Honoring the life of Dr. Paul Farmer by recognizing the duty of the Federal Government to adopt a 21st-century global health solidarity strategy and take actions to address past and ongoing harms that undermine the health and well-being of people around the world.

IV 118TH CONGRESS 1ST SESSION H. RES. 204 Honoring the life of Dr. Paul Farmer by recognizing the duty of the Federal Government to adopt a 21st-century global health solidarity strategy and take actions to address past and ongoing harms that undermine the health and well-being of people around the world. IN THE HOUSE OF REPRESENTATIVES MARCH 7, 2023 Ms. SCHAKOWSKY (for herself, Ms. LEE of California, Mr. RUIZ, Mr. BLU- MENAUER, Mr. CARSON, Mr. COHEN, Mr. DOGGETT, Mr. ESPAILLAT, Mr. GARCI´A of Illinois, Ms. JACKSON LEE, Ms. JAYAPAL, Ms. MCCOLLUM, Mr. MCGOVERN, Mr. MOULTON, Ms. NORTON, Ms. PORTER, Ms. PRESSLEY, Ms. ROSS, Mr. SOTO, Ms. TLAIB, Mr. TRONE, and Mrs. WAT- SON COLEMAN) submitted the following resolution; which was referred to the Committee on Foreign Affairs, and in addition to the Committee on the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the juris- diction of the committee concerned RESOLUTION Honoring the life of Dr. Paul Farmer by recognizing the duty of the Federal Government to adopt a 21st-century global health solidarity strategy and take actions to ad- dress past and ongoing harms that undermine the health and well-being of people around the world. Whereas Dr. Paul Farmer, who pioneered novel community- based strategies for the delivery of high-quality health care in impoverished settings, inspired a paradigmatic shift in global health, including inspiring robust United VerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6300 E:\BILLS\HR204.IH HR204 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HRES 204 IH States leadership to address the global HIV/AIDS epi- demic in the early 2000s via the United States Presi- dent’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Ma- laria; Whereas, in spite of this progress, weak health systems con- tinue to cause millions of people, primarily the global poor, to die tragic and unnecessary deaths, including— (1) annually, approximately— (A) 680,000 deaths from HIV/AIDS; (B) 1,500,000 deaths from tuberculosis; (C) 627,000 deaths from malaria; (D) 295,000 deaths of mothers during and fol- lowing pregnancy and childbirth; (E) 9,560,000 deaths among children under the age of 15; and (F) 560,000 deaths of children and young adults living among the world’s poorest billion people from noncommunicable diseases and injuries; and (2) a COVID–19 case-fatality rate up to 300 per- cent greater in low-income countries than in high-income countries during the first two years of the SARS–CoV– 2 pandemic; Whereas, although progress against unnecessary deaths in impoverished countries is being made, it is occurring so slowly that— (1) based on present rates of decline, it will take ap- proximately a century for core mortality statistics in low- income countries to converge with those of high-income countries, including— (A) 92 years for the tuberculosis death rate; VerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6300 E:\BILLS\HR204.IH HR204 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HRES 204 IH (B) 109 years for the maternal mortality rate; and (C) 88 years for the under-15 child mortality rate; and (2) the death rate in low- and middle-income coun- tries from noncommunicable diseases and injuries, which make up 40 to 60 percent of the disease burden of these countries, will never converge with that of high-income countries with present rates of reduction; Whereas weak health systems that fail to prevent unnecessary deaths also lack the staff, health facility infrastructure, and medical technologies required for effective care deliv- ery and thereby disease containment, thus placing all countries at increased risk of pandemic disease; Whereas essential medical technologies such as diagnostics, treatments, and vaccines for diseases that affect the glob- al poor are frequently unavailable or inaccessible to health systems in developing countries because— (1) investing in research and development for tech- nologies for diseases that disproportionately affect the global poor is often unprofitable for pharmaceutical cor- porations; (2) high intellectual property licensing fees from originator companies to generic manufacturers price the global poor out of access to medical technologies; and (3) originator technology companies refuse to share or license intellectual property to generic manufacturers, which results in limited supply and high prices, as in the case of COVID–19 vaccines; Whereas the Lancet Commission on Investing in Health esti- mates the additional annual spending required to prevent the vast majority of the millions of unnecessary deaths VerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6300 