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ACHIEVING THE UNITED NATIONS MILLENNIUM

DEVELOPMENT GOALS: PROGRESS THROUGH

PARTNERSHIPS

HEARING

BEFORE THE

SUBCOMMITTEE ON INTERNATIONAL 

ORGANIZATIONS, HUMAN RIGHTS AND OVERSIGHT

OF THE

COMMITTEE ON FOREIGN AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS

SECOND SESSION

JULY 27, 2010

Serial No. 111–121

Printed for the use of the Committee on Foreign Affairs

(

Available via the World Wide Web: http://www.foreignaffairs.house.gov/

(II)

COMMITTEE ON FOREIGN AFFAIRS 

HOWARD L. BERMAN, California, Chairman 

GARY L. ACKERMAN, New York 

ENI F.H. FALEOMAVAEGA, American 

Samoa 

DONALD M. PAYNE, New Jersey 

BRAD SHERMAN, California 

ELIOT L. ENGEL, New York 

BILL DELAHUNT, Massachusetts 

GREGORY W. MEEKS, New York 

DIANE E. WATSON, California 

RUSS CARNAHAN, Missouri 

ALBIO SIRES, New Jersey 

GERALD E. CONNOLLY, Virginia 

MICHAEL E. MCMAHON, New York 

THEODORE E. DEUTCH, Florida 

JOHN S. TANNER, Tennessee 

GENE GREEN, Texas 

LYNN WOOLSEY, California 

SHEILA JACKSON LEE, Texas 

BARBARA LEE, California 

SHELLEY BERKLEY, Nevada 

JOSEPH CROWLEY, New York 

MIKE ROSS, Arkansas 

BRAD MILLER, North Carolina 

DAVID SCOTT, Georgia 

JIM COSTA, California 

KEITH ELLISON, Minnesota 

GABRIELLE GIFFORDS, Arizona 

RON KLEIN, Florida 

ILEANA ROS-LEHTINEN, Florida 

CHRISTOPHER H. SMITH, New Jersey 

DAN BURTON, Indiana 

ELTON GALLEGLY, California 

DANA ROHRABACHER, California 

DONALD A. MANZULLO, Illinois 

EDWARD R. ROYCE, California 

RON PAUL, Texas 

JEFF FLAKE, Arizona 

MIKE PENCE, Indiana 

JOE WILSON, South Carolina 

JOHN BOOZMAN, Arkansas 

J. GRESHAM BARRETT, South Carolina 

CONNIE MACK, Florida 

JEFF FORTENBERRY, Nebraska 

MICHAEL T. MCCAUL, Texas 

TED POE, Texas 

BOB INGLIS, South Carolina 

GUS BILIRAKIS, Florida 

RICHARD J. KESSLER, Staff Director 

YLEEM POBLETE, Republican Staff Director 

SUBCOMMITTEE ON INTERNATIONAL ORGANIZATIONS,

HUMAN RIGHTS AND OVERSIGHT

RUSS CARNAHAN, Missouri, Chairman 

BILL DELAHUNT, Massachusetts 

KEITH ELLISON, Minnesota 

DONALD M. PAYNE, New Jersey 

THEODORE E. DEUTCH, Florida 

DANA ROHRABACHER, California 

RON PAUL, Texas 

TED POE, Texas 

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C O N T E N T S 

Page

WITNESSES 

Ms. Kathy Calvin, Chief Executive Officer, United Nations Foundation ........... 7

John McArthur, Ph.D., Chief Executive Officer, Millennium Promise ............... 16

Scott C. Ratzan, M.D., Vice President, Global Health, Government Affairs 

and Policy, Johnson & Johnson .......................................................................... 26

Mr. James Roberts, Research Fellow for Economic Freedom and Growth, 

The Heritage Foundation .................................................................................... 34

LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING 

The Honorable Russ Carnahan, a Representative in Congress from the State 

of Missouri, and Chairman, Subcommittee on International Organizations, 

Human Rights and Oversight: Prepared statement .......................................... 3

Ms. Kathy Calvin: Prepared statement ................................................................. 11

John McArthur, Ph.D.: Prepared statement ......................................................... 20

Scott C. Ratzan, M.D.: Prepared statement .......................................................... 30

Mr. James Roberts: Prepared statement ............................................................... 37

APPENDIX 

Hearing notice .......................................................................................................... 62

Hearing minutes ...................................................................................................... 63

The Honorable Russ Carnahan: Material submitted for the record .................... 64

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ACHIEVING THE UNITED NATIONS MILLENNIUM DEVELOPMENT GOALS: PROGRESS 

THROUGH PARTNERSHIPS 

TUESDAY, JULY 27, 2010

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON INTERNATIONAL ORGANIZATIONS,

HUMAN RIGHTS AND OVERSIGHT,

COMMITTEE ON FOREIGN AFFAIRS, 

Washington, DC. 

The subcommittee met, pursuant to notice, at 9:35 a.m., in room 

2172, Rayburn House Office Building, Hon. Russ Carnahan (chairman of the subcommittee) presiding. 

Mr. CARNAHAN. Good morning. I want to call the Subcommittee 

on International Organizations, Human Rights and Oversight to 

order this morning and kick off our hearing this morning on 

‘‘Achieving the United Nations Millennium Development Goals: 

Progress Through Partnerships.’’

And I will begin with an opening statement. After that, I will 

turn it over to others here for opening remarks and look forward 

to introducing our panel. 

Ten years have passed since 192 nations and multilateral organizations set eight international development targets, which became 

known as the Millennium Development Goals, or MDGs, representing a collective international effort toward improving the 

lives of those living in developing countries. 

The goals include: The eradication of extreme poverty and hunger; achievement of universal primary education; promotion of gender equality and empowerment of women; reduction of child mortality; improvement of maternal health; halting and reversing the 

spread of HIV/AIDS, malaria, and other diseases; environmental 

sustainability; and creation of a global partnership for development. 

At last year’s U.N. General Assembly, President Obama stated, 

‘‘We will support the Millennium Development Goals and approach 

next year’s summit with the goal to make them a reality.’’ It is in 

the interest of the U.S. to stick to this commitment. We must use 

this strategy to take a leadership role at the United Nations highlevel review of the Millennium Development Goals, which takes 

place on September 20th through the 22nd in New York City. I 

look forward to receiving the administration’s MDG strategy in the 

coming days. 

As we recover from an economic recession, it is important to keep 

in mind that the MDG goals are not only a moral commitment of 

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U.S. and universal values, but they are also vital to our security 

and economic prosperity. Fighting poverty, hunger, the lack of access to education and health care helps reduce unrest and extremism, which can contribute to hatred and violence. 

The MDGs also help to leverage U.S. aid, bringing in contributions from other countries, the private sector, and civil society. Collectively, our investment helps to reduce extreme poverty and build 

a growing middle class abroad, which will ultimately buy U.S. 

products. Achieving MDGs helps the world’s most needy, but it also 

is good for America’s producers and consumers. 

Since 2000, the global community moved steadily toward achieving many of these goals. In developing regions, net enrollment in 

primary education increased by 5 percent between 2000 and 2007. 

Globally, the new HIV infection rate decreased from an estimated 

peak of 3.5 million in 1996 down to 2.7 million in 2008. And as we 

heard last month at this subcommittee’s hearing on women as 

agents of change, women’s share of national parliamentary seats 

has increased from 6 percent to 19 percent in the last 10 years. 

Unfortunately, progress has stagnated in other areas. The mortality rate for children under 5 is still well under the target of a 

two-thirds reduction. And we have seen an increase in poverty 

rates over the last year. Finally, as we heard last week at our hearing on the administration’s Feed the Future Initiative, the number 

of hungry people increased from 842 million in the early 1990s to 

over 1 billion people in 2009. 

In order to address these critical challenges, we must adhere to 

a strategy that is cost-effective, invests wisely in the developing 

world, and works with our national security strategy. The U.S. 

Government has played and will continue to play a vital role in 

this effort. 

However, we need to ensure that we do so in a collaborative 

manner that leverages all available resources. The private sector is 

in a unique position to contribute their expertise, resources, and innovative techniques toward this global effort. 

Targeted public-private intervention programs have already 

proven successful. For example, the incidence of polio has plummeted by more than 99 percent since 1988, when Rotary International partnered with the WHO, CDC, and UNICEF to launch 

the Global Polio Eradication Initiative. 

Another project, Millennium Villages, supports social and business development services for more than 400,000 people in rural 

communities across 10 countries in Africa. Finally, there are many 

microfinance programs that serve as examples of successful publicprivate initiatives that have helped to reduce poverty and empower 

women. 

I look forward to hearing from our witnesses today about lessons 

learned from their public-private partnerships and what initiatives 

can be scaled up to meet MDGs. 

I will now recognize our ranking member, Representative Rohrabacher of California, for his opening statement. 

[The prepared statement of Mr. Carnahan follows:]

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Mr. ROHRABACHER. Thank you very much, Mr. Chairman. 

While I am here to listen to what you have to say, you have a 

skeptic here, obviously. You know, when you got $1.5 trillion more 

going out than you got coming in, pretty soon, if we don’t change 

that—you know, last year it was $1.5 trillion deficit, this year it 

is $1.5 trillion—that is not billion-dollar deficit, this is trillions—

within a short period of time, our country is going to turn around 

and our economy will have totally collapsed. 

All these young people you see in the audience, it is going to be 

a disaster for their lives. You know, already they are going to be 

on the hook for hundreds of billions of dollars that is going to be 

taxed from them every year in order just to provide the interest on 

what we are doing in the last 2 years. 

So, yeah, we need to care about people around the world who are 

in need, but we got to put our own house in order. And if trying 

to take care of people across the ocean and in different places 

where people are in need and horrible situations, if by trying to 

care of them we exacerbate our problem at home and dump our 

own future generations into poverty, we will have sinned against 

our own people. 

So I want to know why this is a good idea. If you want to spend 

more money on it, I want to know why it is a good idea for those 

young people and their future, and how it will affect this $1.5 trillion worth of debt that we are putting ourselves into every year. 

It makes no sense. 

We learned from some papers that were leaked—and I thought 

the person who leaked those papers did a good job for the people 

of the world—we learned that Pakistan has continued all of these 

years in supporting the Taliban, while we give, Mr. Chairman, 

what, a $7 billion package to Pakistan to help them build their 


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economy, at a time when we just find out through these leaked documents that Pakistan has been helping the Taliban the whole time. 

Does that make any sense? That makes no sense at all. 

Borrowing money from China in order to give to Pakistan, China’s ally, in order to help the Taliban, while the Taliban are fighting the United States? Well, this is about as much sense as a lot 

of these programs that I have been looking at over these years 

make—you know, when you look back on it, makes no sense at all, 

most of these things. So, now that we are in a crisis, maybe we can 

ask some very fundamental questions. 

So I am looking forward to your testimony. I am going to listen, 

so we will see what happens. 

Mr. CARNAHAN. Thank you. 

I now want to yield 5 minutes for an opening statement to Mr. 

Smith of New Jersey. 

Mr. SMITH. Thank you very much, Mr. Chairman. And I thank 

you for convening this very important hearing on the Millennium 

Development Goals. As you know, the outcome documents of the 

high-level summit on the Millennium Development Goals continues 

to be negotiated at the U.N. this week. It will be an important 

roadmap for the next steps to be taken. 

I wanted to take this opportunity to focus our conversation and 

efforts on achieving MDGs 4 and 5 jointly. We must keep in mind 

that to achieve MDGs 4 and 5, reducing child mortality and maternal mortality, both mother and unborn child must be treated as copatients in need of care, compassion and, when sick, either patient 

or both patients, in need of timely interventions. We must strive 

to save and to affirm both. 

The April 2010 Lancet medical journal published a 

groundbreaking study funded by the Bill and Melinda Gates Foundation that shows that worldwide maternal mortality has been decreasing since 1980. Progress is being made by many countries, 

and the successful policies must continue. 

