of Pittsburgh, and a
bachelor's degree in international affairs from Lafayette
College.
Welcome to our panel. We look forward to hearing from you.
And we will start, and I will recognize Ms. Calvin for 5
minutes.
STATEMENT OF MS. KATHY CALVIN, CHIEF EXECUTIVE OFFICER, UNITED
NATIONS FOUNDATION
Ms. Calvin. Thank you, Mr. Chairman, and good morning.
Thank you for calling today's hearing on the Millennium
Development Goals. Your leadership in support of American
efforts to battle extreme poverty, hunger, and disease in the
developing world and to support the U.N. in its programs is
greatly appreciated.
And thank you for inviting the U.N. Foundation to testify.
When Ted Turner created the U.N. Foundation, it was because he
believed in the U.N. and its value to creating a platform to
connect people, ideas, and resources to support its work around
the world and to strengthen the relationship between the United
States and the U.N.
As you mentioned, the President will be bringing to the
world leaders in just 2 months his plan for the United States
to help achieve the MDGs, as he promised last year when he was
before the world leaders. We believe his speech this vitally
important because it will signal to the world that our Nation
will continue to play a leadership role in battling global
poverty, despite, as you pointed out, the very tough economic
times here at home, and that the United States is fully
committed to working with the U.N., other donor countries, and
the developing world itself.
As you pointed out, the MDGs are an internationally
recognized framework to allow bilateral and multilateral donors
to work together. But it takes more than one sector, and that
is why we are here today to talk about partnerships.
You might expect me to make the point that the MDGs are a
critical component of our strategic imperative, but I want to
quote someone else, and that is Secretary Gates, who said last
year,
``In the campaign against terrorist networks and other
extremists, we know that direct military force will
continue to have a role. But over the long term, it
should be subordinate to measures to promote
participation in government, economic programs to spur
development, and efforts to address the grievances that
often lie at the heart of insurgencies and among the
discontented from which the terrorists recruit.''
That is exactly what the Millennium Development Goals seek to
achieve.
And I think you know, Mr. Chairman, there is strong support
from American voters for the MDGs. In April, the U.N.
Foundation and our sister organization, the Better World
Campaign, conducted bipartisan polling and found that 87
percent of Americans believe the U.S. should achieve the MDGs.
And the majority said they would favorably look on companies
that are using their finances and other resources to support
these programs. That is good news for all of us.
So I want to touch today just very briefly on the kinds of
partnerships that we think work not only to achieve these goals
but actually to multiply the impact and effect of our scarce
public funds.
I will start with a couple campaigns you know about. The
first is Nothing But Nets, which is a campaign to combat
malaria. And thank you for all the work this committee has done
to strengthen and increase the U.S.'s support for fighting
malaria.
As you know, every 30 seconds, a child in Africa dies from
malaria and infection, making it the leading killer of children
on the continent. We believed American citizens wanted to join
this fight against malaria, so we launched a grass-roots
campaign 3 years ago called Nothing But Nets to raise awareness
and funding. It has a simple message: Malaria kills, send a
net, safe a life--a simple $10 donation.
The campaign has been incredibly successful in giving
hundreds of thousands of supporters the chance to raise funds
and awareness, but it wouldn't be possible without partners
from the corporate and foundation world, including diverse
partners such as the National Basketball Association, Major
League Soccer, and the United Methodist Church. So a pairing of
bishops and basketball players might not seen natural, but,
along with 14 other partners, it has allowed us to raise more
than $33 million to distribute more than 3 million nets in 15
countries.
We have also done work in combating measles around the
world. And this is an example of a partnership that draws on
the best of different partners, from the countries themselves
to governments, to private sector. We found that the challenge
from measles was great. Nothing was moving, in terms of its
reduction. But, in the last 10 years, measles deaths have
dropped 10 percent a year in Africa.
One organization on its own could never have done this; it
took a partnership. The partnership includes the American Red
Cross, the U.S. Centers for Disease Control, UNICEF, the World
Health Organization, and the LDS Church, and Vodafone. We have
done work in measles, malaria, and polio. And, as you
mentioned, Rotary International has led perhaps the most
successful partnership of all in almost eradicating that.
We think there are opportunities across the board for
partners to come together. We are currently developing a
campaign around adolescent girls to link girls in this country
with girls around the world so that they can help those girls
share the fortunes that they share here, the same opportunities
to go to school, stay healthy, and be safe.
We are also working on a partnership to bring organizations
together who care about the same issue: Freeing up women and
children from the dangers of black carbon and cookstove smoke
when they are cooking. This is a major effort and has brought
together many, many different partners.
And we have a major partnership around mobile phones, using
them to increase the ability for health workers, as you pointed
out, Congressman Smith, to reach those mothers and children who
most need it. We have created partnerships with the World
Health Organization in 22 African countries so that they could
use mobile phones, instead of the previous pen and paper, to
collect date, share information, and help.
All of those experiments in partnerships have led us to
know a couple different things about partnerships that we think
would be worth sharing with this committee as we think about
making partnerships successful and an important part of the
U.S. commitment to meeting the MDGs.
First, in any partnership, it is important to bring all of
the partners and recipients together at the table from the
start. Co-creation is essential.
Second, partnerships succeed best when everyone has a clear
role to play and can play from their strengths and competencies
and not just financial resources.
Third, we think partnerships work best when they take the
time to create full business plans, with clear goals and
objectives serving the various interests of the diverse
partners.
Fourth, the U.N., which traditionally had not been a
partner-friendly organization outside of it normal member-state
environment, is becoming much more adept and successful at
partnerships, and so is the U.S. Government. And so, too, are
the governments in the countries in which we are trying to make
a difference. They are essential partners, at the end of the
day.
And, fifth, Congress has an important opportunity to
support public-private partnerships in support of the
Millennium Development Goals. So, as this committee considers
legislation to rewrite the Foreign Assistance Act, I hope you
will consider the importance of sending a signal to USAID and
the State Department to work closely and use public-private
partnerships and to actively encourage these efforts which they
are already considering. Given scarce public and private
resources, it is imperative that money be well-spent and
effectively coordinated.
So, in conclusion, I just want to say I am really proud
that the foundation has had a successful history of
partnerships. And looking forward, we continue to look for
opportunities to expand them and scale them up, because we
think that is the most effective way we can help achieve the
Millennium Development Goals.
Thank you very much.
[The prepared statement of Ms. Calvin follows:]
Mr. Carnahan. Thank you.
Next I want to recognize Dr. John McArthur for 5 minutes.
STATEMENT OF JOHN MCARTHUR, PH.D., CHIEF EXECUTIVE OFFICER,
MILLENNIUM PROMISE
Mr. McArthur. Thank you, Mr. Chairman, and thank you to
members of the committee for the honor of inviting me to
testify today and for your leadership in convening this
important hearing on the Millennium Development Goals at what
is very much an important juncture in their history.
The goals were established by world leaders, as you
mentioned, at the Millennium Summit in September 2000. I think
one of their greatest contributions is that they are a series
of specific, quantified, and time-bound targets to address the
integrated challenges of hunger, education, health,
infrastructure, environmental management, and gender equality.
What they have done is they have galvanized a global effort
of unprecedented, if still imperfect, coherence to tackling the
challenges that are faced by the one-fifth of humanity that
still lives under the most extreme forms and conditions of
poverty, which we generally describe as living on less than $1
a day.
The summit this September, which has previously been
referred to, is the last major checkpoint on the status of the
Millennium Goals before the 2015 deadline. World leaders will
convene to agree on the actions required to achieve the goals.
And the ambitions very much were set by President Obama last
September, when he asserted in his speech at the General
Assembly that the United States will support these goals, will
approach this year's summit with a global plan to make them a
reality, and will very much set our sights, as he said, on the
eradication of extreme poverty in our time.
The MDGs are the world's goals. Their emphasis on outcomes
has prompted a global effort to address issues of scale,
metrics, finance, and joint accountability between developed
and developing countries.
Since they were established 10 years ago, the developing
world has seen many breakthroughs, as have been discussed in
some detail already. We have seen hundreds of millions of
people lifted out of conditions of extreme poverty. We have
seen massive expansion in global health efforts. We have seen
dramatic inroads in the fight against disease. We have seen
extraordinary progress in areas of access to water, in some
countries in particular. And there are many, many successes
that many thought were impossible before the goals came to
fruition.
The challenge today is to accelerate progress in the
poorest countries where the MDGs are not on track. In general,
the starkest gaps are in the areas of agricultural
productivity, maternal health and health systems, water, and
economic infrastructure for growth in the poorest countries. I
would be pleased to share more details with the committee
regarding these programs and successes and gaps, but for now
let me stress that these are the areas where an especially
concerted push is needed.
The MDGs should be, but have not been, a strategic priority
for the United States. They have a complicated history in this
country. In 2002, the spirit of the goals was incorporated into
the establishment and naming of, indeed, the Millennium
Challenge Account and, in turn, the Millennium Challenge
Corporation, although that institution has not, in practice,
focused on the Millennium Development Goals. The wording
disconnect has even caused confusion in much of Washington,
since ``millennium'' as a word tends to be associated with the
growing pains of a new institution rather than the
internationally agreed targets that have been driving the
global antipoverty agenda throughout the rest of the world.
