IV 

118TH CONGRESS 

1ST SESSION H. RES. 204 

Honoring the life of Dr. Paul Farmer by recognizing the duty of the Federal 

Government to adopt a 21st-century global health solidarity strategy 

and take actions to address past and ongoing harms that undermine 

the health and well-being of people around the world. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 7, 2023 

Ms. SCHAKOWSKY (for herself, Ms. LEE of California, Mr. RUIZ, Mr. BLUMENAUER, Mr. CARSON, Mr. COHEN, Mr. DOGGETT, Mr. ESPAILLAT, Mr. 

GARCI ́A of Illinois, Ms. JACKSON LEE, Ms. JAYAPAL, Ms. MCCOLLUM, 

Mr. MCGOVERN, Mr. MOULTON, Ms. NORTON, Ms. PORTER, Ms. 

PRESSLEY, Ms. ROSS, Mr. SOTO, Ms. TLAIB, Mr. TRONE, and Mrs. WATSON COLEMAN) submitted the following resolution; which was referred to 

the Committee on Foreign Affairs, and in addition to the Committee on 

the Judiciary, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

RESOLUTION 

Honoring the life of Dr. Paul Farmer by recognizing the 

duty of the Federal Government to adopt a 21st-century 

global health solidarity strategy and take actions to address past and ongoing harms that undermine the health 

and well-being of people around the world. 

Whereas Dr. Paul Farmer, who pioneered novel communitybased strategies for the delivery of high-quality health 

care in impoverished settings, inspired a paradigmatic 

shift in global health, including inspiring robust United 


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States leadership to address the global HIV/AIDS epidemic in the early 2000s via the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and 

the Global Fund to Fight AIDS, Tuberculosis, and Malaria; 

Whereas, in spite of this progress, weak health systems continue to cause millions of people, primarily the global 

poor, to die tragic and unnecessary deaths, including— 

(1) annually, approximately— 

(A) 680,000 deaths from HIV/AIDS; 

(B) 1,500,000 deaths from tuberculosis; 

(C) 627,000 deaths from malaria; 

(D) 295,000 deaths of mothers during and following pregnancy and childbirth; 

(E) 9,560,000 deaths among children under the 

age of 15; and 

(F) 560,000 deaths of children and young 

adults living among the world’s poorest billion people 

from noncommunicable diseases and injuries; and 

(2) a COVID–19 case-fatality rate up to 300 percent greater in low-income countries than in high-income 

countries during the first two years of the SARS–CoV– 

2 pandemic; 

Whereas, although progress against unnecessary deaths in 

impoverished countries is being made, it is occurring so 

slowly that— 

(1) based on present rates of decline, it will take approximately a century for core mortality statistics in lowincome countries to converge with those of high-income 

countries, including— 

(A) 92 years for the tuberculosis death rate; 


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•HRES 204 IH 

(B) 109 years for the maternal mortality rate; 

and 

(C) 88 years for the under-15 child mortality 

rate; and 

(2) the death rate in low- and middle-income countries from noncommunicable diseases and injuries, which 

make up 40 to 60 percent of the disease burden of these 

countries, will never converge with that of high-income 

countries with present rates of reduction; 

Whereas weak health systems that fail to prevent unnecessary 

deaths also lack the staff, health facility infrastructure, 

and medical technologies required for effective care delivery and thereby disease containment, thus placing all 

countries at increased risk of pandemic disease; 

Whereas essential medical technologies such as diagnostics, 

treatments, and vaccines for diseases that affect the global poor are frequently unavailable or inaccessible to 

health systems in developing countries because— 

(1) investing in research and development for technologies for diseases that disproportionately affect the 

global poor is often unprofitable for pharmaceutical corporations; 

(2) high intellectual property licensing fees from 

originator companies to generic manufacturers price the 

global poor out of access to medical technologies; and 

(3) originator technology companies refuse to share 

or license intellectual property to generic manufacturers, 

which results in limited supply and high prices, as in the 

case of COVID–19 vaccines; 

