The CSIS Commission on Smart Global Health Policy

The CSIS Global Health Policy Center publishes a range of timely materials of interest to readers in the policy, government, business, and academic communities. These publications include reports and books from CSIS experts; newsletters; commentaries and Critical Questions on current global health issues issues. Even with the release of the Commission's report, we will continue to publish a range of materials on Smart Global Health over the next year.

Read the Report of the CSIS Commission on Global Health Policy

Published Reports

African Perspectives on Genetically Modified Crops

By Jennifer G. Cooke, Richard Downie. -- The authors gauge the current status of the debate on biotechnology in Africa with a snapshot of three countries at different stages along the spectrum of opinion on genetically modified crops (GMOs): Zambia, where a strong emphasis on the precautionary principle remains very much in place; Kenya, where recent legislation has opened the door to eventual commercialization of GM crops; and South Africa, where GM food crops are widespread and where elaborate regulatory capacities are fully established. The authors look at what practical steps countries are taking to settle the question and examine the wider issue of what debates around GM technology say about the role of science in Africa. The research is based on interviews conducted with policymakers, scientists, farmers’ groups, anti-GMO campaigners, and other interest groups in all three countries in October through December 2009. This report supplements the work of the CSIS Task Force on Global Food Security, chaired by Senators Richard Lugar and Robert Casey. Its final report, Cultivating Global Food Security, published in April 2010, calls on the U.S. government to pursue a multifaceted response to food insecurity, driven by strong White House leadership, focused on specific country needs, and drawing on the strengths of the research community and the private sector. The role of GM technology in enhancing food security does not feature prominently in the work of the task force, but because the issue arises frequently in U.S. discussions on boosting agricultural productivity, it is worthwhile to examine how African opinions are evolving. This report does not take a position either for or against GM technology. Instead, it seeks to highlight current thinking on GM crops in three sample countries; identify the drivers of these discussions; and offer thoughts on how the debate about GMOs might play out in the future. Read More >

Strengthening Global Health Preparedness: Recommendations for Expanding U.S. Engagement and Leadersh

The world has entered an era in which the numbers of new and reemerging global health threats argue for a longer-term, more strategic, and more coherent U.S. approach to global health preparedness. The ongoing threat from emerging infections such as SARS, extensively drug-resistant tuberculosis (XDR-TB), H5N1 (avian) influenza, and most recently, H1N1 influenza has raised awareness within the U.S. government and other partner states and multilateral institutions of the global interdependence of human security and global commerce. This awareness has spurred more systematic efforts to identify and respond to sudden global public health emergencies stemming from infectious diseases, natural disasters, and other public health emergencies. Recent experience has also illustrated the potential damage that can result from unresolved controversies over the global sharing of biological specimens, as well as the closely related and equally sensitive imperative to mitigate stark inequities experienced by poor countries unable to obtain medicines, vaccines, and other commodities in timely, affordable volumes to meet public health crises. Read More >

Building U.S. Diplomatic Capacity for Global Health

By Harley Feldbaum - As U.S. funding for global health has increased, U.S. diplomatic capacity for supporting and leveraging our global health funding remains stagnant and fragmented. This lack of capacity to manage the political aspects of global health is dangerous, because the politics of global health have never been more divisive, and the opportunities for improving health and controlling disease epidemics never more extraordinary. -- U.S. diplomatic capacity for global health represents the organization, staffing, and direction necessary to engage, not only on the charitable, technical, and scientific aspects of global health, but on the political and diplomatic aspects as well. The current lack of diplomatic capacity for global health at the Departments of State, Defense (DOD), Health and Human Services (HHS), the U.S. Agency for International Development (USAID), and the National Security Council (NSC) results in continually missed opportunities to support global health efforts and to leverage U.S. global health funding to support foreign policy objectives, and this imperils the success of U.S. global health aid. In a small number of cases, this lack of capacity threatens U.S. national security by undermining negotiations on influenza virus sharing and global health security. -- Numerous reports have outlined the goals the Obama administration should pursue in global health. This brief does not seek to add to those or to propose detailed policy solutions to the cases discussed. Instead it seeks to demonstrate that U.S. global health policy has global political ramifications that cannot be ignored and that demand permanent capabilities within the U.S. government. It describes the need for improved U.S. diplomatic capacity on global health, outlines the currently fractured architecture of the U.S. government on this issue, and issues recommendations for building diplomatic capacity for global health. Read More >

From Conflict to Pandemics: Three Papers from the CSIS Global Health and Security Working Group