Nonetheless, in 2002, President Bush joined world leaders
in Monterrey, Mexico, and committed the United States, along
with other developed countries, to make concrete efforts toward
the target of 0.7 percent of gross national product as official
development assistance to developing countries.
Fortunately, the Millennium Goals are feasible within this
commitment since the financing requirements are modest:
Approximately \1/2\ of 1 percent of the rich countries'
collective national incomes--\1/2\ of 1 percent.
However, U.S. foreign assistance continues to rank among
the very lowest of advanced economies, at 0.2 percent of
national income. Few people outside of Washington are aware
that, as a share of national income, U.S. Foreign assistance
actually hit its all-time low in 1997. Under the Bush
administration, the U.S. made an important change in direction,
led by targeted and focused programs that tackled challenges of
HIV/AIDS and malaria, in particular, through both bilateral
programs and multilateral programs, such as The Global Fund to
Fight AIDS, TB, and Malaria.
Congress's bipartisan commitment to global health is to be
applauded. It has had a significant multiplier effect in
leveraging additional commitments from around the world. The
Obama administration has continued its predecessor's support
for global health, although there are concerns that support in
this area is flat-lining much too prematurely. The Obama
administration has also played a pivotal role in advancing the
global agriculture agenda.
The U.S. situation can be compared, for example, to the
U.K. situation, where Prime Minister Cameron and the
conservative government in coalition has taken on the 0.7
target to be achieved by 2013. In the most recent budget, the
government confirmed that it would not carry its fiscal
consolidation program on the backs of the world's poorest
people and has actually protected both health and international
development while making dramatic cuts throughout the rest of
the government to consolidate its fiscal position.
Millennium Promise was created amidst this backdrop of
global support for the MDGs, the Millennium Goals, cofounded by
Mr. Raymond Chambers, the path-breaking business leader, and
Professor Jeffrey Sachs, the eminent economist, bringing
together many others like Donald Keough, the former CEO of
Coca-Cola; Quincy Jones, the music legend; and many others from
Columbia University, the U.N. Development Program, and so
forth.
As the chairman said, we convened many people across Africa
to work with nearly 0.5 million local villagers across 10
countries to implement an integrated approach of low-cost,
high-impact interventions. The results have been tremendous: A
tripling of basic maize yields, more than a 50-percent
reduction in malaria prevalence, a three-fold increase in
access to improved drinking water, and a remarkable one-third
reduction in child malnutrition.
This has drawn upon partnerships from leading private
philanthropists, such as Mr. George Soros; from corporate
partners like Ericsson, which is bringing 3G connectivity to
villages across Africa; Sumitomo Chemical, which has piloted
the mass distribution of bed nets; Agrium and Mosaic, which are
making major contributions of fertilizer; and Tommy Hilfiger,
which is supporting programs directly.
These lessons of success have fed into a much broader
movement. And the strategy of partnership is crucial for the
goals to be achieved, from both public and private leaders.
We have seen efforts like Malaria No More take shape,
chaired now by Peter Chernin, the former president of News
Corp., who has provide magnificent leadership with many
celebrities, government leaders, private foundations like the
U.N. Foundation, to make a major breakthrough in malaria
control.
We have seen the World Economic Forum's community of young
global leaders take on a ``People's Plan of Action'' for the
Millennium Development Goals, with the idea that every person
has the ability and a responsibility to make a measurable,
action-oriented pledge to the goals.
Less than 2 months before the summit, the world has been
anxiously awaiting the United States to present its draft
action plan. The administration recently presented a two-page
outline of its strategy, but this is only a loose statement of
general directions. If the U.S. is to provide leadership for
the MDGs, it is imperative that the government presents a draft
action plan in a matter of days, not weeks.
So I would like to conclude, Mr. Chairman and members of
the committee, by offering a few suggestions for that draft
action plan.
First, fully fund the Feed the Future strategy, in
particular through the new multilateral Global Agriculture and
Food Security Program.
Second, support a new global fund for education, as
proposed by President Obama and Secretary Clinton, and include
secondary education in its mandate, with a special focus on
girls.
Third, continue to scale up the U.S. global health
leadership by focusing on the problems that still need to be
solved. That includes full financing for the programs PEPFAR
and PMI for AIDS and malaria and increasing the annual
contribution to The Global Fund from $1 billion to $2 billion a
year, recognizing that $1 from the U.S. leverages $2 from other
advanced economies.
And, crucially, also endorsing the Secretary-General's
proposed joint action plan for child, maternal, and newborn
health, and carry that forward by creating a new multilateral
effort on maternal and child health, anchored in The Global
Fund, with initial U.S. financing of $2 billion per year, again
leveraging the 1:2 ratio that comes with other financing
crowding in with the U.S.
Fourth, support a major scale-up of African economic
infrastructure with U.S. Funding of at least $5 billion per
year, including allocations through the World Bank and the
African Development Bank.
Fifth, work with African countries to support holistic
world development strategies, like the Millennium Villages.
Six, launch a new MDG innovation fund to scale up
successful programs that present new delivery mechanisms for
MDG achievement in low-income countries.
And, seventh and finally, set a 12-month timetable for the
proposal and adoption of a proper international mechanism to
achieve the water and sanitation Millennium Development Goals.
Thank you so much for allowing me to share these thoughts
today, and I look forward to discussing them further.
[The prepared statement of Mr. McArthur follows:]
Mr. Carnahan. Thank you.
And next I would like to recognize Dr. Scott Ratzan.
STATEMENT OF SCOTT C. RATZAN, M.D., VICE PRESIDENT, GLOBAL
HEALTH, GOVERNMENT AFFAIRS AND POLICY, JOHNSON & JOHNSON
Dr. Ratzan. Thank you, Mr. Chairman and committee members.
On behalf of Johnson & Johnson, I really appreciate the
opportunity for you calling this important hearing and inviting
us to share our thoughts and perspectives of achieving the U.N.
Millennium Development Goals.
Particularly, we would like to talk about how public-
private partnerships, or, Mr. Chairman, as you call them,
private interventions or initiatives, can play a significant
role. And we appreciate your leadership, Mr. Chairman, in
supporting efforts to address the MDGs.
The challenges we face as a global community to achieve the
MDGs, particularly in maternal and child health, are great. And
the MDGs that relate to women and children's health are lagging
furthest behind. For example, a woman in an underdeveloped
country is 300 times more likely to die during childbirth or
from pregnancy-related complications than her counterpart in a
developed country. Bold, focused, and coordinated action is
required to accelerate progress on the MDGs related to health.
With only 5 years left until 2015 to achieve the MDGs, U.N.
Secretary-General Ban Ki-moon initiated a new global effort on
women and children's health, titled, ``Investing in Our Common
Future: Joint Plan of Action for Women and Children's Health.''
Johnson & Johnson was one of the two representatives of the
private sector initially selected to participate in the
Secretary-General's initiative, joining others from throughout
the United Nations member states and key civil society actors.
I co-chair the Innovation Working Group of the U.N. Joint
Action Plan, along with Tore Godal, who is special advisor on
Global Health to the Prime Minister of Norway. This group
includes representatives from USAID, the United Nations,
Canada, Rwanda, India, Harvard University, Rockefeller and
Gates Foundations, and others.
The Innovation Working Group has published draft papers
that promote ideas that should catalyze future opportunities
for the MDGs. They are available on the Web site and will be
published later this year. And we have made these available,
Mr. Chairman, to the committee. There are 10 different ones
that are here, with a variety of perspectives, again, to foster
innovation.
We know that progress in developing and delivering healthy
pregnancies and healthier babies is possible with innovation.
Some of the poorest countries are now making significant
reductions in maternal and neonatal mortality. Country-led as
well as global innovations can achieve further reductions
enabling health services to produce better outcomes at the same
costs that we have today. These range from financial incentives
to promote performance and results to innovative use of mobile
phones and other communication tools, some of which you have
already heard about.
These working papers include ways to improve effective
services for women and children, including improving health
literacy, the development and use of new technologies, as well
as innovation and delivery of services through public-private
initiatives.
Johnson & Johnson has a long legacy of engaging in public-
private partnerships focused on maternal and child health
initiatives in many developing and developed countries. All of
these have a focus of making life-changing, long-term,
sustainable differences in human health and tied to advancing
one or more of the Millennium Development Goals. Our approach
focuses on working with community-based partners that have the
greatest insights into the needs of local populations and the
strategies that stand the greatest chances of success.
Some of our examples of our activities include
contributions microbicide development, HIV prevention, helping
children attain their utmost potential by treating and
preventing intestinal worms, efforts to halt the scourge of
tuberculosis, and initiatives to prevent mother-to-child
transmission of HIV. I will go through four of these examples.
The first is from 2004, when Johnson & Johnson established
a first-of-its-kind partnership with the International
Partnership on Microbicides to provide a royalty-free license
and technology transfer to develop, manufacture, and distribute
its compound TMC120 as a topical vaginal microbicide to help
protect women from infection with HIV in developing countries.
We were the first pharmaceutical company, and this effort
spearheaded other companies to follow suit with further
contribution of their compounds to the IPM partnership. And, as
you may have heard last week in Vienna, microbicides are a
promising approach to halting the incidence of HIV.