The study analyzed volumes of studies and data, including WHO 

maternal mortality data. And, using statistical methods now available through advanced computer technology, the study found that 

the number of maternal deaths per year as of 2008 is 342,900. That 

is down from 526,300 in 1980, about a 40-percent drop. The study 

notes that if the world wasn’t suffering from the HIV/AIDS pandemic, the total number would be 281,500, almost 50 percent down 

from the 1980 levels. 

While still too high, this landmark report is encouraging to governments who have been seriously addressing maternal mortality 

in their countries by increasing the number of skilled birth attendants. 

I would note parenthetically that I hosted a group of OB–GYNs 

who talked about their work in Africa, and they said, ‘‘100 years 

ago we realized how to reduce maternal mortality. You need a 

skilled birth attendant, the capability to do a C-section when there 

is an obstructed delivery, and you need to have the ability to provide safe blood so that that woman can get a transfusion, if necessary.’’ Education of women is also important. 

I actually chaired a hearing on safe blood, Mr. Chairman, and 

the WHO rep at that particular hearing said if women in Africa 

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had access to safe blood, maternal mortality would drop by 44 percent. Unfortunately, for so many, that blood is simply not there. 

And, of course, economic development and the education of 

women is also very important, as well. And there are others. 

Many of these countries with very low maternal mortality rates 

have laws, however, that restrict abortion. The inclusion of legalized abortion, or so-called reproductive health services defined as 

abortion in the outcome document, I believe would be unjust, intellectually dishonest, and counterproductive to the littlest humans 

and efforts to provide successful efforts for the MDGs. 

In fact—and this is largely under-known and under-focusedupon—abortion can have a negative effect on the reproductive 

health of the mother as well as the health of her subsequent children. At least 113 studies show a significant association between 

abortion and subsequent premature and low-birth-weight births. 

For example, a study in the International Journal of Obstetrics and 

Gynecology showed a 36-percent increased risk for a preterm birth 

after one abortion and a staggering 93-percent increased risk after 

two. Similarly, the risk of subsequent children being born with low 

birth weight increased by 35 percent after one and 72 percent after 

two or more abortions. Another study showed the risk increases 

nine times after a woman has had three abortions. 

What does this mean for her children? Preterm birth is the leading cause of infant mortality in the United States and causes onefourth of infant mortality in the world. Preterm infants have a 

greater risk of suffering from chronic lung disease, sensory deficits, 

cerebral palsy, cognitive impairments, and behavioral problem. Low 

birth weight is similarly associated with neonatal mortality and 

morbidity. Abortion hurts both mother and child and can cause 

sickness, even death, in future children. 

I would also point out to my colleagues that abortion is child 

mortality for the child who is actually aborted. And, again, the 

mortality and morbidity of future children is at risk. Abortion 

methods chemically poison, dismember, induce premature labor, or 

starve to death the fragile life of an unborn child. So terms like 

‘‘safe abortion,’’ which is thrown around very loosely, is, at best, 

misleading. ‘‘Safe abortion’’ is never safe for the baby. 

Another cause of infant mortality should be addressed in the outcome document, and it is birth asphyxia, which kills 1 million 

newborns each year—more than malaria and five times more than 

AIDS. There is much we can do, even in resource-limited situations, to ensure that babies take their first breath in that golden 

minute right after birth. Skilled attendants, again, at birth; temperature support and stimulation to breathe; and assisted ventilation through the use of low-cost resuscitators are interventions we 

can and should be making available to achieve MDG 4. 

The MDG document will be very important for guiding our steps 

as an international community over the next 5 years. Every step 

counts. And I hope that our panelists will use all of their influence 

to ensure that the outcome document keeps us on the path of saving both mother and child. 

Again, I thank you, Mr. Chairman. 

Mr. CARNAHAN. Thank you. 

And now I want to turn to our panel. 

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And let me start to my left with Ms. Kathy Calvin. She is the 

chief executive officer at the United Nations Foundation. The foundation was created in 1998 with Ted Turner’s $1 billion gift to support U.N. activities. Prior to joining the U.N. Foundation, Ms. Calvin served as president of AOL-Time Warner Foundation. She has 

also worked at Hill and Knowlton, as well as U.S. News and World 

Report. From 1976 to 1984, she served as Senator Gary Hart’s 

press secretary in his Senate office and on his 1984 Presidential 

campaign. She is a graduate of Purdue University. 

Next, Dr. John McArthur. He is chief executive officer of Millennium Promise, a nonprofit organization committed to supporting 

the achievement of the Millennium Development Goals. He is also 

research associate at the Earth Institute at Columbia University 

and teaches at Columbia School of International and Public Affairs. 

Previously, he served as the deputy director and manager of the 

U.N. Millennium Project. He completed his bachelor of arts at the 

University of British Columbia, a master’s in public policy at Harvard’s Kennedy School of Government, and a master’s and doctorate in economics at Oxford University, which he attended as a 

Rhodes Scholar. 

Next, Dr. Scott Ratzan. He serves as vice president for global 

health, government affairs, and policy at Johnson & Johnson. He 

is co-chair of the U.N. Secretary-General’s Joint Action Plan on 

Women and Children’s Health Innovation Working Group. Previously, he served as senior technical adviser in the Bureau of 

Global Health at the USAID, where he developed the global health 

communication strategy for U.S.-funded efforts in 65 countries. He 

received his MD from the University of Southern California, MPA 

from Harvard University’s Kennedy School of Government, and MA 

from Emerson College. 

And, finally, Mr. James Roberts. He is the research fellow in economic freedom and growth at the Heritage Foundation Center for 

International Trade and Economics. His primary responsibility is 

to produce the ‘‘Index of Economic Freedom,’’ an annual analysis of 

the economic climate of countries throughout the world. Before 

joining Heritage, Mr. Roberts worked for the U.S. State Department for 25 years, serving in Mexico, Portugal, France, Panama, 

and Haiti. He also served as an intelligence officer in the U.S. 

Navy Reserve. He has a master’s degree in international development and economics from Yale, an MBA from the University of 

Pittsburgh, and a bachelor’s degree in international affairs from 

Lafayette College. 

Welcome to our panel. We look forward to hearing from you. 

And we will start, and I will recognize Ms. Calvin for 5 minutes. 

STATEMENT OF MS. KATHY CALVIN, CHIEF EXECUTIVE 

OFFICER, UNITED NATIONS FOUNDATION 

Ms. CALVIN. Thank you, Mr. Chairman, and good morning. 

Thank you for calling today’s hearing on the Millennium Development Goals. Your leadership in support of American efforts to battle extreme poverty, hunger, and disease in the developing world 

and to support the U.N. in its programs is greatly appreciated. 

And thank you for inviting the U.N. Foundation to testify. When 

Ted Turner created the U.N. Foundation, it was because he beVerDate 0ct 09 2002 16:56 Nov 17, 2010 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 F:\WORK\IOHRO\072710\57686 HFA PsN: SHIRL
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lieved in the U.N. and its value to creating a platform to connect 

people, ideas, and resources to support its work around the world 

and to strengthen the relationship between the United States and 

the U.N. 

As you mentioned, the President will be bringing to the world 

leaders in just 2 months his plan for the United States to help 

achieve the MDGs, as he promised last year when he was before 

the world leaders. We believe his speech this vitally important because it will signal to the world that our Nation will continue to 

play a leadership role in battling global poverty, despite, as you 

pointed out, the very tough economic times here at home, and that 

the United States is fully committed to working with the U.N., 

other donor countries, and the developing world itself. 

As you pointed out, the MDGs are an internationally recognized 

framework to allow bilateral and multilateral donors to work together. But it takes more than one sector, and that is why we are 

here today to talk about partnerships. 

You might expect me to make the point that the MDGs are a 

critical component of our strategic imperative, but I want to quote 

someone else, and that is Secretary Gates, who said last year,

‘‘In the campaign against terrorist networks and other extremists, we know that direct military force will continue to have 

a role. But over the long term, it should be subordinate to 

measures to promote participation in government, economic 

programs to spur development, and efforts to address the 

grievances that often lie at the heart of insurgencies and 

among the discontented from which the terrorists recruit.’’

That is exactly what the Millennium Development Goals seek to 

achieve. 

And I think you know, Mr. Chairman, there is strong support 

from American voters for the MDGs. In April, the U.N. Foundation 

and our sister organization, the Better World Campaign, conducted 

bipartisan polling and found that 87 percent of Americans believe 

the U.S. should achieve the MDGs. And the majority said they 

would favorably look on companies that are using their finances 

and other resources to support these programs. That is good news 

for all of us. 

So I want to touch today just very briefly on the kinds of partnerships that we think work not only to achieve these goals but actually to multiply the impact and effect of our scarce public funds. 

I will start with a couple campaigns you know about. The first 

is Nothing But Nets, which is a campaign to combat malaria. And 

thank you for all the work this committee has done to strengthen 

and increase the U.S.’s support for fighting malaria. 

As you know, every 30 seconds, a child in Africa dies from malaria and infection, making it the leading killer of children on the 

continent. We believed American citizens wanted to join this fight 

against malaria, so we launched a grass-roots campaign 3 years 

ago called Nothing But Nets to raise awareness and funding. It has 

a simple message: Malaria kills, send a net, safe a life—a simple 

$10 donation. 

The campaign has been incredibly successful in giving hundreds 

of thousands of supporters the chance to raise funds and awareVerDate 0ct 09 2002 16:56 Nov 17, 2010 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 F:\WORK\IOHRO\072710\57686 HFA PsN: SHIRL
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ness, but it wouldn’t be possible without partners from the corporate and foundation world, including diverse partners such as 

the National Basketball Association, Major League Soccer, and the 

United Methodist Church. So a pairing of bishops and basketball 

players might not seen natural, but, along with 14 other partners, 

it has allowed us to raise more than $33 million to distribute more 

than 3 million nets in 15 countries. 

We have also done work in combating measles around the world. 

And this is an example of a partnership that draws on the best of 

different partners, from the countries themselves to governments, 

to private sector. We found that the challenge from measles was 

great. Nothing was moving, in terms of its reduction. But, in the 

last 10 years, measles deaths have dropped 10 percent a year in 

Africa. 

One organization on its own could never have done this; it took 

a partnership. The partnership includes the American Red Cross, 

the U.S. Centers for Disease Control, UNICEF, the World Health 

Organization, and the LDS Church, and Vodafone. We have done 

work in measles, malaria, and polio. And, as you mentioned, Rotary 

International has led perhaps the most successful partnership of all 

in almost eradicating that. 

We think there are opportunities across the board for partners 

to come together. We are currently developing a campaign around 

adolescent girls to link girls in this country with girls around the 

world so that they can help those girls share the fortunes that they 

share here, the same opportunities to go to school, stay healthy, 

and be safe. 

We are also working on a partnership to bring organizations together who care about the same issue: Freeing up women and children from the dangers of black carbon and cookstove smoke when 

they are cooking. This is a major effort and has brought together 

many, many different partners. 

And we have a major partnership around mobile phones, using 

them to increase the ability for health workers, as you pointed out, 

Congressman Smith, to reach those mothers and children who most 

need it. We have created partnerships with the World Health Organization in 22 African countries so that they could use mobile 

phones, instead of the previous pen and paper, to collect date, 

share information, and help. 

All of those experiments in partnerships have led us to know a 

couple different things about partnerships that we think would be 

worth sharing with this committee as we think about making partnerships successful and an important part of the U.S. commitment 

to meeting the MDGs. 

First, in any partnership, it is important to bring all of the partners and recipients together at the table from the start. Co-creation 

is essential. 

Second, partnerships succeed best when everyone has a clear role 

to play and can play from their strengths and competencies and not 

just financial resources. 

Third, we think partnerships work best when they take the time 

to create full business plans, with clear goals and objectives serving 

the various interests of the diverse partners. 

10

Fourth, the U.N., which traditionally had not been a partnerfriendly organization outside of it normal member-state environment, is becoming much more adept and successful at partnerships, 

and so is the U.S. Government. And so, too, are the governments 

in the countries in which we are trying to make a difference. They 

are essential partners, at the end of the day. 

