Foreign Relations of the United States, 1977–1980, Volume II, Human Rights and Humanitarian Affairs

314. Briefing Memorandum From Harry Blaney of the Policy Planning Staff to the Under Secretary of State for Economic Affairs (Cooper)¹

Washington, July 10, 1978

Status Report on Peter Bourne’s International Health Review

After considerable interagency meetings, numerous lengthy drafts of reports, etc., the White House on May 2 released a Presidential Statement on International Health. (See Tab A.)² This statement generally affirmed the intention of the President “to launch a program to strengthen the participation of the United States in worldwide efforts to overcome disease and ill health.” The basic elements of this strategy included:

—concentration on prevention of disease and ill health with emphasis on clean drinking water, basic sanitation, immunization, and blindness;

—control or eradication of major infectious diseases—particularly tropical; and

—causes of death in children.

The President stated that the strategy would be developed “as part of our budgetary and legislative recommendations for the next year. Where possible, however, we will move immediately to carry out this program.” Secretary Califano elaborated on this statement in his speech to the WHO Assembly on May 9. (See Tab B.)³ The basic White House/OMB memo to the President on this is at Tab C.⁴

A World Health Strategy Group was established under Peter Bourne with four agency-led working groups.

I. Initiatives for the Developing Countries (AID-chaired)

II. Scientific and Manpower Development (HEW)

III. Multilateral Agencies (State)

IV. U.S. Commerce in International Health⁵

The goal, originally, was to achieve a single draft document by July 14 with a final report to the President by August 25. A short draft over-view and outline for the health strategy report has been circulated along with a list of key issues and revised work schedule. (See Tab D.)⁶

These latter documents assume an increase in foreign aid and especially health as a part of our BHN strategy. No dollar figures have yet been set for the specific initiatives to our knowledge.

The main initiatives proposed include:

—Support of “Integral Health Services Systems” including Primary Health Care, prevention, health, nutrition and family planning and paramedical training;

—Action against disease control—infectious diseases, blindness, mental health;

—Support for water and sanitation efforts;

—NGO involvement in bilateral assistance programs;

—Helping LDC resource and institutional capacities;

—Establishing foreign centers for research and training;

—Assistance in “Leadership Manpower Development”;

—An “International Health Service Corps”;

—Extension to present ACTION authority to provide assistance to “Domestic Development Service Programs” in LDCs;

—Have UNDP earmark funds for special health programs of multilateral agencies with “minimal growth in regular budget”;

—Increase in USG agency staff responsible for health activities of multilateral agencies;

—Increased reliance on NGOs in multilateral agency activities;

—More program development grants for research to U.S. institutions;

—More PVO involvement in USG programs including more Federal funding for PVOs to coordinate work;

—Fund “U.S. Private Commerce” conference by NAS;

—Establish interagency coordination to develop policy and program design;

—New U.S. manpower clearing house for world health programs;

—Permit foreign assistance funds to be applied to international health programs outside AID, State, Treasury and ACTION.

Comment: The above illustrates the ambitiousness of the initiatives being considered. Many will be hotly debated, especially the establishment of a new International Health Service Corps. Many of the initiatives are not well defined. As there are increasing pressures against AID funds, we face difficult choices among the suggested programs or a reallocation of our assistance priorities towards “health” type activities. Some of the “priority” areas make great sense in terms of impact on health for the relative cost involved and the LDCs existing capabilities, (e.g. community water and sanitation), while others, (e.g., mental health) may prove less effective in terms of foreign assistance.

Within State, Under Secretary Lucy Benson has been the key State coordinator of our work with Dr. Bourne. (The staff person in her office is Bill Lowrance.) Bourne’s staff leader on this is Krys Krystynak. State (T) chairs the Working Group on Multilateral Health Organizations. S/P is a member of the group and assists as required.

If we can be of any further help on this matter please let me know.

1. Source: National Archives, RG 59, Central Foreign Policy File, P780120–1998. Unclassified. Sent through Lake. A copy was sent to Garten.
2. Attached but not printed. See Document 313.
3. Attached but not printed is the Department of Health, Education and Welfare copy of Califano’s May 9 WHO address. For additional information, see Document 313.
4. Printed as Document 311.
5. An unknown hand placed a question mark at the end of this point.
6. Attached but not printed is a June 29 memorandum from Lowrance to the members of the White House Review of International Health Working Group III on Multilateral Health Organizations. Lowrance indicated that Bourne had met with the Consolidation Group, comprised of members from AID, HEW, and the Departments of State and Treasury, which had assumed responsibility for budgetary, organizational, and legislative matters and for drafting an overall international health strategy report. In addition to the draft overview and outline, list of key issues, and revised work plan, Lowrance also included a 9-page strategy and initiatives paper. (National Archives, RG 59, Central Foreign Policy File, P780120–2028)