Secondly, since 2006, we have partnered with the Task Force
for Global Health on Children Without Worms. This is the first
and only entity to focus specifically on global treatment and
prevention of soil-transmitted helminthiasis, or commonly known
as intestinal worms. STH, or soil-transmitted helminthiasis,
contributes to general weakness, malnutrition, iron-deficiency/
anemia, and impaired physical and intellectual development in
school-aged children.
The program that we have helped developed is treating
approximately 20 million people with mebendazole, a drug
developed by our pharmaceutical business, and is working to
stop the cycle of reinfection through health education, access
to clean water, and improved sanitation infrastructures. And
this is currently active in eight countries that have high
prevalence rates.
Third, as the new drugs for development of drug-resistant
tuberculosis are in dire need, Johnson & Johnson formed a
landmark collaboration with the Global Alliance for TB Drug
Development, a not-for-profit product development partnership
to accelerate the discovery and development of new drugs to
fight tuberculosis. This collaboration is maximizing the
expertise and resources from the both the public and private
sectors, with the intent to improve the treatment of one of the
world's oldest and most deadly diseases. We are sharing
expertise and resources in the development of a novel Johnson &
Johnson compound in development, and this is heralded as the
first new tuberculosis drug with a new mechanism of action in
40 years.
And, finally, Mr. Chairman, a final example that we would
like to talk about contributes to how we have helped eliminate
mother-to-child vertical transmission of HIV by 2015, which has
also been heralded as a goal by the United Nations.
For several years, Johnson & Johnson has partnered with the
Elizabeth Glaser Pediatric AIDS Foundation and mothers2mothers.
Our partnership has reached more than 1.9 million women with
counseling, provided more than 1.7 million with HIV testing,
and administered antiretroviral prophylaxis to nearly 140,000
HIV-positive mothers in 11 countries.
J&J also became mothers2mothers' first corporate partner in
2006 and is one of the largest supporters, as this partnership
has reached over 3,500 new HIV-positive mothers each month in
South Africa, Lesotho, and Swaziland.
Each of these examples demonstrates how actors in the
public and private sectors drive innovative solutions to
address some of the world's most pressing global health issues
affecting women and children. These partnerships all call for a
shared vision, strategic thinking, and collaboration to be
successful. Healthy partnerships leverage the unique skills
that each partner brings to the table to effect change.
We believe the best value comes when the United Nations and
other governmental bodies involve the private sector to
catalyze efforts and when the private sector leverages
governmental investments. We see this in our engagement with
the United Nations and other stakeholders, including the U.S.
Government, on health literacy initiatives.
And, Mr. Chairman, health literacy is something not only
heralded domestically in the United States in health reform and
in the National Action Plan with HHS, but also led efforts in
Missouri, with some of the great State innovations that
Missouri is also sharing with the world and vice versa.
We also believe that our efforts at Johnson & Johnson on
global health diplomacy drive new ways of thinking that can
help shape stronger, more sustainable approaches, benefiting
mothers and fathers around the world.
The recent resolution adopted by the United Nations General
Assembly on prevention and control of noncommunicable diseases
stresses the need for a multi-sectoral response also to combat
noncommunicable diseases. In this resolution, the U.N.
recognizes the enormous human suffering caused by
noncommunicable diseases, such as cardiovascular diseases,
cancers, chronic respiratory diseases, and diabetes, and the
threat they pose to the achievement of the MDGs.
We see this challenge of noncommunicable diseases and
support the multi-sectoral input currently being developed by
the United Nations and the World Health Organization. Johnson &
Johnson represents the pharmaceutical industry with our seat on
the World Health Organization's NCDNet, a global
noncommunicable disease network developed.
We also further contribute with our leadership through the
World Economic Forum, chairing the chronic disease and wellness
activities. The World Economic Forum has designated the threat
of noncommunicable diseases to economic and health and
wellbeing. And we also now welcome more engagement with the
U.S. Government, the U.N., and other interested parties in this
effort.
The U.N. joint plan of action for women and children's
health offers renewed hope for the future, as the varied
participants explore ways to build upon, revitalize, and secure
new commitments from a range of influential partners, as well
as provide organization and accountability for delivery at the
highest level. During the formative stages, participants agree
that this joint action plan should focus on increased political
commitment and accountability, integrated delivery, and
enhanced financing for women and children's health.
In conclusion, I would like to remind, as we believe, that
global health and development are too important to relegate to
any one group. Congress has an important opportunity to support
and encourage more public-private partnerships in health
literacy, in maternal and child health, and other related areas
that could help address the Millennium Development Goals.
Additionally, it is critically important to foster public-
private partnerships that build more integrated program
offerings that focus less on trying to solve just one issue and
more on holistic approaches to address the many challenges
facing women and children in resource-poor settings.
Thank you very much.
[The prepared statement of Dr. Ratzan follows:]
Mr. Carnahan. Thank you.
And, finally, I would like to recognize Mr. James Roberts
for 5 minutes.
STATEMENT OF MR. JAMES ROBERTS, RESEARCH FELLOW FOR ECONOMIC
FREEDOM AND GROWTH, THE HERITAGE FOUNDATION
Mr. Roberts. Thank you, Mr. Chairman, and thank you, Mr.
Ranking Member, for this opportunity to appear before your
subcommittee.
In my opinion, Congress should reject approval of future
taxpayer-funded U.S. Government official development assistance
programs, or ODA, that are designed to achieve the U.N. MDGs.
I should note at the outset, I do not include emergency and
humanitarian assistance in my critique of ODA. I would also
like to compliment the significant positive role in development
played by private charities and faith-based groups.
No one disputes the desirability of MDG goals, but there is
significant disagreement about the best approach to achieve
them. In my opinion, the U.N. programs will fail to achieve
their objectives. If Congress continues to fund them, the only
certainty is that they will further enrich corrupt elites in
developing countries and they will provide continuing
employment for a cadre of development assistance bureaucrats
and other professionals who are advancing them.
Increasingly, experts in the developing world, such as
Dambisa Moya of Zambia, who wrote a book recently called ``Debt
Aid,'' are voicing opposition to ODA. They know from firsthand
experience that 50-plus years of foreign aid from OECD
countries, totaling anywhere from $1.6 trillion to $2 trillion,
depending on who your source is, has only strengthened corrupt
elites, encouraged morally corrosive cultures of corruption,
discouraged private and foreign and domestic investment, and
actually contributed to a rise in poverty rates because of the
expanded level of nonproductive government spending and the
welfare-dependency mindset that that encourages.
One has only to drive 50 miles or so beyond the Beltway in
Washington for evidence of the massive government stimulus
spending in the United States in recent years and its failure.
Although it has been a boon to public-sector unions, it has
failed to help the average American to achieve his or her own
set of MDGs. So why should anyone expect U.S. Government
deficit-financed development assistance programs that emphasize
welfare-state redistribution solutions and dependency to be any
more successful in other countries? This is especially true at
a time of unthinkably large U.S. deficits, as Congressman
Rohrabacher mentioned.
A Swedish development economist, Fredrik Segerfeldt, has
noted the failure to lift people out of poverty and has
analyzed the reasons why. And his conclusion--and we share it
at Heritage--is that these problems of development in these
countries simply cannot be solved by foreign aid. Only economic
growth can rescue the poor and extremely poor, and that growth
cannot be generated by statist development assistance programs
that center on an ever-expanding welfare state and
redistribution.
Segerfeldt points out, for example, in 1962, GDP per capita
in East Asia and in sub-Saharan Africa was roughly the same. By
2005, the poverty rate in East Asia had been dramatically
reduced, while in sub-Saharan Africa it was more or less
unchanged. The difference? China, South Korea, the so-called
Asia Tigers, other countries in East Asia generally did not
follow the western development assistance model. They preferred
to stimulate growth through investment and export. Meanwhile,
countries in the sub-Saharan Africa have become increasingly
dependent on ODA.
Development assistance proponents push the MDGs, and they
downplay extensive evidence that growth, not aid, provides the
exit from the poverty trap. For evidence, look no further than
the U.N. Millennium Declaration, which the U.N. Development
Programme purports to be the gold standard of development
assistance policy prescriptions. It does not contain a single
reference to economic growth.
Only fundamental changes in a country's culture and
political philosophy by its own citizens can accomplish these
necessary changes. It is not just formal institutions of a
government in developing countries but the informal customs
governing day-to-day business transactions that must be
reformed. And that can only by accomplished by people living
there. The U.S. taxpayers should not be put on the hook for
that.
If a country's culture and practices are steeped in
corruption and cronyism, no amount of aid will overcome it. In
fact, ODA actually degrades these formal and informal
institutions the longer it exists, because it tends to
perpetuate corrupt regimes that can hang on to power by using
the assistance flows.
It is instructive to look at the countries where the
Millennium Development Goals have actually been realized most
fully in the history of the world, and that would be in the
developed countries with high levels of economic freedom and
low levels of corruption.
And, of course, as you mentioned, Mr. Chairman, I work on
the ``Index of Economic Freedom,'' which annually analyzes
these core principles: Rule of law, secure property rights,
limited government, taxes as low as possible, efforts to
encourage and bolster free markets, entrepreneurship,
democratic governance, political stability, and the resulting
prosperity. According to our index, countries with greater
improvements in economic freedom achieve much higher reductions
in poverty.
