"What exactly does maternal health or immunizations or the fight against HIV and AIDS have to do with foreign policy?" Secretary of State Hillary Rodham Clinton queried a packed crowd
of faculty and students at the Johns Hopkins School of Advance International Studies on Monday. "Well, my answer is 'everything.' "
With a careful nod to the Bush administration's major efforts in global health – the President's Emergency Plan for AIDS Relief (PEPFAR)
and the President's Malaria Initiative
-- Clinton introduced what she called the "next chapter in America's work in health care worldwide" and laid out the basic outline of the Global Health Initiative (GHI)
, a "new approach, informed by new thinking and aimed at new goal: to save the greatest possible number of lives, both by increasing our existing health programs and building upon them to help countries develop their own capacity to improve the health of their own people."
The GHI may be new, but it is not exactly news. Rolled out over the last few months
, GHI will invest $63 billion over the next six years to help partner countries through integrated health systems with a renewed focus on maternal and infant health. The speech at SAIS was meant as a branding of sorts, a popularizing and contextualizing of the massive project.
To do so, Clinton spent the better part of 90 minutes making the case for an integrated, diplomatic approach to global health care policy and the impact of international health on U.S. interests abroad. "From the very beginning of my time as secretary of state," Clinton said during a Q&A session, "I've talked about elevating diplomacy and development alongside defense -- the three D's of 'smart power,' if you will."
Arguing that health is essential to bolstering fragile or failing states, Clinton grounded the GHI in a larger nonpartisan context and the recent history of U.S. global health policy.
"No nation in history has done more to improve global health. We have led the way on some of the greatest health achievements in our time," she told the audience, listing advancements ranging from eradicating smallpox in the 1960s and 1970s to addressing neglected tropical diseases, to preventing and treating malaria.
Today, the secretary explained, "we provide nearly 60 percent -- 60 percent -- of the world's donor funding for HIV and AIDS. All told, 40 percent of the total global funding for development assistance for health comes from the United States. "
But she also made digs at her predecessors. "The United States was once at the forefront of developing and delivering successful family planning programs. But in recent years we have fallen behind. With the Global Health Initiative, we are making up for lost time."
That was a nudge at the Mexico City Policy
-- otherwise known as the global gag rule -- which forbade any U.S. funds from going to a clinic or provider that mentioned abortion, a policy that went above and beyond the Hyde Amendment, which assures no U.S. funds will be used for abortions abroad. (By the summer of 2008, the policy had undermined contraception distribution throughout the developing world.)
Clinton outlined a global-health-supports-security argument, a global-health-as-compassionate-policy argument, and a global-health-as-practical-solution argument.
"We're shifting focus from solving problems, one at a time, to serving people, by considering more fully the circumstances of their lives and ensuring they can get the care they need most over the course of their lifetimes," Clinton explained, and then used an illustrative anecdote about a theoretical rural village woman who can reach a clinic stocked with anti-retroviral medication (to fight HIV) but cannot get antibiotics or contraceptives -- nor can she give birth locally, should her birthing process require intervention. Her children have been protected from malaria, but they may die from dirty water. The moral of the story is one of integrated services and of an assessment of needs on the ground.
"The list of diseases and deficiencies that threaten lives and livelihoods across the world is nearly limitless," she said, "but our resources are not. So therefore we must be strategic and make evidence-based decisions in targeting the most dangerous threats."
Calling for integration, bundling of treatments and coordination, Clinton decried the "vicissitudes of funding cycles and development trends." And, perhaps to quell the concerns of those
who fear the Global Health Initiative will negatively affect PEPFAR, she used the latter as an example of why the GHI would be successful. "We are raising our goal for prevention," she said. "We aim to prevent 12 million new HIV infections. To do that we are embracing a more comprehensive approach and expanding on what we know works. We are moving beyond ABC -- abstinence, be faithful, consistent and correct use of condoms," the phrase is from the Bush era, "to an A to Z approach to prevention. . . . We know we need to confront 2.7 million new infections every year. So in order to win this war, we need better results in prevention. . . . So the immediate impact for PEPFAR is clear. Its funding will increase, its impact will increase, and its prevention strategies will be more comprehensive."
The twitter feed #saisevents was buzzing with commentators throughout and after the event. Mostly positive, there were those, however, who feared Clinton lost a chance for greater substance.
"After the secretary's speech, I have more questions than answers about the Global Health Initiative," Jirair Ratevosian, deputy director of public policy at amfAR, the Foundation for AIDS Research
, tweeted (privately, not on behalf of amFAR) to Politics Daily after the talk. "What are the tangible changes? Budget? Integration?" Agreed Nandini Oomman,
director, HIV/AIDS monitor at the Center for Global Development: "While it was encouraging to hear about the US commitment to global health, the 'HOW' " -- as in how to accomplish these goals -- "isn't being shared and it makes people wonder: why?"