Whereas the Lancet Commission on Investing in Health estimates the additional annual spending required to prevent 

the vast majority of the millions of unnecessary deaths 


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and confer ‘‘essential universal health coverage’’ in lowand lower-middle-income countries is $75,000,000,000 

and $293,000,000,000 (in 2016 United States dollars), 

respectively, representing just— 

(1) 1.6 percent of the United States gross domestic 

product (GDP) in 2021; 

(2) 0.5 percent of G20 GDP in 2021; and 

(3) 2.8 percent of the wealth possessed by the 

world’s billionaires in 2021; 

Whereas regular annual United States appropriations for 

global health have increased by merely 10.6 percent to 

$11,300,000,000 since 2010, and have been outpaced by 

both inflation and the United States economic growth; 

Whereas relative to the size of the United States economy, 

the United States official overseas development spending 

is low at 0.17 percent of gross national income (GNI) in 

2020, placing the United States 24th out of the 29 country members of the Organization for Economic Co-operation and Development’s Development Assistance Committee, and meeting just one-fourth of the United Nations official development assistance target of 0.7 percent 

GNI; 

Whereas dramatically increasing foreign aid may have voter 

support, given that opinion polls consistently find that 

Americans believe United States foreign aid should make 

up approximately 10 percent of the Federal budget; 

Whereas historically, United States and other global Northsupported global health programs have inadvertently entrenched standards of care in low-income countries that 

would be unacceptable in rich countries by funding only 

health services narrowly defined as ‘‘sustainable’’, ‘‘costeffective’’, or ‘‘appropriate’’ in poor settings; 


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Whereas the effectiveness and efficiency of current United 

States overseas development assistance for health is often 

undermined by— 

(1) misalignment with countries’ national health 

plans; 

(2) bypassing delivery systems with parallel inputs, 

leading to fragmentation of care delivery, poor donor coordination across partners, and weak health systems; 

(3) favoring technical assistance from consultants 

from high-income countries, especially the United States, 

over funding health service delivery in beneficiary countries; and 

(4) promoting privatization of health services, thereby undermining public system strengthening, health care 

access, health equity, and financial risk protection; 

Whereas 98 percent of the annual $1,500,000,000,000 in 

health spending in aid-eligible low- and middle-income 

countries is mobilized domestically by these countries 

themselves, and only 2 percent of this spending comes 

from overseas development assistance for health; 

Whereas many of the poorest developing countries presently 

lack the tax capacity to mobilize the necessary resources 

to close the universal health coverage financing gap, 

meaning unnecessary deaths will continue in these settings for the foreseeable future without external donor financing or dramatic increases in domestic tax capacity; 

Whereas the inability of many of the poorest developing countries to fully close the financing gap for universal health 

coverage and the provision of numerous other public 

goods and services is in part due to the intimate economic links between these countries and high-income 

countries, including the United States, which have been 


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marked throughout history by acts of violence and coercion, including, but not limited to— 

(1) the fundamental injustice, cruelty, brutality, and 

inhumanity of colonization and slavery; 

(2) the overthrow of governments and backing of 

dictatorships in the postcolonial era; 

(3) the imposition of structural adjustment programs by international financial institutions controlled by 

high-income countries, which forced austerity, privatization, and liberalization on developing countries, resulting 

in an estimated loss of $480,000,000,000 per year in potential GDP during the 1980s and 1990s, nearly 5 times 

more than aid provided during the same period; 

(4) the loss of economic sovereignty imposed by fundamentally undemocratic global governance institutions, 

such as the International Monetary Fund, the World 

Bank, and the World Trade Organization, at which decisions that shape the unequal terms of the global economic system and determine countries’ abilities to finance health systems are made; 

(5) capital flight from developing countries consisting of mostly illegal financial flows, estimated by 

Global Financial Integrity to total approximately 

$1,700,000,000,000 each year, including— 

(A) $700,000,000,000 from deliberate trade 

misinvoicing; and 

(B) $261,000,000,000 from hot money narrow 

outflows; and 

(6) external debt repayments, often undemocratically 

and unjustly imposed, commonly sold by corrupt lenders, 

regularly accumulated by dictators without a democratic 

mandate, and exacerbated by compound interest as a result of United States interest rate increases; 