The CSIS Global Health Policy Center formed a working group in the spring of 2009 to examine the nexus of security and global health, with a special focus on the missions and programs of the U.S. Department of Defense (DOD). Specifically, the group concentrated on: The role of the U.S. Department of Defense in preparing for global pandemics - Leveraging military-to-military cooperation to support global health - Preserving and improving civilian health in conflict-affected nations. An additional appendix examines the respective roles of civilian institutions and the military in promoting health in conflicted settings. The CSIS Global Health and Security Working Group, cochaired by recently retired Colonel Eugene Bonventre, M.D., and former Secretary of Veterans Affairs James B. Peake, M.D., convened health and security experts from U.S. government agencies, humanitarian organizations, academia, the private sector, and foundations. Over the course of 10 months, the 40-member group held four formal meetings, hosted multiple guest lecturers, and had numerous side discussions. Out of this emerged a realistic strategy, detailed in the three papers contained herein, for the United States to concurrently improve global health and security. This report represents the majority opinion of working group members, not a unanimous consensus on every last issue. The opinions expressed in the report are those of the cochairs. Within this report are actionable recommendations for how the Obama administration can better use its military health programs to overcome knowledge gaps between the often segregated global health and national security objectives and improve interagency and civil-military communication. Recommendations focus on increasing global public health capacity, improving access to health care for host-nation civilians, and increasing security and stability abroad. Read More >

A Healthier, Safer, and More Prosperous World

As the United States applies smart power to advance U.S. interests around the world, it is time to leverage the essential role that U.S. global health policy can play. Americans have long understood that promoting global health advances our basic humanitarian values in saving and enhancing lives. In recent years, support for global health has also proven its broader value in bolstering U.S. national security and building constructive new partnerships. A smart, strategic, long-term global health policy will advance America�s core interests, building on remarkable recent successes, making better use of the influence and special capabilities of the United States, motivating others to do more, and creating lasting collaborations that could save and lift the lives of millions worldwide. It will usher in a new era in which partner countries take ownership of goals and programs; in which evaluation, cost effectiveness, and accountability assume vital roles; and in which a focus on the health of girls and women becomes a strategic means to bring lasting changes. And it will enhance America�s influence, credibility, and reservoir of global goodwill. Read More >

Innovative Financing for Global Health: A Moment for Expanded U.S. Engagement?

By Robert Hecht, Amrita Palriwala, and Aarthi Rao -- Mar 16, 2010 -- In this paper, the authors assess some of the most promising new financing mechanisms for global health, describing their current status, actual and potential benefits, and limitations. They also examine the prospects for increased U.S. involvement in innovative financing for global health, discuss some of the barriers that have hampered U.S. support in this area, and point to actions that could be taken to address these barriers. --Their conclusion is that new forms of financing are important, and that furthermore, the United States should become a more engaged participant in shaping and backing efforts in this area. Doing so could yield important health and economic benefits for millions of people in the world�s poorest countries and also generate important political and economic gains for the United States. Read More >

Kenya Trip Report: CSIS/CARE Joint Delegation to Kenya

Members of the CSIS Commission on Smart Global Health Policy traveled to Kenya from August 8�12 to get a snapshot of multiple U.S. health investments on the ground and gather perspectives on the core questions of impact, measurement, integration, and sustainability of current efforts. Read More >

Prevention of New HIV Infections: Priorities for U.S. Action

Building on its work of the last several years, the CSIS HIV Prevention Working Group organized in the summer of 2009 a consultation on �Revisiting U.S. Approaches to HIV Prevention�. The discussion brought together more than twenty HIV prevention experts to review the concrete priority steps the U.S. could take to enhance the effectiveness of HIV prevention programs during the next fi ve years of the President�s Emergency Plan for AIDS Relief (PEPFAR). Participants were drawn from academia, research institutions, foundations, civil society, government and service delivery organizations. Each brought to the table significant professional expertise,operational experience and personal commitment. We are grateful to them for their valuable contributions. Read More >

Making Gender a Global Health Priority

The world faces enormous challenges in the global health arena, many of which have a disproportionate impact on women and girls. Many key global health priorities revolve in fundamental ways around the gender-related barriers that women and girls face in accessing health-related information, services, and resources, all of which increase their vulnerability to ill health. For success and sustainability, the United States should anchor its global health strategy in a firm commitment to address the gender disparities that affect global health outcomes. Read More >

The European Approach to Global Health: Identifying Common Ground for a U.S.-EU Agenda

