Originally published at The Hill

When parents in America think about their children turning five, sending them off to kindergarten for the first time can be stressful. But if you live in the developing world, your biggest worry is whether your children will even live to see their fifth birthday.

But that is changing, and this year six million fewer children will die before their 5th birthday than in 1990.  To put that in perspective, that’s 2 million more children than are even in kindergarten in America today.  Driving that change is an unparalleled reduction in deaths and sickness from pneumonia, diarrhea, measles, HIV/AIDS, malaria, polio and neglected tropical diseases.

This is a global sea change, and if it surprises you, you are not alone. Relatively few Americans are aware of this remarkable story, much less the role the United States and many other global actors played in making it happen.

Americans can be proud that these unprecedented advances would not have happened without our involvement as the largest single donor to global health and working in historic collaboration with the other governments, multilateral institutions, local entities, NGOs, civic groups, faith and business communities, universities and philanthropies.

As the majority and minority leaders of the Senate in 2003 when the President’s Emergency Plan for AIDS Relief, or PEPFAR, was created, we know firsthand how pivotal the U.S. role was in one of the biggest pieces of the global health puzzle.

Through PEPFAR – which President George W. Bush initiated with vision and strength, and President Obama has worked hard to continue – the U.S. led the international community by providing tens of billions of dollars to stop the spread of HIV, giving appropriate care to the millions ravaged by AIDS and keeping them alive with anti-retroviral and other interventions.

PEPFAR is one of the crowning examples of how American resolve and leadership can bring about an enormous impact with a relatively small portion of our national budget. It shows that Democrats and Republicans can actually agree on historic health initiatives, not only on HIV/AIDS, but also in tackling malaria, vaccines, clean water and other smart and effective interventions. That same collaboration of compassion can continue to save millions of lives in the future.   

The improved child survival rates are so startling they are hard to believe at first glance. According to a 2013 UNICEF report, the global mortality rate of children under five years old dropped by 47 percent, from 90 deaths per 1,000 live births in 1990 to 48 per 1,000 in 2012. In some regions, the decline in under-five mortality was even steeper– as high as 65 percent in both the East Asia and Pacific and the Latin America and Caribbean regions.

A large portion of the progress came in much of the last decade, not coincidentally after the historic international commitment to the Millennium Development Goals. UNICEF estimates that, as compared to 12 years ago, today 700,000 fewer children die of pneumonia, and 600,000 fewer children die of measles.

Not only did deaths decline, so did sicknesses. Polio cases have decreased by more than 99 percent since 1988, when the disease was endemic in 125 countries. Today, polio is in only three countries. That is nearly all-out eradication of a dreaded malady that it seemed would never go away.

Encouraged as we all should be about the successes so far, there remain 6.6 million children under five who will not reach their fifth birthdays this year, dying mainly from preventable diseases. That is just not acceptable. Without a similar commitment by the U.S. and other international partners in the foreseeable future, we risk squandering the gains of the last 25 years and missing the opportunity to go even further in the next 25. We must keep driving the momentum that got global health to this point.

Some worry the commitment could wane, as Congress has struggled of late to achieve bipartisan consensus on much of anything and, according to a recent Pew Research Center study, a majority of Americans prefer to limit our international engagement to take care of problems at home.

Based on our experience with PEPFAR and other global health initiatives, we are convinced members of Congress from both sides of the aisle remain united around the small, but smart, investments in global health that have historically yielded extraordinary results.

And this week, businesses, NGO, faith, civic and philanthropic leaders are increasing their own investments, coming together to affirm their commitments of more than $2 billion of private resources to invest in ensuring children survive and thrive beyond their fifth birthday.

The world knows what works to increase child survival rates, and we can do this.  But doing it will require continue bipartisan cooperation and the energetic grassroots efforts that made the last 25 years of progress possible.

