Kaiser Family Foundation

A Reporter's Guide to U.S. Global Health Policy

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U.S. Global Health Policymaking

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The U.S. government has been engaged in international health activities for more than a century, beginning with efforts in the late 1800s to join with other nations to form the first international health organizations, standards, and treaties designed to promote growing international trade and travel while protecting borders from external disease threats.

The U.S. government has been engaged in international health activities for more than a century, beginning with efforts in the late 1800s to join with other nations to form the first international health organizations, standards, and treaties designed to promote growing international trade and travel while protecting borders from external disease threats.

Chart Global health policymaking is currently led by a number of international groups -- including United Nations agencies and independent multilateral organizations -- and bilateral efforts by higher-income countries, with the U.S. playing a primary role. The U.S. serves as a donor to low- and middle-income countries, provides technical assistance, operates programs throughout the world, and leads research and development efforts.

This section provides background and resources on U.S. global health activities, including major health initiatives, and federal agencies and Congressional committees involved in policymaking. More information on the architecture of U.S. global health policy is available here, including a list (.pdf) of senior global health policy leadership positions in the federal government.

 

Health Initiatives

The U.S. government has launched several major global health initiatives in recent years, generally targeting a specific disease or issue and a subset of focus countries. The initiatives -- which increasingly dominate the U.S. approach to global health -- are led by the State Department or USAID, while relying on several other agencies for implementation and coordination. Major initiatives include:

Global Health Initiative (GHI)

In his FY 2010 budget request, President Obama announced the creation of the Global Health Initiative (GHI), which would over six years direct $51 billion to address HIV, TB, and malaria, as well as $12 billion towards other global health problems, including maternal (e.g., pre- and post-natal care) and child health. As part of its consultation process with Congress, partner countries, civil society, other donors and governments, the private sector, and multilateral and international institutions, in February 2010 the Obama administration released a consultation document on implementation of the GHI. The initiative, which so far represents an amalgam of existing programs, centers on the following: women and girls; coordination and integration of programs; strengthening multilateral institutions; encouraging country ownership; strengthening health systems; improving the measurement and monitoring of progress; and promoting research and innovation. Through "GHI Plus," a subset of 20 countries will receive additional funding and technical assistance to accelerate implementation. The GHI includes a number of specific targets related to health outcomes and systems, with a particular focus on women and girls, as well as children.

Media inquiries: There is not yet a lead agency designated for the GHI. Press officers at the State Department can be reached Monday through Saturday until 11:00 p.m. at (202) 647-2492 during work hours or at (202) 647-1512 outside regular work hours. Resources for reporters are available on the State Department web site.

For more information:

President's Emergency Plan for AIDS Relief (PEPFAR)

Originally announced in 2003 by President George W. Bush, PEPFAR is the largest commitment in history by any nation to combat a single disease. Its first five-year authorization was for $15 billion, though Congress appropriated more over that period. The legislation was reauthorized in 2008 at $48 billion for an additional five years. (It was technically renamed the United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act, though is still commonly known as PEPFAR.) The original legislation created the Office of the Global AIDS Coordinator (OGAC) at the State Department, headed by an appointee with the rank of Ambassador. The work of PEPFAR is carried out through a variety of government agencies in addition to the State Department, with the two main ones being USAID and the CDC. Most PEPFAR funding is concentrated in 31 countries heavily affected by HIV, including 15 original "focus countries." It also includes funding for the Global Fund.

Media inquiries: A media representative can be reached at (202) 663-2708. Press releases and other resources for journalists are available here.

For more information:

President's Malaria Initiative (PMI)

The PMI, announced by President Bush in 2005, is a five-year $1.2 billion expansion of the U.S. government's efforts to address malaria in hard hit countries. Its goal is to reduce malaria-related deaths by 50% in 15 focus countries by expanding coverage of malaria prevention and treatment measures to 85% of the most vulnerable populations (i.e., children and pregnant women). The PMI is an interagency initiative led by USAID, and implemented in partnership with the CDC.

Media inquiries: A media representative at USAID can be reached at (202) 712-4320. Press releases and other resources for journalists are available here.

For more information:

Neglected Tropical Diseases Initiative

Announced in 2008, this five-year $350 million initiative seeks to control seven neglected tropical diseases through mass drug administration in Africa, Asia, and Latin America. Led by USAID with additional support from the CDC, the NTD initiative builds on a prior program at USAID that began in 2006. The initiative currently focuses on 12 countries with plans to expand to 30 by 2013.

Media inquiries: Press releases and other resources for journalists are available here.

For more information:

Water for the Poor Act

The Senator Paul Simon Water for the Poor Act of 2005 (WfP Act), passed in 2005, builds on prior U.S. international water and sanitation programs. The WfP Act requires the Secretary of State, in consultation with USAID (the main implementing agency) and other agencies, to develop and implement a strategy "to provide affordable and equitable access to safe water and sanitation in developing countries." Funding for the WfP Act is provided through foreign assistance appropriations at USAID and the Millennium Challenge Corporation (in addition to some funding from the Department of Defense), while USAID operates most bilateral water programs. In March 2009, Senator Richard Durbin (D-Ill.), the original sponsor of the WfP Act, introduced The Paul Simon Water for the World Act of 2009 to build on the efforts of the WfP of 2005, with the goal of reaching 100 million people around the world with sustainable access to clean water and sanitation by 2015.