And, fifth, Congress has an important opportunity to support 

public-private partnerships in support of the Millennium Development Goals. So, as this committee considers legislation to rewrite 

the Foreign Assistance Act, I hope you will consider the importance 

of sending a signal to USAID and the State Department to work 

closely and use public-private partnerships and to actively encourage these efforts which they are already considering. Given scarce 

public and private resources, it is imperative that money be wellspent and effectively coordinated. 

So, in conclusion, I just want to say I am really proud that the 

foundation has had a successful history of partnerships. And looking forward, we continue to look for opportunities to expand them 

and scale them up, because we think that is the most effective way 

we can help achieve the Millennium Development Goals. 

Thank you very much. 

[The prepared statement of Ms. Calvin follows:]

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Mr. CARNAHAN. Thank you. 

Next I want to recognize Dr. John McArthur for 5 minutes. 

STATEMENT OF JOHN MCARTHUR, PH.D., CHIEF EXECUTIVE 

OFFICER, MILLENNIUM PROMISE 

Mr. MCARTHUR. Thank you, Mr. Chairman, and thank you to 

members of the committee for the honor of inviting me to testify 

today and for your leadership in convening this important hearing 

on the Millennium Development Goals at what is very much an important juncture in their history. 

The goals were established by world leaders, as you mentioned, 

at the Millennium Summit in September 2000. I think one of their 

greatest contributions is that they are a series of specific, quantified, and time-bound targets to address the integrated challenges 

of hunger, education, health, infrastructure, environmental management, and gender equality. 

What they have done is they have galvanized a global effort of 

unprecedented, if still imperfect, coherence to tackling the challenges that are faced by the one-fifth of humanity that still lives 

under the most extreme forms and conditions of poverty, which we 

generally describe as living on less than $1 a day. 

The summit this September, which has previously been referred 

to, is the last major checkpoint on the status of the Millennium 

Goals before the 2015 deadline. World leaders will convene to agree 

on the actions required to achieve the goals. And the ambitions 

very much were set by President Obama last September, when he 

asserted in his speech at the General Assembly that the United 

States will support these goals, will approach this year’s summit 

with a global plan to make them a reality, and will very much set 

our sights, as he said, on the eradication of extreme poverty in our 

time. 

The MDGs are the world’s goals. Their emphasis on outcomes 

has prompted a global effort to address issues of scale, metrics, finance, and joint accountability between developed and developing 

countries. 

Since they were established 10 years ago, the developing world 

has seen many breakthroughs, as have been discussed in some detail already. We have seen hundreds of millions of people lifted out 

of conditions of extreme poverty. We have seen massive expansion 

in global health efforts. We have seen dramatic inroads in the fight 

against disease. We have seen extraordinary progress in areas of 

access to water, in some countries in particular. And there are 

many, many successes that many thought were impossible before 

the goals came to fruition. 

The challenge today is to accelerate progress in the poorest countries where the MDGs are not on track. In general, the starkest 

gaps are in the areas of agricultural productivity, maternal health 

and health systems, water, and economic infrastructure for growth 

in the poorest countries. I would be pleased to share more details 

with the committee regarding these programs and successes and 

gaps, but for now let me stress that these are the areas where an 

especially concerted push is needed. 

The MDGs should be, but have not been, a strategic priority for 

the United States. They have a complicated history in this country. 

17

In 2002, the spirit of the goals was incorporated into the establishment and naming of, indeed, the Millennium Challenge Account 

and, in turn, the Millennium Challenge Corporation, although that 

institution has not, in practice, focused on the Millennium Development Goals. The wording disconnect has even caused confusion in 

much of Washington, since ‘‘millennium’’ as a word tends to be associated with the growing pains of a new institution rather than 

the internationally agreed targets that have been driving the global 

antipoverty agenda throughout the rest of the world. 

Nonetheless, in 2002, President Bush joined world leaders in 

Monterrey, Mexico, and committed the United States, along with 

other developed countries, to make concrete efforts toward the target of 0.7 percent of gross national product as official development 

assistance to developing countries. 

Fortunately, the Millennium Goals are feasible within this commitment since the financing requirements are modest: Approximately 1⁄2 of 1 percent of the rich countries’ collective national incomes—1⁄2 of 1 percent. 

However, U.S. foreign assistance continues to rank among the 

very lowest of advanced economies, at 0.2 percent of national income. Few people outside of Washington are aware that, as a share 

of national income, U.S. Foreign assistance actually hit its all-time 

low in 1997. Under the Bush administration, the U.S. made an important change in direction, led by targeted and focused programs 

that tackled challenges of HIV/AIDS and malaria, in particular, 

through both bilateral programs and multilateral programs, such 

as The Global Fund to Fight AIDS, TB, and Malaria. 

Congress’s bipartisan commitment to global health is to be applauded. It has had a significant multiplier effect in leveraging additional commitments from around the world. The Obama administration has continued its predecessor’s support for global health, although there are concerns that support in this area is flat-lining 

much too prematurely. The Obama administration has also played 

a pivotal role in advancing the global agriculture agenda. 

The U.S. situation can be compared, for example, to the U.K. situation, where Prime Minister Cameron and the conservative government in coalition has taken on the 0.7 target to be achieved by 

2013. In the most recent budget, the government confirmed that it 

would not carry its fiscal consolidation program on the backs of the 

world’s poorest people and has actually protected both health and 

international development while making dramatic cuts throughout 

the rest of the government to consolidate its fiscal position. 

Millennium Promise was created amidst this backdrop of global 

support for the MDGs, the Millennium Goals, cofounded by Mr. 

Raymond Chambers, the path-breaking business leader, and Professor Jeffrey Sachs, the eminent economist, bringing together 

many others like Donald Keough, the former CEO of Coca-Cola; 

Quincy Jones, the music legend; and many others from Columbia 

University, the U.N. Development Program, and so forth. 

As the chairman said, we convened many people across Africa to 

work with nearly 0.5 million local villagers across 10 countries to 

implement an integrated approach of low-cost, high-impact interventions. The results have been tremendous: A tripling of basic 

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lence, a three-fold increase in access to improved drinking water, 

and a remarkable one-third reduction in child malnutrition. 

This has drawn upon partnerships from leading private philanthropists, such as Mr. George Soros; from corporate partners like 

Ericsson, which is bringing 3G connectivity to villages across Africa; Sumitomo Chemical, which has piloted the mass distribution of 

bed nets; Agrium and Mosaic, which are making major contributions of fertilizer; and Tommy Hilfiger, which is supporting programs directly. 

These lessons of success have fed into a much broader movement. 

And the strategy of partnership is crucial for the goals to be 

achieved, from both public and private leaders. 

We have seen efforts like Malaria No More take shape, chaired 

now by Peter Chernin, the former president of News Corp., who 

has provide magnificent leadership with many celebrities, government leaders, private foundations like the U.N. Foundation, to 

make a major breakthrough in malaria control. 

We have seen the World Economic Forum’s community of young 

global leaders take on a ‘‘People’s Plan of Action’’ for the Millennium Development Goals, with the idea that every person has the 

ability and a responsibility to make a measurable, action-oriented 

pledge to the goals. 

Less than 2 months before the summit, the world has been anxiously awaiting the United States to present its draft action plan. 

The administration recently presented a two-page outline of its 

strategy, but this is only a loose statement of general directions. If 

the U.S. is to provide leadership for the MDGs, it is imperative 

that the government presents a draft action plan in a matter of 

days, not weeks. 

So I would like to conclude, Mr. Chairman and members of the 

committee, by offering a few suggestions for that draft action plan. 

First, fully fund the Feed the Future strategy, in particular 

through the new multilateral Global Agriculture and Food Security 

Program. 

Second, support a new global fund for education, as proposed by 

President Obama and Secretary Clinton, and include secondary 

education in its mandate, with a special focus on girls. 

Third, continue to scale up the U.S. global health leadership by 

focusing on the problems that still need to be solved. That includes 

full financing for the programs PEPFAR and PMI for AIDS and 

malaria and increasing the annual contribution to The Global Fund 

from $1 billion to $2 billion a year, recognizing that $1 from the 

U.S. leverages $2 from other advanced economies. 

And, crucially, also endorsing the Secretary-General’s proposed 

joint action plan for child, maternal, and newborn health, and carry 

that forward by creating a new multilateral effort on maternal and 

child health, anchored in The Global Fund, with initial U.S. financing of $2 billion per year, again leveraging the 1:2 ratio that comes 

with other financing crowding in with the U.S. 

Fourth, support a major scale-up of African economic infrastructure with U.S. Funding of at least $5 billion per year, including allocations through the World Bank and the African Development 

Bank. 

19

Fifth, work with African countries to support holistic world development strategies, like the Millennium Villages. 

Six, launch a new MDG innovation fund to scale up successful 

programs that present new delivery mechanisms for MDG achievement in low-income countries. 

And, seventh and finally, set a 12-month timetable for the proposal and adoption of a proper international mechanism to achieve 

the water and sanitation Millennium Development Goals. 

Thank you so much for allowing me to share these thoughts 

today, and I look forward to discussing them further. 

[The prepared statement of Mr. McArthur follows:]

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Mr. CARNAHAN. Thank you. 

And next I would like to recognize Dr. Scott Ratzan. 

STATEMENT OF SCOTT C. RATZAN, M.D., VICE PRESIDENT, 

GLOBAL HEALTH, GOVERNMENT AFFAIRS AND POLICY, 

JOHNSON & JOHNSON 

Dr. RATZAN. Thank you, Mr. Chairman and committee members. 

On behalf of Johnson & Johnson, I really appreciate the opportunity for you calling this important hearing and inviting us to 

share our thoughts and perspectives of achieving the U.N. Millennium Development Goals. 

Particularly, we would like to talk about how public-private partnerships, or, Mr. Chairman, as you call them, private interventions 

or initiatives, can play a significant role. And we appreciate your 

leadership, Mr. Chairman, in supporting efforts to address the 

MDGs. 

The challenges we face as a global community to achieve the 

MDGs, particularly in maternal and child health, are great. And 

the MDGs that relate to women and children’s health are lagging 

furthest behind. For example, a woman in an underdeveloped country is 300 times more likely to die during childbirth or from pregnancy-related complications than her counterpart in a developed 

country. Bold, focused, and coordinated action is required to accelerate progress on the MDGs related to health. 

With only 5 years left until 2015 to achieve the MDGs, U.N. Secretary-General Ban Ki-moon initiated a new global effort on women 

and children’s health, titled, ‘‘Investing in Our Common Future: 

Joint Plan of Action for Women and Children’s Health.’’ Johnson & 

Johnson was one of the two representatives of the private sector 

initially selected to participate in the Secretary-General’s initiative, 

joining others from throughout the United Nations member states 

and key civil society actors. 

I co-chair the Innovation Working Group of the U.N. Joint Action 

Plan, along with Tore Godal, who is special advisor on Global 

Health to the Prime Minister of Norway. This group includes representatives from USAID, the United Nations, Canada, Rwanda, 

India, Harvard University, Rockefeller and Gates Foundations, and 

others. 

The Innovation Working Group has published draft papers that 

promote ideas that should catalyze future opportunities for the 

MDGs. They are available on the Web site and will be published 

later this year. And we have made these available, Mr. Chairman, 

to the committee. There are 10 different ones that are here, with 

a variety of perspectives, again, to foster innovation. 

We know that progress in developing and delivering healthy 

pregnancies and healthier babies is possible with innovation. Some 

of the poorest countries are now making significant reductions in 

maternal and neonatal mortality. Country-led as well as global innovations can achieve further reductions enabling health services 

to produce better outcomes at the same costs that we have today. 

These range from financial incentives to promote performance and 

results to innovative use of mobile phones and other communication tools, some of which you have already heard about. 

27

These working papers include ways to improve effective services 

for women and children, including improving health literacy, the 

development and use of new technologies, as well as innovation 

and delivery of services through public-private initiatives. 