The European Approach to Global Health - By Gaudenz Silberschmidt - Nov 13, 2009 - The advent of the Obama administration offers an important opportunity to launch a serious dialogue on strengthening transatlantic collaboration on global health issues. This dialogue will require high-level commitment and engagement from both Europe and the United States. And it will naturally emanate from each side�s internal processes and strategic approach to global health. his paper, based on a series of interviews with senior European health leaders, seeks to shed light on European approaches to global health; the interactions among the European Union (EU), the European Commission (EC), and member states; and, finally, European perceptions of U.S. global health policies. All of those interviewed strongly support the need for a more consistent and reciprocal dialogue between the United States and Europe, although there were varying opinions on what the initial focus of such a dialogue should be. The paper concludes with suggestions for enhancing U.S.-EU engagement to better identify partnership opportunities in improving global public health in the long term. Read More >

Global Health Interventions for U.S. Food and Drug Safety

By Thomas J. Bollyky - Nov 13, 2009 - In 2007, a series of high-profile scandals involving contaminated blood thinner, toxic toothpaste, and melamine-laced pet food demonstrated the threat that unsafe food and drug imports pose to U.S. public health and international trade. Contaminated and adulterated products have sickened and killed U.S. consumers, fueled protectionism, raised business costs, and destabilized markets. A 2008 public opinion poll found that 67 percent of Americans are worried about food safety, ranking it higher than concerns about pandemic flu or natural disasters. Food and drug safety also has the attention of U.S. policymakers. In 2007, the Bush administration convened an Import Safety Working Group that called for an increased focus on prevention, more resources and greater mandates for the Food and Drug Administration (FDA) and other U.S. regulators, and increased engagement with trading partners and industry. President Obama appointed a cabinet-level Food Safety Working Group and requested the largest-ever budget increase for FDA food programs. The House of Representatives recently passed food safety legislation to modernize the authorities of the FDA and improve the ability of the FDA to trace and register facilities that import food, issue mandatory food recalls, and conduct border surveillance and enforcement. The Senate is scheduled to take up the food safety legislation in the coming weeks. Drug safety bills, pending in the House and Senate, would increase the mandate and resources for the FDA to conduct inspections of foreign drug suppliers. Increasing the resources and mandate of U.S. regulators to conduct border and foreign risk-based inspections are positive and necessary steps, but insufficient. There are legal and practical limits to the ability of U.S. regulatory authorities to conduct inspections of foreign food and drug producers and suppliers. The scale and complexity of the global trade in food and drugs overwhelm traditional methods of border control and inspection at ports of entry. Ensuring the safety of U.S. food and drug imports requires new approaches as well as new resources for traditional interventions. Read More >

China�s Health amidst the Global Economic Crisis

Potential Effects and Challenges -- By Charles Freeman, Xiaoqing Lu Boynton -- Oct 19, 2009 -- The current economic crisis has hit China hard. China's high savings rate is a significant deterrent to boosting domestic consumption, and with little sign of a resumption of global demand for Chinese exports, the leadership recognized early in the crisis that it needed to take aggressive action to ensure growth from alternative sources. Hence, Beijing leapt into the fray with a massive $586-billion fiscal stimulus package in November 2008. As China moves to restructure its economy, a major overhaul of its health care system has become one of its top priorities. In April 2009, after over two years of intense debate and repeated revisions, Beijing unveiled its blueprint for health care as part of its economic stimulus package�a much-anticipated reform to fix the ailing medical system and ensure fair and affordable health services for all 1.3 billion citizens. The reform plan anticipates improving public confidence in China's health care system and thus creating a multiplier effect through the economy in response to the global economic downturn. Despite these aspirations, however, Beijing's objectives might not be achieved without proper implementation of the plan. Read More >

International Family Planning

A Common-Ground Approach to an Expanded U.S. Role -- By Janet Fleischman, Allen Moore -- Jul 23, 2009 -- The election of Barack Obama has fundamentally changed the landscape for the debates around U.S. support for international family planning (FP) programs. The personal engagement of top government officials, combined with policy and budgetary announcements that make averting unintended pregnancies a priority issue, clearly signal the administration's intention to promote family planning as part of a comprehensive approach to global health. Despite the polarization that often surrounds the debates on these issues in the United States, largely over their perceived linkage to the highly charged issue of abortion, an unprecedented opportunity now exists to significantly expand international FP programs based on a �common-ground� approach. The core element of this approach is the need to move toward universal access to FP services�defined throughout this paper as education, counseling, and contraceptive commodities�provided on a voluntary basis to females and couples. The common ground does not include abortion, which is prohibited by U.S. laws governing foreign assistance. In most developed countries, a wide array of contraceptive options are available so people can plan whether and when to have children. It is precisely that acceptance and availability of FP services in the developed world that forms the basis for a common-ground policy toward international FP services. Read More >