For more information:

  • Information on the WfP Act and annual reports to Congress are available here.

Global Hunger and Food Security Initiative

The Obama Administration announced a new Global Hunger and Food Security Initiative in 2009, releasing a consultation document in September that lays out principles for the new effort. These principles, based on an agreement (.pdf) by G8 members at the L'Aquila summit in 2009, include: adopting a comprehensive approach that focuses in particular on agricultural development, investing in country-led plans, improving coordination across programs and institutions, leveraging multilateral institutions, making a sustained commitment with targets and tools to monitor progress.

For more information:

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Federal Agencies

Department of State

The State Department leads the executive branch in all matters related to foreign policy, including relationships with foreign governments and international organizations through U.S. embassies, consulates, and diplomatic missions. It negotiates international agreements and treaties and manages foreign aid to low- and middle-income countries. It has played an increasingly significant role in global health in recent years as the resources provided by the U.S. have expanded.

Most of the State Department’s global health policy development and coordination activity is overseen by the Under Secretary for Democracy and Global Affairs -- including the Office of International Health and Biodefense (OES/IHB), the Department’s policy coordination office for global health activities -- and the Office of the Global AIDS Coordinator (OGAC). OGAC, headed up by an ambassador-level appointee, oversees PEPFAR, the U.S. global AIDS program. The State Department also provides policy direction to USAID, the independent federal agency that provides development assistance.

In addition to these centralized efforts, hundreds of U.S. missions and embassies abroad play a significant role in coordinating U.S. government global health programs in the field as well as supporting their operations and interactions with host country governments.

Media inquiries : Press officers can be reached Monday through Saturday until 11:00 p.m. ET at (202) 647-2492 during work hours or at (202) 647-1512 outside regular work hours. Press officers for OGAC can be reached at (202) 663-2708. Resources for reporters are available for the State Department and PEPFAR.

For more information:

U.S. Agency for International Development (USAID)

Established in 1961, the U.S. Agency for International Development (USAID) historically has served as the government’s lead agency in providing economic development and humanitarian assistance to people around the world. While USAID is technically an independent agency of the federal government, it works under the aegis and policy direction of the Secretary of State, and the State Department has statutory authority over the USAID budgeting process. In addition, as of 2006, the USAID Administrator began serving concurrently as the newly-created State Department Director of U.S. Foreign Assistance. USAID -- which operates in more than 100 countries around the world through more than 80 field missions -- is organized into several programmatic bureaus, including global health, as well as regional bureaus. USAID serves as the lead agency for the President’s Malaria Initiative (PMI)  -- a five-year $1.2 billion interagency initiative targeting 15 focus countries that is implemented along with the CDC -- as well as the Neglected Tropical Diseases Initiative.

Media inquiries: A media representative can be reached at (202) 712-4320. Press releases are available here.

For more information:

Millennium Challenge Corporation

The Millennium Challenge Corporation (MCC), a U.S. corporation that functions as an independent government agency, was established in 2004 to reduce "global poverty through the promotion of sustainable economic growth." Although health is not the main focus of its work, its activities include projects aimed at health generally and HIV specifically. The MCC is responsible for the stewardship of the Millennium Challenge Account (MCA), which receives funds appropriated by Congress every year. The MCC provides country funds through competitive, multi-year "compacts" based on their demonstrated commitment in three areas: good governance; economic freedom; and investment in people, particularly women and children.

Media inquiries: A media representative can be reached at (202) 521-3850. Press releases are available here.

For more information:

Department of Health and Human Services

The Department of Health and Human Services (HHS) serves as the U.S. government’s principal agency in all areas of health, supporting activities that range from basic research to financing health care. Within HHS, the major divisions involved in global health are the Centers for Disease Control and Prevention (CDC), the National Institutes of Health(NIH), and the Food and Drug Administration (FDA), which are described in greater detail below.

HHS also has an Office of Global Health Affairs (OGHA), which represents the department with international organizations and multilateral institutions and reviews all documents related to international health.

Media inquiries: A media representative can be reached at (202) 690-6343, or at (202) 619-7800 after hours. Press releases are available here. Resources for reporters related to global health are available here.

For more information:

  • Centers for Disease Control and Prevention (CDC)

The CDC is generally responsible for activities related to health promotion, prevention, and preparedness for health threats in the U.S. Since the late 1960s, CDC has also engaged in international health efforts, though only recently has the agency received substantial global health funding. Through the Center for Global Health, the CDC provides development aid and technical assistance, conducts research, and operates disease surveillance programs.

Media inquiries: A media representative can be reached at (404) 639-3286, or at (404) 639-2888 after hours. Contacts by topic are available here, and press releases and other resources for journalists are available here.

