Feb. 29, 2016 | The Hill

Senator Bill Frist water

As the 2016 primaries unfold, it’s time for candidates of both parties to focus on expanding the big-hearted policies that have made this nation so exceptional.

In recent years, the most effective of those policies has been global health — that is, putting U.S. resources to work saving lives in developing nations by spreading health treatments that work here at home. In a study for the Bipartisan Policy Center last November, we showed how the largest global health project in history, the President’s Emergency Plan for AIDS Relief (PEPFAR), has not only saved millions of lives but also improved America’s national security.

Under PEPFAR, launched under former President George W. Bush and enhanced under President Obama, with bipartisan support in Congress over more than a decade, 9.5 million men, women and children, mainly in Africa, are receiving lifesaving anti-retroviral drugs. Some 68 million have gotten HIV testing and counseling, 5.5 million orphans and vulnerable children have received care and support, and 190,000 new healthcare workers have been trained. In addition, our study found that in PEPFAR countries, political instability and violence have fallen 40 percent (compared to just 3 percent in equivalent non-PEPFAR countries), while economic growth has increased — and so has America’s reputation.

Now, a new survey by the Kaiser Family Foundation, released in January, has discovered that, while Americans are proud of the accomplishments of programs like PEPFAR, a majority (53 percent) believe we are already “doing enough to improve health in developing countries.” And a majority (55 percent) believe that “spending more money won’t make much difference in improving health in developing countries.”

Those are disturbing statistics. They stray far from reality. The truth is that the U.S. has the innovation and the resources to put an end to rampant deaths not only from AIDS but from such scourges as malaria, tuberculosis and hepatitis C. Based on the PEPFAR experience, we have proof that health will be improved dramatically — and Americans themselves will benefit.

The good news is that the Kaiser study provides important guidance on how to persuade Americans that our nation should do more. The starting point is better education about global health.

The public is woefully misinformed not just about the success of U.S. programs but about their cost. The Kaiser survey, taken in December, found that, on average, those polled believed that 31 percent of the federal budget is spent on foreign aid (including health programs). The actual figure is less than 1 percent (correctly estimated by just 3 percent of those polled). Researchers discovered that, when respondents were informed of the correct spending on foreign aid, their support of increased spending on global health improved significantly.

Actual spending on global health by the U.S. government has been steady at between $9.2 billion and $10.2 billion per year since 2009, with the exception of 2015, when an additional $3.7 billion was spent to stem the Ebola crisis that directly threatened the health of Americans. For 2016, global health represents just 0.2 percent of federal spending, or about $10 billion out of $4.1 trillion. Another way of saying this is that just $32 out of the average American’s tax bill will go to global health programs — with about $19 for fighting AIDS, $2 for malaria, $1 for tuberculosis and $2 for maternal and child health.

Kaiser’s national study also asked respondents to give the most important reason for spending U.S. tax dollars to improve global health. In first place, by far, was “because it’s the right thing to do,” chosen by 46 percent. That’s no surprise. This is the most benevolent country in the world. When our 43rd president announced PEPFAR in 2003, he said, “Seldom has history offered a greater opportunity to do so much for so many.”

Our humanitarian instincts are the bedrock of global health programs, but the Kaiser study also pointed to other strong reasons to spend federal money: “to improve our diplomatic relationships,” “to help ensure national security,” “to help the U.S. economy,” and “to improve the U.S.’s image around the world.” In total, these four justifications topped the list for 48 percent of respondents. Another practical reason to improve health abroad is to prevent diseases like Ebola and the Zika virus from spreading through our own population.

As the presidential campaign progresses, we believe that Americans will want to hear candidates appeal to what Abraham Lincoln referred to as “the better angels of our nature.” Wiping out diseases in poorer countries is simply the right thing to do. But Americans are pragmatic people, too, and, as the Kaiser research shows, we want our contributions to be both cost-effective and beneficial to our own nation as well.

As our research has shown, programs like PEPFAR meet all of those tests: humanitarian, practical and self-serving. In this election season, Americans must require candidates for public office who demonstrate the leadership we will need to ensure global — and national — health.

Daschle served in the Senate from 1987 to 2005 and as Senate majority leader from 2001 to 2003. Frist, a physician, served in the Senate from 1995 to 2007 and as Senate majority leader from 2003 to 2007.

This post first appeared in The Hill.

