 We are immensely grateful. Jack. It's a pleasure to be here this afternoon with so many friends, colleagues, and partners on an issue that's of critical importance to all of us in the nation and the world, global health. I want to thank Helene for that generous introduction and for her leadership, for her work at the CDC, the Gates Foundation in care, as co-chair of this commission. She's played an integral role in shaping our nation's approach to improving healthcare here at home and around the world. I also want to thank Admiral Fallon after a distinguished military career. He has turned his attention to the very real national and global security threats posed by the inadequate health systems of the world. The world's coming to realize something that Admiral Fallon figured out a long time ago that when people's lives and livelihoods are at risk, their communities are not secure and that insecurity can spread across borders and oceans and affect all of us. I also want to thank everyone who served here at CSIS on the commission on smart global health policy. The commission represents a broad range of expertise and viewpoints, including my good friend Donna Shalala and my friend Bob Rubin, Senator Bill Frist, who recently returned himself from doing heroic work caring for victims of the earthquake in Haiti. And to the outstanding team here at CSIS, John Hamry, Lisa Cardi, Steve Morrison. As a group, these commissioners remind us that saving lives and preventing disease are shared goals that transcend political differences and draw on the deepest of American values. This report reflects their broad knowledge, experience, and dedication. It's full of innovative thinking and persuasive arguments for how our country can get better results from our work to improve health worldwide. And I join you in looking forward to seeing these ideas take root in policies and programs. I also bring the congratulations of the Secretary of State who is in Moscow today representing the United States at a meeting with Russia, the EU, and the UN and making progress, we hope, on resolving the Middle East conflict. She sends her thanks to all of you for the work you were doing here to foster peace through health. Let me begin today by asking you to imagine two women who live not far from each other on the other side of the world. Both have just given birth. Like most women worldwide, they did not deliver their babies in a hospital but at home with the help of family members and perhaps a midwife. And they both experienced a not uncommon consequence of childbirth, postpartum hemorrhage. The first woman lives in a village with a small health clinic that has a trained nurse and is stocked with oxytocin, an inexpensive drug that can stop the bleeding. The second woman does not. The first woman lives, the second woman dies and her children lose their mother and their provider. It's clear how the absence of a simple intervention devastated this one woman's family. What may be less clear is why her life and her family's health matters to us. That's what I'd like to discuss today. How the health of people on the other side of the planet affect the lives of people everywhere including the United States and how, as a result, the Obama administration is working to improve global health in a new way with a new commitment. When people think of global health threats, they often think of pandemics and it's true that the diseases in one country can quickly spread to another which we saw earlier in the last year with H1N1 which swept the globe in a matter of weeks. But the impact of poor health care goes beyond the spread of disease. Poor health prolongs poverty. When people are sick, injured or underfed, their ability to work or attend school declines. Health crises foster political instability as we've seen in countries ravaged by AIDS when millions of adults disappear and states shut down or fall apart. Disease fuels famine when farmers grow too sick to work, their crops die and widespread hunger can result and that sparks violence. There have been food riots in more than 60 countries since 2007 because people who can't feed themselves to their children find themselves in situations where sometimes all they can do to express themselves is riot. And disease and under nutrition sustain the social and economic divides that prevent billions of people from participating in the life of their communities contributing to broader progress and pursuing their own dreams and aspirations. In other words, health crisis is more than a health crisis. It's a political crisis, an economic crisis, a social crisis, and a security crisis. And in our interconnected world, crises that start in other countries rarely stay there. But this is only half of the story. Just as poor health has a broad impact, promoting better health can have a broad impact. When health improves, economies grow, opportunities rise, trust in government increases, society is flourished and life becomes more stable and secure. Furthermore, as the story of the two women illustrates, life-saving interventions are often inexpensive and easy to administer. A dose of the virpin costs less than $5. A shot of the measles vaccine costs less than a quarter. An dose of oral rehydration therapy costs about a dime. Yet every year, more than 400,000 babies are infected with HIV, about three million people die from vaccine-preventable diseases, and one and a half million children die from diarrheal disease. For these reasons, a strong connection between health and broader progress and the potential for investments in health to have a significant impact across many lives. The Obama administration has made global health a central priority of U.S. foreign policy. We're investing in health to save lives and alleviate needless human suffering. We're also doing it as a means of protecting our citizens, supporting our partners, and making headway across a range of issues. Improving global health accords with both our values and our interests. It is an urgent national and global need that we cannot underestimate or overlook. Last May, as Gal and Admiral Fallon noticed, President Obama announced the launch of the Global Health Initiative, a $63 billion