Forbes | December 18, 2014

By Bill Frist

President Obama has on his desk the Senator Paul Simon Water for the World bill. The bill passed both the House and the Senate with no objection, and it has the power to save millions of lives and serve as a beacon of health diplomacy globally.

It’s a bill with far-reaching and powerful implications for health worldwide, and it represents a decade of bipartisan advocacy.

In the fall of 2003, as the only physician in the U.S. Senate, I led a delegation of Senate colleagues to Mozambique to take a closer look at U.S. policy on HIV/AIDS.  We found an HIV emergency, but we also identified a health need more fundamental than even treating the virus: access to clean water.

Just imagine mothers and daughters traveling three to four hours daily just to collect water for their families, leaving less time for other productive family, educational and economic activities. Imagine living in a rural village in Sub-Saharan Africa or East Asia where village members bathe, drink, and wash in the same water source as their livestock. Imagine being a grandmother in a small Ethiopian village and watching five of your grandchildren between the ages of 3 and 8 die from preventable water-related diseases. Try to imagine continuous diarrhea and excruciating stomach pain, leading to dehydration and death. This is what we saw firsthand.

The experience brought the statistics to life. Each year 5 million people—14,000 per day—were dying from preventable waterborne illnesses such as typhoid fever, cholera, dysentery, dengue fever, trachoma, intestinal helminth infections, and schistosomiasis. A child was dying from preventable water borne illnesses every 15 seconds, and these totals exceeded the numbers dying from HIV, malaria, and tuberculosis combined.

Moreover, two-thirds of the world’s population was living in an area of political unrest, and many of these conflicts were over natural resources as important and necessary as shared water basins. The potential impact of a U.S. commitment to helping build healthy communities and strong local governments would be doomed from the start without addressing this backdrop of inadequate access to water, and the resultant morbidity and mortality.

Within months of our return to Washington with these shocking stories, President George Bush and the U.S. Congress made an unprecedented commitment to address the HIV crisis called the President’s Emergency Plan for AIDS Relief (PEPFAR).  Simultaneously, we moved Congress to actively address the less visible yet crucial crisis of unclean water.

As majority leader in the Senate, I asked staff to start drafting legislation to formalize U.S. policy addressing the issues of unsafe water and lack of sanitation in developing nations. We worked side by side with a broad array of stakeholders including a number of faith-based international organizations, such as the Millennium Water Alliance, and the Bush Administration. Throughout 2004 we helped raise the attention of Congress, the public, and the global community to the dire need for safe drinking water, sanitation and hygiene (WASH).

In January 2005, I accompanied another bipartisan group of Senators to East Asia to assist in the aftermath of the December 26, 2004, Indian Ocean tsunami. Traveling along the Sri Lanka coast, the breadth of devastation the storm had caused was staggering.  Local water sources were destroyed, water buckets washed away, and local water sources were contaminated with saltwater. That lack of access to clean water could have led to dysentery, cholera, and malaria, but it didn’t.  Sri Lanka experienced a rapid influx of relief aid to restore access to WASH, and a medical crisis was averted.

Water policy is a bipartisan issue. On March 2, 2005, I, a Republican, was joined by the Democratic Leader Harry Reid when I introduced the “Safe Water: Currency for Peace Act”.  That the bill was bipartisan and introduced by the two leaders in the Senate underscored the significance of the bill and the level to which the issue of clean water had risen in our government.

In the meantime, amid the U.S. House of Representatives hearings on the global water crisis, the United Nations General Assembly adopted Resolution 58 designating March 22 World Water Day and launched the International Decade For Action on global water issues.  This was prompted in part by the strong bipartisan support and attention we from the platform of the Senate Majority Leader office had brought to the issue. The UN resolution established a Millennium Development Goal (MDG) for 2015: to reduce by half the number of people without access WASH.

Back in Washington, DC, we had designed our bipartisan water bill to do three things.  One, it made a clear and unequivocal pronouncement that WASH for people around the world would be a major U.S. policy goal. Two, it authorized a five-year pilot program launched to assist countries with the highest rates of waterborne diseases to develop sustainable water infrastructure systems.  And three, it directed the Secretary of State, along with the Administrator of the USAID, to develop a comprehensive national strategy that would both assess the threats and challenges and recommend specific actions for addressing them. In making this commitment, we would codify in US law for the first time a Millennium Development Goal (MDG).

