,,iii #aaith ,,congress #ast ,session ,s4 ,,res4 #ceh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #ca1 #bjbe,mr4 ,markey 7for himself and ,ms4 ,warren7 submitted the following resolution2 which was referred to the ,committee on ,foreign ,relations ,,resolution ,honoring the life of ,dr4 ,paul ,farmer by recognizing the duty of the ,federal ,government to adopt a #bast 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 world4 ,whereas ,dr4 ,paul ,farmer1 who pioneered novel community-based strategies for the delivery of high-quality health care in impoverished settings1 inspired a paradigmatic shift in global health1 including inspiring robust ,united ,states leadership to address the global ,,hiv_/,,aids epidemic in the early #bjjjs through the ,united ,states ,president's ,emergency ,plan for ,,aids ,relief and the ,global ,fund to ,fight ,,aids1 ,tuberculosis1 and ,malaria2 ,whereas1 in spite of progress made in global health1 weak health systems continue to cause millions of people1 primarily the global poor1 to die tragic and unnecessary deaths1 including-- 7#a7 annually1 approximately-- 7,a7 #fhj1jjj deaths from ,,hiv_/,,aids2 7,b7 #a1ejj1jjj deaths from tuberculosis2 7,c7 #fbg1jjj deaths from malaria2 7,d7 #bie1jjj deaths of mothers during and following pregnancy and childbirth2 7,e7 #i1efj1jjj deaths among children under the age of #ae2 and 7,f7 #efj1jjj deaths of children and young adults1 living among the poorest billion people in the world1 from non-communicable diseases and injuries2 and 7#b7 a ,,sars-,co,v-#b case-fatality rate of up to #cjj percent greater in low-income countries than in high-income countries during the first #b years of the ,,covid-#ai pandemic2 ,whereas progress against unnecessary deaths in impoverished countries is being made1 but progress is occurring so slowly that-- 7#a7 based on rates of decline from #bjac to #bjbb1 it will take approximately a century for core mortality statistics in low-income countries to converge with those of high-income countries1 including-- 7,a7 #ib years for the tuberculosis death rate2 7,b7 #aji years for the maternal mortality rate2 and 7,c7 #hh years for the under-#ae child mortality rate2 and 7#b7 the death rate in low- and middle-income countries from non-communicable diseases and injuries1 which make up #dj to #fj percent of the disease burden of those countries1 will never converge with that of high-income countries based on rates of reduction from #bjac to #bjbb2 ,whereas weak health systems that fail to prevent unnecessary deaths also lack the staff1 health facility infrastructure1 and medical technologies required for effective care delivery and disease containment1 placing all countries at increased risk of pandemic disease2 ,whereas essential medical technologies1 such as diagnostics1 treatments1 and vaccines for diseases that affect the global poor1 are frequently unavailable or inaccessible to health systems in developing countries1 because-- 7#a7 investing in research and development of technologies for diseases that disproportionately affect the global poor is often unprofitable for pharmaceutical corporations2 7#b7 costly intellectual property licensing fees from originator companies to generic manufacturers frequently leave the global poor unable to purchase or access medical technologies2 and 7#c7 originator technology companies often refuse to share or license intellectual property to generic manufacturers1 which results in limited supply and high prices1 as was the case with the ,,covid-#ai vaccine2 ,whereas1 according to the ,lancet ,commission on ,investing in ,health1 preventing most avertable deaths and conferring essential universal health coverage in low- and lower-middle income countries requires an increase in annual health systems resources in those countries of #ge1jjj1jjj1jjj and #bic1jjj1jjj1jjj 7in ,united ,states dollars as of #bjaf71 respectively2 ,whereas1 historically1 the ,united ,states and other global ,north-supported 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 sustainable1 cost-effective1 or appropriate in poor settings2 ,whereas the effectiveness and efficiency of current ,united ,states overseas development assistance for health is often undermined by-- 7#a7 misalignment with the national health plans of the host country2 7#b7 bypassing delivery systems with parallel inputs1 leading to-- 7,a7 fragmentation of care delivery2 7,b7 poor donor coordination across partners2 and 7,c7 weak health systems2 7#c7 favoring technical assistance from consultants from high-income countries1 especially the ,united ,states1 over funding health service delivery in beneficiary countries2 and 7#d7 promoting privatization of health services1 which weakens-- 7,a7 the public health system2 7,b7 health care access2 7,c7 health equity2 and 7,d7 financial risk protection2 ,whereas #ih percent of the annual #a1ejj1jjj1jjj1jjj in health spending in aid-eligible low- and middle-income countries is mobilized domestically by the countries themselves1 and only #b percent of this spending comes from overseas development assistance for health2 ,whereas many of the poorest developing countries lack the tax capacity to mobilize the necessary resources to close the universal health coverage financing gap1 meaning unnecessary deaths will continue in the poorest developing countries for the foreseeable future without external donor financing or dramatic increases in domestic tax capacity2 ,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 those countries and high-income countries1 including the ,united ,states1 which have been marked throughout history by acts of violence and coercion2 ,whereas these harms have entrenched a global economic architecture of upward wealth redistribution that has resulted in-- 7#a7 depressed wages of workers and artificially low prices of natural resources in developing countries1 amounting to an appropriation of tens of billions of tons of raw materials and hundreds of billions of hours of human labor through unequal exchange2 7#b7 #c1ejj1jjj1jjj people living under the poverty line of #e4ej from #aiic to #bjbc1 even as global gross domestic product has more than tripled in size during this time2 7#c7 more financial resources flowing out of developing