commitment over six years to improve health outcomes, with a particular focus on improving the health of women, newborns, and children. This initiative continues a strong tradition of U.S. support for global health. The United States is the world's leading contributor to the global fund to fight AIDS, tuberculosis, and malaria. We're the largest donor country to the Gavi Alliance, and we've had great success in fighting AIDS through PEPFAR. Since President Bush launched PEPFAR in 2003, it has delivered lifesaving antiretroviral medicine to more than 2.4 million people, provided care to nearly 11 million, and prevented almost 350,000 cases of mother-to-child transmission of the virus. And now PEPFAR will be a cornerstone of the Global Health Initiative. Our budget request for 2011 represents the largest commitment the United States has ever made towards fighting AIDS. So with the Global Health Initiative, we're building on years of experience and commitment, much of it done with the support of many here today. But this initiative is not simply a continuation of past practices, it represents a new business model, one that emphasizes integration and coordination across the health spectrum, rather than addressing single diseases in isolation. One that leverages our existing investments for broader impact, and one that is built upon the principle of partnership so that the countries we work with can in time provide care to their own citizens without relying on us or other donor countries to fill critical gaps. We are reaffirming our commitment to the core services that have saved countless lives and served as the hallmark of our global health efforts. The United States will continue to deliver drugs and vaccines and bed nets and birthing kits to people worldwide. But we all know this model of AIDS cannot be sustained indefinitely. That's why we're working to make our health programs, take our health programs to the next level by helping our partners expand and strengthen their own systems. For example, by establishing better supply chains so local clinics have enough frontline drugs and basic supplies to serve their communities. And by building on existing clinics so a woman gains access to HIV counseling, prenatal care, delivery care, and family planning all at one location. We also hope to help countries provide not only treatment for those who are sick but preventative care to protect people from getting sick in the first place. It may not be self-evident to place prevention as a top priority when the needs of the sick are so great. But that is when prevention is even more critical to stop the spread of illness and lessen a given disease's long-term impact. For example, for every two people we put on AIDS treatment today, five more are infected and we continue to lose ground against this and other epidemics. In many places today, local health workers are too overwhelmed by patients with urgent needs to focus on prevention and wellness. By expanding their capacity, we hope to change that. We are doing our work with an eye towards innovation. The United States has a strong tradition of funding developing and implementing health innovations and that tradition must continue across the board from the pursuit of new vaccines to the use of new diagnostic technologies to the development of innovative financing mechanisms. We're calling on our ambassadors to play a new coordinating role. As our chiefs of mission, they're best positioned to bring everyone together around one table and harmonize their efforts. Not only in health, but in our work on climate change, food security, and so many other areas. And we are embracing a new commitment to results rather than measuring our success by how many programs we run or how many dollars we spend. We're investing in monitoring and evaluating our work so we can track our progress and learn from both our mistakes and best practices. There are a few specific health issues we are focusing on immediately, including nutrition, safe water, and neglected tropical diseases. But there's one area in particular that I'd like to address today and that's maternal and child health. Because of the central role they play in caring for others, the health of women is critical to the health of children, families, and communities. When mothers are sick, their children suffer. When mothers die, their children are more likely to die. This has brought implications, in fact, one of the most constant predictors for political upheaval is the rate of infant mortality. Because in places where infant mortality is high, the quality of life is often low. Despite the importance of women's and children's health to larger progress, unfortunately, they're particularly vulnerable to poor health. In part because of entrenched attitudes about whether women and children, particularly girls, should receive care as a matter of high priority. As a result, childbirth continues to be one of the leading causes of death for women in low income countries and nearly nine million children under the age of five die every year, mostly from preventable causes. This issue features prominently and persuasively in your report and is a priority that we share. Some of the changes to US policy I've discussed today are already underway. Others will be implemented in the months ahead. Virtually all are addressed in this commission's important work, which we're here to celebrate the launch of today. Together, they represent a new approach and new commitment to improving the health of people worldwide. This work won't be finished in a year, but the United States is invested in it for the long term. We are committed to seeing it through and we are committed to trying our programmatic efforts with a renewed emphasis on global health diplomacy to raise health issues not only in the context of development, but also in the context of democracy and security of nations and institutions worldwide. The people in this room represent our country's top talent in the field of global health. We are counting on each of you and the organizations and institutions that you represent to help. Your experience and dedication will make all the difference in our work worldwide. We need your