Enhancing U.S. Leadership on Drinking Water and Sanitation

Opportunities within Global Health Programs, By Katherine Bliss - Sep 24, 2009 - In the United States, domestic support for greater investments in projects dedicated to improving global health through addressing water, sanitation, and hygiene issues has gathered momentum in recent years. In 2005 President George W. Bush signed into law the Senator Paul Simon Water for the Poor Act, making water, sanitation, and hygiene (WSH) activities a strategic focus of United States foreign assistance. In FY 2008 and FY 2009, Congress appropriated $300 million to support international WSH activities for the poorest and most vulnerable populations. During a period of economic crisis in which some U.S. citizens have questioned the utility of overseas assistance programs and believe the government should focus more attention on domestic concerns, a poll released in May 2009 showed that 61 percent put improving access to safe drinking water at the top of a list of issues Americans believe should be global health priorities for the U.S. government. With the Obama administration's announcement of a new Global Health Initiative, the time is right for U.S. agencies to assert political leadership in addressing the persistent and significant global health challenges related to water and sanitation. This report focuses on the links among water, sanitation, and the health sector and identifies opportunities for greater U.S. engagement on water and sanitation as global health challenges. Read More >

Using Measurement to Drive Results

We are in the midst of a major transition in the core U.S. goals for global health. During the period 2003�2008, the predominant goal was to respond to a health emergency, through large-scale, dramatic, single-disease initiatives: the President's Emergency Plan for AIDS Relief (PEPFAR) and subsequently the President's Malaria Initiative (PMI). Increasingly now, the overriding goal is to help create in partner countries sustainable, long-term programs that will decrease mortality and morbidity in most at-risk populations while strengthening health systems. That will involve building on the success of the HIV/AIDS and malaria platforms, while broadening approaches to put a new emphasis on maternal and child health, family planning, and prevention of high-burden, high-risk conditions. In this new phase, there is a corresponding paradigm shift with respect to measurement: from a focus on inputs and process to a higher priority on ensuring that U.S. investments are leading to the greatest health impacts possible. The ability to link new goals with concrete results is contingent on this new paradigm of measurement. Read More >

A Call for a Strategic U.S. Approach to the Global Food Crisis

In May 2008, in response to the growing global food crisis, the Center for Strategic and International Studies (CSIS) launched a task force to assess the rising humanitarian, security, developmental, and market impacts of rising food costs and shortages. Its cochairs, Senators Richard G. Lugar (R-IN) and Robert P. Casey (D-PA) charged the task force with identifying, by late July 2008, a feasible but bold plan of action that the Bush administration, the presidential campaigns, Congress, and the next administration could embrace on a bipartisan basis. The result, outlined in the following report, is an argument for modernizing and doubling emergency assistance, elevating rural development and agricultural productivity to be new foreign policy priorities, revising the U.S. approach to biofuels so that fuel and food security objectives are effectively de-conflicted, acting on an urgent basis to conclude the Doha Development Round, and creating a strategic U.S. approach to global food security that interlinks approaches to relief, development, energy, and trade and that is backed by new robust organizational capacities. Read More >

Health in Latin American and the Caribbean

The United States' geographic proximity to Latin America and the Caribbean, as well as its extensive trade, migration, and border relationships with countries in the hemisphere, make addressing health issues in the Americas a matter of national interest. Challenges include the persistence of high maternal and infant mortality rates; diarrheal and respiratory diseases; and vaccine-preventable infections in some countries, along with the emergence of noncommunicable chronic diseases as an increasing cause of disability and death among aging populations across the region. Drug resistant infectious agents; an inadequate food and drug safety system; and the emigration of health personnel undermine the region's efforts to promote disease surveillance and prepare for emergencies. By updating its foreign assistance health priorities for Latin America and the Caribbean; expanding technical cooperation activities; and working with host countries, nongovernmental organizations (NGOs), and other partners to reach underserved communities, the United States can better promote health, security, development, and good will in the region. Read More >

The Dramatic Expansion of University Engagement in Global Health

Global health is experiencing an unprecedented and palpable surge of attention and growth on universities campuses across the United States. Curricula, programs, centers, departments, and institutes of global health are being established as either free-standing entities or within schools of medicine and public health at major universities. In direct response to this growth and the need for academic stewardship, the Consortium of Universities for Global Health (CUGH) was formed in 2008 to promote, facilitate and enhance the growth of global health as an academic field of study. This country-wide growth creates a new constituency and voice for global health in this country and for the new Obama administration. Read More >

