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. BLU-
MENAUER, 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. WAT-
SON 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 juris-
diction 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 ad-
dress past and ongoing harms that undermine the health 
and well-being of people around the world. 
Whereas Dr. Paul Farmer, who pioneered novel community- 
based 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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•HRES 204 IH 
States leadership to address the global HIV/AIDS epi-
demic in the early 2000s via the United States Presi-
dent’s Emergency Plan for AIDS Relief (PEPFAR) and 
the Global Fund to Fight AIDS, Tuberculosis, and Ma-
laria; 
Whereas, in spite of this progress, weak health systems con-
tinue 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 fol-
lowing 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 per-
cent 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 ap-
proximately a century for core mortality statistics in low- 
income 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 coun-
tries 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 deliv-
ery 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 glob-
al poor are frequently unavailable or inaccessible to 
health systems in developing countries because— 
(1) investing in research and development for tech-
nologies for diseases that disproportionately affect the 
global poor is often unprofitable for pharmaceutical cor-
porations; 
(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 esti-
mates the additional annual spending required to prevent 
the vast majority of the millions of unnecessary deaths 
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•HRES 204 IH 
and confer ‘‘essential universal health coverage’’ in low- 
and 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 coun-
try members of the Organization for Economic Co-oper-
ation and Development’s Development Assistance Com-
mittee, and meeting just one-fourth of the United Na-
tions 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 North- 
supported global health programs have inadvertently en-
trenched standards of care in low-income countries that 
would be unacceptable in rich countries by funding only 
health services narrowly defined as ‘‘sustainable’’, ‘‘cost- 
effective’’, or ‘‘appropriate’’ in poor settings; 
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•HRES 204 IH 
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 co-
ordination 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 coun-
tries; and 
(4) promoting privatization of health services, there-
by 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 set-
tings for the foreseeable future without external donor fi-
nancing or dramatic increases in domestic tax capacity; 
Whereas the inability of many of the poorest developing coun-
tries 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 eco-
nomic links between these countries and high-income 
countries, including the United States, which have been 
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•HRES 204 IH 
marked throughout history by acts of violence and coer-
cion, 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 pro-
grams by international financial institutions controlled by 
high-income countries, which forced austerity, privatiza-
tion, and liberalization on developing countries, resulting 
in an estimated loss of $480,000,000,000 per year in po-
tential 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 fun-
damentally undemocratic global governance institutions, 
such as the International Monetary Fund, the World 
Bank, and the World Trade Organization, at which deci-
sions that shape the unequal terms of the global eco-
nomic system and determine countries’ abilities to fi-
nance health systems are made; 
(5) capital flight from developing countries con-
sisting 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 re-
sult of United States interest rate increases; 
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•HRES 204 IH 
Whereas the harms have entrenched a global economic archi-
tecture 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 ap-
propriation of tens of billions of tons of raw materials 
and hundreds of billions of hours of human labor, esti-
mated 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 devel-
oping 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 attrib-
utable 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 evi-
denced by United States leadership to address the HIV/ 
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•HRES 204 IH 
AIDS epidemic in the early 2000s, spurring a 100-per-
cent increase in global overseas development assistance 
among all donor partners from 2000 to 2006; 
Whereas official United States development assistance to low- 
and lower-middle-income countries are not a supplement 
for United States action to stop ongoing structural vio-
lence 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, unneces-
sary deaths requires both a modest but meaningful in-
crease in global health aid funding and a meaningful ef-
fort to stop the economic abuse of low- and middle-in-
come countries: Now, therefore, be it 
(1) the Federal Government should adopt a 
new, 21st-century global health solidarity strategy to 
end medically avertable deaths and respond to the 
full burden of disease in poor countries by— 
(A) supporting developing countries to 
meet the material needs of their health systems 
by localizing investments in support of national 
public sector and local priorities, referred to as 
‘‘accompaniment’’ by Dr. Paul Farmer and de-
livered through what he called the ‘‘Five S’s’’, 
which include— 
(i) staff, the human resources nec-
essary for high-quality service delivery, in-
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•HRES 204 IH 
