 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. Thank you very much for being here and helping. Thank you. Thank you. Thanks a lot. Those three. Thanks. Thank you. I'm going to 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. Yeah, that'll be good. And the mic's on. Okay. So this panel is 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 women's health, children's health in the world today is sadly a picture of death, disability, and suffering. And it's been called a human disaster. It's been called, the situation's been called dire or a health emergency. And there's one clear fact, and that is that the fourth and fifth millennium development goal targets, which are reducing by two-thirds child mortality rate and by three-quarters the maternal mortality rate by 2015. They are, particularly the maternal rate, we're doing really poorly. About as badly as we're doing on any other millennium development goal. And I'm not going to recite all the numbers, but I think we know them all, but I don't think anyone believes we can let this situation continue. And we have three great panelists who are going to address this issue. And, of course, it's also addressed in the report. Let me start with Secretary Shalala. Share with us your thoughts on the report and how it relates to... The report does something else that I wanted to comment on. It may be the first commission I've sat on in almost a generation that didn't represent, that didn't recommend a new agency. Even though the answer to the question of who's in charge here was no one in terms of global health, it answers the question in a very strategic way. Number one, it recognizes the use of interagency efforts, and that an integrated global health plan is not a compilation of the programs of various agencies. It, in fact, has to be carefully integrated and focused on this being a major one, and that requires leadership from the White House and from the National Security Council in particular, and from the two secretaries, State and HHS, that would play major roles. So it actually recommends some organizations, interagency councils, a council coming out of the NSC as a way to avoid the kind of turf wars that you have between agencies. But it doesn't leave out a recognition that there are numerous congressional committees. I probably had ten congressional committees on international health issues, and that they themselves, it does no good for the administration to organize itself if the Congress hasn't organized itself. So if we're really going to deal with the issue of women and children, my point would be that we have to have some organizational form so that we answer the question that someone indeed is in charge and there is, in fact, an integrated plan properly resourced that is truly integrated and accountable as opposed to the usual trying to get people that run different programs to try to talk to each other. And I think that the combination of the strategic recommendations on women and kids and organizational form both at the Congress and the administration are really the significant recommendations here. And I can spend this much time talking about it, not only because I have to run off and catch a plane, because this is the only audience I think we'll ever talk to that thinks that organization is sexy when it comes to inter... and we'll understand why you have to have some kind of a framework, a carefully put together leadership team to really pull this off. So thanks, Mike. Maybe before you go, you could just tell us are you as optimistic as what we heard today from the Deputy Secretary? It's a lot of money and given by partisan support and you think we're going to hold it? Listen, 20 years ago I debated Jean Kirkpatrick on whether health had any relationship to national security or to international security and whether it really should be on the agenda. We have come so far from those initial debates from Helene and I begging, and you Mike, begging for money from various congressional committees. The last thing I did before I left government was Peggy Hamburg, who's now the FDA commissioner and I, went around to the appropriations committees of the military and systematically asked them for money and international health pointing out the challenge of bioterrorism. I mean, it was like, they were very nice people, but it was like we came from a foreign land having those conversations. Boy, have we come a long way and I'm very optimistic. That's great to hear. Thank you. So Joe, you and I, we had a chance to travel together to Kenya. We were in Nairobi, but we also went way out in western Kenya and saw a lot of the rural areas. Tell us, sort of, give us your impression of what you saw and tell us a little bit of how maternal and child health, how what's in this report links up to what you saw in Kenya and links up to the American public in general. You're a communications guru and I think you can put it in the right perspective. Yeah, what I think was interesting about the trip was that we got to look at the different parts of the health system from the very top to the community-based organizers and health workers. And what was interesting was that what we saw there reflected a lot of what we heard from the folks who were participating on smartglobalhealth.org. In particular, maternal and child health was the most popular topic. When we asked people to submit essays for inclusion in the report, it was the most popular topic that came in and people frequently referred to it as a gateway issue to so many others, whether those are other health issues or economic issues or security issues. And so those pieces of feedback that we started getting in terms of what folks were already submitting from their feedback around the country, we saw up close talking to community health workers and to folks at clinics in Kenya. And folks can see on page 41 of the report the breadth of places that those essays came in from. And those essays reflect the level of participation that, as Donna said, there's a lot of commissions in this town and they frequently recommend new agencies, but one of the things that they don't frequently do is open up the conversation to folks outside the members of the commission. So what we tried to do here from the very beginning was to take the very unique collection of people that CSIS put together, a couple of dozen folks from very different backgrounds and try to build a constituency that reflected those different backgrounds, but instead of a couple of dozen people, have it being a couple of thousand people. And so over the course of the commission, we tried to document the commission's work, especially the trip to Kenya through a lot of content, written photo video, as well as to encourage participation in the Q&A around the topics that we were encountering there in Kenya, but also through all the different commission meetings. So I would encourage everyone to both look at the report, but also to engage in the further conversation about the report and about maternal and child health specifically and continue on Smart Global Health.org, because that's how this report's going to turn into a particular advocacy. It was surprising and encouraging to see just how many people with such a depth of expertise, whether it's in academia or in the field or in policy, to gravitate towards the commission's work because they have such a deep level of passion and a unique experience to bring to the table. Yes, you and I, we rode motorcycles together. I remember that out there in western Kenya, and for transportation. With