Henry Hyde, the Republican Chairman of the House International Relations Committee, held hearings during the summer of 2005 on the global water crisis. In October the House reported legislation modeled on our Senate bill.  To ensure smooth passage of the legislation, the Speaker of the House and I agreed that once the House passed their version of the bill, I would see that it passed the Senate without changes and was sent directly to the President.

To honor a former colleague in the US Senate, we changed the name of the bill to the “Senator Paul Simon Water for the Poor” Act. Senator Simon was the much beloved and respected Democrat from Mr. Hyde’s home state of Illinois who had recently passed away. His book, “Tapped Out” addressed the potential impending disaster of water shortages making the bill an apt homage to his efforts.

The bill passed overwhelmingly in the House (319–34) and was adopted by unanimous consent in the Senate on November 16. The enrolled bill was signed into law by President Bush on December 1, 2005.

March 2015 will mark the end of the U.N.’s “Water for Life” Decade For Action. Thanks to bipartisan support and the tireless work of those who have seen firsthand the power of clean water, the Millennium Development Goal of reducing the number people without access to clean water has already been met.

But we are far from done.  Indeed today 748 million people still do not have clean water and 2.5 billion live without adequate sanitation. Children are still dying from preventable waterborne disease and too many women’s lives are limited by the toil of collecting clean water each day.

Last May, USAID announced the creation of an Office of Water and a specific focus on a more cohesive Water and Development Strategy. The Senator Paul Simon Water for the World Act was introduced in the House in August of 2013 by Congressman Earl Blumenauer (D-Oregon) and Congressman Ted Poe (R-Texas) in a continuing bipartisan manner to recognize and build on the work of USAID. The Senate bill was introduced in November 2014 by Senators Dick Durbin (D-Illinois), Bob Corker (R-Tennessee), Chris Coons (D-Delaware) and Jeff Flake (R-Arizona). This bill engendered the same bipartisan support as the initial Water for the Poor Act, and it will continue to support the work we started in 2005.

As of this writing, the bill has passed both the House and Senate without objection, and is on its way to President Obama for his signature. The most recent iteration of the Act introduces accountability strategies to address implementation challenges and focus resources where they are most needed.

Additionally, the annual amount appropriated by the U.S. Congress to implement the Water for the Poor Act of 2005 has now grown to $382.5 million in Fiscal Year 2015 and the most recent spending bill also requires that not less than $145 million of that be spent on programs in sub-Saharan Africa.

Water policy extends far beyond health issues, important as they are.  It undergirds our U.S. foreign diplomacy as well.  A 2012 National Intelligence Estimate on Global Water Security found that over the next decade, countries of strategic importance to the United States will experience water shortages, poor water quality, or floods that will risk instability increase regional tensions.

In my own experiences as a physician regularly leading medical mission trips, I am constantly struck that providing medical assistance and public health services to others is interpreted as a currency of peace and ultimately as an aspect of public diplomacy. Our assistance to other nations in these areas seems to accelerate in impact when it provides tangible benefits to everyday people.  The Water for the Poor Act has been proven.

The economic impact of smart water policy has been demonstrated.  Every $1 spent on clean drinking water and sanitation is returned as $4 of savings in health costs and economic benefit.

We’ve made great strides since I first saw the reality of the water crisis in Mozambique in 2003, but there are still lives to be saved. In our ever more tenuous global community, it seems to me that what we knew in 2005 continues to hold true today: smart water national policy is a moral, economic, and diplomatic imperative.

FBC for HMACW logoSen. Bill Frist, Amy Grant, Kimberly Williams Paisley, Jennifer Nettles and Dr. Tony Campolo among signatories on letter sent to Congress

NASHVILLE, Tenn., Dec. 8, 2014 – As Congress is expected this week to finalize and vote on its funding bills for Fiscal Year 2015, which includes the funding for global maternal and child health programs, the Faith-Based Coalition for Healthy Mothers & Children Worldwide is seizing this moment to encourage the leaders of the House and Senate Appropriations Committees to protect these vital investments.

The Coalition, which was formed by the faith-based medical nonprofit Hope Through Healing Hands, recently invited dozens of leaders across the country to “stand up and advocate this holiday season for the lives of mothers, newborns and children around the world,” just as they do for those in need in their own communities and congregations this time of year.