cluding clinical staff, transportation teams, 
and community health workers, especially 
by— 
(I) supporting long-term training 
and education systems, including med-
ical schools and teaching hospitals to 
train the health workforce and im-
prove the quality of care across dis-
eases; and 
(II) supporting professionalized 
community health workers programs 
whereby community health workers 
are 
recruited, 
adequately 
com-
pensated, 
comprehensively 
trained, 
supported for long-term retention, po-
sitioned as bridges to care, and tasked 
with undertaking community work 
with appropriate patient ratios and a 
manageable scope of work; 
(ii) space, the infrastructure needed 
for service delivery at primary, secondary, 
and tertiary levels to deliver safe and high- 
quality care to meet all health care needs; 
(iii) stuff, the tools and resources nec-
essary for high-quality care provision, in-
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•HRES 204 IH 
cluding medical supplies, technologies, and 
equipment; 
(iv) systems, the leadership and gov-
ernance, health information systems, sup-
ply chain systems, logistics, laboratory ca-
pacity, and referral pathways required to 
meet the health needs of the population; 
and 
(v) social support, the necessary re-
sources needed, beyond the direct delivery 
of health care, to ensure effective care; and 
(B) financing the discovery and develop-
ment of urgently needed new health tech-
nologies such as diagnostics, treatments, and 
vaccines, particularly for neglected diseases of 
poverty, and ensuring their availability as global 
public goods; 
(2) the objectives described in paragraph (1) 
will require— 
(A) increased United States investment in 
development assistance over the coming years, 
sufficient to— 
(i) for the first time, meet the United 
Nations development assistance target of 
spending the equivalent of 0.7 percent 
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•HRES 204 IH 
gross national income on development as-
sistance, which 6 other countries have pre-
viously met; and 
(ii) close over 100 percent of the pre-
viously described essential universal health 
coverage financing gap for low-income 
countries, and 30 percent of the overall fi-
nancing gap for low- and lower-middle-in-
come 
countries, 
by 
dedicating 
$125,000,000,000 per year for global 
health investment; 
(B) optimizing global health delivery 
spending by— 
(i) introducing a new form of coordi-
nated multilateral fiscal cooperation for 
global public investment that ensures in-
creased and ongoing global public funding 
of common goods for health, exhibiting 
shared governance with global South gov-
ernments and meaningful participation of 
civil society, which is also essential for ad-
dressing intersectional crises of social in-
equalities including the climate crisis; 
(ii) ensuring funding directly supports 
national health plans, public institutions, 
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•HRES 204 IH 
local priorities, and donor coordination, 
practices aligned with what Dr. Paul 
Farmer called ‘‘accompaniment’’; and 
(iii) focusing on health service delivery 
for vulnerable populations, such as people 
living in poverty, women, and children; and 
(C) optimizing research and development 
spending for neglected diseases of poverty by 
ensuring the knowledge and technology pro-
duced by these efforts remains accessible to all 
as global public goods; 
(3) the Federal Government should pass and 
enforce laws and use its diplomatic influence to stop 
ongoing economic harms to the global South that de-
plete impoverished countries of the resources re-
quired to provide health and social services for their 
populations by— 
(A) canceling debt for all low- and middle- 
income countries in need of debt cancellation, 
and supporting debt cancellation initiatives 
across all creditors: bilateral, multilateral, and 
private; 
(B) democratizing institutions of global 
governance, such as the International Monetary 
Fund, the World Bank, and the World Trade 
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•HRES 204 IH 
Organization, to ensure fair and equal represen-
tation among member countries so that low- 
and middle-income countries can have greater 
decisionmaking power in the creation of policies 
that affect them; 
(C) supporting a United Nations Conven-
tion on Tax and other measures to dramatically 
reduce tax avoidance, tax evasion, and other 
forms of harmful licit and illicit financial flows 
from developing countries through fundamental 
reform of international tax cooperation; 
(D) supporting global labor rights and liv-
ing wages, such as a global minimum wage set 
at local living-income thresholds; and 
(E) adopting new indicators of progress 
that measure social and ecological health and 
abandon gross domestic product as a measure 
of progress; and 
(4) it is the duty of the Federal Government to 
issue reparations, containing multiple elements in-
cluding apology, award, and guarantees of nonrepeti-
tion of harms, for— 
(A) the institution of slavery, its subse-
quent 
racial 
and 
economic 
discrimination 
against African Americans, and the impact of 
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•HRES 204 IH 
these forces on living African Americans, fol-
lowing the establishment of a commission as per 
the ‘‘Commission and Develop to Study Repara-
tion Proposals for African Americans Act’’ 
(H.R. 40 of the 117th Congress); 
(B) the harms of colonialism and subse-
quent forms of imperialism, which have under-
mined sovereignty, democracy, self-determina-
tion, social and economic rights, and human 
and ecological well-being in both the colonial 
and postcolonial eras; and 
(C) its disproportionate responsibility for 
climate breakdown, the burden of which un-
justly and overwhelmingly falls on the global 
South. 
Æ 
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