ideas, we invite your critiques, and we ask for your support. The road ahead is sure to be full of obstacles. There will be times that we try something new and fail. We will grapple with tangled bureaucracies and struggle to maintain momentum. This will not be easy. Indeed, it's one of the most ambitious projects we've ever embarked upon. But we must always remember that the future we are working to achieve is the real goal. It's a future where parents line up outside clinics on vaccination day and there are always enough shots for every child. Where mothers receive competent and compassionate care as they bring new life into the world. Where pharmacies are stocked with the essentials so no one has to die for want of a simple cure. And where people everywhere have the chance to live safe, healthy, and productive lives no matter where they live or what their income. This is the future we hope to achieve in the foundation of stability, prosperity, and peace for our country and for the world. Thank you. Thanks so much for those comments. And again, we really want to, on behalf of the commissioners, really thank you for the time that you and Dana and others on your staff have taken as we've worked through this. Let me just throw out a couple of questions to begin with. This is a town that does a lot of reports. A lot of report writing. And clearly, as you said, this area is something that the administration has already taken on and made a commitment. Tell us a little bit why a report like this is or is not helpful. Well, it is helpful, hopefully. But tell us what a report like this does. And then maybe how should we think about the next stage of this? Because we don't want this to just be a report that sits on a shelf. How can this continue to be helpful to your work? Well, it's already more than just a report that sits on a shelf. When we had our first meeting, better part of a year ago, we went over what our schedule was for putting together the Global Health Initiative. And in fact, we've already had the kinds of conversations where the work leading up to this report has helped us develop our thinking as we've developed the Global Health Initiative. I think if you look at the content of the Global Health Initiative and the context of this report, there are a lot of similar strains of thought and the basic direction of the objectives. I think as we go forward, there's obviously a challenge in the fiscal climate we're in to maintain the sense of urgency. The funding for the program will be critical to our being able to implement it. The transition from focusing exclusively or primarily on disease treatment to the broader connection between different aspects of health programs challenges a way of doing business that was pretty well established. We think it's critical. I think reading the report, the report thinks it's critical and the debate continues. So we need both the members of the commission and those who agree with its results to remain engaged in the public debate. Mr. Secretary, the Department of State, of course engages with our neighbors and friends and countries around the world. One of the observations that we, as commissioners, came to realize pretty quickly was how essential it is for these partner countries to actually work with us. So it seems we may have great ideas and hopefully we'll have the funding to support this. Any ideas or thoughts about how we get these other countries to really be true partners with us in this effort? I've had bilateral conversations with probably the very part of a dozen countries. I've spoken to the leaders of most of the international health organizations and I think we've made substantial progress in the last year. The issues that we're discussing have resonance in foreign capitals and international organizations. I think we're at a point where our following through on our piece of it is what we need to do to gain the credibility and have the leverage to take it to the next step. I think there's a growing appreciation amongst donor countries that there's a need for ownership in the countries that we're trying to help. You see it in the Paris and the Accra Accords. You see it in the principles that our president laid out when he was in Laquilla last year. And it's very deeply embedded in our Global Health Initiative and the direction of the report. I think we also have to be sensitive to the fact that we're going into countries that almost by definition because they're developing countries don't have the very high level of resource to be dealing separately with 20 or 30 or 40 of us who wanna help. So we owe it to them to coordinate a little bit and make it easier for them. And I think that there is an interest in the world community to do that. We're certainly through the State Department and USAID investing a lot in the effort of reaching out on a diplomatic and a kind of development partner basis to make that happen. You know, you've got a lot of things on your plate and Global Health is one of those. And one of the things you're leading on is really looking at the overall picture of how we do our foreign assistance and how we go about doing that perhaps in a way that's more integrated, more strategic, longer term vision, et cetera. Say a little bit about how this area of Global Health fits into the overall thinking. You touched on it a little bit in your comments, but as you look at the broad picture of our efforts and foreign assistance and foreign development, where does this fit? How does it integrate? And what's been your thinking about that as you go through some of the studies that are ongoing now? Health starts out in a different place than other issues because we have a pre-existing set of programs that are so well-established. So it's a great benefit in health that we have a rich resource base and the question is how can we use that resource base in the additions to it most effectively? It's a little bit more complicated than some other areas. Because of that well-established history, we're not starting with a clean slate. We're starting with programs that work well where we don't wanna do any harm to the programs that are working well as we move forward. I think that if you look at our