For more information:

  • National Institutes of Health (NIH)

The National Institutes of Health (NIH) conducts and sponsors biomedical and behavioral science research. The National Institute of Allergy and Infectious Diseases (NIAID) is key in carrying out research on diseases at the center of global health efforts (including HIV/AIDS, tuberculosis, and malaria). NIH also operates the Fogarty International Center, which works to build partnerships between health research institutions in the U.S. and abroad and train research scientists, and is a PEPFAR implementing agency. In addition, a portion of U.S. funding for the Global Fund is provided through the NIH appropriation (with the remainder provided through foreign operations appropriations to the State Department).

Media inquiries: A media representative can be reached at (301) 496-5787. Contact numbers by topic are available here, and press releases and other resources for journalists are available here.

For more information:    

  • Food and Drug Administration (FDA)

The Food and Drug Administration (FDA) regulates the safety and efficacy of drugs, biological products, and medical devices. FDA also acts as a PEPFAR implementing agency, and is charged with expediting the review of pharmaceuticals for purchase by the office of the U.S. Global AIDS Coordinator.

Media inquiries: A media representative can be reached at (301) 796-4540. Press contacts by topic are available here, and press releases and other resources for journalists are available here.

For more information:

Other Offices and Agencies

A variety of other government departments and offices have involvement in global health, including:

  • The National Security Council, which coordinates national security and foreign policy within the Executive Office of the President, including a focus on security issues related to global health.
  • The Department of Defense, which supports humanitarian aid, assistance with other military health systems, disease surveillance, and research.
  • The Office of Management and Budget, which prepares the President's budget requests to Congress.
  • The Department of Agriculture, which provides food assistance to low-income countries.
  • The Peace Corps, which provides volunteers to communities in developing nations, including assistance with health services and food security.
  • The White House Office of National AIDS Policy, which coordinates the government's effort to address HIV/AIDS within the U.S. and additionally coordinates with international bodies.

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Congressional Committees

Much of the more detailed policy deliberations in Congress occurs at the committee level, including both authorizing committees (which authorize government programs and provide legislative oversight of executive agencies) and appropriating committees (which consider specific funding levels for programs). In the arena of global health, key committees include:

House Committee on Foreign Affairs

The Foreign Affairs Committee is responsible for oversight and legislation relating to all foreign assistance, including programs operated by the State Department, the Millennium Challenge Corporation, and USAID.

Key subcommittees include: Africa and Global Health (which has jurisdiction over global health issues generally, including specific responsibility for the region of Africa); and International Organizations, Human Rights and Oversight (which includes jurisdiction over the issues relating the United Nations).

Media inquiries: The phone number for press inquiries to the majority is (202) 225-5021. The minority office of the committee can be reached at (202) 226-8467. Press releases are available for majority and the minority.

For more information:    

Senate Committee on Foreign Relations

The Foreign Relations Committee is responsible for oversight and legislation relating to all foreign assistance, including programs operated by the State Department, the Millennium Challenge Corporation, and USAID.

Key subcommittees include: International Development and Foreign Assistance, Economic Affairs and International Environmental Protection; and International Operations and Organizations, Human Rights, Democracy and Global Women's Issues.

Media inquiries: The majority office can be reached at (202) 224-4651, and the minority office at (202) 224-6797. Press releases are available from the committee chair and ranking minority member.

For more information:

House Committee on Energy and Commerce

The Energy and Commerce Committee has jurisdiction over a number of areas of health care, including biomedical research, public health, and the regulation of drugs.

Key subcommittees include: Health; and Oversight and Investigations.

Media inquiries: The majority office can be reached at (202) 225-2927, and the minority office at (202) 225-3641. Press releases are available from the majority and minority.

For more information:    

Senate Committee on Health, Education, Labor and Pensions

The Senate Committee on Health, Education, Labor and Pensions (HELP) has jurisdiction over a number of areas of health care, including biomedical research, public health, and the regulation of drugs.

Media inquiries: The majority office can be reached at (202) 224-2633, and the minority office can be reached (202) 224-6770. Press releases are available from the majority and minority.

For more information:

House Committee on Appropriations

The House Committee on Appropriations has jurisdiction over the appropriation of funds for government agencies and programs. Key subcommittees include: Labor, Health and Human Services, Education, and Related Agencies (with responsibility for NIH and CDC); and State, Foreign Operations, and Related Programs (with responsibility for the State Department and USAID).

Media inquiries: The majority office can be reached at (202) 225-2771, and the minority office can be reached at (202) 225-3481. Press releases are available from the majority and minority.

For more information:

Senate Committee on Appropriations

The Senate Committee on Appropriations has jurisdiction over the appropriation of funds for government agencies and programs. Key subcommittees include: Labor, Health and Human Services, Education, and Related Agencies (with responsibility for NIH and CDC); and State, Foreign Operations, and Related Programs (with responsibility for the State Department and USAID).

Media inquiries: The majority press office can be reached at (202) 224-3751. Press releases are available from the majority.

For more information:

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