The letter to Congress states:

Our coalition is comprised of advocates who are speaking out about the struggles that mothers and children in developing nations face every day. When women and girls lack access to the education and resources they need to create a healthy plan for becoming mothers, the result is tragic: 287,000 women in developing nations die from preventable complications during childbirth, and 6.6 million children die before their fifth birthday each year.
We seek to galvanize faith-based leaders and their constituencies around the issues of maternal, newborn, and child health (MNCH) as well as healthy timing and spacing of pregnancies (HTSP) to improve maternal health and reduce child mortality. We recognize the difficult decisions you face as you finalize funding levels, and we respectfully request that you make the Maternal and Child Health and International Family Planning accounts a priority as you decide the final FY 2015 funding levels. We have seen firsthand the life-saving impacts that these programs achieve, and as people of faith we believe that we all have a duty to do what is within our power to help these women and their families to achieve their potential through improved health.

The list of individuals of influence who have signed their name to the letter includes:

Tony Campolo, Ph.D., Author & Speaker, Eastern University, St. David’s, Pennsylvania
Gary Edmonds, President/CEO, Food for the Hungry, Phoenix, Arizona
Bill Frist, Hope Through Healing Hands, Nashville, Tennessee
Gary Furr, Ph.D., Pastor, Vestavia Hills Baptist Church, Birmingham, Alabama
Mike Glenn, Sr. Pastor, Brentwood Baptist Church, Brentwood, Tennessee
Amy Grant, Artist, Nashville, Tennessee
Scott Hamilton, Olympic Gold Medalist & Philanthropist, Franklin, Tennessee
Tracie Hamilton, Philanthropist and Mother, Franklin, Tennessee
Dan Haseltine, Artist, Jars of Clay, Franklin, Tennessee
Brian McLaren, Author & Speaker, Marco Island, Florida
Bill Mugford, Pastor, HIV&AIDS Initiative, Saddleback Church, Lake Forest, California
Jena Nardella, Blood:Water Mission, Nashville, Tennessee
Jennifer Nettles, Artist (Sugarland), Nashville, Tennessee
Lindsey Nobles, COO, If: Gathering, Austin, Texas
Scott Sauls, Sr. Pastor, Christ Presbyterian Church, Nashville, Tennessee
Rev. Sarah Shelton, Sr. Pastor, Baptist Church of the Covenant, Birmingham, Alabama
Anita Smith, Childrens AIDS Fund, Washington, D.C.
Michael W. Smith, Artist, Franklin, Tennessee
Shepherd Smith, International Youth Development, Washington, D.C.
Third Day, Christian Band, Atlanta, Georgia
Larry Thompson, Pastor, First Baptist Church Fort Lauderdale, Fort Lauderdale, Florida
Sten Vermund, M.D., Ph.D., Vanderbilt Institute for Global Health, Nashville, Tennessee
Kimberly Williams Paisley, Actor & Philanthropist, Franklin, Tennessee
Jim Wallis, President and Founder, Sojourners, Washington, D.C.
           

As a signatory and CEO/Executive Director of Hope Through Healing Hands, Jenny Eaton Dyer, Ph.D., is excited about the variety of individuals who are coming together to lift their voices on behalf of women and children in the developing world.

“In the words of Margaret Mead, it ‘only takes a small group of thoughtful, committed citizens [to] change the world.’ Such is the case with global health advocacy. These activists are taking a stand for women’s health worldwide. We hope Congress hears their voices.” said Dyer.

Hope Through Healing Hands is a Nashville-based 501(C) 3 nonprofit with a mission to promote improved quality of life for citizens and communities around the world using health as a currency for peace.  Senator Bill Frist, M.D., is the founder and chair of the organization, and Jenny Eaton Dyer, Ph.D., is the CEO/Executive Director.

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Note to editors: For more information, visit http://www.alarryross.com/newsroom/hope-through-healing-hands-2/.

Forbes | December 5, 2014

By Bill Frist, MD and Jenny Eaton Dyer, PhD

As governments, organizations, and private individuals commit large contributions to fight Ebola in western Africa, we are reminded of the need to invest in building health care systems in developing nations that are designed to handle public health crises, and provide basic primary health services for the people they serve. The World Bank estimates that the world will spend $32.6 billion by the end of 2015 to combat the spread of Ebola.

The human and economic return on that investment is yet to be determined. But for many global health issues, we know every dollar we invest today will allow us to reap a strong return on investment. For instance, every dollar invested in clean water initiatives now will return at least $4 in economic productivity and decreased health care costs.

