A UMNS Feature
By Tim Tanton*
September 25, 2009
Dr. Bill Frist was flying low in a Cessna Caravan above the treetops in southern Sudan, an area routinely bombed by government forces during the country’s ongoing civil war.
The year was 1998. Frist, a U.S. senator, was entering Sudan surreptitiously as part of a medical mission sponsored by Samaritan’s Purse. Sudan had no diplomatic relations with the United States, which had identified the African country as a sponsor of terrorism.
In the remote Liu area, Frist flew over a site where bombing had claimed a rural hospital.
“It had been destroyed,” he recalls. “There was fighting all around.” However, his team was able to work in a makeshift clinic.
“I came back the next year, the fighting had stopped,” Frist, 57, says. “I came back the next year, and there was a little tiny village, maybe a hundred … huts there. And then I came back the next year, and all of a sudden the church, which had been bombed, was blossoming. There was a school there. There was a hospital there. Nobody was fighting.
“So then I said that, basically, there is something to this – that medicine or health is a currency for peace,” he says.
That idea became the foundation for his global health nonprofit, Hope Through Healing Hands. For the surgeon and former U.S. Senate majority leader, health care has a role to play in building communities – and building peace.
“You don’t go to war with somebody who has just saved the life of your child,” he explains.
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In May, Senator Frist co-led a conference at CSIS entitled U.S.-Russian Global Health Collaboration. Given the outcome of discussion at the conference, the Senator produced this Op-Ed recently published in Foreign Policy.
On Wednesday night, U.S. President Barack Obama made a historic address to a joint session of Congress on the issue of health-care coverage and affordability. It is the banner issue of his first year in office, and Washington's top domestic priority. At the same time, nearly 5,000 miles away, in Moscow, legislators are undergoing a strikingly similar process to reform their health-care delivery system. Given the importance of the U.S.-Russia relationship and the similarity of the challenges confronting us, our two countries have a historic opportunity to expand our health collaboration and, in so doing, improve our diplomatic ties.
Thankfully, this process is already underway. At a summit in early July, Obama and Russian President Dmitry Medvedev announced a memorandum of understanding to expand cooperation on public health and medical sciences. The meeting also produced an agreement for Secretary of State Hillary Clinton and her Russian counterpart, Foreign Minister Sergei Lavrov, to co-chair a forthcoming bilateral commission on health collaborations.
But both countries can and should continue to do more. In May, Dr. Nikolai Gerasimenko -- vice chair of the Duma's Committee on Health Protection -- and I hosted a daylong discussion on the topic at the Center for Strategic and International Studies. Our objective was to generate a blueprint for a future strategic collaboration on health. The conference revealed a strong desire to build genuine partnerships around health on the basis of two key challenges.
The first is national demographics. Both Russia and the United States grapple with rapidly aging populations, with all that implies for the provision of health care and social services. Russia's problems are compounded by alarmingly high middle-aged male mortality and birthrates that are too low to sustain the current size of the population. Demographic regression, the Russian delegates emphasized, is the top health-policy priority. In each of our societies, efforts to encourage healthier lifestyles -- in diet, and alcohol and tobacco use -- will reduce chronic disorders, extend lives, and make for a healthier next generation.
The second challenge is the pressing need for health-care reform. Both of our countries struggle to balance the competing imperatives of high quality, equity in access and affordability, and containment of health-care costs. We are each in the midst of a historic effort to reform our health systems, bring about greater efficiencies in complex federal systems, and produce better health outcomes as a return on substantial investments.
Our dialogue also identified five choice opportunities that I hope will inform the next steps by the United States and Russia in building health cooperation.
First, there is much to be learned from each other with respect to lowering health risks associated with tobacco and alcohol use, especially among young people, including through public-education strategies and community engagement.