Johnson & Johnson has a long legacy of engaging in public-private partnerships focused on maternal and child health initiatives 

in many developing and developed countries. All of these have a 

focus of making life-changing, long-term, sustainable differences in 

human health and tied to advancing one or more of the Millennium 

Development Goals. Our approach focuses on working with community-based partners that have the greatest insights into the needs 

of local populations and the strategies that stand the greatest 

chances of success. 

Some of our examples of our activities include contributions 

microbicide development, HIV prevention, helping children attain 

their utmost potential by treating and preventing intestinal worms, 

efforts to halt the scourge of tuberculosis, and initiatives to prevent 

mother-to-child transmission of HIV. I will go through four of these 

examples. 

The first is from 2004, when Johnson & Johnson established a 

first-of-its-kind partnership with the International Partnership on 

Microbicides to provide a royalty-free license and technology transfer to develop, manufacture, and distribute its compound TMC120 

as a topical vaginal microbicide to help protect women from infection with HIV in developing countries. We were the first pharmaceutical company, and this effort spearheaded other companies to 

follow suit with further contribution of their compounds to the IPM 

partnership. And, as you may have heard last week in Vienna, 

microbicides are a promising approach to halting the incidence of 

HIV. 

Secondly, since 2006, we have partnered with the Task Force for 

Global Health on Children Without Worms. This is the first and 

only entity to focus specifically on global treatment and prevention 

of soil-transmitted helminthiasis, or commonly known as intestinal 

worms. STH, or soil-transmitted helminthiasis, contributes to general weakness, malnutrition, iron-deficiency/anemia, and impaired 

physical and intellectual development in school-aged children. 

The program that we have helped developed is treating approximately 20 million people with mebendazole, a drug developed by 

our pharmaceutical business, and is working to stop the cycle of reinfection through health education, access to clean water, and improved sanitation infrastructures. And this is currently active in 

eight countries that have high prevalence rates. 

Third, as the new drugs for development of drug-resistant tuberculosis are in dire need, Johnson & Johnson formed a landmark 

collaboration with the Global Alliance for TB Drug Development, a 

not-for-profit product development partnership to accelerate the 

discovery and development of new drugs to fight tuberculosis. This 

collaboration is maximizing the expertise and resources from the 

both the public and private sectors, with the intent to improve the 

treatment of one of the world’s oldest and most deadly diseases. We 

are sharing expertise and resources in the development of a novel 

Johnson & Johnson compound in development, and this is heralded 

28

as the first new tuberculosis drug with a new mechanism of action 

in 40 years. 

And, finally, Mr. Chairman, a final example that we would like 

to talk about contributes to how we have helped eliminate motherto-child vertical transmission of HIV by 2015, which has also been 

heralded as a goal by the United Nations. 

For several years, Johnson & Johnson has partnered with the 

Elizabeth Glaser Pediatric AIDS Foundation and mothers2mothers. 

Our partnership has reached more than 1.9 million women with 

counseling, provided more than 1.7 million with HIV testing, and 

administered antiretroviral prophylaxis to nearly 140,000 HIV-positive mothers in 11 countries. 

J&J also became mothers2mothers’ first corporate partner in 

2006 and is one of the largest supporters, as this partnership has 

reached over 3,500 new HIV-positive mothers each month in South 

Africa, Lesotho, and Swaziland. 

Each of these examples demonstrates how actors in the public 

and private sectors drive innovative solutions to address some of 

the world’s most pressing global health issues affecting women and 

children. These partnerships all call for a shared vision, strategic 

thinking, and collaboration to be successful. Healthy partnerships 

leverage the unique skills that each partner brings to the table to 

effect change. 

We believe the best value comes when the United Nations and 

other governmental bodies involve the private sector to catalyze efforts and when the private sector leverages governmental investments. We see this in our engagement with the United Nations and 

other stakeholders, including the U.S. Government, on health literacy initiatives. 

And, Mr. Chairman, health literacy is something not only heralded domestically in the United States in health reform and in the 

National Action Plan with HHS, but also led efforts in Missouri, 

with some of the great State innovations that Missouri is also sharing with the world and vice versa. 

We also believe that our efforts at Johnson & Johnson on global 

health diplomacy drive new ways of thinking that can help shape 

stronger, more sustainable approaches, benefiting mothers and fathers around the world. 

The recent resolution adopted by the United Nations General Assembly on prevention and control of noncommunicable diseases 

stresses the need for a multi-sectoral response also to combat noncommunicable diseases. In this resolution, the U.N. recognizes the 

enormous human suffering caused by noncommunicable diseases, 

such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, and the threat they pose to the achievement 

of the MDGs. 

We see this challenge of noncommunicable diseases and support 

the multi-sectoral input currently being developed by the United 

Nations and the World Health Organization. Johnson & Johnson 

represents the pharmaceutical industry with our seat on the World 

Health Organization’s NCDNet, a global noncommunicable disease 

network developed. 

We also further contribute with our leadership through the 

World Economic Forum, chairing the chronic disease and wellness 

29

activities. The World Economic Forum has designated the threat of 

noncommunicable diseases to economic and health and wellbeing. 

And we also now welcome more engagement with the U.S. Government, the U.N., and other interested parties in this effort. 

The U.N. joint plan of action for women and children’s health offers renewed hope for the future, as the varied participants explore 

ways to build upon, revitalize, and secure new commitments from 

a range of influential partners, as well as provide organization and 

accountability for delivery at the highest level. During the formative stages, participants agree that this joint action plan should 

focus on increased political commitment and accountability, integrated delivery, and enhanced financing for women and children’s 

health. 

In conclusion, I would like to remind, as we believe, that global 

health and development are too important to relegate to any one 

group. Congress has an important opportunity to support and encourage more public-private partnerships in health literacy, in maternal and child health, and other related areas that could help address the Millennium Development Goals. 

Additionally, it is critically important to foster public-private 

partnerships that build more integrated program offerings that 

focus less on trying to solve just one issue and more on holistic approaches to address the many challenges facing women and children in resource-poor settings. 

Thank you very much. 

[The prepared statement of Dr. Ratzan follows:]

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Mr. CARNAHAN. Thank you. 

And, finally, I would like to recognize Mr. James Roberts for 5 

minutes. 

STATEMENT OF MR. JAMES ROBERTS, RESEARCH FELLOW 

FOR ECONOMIC FREEDOM AND GROWTH, THE HERITAGE 

FOUNDATION 

Mr. ROBERTS. Thank you, Mr. Chairman, and thank you, Mr. 

Ranking Member, for this opportunity to appear before your subcommittee. 

In my opinion, Congress should reject approval of future taxpayer-funded U.S. Government official development assistance programs, or ODA, that are designed to achieve the U.N. MDGs. 

I should note at the outset, I do not include emergency and humanitarian assistance in my critique of ODA. I would also like to 

compliment the significant positive role in development played by 

private charities and faith-based groups. 

No one disputes the desirability of MDG goals, but there is significant disagreement about the best approach to achieve them. In 

my opinion, the U.N. programs will fail to achieve their objectives. 

If Congress continues to fund them, the only certainty is that they 

will further enrich corrupt elites in developing countries and they 

will provide continuing employment for a cadre of development assistance bureaucrats and other professionals who are advancing 

them. 

Increasingly, experts in the developing world, such as Dambisa 

Moya of Zambia, who wrote a book recently called ‘‘Debt Aid,’’ are 

voicing opposition to ODA. They know from firsthand experience 

that 50-plus years of foreign aid from OECD countries, totaling 

anywhere from $1.6 trillion to $2 trillion, depending on who your 

source is, has only strengthened corrupt elites, encouraged morally 

corrosive cultures of corruption, discouraged private and foreign 

and domestic investment, and actually contributed to a rise in poverty rates because of the expanded level of nonproductive government spending and the welfare-dependency mindset that that encourages. 

One has only to drive 50 miles or so beyond the Beltway in 

Washington for evidence of the massive government stimulus 

spending in the United States in recent years and its failure. Although it has been a boon to public-sector unions, it has failed to 

help the average American to achieve his or her own set of MDGs. 

So why should anyone expect U.S. Government deficit-financed development assistance programs that emphasize welfare-state redistribution solutions and dependency to be any more successful in 

other countries? This is especially true at a time of unthinkably 

large U.S. deficits, as Congressman Rohrabacher mentioned. 

A Swedish development economist, Fredrik Segerfeldt, has noted 

the failure to lift people out of poverty and has analyzed the reasons why. And his conclusion—and we share it at Heritage—is that 

these problems of development in these countries simply cannot be 

solved by foreign aid. Only economic growth can rescue the poor 

and extremely poor, and that growth cannot be generated by statist 

development assistance programs that center on an ever-expanding 

welfare state and redistribution. 

35

Segerfeldt points out, for example, in 1962, GDP per capita in 

East Asia and in sub-Saharan Africa was roughly the same. By 

2005, the poverty rate in East Asia had been dramatically reduced, 

while in sub-Saharan Africa it was more or less unchanged. The 

difference? China, South Korea, the so-called Asia Tigers, other 

countries in East Asia generally did not follow the western development assistance model. They preferred to stimulate growth through 

investment and export. Meanwhile, countries in the sub-Saharan 

Africa have become increasingly dependent on ODA. 

Development assistance proponents push the MDGs, and they 

downplay extensive evidence that growth, not aid, provides the exit 

from the poverty trap. For evidence, look no further than the U.N. 

Millennium Declaration, which the U.N. Development Programme 

purports to be the gold standard of development assistance policy 

prescriptions. It does not contain a single reference to economic 

growth. 

Only fundamental changes in a country’s culture and political 

philosophy by its own citizens can accomplish these necessary 

changes. It is not just formal institutions of a government in developing countries but the informal customs governing day-to-day 

business transactions that must be reformed. And that can only by 

accomplished by people living there. The U.S. taxpayers should not 

be put on the hook for that. 

If a country’s culture and practices are steeped in corruption and 

cronyism, no amount of aid will overcome it. In fact, ODA actually 

degrades these formal and informal institutions the longer it exists, 

because it tends to perpetuate corrupt regimes that can hang on to 

power by using the assistance flows. 

It is instructive to look at the countries where the Millennium 

Development Goals have actually been realized most fully in the 

history of the world, and that would be in the developed countries 

with high levels of economic freedom and low levels of corruption. 

And, of course, as you mentioned, Mr. Chairman, I work on the 

‘‘Index of Economic Freedom,’’ which annually analyzes these core 

principles: Rule of law, secure property rights, limited government, 

taxes as low as possible, efforts to encourage and bolster free markets, entrepreneurship, democratic governance, political stability, 

and the resulting prosperity. According to our index, countries with 

greater improvements in economic freedom achieve much higher reductions in poverty. 

As you mentioned, Mr. Chairman, the deficit is a major concern. 

And no one is going to be deluded into thinking that even if the 

entire U.S. foreign assistance budget were eliminated—and I don’t 

recommend that—it would not solve our deficit problem. But most 

of it should be eliminated, on principle. I would make an exception, 

certainly, for direct, short-term U.S. national security goals that 

should be tackled by joint U.S. military and civilian agency teams. 

But, other than that, and there may be a few other exceptions, I 

think, actually, that development assistance policies have been a 

block to growth and to lifting people out of poverty. 

The best thing the United States can do right now to help the 

developing world is to get its own financial house in order and regain its status as a role model for developing countries. Take the 

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stead, encourage more trade and investment, for example, by approving the pending free trade agreements with Panama, Colombia, and South Korea, and negotiating more. 

That will make more capital available to the private sector and 

spur a renewed level of economic growth in the U.S. and globally. 

That is the best model for sustainable development: Through economic growth. 

Thank you very much. 

[The prepared statement of Mr. Roberts follows:]

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Mr. CARNAHAN. Thank you. 

I appreciate our panel and all of your diverse backgrounds and 

opinions. I think we have covered a lot here. 