Similarly, global investments that provide women and girls with the information and tools they need to time and space their pregnancies are driving progress across the health and development spectrums. This November, a report by the global initiative FP2020 showcased the impressive progress in 2013 to expand access to contraceptives across 69 of the world’s poorest countries:

  • More than 8.4 million additional women and girls, compared to the prior year, gained access to contraceptives
  • More than 77 million unintended pregnancies were averted
  • More than 125,000 women and girls’ lives were saved from complications due to unintended pregnancies
  • More than 24 million abortions were averted

Let’s understand the realities behind these numbers. First and foremost, healthy timing and spacing of pregnancies saves lives. We know that if young women in developing countries delay their first pregnancy until they are 20-24 years old, they are 10-14 times more likely to survive than those who have babies when they are younger.

And if women in these countries are able to space their children every three years, their newborns are twice as likely to survive their first year. Access to family planning reduces maternal and infant mortality worldwide. This is why our organization, Hope Through Healing Hands, is leading an awareness and advocacy initiative to promote education and action for maternal and child health, with a special emphasis on healthy timing and spacing of pregnancies.

Ethiopian First Lady Mrs. Roman Tesfaye recently told the Center for Strategic and International Studies, “To be engaged in the economic sphere, to create income, to contribute to family health and well-being and to the country’s development, we must have family planning services.”

Ethiopia has become a standard-bearer for increases in healthy timing and spacing of pregnancies. Between 2005 and 2011, the country increased women’s access to education and contraceptives for family planning, leading its contraceptive prevalence rate to increase by 51%, from 14.7% to 28.6%.

At the same time, the country’s GDP per capita also increased from $236 in 2007 to $453 in 2012, a 47% increase per capita. While there are clearly many factors in such a change at the national level, access to family planning is one of them. Access can allow mothers to work for income, providing stronger financial support for their families. This is a critical component of lifting families, communities, and nations out of poverty. For every dollar invested to support women in healthy timing and spacing of pregnancies, countries save at least $6 in health, education, water, housing, and other public services.

There is another dimension to the economic impact of healthy timing and spacing of pregnancies. When infant and child mortality rates decline, population growth rates decline as well. This makes sense—when women are educated, have the information and tools they need to plan their families, and are confident their children will survive childhood, many naturally choose to have smaller families.

The aggregate effect of these individual decisions is that there are relatively fewer dependents that rely on government services, and the working-age—and therefore economically productive—population goes up in relative terms, setting the stage for rapid economic growth. Examples of the effects of this shift, known as the ‘demographic dividend,’ can be seen in the economies of Thailand, Bangladesh, South Korea, and Brazil.

Investing in global health issues, like healthy timing and spacing of pregnancies, yields impressive returns in terms of saving lives and promoting economic growth in developing nations. Yet family planning often goes overlooked on the crowded landscape of urgent global health issues. Let’s reconsider its role, and how the U.S. budget might better invest in programs that save the lives of women and children while also helping to break the cycle of poverty and create sustainable futures for some of the world’s most vulnerable populations.

Roll Call | December 4, 2014 

By Bruce Wilkinson

Pandemics as rapid and devastating as the current Ebola outbreak, although rare, serve as an important reminder of the critical security and humanitarian work the U.S. does around the world and here at home — not with drones and air bases, but with medical tents and syringes.

It is my hope at times such as these that, despite fear-inducing headlines and finger-pointing politics, U.S. foreign aid will find a moment of rare appreciation, and support. U.S. foreign assistance provides indispensable global leadership concerning both emergency and on-going global health needs. This work is instrumental in saving millions of lives around the world and protecting ourselves here at home.

At just one fifth of 1 percent of the entire federal budget, U.S. global health funding is a tiny portion of government spending, but the American government nevertheless remains the world’s single largest development donor.

Read more at Roll Call

How time flies, it is hard to believe my days in Munsieville will come to an end soon. We come and help building the new home every weekend (everyone was volunteering, so progress is slow, but tent and food are provided, so the family who lost their home is fine), today, the house is finally done, and I feel so happy and think it is a privilege to help people who live in shack. It is amazing that, with such limited resource, we build a high quality house in the shack with passion and faith.
There was an exciting activity going on throughout the whole week! It is called Munzy Kids Holiday Club. This five-day long event gathered nearly 200 children from kids in the community, most of them are from shack area like Mshenguville and Mayibuye. Without education background of leadership, our Thoughtful Path director Betty, a local woman, is naturally an excellent leader.
I was warmly welcomed by Mr. Paul Brooks, the executive director of Project HOPE UK and Ms. Betty Nkoana, the director of Thoughtful Path, Munsieville when I arrived in Johannesburg, South Africa. Before I came to South Africa, I learn from newspaper and other media source that although South Africa has the best economics condition in Africa continent, it has one of the highest HIV/AIDS prevalence as well as many other infectious diseases.

