Report Urges U.S. to “Stay the Course” in Health and Development Goals Despite Economic Crisis

January 22, 2009 10:27 am (EST)

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As the world economic crisis threatens to undermine strides made in combating poverty since the 1960s, a new report calls on the U.S. government to, "at a minimum, stay the course in its commitments to global health and development" and to ideally increase its foreign assistance spending.

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The author of the report, CFR Senior Fellow for Global Health Laurie Garrett, writes that even before the onset of the global economic crisis, worldwide foreign assistance had declined, dropping 4.7 percent in 2006 and 8.4 percent in 2007. She warns that, "as the costs and risks of doing the business of humanitarian aid in the world increase, so must U.S. financial support" and urges President Obama to fulfill his promise to double U.S. official development assistance to $44 billion in FY09.

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The report, The Future of Foreign Assistance Amid Global Economic and Financial Crisis: Advancing Global Health in the U.S. Development Agenda, focuses on global health as a part of the broader foreign assistance program. It argues that "it has long been acknowledged that no question of disease, survival, or longevity can be separated entirely from larger development issues, food security, or humanitarian crises." It offers recommendations for reforming the U.S. foreign assistance program, which were developed during meetings with government officials, Congressional staff, policy analysts, members of the religious, health, and NGO sectors, and others. These recommendations include the following:

  • The 1961 Foreign Assistance Act should be rewritten to provide a clear explanation of the mission and strategy of U.S. foreign assistance initiatives.
  • The architecture of U.S. foreign assistance should be restructured, giving authority for overseeing implementation across dozens of agencies to a single office, a deputy directorship in the National Security Council.
  • Provide strong oversight, ideally from a White House-based coordinator, to create coherence among the many private intermediaries who typically execute U.S. foreign aid initiatives.
  • The United States should work with, and through, multi-donor institutions and move away from bilateral mechanisms.
  • The United States should repeal foreign assistance requirements that limit efficacy, such as the tying of food aid and the Mexico City Policy gag rule, which denies aid to foreign groups that provide abortions, referrals to abortion providers, or counseling related to abortion.

The report also calls for reforms more specifically related to global health development assistance, including:

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  • "Empiricism should guide decisions related to global health...The best metric for measuring the performance of medical care systems in developing countries are maternal survival rates; the best measure of the efficacy of basic public health services is child survival."
  • "Greater commitment should be given to aligning U.S. aid priorities in health with the priorities of national governments and local ensure sustainability, ownership, and capacity building."
  • "The United States should maintain [a] leadership role [in basic science research] while encouraging work on drugs, vaccines, medical devices, and laboratory tools relevant to resource-scarce countries."
  • The United States should support efforts to improve local disease surveillance and "lead G8 nations in supporting profound improvements in WHO capacity to detect and respond to outbreaks."

This initiative was made possible through the generous support of the Bill and Melinda Gates Foundation, CFR’s Program on International Institutions and Global Governance, Merck & Co., Inc., the Robina Foundation, and the Rockefeller Foundation.

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For full text of the report, visit

Laurie A. Garrett is senior fellow for global health at the Council on Foreign Relations. Garrett was the president of the National Association of Science Writers during the mid-1990s. She is the only writer ever to have been awarded all three of the Big ‘‘Ps’’ of journalism: the Peabody, the Polk, and the Pulitzer, and she has been honored with two doctorates in humane letters honoris causa, from Weslayan Illinois University and the University of Massachusetts, Lowell. Her expertise includes global health systems, chronic and infectious diseases, and bioterrorism. Ms. Garrett is the best-selling author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Betrayal of Trust: The Collapse of Global Public Health. She is also author of the recent CFR Working Paper Food Failures and Futures. She lives in Brooklyn, New York.

The Council on Foreign Relations is an independent, nonpartisan membership organization, think tank, and publisher dedicated to being a resource for its members, government officials, business executives, journalists, educators and students, civic and religious leaders, and other interested citizens in order to help them better understand the world and the foreign policy choices facing the United States and other countries.


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