Since the 1990's, the U.S. foreign aid budget has helped cut global poverty in HALF. Yet, foreign aid comprises less than 1% of the entire U.S. budget. Foreign aid isn't just a humanitarian cause - when global health improves and poverty is eliminated, citizens of the U.S. benefits from greater global security and a thriving global economy.

Feb. 22, 2016 | The Tennessean

Senator Bill FristOf the thousands of heart and lung operations I have performed, the most common cause of the underlying disease in these patients was a single voluntary behavior: smoking.

That tragedy is what Tennessee Quit Week (Feb. 22-28) is all about.

Smoking absolutely leads to a shorter, poorer-quality life. It more than doubles a person’s risk of stroke or heart disease, and increases the risk of lung cancer by 25 times!

Each year it causes more deaths than automobile accidents, firearm-related injuries, HIV, illegal drug use and alcohol abuse combined.

The good news is that most smokers want to stop, and there are effective tools to help. The benefits are almost immediate: Within two days of smoking cessation, nerve endings regenerate. In two weeks, circulation improves; after just one year, the risk for heart attack is cut in half.

Tobacco use is the most preventable cause of premature mortality and morbidity, yet one of five Tennessee adults smokes regularly and one of nine adolescents self-report smoking.

That’s why smoking prevention and cessation is the first priority of the new grassroots, community collaborative NashvilleHealth.

Nashville's smoking rates are higher than the national average and that of all our peer cities. We must aggressively address this most preventable cause of premature disability and death.

Governor Bill Haslam has proclaimed the week of Feb. 22 as “Tennessee Quit Week." This effort comes on the heels of a new report from the American Lung Association that found Tennessee flunking tobacco control, receiving a “C” grade for smoke-free air and “F's” for tobacco prevention and cessation funding, access to cessation services and tobacco taxes.

That's our clarion call to action.

First, communities must insist that state government more adequately fund programs on tobacco cessation that we know work.

In 2014 the Haslam administration and state legislature allocated $15 million over three years to county health departments to implement tobacco cessation programs locally.

This funding has a lifesaving impact, but it is too little. The Volunteer State spends just 9 percent of what the Centers for Disease Control and Prevention (CDC) recommends, even though it annually brings in over $400 million in tobacco-related revenue.

Second, we know that secondhand smoke kills. Yet in Tennessee, local municipalities are not permitted to strengthen the state’s smoke-free laws in their region. Communities should be empowered to make parks, playgrounds and venues like Nashville’s new Ascend Amphitheater smoke-free zones.

The CDC reminds us there is “no risk-free level of secondhand smoke exposure; even brief exposure can be harmful to health.”

The Metro Public Health Department (MPHD) is already working hard to provide tools and education to those who need help quitting, and NashvilleHealth is happy to join in.

The MPHD will offer to the public the American Lung Association’s “Freedom From Smoking” cessation course beginning the last week of February. Its “Breathe Easy” campaign is wisely encouraging multi-unit housing to go smoke-free. And it will be rolling out the “Baby and Me Tobacco Free” program, which provides quit assistance to pregnant women and new mothers this month.

What can individuals do?

  • Call the Tobacco Quit Line, 1-800-QUIT-NOW (784-8669). You can talk to a counselor who will help create a plan tailored specifically to you, free of charge. If indicated they will provide you with two weeks of free nicotine patches to get you started.
  • Attend the Metro Public Health Department’s new “Freedom from Smoking” quit course; call 615-340-5334 or contact Lillian.Maddox-Whitehead@nashville.gov.
  • Visit the “It’s Quittin’ Time in Tennessee" online calendar and resource page.
  • Share personal stories and innovative ideas on how our community might better tackle tobacco prevention and cessation with us directly at nashvillehealth.org.

No amount of prescriptions, operations or doctor’s office visits will correct for our unhealthy behavior. Let's together make Nashville healthier today, by wiping out smoking.

Dr. William H. Frist is a nationally acclaimed heart and lung transplant surgeon. He served as U.S. senator from Tennessee from 1995 to 2007 and as former U.S. Senate majority leader from 2003 to 2007.

This op-ed originally appeared in The Tennessean.

Feb. 22, 2016 | The Christian Post

Zika Virus

As of February 1, the World Health Organization has declared the Zika virus, largely across Central and South America and the Carribbean, a "public health event of international concern." They believe over 4 million people may become infected in 2016. The virus has been associated with over 4,000 cases of microcephaly, and doctors are currently studying the link between the severe birth defect and the infectious disease in Brazil and other countries.