kind of overall approach and Secretary's speech recently highlighted this, we're gonna focus on doing the things that we do well and that we are really effective at in places where we can really make a difference. That's reflected in the principles of our Global Health Initiative because we're gonna make that extra level of investment in the countries where we think we can really move the ball forward. It's in our food security initiative, that's a principle that we followed as well. It's not something we can do unilaterally. We have to do it with the partners in the countries we're trying to help. They have to have a plan, they have to have ownership of it. We have to tie together the programmatic spending and our diplomacy. It's not just a question of can we write checks to pay for programs, but can we work with heads of states, finance ministers to build the support for programs like health security into their future budgets, into their own priorities. It's a diplomatic as well as a development challenge. I think in some ways it reflects what we're trying to do overall in our foreign assistance programs. It's kind of outsized just because our commitment to health is so large, which creates, I think as I said, special opportunities, but also unique challenges. Let me just follow that up with one and then Bill to wrap up with the last question. You know, your background before was looking at budgets. This is gonna be a big ticket item. This is a tough time. Why are you optimistic that we will find the will to be able to provide the resources that are necessary to move this more broader agenda forward? I think we're in a very challenging fiscal environment. We're obviously at a moment where our national deficit and our national economy make the kind of sustained commitments to any program more challenging than they would have been in an environment that existed not that many years ago when we had a surplus and the ability to do things with more ease. I think you have to ask why over the last few years with this growing sense of concern for fiscal discipline and extremely weak U.S. economy, why did we see increasing levels of support for foreign assistance? In the 13 months since we've been in office, we've seen several instances in the budget appropriation process of quite significant increases in spending in this area. I think it reflects the challenges of the world we're in. There's a profound sense that our security depends on our having the kind of connection between the programs that we're supporting because they're the right things to do and the kind of world we need to live in to make it a safe world for our people. I think those are not contradictory concepts. You can do something because you wanna help people, but you can also be honest about the fact that by helping others, we make the world safer for ourselves. I think that has a lot to do with why we're seeing the kind of support. I think that the clear focus on results has been one of the hallmarks of recent years. The PEPFAR program has delivered on the promise to cover people in treatment programs. That's been enormously important. I think we have to, in this initiative, have clear benchmarks of how many lives are we saving? How many mothers are not dying in childbirth? How many children are not dying unnecessarily of diseases of infancy? I think if we can show results and show that it is tied to the security of the countries that we're helping, I'm an optimist. We need optimists. Jack, just one final question. Around this town, people get diverted pretty quickly into the issues du jour, and certainly health is in the limelight, but it's domestic health. We've articulated and you've very, very, very convincingly laid out these connections between our future here in this country and security and the tying in the health business. How do you think we're gonna be able to keep the political attention on this issue, keep enough attention on it to actually make progress while we're dealing with all these other things that are much closer to home? Well, I think in terms of the administration, you have a group of people who care passionately about this issue, so it's not gonna take a lot to keep the administration focused on it. It starts out from the Secretary of State to the Administrator of USAID all the way to the President of the United States, the kind of commitment to this issue that's strong and deep. I think you have from the last decade a growing commitment in Congress to take global health issues seriously. I also think not unimportantly, and somebody who left Washington nine years ago came back a year, just a year ago, a different environment in terms of there being a community of interest that expresses its views in an effective way. 10 years ago, you didn't have effective advocacy for these issues where it showed that it's not just an issue that a few doctors or a few health experts cared about, but it's something that went deep into the values of American communities and it resonates with our security values the way we're talking about today. I think we have to maintain that. I think it's very real, it's true, but as somebody who had to defend foreign assistance budgets 10 years ago and last year, it's a different story when there's a perception that people outside of the room, you're in care about it. And I just thank you for the work that all of you have done, and for the many people in this room who've made that change happen. I think it's a meaningful difference. Well, Mr. Secretary, thank you very much for your very, very generous commitment of time and effort and great thoughts and ideas. Thank you. For joining us here and our help. Thank you. Thank you. Thank you. Thanks a lot. It was great. Thanks. Thank you. I'm gonna move very rapidly to our next panel. I'd like to invite Mike Merson, Donna Shalala and Joe Rospers to come up and join Helene Gale for the panel on women and girls. Thank you. Have the mics on. Okay. So this panel is on delivering on a new commitment to mothers and girls. We're a little bit behind schedule already and I had been asked to frame this, but I think it's been beautifully framed already. By Helene, by Deputy Secretary. Clearly the state of.