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and an opportunity as a global leader, to contribute to improved health around the world. The U.S. government should act in the global interest, recognizing that long-term diplomatic, economic, and security benefits for the United States will follow.

If health is to hold a more prominent position in U.S. foreign policy, the U.S. government will need to increase coordination among the multiple agencies and departments engaged in global health. A 1997 Institute of Medicine report, America’s Vital Interest in Global Health, called for the establishment of a government Interagency Task Force on Global Health, led by the U.S. Department of Health and Human Services. The committee supports this recommendation, but calls for the interagency group to be located more centrally, in the White House. Locating the effort in the White House, potentially within the National Security Council (NSC) and reporting to the President through the NSC Advisor, would give it convening authority among sometimes competing agencies and the ability to make policy recommendations directly to the President.

Within the first year of his administration, the committee recommends that the President create a White House Interagency Committee on Global Health to lead, plan, prioritize, and coordinate the budgeting for major U.S. government global health programs and activities. The Interagency Committee—consisting of heads of major U.S. departments and agencies involved in global health activities—should play the crucial role of ensuring that the U.S. government has a coherent strategy for ongoing investments in global health, and also that health is taken into account when setting U.S. foreign policy in other areas, such as trade, environment, and security.

The committee also calls on the President to designate a senior official at the White House (Executive Office of the President, potentially within the NSC) at the level of Deputy Assistant to the President for Global Health to chair the Interagency Committee. The Deputy for Global Health should serve as the primary adviser at the White House on global health, attend NSC meetings which deal in any way with global health issues, and work with the National Security Advisor, the Director of Management and Budget, and the President’s Science Advisor in carrying out his or her responsibilities.

The committee also asks that by the end of the administration’s term, the President and Congress double annual U.S. commitments to global health between 2008 ($7.5 billion) and 2012 ($15 billion). The committee recommends that the U.S. government commit to $13 billion for the health-related Millennium Development Goals (MDGs) and an additional $2 billion to address the challenges of noncommunicable diseases and injuries.

Meeting the globally recognized MDGs, adopted by the Member States of the United Nations (UN) in 2000, would require advanced economies to devote 0.54 percent of their gross national income (GNI) to overseas development assistance. Accordingly, the committee estimates that the U.S. contribution to the health-related MDGs (Goal 4: Reduce child mortality, Goal 5: Improve maternal health, and Goal 6: Combat HIV/AIDS, malaria and other diseases) would be $13 billion per year by 2012.

The allocation of this $13 billion per year should be balanced across the portfolio of global health spending to reflect the breadth of the health-related MDGs. The U.S. government should fulfill its implied commitments under the President’s Emergency Plan for AIDS Relief (PEPFAR) reauthorization to global AIDS programs ($7.8 billion per year), malaria ($1 billion per year), and tuberculosis ($800 million per year). The remaining $3.4 billion per year would double current levels of spending by the U.S. government for global programs in support of health systems strengthening, child and women’s health, nutrition, family planning and reproductive health, and neglected diseases of poverty, all of which have been severely under-resourced during the past decade.



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