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Whereas the harms have entrenched a global economic architecture of upward wealth redistribution that has resulted 

in— 

(1) depressed workers’ wages and artificially low 

prices of natural resources in developing countries to 

serve consumption in rich countries, amounting to an appropriation of tens of billions of tons of raw materials 

and hundreds of billions of hours of human labor, estimated to value over $10,000,000,000,000 in losses 

through unequal exchange annually; 

(2) 3,500,000,000 people living under the poverty 

line of $5.50, which according to the World Bank is a 

poverty headcount that has ‘‘barely changed in the last 

30 years’’, even as global GDP has more than tripled in 

size during this time; 

(3) more financial resources flowing out of developing countries than into them each year, estimated by 

Global Financial Integrity to total net negative 

$2,000,000,000,000 annually in 2012, meaning poorer 

countries are developing richer countries rather than the 

other way around; and 

(4) developing countries bearing 98 percent of 

deaths and 80 to 90 percent of economic losses attributable to climate change, despite rich countries bearing 

92 percent of the responsibility for climate change due to 

carbon emissions in excess of safe planetary boundaries, 

meaning those who suffer the most from climate change 

are least responsible for the crisis; 

Whereas the United States leadership to close the financing 

gaps for essential universal health coverage in low- and 

lower-middle-income countries could precipitate increased 

global health financing from other donor partners as evidenced by United States leadership to address the HIV/ 


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AIDS epidemic in the early 2000s, spurring a 100-percent increase in global overseas development assistance 

among all donor partners from 2000 to 2006; 

Whereas official United States development assistance to lowand lower-middle-income countries are not a supplement 

for United States action to stop ongoing structural violence and economic injustices preventing countries from 

financing and delivering universal health care and other 

social services for their populations; and 

Whereas it is the view of the House of Representatives that 

creating a decent, humane world without tragic, unnecessary deaths requires both a modest but meaningful increase in global health aid funding and a meaningful effort to stop the economic abuse of low- and middle-income countries: Now, therefore, be it 

1 (1) the Federal Government should adopt a 

2 new, 21st-century global health solidarity strategy to 

3 end medically avertable deaths and respond to the 

4 full burden of disease in poor countries by— 

5 (A) supporting developing countries to 

6 meet the material needs of their health systems 

7 by localizing investments in support of national 

8 public sector and local priorities, referred to as 

9 ‘‘accompaniment’’ by Dr. Paul Farmer and de10 livered through what he called the ‘‘Five S’s’’, 

11 which include— 

12 (i) staff, the human resources nec13 essary for high-quality service delivery, inVerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\HR204.IH HR204

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1 cluding clinical staff, transportation teams, 

2 and community health workers, especially 

3 by— 

4 (I) supporting long-term training 

5 and education systems, including med6 ical schools and teaching hospitals to 

7 train the health workforce and im8 prove the quality of care across dis9 eases; and 

10 (II) supporting professionalized 

11 community health workers programs 

12 whereby community health workers 

13 are recruited, adequately com14 pensated, comprehensively trained, 

15 supported for long-term retention, po16 sitioned as bridges to care, and tasked 

17 with undertaking community work 

18 with appropriate patient ratios and a 

19 manageable scope of work; 

20 (ii) space, the infrastructure needed 

21 for service delivery at primary, secondary, 

22 and tertiary levels to deliver safe and high23 quality care to meet all health care needs; 

24 (iii) stuff, the tools and resources nec25 essary for high-quality care provision, inVerDate Sep 11 2014 00:17 Mar 09, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\HR204.IH HR204

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1 cluding medical supplies, technologies, and 

2 equipment; 

3 (iv) systems, the leadership and gov4 ernance, health information systems, sup5 ply chain systems, logistics, laboratory ca6 pacity, and referral pathways required to 

7 meet the health needs of the population; 

8 and 

9 (v) social support, the necessary re10 sources needed, beyond the direct delivery 