As you mentioned, Mr. Chairman, the deficit is a major
concern. And no one is going to be deluded into thinking that
even if the entire U.S. foreign assistance budget were
eliminated--and I don't recommend that--it would not solve our
deficit problem. But most of it should be eliminated, on
principle. I would make an exception, certainly, for direct,
short-term U.S. national security goals that should be tackled
by joint U.S. military and civilian agency teams. But, other
than that, and there may be a few other exceptions, I think,
actually, that development assistance policies have been a
block to growth and to lifting people out of poverty.
The best thing the United States can do right now to help
the developing world is to get its own financial house in order
and regain its status as a role model for developing countries.
Take the lead among OECD countries to end ineffective ODA
programs. Instead, encourage more trade and investment, for
example, by approving the pending free trade agreements with
Panama, Colombia, and South Korea, and negotiating more.
That will make more capital available to the private sector
and spur a renewed level of economic growth in the U.S. and
globally. That is the best model for sustainable development:
Through economic growth.
Thank you very much.
[The prepared statement of Mr. Roberts follows:]
Mr. Carnahan. Thank you.
I appreciate our panel and all of your diverse backgrounds
and opinions. I think we have covered a lot here.
But I am going to start with recognizing myself for 5
minutes of questions. And I want to start out asking each of
you, as has been mentioned in various forums, about the
security and economic connection to these goals. And I know you
quoted Secretary Gates, but I would like each of you to talk
about that and also the third component, how this helps
leverage other aid.
I also like the comment that was made that this was too big
for any one group to do on its own. I think that is an
important theme here.
But if you could each address that, and I will start with
Ms. Calvin.
Ms. Calvin. Thank you.
I believe Secretary Gates had it exactly right when he made
that critical connection between ensuring that there are
peaceful and conflict-free areas in the world where we can help
nations grow to their full potential and their citizens live to
their full potential and to become eventually some customers
and clients of U.S. companies.
But I think the most important thing here is the
recognition that people around the world are all of equal value
and that we need to address that basic core instinct that
Americans have. Once we make a nation have access to the health
and other benefits that we are talking about here, we know that
we can encourage the keeping of girls and other young people in
school, which leads to long-term security and stability in a
country. A lot of the work that the U.S. ODA is already doing
is in the area of democracy-building and rule of law, and we
know that those two things then work hand in hand.
And it is important to recognize that so much of ODA is
currently not even in the areas that my colleagues have talked
about. Even though it has been increased in recent years around
AIDS treatment and other areas, it has been a full panoply of
supporting the economic growth of these countries in lots of
different ways. And the most important way we can help a
country grow economically is to make sure that its citizens are
educated and have health.
Mr. Carnahan. Dr. McArthur?
Mr. McArthur. Thank you, Mr. Chairman. These are terrific
questions. And I would just start by saying that I think
official development assistance and aid often is very broadly
misunderstood as a charitable endeavor. There certainly are
humanitarian emergencies which require that form of logic, but
what we are really talking about here is investments, and
investments in very specific and practical programs and
targets.
If we even look at the challenge of economic growth for the
poorest countries and communities in the world, the majority of
them are farmers. Economic growth to a farmer means growing a
better crop, literally. And so, when we are talking about
agriculture, for example, and support for agriculture, that has
a double dividend of both tackling hunger and promoting
economic growth.
Now, Malawi is a very important example. Malawi supported,
with international--the President, Mutharika, put forward a
program to make sure that every small farmer in Malawi got
access to a bag of fertilizer and a can of seeds. You couldn't
think of anything more simple and straightforward. This was
only made possible because of international support. That
program then doubled the country's food production, and, in
2008, when the global economy was imploding, Malawi grew at 9
percent.
So the economic dividend is very important. And the fact
that agriculture has basically missing from the international
agenda for a generation is, in my view, one of the deepest
reasons why we haven't seen more direct links between foreign
aid and growth.
Now, we certainly need the longer-term support for
education and health, as well, which will undoubtedly affect
growth in the medium and longer term where the programs are
successful, because children that survive and are better
educated will be very active economic players. And even higher
child survival is linked to lower fertility rates, which is
part of managing a demographic transition where we have the
fastest-growing populations in the poorest countries. The
greatest, you know, risks of instability are also in those poor
countries. And we don't just have to think about these
countries as islands because they are very much part of the
connected world.
Now, if we look at the evidence, which is quite strong and
in the top journals, the risk of conflict, civil conflict, is
much higher at lower levels of income per capita. Many of the
places that we read about in the newspaper every day, which are
our direct security interests, also happen to be those places.
There is an extra overlay, which is the climate issue. The
top research now shows that risk of climate, whether it is
temperature, whether it is rainfall variation, especially in
Africa, is directly linked statistically to the onset of
conflict and domestic conflict. And the logic is quite
straightforward: When the rains fail or the temperature is too
high, the crops fail, and hungry people are ultimately more
likely to fight. And we have a whole drylands issue throughout
the Sahel, where these are also the hot-button security places
that we are worried about on all sides of our foreign policy.
So we need to understand that there is a direct effect on
health and delivery targets and education and infrastructure.
We also need to understand that aid can go, and must go,
directly to supporting the productive sectors. And that won't
just help these countries escape from aid and graduate from the
need for support, but will also help them develop the robust,
kind of economic and social capacity that will really be in our
global long-term interest for stability.
Mr. Carnahan. Thank you.
Dr. Ratzan?
Mr. Ratzan. Thank you, Mr. Chairman.
I think that is an excellent question that leads to what we
encompass under global health diplomacy, notwithstanding the
ideas of health as a bridge to peace, health with conflict
resolution, but the idea that health investments are
investments in wealth and economic wellbeing.
And there are basically three areas where I think this
makes the largest and best example: One is infectious disease,
which has no borders; second, chronic disease, which continues
to be a threat; and, thirdly, as you mentioned, mothers'
education, or as we link it even more with health literacy in
general.
We looked at last year's risk report, which is done
annually with the World Economic Forum that goes to both
private-sector groups as well as governments and throughout the
world. And if you look at the risk report, it puts on one axis
the potential or the likeliness of something to occur and on
the other axis the threat that it is to society with economic
wellbeing.
And what is highest on that list are three health-related
areas: Chronic disease, pandemics, and some of the threats that
Dr. McArthur mentioned related to climate change. It is higher
than some of the economic collapse items that are there, yet
the world does not invest the same in the fundamentals of
health and economic wellbeing to help prevent those risks.
So what we are trying to do is integrate some of the
activities that I mentioned. With tuberculosis, we cannot do
this alone. Multiple-drug-resistant tuberculosis could come
into the United States. It could threaten the world in a
broader way. In areas that we have heard in the past of
extremely drug-resistant tuberculosis, that has been a threat
for communicable disease.
Chronic disease, mostly, at this juncture, it tends to be
diabetes, but notwithstanding tobacco use and the Framework
Convention on Tobacco Control, another piece that was heralded
by both the United Nations and World Health Organization, with
their authority, where also countries could help make a
difference in preventing cancer and prevent treatment for
mortality, morbidity related to tobacco.
And then thirdly, health literacy. United Nations
resolution last year relating to health literacy can make a
major difference in better health outcomes; has spearheaded
efforts in China, with 66 indicators for health literacy; the
United States national action plan, eight member states in
Europe and other countries that are looking at ways that if we
just educate and give people the knowledge and the skills and
simplify the demands and complexity of the system, we can also
have better health outcomes and better economic wellbeing.
So those are the three areas that I think could help make a
difference and really do link the overall security and economic
connection to the MDGs.
Mr. Carnahan. Okay.
And Mr. Roberts?
Mr. Roberts. Thank you.
Since the end of the World War II, really the best ally and
friend of people all over the world has been a strong United
States--strong economically, diplomatically, and militarily.
The United States has kept the air and sea lanes open, which
has spurred globalization. And that globalization, that
investment in trade, has been what has really helped people and
lifted them out of poverty. And it has been hundreds of
millions of people, as I am sure no one would disagree with.
And those flows, the investment in trade flows dwarf a combined
ODA of the whole world, as you also know.
But the biggest threat right now to the United States'
national security are the deficits in this country that could
lead to our financial ruin. Cutting ODA will be only one of
probably thousands of budget and spending cuts, difficult and
painful, that Congress will likely have to confront in order to
restore U.S. economic prosperity.
Thank you.
Mr. Carnahan. Thank you.
Now I would like to recognize our ranking member, Mr.
Rohrabacher.
Mr. Rohrabacher. Thank you, Mr. Chairman.
How much is it that you think that we should be spending
that we are not spending?
I mean, Dr. McArthur, you were relatively hard on your
country here, in terms of ``We are not doing our''--so what
level of spending are we at now, and what would you want us to
spend at?
Mr. McArthur. The international commitment is to 0.7
percent.
Mr. Rohrabacher. No, no, no, no, the actual amount. I mean,
I am not talking about--I understand it is a percentage of your
economy. No. How much do we spend now? How much do you want us
to spend?
Mr. McArthur. Right. So the numbers would be--current
development assistance is on the order of $30 billion. I can
get the specifics.
Mr. Rohrabacher. Okay. So, currently, we spend $30 billion.
Mr. McArthur. Right.