Daschle served South Dakota in the U.S. Senate from 1987 to 2005 and was the Majority Leader from 2001 to 2003. Frist served Tennessee in the U.S. Senate from 1995 to 2007 and was Majority Leader from 2003 to 2007.

*I’m in Rwanda this week representing Hope Through Healing Hands with Dr. Paul Farmer, Partners in Health Rwanda, and Harvard Medical School. These dispatches from the road are my personal journal–recording what I’ve seen and learned on this trip. See my pre-trip thoughts, and blogs from Monday, Tuesday, and Wednesday.

Today we went to see some of Rwanda’s natural treasures: mountain gorillas.
*I’m in Rwanda this week representing Hope Through Healing Hands with Dr. Paul Farmer, Partners in Health Rwanda, and Harvard Medical School. These dispatches from the road are my personal journal–recording what I’ve seen and learned on this trip. See my pre-trip thoughts, Monday’s blog, and Tuesday’s notes.

This morning we met with patients and physicians at Centre Hospitalier Universitaire de Kigali (CHUK), the urban hospital equivalent. For the past few days we have explored Paul Farmer’s vision of taking health care to the people in rural areas, so often neglected around the world. Today we looked at health care in the city.
*I’m in Rwanda this week representing Hope Through Healing Hands with Dr. Paul Farmer, Partners in Health Rwanda, and Harvard Medical School. These dispatches from the road are my personal journal–recording what I’ve seen and learned on this trip. See my pre-trip thoughts, and Monday’s blog.

Who says you can’t treat patients suffering from cancer in the poorest, most rural parts of the world?

I’m writing on my iPhone on a bumpy dirt road that I am told will be paved next year. It winds for two hours through gorgeous green mountains sculpted with terraced plots of land and scattered homes stepped up and down the hillside.
Why are we in Rwanda? What makes it a unique place to learn about health policy, and health care delivery? What will we learn that can make us smarter as we address health issues back at home?

I thought through these questions on the flight to Rwanda, and I had plenty of time. It’s been a long series of flights—Aspen to Denver to Chicago to New York to Amsterdam to Kigali. But the real journey began today as we saw our first health facilities.

Today (Monday), the delegation piled into a Land Rover after breakfast for the 2.5 hour drive to our first stop: the Partners in Health (PIH) headquarters at Rwinkwavu. We toured the Rwinkwavu District Hospital & Health Center, which was funded in part by the Rwandan government, PIH, and Bill & Melinda Gates.
I was in Aspen earlier this week working on some of the challenges facing healthcare and the health industry in the US, but it’s time to switch gears.

Sunday, I leave for Rwanda to lead a one week group trip with my friend Dr. Paul Farmer to see some of the work being done byPartners in Health (PIH) in the country. I haven’t been in countrysince 2008, and I’m anxious to see the progress PIH and other groups are making in health.

Motherhood is a dangerous journey to take in most of the world. Nearly 300,000 women die each year from complications due to pregnancy, and 99 percent of those women are in the developing world. In Malawi, an estimated 510 out of 100,000 women will die giving birth. But Chief Kwataine, a former English teacher, has become well-known in the country for his work developing safe motherhood activities for nearly the last twenty years.

Watch this short, two-minute video to learn more about how women's (and children's) lives are being saved in Malawi. It's well worth your time.

“If you don’t practice family planning, you will have a child on your back, in your belly, on your shoulders and in a baby basket on your head.” Malawi nurse Mercy Chikhosi Nyirongo describing the song and dance from a women’s health meeting in Madisi, Malawi 2013.

Behavior change communications take many forms throughout a lifetime . . . from the parent who scolds a child for doing something harmful, to government warning labels about health hazards. Somewhere in between are the messages from this video that rise up from women simply wanting to build healthy families by practicing family planning. With one in 39 women on the continent of Africa dying from pregnancy complications, it is easy to understand this group putting family planning at the top of their health priorities.
First off, an update on the two abandoned babies: they were not there when I went to work after my three days off. I was told that the girl (who was very cute and term) had been adopted, while the boy (who was a premi, but seemed very healthy—though of course small—to me) had died.