Second, in the face of the H1N1 pandemic flu threat, there is much we can do to improve surveillance and data use to bring about better global detection and response to emerging infectious disease threats. Even at the height of the Cold War, the Soviet Union and the United States worked together to create vaccines. Our countries could certainly benefit from such collaboration today.
Third, we should launch an annual U.S.-Russia forum on the reform of national health systems, with a special focus on financing, cost controls, and evaluation. Comparative effectiveness research across national boundaries is a vitally important undertaking. In particular, a U.S.-Russian initiative could include joint exploration of innovative approaches such as e-health and electronic medical records.
Fourth, we should engage in a discussion on how to best leverage our mutual efforts to support global health programs in those countries most affected by infectious diseases such as HIV, tuberculosis, and malaria. The Obama administration recently committed to billions in donations in this area, and Russia is emerging as a significant global health donor as well. Thus, the time is right for our two countries to more closely collaborate.
Lastly, substantial ongoing joint research, institutional twinning and professional exchanges could be expanded. This includes research and research training in alcohol abuse and related disorders, cardiovascular disease, cancer, and tuberculosis. These efforts could be broadened to encompass chronic-disease prevention and management and national health-care reform as well.
Health collaboration is a surprisingly powerful foreign-policy tool and one where U.S. and Russian interests converge. Expanded communication and cooperation will build on a history of collaboration that survived periods of acute strain. There is active interest in both our societies -- among universities, medical schools, research institutions, and private businesses, as well as key government agencies -- in joining such an enterprise.
I urge Secretary Clinton and Foreign Minister Lavrov to commission in the coming months a joint organizing committee charged with prioritizing issues, laying down a timetable, and agreeing upon some early concrete products. It could prove a vital platform for the health of our countries and the health of our bilateral relationship.
William H. Frist, M.D., is a former two-term U.S. senator from Tennessee and was the U.S. Senate majority leader from 2003 to 2007. He is a member of the Center for Strategic and International Studies' board of trustees.
Healthier beginnings
What the world can learn from Pittsburgh
Monday, September 14, 2009
By Bill Frist
When world leaders chart a course toward a more prosperous future at next week's G-20 summit, Pittsburgh can inspire in more ways than one.
The city built on steel has renewed its shine as a center for research and technology and become a model for economic comeback. When this recession recedes, Pittsburgh is poised to jump far ahead of cities where "rust belt" still rings true.
But progress is not measured solely in economic terms. Presidents and prime ministers should note a different kind of progress that Pittsburgh pursued and achieved in the years it was still building its first boom. This kind of progress has yet to reach many parts of the planet, but, in the interests of all, must.
Sustainable recovery and long-term economic growth depend on improving the well-being of the world's most vulnerable people and ensuring they, too, participate in recovery. To that end, improving the health of children and mothers is fundamental.
In 1920, Pittsburgh had the worst recorded infant mortality rate of any large U.S. city. Some of the oldest residents of Pittsburgh today started life with the same odds of reaching their first birthday as newborns in Somalia do now. One in nine babies died.
Several other cities also had dismal records, but Pittsburgh's last-place ranking prompted the federal government to make a case study of the city. After World War I, the United States had recognized that resilience and continued growth depended on healthy babies who would grow into strong, productive adults.
In "Infant Mortality in Pittsburgh," the Children's Bureau of the U.S. Department of Labor recorded diarrhea and pneumonia as the most-common infections killing babies in Pittsburgh. Remarkably, despite decades of medical advances and low-cost, easy-to-administer treatments, this still holds true in the developing world.
The study also noted that nearly half of Pittsburgh's infant deaths occurred in the first month of life from prenatal or birth-related causes. Today, this remains by far the most dangerous month of life in poor countries. Nearly 4 million newborns die every year, half on the day they're born.
In analyzing Pittsburgh nearly 90 years ago, the Children's Bureau wrote that most newborn deaths had already been "clearly demonstrated" to be "largely preventable." Yet, the kind of basic health services and practices that Pittsburgh subsequently embraced are still lacking in many countries today.
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