305. Memorandum From the Administrator of the Agency for International Development (Gilligan) to the President’s Special Assistant for International Health (Bourne)1
- Executive Branch Organization for International Health and Agriculture
You have now received comments from various agencies on your proposals for U.S. initiatives to improve world health and alleviate world hunger.2 I understand Secretary Califano’s comments emphasize that HEW should assume “lead” responsibility for international health, in addition to its domestic responsibilities. USDA has made a similar suggestion regarding international agriculture. While we have always encouraged greater HEW or USDA involvement in international programs, the shift they now suggest would divest AID of much of its legislated responsibility for U.S. assistance to developing countries.[Page 1004]
Their proposals raise the issue of whether U.S. assistance programs in agriculture and health—and by implication in population, education, technology, environment, and other areas—should remain principally the responsibility of one development agency or be dispersed to various government Departments. This is a fundamental question of government organization that concerns your work, the interagency study of future directions for foreign assistance, and OMB’s proposals for reorganization of the Executive Branch.
If the United States is to make a serious attack on problems of development, one agency must be the focal point for responsibility, drawing upon the best skill and experience the U.S. public and private sectors have to offer. The problems of developing countries must be this Agency’s priority concern. A long-term commitment must be made to strategies and programs that meld together various sectors and disciplines. If development assistance programs are folded into other Departments they will inevitably be given less attention than the principal programs of these essentially domestic agencies.
Meeting basic needs in poor countries—e.g., by improving health or agricultural productivity—requires approaches radically different from those required in the United States. In developing countries half of those who die are children under five, and the underlying causes of death include malnutrition, high fertility, and parasitic infection. In developed countries mortality centers in the population over 50 and arises from heart attack, stroke, cancer, and other conditions often associated with rich diets, obesity, and sedentary work habits. The solutions to health problems in developed and developing countries also differ dramatically; few LDC’s can afford per capita health expenditures of more than a few dollars annually. Thus they must rely less on hospitals and physicians and much more on paramedicals and traditional healers.
Similarly in agriculture, American success derives from large farms with relatively few people but much heavy equipment, irrigation, fertilizer, pesticides, and so on. But poor food-deficit countries must rely on small farms, labor-intensive approaches, and the sparing use of capital to spur agriculture.
Furthermore, health and agricultural programs in developing countries are closely linked. Improved health depends heavily on programs in agriculture that enhance nutrition and incomes; agricultural productivity is much influenced by health programs that affect labor productivity. In general, programs in several sectors, as well as underlying economic and social policies, strongly affect the achievement of objectives in any one sector.
Effective development assistance programs thus require consideration of health, agriculture, and other problems in the framework of a [Page 1005] broad development strategy. This approach lies at the heart of the “New Directions” legislation underlying AID’s programs;3 it has been reinforced by the enthusiastic endorsement given the basic human needs strategy by this Administration.
AID’s job, under the foreign policy guidance of the Secretary of State, is to design and implement such programs. Fragmenting responsibility for assistance programs now among several agencies would destroy the solid base that has been built. As a practical matter, these other agencies cannot establish mini-foreign-aid offices, operate the necessary overseas staff, or coordinate international assistance efforts effectively. The inevitable result of such fragmentation would be a call for one agency to manage and coordinate assistance programs. We would have come full circle, and lost precious time in the interim.
I urge you, therefore, to resist vigorously any proposals to fragment development assistance responsibilities within the U.S. Government—especially by dispersing authority to agencies whose primary concerns are domestic.
- Source: Carter Library, Staff Office Files, Special Assistant for Health Issues—Peter Bourne Files, Subject Files, Box 35, International Health, 12/1/77–12/29/77. No classification marking.↩
- See footnote 6, Document 302.↩
- Reference is to amendments to the 1973 Foreign Assistance Act (P.L. 93–189; 87 Stat. 715) that added a statement of policy to the original Foreign Assistance Act of 1961 (P.L. 87–195; 75 Stat. 424) emphasizing “basic human needs,” such as food and nutrition.↩