But I am going to start with recognizing myself for 5 minutes of 

questions. And I want to start out asking each of you, as has been 

mentioned in various forums, about the security and economic connection to these goals. And I know you quoted Secretary Gates, but 

I would like each of you to talk about that and also the third component, how this helps leverage other aid. 

I also like the comment that was made that this was too big for 

any one group to do on its own. I think that is an important theme 

here. 

But if you could each address that, and I will start with Ms. Calvin. 

Ms. CALVIN. Thank you. 

I believe Secretary Gates had it exactly right when he made that 

critical connection between ensuring that there are peaceful and 

conflict-free areas in the world where we can help nations grow to 

their full potential and their citizens live to their full potential and 

to become eventually some customers and clients of U.S. companies. 

But I think the most important thing here is the recognition that 

people around the world are all of equal value and that we need 

to address that basic core instinct that Americans have. Once we 

make a nation have access to the health and other benefits that we 

are talking about here, we know that we can encourage the keeping of girls and other young people in school, which leads to longterm security and stability in a country. A lot of the work that the 

U.S. ODA is already doing is in the area of democracy-building and 

rule of law, and we know that those two things then work hand 

in hand. 

And it is important to recognize that so much of ODA is currently not even in the areas that my colleagues have talked about. 

Even though it has been increased in recent years around AIDS 

treatment and other areas, it has been a full panoply of supporting 

the economic growth of these countries in lots of different ways. 

And the most important way we can help a country grow economically is to make sure that its citizens are educated and have 

health. 

Mr. CARNAHAN. Dr. McArthur? 

Mr. MCARTHUR. Thank you, Mr. Chairman. These are terrific 

questions. And I would just start by saying that I think official development assistance and aid often is very broadly misunderstood 

as a charitable endeavor. There certainly are humanitarian emergencies which require that form of logic, but what we are really 

talking about here is investments, and investments in very specific 

and practical programs and targets. 

If we even look at the challenge of economic growth for the poorest countries and communities in the world, the majority of them 

are farmers. Economic growth to a farmer means growing a better 

crop, literally. And so, when we are talking about agriculture, for 

example, and support for agriculture, that has a double dividend of 

both tackling hunger and promoting economic growth. 

43

Now, Malawi is a very important example. Malawi supported, 

with international—the President, Mutharika, put forward a program to make sure that every small farmer in Malawi got access 

to a bag of fertilizer and a can of seeds. You couldn’t think of anything more simple and straightforward. This was only made possible because of international support. That program then doubled 

the country’s food production, and, in 2008, when the global economy was imploding, Malawi grew at 9 percent. 

So the economic dividend is very important. And the fact that agriculture has basically missing from the international agenda for a 

generation is, in my view, one of the deepest reasons why we 

haven’t seen more direct links between foreign aid and growth. 

Now, we certainly need the longer-term support for education 

and health, as well, which will undoubtedly affect growth in the 

medium and longer term where the programs are successful, because children that survive and are better educated will be very active economic players. And even higher child survival is linked to 

lower fertility rates, which is part of managing a demographic transition where we have the fastest-growing populations in the poorest 

countries. The greatest, you know, risks of instability are also in 

those poor countries. And we don’t just have to think about these 

countries as islands because they are very much part of the connected world. 

Now, if we look at the evidence, which is quite strong and in the 

top journals, the risk of conflict, civil conflict, is much higher at 

lower levels of income per capita. Many of the places that we read 

about in the newspaper every day, which are our direct security interests, also happen to be those places. 

There is an extra overlay, which is the climate issue. The top research now shows that risk of climate, whether it is temperature, 

whether it is rainfall variation, especially in Africa, is directly 

linked statistically to the onset of conflict and domestic conflict. 

And the logic is quite straightforward: When the rains fail or the 

temperature is too high, the crops fail, and hungry people are ultimately more likely to fight. And we have a whole drylands issue 

throughout the Sahel, where these are also the hot-button security 

places that we are worried about on all sides of our foreign policy. 

So we need to understand that there is a direct effect on health 

and delivery targets and education and infrastructure. We also 

need to understand that aid can go, and must go, directly to supporting the productive sectors. And that won’t just help these countries escape from aid and graduate from the need for support, but 

will also help them develop the robust, kind of economic and social 

capacity that will really be in our global long-term interest for stability. 

Mr. CARNAHAN. Thank you. 

Dr. Ratzan? 

Mr. RATZAN. Thank you, Mr. Chairman. 

I think that is an excellent question that leads to what we encompass under global health diplomacy, notwithstanding the ideas 

of health as a bridge to peace, health with conflict resolution, but 

the idea that health investments are investments in wealth and 

economic wellbeing. 

44

And there are basically three areas where I think this makes the 

largest and best example: One is infectious disease, which has no 

borders; second, chronic disease, which continues to be a threat; 

and, thirdly, as you mentioned, mothers’ education, or as we link 

it even more with health literacy in general. 

We looked at last year’s risk report, which is done annually with 

the World Economic Forum that goes to both private-sector groups 

as well as governments and throughout the world. And if you look 

at the risk report, it puts on one axis the potential or the likeliness 

of something to occur and on the other axis the threat that it is 

to society with economic wellbeing. 

And what is highest on that list are three health-related areas: 

Chronic disease, pandemics, and some of the threats that Dr. 

McArthur mentioned related to climate change. It is higher than 

some of the economic collapse items that are there, yet the world 

does not invest the same in the fundamentals of health and economic wellbeing to help prevent those risks. 

So what we are trying to do is integrate some of the activities 

that I mentioned. With tuberculosis, we cannot do this alone. Multiple-drug-resistant tuberculosis could come into the United States. 

It could threaten the world in a broader way. In areas that we 

have heard in the past of extremely drug-resistant tuberculosis, 

that has been a threat for communicable disease. 

Chronic disease, mostly, at this juncture, it tends to be diabetes, 

but notwithstanding tobacco use and the Framework Convention 

on Tobacco Control, another piece that was heralded by both the 

United Nations and World Health Organization, with their authority, where also countries could help make a difference in preventing 

cancer and prevent treatment for mortality, morbidity related to tobacco. 

And then thirdly, health literacy. United Nations resolution last 

year relating to health literacy can make a major difference in better health outcomes; has spearheaded efforts in China, with 66 indicators for health literacy; the United States national action plan, 

eight member states in Europe and other countries that are looking 

at ways that if we just educate and give people the knowledge and 

the skills and simplify the demands and complexity of the system, 

we can also have better health outcomes and better economic 

wellbeing. 

So those are the three areas that I think could help make a difference and really do link the overall security and economic connection to the MDGs. 

Mr. CARNAHAN. Okay. 

And Mr. Roberts? 

Mr. ROBERTS. Thank you. 

Since the end of the World War II, really the best ally and friend 

of people all over the world has been a strong United States—

strong economically, diplomatically, and militarily. The United 

States has kept the air and sea lanes open, which has spurred 

globalization. And that globalization, that investment in trade, has 

been what has really helped people and lifted them out of poverty. 

And it has been hundreds of millions of people, as I am sure no 

one would disagree with. And those flows, the investment in trade 

flows dwarf a combined ODA of the whole world, as you also know. 

45

But the biggest threat right now to the United States’ national 

security are the deficits in this country that could lead to our financial ruin. Cutting ODA will be only one of probably thousands of 

budget and spending cuts, difficult and painful, that Congress will 

likely have to confront in order to restore U.S. economic prosperity. 

Thank you. 

Mr. CARNAHAN. Thank you. 

Now I would like to recognize our ranking member, Mr. Rohrabacher. 

Mr. ROHRABACHER. Thank you, Mr. Chairman. 

How much is it that you think that we should be spending that 

we are not spending? 

I mean, Dr. McArthur, you were relatively hard on your country 

here, in terms of ‘‘We are not doing our’’—so what level of spending 

are we at now, and what would you want us to spend at? 

Mr. MCARTHUR. The international commitment is to 0.7 percent. 

Mr. ROHRABACHER. No, no, no, no, the actual amount. I mean, 

I am not talking about—I understand it is a percentage of your 

economy. No. How much do we spend now? How much do you want 

us to spend? 

Mr. MCARTHUR. Right. So the numbers would be—current devel- opment assistance is on the order of $30 billion. I can get the specifics. 

Mr. ROHRABACHER. Okay. So, currently, we spend $30 billion. 

Mr. MCARTHUR. Right. 

Mr. ROHRABACHER. And you would want us to spend? 

Mr. MCARTHUR. It would be closer to $100 billion. 

Mr. ROHRABACHER. Closer to $100 billion. Okay. 

And when you are talking about our contribution to the world, 

you are not including some of the things Mr. Roberts was alluding 

to, that we send our military forces throughout the world in order 

to prevent conflicts from overwhelming regions. 

Mr. MCARTHUR. I should clarify, those are——

Mr. ROHRABACHER. Because we spent $1 trillion in Iraq. 

Mr. MCARTHUR. Right. 

Mr. ROHRABACHER. Okay. And we are spending, you know, hundreds of billions of dollars in Afghanistan. And you don’t count 

that, really, as a contribution. You think it has to be in the form 

of grain seed. 

Mr. MCARTHUR. That is not what I said, Congressman, excuse 

me. 

Mr. ROHRABACHER. Okay. 

Mr. MCARTHUR. Just to clarify, I think we are talking about complementary strategies. And so that is why I think the testimony of 

Secretary Gates is so important, because we are talking about both 

security and development and development for security. The reality 

is that there is about a 30:1 ratio of the military expenditures to 

the development expenditures. 

No one is questioning the importance of the defense spending; far 

from it. What we are talking about——

Mr. ROHRABACHER. Yeah. I read Secretary Gates’s remarks, and 

let me just note, it does exemplify the difference in approach that 

people, honest people, have——

Mr. MCARTHUR. Right. 

46

Mr. ROHRABACHER [continuing]. In terms of how to find prosperity and peace in the world. 

I think that Secretary Gates does not fully and other people have 

not fully understood that Adolph Hitler came from a developed 

country, the communists who were in power generally came from 

upper-middle-income families and upper-income families, and the 

radical Islamic movement today is not fed on poverty but instead 

on fanaticism that is being financed by some of the wealthiest 

groups of people on the planet. And so I would disagree with him 

that poverty leads to this type of national security challenges that 

we face today. 

Now, we can still believe that it is the humanitarian responsibility of people who have been blessed to live in free societies and 

have prosperity to help those in less free societies. I disagree with 

them as that is a strategy for a more peaceful world. 

Let me just go back—and, with all due respect, Doctor, the idea 

that you presented, this image of, well, what they really need is a 

sack of fertilizer, is probably the most naive approach that leads 

to the waste of huge amounts of money that should be going to improve people’s lives. 

Frankly, that a sack of fertilizer in most of these developing 

countries will lead—even if it leads to a little bit more production 

by that farmer, no, it is not growing a better crop. It happens to 

be also that people are taking bribes and demanding bribes from 

that farmer; the people who are stealing from that farmer legally 

and illegally; the lack of transportation because the money in that 

country, instead of going to transportation, has gone into the pockets of corrupt officials; the fact that they don’t have clean water because those same corrupt officials have pocketed that money. No, 

it is not a sack of fertilizer. 

And until we begin realizing that those type of problems, which 

Mr. Robertsoutlined, those things have more to do with the poverty 

than does the lack of sack of fertilizer. And from $30 billion to $100 

billion may provide more fertilizer for those farmers at our expense, at the expense of our kids here—we are going to borrow that 

extra $70 billion, we are going to borrow it from China in order to 

help these people. And I would submit to you that that will not improve the life of those people that you are intending it to and will 

actually bring down the quality of life of our own people. 

Let me ask you this. About the people who run these programs, 

we are talking about—by the way, let me congratulate anybody 

around the world, anybody personally and anyone here domestically, who is engaged in helping other people with their own resources. And George Soros is a mixed bag. I mean, George Soros 

manipulated the currency in various developing countries, impoverishing certain people in those countries, but at the same time he 

has been a great contributor to various humanitarian causes. And 

I realize there is—when you are talking about him, but Ted Turner 

has done some wonderful things. The Bill Gates Foundation has 

done some wonderful things. We applaud their activity, especially 

if they are doing it unilaterally, on their own, going out and trying 

to make their money count. 