The Hill

by Senator Bill Frist, MD

The United States has shown courageous leadership over the last decade on global health. Earlier this year, Congress once again voted to protect the budget for those critical investments that we make to save lives, prevent the transmission of diseases and end preventable child deaths.  During my time in Congress, we fought hard for life-saving global health programs.  We were able to work together with both Democrat and Republican presidents to launch and implement historic health initiatives in priority areas such as HIV/AIDS, malaria, vaccines, and clean water.  These programs have saved millions of lives, and proven that health is the best currency for peace.

But even as funding for global health soared, foundational programs promoting maternal and child nutrition were largely overlooked.  Yet the need for greater leadership and investments in nutrition could not be more clear.  Across the world today, 162 million children—1 in 4 children under 5 years of age—are physically and developmentally stunted, and 80 percent of those live in just 14 countries.  The combination of physical limitations and reduced cognitive development directly linked to poor nutrition sentences these children to lives of unfulfilled potential, and it creates a severe drain on their communities and countries.  A 2013 report from the UN Food and Agricultural Organization (FAO) estimates that the social and economic costs of malnutrition are unconscionably high, amounting to as much as $US3.5 trillion per year or $US500 per person globally.

Thanks to U.S. leadership on global health, child death rates have been cut in half over the last 20 years from 12 million to 6 million per year. With continued investments and unwavering leadership, child death rates could be cut in half again over the next decade. We must not save these children, only to abandon them in their most crucial developmental years.

Providing the right nutrients is fundamental to health, particularly during the first 1,000 days from a woman’s pregnancy to her child’s second birthday.  In the 2012 Copenhagen Consensus report, an expert panel of economists concluded that every $1 invested in nutrition generates as much as $138 in better health and increased productivity. Yet despite the severe costs associated with malnutrition and the extraordinary returns on nutrition investments, the world spends less than 1 percent of development aid on life saving, basic nutrition solutions.

The tide is turning. In the 2014 budget, Congress provided a funding boost to the global nutrition account, signaling strong bipartisan support to combat malnutrition.  President Obama has committed to developing a global nutrition strategy, and USAID Administrator Dr. Raj Shah, who has taken the lead on this initiative, just announced the completion of that strategy and the effort underway to develop a coordination plan across all agencies and programs that contribute to improved nutritional outcomes.   

Moreover, in June 2013 at the Nutrition for Growth event in London, the U.S. joined other world leaders and signed a global agreement that will boost global prosperity, prevent millions of infant deaths, and unlock greater human potential by working in partnership with developing countries to tackle malnutrition. This commitment is reflected in the Global Nutrition for Growth Compact, which has been endorsed by over 90 stakeholders.

Governments from Scaling Up Nutrition (SUN) countries and their development partners are also taking nutrition seriously. A total of 50 countries have joined the SUN movement to date, committing to driving forward their national nutrition plans at scale.

These plans and commitments are encouraging, but we must sustain and build upon the momentum that has been created over the last year on global nutrition. The president and Congress must remain resolute in their support for strong global health and nutrition funding in the FY15 budget and in prioritizing nutrition as a critical pillar in our foreign assistance investments.  They must work together to oversee the implementation of the new strategy, and to provide the increased resources that are necessary to reach the millions of children who continue to suffer needlessly from poor nutrition.

Investments in maternal and child nutrition build the foundation for the next generation to survive and thrive, and serve as a shining example of U.S. global leadership at its best.  

Frist, an acclaimed heart transplant surgeon, served Tennessee in the U.S. Senate from 1995 to 2007. He was Senate Majority Leader from 2003 to 2007. He is chairman of Hope Through Healing Hands and Tennessee SCORE, a professor of surgery and author of six books. Learn more about his work at BillFrist.com.

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