292. Memorandum From the Assistant to the President’s Special Assistant for Health Issues (Fill) to the President’s Special Assistant for Health Issues (Bourne)1


  • Meeting with the President, Friday, July 29, 1977

In order to begin to map out a strategy for your meeting on Friday,2 the following items are suggested for you to think about raising during the meeting.

1. International Health Strategy.

—Decision memorandum on this subject will be ready by late September.

—The structure has been agreed to; it has applicability to be used as a planning and analysis tool on other crosscutting issues which cover both domestic and international issues such as hunger, family planning, disaster relief, child health.

—It has been very difficult to gain agreement on structure of all the agencies involved to procedures to follow on international health because of the competing and overlapping interests on this issue; the same problems are relevant to World Food policy which encompasses 26 Federal agencies.

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2. World Hunger Initiative.

—The National Security Council proposes that we use the PRM review process to come to grips with this particular issue and develop a governmentwide world food policy plan, I disagree for the following reasons:

—Does not involve the private sector early.

—Does not involve the President in interacting with the private sector before the policy is developed.

—The issue has been extensively studied and a different approach, which includes a policy review should be followed.

—Does not provide the mechanism by which we develop a political constituency for this issue on the Hill.

NSC and the Domestic Council propose that they jointly chair this initiative; this is entirely too much Executive Office involvement and detracts from Cabinet-level responsibility (State, AID, Agriculture).

—Your involvement in this issue may be an important example of your international human needs initiatives and can have the effect of mobilizing support for your overall foreign policy objectives. Thus the necessity of seeking a different format for conducting a policy review which involves substantial private sector participation.

—The difficult issue of price of food and other difficult agri-business, farm labor, and consumer group issues may be very difficult to cope with politically, especially in the West (business and farmers), and, therefore, early involvement between the government and these interest groups will have the effect of defining the differences before the public and Congress, thus enabling you to make tough decisions which may be more politically acceptable and saleable later on in the process.

—Some things may be accomplished in this area over the next year or two like providing a set-aside contingency fund for food assistance and other visible, tangible initiatives which will have the effect of diverting attention from the emotion-charged political rights issues to the related human needs issue.

—I have been in close touch with people like Jim Grant of the Overseas Development Council, and through him an Interreligious Task Force on World Food Policy which includes Father Hesburgh; they believe your visible involvement early on will be helpful to you with Congress.

—My image as a physician and an anthropologist and the way I have been working in a cross-cutting approach, both domestically and internationally, may be a useful vehicle to mobilize the different interests on this subject.

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3. Fourteen Country Diplomatic Initiative

—You have mentioned publicly your interest in improving diplomatic relationships with the 14 countries with which we do not have formal diplomatic relations.

—I have been attempting to pursue this recently using primarily medicine and health but also wildlife management to open up diplomatic relations and to follow-up your initiative in this area in a comprehensive fashion. For example:

The medical diplomacy initiative with Iraq. This has recently resulted in a formal request from the Minister of Health for assistance in medical and public health despite the fact that we do not have diplomatic relations with them.

The People’s Republic of China. I have been encouraging and involving the private physicians in the United States to become involved in diplomatic initiatives. Most recently, the U.S.-Chinese Friendship Association met with the Vice Minister of Health and the Chinese Foreign Minister, Huang Hua, and provisionally agreed to send a medical team to the United States next year.

The People’s Republic of Mongolia has been quite interested in wildlife management and endangered species. I have been very quietly working with experts in the wildlife management and endangered species area to develop communications linkages directly with the Mongolian officials and through the Soviet Union.

Somalia. We have been successful as the result of my discussions in Geneva in placing five U.S. Public Health Service people in Somalia to work on the smallpox eradication program.

Cuba. The Minister of Health of Cuba complained about isolation from U.S. medical/scientific journals. We have been able to identify problems in the transfer of this literature; I believe we have worked out an arrangement where it will not be a problem in the near future.

4. The Soviet Proposal to Involve Them in Third World Medical Assistance Projects with the U.S.

—This proposal3 has been widely accepted throughout the government as a unique and creative proposal that will have the effect of reducing the competition over potentially neutral countries which are in need of medical and public health assistance. The State Department is now preparing to formally propose this proposal after months of preparation of the concept.

—To involve the Soviet Union in an international human needs endeavor with the United States will be a dramatic manifestation of the effect of your international human needs/human rights policy, and will give them an opportunity to score big internationally with you in [Page 972] an area that they feel much more comfortable about than the political rights issue.

—This will take perhaps a great deal of time and effort but will have the effect of defusing some of the pressure on them by virtue of your human rights initiative.

5. The World Health Organization and the Visit of Dr. Halfdan Mahler

—Dr. Mahler is a very creative, innovative and brilliant thinker about the world health situation, and it is in the interests of the United States government to support his re-election candidacy next year.

—A visit to the United States and an audience with the President would have the effect of strengthening his candidacy.4

—Mention the need to continue to strengthen the WHO as an instrument of global health policy; that the problems of health transcend the capacity of the U.S. government to solve and the need to look to WHO.

6. Work Plan for the Office of the Special Assistant for International Human Needs and Health (separate sheet on this)5

7. Office staffing needs now

8. Office of Drug Abuse Policy (ODAP)

  1. Source: Carter Library, Staff Office Files, Special Assistant for Health Issues—Peter Bourne Files, Subject Files, Box 34, International Health, 7/1/77–7/31/77. No classification marking.
  2. According to the President’s Daily Diary, Bourne met with the President in the White House Oval Office on July 29 from 1:57 to 2:12 p.m. to discuss drug policy-related issues. No record of the meeting has been found, although the Daily Diary indicates that a Public Broadcasting Service (PBS) crew filmed a portion of the discussion for inclusion in a three-part series on international drug issues, scheduled to debut during the spring of 1978. (Carter Library, Presidential Materials, President’s Daily Diary) In Carter’s personal diary, he noted: “Peter Bourne came by to go over the final drug message and to talk about his role in the White House. I want him to be in charge of drugs, world hunger, world health, and so forth, and to work directly with me.” (White House Diary, p. 74) In a July 29 memorandum to Bourne, Fill outlined his thinking regarding the benefits and problems associated with Bourne’s international role, concluding: “There is no place in the U.S. government similar to where you have placed yourself; there is no one else in the White House that has the combined relationship to the President, credentials, intellectual capacity, and openness which you bring to your position. The power of fresh, new, human needs ideas or old, good ones emanating from the White House is enormous, and may be critical to the balance which needs to be maintained between political/institutional needs and human needs.” (Carter Library, Staff Office Files, Special Assistant for Health Issues—Peter Bourne Files, Subject Files, Box 34, International Health, 7/1/77–7/31/77)
  3. See Document 286.
  4. According to the President’s Daily Diary, Carter met with Mahler, Warren Furth, and Bourne in the Oval Office on November 18 from 9:17 to 9:32 a.m. (Carter Library, Presidential Materials, President’s Daily Diary) No record of this conversation has been found.
  5. Not found.