The Tennessean | November 24, 2014

By Bill Frist

In traveling the country I love to brag on Nashville as the "Silicon Valley" of health services. And that's not an affectionate epithet — it's true.

The Nashville health-care industry contributes $30 billion locally and $70 billion globally. With this amount of health-care dollars in Nashville, and with Nashville as a rising "it" city, one would expect to see a reflection in the health of Nashville. But this is simply not the case.

Currently, Tennessee holds the ignoble distinction of being one of the unhealthiest states in the union: 42nd out of 50. And Nashville/Davidson County specifically ranks 13th out of Tennessee's 95 counties, according to the Robert Wood Johnson Foundation Healthy County Rankings.

Davidson County is also not competing with our peer cities. Compared with Austin, Texas; Charlotte, North Carolina; Cincinnati, Ohio; and Raleigh-Durham, North Carolina, Nashville ranks fourth among the five, according to researchers at the University of Wisconsin. Specifically, Nashville has the worst rates of obesity, children living in poverty, children living in single-parent homes, premature death, injury deaths and violent crime of all five cities.

Poor health carries a cost, and the price of inaction over the next decade will cost us at least $10 billion.

We absolutely have to do something about this.

In taking a closer look at the $70 billion in health-care dollars coming out of Nashville, we see that it comes from the work product of more than 250 health-care companies operating in Nashville and working on a multistate, national and international basis. Nashville is also home to more than 300 additional professional service firms (e.g. accounting, architecture, finance, legal) working in the "peri health care" space. Of these corporations, more than 260 of them are members of the Nashville Health Care Council, which is also something unique. This nonprofit organization holds together a coalition of the most powerful names in health care.

We are sitting on a powerhouse of health-care resources and dollars. So how did this happen to us?

We know that health care does not equal health, and 80 percent of how healthy we are depends on social determinants like local environment, education, diet and culture. For example, 72 percent of Davidson County Metro public schoolchildren suffer from economic disadvantages. We may be succeeding in these large business arenas, but the well-being of our population is not following.

If we consider actual health-care dollars spent on avoidable illness and loss of productivity of our workforce — either because they are sick or are caring for an ill loved one — the price of an unhealthy community over the next decade will cost us at least $10 billion, and maybe as much as $20 billion. It will be more expensive to live and raise families here, and more expensive for employers to build here or even continue to stay here. Inaction will result in lost jobs over time, a stagnation of our economic market, rising unemployment and a rising cost of health care for our population.

If we want to build a thriving and successful city and state, this has to change, because the health of our workforce and citizenry are paramount to the success of the region.

The good news is there is something we can do.

Already in Nashville there are public health champions doing incredible work every day. But our city is large and our problems complicated. No one organization working alone or even with a few others is capable of the scale of change we need to reset the trajectory of our city. But together we can do this work. We must organize as a citywide collaborative, leveraging the relationships we already have and the dollars we know are here. This way we can attack the problems from multiple angles, focus resources on the neediest areas and, in making these changes, save the city millions of dollars over the next decade.

In my opinion, this is the most important thing we can do for our city and our state right now and for the next 10 years. If we truly want to ensure Nashville stays an "it" city for years to come, and more importantly remains the place we all love and want to raise our families, we have no choice.

William H. Frist, M.D is a nationally acclaimed heart and lung transplant surgeon, former U.S. Senate majority leader, and chairman of the executive board of the health service private equity firm Cressey & Company.

In my third week at Karapitiya Hospital I was introduced to Dr. Kumara, senior lecturer in Surgery. Participating in various surgical cases was what I was most looking forward to on my rotation in Sri Lanka. Walking into the OT I noticed it was quite a different set up from the operating rooms back in the states. Patients were lined up on a bench right outside of the open theater doors with their medical chart in hand.
Last month I sat on a panel hosted by the Center for Strategic and International Studies (CSIS), the Vanderbilt Institute for Global Health, and Hope Through Healing Hands. I want to share some notes from the discussion.

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