Once discovered, the Pan American Health Organization and the Centers for Disease Control and Prevention have issued announcements across the Americas calling for postponing travel to these areas, avoiding mosquito bites, safe sex practices, and in some countries, for women to consider delaying pregnancy for the next two years.

For this last call to action, addressing family planning for women, there are myriad obstacles. Over half the pregnancies in El Salvador, for example, are unintended; there are high rates of sexual violence; and there is limited access to contraceptives due to both "gatekeepers" who may not allow for access to contraceptives to women as well as legitimate "stock outs" where modern methods of contraceptives are simply unavailable.

This is a crisis.

Why did it take the Zika virus to alert the world to the need for women to have access to contraceptives and the obstacles therein?

Jenny Dyer HeadshotOver 220 million women around the world say that they want to either delay their next pregnancy or avoid becoming pregnant, but they have neither the information nor the resources to do so. While the U.S. leads the world in provision of access to contraceptives, we still are woefully short of meeting this need.

Each year over 300,000 women die from complications during birth and pregnancy; and 5.9 million children die before their fifth birthday each year. One way to improve maternal health and reduce child mortality is simply access to family planning, or healthy timing and spacing of pregnancies (HTSP).

Many women in developing countries are married by the time they are sixteen. If they become pregnant in their late teens, these young women are three times more likely to die than if they could wait until after twenty years of age to have their first child. Timing is critical in the debut of the first pregnancy to save the life of the mother. And when a mother dies during childbirth, the newborn is ten times more likely to die within two years of his or her mother's death. And if she can just space her pregnancies three years apart, the child is twice as likely to survive the newborn stage.

If a young woman can have access to healthy timing and spacing of pregnancies, she can finish her secondary education, prepare for a job, and set up a strong foundation for a thriving family later in life. She can choose to have fewer children that she and her husband can afford to house, feed, and send to school. Planning a family is critical to undermining a cycle of poverty to create a new, virtuous cycle of sustainability.

Without access to contraceptives, maternal mortality, infant mortality, and child survival issues are realities millions of families must face. Alongside these issues, those living in extreme poverty without access to adequate nutrition, including vitamin deficiencies, during pregnancy and post-pregnancy, can lead to stunting and lagging brain development among children. To put this into perspective, this slowed growth currently affects over 165 million children worldwide.

Finally, access to contraceptives in developing nations is a means to combatting the orphanhood crisis, human and sex trafficking, and prevention of mother to child transmission of HIV/AIDS.

The Zika virus is just one more reason women, not just across the Americas but worldwide, should have access to contraceptives and the knowledge to better time and space pregnancies for her life, the life of her children, and the flourishing of her family. Even Pope Francis has noted that contraceptives could be used to slow the spread of the disease.

Our U.S. government spends less than a fraction of 1% of our budget on international, voluntary family planning for these women, not including abortion as prohibited by the Helms Amendment. We should urge our members of Congress to protect and increase this funding for voluntary access to contraceptives and counseling to save the lives of millions of women and children around the world.

Jenny Eaton Dyer is the Executive Director for Hope Through Healing Hands and directs the Faith-based Coalition for Healthy Mothers and Children Worldwide which seeks to enable women and couples in developing nations to determine the timing and spacing of their pregnancies in a manner that includes the voluntary use of methods for preventing pregnancy—not including abortion—that are harmonious with their values and religious beliefs.

This op-ed originally appeared in The Christian Post.

Hope Through Healing Hands was proud to be a key sponsor this past weekend at the Mobilizing Medical Missions Conference (M3) at Lakewood Church in Houston, TX. At the conference, doctors, nurses, and other global healthcare professionals and advocates gathered from all over the world. Led by Paul Osteen MD, Lakewood hosted over 1,600 people gathering for the inaugural year of the M3 conference. The crowd was charged with the aim to Be Inspired. Connect With Others. Find Your Mission.
Most Americans believe 26% of the U.S. budget is allocated for foreign aid. The reality? Less than 1%. Contrary to popular belief - this is not an altruistic expenditure. The foreign aid budget actually makes the U.S. more prosperous and secure.
In honor of the International Day of Zero Tolerance for Female Genital Mutilation, we've re-published this essay by James Nardella that originally appeared in The Mother & Child Project: Raising Our Voices For Health And Hope. As a tireless advocate for human rights and women's empowerment, Nardella's essay shows how men must become agents for change when it comes to putting a stop to practices such as FGM that devalue women. It isn't until all humans are treated equally that our world will see an end to poverty and suffering.

