U.S. Congressional Representatives Introduce The Paul Farmer Memorial Resolution

“North Star” enshrines Farmer’s vision for global health equity, precursor to future legislation

Posted on Sep 20, 2022

Dr. Paul Farmer making rounds with four clinicians in Haiti
Dr. Paul Farmer making rounds with four clinicians in the pediatric ward at University Hospital of Mirebalais, Haiti. Photo by Rebecca E. Rollins / PIH

A new coalition in the U.S. House of Representatives today introduced a resolution honoring the life and work of Partners In Health Co-founder Dr. Paul Farmer with an ambitious roadmap to end medically avertable deaths and realize global health equity.

The resolution calls on the U.S. government to adopt a bold “21st century global health solidarity strategy” to end poverty, ensure health care as a human right, and address structural, economic, environmental, and colonial harms that undermine the health and well-being of people around the world. At its core, the resolution enshrines Farmer’s vision for global health equity, serving as a “North Star” for global health politics into the future.

Sponsored by Rep. Jan Schakowsky, an Illinois Democrat, Rep. Barbara Lee, a California Democrat, Rep. Raul Ruiz, a California Democrat and physician, and about a dozen original co-sponsors, the Paul Farmer Memorial Resolution is aspirational, bold, and visionary, much like Farmer, who died in February in Rwanda. Specific legislation from each of the resolution's core pillars will emerge from this effort in the near future, supporters said.

“Dr. Paul Farmer is responsible for transforming the lives of millions and millions of poor and marginalized people around the world, bringing them health care, dignity, and justice," Rep. Schakowsky said. “A true visionary, Paul insisted that all people have a right to excellent health care, and he developed the systems to deliver it in places people had written off. Gleaming world class hospitals and locally trained doctors, nurses, and community workers now exist in places like Haiti and Rwanda."

She added: 

“We are the richest country in the world at the richest time in the world. Paul called on us to understand global health inequity as an injustice—a result of centuries of violence and exploitation inflicted on the global poor. We can make the choice to end global health inequity, and with Paul’s vision guiding us, we will.”

The idea for the resolution came immediately after Farmer’s death, when his long-term supporters and admirers in Congress began discussing how to honor him and carry his vision forward. Rep. Schakowsky led the construction of the text, with input from Farmer’s colleagues at Partners In Health and Harvard Medical School.

“Paul’s long-time collaborators and global health champions in Congress wanted to honor his legacy by taking action in solidarity with the global poor,” said Joel Curtain, director of advocacy for PIH.

The Paul Farmer Memorial Resolution

The resolution seeks to put an end to “the tragic and unnecessary deaths” of more than 13 million people each year, largely the global poor, by adopting new strategies to strengthen health systems, including:

  • Increasing U.S. global health spending to $125 billion per year;
  • Reforming global health aid to support national health systems and direct funding to align with local plans and priorities, not the development industry;
  • Creating new medical technologies for diseases of poverty and ensuring their availability as global public goods; 
  • Making the global economy more fair, just, and democratic by: 1) Democratizing the International Monetary Fund [IMF], World Bank, and World Trade Organization [WTO] so that impoverished countries have equal representation and a greater say over decisions that affect their economies and their ability to finance health systems; 2) Canceling global debt for all developing countries that need it, acknowledging these debts have often been unjustly imposed and maintained;  3) Ending harmful licit and illicit financial flows from poor countries, such as global tax evasion;
  • Supporting global labor rights, such as a global minimum wage;
  • Proposing reparations, including award, apology, and guarantee of non-repetition of harms for the institution of slavery, colonialism, imperialism, and ecological breakdown. 

Following Farmer's Vision

In his body of work, Farmer argued our world has more resources than at any point in history. Yet, tragically, over 100 million people die every decade because they lack access to basic medical care, what he often referred to as “stupid deaths.” There is no way, he said, that we stop this injustice without ensuring the poorest countries have more resources to build health systems. To do this, he argued in much of his writing—including the books “Fever, Feuds, and Diamonds” and “Pathologies of Power”—the global community must:

  • Increase global health funding to close the financing gap for universal health care, at the same time ensure this funding is used to support local public health systems, train and pay doctors, nurses, community health workers, and ensure medicines are available to the global poor, and
  • Stop the ongoing economic harms to poor countries that rob them of the resources they need to provide health care for their citizens, and redress past harms and legacies of the colonial and postcolonial eras.

As Farmer pointed out, poor countries have helped develop rich countries for hundreds of years, not the other way around. We must reverse this trend as a matter of justice, he said.

A fundamental problem in global health is the low aspirations of people in power, borne partly out of a misunderstanding of the causes of and solutions to global health inequity. Farmer termed these chronically low aspirations as being “socialized for scarcity on behalf of others.”

This resolution is the most serious effort Congress has made to address this problem, Curtain said.  

Paying for universal health care

The fundamental question addressed by the resolution is: why don’t poor countries have the resources to provide universal health care?

The resolution points out that the current global economic architecture siphons resources from poor countries to rich countries.

And that this is by design, from the colonial period to today’s governance structure of the WTO, IMF, and World Bank. The resolution states: “Many of the poorest developing countries presently lack the tax capacity to mobilize the necessary resources to close the universal health coverage financing gap, meaning unnecessary deaths will continue in these settings for the foreseeable future without external donor financing or dramatic increases in domestic tax capacity.” The spending gap to achieve essential universal health care in low- and lower-middle income countries,according to the Lancet Commission on Investing in Health, cited in the resolution, is around $350 billion per year (in 2016 U.S. dollars).

Experts estimate that conferring essential universal health care in these settings would end the vast majority of medically avoidable deaths globally, preventing approximately 100 million unnecessary deaths per decade. Ensuring universal health care and strong health systems would also further protect countries currently vulnerable to pandemics. While $350 billion seems like a large figure, it represents only 0.5% of the G20 GDP in 2021,and only 2.8% of the wealth possessed by billionaires in 2021. The problem, Curtain said, is not a lack of resources but a lack of ambition.

Contrary to popular belief, the U.S. has room to significantly increase development spending; the resolution proposes increasing global health spending from $11.4 to $125 billion annually, which could come through a number of different Congressional committees, proponents said. This spending would meet around 30% of the “essential universal health care” financing gap for low- and lower-middle income countries and allow the U.S. to meet the United Nations [UN] aid target of 0.7% gross national income for the first time.

Reimagining global health

The resolution argues we should reform global health delivery spending to make sure it funds public institutions in alignment with national health plans, not private contractors in the development industry.

The resolution also asserts that the government should fund areas seldom funded in global health, like the creation of hospitals and clinics, new medical and nursing schools, and the payment of existing clinicians. It also points out that medical technologies for diseases of poverty are rarely researched; and medical technologies are also priced out of reach for the global poor. One use of the $125 billion in spending, the resolution proposes, should also be to fund an ambitious research and development program that results in new technologies available as global public goods—not kept away from the global poor behind patents, trade secrets, and market forces.

As one undeniable case in point, the COVID-19 pandemic illustrated how high-income countries’ vaccine research and development policies failed to treat vaccines as a global public good, which led to an unnecessary scarcity of COVID-19 vaccine and left millions of people without access to lifesaving tools to prevent the virus’s spread.

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