Mr. Rohrabacher. And you would want us to spend?
Mr. McArthur. It would be closer to $100 billion.
Mr. Rohrabacher. Closer to $100 billion. Okay.
And when you are talking about our contribution to the
world, you are not including some of the things Mr. Roberts was
alluding to, that we send our military forces throughout the
world in order to prevent conflicts from overwhelming regions.
Mr. McArthur. I should clarify, those are----
Mr. Rohrabacher. Because we spent $1 trillion in Iraq.
Mr. McArthur. Right.
Mr. Rohrabacher. Okay. And we are spending, you know,
hundreds of billions of dollars in Afghanistan. And you don't
count that, really, as a contribution. You think it has to be
in the form of grain seed.
Mr. McArthur. That is not what I said, Congressman, excuse
me.
Mr. Rohrabacher. Okay.
Mr. McArthur. Just to clarify, I think we are talking about
complementary strategies. And so that is why I think the
testimony of Secretary Gates is so important, because we are
talking about both security and development and development for
security. The reality is that there is about a 30:1 ratio of
the military expenditures to the development expenditures.
No one is questioning the importance of the defense
spending; far from it. What we are talking about----
Mr. Rohrabacher. Yeah. I read Secretary Gates's remarks,
and let me just note, it does exemplify the difference in
approach that people, honest people, have----
Mr. McArthur. Right.
Mr. Rohrabacher [continuing]. In terms of how to find
prosperity and peace in the world.
I think that Secretary Gates does not fully and other
people have not fully understood that Adolph Hitler came from a
developed country, the communists who were in power generally
came from upper-middle-income families and upper-income
families, and the radical Islamic movement today is not fed on
poverty but instead on fanaticism that is being financed by
some of the wealthiest groups of people on the planet. And so I
would disagree with him that poverty leads to this type of
national security challenges that we face today.
Now, we can still believe that it is the humanitarian
responsibility of people who have been blessed to live in free
societies and have prosperity to help those in less free
societies. I disagree with them as that is a strategy for a
more peaceful world.
Let me just go back--and, with all due respect, Doctor, the
idea that you presented, this image of, well, what they really
need is a sack of fertilizer, is probably the most naive
approach that leads to the waste of huge amounts of money that
should be going to improve people's lives.
Frankly, that a sack of fertilizer in most of these
developing countries will lead--even if it leads to a little
bit more production by that farmer, no, it is not growing a
better crop. It happens to be also that people are taking
bribes and demanding bribes from that farmer; the people who
are stealing from that farmer legally and illegally; the lack
of transportation because the money in that country, instead of
going to transportation, has gone into the pockets of corrupt
officials; the fact that they don't have clean water because
those same corrupt officials have pocketed that money. No, it
is not a sack of fertilizer.
And until we begin realizing that those type of problems,
which Mr. Robertsoutlined, those things have more to do with
the poverty than does the lack of sack of fertilizer. And from
$30 billion to $100 billion may provide more fertilizer for
those farmers at our expense, at the expense of our kids here--
we are going to borrow that extra $70 billion, we are going to
borrow it from China in order to help these people. And I would
submit to you that that will not improve the life of those
people that you are intending it to and will actually bring
down the quality of life of our own people.
Let me ask you this. About the people who run these
programs, we are talking about--by the way, let me congratulate
anybody around the world, anybody personally and anyone here
domestically, who is engaged in helping other people with their
own resources. And George Soros is a mixed bag. I mean, George
Soros manipulated the currency in various developing countries,
impoverishing certain people in those countries, but at the
same time he has been a great contributor to various
humanitarian causes. And I realize there is--when you are
talking about him, but Ted Turner has done some wonderful
things. The Bill Gates Foundation has done some wonderful
things. We applaud their activity, especially if they are doing
it unilaterally, on their own, going out and trying to make
their money count.
But when we are talking about these joint programs, how
much money goes into administration? For example, someone who
runs some of the programs that you are talking about, do they
make more money than a congressman makes? How much money do
they make? Do they make over $100,000 a year? Should we set a
cap on any organization that we are in a partnership with that
they won't be paying their executives a certain amount of
money?
So what about the pay level of the people who may just be
sucking off that money that should be going into fertilizer for
that farmer in Africa?
Mr. McArthur. I am very glad you raised these points, so
thank you.
And I would say, first of all, no one is advocating money
for process, and no one is advocating a penny go to corruption.
And that has to be very clear. This is about results and
direct, auditable, monitorable, deliverable targets that you
can do a spot-check on to make sure it is happening where it
should.
That has been the great success, I would say, of the
President's Emergency Program for AIDS Relief, which the
Congress had played such a crucial role on, as it was about
actually making sure that those people get the antiretroviral
medicines. And this was deemed, less than a decade ago, as you
know, I am sure, much better than me, impossible. And now we
have 5 million people on AIDS treatment, thanks to a
breakthrough program where it was about auditable results and
delivery metrics.
For fertilizer and so forth, I actually, with utmost
respect, have a different read on history, where throughout
Asia, going back to Korea in the 1930s, Taiwan in the 1920s,
India and Pakistan in the 1960s, every single case of economic
takeoff that wasn't about discovering a mine was linked to
strong public support, public investments in agriculture, in
smallholder agriculture.
Norman Borlaug, the Nobel laureate who won the Presidential
Medal of Freedom, was the great leader, with M.S. Swaminathan,
around India at making sure, literally, that farmers got
fertilizer and seed. Literally, that was the program. So, with
utmost respect, I don't think it is a naive view; I believe it
is a practical view, linked to actually what is the
monitorable, auditable program delivery target. And, in Malawi,
the government has used a voucher system, with even biometrics
in place, to make sure this is an efficient system. And that
has been a breakthrough in a country that was previously
considered the perfect storm of disasters.
So I think we need to have a very hardheaded approach. And,
with full candor, I used to write the Global Competitiveness
Report, I am a macroeconomist, I believe in economic growth as
much as anyone. But what I am supporting is a view that thinks
through: What are the investments required to support robust,
long-term economic growth in the poorest countries while
solving the practical problems?
I believe that we have to be focusing on programs first,
direct commodities. We have to be using local staff. This is
not about armies of aid workers going from the rich countries;
this is about local programs. In the Millennium Village
project, all of these staff in Africa are African. And that is
a very crucial component of our work, because there is so much
expertise that just needs to be empowered by tools.
I was in Tanzania a few weeks ago, and I was with a farmer
who had 6 years of primary school education, who was a
community health worker, with a cell phone treating malaria in
front of my eyes with new technologies. This is something that
would never have been possible if it weren't for the
Presidential Malaria Initiative or The Global Fund to make
malaria treatment possible.
Mr. Rohrabacher. Thank you very much. I think my time has
about expired. But let me note that we still have a
disagreement, but it was a good comeback.
Mr. McArthur. Thank you.
Mr. Rohrabacher. And I will also note that malaria--I mean,
what has been said about malaria today, it hasn't escaped many
of us that when you get involved with these global projects and
government programs, that the politically correct attitudes on
things tend to take hold. And many of us believe that the
malaria epidemic that we are facing now can be traced right
back to the politically correct science of eliminating DDT,
which, once it was eliminated by people who have these
politically correct notions, we saw a massive increase in the
death of children in Africa.
And so we are talking about millions of children here who
have lost their lives by people who, of course, are part of
this very benevolent approach but mindset, liberal mindset,
that has outlawed DDT in order to protect the thickness of bird
shells--yes.
Thank you very much.
Mr. Carnahan. I certainly enjoy the debate and discussion
and give-and-take of this committee. I thank the gentleman and
thank our witnesses.
I want to talk about a success that has been mentioned here
with regard to the Global Polio Eradication Initiative and the
work that has been done with Rotary International, WHO, CDC,
and UNICEF.
If you can comment on the success of that program that has
seen polio plummet 99 percent since 1988 and what is needed to
make that final push in the four remaining endemic countries--
Afghanistan, India, Nigeria, Pakistan. And, finally, what
lessons can we learn from that program that we can apply to
some of these others that are just really getting started?
And I am going to reverse the order this time and start
with Mr. Roberts.
Mr. Roberts. I would have to do some research on some of
the specifics. I would refer the committee to the many
scholarly works of Professor William Easterly at NYU, who is
probably one of the best, most solid, robust economists who has
written critically about these issues.
I would also note just in passing that the PEPFAR is a good
example of a program that worked well. And I think it did
because it was private money and it was private corporate
management methods that were brought into the government and it
was fenced off from the rest of the government. And I think
that that is--it was a good example of a program that worked.
Although, as I have mentioned in my testimony, we have to make
very difficult choices because of the budgetary reality we
face.
Thank you, sir.
Mr. Carnahan. Thank you.
Dr. Ratzan?
Mr. Ratzan. Thank you, Mr. Chairman. That is a very
important question and something that, unfortunately, we have
been unable to end polio in the last century.
And, ironically, I also edit the Journal of Health
Communication, and we just did a whole supplement----
Mr. Carnahan. Is there anything you don't do?
Mr. Ratzan. Thanks. We did a whole supplement with USAID
and George Washington University Global Health on polio
communication and what are the final challenges, to answer that
question directly.