Feb. 3, 2016 | Kennedy School Review

Strategic Health Diplomacy (SHD) recognizes that targeted global health initiatives can be an important foreign policy tool for the United States.  Healthier populations are productive, safe, and less vulnerable to instability. By addressing global health in Latin America and the Caribbean (LAC), the United States can save lives and improve its national strategic interests.

The United States Southern Command (USSOUTHCOM) has always taken a leadership role in becoming a “partner in international health” in the LAC region. SHD can broaden this concept by forming a tripod of health initiatives that rests on short-term military disaster relief, long-term humanitarian assistance, and integrative healthcare education.

Delivery of targeted global healthcare is directly in line with President Obama’s 2015 National Security Strategy; “The United States is safer and stronger when fewer people face destitution, when our trading partners are flourishing, and when societies are freer,” the president proposed.

This model has proven very successful in Africa. The President’s Emergency Plan for AIDS Relief (PEPFAR) launched in 2003, when President Bush delivered $15 billion to counter HIV/AIDS, tuberculosis, and malaria in vulnerable countries. Since then, 7.7 million people have received HIV/AIDS retroviral treatment. The program is credited with saving 1.1 million lives and reducing the HIV/AIDS death rate by 10 percent.

Under PEPFAR, healthier societies have also become safer societies. Since 2004, violent activity and political instability has decreased 40 percent in PEPFAR countries.  Similar non-PEPFAR countries have only seen a 3 percent decrease over the same time period. Healthier people can also contribute to their economy. Life expectancy, education, and income also increased in PEPFAR countries during the same time period.

PEPFAR illustrated that SHD can foster support and goodwill for the United States. The twelve countries in Sub-Saharan Africa receiving PEPFAR assistance had an average 68 percent approval rating of the United States.  Across the same time period, the global average was 46 percent.

The same results could be seen in Latin America.

Avoidable mortality in LAC still totals over one million deaths annually. One of USSOUTHCOM’s first responses to this tragedy was via the hospital ship USNS Comfort.

The USNS Comfort is a floating hospital that provides meaningful relief during times of crisis or need within Latin America and the Caribbean. It boasts more than 12 operating theatres, 80 intensive care beds, and 1000 hospital beds.  In 2011, Operation Continuing Promise treated more than 100,000 patients and performed over 1,100 surgeries in 11 countries.

The value of this particular disaster relief and humanitarian assistance model is that it is extremely visible and quantifiable.  The limitation is that it is extremely specific and temporally limited.  Previous deployment of Navy hospital ships showed a significant improvement in the opinion of the United States during deployment.  However, after six months, public opinion returned to pre-disaster levels.

Strategic Health Diplomacy and an on-the-ground long-term plan like PEPFAR is the logical extension for a more longstanding improvement in public health for the region.

In LAC, significant variation exists in public health capacity. LAC is the world’s most unequal region.  Poor, rural, and indigenous populations suffer a growing health outcomes disparity. This allows for greater manipulation of one vulnerable group against another, a vulnerability that is currently being exploited by drug-related violence.

The World Health Organization proposes strengthening public health capacity in LAC through the following elements: Public Health Workforce, Public Health Information Systems, Public Health Technologies, Institutional and Organizational Capacity, and Financial Resources.

SHD can target the public health workforce effectively and measurably with humanitarian aid.  The LAC public health workforce is severely undermanned and represents a “global health workforce crisis.” There are not enough properly trained professionals to administer and deliver healthcare.

In LAC, training and development of a public health workforce has been largely ignored. The volatile sub-region of Central America showed its highest public health deficit in human resources training and development.  Emigration has left a 35 percent nursing vacancy at Caribbean hospitals.  Specialty doctors outnumber community healthcare providers. The United States can help bridge this gap.

The long-term humanitarian aid of Strategic Health Diplomacy can save lives, begin to reduce inequity, and look to foster regional healthcare leadership in regions of strategic importance. Furthermore, educating, coordinating, and empowering regional leaders in the application of public health and the delivery of primary healthcare is vital to a healthy society, but it must be done with attention to sustainability and training.

Hope Through Healing Hands, a global health nonprofit started by Senator William Frist, works to educate and equip local leaders through the Frist Global Health Leaders program. The program offers grants for health professional students, residents, and fellows to serve and train abroad in underserved communities. Their efforts bolster capacity in clinics in need of support as well as offer training to community health workers to promote sustainability.

The Pan American Health Organization gives specific recommendations for the development of vertically integrated primary care health teams in the Americas. These include healthcare providers but also community leaders. These teams are regionally targeted to meet the unique needs of diverse populations. They have distinct goals and public health core competencies.