U.S. National Security and Global Health

Despite a broadening consensus that global health care efforts have an impact on national and global security, the U.S. national security community's efforts to address global health are weak and uncoordinated. The 2006 National Security Strategy states that "development reinforces diplomacy and defense, reducing long-term threats to our national security by helping to build stable, prosperous, and peaceful societies." While the U.S. government struggles to find the right balance among the "three Ds" of defense, diplomacy, and development, the U.S. military has increased its involvement in global health where it perceives the diplomacy and development to be underresourced--or to achieve its own specific objectives. As efforts to renew the capabilities of civilian agencies proceed, it is an appropriate time to step back and consider the role that the U.S. Department of Defense (DoD) currently plays in global health, the impact of its health activities on national and regional security, and the role it could play to support a newly balanced U.S. foreign policy. Read More >

Public Health in Africa

Nowhere are global public health challenges more acute than in sub-Saharan Africa. With just 13 percent of the world's population, this region carries 24 percent of the global burden of disease. The continent's immense disease burden and frail health systems are embedded in a broader context of poverty, underdevelopment, conflict, and weak or ill-managed government institutions. These complex, interrelated challenges will ultimately demand sustained, patient, and integrated responses. This report examines these challenges and makes recommendations for a strategic U.S. response by the Obama administration. Read More >

Policies and Practices to Advance global Health Technologies

Innovation in global health technologies has been a hallmark of the past century. Often advanced through U.S. leadership, these new technologies have contributed to enormous progress in the battle against some of the world's greatest public health challenges. Significant barriers remain, however, and the world lacks many important tools to address existing and emerging health threats. Continued support for the development and delivery of global health technologies is critical to ensuring better health for all. Read More >

U.S. Global Health and National Security Policy

The emergence of HIV/AIDS, SARS, extensively drug-resistant tuberculosis, and avian influenza, as well as the Aum Shinrikyo sarin gas attack and anthrax letters, have demonstrated the threat that certain global health issues pose to U.S. national security. The related threats of infectious disease epidemics and bioterrorism are being driven by trends related to globalization. Increased travel, trade, development, and land use are creating new infectious disease threats, and the rise of nonstate actors and the global dissemination of advances in biology and technology are facilitating the potential use of biological weapons. Underlying both threats is a growing acceptance of global interdependence on health issues. U.S. policymaking to address global health threats is complicated by a rising dependence of U.S. security on health conditions in other countries as well as weak health knowledge among foreign policy and national security decisionmakers. Overall, the U.S. response to infectious diseases and bioterrorism has overemphasized defensive medical countermeasures and treatment while underinvesting in prevention, strengthening of public health systems, and the surveillance and response capacities of developing countries. This paper recommends an increased focus on global surveillance and response capacity, heightened attention to the World Health Organization's International Health Regulations, and putting a high priority on meeting the health needs of developing countries as core elements of a U.S. strategy to address the national security threats of emerging infectious diseases and bioterrorism. Read More >

U.S. Policy Options for Strengthening Coordination between Global HIV/AIDS and TB Programs

Over the past two decades, the relentless spread of human immunodeficiency virus (HIV) has amplified the global tuberculosis (TB) pandemic, which had previously been coming under increasing control. Currently, approximately onethird of those living with HIV around the world are coinfected with TB Worldwide, active TB is the most common infection heralding the onset of acquired immune deficiency syndrome (AIDS), as well as the leading cause of death among people living with AIDS. TB kills about 1.6 million people annually, including an estimated 195,000 people who are also infected by HIV. Of the 10 countries with the highest TB incidence rates among HIV-infected people, 7 are focus countries of the President's Emergency Plan for AIDS Relief (PEPFAR), illustrating the importance of coinfection as an issue in places where the United States is concentrating its HIV/AIDS programs and investments. Read More >

Combating the Twin Epidemics of HIV/AIDS and Drug Addiction

This report examines on 12 countries in Asia, Africa, and eastern Europe that have experienced significant increases in reports of injection drug use, injection-related HIV, or both during the past decade. These countries receive significant aid from the United States either directly through the President's Emergency Plan for AIDS Relief (PEPFAR) or through the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The report focuses on a particular intervention--medication-assisted maintenance treatment for drug dependence--an area in which the United States has considerable experience and strength and that offers an opportunity to expand engagement in global HIV efforts. U.S. efforts should be coordinated with those of recipient governments and other donors in an integrated, comprehensive approach that ultimately will be the most effective strategy to curb the rapid growth of injection-driven HIV epidemics. Read More >

The Commission on Smart Global Health Policy

Center for Strategic and International Studies