281. Memorandum From the President’s Special Assistant for Health Issues (Bourne) to the Secretary of the Cabinet (Watson)1


  • Cabinet-Level Task Force on International Health

Following up on our recent phone conversation, here are the basic reasons for establishing such a group:

1. Enables the President to mobilize government-wide support on a cross-cutting issue which involves 18 federal agencies and departments. The far flung nature of this area means there are various competing interests, especially between State, AID and HEW. Any study or plan conducted within or among these agencies without executive office involvement in balancing competing interests during the phase when policies are being formulated merely perpetuates and may even further polarize and diffuse interests and responsibility.

2. Improves prospects for enactment of legislative reforms and fostering balanced policies within the Cabinet thus reducing resistance in Congress.

The Congressional committee jurisdictional makeup encourages that HEW advocates will be pitted against State/AID advocates and any legislation or program proposals which do not take this into account enhances a confrontation between committees. I am interested in results and action, especially so that the President is in the position of leading and not reacting on this issue to Congressional initiatives which could emerge from four different committees representing distinct special interest constituencies, eg, those advocating a lead agency for HEW and those advocating a lead agency role for State. This is of particular significance in view of the effort by Senator Kennedy to seize the initiative of this issue from the President.

3. Helps to establish and strengthen the Cabinet structure concept in the Carter Presidency as a useful planning and decision making tool for the President.

If this Administration is to achieve a reduction in the number of special purpose entities institutionalized within EOP, and demonstrate to Congress that the Cabinet can carry out planning and analysis functions of a cross-cutting nature, then we must begin now to use the Cab[Page 937]inet for precisely that purpose. If we don’t, then Congress, acting in response to special purpose constituencies or visceral public outcry concerning Executive branch failure to develop comprehensive programs involving a number of agencies will again begin to enact legislation designed to circumvent the bureaucratic structures they originally created. Conceivably four years from now we may be little better off than we are now in strengthening the Presidency or the Cabinet over the long run notwithstanding temporary success in eliminating EOP functions.

In summary, what I have proposed to the President is to bring together a cabinet-level group which represents the agencies and Departments who impact on international health, study the issues (a great deal has already been completed in the past 8 weeks), identify problems, and opportunities, and estimate the costs of new initiatives. Upon completion of a report and submission to the President the Cabinet structure will be disbanded, and in its stead will likely be a number of ad hoc clusters who will implement the proposals accepted by the President. A government-wide report on this subject is unprecedented and has strong potential to be a major ingredient of the President’s personal diplomacy strategy for the remainder of this Administration.

Attached for your review is a scenario to initiate this effort, a draft memo which the President would eventually sign announcing and directing the report on international health be implemented, and the cabinet organizational structure.2

  1. Source: Carter Library, Staff Office Files, Special Assistant for Health Issues—Peter Bourne Files, Subject Files, Box 34, International Health, 4/1/77–4/28/77. No classification marking.
  2. The scenario, entitled “Steps to Implement Cabinet Level Committee on International Health,” is attached but not printed. Neither the draft memorandum nor the Cabinet organizational structure is attached. The President, in an August 15 memorandum to Bourne, Vance, Blumenthal, Califano, and Gilligan, instructed Bourne to undertake a study of international health problems (See Document 293).