But when we are talking about these joint programs, how much 

money goes into administration? For example, someone who runs 

47

some of the programs that you are talking about, do they make 

more money than a congressman makes? How much money do they 

make? Do they make over $100,000 a year? Should we set a cap 

on any organization that we are in a partnership with that they 

won’t be paying their executives a certain amount of money? 

So what about the pay level of the people who may just be sucking off that money that should be going into fertilizer for that farmer in Africa? 

Mr. MCARTHUR. I am very glad you raised these points, so thank 

you. 

And I would say, first of all, no one is advocating money for process, and no one is advocating a penny go to corruption. And that 

has to be very clear. This is about results and direct, auditable, 

monitorable, deliverable targets that you can do a spot-check on to 

make sure it is happening where it should. 

That has been the great success, I would say, of the President’s 

Emergency Program for AIDS Relief, which the Congress had 

played such a crucial role on, as it was about actually making sure 

that those people get the antiretroviral medicines. And this was 

deemed, less than a decade ago, as you know, I am sure, much better than me, impossible. And now we have 5 million people on 

AIDS treatment, thanks to a breakthrough program where it was 

about auditable results and delivery metrics. 

For fertilizer and so forth, I actually, with utmost respect, have 

a different read on history, where throughout Asia, going back to 

Korea in the 1930s, Taiwan in the 1920s, India and Pakistan in the 

1960s, every single case of economic takeoff that wasn’t about discovering a mine was linked to strong public support, public investments in agriculture, in smallholder agriculture. 

Norman Borlaug, the Nobel laureate who won the Presidential 

Medal of Freedom, was the great leader, with M.S. Swaminathan, 

around India at making sure, literally, that farmers got fertilizer 

and seed. Literally, that was the program. So, with utmost respect, 

I don’t think it is a naive view; I believe it is a practical view, 

linked to actually what is the monitorable, auditable program delivery target. And, in Malawi, the government has used a voucher 

system, with even biometrics in place, to make sure this is an efficient system. And that has been a breakthrough in a country that 

was previously considered the perfect storm of disasters. 

So I think we need to have a very hardheaded approach. And, 

with full candor, I used to write the Global Competitiveness Report, I am a macroeconomist, I believe in economic growth as much 

as anyone. But what I am supporting is a view that thinks 

through: What are the investments required to support robust, 

long-term economic growth in the poorest countries while solving 

the practical problems? 

I believe that we have to be focusing on programs first, direct 

commodities. We have to be using local staff. This is not about armies of aid workers going from the rich countries; this is about 

local programs. In the Millennium Village project, all of these staff 

in Africa are African. And that is a very crucial component of our 

work, because there is so much expertise that just needs to be empowered by tools. 

48

I was in Tanzania a few weeks ago, and I was with a farmer who 

had 6 years of primary school education, who was a community 

health worker, with a cell phone treating malaria in front of my 

eyes with new technologies. This is something that would never 

have been possible if it weren’t for the Presidential Malaria Initiative or The Global Fund to make malaria treatment possible. 

Mr. ROHRABACHER. Thank you very much. I think my time has 

about expired. But let me note that we still have a disagreement, 

but it was a good comeback. 

Mr. MCARTHUR. Thank you. 

Mr. ROHRABACHER. And I will also note that malaria—I mean, 

what has been said about malaria today, it hasn’t escaped many of 

us that when you get involved with these global projects and government programs, that the politically correct attitudes on things 

tend to take hold. And many of us believe that the malaria epidemic that we are facing now can be traced right back to the politically correct science of eliminating DDT, which, once it was eliminated by people who have these politically correct notions, we saw 

a massive increase in the death of children in Africa. 

And so we are talking about millions of children here who have 

lost their lives by people who, of course, are part of this very benevolent approach but mindset, liberal mindset, that has outlawed 

DDT in order to protect the thickness of bird shells—yes. 

Thank you very much. 

Mr. CARNAHAN. I certainly enjoy the debate and discussion and 

give-and-take of this committee. I thank the gentleman and thank 

our witnesses. 

I want to talk about a success that has been mentioned here with 

regard to the Global Polio Eradication Initiative and the work that 

has been done with Rotary International, WHO, CDC, and 

UNICEF. 

If you can comment on the success of that program that has seen 

polio plummet 99 percent since 1988 and what is needed to make 

that final push in the four remaining endemic countries—Afghanistan, India, Nigeria, Pakistan. And, finally, what lessons can we 

learn from that program that we can apply to some of these others 

that are just really getting started? 

And I am going to reverse the order this time and start with Mr. 

Roberts. 

Mr. ROBERTS. I would have to do some research on some of the 

specifics. I would refer the committee to the many scholarly works 

of Professor William Easterly at NYU, who is probably one of the 

best, most solid, robust economists who has written critically about 

these issues. 

I would also note just in passing that the PEPFAR is a good example of a program that worked well. And I think it did because 

it was private money and it was private corporate management 

methods that were brought into the government and it was fenced 

off from the rest of the government. And I think that that is—it 

was a good example of a program that worked. Although, as I have 

mentioned in my testimony, we have to make very difficult choices 

because of the budgetary reality we face. 

Thank you, sir. 

Mr. CARNAHAN. Thank you. 

49

Dr. Ratzan? 

Mr. RATZAN. Thank you, Mr. Chairman. That is a very important 

question and something that, unfortunately, we have been unable 

to end polio in the last century. 

And, ironically, I also edit the Journal of Health Communication, 

and we just did a whole supplement——

Mr. CARNAHAN. Is there anything you don’t do? 

Mr. RATZAN. Thanks. We did a whole supplement with USAID 

and George Washington University Global Health on polio communication and what are the final challenges, to answer that question 

directly. 

And I can’t summarize the hundred pages from experts in a peerreviewed publication. But what I can say is that some of the fundamental areas that would help make a difference would be better 

communication—and, most particularly, this is political-level communication—to get the leadership and community-based leaders 

able to understand the value of the polio vaccination. And that has 

been a very large challenge, not only with the anti-vaccine lobby, 

frankly, here in the United States, but really globally, the whole 

idea of vaccines making a difference in the challenge are continuing to be not only for polio but for other vaccine-preventible illnesses. 

And then finally I think—and I do believe that the work at 

USAID and others have been quite successful in working in this 

public-private partnership. But we need to continue to support to 

end polio. And part of that, again, is both political communication 

as well as efforts on the ground with community-based efforts. 

Mr. CARNAHAN. Thank you. 

Dr. McArthur? 

Mr. MCARTHUR. I am not an expert on polio, but I can say, the 

general lesson on that program and others is that you have a few 

basic steps that come together. One is you have implementation of 

known technologies. The vaccine is very important. Two is you 

have developing-country-driven national implementation strategies. 

That developing-country ownership is central—and accountability. 

Third is that you have those national strategies regularly and 

rigorously evaluated through independent technical review. Fourth 

is that those programs are driven by a clear emphasis on performance metrics, so there are delivery targets that everyone is accountable for. 

And then, fifth, they have adequate finance through, in this instance, a blend of public and private sectors. But we can’t expect 

these programs to be implemented in the absence of adequate finance. And so the dollars are not about throwing dollars; they are 

about funding very practical mechanisms. 

Mr. CARNAHAN. Ms. Calvin? 

Ms. CALVIN. I would be happy to add a few lessons. 

The U.N. Foundation has been involved in the fight against polio 

since its inception. But, you know, really, the Rotary International 

deserves the largest credit here for jumping on this in 1988 with 

the World Health Organization. 

I would say the most important thing that was done initially was 

that a goal was set and that the world rallied around it, following 

on the success of smallpox elimination, which, prior to polio, was 

50

the only major disease ever eliminated in the United States, in the 

world. 

Second, an infrastructure was built that we have since built upon 

to eliminate measles and other diseases, and to build a health systems infrastructure that now works in the countries where polio is 

done. 

And third, because it was public and private, Rotary showed it 

is not just the money that they could raise in this country and 

around the world—and they have raised over $600 million—but it 

is that they use their volunteers around the world to help deliver 

the vaccine. And that made a huge difference. 

The hurdles have been cultural. At some point, if someone went 

to the annual pilgrimage and exposed others at the Hajj to polio, 

and Saudi Arabia responded by having a rule now that you can’t 

come to the Hajj unless you have had polio vaccination. And they 

have stepped up to help eliminate it in the Muslim areas where it 

has been endemic. We need every country to realize how important 

it is that we reach this goal. And we see that, in the countries 

where it is still endemic, which tend to have largely Muslim populations, the religious leaders have been both initially the problem 

and now are helping us get to that final stage. 

We think we will get there. It has taken also some efforts to refresh the campaign. And the Gates Foundation most recently 

stepped in to really make this a major effort and initiative of 

theirs, making this point that the public-private partnership is 

what really multiplies the impact of U.S. money. 

And the U.S. has been the biggest donor in this space, and I 

would say this is an investment well worth making. 

Mr. CARNAHAN. Thank you. 

Mr. Rohrabacher? 

Mr. ROHRABACHER. I didn’t quite get the—we covered some of the 

other areas of my question, so I didn’t quite get to the salaries of 

people. 

Should we have a cap on salaries for people? But private institutions, if they want to pay their people $250,000, $300,000 a year, 

that is their business, as long as they are doing that independently 

of government. But if you have an institution that is in partnership 

with government, should we not have a cap on salaries for these 

charitable institutions so that the people there are not making 

more than their counterparts in government? 

Ms. CALVIN. Well, I don’t believe in a cap, myself. I believe in 

disclosure, I believe in measurement and accountability, and I believe in reform. 

And I think part of what USAID should be all about is making 

sure that our investments around the world are done in the best 

possible fashion. I think it is important that we are doing the Foreign Assistance Act to look at that. I don’t think a cap is necessarily the right solution in every case, because I don’t even know 

how you would pick it. 

Mr. ROHRABACHER. Okay, so you don’t believe that we should 

have a—if the government is going to go into a partnership with 

a private organization, that we should require that that private organization does not consume its resources on salaries for its top exVerDate 0ct 09 2002 16:56 Nov 17, 2010 Jkt 000000 PO 00000 Frm 00054 Fmt 6633 Sfmt 6633 F:\WORK\IOHRO\072710\57686 HFA PsN: SHIRL
51

ecutives at a level that is higher than what you find in the government. 

Ms. CALVIN. Oh, I agree with what you are saying. I just don’t 

know if a cap is the right answer to that. I think that absolutely 

should be one of the judgment measurements. 

Mr. ROHRABACHER. So you are against that. 

Dr. McArthur? 

Mr. MCARTHUR. Are you referring to organizations in the advanced countries or in the local economy? 

Mr. ROHRABACHER. I am talking about people where we have 

been talking about partnerships between private groups and government, at our level and at international level. Should there be 

a cap on the pay levels of those private organizations if, indeed, 

they are going into this partnership? 

And, by the way, if they aren’t in a partnership, they can pay 

whatever they darn well want. But if we are talking about partnership here today, if that is what you are advocating, would you advocate that we put a cap on the salaries of those top people in those 

organizations so that they aren’t making more money than their 

government counterparts? 

Mr. MCARTHUR. It is a question I don’t have a specific answer 

to. I would say——

Mr. ROHRABACHER. Your answer is no. If you don’t have a specific answer, it is no. Because this is a policy, and so, if you are 

not for it, that means you are not for the policy. 