11 of health care, to ensure effective care; and 

12 (B) financing the discovery and develop13 ment of urgently needed new health tech14 nologies such as diagnostics, treatments, and 

15 vaccines, particularly for neglected diseases of 

16 poverty, and ensuring their availability as global 

17 public goods; 

18 (2) the objectives described in paragraph (1) 

19 will require— 

20 (A) increased United States investment in 

21 development assistance over the coming years, 

22 sufficient to— 

23 (i) for the first time, meet the United 

24 Nations development assistance target of 

25 spending the equivalent of 0.7 percent 


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1 gross national income on development as2 sistance, which 6 other countries have pre3 viously met; and 

4 (ii) close over 100 percent of the pre5 viously described essential universal health 

6 coverage financing gap for low-income 

7 countries, and 30 percent of the overall fi8 nancing gap for low- and lower-middle-in9 come countries, by dedicating 

10 $125,000,000,000 per year for global 

11 health investment; 

12 (B) optimizing global health delivery 

13 spending by— 

14 (i) introducing a new form of coordi15 nated multilateral fiscal cooperation for 

16 global public investment that ensures in17 creased and ongoing global public funding 

18 of common goods for health, exhibiting 

19 shared governance with global South gov20 ernments and meaningful participation of 

21 civil society, which is also essential for ad22 dressing intersectional crises of social in23 equalities including the climate crisis; 

24 (ii) ensuring funding directly supports 

25 national health plans, public institutions, 


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1 local priorities, and donor coordination, 

2 practices aligned with what Dr. Paul 

3 Farmer called ‘‘accompaniment’’; and 

4 (iii) focusing on health service delivery 

5 for vulnerable populations, such as people 

6 living in poverty, women, and children; and 

7 (C) optimizing research and development 

8 spending for neglected diseases of poverty by 

9 ensuring the knowledge and technology pro10 duced by these efforts remains accessible to all 

11 as global public goods; 

12 (3) the Federal Government should pass and 

13 enforce laws and use its diplomatic influence to stop 

14 ongoing economic harms to the global South that de15 plete impoverished countries of the resources re16 quired to provide health and social services for their 

17 populations by— 

18 (A) canceling debt for all low- and middle19 income countries in need of debt cancellation, 

20 and supporting debt cancellation initiatives 

21 across all creditors: bilateral, multilateral, and 

22 private; 

23 (B) democratizing institutions of global 

24 governance, such as the International Monetary 

25 Fund, the World Bank, and the World Trade 


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1 Organization, to ensure fair and equal represen2 tation among member countries so that low3 and middle-income countries can have greater 

4 decisionmaking power in the creation of policies 

5 that affect them; 

6 (C) supporting a United Nations Conven7 tion on Tax and other measures to dramatically 

8 reduce tax avoidance, tax evasion, and other 

9 forms of harmful licit and illicit financial flows 

10 from developing countries through fundamental 

11 reform of international tax cooperation; 

12 (D) supporting global labor rights and liv13 ing wages, such as a global minimum wage set 

14 at local living-income thresholds; and 

15 (E) adopting new indicators of progress 

16 that measure social and ecological health and 

17 abandon gross domestic product as a measure 

18 of progress; and 

19 (4) it is the duty of the Federal Government to 

20 issue reparations, containing multiple elements in21 cluding apology, award, and guarantees of nonrepeti22 tion of harms, for— 

23 (A) the institution of slavery, its subse24 quent racial and economic discrimination 

25 against African Americans, and the impact of 


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1 these forces on living African Americans, fol2 lowing the establishment of a commission as per 

3 the ‘‘Commission and Develop to Study Repara4 tion Proposals for African Americans Act’’ 

5 (H.R. 40 of the 117th Congress); 

6 (B) the harms of colonialism and subse7 quent forms of imperialism, which have under8 mined sovereignty, democracy, self-determina9 tion, social and economic rights, and human 

10 and ecological well-being in both the colonial 

11 and postcolonial eras; and 

12 (C) its disproportionate responsibility for 

13 climate breakdown, the burden of which un14 justly and overwhelmingly falls on the global 

15 South. 

Æ 


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