E:\BILLS\HR204.IH HR204 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HRES 204 IH and confer ‘‘essential universal health coverage’’ in low- and lower-middle-income countries is $75,000,000,000 and $293,000,000,000 (in 2016 United States dollars), respectively, representing just— (1) 1.6 percent of the United States gross domestic product (GDP) in 2021; (2) 0.5 percent of G20 GDP in 2021; and (3) 2.8 percent of the wealth possessed by the world’s billionaires in 2021; Whereas regular annual United States appropriations for global health have increased by merely 10.6 percent to $11,300,000,000 since 2010, and have been outpaced by both inflation and the United States economic growth; Whereas relative to the size of the United States economy, the United States official overseas development spending is low at 0.17 percent of gross national income (GNI) in 2020, placing the United States 24th out of the 29 coun- try members of the Organization for Economic Co-oper- ation and Development’s Development Assistance Com- mittee, and meeting just one-fourth of the United Na- tions official development assistance target of 0.7 percent GNI; Whereas dramatically increasing foreign aid may have voter support, given that opinion polls consistently find that Americans believe United States foreign aid should make up approximately 10 percent of the Federal budget; Whereas historically, United States and other global North- supported global health programs have inadvertently en- trenched standards of care in low-income countries that would be unacceptable in rich countries by funding only health services narrowly defined as ‘‘sustainable’’, ‘‘cost- effective’’, or ‘‘appropriate’’ in poor settings; VerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6300 E:\BILLS\HR204.IH HR204 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HRES 204 IH Whereas the effectiveness and efficiency of current United States overseas development assistance for health is often undermined by— (1) misalignment with countries’ national health plans; (2) bypassing delivery systems with parallel inputs, leading to fragmentation of care delivery, poor donor co- ordination across partners, and weak health systems; (3) favoring technical assistance from consultants from high-income countries, especially the United States, over funding health service delivery in beneficiary coun- tries; and (4) promoting privatization of health services, there- by undermining public system strengthening, health care access, health equity, and financial risk protection; Whereas 98 percent of the annual $1,500,000,000,000 in health spending in aid-eligible low- and middle-income countries is mobilized domestically by these countries themselves, and only 2 percent of this spending comes from overseas development assistance for health; Whereas many of the poorest developing countries presently lack the tax capacity to mobilize the necessary resources to close the universal health coverage financing gap, meaning unnecessary deaths will continue in these set- tings for the foreseeable future without external donor fi- nancing or dramatic increases in domestic tax capacity; Whereas the inability of many of the poorest developing coun- tries to fully close the financing gap for universal health coverage and the provision of numerous other public goods and services is in part due to the intimate eco- nomic links between these countries and high-income countries, including the United States, which have been VerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6300 E:\BILLS\HR204.IH HR204 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HRES 204 IH marked throughout history by acts of violence and coer- cion, including, but not limited to— (1) the fundamental injustice, cruelty, brutality, and inhumanity of colonization and slavery; (2) the overthrow of governments and backing of dictatorships in the postcolonial era; (3) the imposition of structural adjustment pro- grams by international financial institutions controlled by high-income countries, which forced austerity, privatiza- tion, and liberalization on developing countries, resulting in an estimated loss of $480,000,000,000 per year in po- tential GDP during the 1980s and 1990s, nearly 5 times more than aid provided during the same period; (4) the loss of economic sovereignty imposed by fun- damentally undemocratic global governance institutions, such as the International Monetary Fund, the World Bank, and the World Trade Organization, at which deci- sions that shape the unequal terms of the global eco- nomic system and determine countries’ abilities to fi- nance health systems are made; (5) capital flight from developing countries con- sisting of mostly illegal financial flows, estimated by Global Financial Integrity to total approximately $1,700,000,000,000 each year, including— (A) $700,000,000,000 from deliberate trade