And I can't summarize the hundred pages from experts in a
peer-reviewed publication. But what I can say is that some of
the fundamental areas that would help make a difference would
be better communication--and, most particularly, this is
political-level communication--to get the leadership and
community-based leaders able to understand the value of the
polio vaccination. And that has been a very large challenge,
not only with the anti-vaccine lobby, frankly, here in the
United States, but really globally, the whole idea of vaccines
making a difference in the challenge are continuing to be not
only for polio but for other vaccine-preventible illnesses.
And then finally I think--and I do believe that the work at
USAID and others have been quite successful in working in this
public-private partnership. But we need to continue to support
to end polio. And part of that, again, is both political
communication as well as efforts on the ground with community-
based efforts.
Mr. Carnahan. Thank you.
Dr. McArthur?
Mr. McArthur. I am not an expert on polio, but I can say,
the general lesson on that program and others is that you have
a few basic steps that come together. One is you have
implementation of known technologies. The vaccine is very
important. Two is you have developing-country-driven national
implementation strategies. That developing-country ownership is
central--and accountability.
Third is that you have those national strategies regularly
and rigorously evaluated through independent technical review.
Fourth is that those programs are driven by a clear emphasis on
performance metrics, so there are delivery targets that
everyone is accountable for.
And then, fifth, they have adequate finance through, in
this instance, a blend of public and private sectors. But we
can't expect these programs to be implemented in the absence of
adequate finance. And so the dollars are not about throwing
dollars; they are about funding very practical mechanisms.
Mr. Carnahan. Ms. Calvin?
Ms. Calvin. I would be happy to add a few lessons.
The U.N. Foundation has been involved in the fight against
polio since its inception. But, you know, really, the Rotary
International deserves the largest credit here for jumping on
this in 1988 with the World Health Organization.
I would say the most important thing that was done
initially was that a goal was set and that the world rallied
around it, following on the success of smallpox elimination,
which, prior to polio, was the only major disease ever
eliminated in the United States, in the world.
Second, an infrastructure was built that we have since
built upon to eliminate measles and other diseases, and to
build a health systems infrastructure that now works in the
countries where polio is done.
And third, because it was public and private, Rotary showed
it is not just the money that they could raise in this country
and around the world--and they have raised over $600 million--
but it is that they use their volunteers around the world to
help deliver the vaccine. And that made a huge difference.
The hurdles have been cultural. At some point, if someone
went to the annual pilgrimage and exposed others at the Hajj to
polio, and Saudi Arabia responded by having a rule now that you
can't come to the Hajj unless you have had polio vaccination.
And they have stepped up to help eliminate it in the Muslim
areas where it has been endemic. We need every country to
realize how important it is that we reach this goal. And we see
that, in the countries where it is still endemic, which tend to
have largely Muslim populations, the religious leaders have
been both initially the problem and now are helping us get to
that final stage.
We think we will get there. It has taken also some efforts
to refresh the campaign. And the Gates Foundation most recently
stepped in to really make this a major effort and initiative of
theirs, making this point that the public-private partnership
is what really multiplies the impact of U.S. money.
And the U.S. has been the biggest donor in this space, and
I would say this is an investment well worth making.
Mr. Carnahan. Thank you.
Mr. Rohrabacher?
Mr. Rohrabacher. I didn't quite get the--we covered some of
the other areas of my question, so I didn't quite get to the
salaries of people.
Should we have a cap on salaries for people? But private
institutions, if they want to pay their people $250,000,
$300,000 a year, that is their business, as long as they are
doing that independently of government. But if you have an
institution that is in partnership with government, should we
not have a cap on salaries for these charitable institutions so
that the people there are not making more than their
counterparts in government?
Ms. Calvin. Well, I don't believe in a cap, myself. I
believe in disclosure, I believe in measurement and
accountability, and I believe in reform.
And I think part of what USAID should be all about is
making sure that our investments around the world are done in
the best possible fashion. I think it is important that we are
doing the Foreign Assistance Act to look at that. I don't think
a cap is necessarily the right solution in every case, because
I don't even know how you would pick it.
Mr. Rohrabacher. Okay, so you don't believe that we should
have a--if the government is going to go into a partnership
with a private organization, that we should require that that
private organization does not consume its resources on salaries
for its top executives at a level that is higher than what you
find in the government.
Ms. Calvin. Oh, I agree with what you are saying. I just
don't know if a cap is the right answer to that. I think that
absolutely should be one of the judgment measurements.
Mr. Rohrabacher. So you are against that.
Dr. McArthur?
Mr. McArthur. Are you referring to organizations in the
advanced countries or in the local economy?
Mr. Rohrabacher. I am talking about people where we have
been talking about partnerships between private groups and
government, at our level and at international level. Should
there be a cap on the pay levels of those private organizations
if, indeed, they are going into this partnership?
And, by the way, if they aren't in a partnership, they can
pay whatever they darn well want. But if we are talking about
partnership here today, if that is what you are advocating,
would you advocate that we put a cap on the salaries of those
top people in those organizations so that they aren't making
more money than their government counterparts?
Mr. McArthur. It is a question I don't have a specific
answer to. I would say----
Mr. Rohrabacher. Your answer is no. If you don't have a
specific answer, it is no. Because this is a policy, and so, if
you are not for it, that means you are not for the policy.
Mr. McArthur. Well, I would be happy to follow up with you
on it to think through all the mechanics of what it could
include, because I think it is a very important question. I
have spent a lot of time thinking about what different salary
scales could look like based on value for money. And whether it
is hiring a community health worker who is a farmer part-time
in a village, whether it is a Ph.D. working in rural Africa who
is a local African Ph.D.----
Mr. Rohrabacher. I am actually talking more about your
organizations, not the guys down in Africa. I am saying, should
people who work for--if the Turner Foundation and other groups
that are in private sector here are going to be partners with
the U.S. Government, should we expect that the money that they
are consuming as part of that charitable operation not be
consumed via top-level salaries as compared to--and the
standard you would use would be their counterparts in the
public sector.
Mr. McArthur. Right. So I would say to that that any public
funding that goes through a partner organization, it makes good
sense to me that that be aligned with U.S. Government salary
pay scales. If it is a privately funded organization where
private supporters want to pay at their discretion----
Mr. Rohrabacher. I understand. But you are----
Mr. McArthur. I am dividing it. I am segmenting the
problem.
Mr. Rohrabacher. Yeah, yeah, right. The fact is that if you
are in a partnership, you are--that the program--your programs
are tied. And I am just saying, if you are going to tie your
programs, should we not also tie how much money is being
consumed for upper-level salaries?
Doctor, what would you say?
And by the way, let me just note, I commended the Turner
Foundation and others. I forgot to say Johnson and Johnson
Foundation. Because you guys are doing terrific work, and you
can be proud of the good things that your company and the
foundation of Johnson and Johnson has been doing. You have
expressed that today, and we have heard that, and that is
wonderful. So, pardon me for not adding you on the list of
people to commend.
Mr. Ratzan. Thank you very much, Congressman Rohrabacher.
In response to your question, I think we have to look at
this very broad issue of how health care and health services
are delivered throughout the world. And, frankly, a lot of it
is delivered through the private sector. So the partnership
might be, in some cases, public funding and private-sector
delivery; other cases, it is private-sector funding and then
public-sector interventions and research and so forth.
So there is no one solution that exists. And we are always
seeking out the best-quality people and resources throughout
the world. And, with that, you know, free-market activities
clearly are in place.
Mr. Rohrabacher. So let's get down to the basic question.
If you are in a partnership, if you have a private foundation
or whatever it is in partnership, as we are advocating today,
as a joint effort with government, should the government put a
cap in saying, ``We are not going to be in partnership with a
charitable organization that pays its top-level executives more
than their government counterparts''?
Mr. Ratzan. We don't get into the governance nor a litmus
test of partnerships based upon funding at that level, so we
would not advocate for that.
Mr. Rohrabacher. Okay. But we do actually take a look. The
government does say, ``Well, here is a foundation that is
spending 90 percent of its money'' or 75 percent or whatever,
``they are consuming it among their own executives; thus, we
are not going to get in a partnership with them,'' I am sure
that happens. So that has been a no, as well.
Now, Mr. Roberts.
Mr. Roberts. Well, Congressman, it might not come as a
surprise to you that I would say, yes, that they would have to
be bound. And I think your point--and I am sure you know this
better than I--that what you are illustrating is a larger
problem and real threat and danger, and that is of a creeping
cronyism, of a state corporatism that we are seeing with these
public-private ideas, a corporate social responsibility. It is
really the government trying to take over, in a sense, these
assets that are privately held that belong to shareholders.
And so, of course, we oppose that at Heritage, as you
would----
Mr. Rohrabacher. Okay. Let me just note, and I know my time
has been used up here, but just a little story that really
indicates why I think this thing.
Years ago, when I was 19, I spent some time with some
projects in Vietnam. And it was a long time ago, different
life. And I had been up in the central highlands, and I was
really, you know, just a long way from home. And I was taking a
flight to Bangkok, and I met a guy on the airplane, and he
said, ``Hey, where are you coming from?'' And I told him I was
up there with the Montagnards and all this stuff, and he said,
``Well, you know, my wife''--he is American. He said, ``My wife
actually can cook a great American meal. Would you like to come
over for some meatloaf at my house?'' Oh, yes, that is
terrific, okay, I would love to have it.