Mr. MCARTHUR. Well, I would be happy to follow up with you on 

it to think through all the mechanics of what it could include, because I think it is a very important question. I have spent a lot of 

time thinking about what different salary scales could look like 

based on value for money. And whether it is hiring a community 

health worker who is a farmer part-time in a village, whether it 

is a Ph.D. working in rural Africa who is a local African Ph.D.——

Mr. ROHRABACHER. I am actually talking more about your organizations, not the guys down in Africa. I am saying, should people 

who work for—if the Turner Foundation and other groups that are 

in private sector here are going to be partners with the U.S. Government, should we expect that the money that they are consuming 

as part of that charitable operation not be consumed via top-level 

salaries as compared to—and the standard you would use would be 

their counterparts in the public sector. 

Mr. MCARTHUR. Right. So I would say to that that any public 

funding that goes through a partner organization, it makes good 

sense to me that that be aligned with U.S. Government salary pay 

scales. If it is a privately funded organization where private supporters want to pay at their discretion——

Mr. ROHRABACHER. I understand. But you are——

Mr. MCARTHUR. I am dividing it. I am segmenting the problem. 

Mr. ROHRABACHER. Yeah, yeah, right. The fact is that if you are 

in a partnership, you are—that the program—your programs are 

tied. And I am just saying, if you are going to tie your programs, 

should we not also tie how much money is being consumed for 

upper-level salaries? 

Doctor, what would you say? 

52

And by the way, let me just note, I commended the Turner Foundation and others. I forgot to say Johnson and Johnson Foundation. 

Because you guys are doing terrific work, and you can be proud of 

the good things that your company and the foundation of Johnson 

and Johnson has been doing. You have expressed that today, and 

we have heard that, and that is wonderful. So, pardon me for not 

adding you on the list of people to commend. 

Mr. RATZAN. Thank you very much, Congressman Rohrabacher. 

In response to your question, I think we have to look at this very 

broad issue of how health care and health services are delivered 

throughout the world. And, frankly, a lot of it is delivered through 

the private sector. So the partnership might be, in some cases, public funding and private-sector delivery; other cases, it is private-sector funding and then public-sector interventions and research and 

so forth. 

So there is no one solution that exists. And we are always seeking out the best-quality people and resources throughout the world. 

And, with that, you know, free-market activities clearly are in 

place. 

Mr. ROHRABACHER. So let’s get down to the basic question. If you 

are in a partnership, if you have a private foundation or whatever 

it is in partnership, as we are advocating today, as a joint effort 

with government, should the government put a cap in saying, ‘‘We 

are not going to be in partnership with a charitable organization 

that pays its top-level executives more than their government counterparts’’? 

Mr. RATZAN. We don’t get into the governance nor a litmus test 

of partnerships based upon funding at that level, so we would not 

advocate for that. 

Mr. ROHRABACHER. Okay. But we do actually take a look. The 

government does say, ‘‘Well, here is a foundation that is spending 

90 percent of its money’’ or 75 percent or whatever, ‘‘they are consuming it among their own executives; thus, we are not going to 

get in a partnership with them,’’ I am sure that happens. So that 

has been a no, as well. 

Now, Mr. Roberts. 

Mr. ROBERTS. Well, Congressman, it might not come as a surprise to you that I would say, yes, that they would have to be 

bound. And I think your point—and I am sure you know this better 

than I—that what you are illustrating is a larger problem and real 

threat and danger, and that is of a creeping cronyism, of a state 

corporatism that we are seeing with these public-private ideas, a 

corporate social responsibility. It is really the government trying to 

take over, in a sense, these assets that are privately held that belong to shareholders. 

And so, of course, we oppose that at Heritage, as you would——

Mr. ROHRABACHER. Okay. Let me just note, and I know my time 

has been used up here, but just a little story that really indicates 

why I think this thing. 

Years ago, when I was 19, I spent some time with some projects 

in Vietnam. And it was a long time ago, different life. And I had 

been up in the central highlands, and I was really, you know, just 

a long way from home. And I was taking a flight to Bangkok, and 

I met a guy on the airplane, and he said, ‘‘Hey, where are you comVerDate 0ct 09 2002 16:56 Nov 17, 2010 Jkt 000000 PO 00000 Frm 00056 Fmt 6633 Sfmt 6633 F:\WORK\IOHRO\072710\57686 HFA PsN: SHIRL
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ing from?’’ And I told him I was up there with the Montagnards 

and all this stuff, and he said, ‘‘Well, you know, my wife’’—he is 

American. He said, ‘‘My wife actually can cook a great American 

meal. Would you like to come over for some meatloaf at my house?’’ 

Oh, yes, that is terrific, okay, I would love to have it. 

So I went over to—this guy was the head of UNICEF, I think it 

was, okay, in Bangkok. So I said, ‘‘Well, we will catch a cab,’’ and 

he said, ‘‘Oh, no, no, no, I have a car.’’ Oh, he had a car. He had 

a car, he had a driver, and it was a big car. So we got in the car, 

and we went to his—not his little house—his huge house with the 

fence around it and the servants. 

And then—look, I am sure he is a wonderful guy. And the money 

that was going for these children’s activities in Thailand, I am sure 

he took his job seriously. But he was consuming a lot of that money 

himself. And he had a driver, he had a doorman, he had a cook, 

he had a housekeeper, he had a big house. 

And when we went in, in the middle of the meal, he says, ‘‘You 

know, how would you guys like some good whiskey?’’ I said, well, 

all right. You know, I had been drinking this rice wine they have 

up where the Montagnards—in the central highlands. So, yeah, 

good whiskey, all right. 

He says, ‘‘Come with me.’’ And he grabbed me by the arm, and 

we went out into the garage. And there were all these cases in the 

garage. And they were these boxes, these boxes made out of wood, 

and they had ‘‘children’s books,’’ ‘‘UNICEF children’s books,’’ on the 

side of it. And he grabbed one, said, ‘‘Help me down with this.’’ And 

he opened it up, and it was filled with whiskey. 

Now, all I am saying is that, you know, if we don’t watch out, 

the people who are actually running the programs in a lot of these 

areas, what we have found is that a lot of the times people come 

in and they say, ‘‘Well, we spent this much money in this area,’’ 

it has really been consumed by the management of the organization. And you have to pay attention to that. 

If we really are serious and we want to help people, you can’t 

just sit here and say, ‘‘We really have to raise the money from $30 

billion to $100 billion.’’ That may not make any impact at all, except at the debt level of these young people who are in the audience. 

And we have to have the courage to look at things and especially 

have the courage to say, yeah, I don’t think we should pay people—

if this is going to be a charitable operation, those involved should 

be contributing to that charitable operation by actually receiving 

less pay than they would if they went into another endeavor. That 

is their contribution. 

Thank you, Mr. Chairman. 

Mr. CARNAHAN. Thank you. 

And I want to go on to another tack. And I guess I would like 

to ask the witnesses: With the 5 years left to achieve the MDGs, 

certainly we can all make the case that all of them are critically 

important. But given our limited time and limited resources, I 

would like to ask you to prioritize what you think would be the 

most critical and the most achievable in these remaining 5 years. 

Ms. Calvin, let’s start with you. 

54

Ms. CALVIN. Well, I will pick up on the last conversation to say, 

not only do we need more money for all of this work, but we need 

to get more for our money. So, more health for the money I think 

is the mission and the goal for the next 5 years. 

Vaccine interventions are probably going to be one of the most 

important pieces of that. We know that with vaccine interventions 

we can prevent 8 million more deaths between now and 2020. So, 

anything we can do to encourage the research and development, 

distribution, and uptake on vaccinations and immunizations 

around the world is critical. 

Second, I would say a focus on women and girls—which, Mr. 

Chairman, I know you did a hearing on this just a few weeks ago—

is essential. I think we have all learned that if you can keep a girl 

in school, if you can prevent her from marrying too early, if you can 

give her the opportunity to structure and create her own life, you 

have not only impacted her and her family but also her whole village. And so I think a whole focus and a lens looking at ensuring 

that women and girls, and particularly adolescent girls, are taken 

care of is essential. 

Third, I think we need to look at all of the goals in an integrated 

fashion. The goals were set up as eight individual goals, but, to 

some degree, they work most effectively and countries and publicprivate partnerships will work most effectively if we can integrate 

our approaches and, again, get the most for our money. 

Fourth, I would say technology and the use of new modern technologies, whether it is mobile phones or others, is essential. And 

we have been negligent, not using that and thinking that we needed investments financially. There are many innovative solutions 

that ought to be taken forward, and we would encourage that. 

Finally, goal 8 is something that we don’t talk about as often as 

we talk about 1 through 7, and that is the one that has to do with 

trade and debt. And I think it is as important for this country to 

focus on those issues and help other countries move forward economically if we can. 

And fifth, I think, as Dr. McArthur said, the Millennium Development Goals are not just the U.N.’S goals, not just America’s 

goals, they are everyone’s goals. So, to the degree that there is an 

approach to these goals that everyone can adopt—and I think that 

is why we have young people sitting in this room; they understand 

that these are the goals that will affect their future—that is the 

way we need to approach it. 

Thank you. 

Mr. CARNAHAN. Dr. McArthur? 

Mr. MCARTHUR. Thank you, Mr. Chairman. It is a great question. 

I would just submit that we have to avoid false choices when 

thinking through the goals. Just like, in my view, we should not 

make false choices between development and security, we have to 

think of both together, we have to think of fiscal stability and investments for the medium and long term. The goals are holistic, 

not just as a package, but also because they are essentially for selfreinforcing activities. 

So if you want to cut child mortality, clean drinking water is crucial. If you want to cut maternal mortality, girls’ education is cruVerDate 0ct 09 2002 16:56 Nov 17, 2010 Jkt 000000 PO 00000 Frm 00058 Fmt 6633 Sfmt 6633 F:\WORK\IOHRO\072710\57686 HFA PsN: SHIRL
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cial. And vice versa. So those are very much a package, which is 

why we have to be careful not to cherry-pick. I liken it to saying 

whether I want my heart, my lungs, my liver, or my brain. I actually think I need all of them to function as a human being. Economies and societies need health, education, food, infrastructure, and 

so forth. 

So I think the holistic underpinning of the goals is essential. But 

back to Congressman Rohrabacher’s point, I think the goal-based 

element is crucial. This isn’t about anything other than delivery 

targets, in the end. And every resource allocation should be linked 

to outcomes through action areas. And I think that is exactly the 

perfect logic for this. 

With all of those points in mind, if I were to pick the areas that 

I think could make the greatest breakthroughs in the next few 

years, remembering how many breakthroughs have happened in 

the past 10 years and 5 years that we all thought were—or many 

people thought were just too hard, I think in agriculture, again, 

this is an area where the world can make a tremendous breakthrough. Africa as a continent could basically double its food production within 5 years. This is an extraordinary biophysical reality 

that we have not yet got our heads around as a global community. 

We could have, second, a major breakthrough, I would say, in 

health systems and maternal health and child health, not by paying high salaries to people from rich countries, but by training millions of community health workers with very basic skills—it is 

called ‘‘task shifting’’—so that they can do the simple life-saving 

interventions, so that if that mother is about to deliver, they get 

to the clinic where that skilled birth attendant is. It is not just 

about the skilled birth attendant, but actually getting them to that 

skilled birth attendant if they are prepared to deliver at home. 

And then a third thing I would stress is the girls’ education, and 

really emphasizing secondary education, which has so many transformative effects for health, for economic growth, for broader economic activity in a society. 

I don’t want to say we don’t need economic infrastructure, we 

don’t need roads, we don’t need ports, we don’t need energy, because that is where the growth will come from. It will probably 

take a little longer for the international community to get its head 

around those systems that are needed—and also for water, which 

is technically probably the toughest problem because drinking 

water is only a small share of the uses of water. We are going have 

to have a lot better water systems for agriculture, for industrial 

use, and so forth. 

But those would be my general recommendations on how to think 

through the breakthroughs that can happen in the next 5 years. 

Mr. CARNAHAN. Thank you. 

Dr. Ratzan? 

Mr. RATZAN. Thank you for the opportunity on this regard of 

what can be done. 