misinvoicing; and (B) $261,000,000,000 from hot money narrow outflows; and (6) external debt repayments, often undemocratically and unjustly imposed, commonly sold by corrupt lenders, regularly accumulated by dictators without a democratic mandate, and exacerbated by compound interest as a re- sult of United States interest rate increases; VerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6300 E:\BILLS\HR204.IH HR204 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HRES 204 IH Whereas the harms have entrenched a global economic archi- tecture of upward wealth redistribution that has resulted in— (1) depressed workers’ wages and artificially low prices of natural resources in developing countries to serve consumption in rich countries, amounting to an ap- propriation of tens of billions of tons of raw materials and hundreds of billions of hours of human labor, esti- mated to value over $10,000,000,000,000 in losses through unequal exchange annually; (2) 3,500,000,000 people living under the poverty line of $5.50, which according to the World Bank is a poverty headcount that has ‘‘barely changed in the last 30 years’’, even as global GDP has more than tripled in size during this time; (3) more financial resources flowing out of devel- oping countries than into them each year, estimated by Global Financial Integrity to total net negative $2,000,000,000,000 annually in 2012, meaning poorer countries are developing richer countries rather than the other way around; and (4) developing countries bearing 98 percent of deaths and 80 to 90 percent of economic losses attrib- utable to climate change, despite rich countries bearing 92 percent of the responsibility for climate change due to carbon emissions in excess of safe planetary boundaries, meaning those who suffer the most from climate change are least responsible for the crisis; Whereas the United States leadership to close the financing gaps for essential universal health coverage in low- and lower-middle-income countries could precipitate increased global health financing from other donor partners as evi- denced by United States leadership to address the HIV/ VerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6300 E:\BILLS\HR204.IH HR204 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HRES 204 IH AIDS epidemic in the early 2000s, spurring a 100-per- cent increase in global overseas development assistance among all donor partners from 2000 to 2006; Whereas official United States development assistance to low- and lower-middle-income countries are not a supplement for United States action to stop ongoing structural vio- lence and economic injustices preventing countries from financing and delivering universal health care and other social services for their populations; and Whereas it is the view of the House of Representatives that creating a decent, humane world without tragic, unneces- sary deaths requires both a modest but meaningful in- crease in global health aid funding and a meaningful ef- fort to stop the economic abuse of low- and middle-in- come countries: Now, therefore, be it (1) the Federal Government should adopt a 1 new, 21st-century global health solidarity strategy to 2 end medically avertable deaths and respond to the 3 full burden of disease in poor countries by— 4 (A) supporting developing countries to 5 meet the material needs of their health systems 6 by localizing investments in support of national 7 public sector and local priorities, referred to as 8 ‘‘accompaniment’’ by Dr. Paul Farmer and de- 9 livered through what he called the ‘‘Five S’s’’, 10 which include— 11 (i) staff, the human resources nec- 12 essary for high-quality service delivery, in- 13 VerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\HR204.IH HR204 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HRES 204 IH cluding clinical staff, transportation teams, 1 and community health workers, especially 2 by— 3 (I) supporting long-term training 4 and education systems, including med- 5 ical schools and teaching hospitals to 6 train the health workforce and im- 7 prove the quality of care across dis- 8 eases; and 9 (II) supporting professionalized 10 community health workers programs 11 whereby community health workers 12 are recruited, adequately com- 13 pensated, comprehensively trained, 14 supported for long-term retention, po- 15 sitioned as bridges to care, and tasked 16 with undertaking community work 17 with appropriate patient ratios and a 18 manageable scope of work; 19 (ii) space, the infrastructure needed 20 for service delivery at primary, secondary, 21 and tertiary levels to deliver safe and high- 22 quality care to meet all health care needs; 23 (iii) stuff, the tools and resources nec- 24 essary for high-quality care provision, in- 25 VerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\HR204.IH HR2 [Text truncated for display. Full text available on Congress.gov.]