A Bold Vision for Global Health: The Paul Farmer Memorial Resolution

This year, as foreign aid was abruptly pulled back, global health programming faced a severe funding shortfall. Officials in the U.S. Government claimed they were cutting wasteful and fraudulent spending and improving our foreign aid approach through an “America First” policy. However, in practice, these reforms left millions of people around the world without access to lifesaving care, with no warning or safety net.  

These attacks on global health funding have laid bare an acute-on-chronic crisis. The rapid removal of aid has caused an acute emergency—risking the lives of millions—that demands urgent action. However, we cannot ignore the underlying, chronic inequities that made this crisis possible. The current aid system often obscures the structural forces at play that create the need for aid in the first place.  

While many have called for aid reform without a clear strategy, Partners In Health (PIH), alongside Congressional global health champions, has developed a “north star” for global health politics: the Paul Farmer Memorial Resolution, which can guide policy and practice for decades to come.

On Thursday, July 31, 2025, a coalition in the U.S. House of Representatives and U.S. Senate announced the reintroduction of the Paul Farmer Memorial Resolution, first introduced in the fall of 2022. Led in the House by Representatives Jan Schakowsky, Raul Ruiz, and Pramila Jayapal and in the Senate by Ed Markey, this coalition is proposing what they've termed a "21st-century global health strategy," grounded in the life's work of the late Dr. Paul Farmer.  

“In this moment of crisis, we need Paul’s vision for global health justice more than ever. Thankfully, that vision is captured in this resolution,” said Shelia Davis, PIH CEO, in a press release from Representative Schakowsky. “It provides us with a much-needed roadmap for global cooperation based on solidarity and justice by getting to the root causes of unnecessary suffering and death, or what Paul called ‘structural violence’. This includes greatly improving development assistance for health but also going well beyond aid to address ongoing extractive colonial arrangements, which preclude local investments in health systems.”

A fundamental problem in global health is the low level of aspiration among people in power, borne partly out of a misunderstanding of the causes and solutions to health care inequity. Dr. Farmer termed these chronically low aspirations  "being socialized for scarcity on behalf of others." The resolution represents Congress's most serious effort yet to address this issue.

An Aspiration for Health Equity

Over 100 million people die each decade because they lack access to basic health services—what Dr. Farmer often referred to as "stupid deaths." This resolution aims to provide an ambitious roadmap toward global health equity and universal health coverage to prevent needless deaths in the future.

In 2021, about 4.5 billion people were not fully covered by essential health services. The spending gap to achieve universal health coverage in low- and lower-middle-income countries is around $400 billion annually. With adequate funding, expanding universal health coverage to 1 billion more people could avert over 24.4 million deaths in five years. Such investments also yield significant economic gains. High-impact health interventions in low- and middle-income countries can generate up to $9 for every $1 invested.

"Many of the poorest developing countries presently lack the tax capacity to mobilize the necessary resources to close the universal health coverage financing gap," the resolution states, "meaning unnecessary deaths will continue in these settings for the foreseeable future without external donor financing or dramatic increases in domestic tax capacity."  

The Paul Farmer Memorial Resolution

To realize health for all, the resolution proposes:

• Reforms to global cooperation by:
  • Addressing the sovereign debt crisis through initiatives to restructure and eliminate unsustainable and unjust debt burdens
  • Advancing a strong UN Tax Convention and other measures to end illicit financial flows and other forms of transnational tax abuse
  • Developing new medical technologies for diseases of poverty and ensuring their availability as global public goods
  • Supporting initiatives to advance global labor rights
  • Democratizing international financial and trade institutions
• Reforms to global health assistance by:
  • Increasing global health funding to enable the U.S. to finally meet the decades-long global cooperation aid target of 0.7% Gross National Income
  • Focusing on strengthening public national health systems, especially via multilateral institutions

A Financing Solution

The resolution calls for both increased global health funding and global economic reforms to achieve these objectives. Contrary to popular belief, and especially now, following severe funding cuts under the current administration, the U.S. has room to significantly expand development spending.

As the resolution states, "Relative to the size of the United States economy, the United States' official overseas development spending is low at 0.17 percent of gross national income in 2020, placing the United States 24th out of the 29 country members of the Organization for Economic Cooperation and Development's Development Assistance Committee.”

For those concerned that foreign aid constitutes wasteful spending, the resolution emphasizes that reform, not retreat, is the solution. Global health spending should strengthen public institutions in alignment with national health plans, not funnel money to private contractors. Funding should prioritize historically neglected areas such as hospital and clinic construction, new medical and nursing schools, clinician salaries, and research and development of medical technologies for diseases of poverty.

Why Aid is Our Responsibility  

In the current global economic architecture, poor countries effectively develop rich countries, rather than the other way around. Research estimates that upwards of $2 trillion more flows out of poor countries than into them each year—more than ten times the entire global aid budget.

If the goal is to help poor countries build strong health systems, development efforts must also end the economic harms that prevent low-income countries from mobilizing their own resources for health spending in the first place.  

The resolution lays out a variety of policy areas where the U.S. can use its legal and diplomatic power to make the global economy more fair, just, and democratic—a powerful and fitting legacy for Dr. Farmer.