The United States can aid in this process through education, coordination, and mechanisms of disrupting health inequity by providing clear and transparent objectives. This is tangible, has quantifiable measures, and is algorithmically reproducible.  As the host nation grows, its medical and regional educational capabilities can increase exponentially.

The healthcare sector in Cuba is an excellent example of opportunities for explosive growth. Sen. Frist has made several trips to Cuba in the past year. As the United States re-establishes relations with the country for the first time since 1959, there are valuable opportunities for science and medical exchanges to further our understanding of the area’s needs and strengths and to support the health infrastructure with training and education.

Future application of SHD should focus on specific communicable and non-communicable diseases in areas with strategic value within USSOUTHCOM. The disease should be both prevalent and treatable.

Any initiative designed should identify clear goals with distinct policies that have a visible effect in a transparent and accountable fashion. These considerations should be sensitive to local contexts, rooted in building host nation capacity, and designed for long-term solutions.

Improved overall health in developing countries will increase economic opportunity, promote stability, and resist political upheaval.  Military disaster relief is immediate, visible, and measurable.  Humanitarian assistance through SHD will create a more long-term health imprint through education and expansion of primary health teams.

Richard Menger MD is a neurosurgery resident who currently serves as the Hale Champion Public Service Fellow and a Master in Public Administration candidate at the Harvard Kennedy School of Government.  He is a lieutenant in the Navy Medical Corps (Reserve).

Anil Nanda MD MPH is the Professor and Chairman of Neurosurgery at LSU Health Sciences Center in Shreveport LA. A leader in global neurosurgery, he has authored more than 380 publications and has spoken at over 400 conferences and institutions.

William Frist MD is a nationally acclaimed heart and lung transplant surgeon and former Senate Majority Leader.  He is currently co-chairs the Bipartisan Policy Center’s Health Project is the founder and Chairman of Hope Through Healing Hands. 

The views expressed are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. 

This article originally appeared on the Kennedy School Review

Jan. 28, 2016 | Medium

Four years ago, I stood with an international alliance of family planning advocates to set an ambitious goal for the world. We pledged that by 2020, 120 million more women and girls would have access to the family planning services they want and need to live their healthiest, best lives.

The good news is that, thanks to our collective efforts, over the last four years, tens of millions of unintended pregnancies have been avoided.

The bad news is that if we continue at current rates, we will fall short of our goal, breaking our promise to millions of women.

The consequences of failure are huge?—?for women, for their children, for everyone. An unplanned pregnancy often means that girls are forced to drop out of school and that women can no longer work outside the home, both of which contribute to keeping families and communities trapped in cycles of poverty. Unplanned pregnancies also carry significant health risks to both women and their children.

These 120 million women and girls are counting on us to keep our promise. We need to get back on track now.

Read the full post on Medium

Jan. 25, 2016 | Foreign Policy

If you weren’t paying close attention during the president’s final State of the Union speech — and perhaps even if you were — you probably missed the shout out to one of the great foreign policy success of George W. Bush. In a speech that was otherwise criticized for its sunny characterization of perilous times, it was a welcome if brief indication that, from the beginning of his first term, Barack Obama embraced what was then and still is widely viewed as George Bush’s most enduring legacy — the President’s Emergency Plan for AIDS Relief (PEPFAR) and the subsequent President’s Malaria Initiative (PMI). Here, the progress is real and the president’s optimism appropriate.

What the president surely understands is that, more than a decade on, Bush’s vision for defeating global AIDS and malaria is more than a humanitarian success story — it is a foreign policy success story that has profoundly redefined our relationship with sub-Saharan Africa. This success likely has broader implications for America’s standing in the world that are still not fully understood or appreciated. Certainly, President Obama is viewed positively in Africa, in no small part because of his African heritage, but there can be no doubt that he stands firmly on the foundation laid by President Bush.

The fact that the president singled out malaria as worth his and Congress’ special attention in his final year is significant. Although sometimes viewed as a kid brother to the United States’ global AIDS program, it’s not an exaggeration to say that the progress against malaria in the past decade has brought us close to a true milestone of human history. When I began working on malaria at USAID in 2004, the disease killed more than a million people annually — the vast majority of them African children. Since then, deaths have been cut roughly in half, and endemic countries and donors are looking to achieve a state just short of eradication in coming years. One of mankind’s deadliest and most persistent killers is in retreat.

Read the full article on ForeignPolicy.com

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