helmets. With helmets. I'm not going to say, but we wanted helmets. Let me say that. But tell me how the field of maternal and child health, how do we... I mean, the American public, and you know this well, has been very favorable to the previous administration's initiative and how do we keep... In the context of our domestic situation and all the crises we face around the world, how do we keep the public focused on the importance of the issue and keep the support politically for it? Because as we know, a lot of our votes in the Congress are going to be based on local views on topics. The answer is you have to organize. There is energy out there on maternal and child health specifically, and I saw in the essays they came in that that's a very deep well of passion for this part of global health in particular. And it's not enough for folks on commissions like this one to just say, oh, well, it's us that the American public isn't engaged in. In fact, there are a lot of people who not only are engaged on it at an intellectual and sort of policy level, but who have actual experience out in the field, whether it's having gone out in the Peace Corps or working for an organization like HAIR or having taken a global health certificate like they offer at Duke. People have a deep level of understanding and there need to be whether it's through organizations convening conversations like CSIS is doing or other organizations that are doing legislative advocacy and actual organizing around these issues. People need to be connected and they need to make a voice for it. Because there is a position to go to. Okay, so Helene, you articulated a few minutes ago in a nutshell the main strategy for reducing mortality for women and children. We've just taken our eye off the ball for the past decade or two on these issues and so how do you feel do you think we've got a good package of interventions and how are we going to get them implemented? How are we going to convince people that we really can make a difference since we haven't had the support that looks like we have now? Yes, I think we do have the right tools and the right package and let me just say again to this issue of why this is the right time to be moving this forward, I think as several of the previous speakers have said I think we are in a different place than we were 10, 15 years ago. I think people do recognize the importance of global health and issues that unlike HIV that both of you and I have worked on for many years one of the reasons why there was such a resonance with HIV is that people here in this country felt it too. It was truly a global issue. It impacted us domestically and so I think it was easier for people to kind of make that leap of caring for people in other parts of the world where HIV was also having an impact. I think today thanks to communication efforts like people like Joe and I know Pat Mitchell will talk more about why it's so important to keep the communication aspect. I think in some ways we've been able to bridge that gap where people today understand these issues if we don't have the same rates of maternal mortality or infant mortality I think these issues are becoming more real to our public. I think all the work that's gone on to make the sense of our global interconnectedness real to people means that we're at a different point in time where these issues really do resonate with the public. So I think one, I think we are really in a good place to move this forward. Two, I think we do have much more knowledge of the interventions and what makes a difference. They're pretty straightforward. We know that women need to have access to family planning so that they can face births to begin with. We know unwanted pregnancies are a huge part of what leads ultimately to unsafe pregnancies and maternal mortality. I'm proud that in this report we didn't back away from that issue. We know that that whole issue, the issue of family planning can be incredibly divisive. But I think we took the approach that this is around saving people's lives and we know that a woman who has the opportunity to space birth will be a healthier mother and her children will also have a healthier survival. So access to the ability to space births. Secondly, making sure that people have access to skilled birth attendants and that that access is appropriate depending on the level of health, whether it's at the community level, on up to the national level, and that there's in place a system for referral when there are complicated pregnancies, so emergency obstetrical care. But another reason why we converged on this as an issue is that doing all those things means that you also have to put a focus on a functioning health system because it doesn't just happen without having in place a health system that supports the different levels of care that are necessary. So in some ways, by being able to measure what happens with maternal mortality, it's a way of measuring how well we're doing on strengthening health systems overall. And I think again that's something that comes out in this report that while it's important to continue to have these very focused efforts in particular diseases, we also want to be able to push towards strengthening the health system more broadly and I think maternal health does that. I just want to ask you to comment. Yesterday I believe the Kaiser Daily Global Health Report, which comes out, maybe you probably read every day, had a story that at least was a concern to me, and I just quoted, it says that in June, as you know, the G8 summit is going to be meeting and the signature initiative of the Canadians is supported to be on mother producing maternal child mortality in poor countries, but the Canadian Foreign Minister said on Tuesday, and I'm quoting here, in the Globe and Mail that this initiative, quote, does not deal in any way, shape or form, which is to be able to save lives. This is coming from our northern partner, which normally as you said to me is quite enlightened. So I wondered how we're going to, the G8 is a critical moment. It's only a few months away and how are we going to bring family planning into this? Well, you know, I think it is of note that this is something, as I said, we didn't shy away from. I think that the Global Health Initiative that the administration is putting forward hasn't shyed away from it. I think it is a tough issue for a lot of reasons. It has been used as a divisive issue. It doesn't have to be. It is about saving lives. It really should be the opportunity for women to have safe pregnancies and to make sure that their children have the start of safe and healthy lives. We know that children who are born too close together are more likely to have bad health outcomes. So it is absolutely about saving lives. I think our time is up. I just want to say that I agree with you and the panelists that this is really a great moment for those who have been working for decades in this field. We need to seize it and think of it as a continuum of care from the home to the health facility. I also think we need to think of it as a continuum of care from the mother to the newborn to the child. I think historically the newborn has been forgotten. We talked about maternal health and child health. I think as you see in the report, we really emphasize this continuum of care both in terms of the mother to the newborn to the child as well as from a delivery standpoint from the home to the community health worker to the health facility. So thank you all and I think we can move on to the next panel. Thanks.