So I went over to--this guy was the head of UNICEF, I think
it was, okay, in Bangkok. So I said, ``Well, we will catch a
cab,'' and he said, ``Oh, no, no, no, I have a car.'' Oh, he
had a car. He had a car, he had a driver, and it was a big car.
So we got in the car, and we went to his--not his little
house--his huge house with the fence around it and the
servants.
And then--look, I am sure he is a wonderful guy. And the
money that was going for these children's activities in
Thailand, I am sure he took his job seriously. But he was
consuming a lot of that money himself. And he had a driver, he
had a doorman, he had a cook, he had a housekeeper, he had a
big house.
And when we went in, in the middle of the meal, he says,
``You know, how would you guys like some good whiskey?'' I
said, well, all right. You know, I had been drinking this rice
wine they have up where the Montagnards--in the central
highlands. So, yeah, good whiskey, all right.
He says, ``Come with me.'' And he grabbed me by the arm,
and we went out into the garage. And there were all these cases
in the garage. And they were these boxes, these boxes made out
of wood, and they had ``children's books,'' ``UNICEF children's
books,'' on the side of it. And he grabbed one, said, ``Help me
down with this.'' And he opened it up, and it was filled with
whiskey.
Now, all I am saying is that, you know, if we don't watch
out, the people who are actually running the programs in a lot
of these areas, what we have found is that a lot of the times
people come in and they say, ``Well, we spent this much money
in this area,'' it has really been consumed by the management
of the organization. And you have to pay attention to that.
If we really are serious and we want to help people, you
can't just sit here and say, ``We really have to raise the
money from $30 billion to $100 billion.'' That may not make any
impact at all, except at the debt level of these young people
who are in the audience.
And we have to have the courage to look at things and
especially have the courage to say, yeah, I don't think we
should pay people--if this is going to be a charitable
operation, those involved should be contributing to that
charitable operation by actually receiving less pay than they
would if they went into another endeavor. That is their
contribution.
Thank you, Mr. Chairman.
Mr. Carnahan. Thank you.
And I want to go on to another tack. And I guess I would
like to ask the witnesses: With the 5 years left to achieve the
MDGs, certainly we can all make the case that all of them are
critically important. But given our limited time and limited
resources, I would like to ask you to prioritize what you think
would be the most critical and the most achievable in these
remaining 5 years.
Ms. Calvin, let's start with you.
Ms. Calvin. Well, I will pick up on the last conversation
to say, not only do we need more money for all of this work,
but we need to get more for our money. So, more health for the
money I think is the mission and the goal for the next 5 years.
Vaccine interventions are probably going to be one of the
most important pieces of that. We know that with vaccine
interventions we can prevent 8 million more deaths between now
and 2020. So, anything we can do to encourage the research and
development, distribution, and uptake on vaccinations and
immunizations around the world is critical.
Second, I would say a focus on women and girls--which, Mr.
Chairman, I know you did a hearing on this just a few weeks
ago--is essential. I think we have all learned that if you can
keep a girl in school, if you can prevent her from marrying too
early, if you can give her the opportunity to structure and
create her own life, you have not only impacted her and her
family but also her whole village. And so I think a whole focus
and a lens looking at ensuring that women and girls, and
particularly adolescent girls, are taken care of is essential.
Third, I think we need to look at all of the goals in an
integrated fashion. The goals were set up as eight individual
goals, but, to some degree, they work most effectively and
countries and public-private partnerships will work most
effectively if we can integrate our approaches and, again, get
the most for our money.
Fourth, I would say technology and the use of new modern
technologies, whether it is mobile phones or others, is
essential. And we have been negligent, not using that and
thinking that we needed investments financially. There are many
innovative solutions that ought to be taken forward, and we
would encourage that.
Finally, goal 8 is something that we don't talk about as
often as we talk about 1 through 7, and that is the one that
has to do with trade and debt. And I think it is as important
for this country to focus on those issues and help other
countries move forward economically if we can.
And fifth, I think, as Dr. McArthur said, the Millennium
Development Goals are not just the U.N.'S goals, not just
America's goals, they are everyone's goals. So, to the degree
that there is an approach to these goals that everyone can
adopt--and I think that is why we have young people sitting in
this room; they understand that these are the goals that will
affect their future--that is the way we need to approach it.
Thank you.
Mr. Carnahan. Dr. McArthur?
Mr. McArthur. Thank you, Mr. Chairman. It is a great
question.
I would just submit that we have to avoid false choices
when thinking through the goals. Just like, in my view, we
should not make false choices between development and security,
we have to think of both together, we have to think of fiscal
stability and investments for the medium and long term. The
goals are holistic, not just as a package, but also because
they are essentially for self-reinforcing activities.
So if you want to cut child mortality, clean drinking water
is crucial. If you want to cut maternal mortality, girls'
education is crucial. And vice versa. So those are very much a
package, which is why we have to be careful not to cherry-pick.
I liken it to saying whether I want my heart, my lungs, my
liver, or my brain. I actually think I need all of them to
function as a human being. Economies and societies need health,
education, food, infrastructure, and so forth.
So I think the holistic underpinning of the goals is
essential. But back to Congressman Rohrabacher's point, I think
the goal-based element is crucial. This isn't about anything
other than delivery targets, in the end. And every resource
allocation should be linked to outcomes through action areas.
And I think that is exactly the perfect logic for this.
With all of those points in mind, if I were to pick the
areas that I think could make the greatest breakthroughs in the
next few years, remembering how many breakthroughs have
happened in the past 10 years and 5 years that we all thought
were--or many people thought were just too hard, I think in
agriculture, again, this is an area where the world can make a
tremendous breakthrough. Africa as a continent could basically
double its food production within 5 years. This is an
extraordinary biophysical reality that we have not yet got our
heads around as a global community.
We could have, second, a major breakthrough, I would say,
in health systems and maternal health and child health, not by
paying high salaries to people from rich countries, but by
training millions of community health workers with very basic
skills--it is called ``task shifting''--so that they can do the
simple life-saving interventions, so that if that mother is
about to deliver, they get to the clinic where that skilled
birth attendant is. It is not just about the skilled birth
attendant, but actually getting them to that skilled birth
attendant if they are prepared to deliver at home.
And then a third thing I would stress is the girls'
education, and really emphasizing secondary education, which
has so many transformative effects for health, for economic
growth, for broader economic activity in a society.
I don't want to say we don't need economic infrastructure,
we don't need roads, we don't need ports, we don't need energy,
because that is where the growth will come from. It will
probably take a little longer for the international community
to get its head around those systems that are needed--and also
for water, which is technically probably the toughest problem
because drinking water is only a small share of the uses of
water. We are going have to have a lot better water systems for
agriculture, for industrial use, and so forth.
But those would be my general recommendations on how to
think through the breakthroughs that can happen in the next 5
years.
Mr. Carnahan. Thank you.
Dr. Ratzan?
Mr. Ratzan. Thank you for the opportunity on this regard of
what can be done.
I think the previous witnesses have certainly talked about
the holistic approach, and clearly that is necessary. And I
know there is consideration with the Global Health Initiative
of giving some flexibility for formation of public-private
initiatives that could help address some of the areas that are
both health-related, education-related, environment-related,
and so forth.
And when I look at the Millennium Development Goals, for
example, Millennium Development Goal 1 on poverty and hunger,
amongst that it has nutrition-related factors and deworming.
Those, frankly, have not got the same level of partnerships as
maybe infectious disease has in the past.
Millennium Development Goal 2 of course dealing with
education, again, the idea of health literacy, the opportunity
to empower women and mothers and fathers and so forth to have
the information and skills to demand appropriate health
services and to get the--whether it be clean water or
transference and choice of vaccines and so forth.
Millennium Development 3, gender equality and empowerment--
clearly, that is quite important. Also with health areas in
terms of HIV and giving women the opportunity, not only with
microbicides but others, of preventing mother-to-child
transmission. Child mortality obviously is broad and obviously
a big emphasis that we have.
HIV/AIDS, malaria, and other diseases, number six. I think
we can make a difference in preventing mother-to-child
transmission. And the charge that happened last week at the
United Nations and WHO to eliminate this by 2015 is achievable
if we put the right emphasis in funds and technical resources
there, as well as helping foster the kind of research necessary
for it.
Amongst that I think we need to presage the next phase,
post-2015, when we will have new interventions for HIV, such as
preexposure prophylaxis, preventing HIV not just by choice of
behaviors but also by having technological and medical
interventions with new medicines that could be delivered. And
similarly with tuberculosis, of being able to shorten whether
it be course of therapy or also the transmission thereof.
And then, finally, I think the last two, with whether it be
environmental sustainability or trade and debt, these are very,
very important, that we need to think about. That, again,
infectious disease has no borders, and whether it be SARS,
whether it be a swine or H1N1 or H5N1, whatever might be there,
it is not if this happens, it is when it happens.
And these require fundamental health systems that are
functioning and in place and something where, while the United
States has fundamentally been leading this with the Centers for
Disease Control and Prevention and our epidemiologic service
and so forth, we nonetheless also have to have the kind of
fundamental health diplomacy that is the holistic approach of
being able to work with both governments, with public health
authorities, community health leaders and others to address
future health scourges.