I think the previous witnesses have certainly talked about the 

holistic approach, and clearly that is necessary. And I know there 

is consideration with the Global Health Initiative of giving some 

flexibility for formation of public-private initiatives that could help 

56

address some of the areas that are both health-related, educationrelated, environment-related, and so forth. 

And when I look at the Millennium Development Goals, for example, Millennium Development Goal 1 on poverty and hunger, 

amongst that it has nutrition-related factors and deworming. 

Those, frankly, have not got the same level of partnerships as 

maybe infectious disease has in the past. 

Millennium Development Goal 2 of course dealing with education, again, the idea of health literacy, the opportunity to empower women and mothers and fathers and so forth to have the information and skills to demand appropriate health services and to 

get the—whether it be clean water or transference and choice of 

vaccines and so forth. 

Millennium Development 3, gender equality and empowerment—

clearly, that is quite important. Also with health areas in terms of 

HIV and giving women the opportunity, not only with microbicides 

but others, of preventing mother-to-child transmission. Child mortality obviously is broad and obviously a big emphasis that we 

have. 

HIV/AIDS, malaria, and other diseases, number six. I think we 

can make a difference in preventing mother-to-child transmission. 

And the charge that happened last week at the United Nations and 

WHO to eliminate this by 2015 is achievable if we put the right 

emphasis in funds and technical resources there, as well as helping 

foster the kind of research necessary for it. 

Amongst that I think we need to presage the next phase, post2015, when we will have new interventions for HIV, such as 

preexposure prophylaxis, preventing HIV not just by choice of behaviors but also by having technological and medical interventions 

with new medicines that could be delivered. And similarly with tuberculosis, of being able to shorten whether it be course of therapy 

or also the transmission thereof. 

And then, finally, I think the last two, with whether it be environmental sustainability or trade and debt, these are very, very important, that we need to think about. That, again, infectious disease has no borders, and whether it be SARS, whether it be a 

swine or H1N1 or H5N1, whatever might be there, it is not if this 

happens, it is when it happens. 

And these require fundamental health systems that are functioning and in place and something where, while the United States 

has fundamentally been leading this with the Centers for Disease 

Control and Prevention and our epidemiologic service and so forth, 

we nonetheless also have to have the kind of fundamental health 

diplomacy that is the holistic approach of being able to work with 

both governments, with public health authorities, community 

health leaders and others to address future health scourges. 

So I would say, again, any investment in health is a wise investment. I think it will pay back not only United States but really, 

most importantly, the health of individuals and citizens throughout 

the world. And it is a positive opportunity to be able to speak and 

share this today. And hopefully we can continue to have this global 

investment. 

Mr. CARNAHAN. Okay. Thank you. 

Mr. Roberts? 

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Mr. ROBERTS. Thank you, Mr. Chairman. 

I certainly don’t want to minimize the suffering of the poor, but 

I do want to note that bureaucrats all over the world are always 

creating action-forcing—artificial action-forcing deadlines, such has 

this 5-year deadline. And I say that as a former bureaucrat myself. 

But I recall the Copenhagen climate change commitment and that 

deadline, with a drop-dead date last December. Well, all that went 

by the wayside when China and India refused to go along and, at 

the same time, the Climategate scandal broke. 

And so, I think we should solve these problems as quickly as we 

can and we are financially capable of doing. And, of course, I go 

back to the recommendations that were in my testimony for the 

best way to do it. 

Thank you. 

Mr. CARNAHAN. Mr. Rohrabacher? 

Mr. ROHRABACHER. Thank you very much. 

What we are talking about, basically, is providing a service to 

the world’s poorest people and people who live in deprivation, and 

usually the deprivation coincides with the fact they also live under 

tyranny and under a corrupt government. Inoculations, clean 

water, deworming—all of these basically are services that should 

be provided by once’s own government or should be provided with 

their local government working in coordination with private-sector 

groups, such as your own. 

If we provide the services, if these young people are burdened 

with more debt, especially if we end up borrowing the money to 

provide these services and then expect these young people to pay 

taxes on it for the rest of their lives in order to provide these services on an ongoing basis, doesn’t this mean that, unless there is the 

reform that Mr. Roberts is talking about in their society, that as 

soon as we quit providing the services, the worms will come back 

and the diseases will come back and the dirty water will come 

back. 

Isn’t that the case? Unless there is the reform he is talking 

about, no matter what we do temporarily to alleviate the current 

suffering, are we not just saddling our young people with this monstrous burden of debt in order just to provide something that is 

going to go right back to its bad state anyway? Is that not the case? 

Go right ahead. 

Ms. CALVIN. Well, I will take on a couple of those. 

I mean, I hear exactly what you are saying, and probably the biggest buzzword in this whole area is ‘‘sustainability,’’ to make sure 

that anything that is done has a chance for being carried forward 

in the future. 

So, a couple of things. Obviously, we did eradicate smallpox. And 

systems were kept in place to ensure that it didn’t come in back. 

So that has to be a goal that is put into every program. 

Mr. ROHRABACHER. It hasn’t come back yet. 

Ms. CALVIN. It hasn’t come back yet. 

Mr. ROHRABACHER. But the fact is that if we are not successful 

in much of the Third World, it will come back, just like malaria 

was almost eliminated, as well, correct? I mean, malaria almost 

disappeared. Now, I mentioned that—well, I think it was pretty 

well attacked in Africa, as well. So the rates of malaria now have 

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not gone up in the last 10 years in Africa? Yeah, they have dramatically risen in Africa in the last 10 years. Not that we have 

eliminated it, but the fact is that the DDT decision—but that is different than the point I am making. 

Ms. CALVIN. So I want to agree with your point, basically, because I think you are right, that this is the most important thing. 

So things like The Global Fund, which requires countries to submit 

a plan—and the plan is not just to get the money for the services 

they are seeking, but it is to show a plan for how they will continue 

the program going forward, how they will be investing increasing 

parts of their own resources to make this a country-led plan in the 

future. So I think that is a shift that we are seeing in——

Mr. ROHRABACHER. So the corrupt dictator someplace in one of 

these despotic little countries, the corrupt dictator, he has to make 

that deal. But do you know what happens when you are dealing 

with people who have the morality level that they murder their 

own people because they might have said something in opposition 

to the government? Do you know what the morality level—do you 

know what the chances of that leader keeping his word is? Almost 

zero, because he has no morality. 

There are large numbers of people in power in various parts of 

the world who murder their own constituents, you might say, if 

there was any threat to their power. And they are not going to 

keep their word on that anyway. 

So, in the end, I would hope that, yes—by the way, the 

deworming thing is a very—and clean water, all of these things are 

very easily seen as a horrendous condition that poor people around 

the world find themselves. Their children end up with worms, and, 

like you say, it affects their ability to deal in school. We know that 

without clean water, it just saps the ability of people to live a 

healthy life and, thus, have progress in their society. So—and inoculations, I mean, it goes unsaid. 

But, in the end, these are services that their government is supposed to provide and they are not doing it. And most of the time, 

we are just suggesting, I think Mr. Robertsis suggesting, most of 

the time that is tied to the corruption and despotism of their own 

government. And until that changes, all we can do is temporarily 

alleviate some suffering. And whether or not the temporary alleviating of suffering is worth the type of major expenditures that we 

are talking about, I am not sure, unless it is coupled—now, by the 

way, you have made the point that we are talking about specific 

goals. But the specific goals in eliminating that suffering for now 

is not necessarily eliminating the fundamental cause of the problem, which was outlined by Mr. Roberts. 

And, Dr. McArthur, you have always had good comebacks, so go 

right ahead. 

Mr. MCARTHUR. I don’t want to disappoint. 

Just on the malaria bit—again, happy to follow up with you after 

that—the ecological factors affecting malaria transmission in Africa 

are actually different. So it never had the same inroads because it 

is actually a denser parasite there, in effect. So it is actually a 

unique case, which is why the breakthroughs now are the first time 

we have ever had it in the scale we have had. 

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In terms of the points on corruption, I would only want to agree 

on the principle, but differing the application of its logic. So, corruption should be a vetting factor, and I would never advocate supporting dollars going to a disappearance act. That is absolutely the 

opposite of the point. 

I think we need to segment the developing countries in a couple 

of ways. One is the very poor versus the up-and-coming. I, roughly 

speaking, would draw the line at about $1,000 per capita income. 

So India, for example, is in the process of graduating from development assistance, and that is a great success. The countries that are 

at $200 per capita, $300 per capita income, they can’t even afford, 

if they had every penny in their budget put to these things that 

you just described, they can’t afford that. 

And so we need to segment to the second criteria on the countries that are committed to doing this, like that Malis that just 

democratically reelected President Toure, a terrific leader, like 

President Mutharika, democratically reelected, great support. And 

we need to help them implement the programs with all the accountability structures we have described. 

So if we think about the qualification hurdles of commitment and 

poverty, then we help support the integrated set of activities that 

help a country escape extreme poverty through growth, health, infrastructure, education, and so forth—and it has to be a joint venture strategy. It is not us bringing in all the resources. It is a joint 

financing strategy, theirs and the international community’s. That 

is where we start to see real results, in our experience. 

I would just flag one final point. If we look at the questions of 

the deficit and the debt, the absolute values of the dollars we are 

talking about, I wish they were at the scale that were affecting 

those calculations in a real way. Again, we are talking about in an 

era of 10 percent of GNP deficits, down to 9 percent in the latest 

projections, we are talking about increasing by a few tenths of a 

point of a percent. Total U.S. Assistance to Africa was about $7.5 billion in 2009—

$7.5 billion. It is almost rounding error for most budgets. Compare 

that to any normal aggregate that we read about in the papers 

these days. The Wall Street bonuses alone in 2009 were $20 billion. 

So, whatever one might think of those bonuses, that reflects how 

these resources are actually being allocated in any aggregate scale. 

And so I think we need to understand that there are very small 

amounts of money—total global assistance to Africa from all the 

countries put together works out to about $45 per African. And 

that is to pay for everything. 

So I think it has to be, as you said, goal-based, targeted, outcome-driven, owned by national countries, joint financed, and then 

that is where we will see the breakthrough results continuing. 

Mr. ROHRABACHER. Well, you know, a billion here and a billion 

there, and pretty soon you are talking about real money. 

Mr. MCARTHUR. I agree. 

Mr. ROHRABACHER. As to paraphrase our good friend Everett 

Dirksen. 

Just one thought on the bonuses. I happen to have been author 

of a piece of legislation that unfortunately didn’t get anywhere, 

that any company that provided bonuses to their senior executives, 

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the executives had to give that back before they could receive any 

support from the Federal Government in the form of bailouts. 

Unfortunately, the people giving these bailouts decided not to put 

that restriction on, just, as I might add, there are some people who 

don’t want to put caps on the amount of money that is paid to executives who are partners of the United States but in a charitable 

institution. 

Thank you very much, Mr. Chairman. 

Mr. CARNAHAN. Thank you. 

And I just want to thank our panel today for illuminating us on 

these initiatives, the public and private partnerships that we have 

heard some great success stories but also some continuing challenges and I think a variety of different approaches, that we all 

need to be part of this debate. 

So thanks to all of you. Thanks to those of you who attended, especially the young people here. This is really important for you and 

your futures, as well. So thank you all for being here. 

We are adjourned. 

[Whereupon, at 11:28 a.m., the subcommittee was adjourned.] 

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A P P E N D I X 

MATERIAL SUBMITTED FOR THE HEARING RECORD

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MATERIAL SUBMITTED FOR THE RECORD BY THE HONORABLE RUSS CARNAHAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MISSOURI, AND CHAIRMAN, SUBCOMMITTEE ON INTERNATIONAL ORGANIZATIONS, HUMAN RIGHTS AND OVERSIGHT


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[NOTE: ‘‘From Promises to Delivery, Putting Human Rights at the Heart of the Millennium Development Goals,’’ by Amnesty International, and ‘‘Joint Action Plan for 

Women’s and Children’s Health, Investing in Our Common Future,’’ Working Papers of the Innovation Working Group, are not reprinted here but are available in 

committee records.]

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