So I would say, again, any investment in health is a wise
investment. I think it will pay back not only United States but
really, most importantly, the health of individuals and
citizens throughout the world. And it is a positive opportunity
to be able to speak and share this today. And hopefully we can
continue to have this global investment.
Mr. Carnahan. Okay. Thank you.
Mr. Roberts?
Mr. Roberts. Thank you, Mr. Chairman.
I certainly don't want to minimize the suffering of the
poor, but I do want to note that bureaucrats all over the world
are always creating action-forcing--artificial action-forcing
deadlines, such has this 5-year deadline. And I say that as a
former bureaucrat myself. But I recall the Copenhagen climate
change commitment and that deadline, with a drop-dead date last
December. Well, all that went by the wayside when China and
India refused to go along and, at the same time, the
Climategate scandal broke.
And so, I think we should solve these problems as quickly
as we can and we are financially capable of doing. And, of
course, I go back to the recommendations that were in my
testimony for the best way to do it.
Thank you.
Mr. Carnahan. Mr. Rohrabacher?
Mr. Rohrabacher. Thank you very much.
What we are talking about, basically, is providing a
service to the world's poorest people and people who live in
deprivation, and usually the deprivation coincides with the
fact they also live under tyranny and under a corrupt
government. Inoculations, clean water, deworming--all of these
basically are services that should be provided by once's own
government or should be provided with their local government
working in coordination with private-sector groups, such as
your own.
If we provide the services, if these young people are
burdened with more debt, especially if we end up borrowing the
money to provide these services and then expect these young
people to pay taxes on it for the rest of their lives in order
to provide these services on an ongoing basis, doesn't this
mean that, unless there is the reform that Mr. Roberts is
talking about in their society, that as soon as we quit
providing the services, the worms will come back and the
diseases will come back and the dirty water will come back.
Isn't that the case? Unless there is the reform he is
talking about, no matter what we do temporarily to alleviate
the current suffering, are we not just saddling our young
people with this monstrous burden of debt in order just to
provide something that is going to go right back to its bad
state anyway? Is that not the case?
Go right ahead.
Ms. Calvin. Well, I will take on a couple of those.
I mean, I hear exactly what you are saying, and probably
the biggest buzzword in this whole area is ``sustainability,''
to make sure that anything that is done has a chance for being
carried forward in the future.
So, a couple of things. Obviously, we did eradicate
smallpox. And systems were kept in place to ensure that it
didn't come in back. So that has to be a goal that is put into
every program.
Mr. Rohrabacher. It hasn't come back yet.
Ms. Calvin. It hasn't come back yet.
Mr. Rohrabacher. But the fact is that if we are not
successful in much of the Third World, it will come back, just
like malaria was almost eliminated, as well, correct? I mean,
malaria almost disappeared. Now, I mentioned that--well, I
think it was pretty well attacked in Africa, as well. So the
rates of malaria now have not gone up in the last 10 years in
Africa? Yeah, they have dramatically risen in Africa in the
last 10 years. Not that we have eliminated it, but the fact is
that the DDT decision--but that is different than the point I
am making.
Ms. Calvin. So I want to agree with your point, basically,
because I think you are right, that this is the most important
thing. So things like The Global Fund, which requires countries
to submit a plan--and the plan is not just to get the money for
the services they are seeking, but it is to show a plan for how
they will continue the program going forward, how they will be
investing increasing parts of their own resources to make this
a country-led plan in the future. So I think that is a shift
that we are seeing in----
Mr. Rohrabacher. So the corrupt dictator someplace in one
of these despotic little countries, the corrupt dictator, he
has to make that deal. But do you know what happens when you
are dealing with people who have the morality level that they
murder their own people because they might have said something
in opposition to the government? Do you know what the morality
level--do you know what the chances of that leader keeping his
word is? Almost zero, because he has no morality.
There are large numbers of people in power in various parts
of the world who murder their own constituents, you might say,
if there was any threat to their power. And they are not going
to keep their word on that anyway.
So, in the end, I would hope that, yes--by the way, the
deworming thing is a very--and clean water, all of these things
are very easily seen as a horrendous condition that poor people
around the world find themselves. Their children end up with
worms, and, like you say, it affects their ability to deal in
school. We know that without clean water, it just saps the
ability of people to live a healthy life and, thus, have
progress in their society. So--and inoculations, I mean, it
goes unsaid.
But, in the end, these are services that their government
is supposed to provide and they are not doing it. And most of
the time, we are just suggesting, I think Mr. Robertsis
suggesting, most of the time that is tied to the corruption and
despotism of their own government. And until that changes, all
we can do is temporarily alleviate some suffering. And whether
or not the temporary alleviating of suffering is worth the type
of major expenditures that we are talking about, I am not sure,
unless it is coupled--now, by the way, you have made the point
that we are talking about specific goals. But the specific
goals in eliminating that suffering for now is not necessarily
eliminating the fundamental cause of the problem, which was
outlined by Mr. Roberts.
And, Dr. McArthur, you have always had good comebacks, so
go right ahead.
Mr. McArthur. I don't want to disappoint.
Just on the malaria bit--again, happy to follow up with you
after that--the ecological factors affecting malaria
transmission in Africa are actually different. So it never had
the same inroads because it is actually a denser parasite
there, in effect. So it is actually a unique case, which is why
the breakthroughs now are the first time we have ever had it in
the scale we have had.
In terms of the points on corruption, I would only want to
agree on the principle, but differing the application of its
logic. So, corruption should be a vetting factor, and I would
never advocate supporting dollars going to a disappearance act.
That is absolutely the opposite of the point.
I think we need to segment the developing countries in a
couple of ways. One is the very poor versus the up-and-coming.
I, roughly speaking, would draw the line at about $1,000 per
capita income. So India, for example, is in the process of
graduating from development assistance, and that is a great
success. The countries that are at $200 per capita, $300 per
capita income, they can't even afford, if they had every penny
in their budget put to these things that you just described,
they can't afford that.
And so we need to segment to the second criteria on the
countries that are committed to doing this, like that Malis
that just democratically reelected President Toure, a terrific
leader, like President Mutharika, democratically reelected,
great support. And we need to help them implement the programs
with all the accountability structures we have described.
So if we think about the qualification hurdles of
commitment and poverty, then we help support the integrated set
of activities that help a country escape extreme poverty
through growth, health, infrastructure, education, and so
forth--and it has to be a joint venture strategy. It is not us
bringing in all the resources. It is a joint financing
strategy, theirs and the international community's. That is
where we start to see real results, in our experience.
I would just flag one final point. If we look at the
questions of the deficit and the debt, the absolute values of
the dollars we are talking about, I wish they were at the scale
that were affecting those calculations in a real way. Again, we
are talking about in an era of 10 percent of GNP deficits, down
to 9 percent in the latest projections, we are talking about
increasing by a few tenths of a point of a percent.
Total U.S. Assistance to Africa was about $7.5 billion in
2009--$7.5 billion. It is almost rounding error for most
budgets. Compare that to any normal aggregate that we read
about in the papers these days. The Wall Street bonuses alone
in 2009 were $20 billion. So, whatever one might think of those
bonuses, that reflects how these resources are actually being
allocated in any aggregate scale.
And so I think we need to understand that there are very
small amounts of money--total global assistance to Africa from
all the countries put together works out to about $45 per
African. And that is to pay for everything.
So I think it has to be, as you said, goal-based, targeted,
outcome-driven, owned by national countries, joint financed,
and then that is where we will see the breakthrough results
continuing.
Mr. Rohrabacher. Well, you know, a billion here and a
billion there, and pretty soon you are talking about real
money.
Mr. McArthur. I agree.
Mr. Rohrabacher. As to paraphrase our good friend Everett
Dirksen.
Just one thought on the bonuses. I happen to have been
author of a piece of legislation that unfortunately didn't get
anywhere, that any company that provided bonuses to their
senior executives, the executives had to give that back before
they could receive any support from the Federal Government in
the form of bailouts.
Unfortunately, the people giving these bailouts decided not
to put that restriction on, just, as I might add, there are
some people who don't want to put caps on the amount of money
that is paid to executives who are partners of the United
States but in a charitable institution.
Thank you very much, Mr. Chairman.
Mr. Carnahan. Thank you.
And I just want to thank our panel today for illuminating
us on these initiatives, the public and private partnerships
that we have heard some great success stories but also some
continuing challenges and I think a variety of different
approaches, that we all need to be part of this debate.
So thanks to all of you. Thanks to those of you who
attended, especially the young people here. This is really
important for you and your futures, as well. So thank you all
for being here.
We are adjourned.
[Whereupon, at 11:28 a.m., the subcommittee was adjourned.]
A P P E N D I X
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Material Submitted for the Hearing RecordNotice deg.
Material Submitted for the Record by the Honorable Russ Carnahan, a
Representative in Congress from the State of Missouri, and Chairman,
Subcommittee on International Organizations, Human Rights and Oversight
[Note: ``From Promises to Delivery, Putting Human Rights at the Heart
of the Millennium Development Goals,'' by Amnesty International, and
``Joint Action Plan for Women's and Children's Health, Investing in Our
Common Future,'' Working Papers of the Innovation Working Group, are
not reprinted here but are available in committee records.]