countries than into developing countries each year1 estimated by ,global ,financial ,integrity to total a net negative of #b1jjj1jjj1jjj1jjj annually in #bjab2 and 7#d7 developing countries bearing nearly all deaths and the vast majority of economic losses attributable to climate change1 despite rich countries bearing #ib percent of the responsibility for climate change2 ,whereas leadership from the ,united ,states 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 partners1 as evidenced by ,united ,states leadership that addressed the ,,hiv_/,,aids epidemic in the early #bjjjs1 which spurred a #ajj-percent increase in global overseas development assistance among all donor partners from #bjjj to #bjjf2 ,whereas official ,united ,states development assistance to lower-middle income countries is 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 populations2 and ,whereas it is the view of the ,senate that creating a decent1 humane world without tragic1 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 countries3 ,now1 therefore1 be it ,that it is the sense of the ,senate that-- 7#a7 the ,federal ,government should adopt a new1 #bast century global health solidarity strategy to end medically unnecessary deaths and respond to the full burden of disease in poor countries by-- 7,a7 supporting developing countries to meet the material needs of their health systems by localizing investments in support of national public-sector and local priorities1 referred to as accompaniment by ,dr4 ,paul ,farmer1 and delivered through what ,dr4 ,paul ,farmer called the ,five ,s's1 which refers to-- 7i7 staff1 meaning the human resources necessary for high-quality service delivery1 including clinical staff1 transportation teams1 and community health workers1 especially by-- 7,i7 supporting long-term training and education systems1 including medical schools and teaching hospitals to train the health workforce and improve the quality of care across diseases2 and 7,,ii7 supporting professionalized community health worker programs whereby community health workers are recruited1 adequately compensated1 comprehensively trained1 supported for long-term retention1 positioned as bridges to care1 and tasked with undertaking community work with appropriate patient ratios and a manageable scope of work2 7ii7 space1 meaning the infrastructure needed for service delivery at primary1 secondary1 and tertiary levels to deliver safe and high-quality care to meet all health care needs2 7iii7 stuff1 meaning the tools and resources necessary for high-quality care provision1 including medical supplies1 technologies1 and equipment2 7iv7 systems1 meaning the leadership and governance1 health information systems1 supply chain systems1 logistics1 laboratory capacity1 and referral pathways required to meet the health needs of the population2 and 7v7 social support1 meaning the resources needed1 beyond the direct delivery of health care1 to ensure effective care2 and 7,b7 financing the discovery and development of new1 urgently needed health technologies1 such as diagnostics1 treatments1 and vaccines1 particularly for neglected diseases of poverty1 and ensuring their availability as global public goods2 7#b7 the objectives of adopting a #bast century global health solidarity strategy to end medically unnecessary deaths and responding to the full burden of disease in poor countries will require-- 7,a7 increasing annual global health spending to #abe1jjj1jjj1jjj1 sufficient-- 7i7 for the first time1 to meet the ,united ,nations development assistance target of spending the equivalent of #j4g percent gross national income on development assistance1 which #f other countries have previously met2 and 7ii7 to close over #ajj percent of the essential universal health coverage financing gap for low-income countries1 and #cj percent of the overall financing gap for low- and lower-middle income countries2 7,b7 optimizing global health delivery spending by-- 7i7 introducing a new form of coordinated1 multilateral fiscal cooperation for global public investment that-- 7,i7 ensures increased and ongoing global public funding of common goods for health2 and 7,,ii7 exhibits shared governance with global ,south governments and meaningful participation of civil society1 which is also essential for addressing intersectional crises of social inequalities including the climate crisis2 and 7ii7 ensuring funding directly supports national health plans1 public institutions1 local priorities1 and donor coordination1 practices aligned with what ,dr4 ,paul ,farmer called accompaniment2 7,c7 focusing on health service delivery for vulnerable populations1 such as-- 7i7 people living in poverty2 7ii7 women2 and 7iii7 children2 and 7,d7 optimizing research and development spending for neglected diseases of poverty by ensuring the knowledge and technology produced by these efforts remains accessible to all as global public goods2 7#c7 the ,federal ,government should pass and enforce laws and use its diplomatic influence to stop ongoing economic harms to developing countries that deplete impoverished countries of the resources required to provide health and social services for their populations by-- 7,a7 supporting debt cancellation initiatives for low- and middle-income countries1 particularly countries in need of debt cancellation1 across bilateral1 multilateral1 and private creditors2 7,b7 democratizing institutions of global governance1 such as the ,international ,monetary ,fund1 the ,world ,bank1 and the ,world ,trade ,organization1 to ensure fair and equal representation among member countries so that low- and middle-income countries can have greater decisionmaking power in the creation of policies that affect them2 7,c7 supporting a ,united ,nations ,convention on ,tax and other measures to dramatically reduce tax avoidance1 tax evasion1 and other forms of harmful licit and illicit financial flows from developing countries through fundamental reform of international tax cooperation2 7,d7 supporting global labor rights and living wages1 such as a global minimum wage set at local living-income thresholds2 and 7,e7 adopting new indicators of progress that measure social and ecological health and abandon gross domestic product as a measure of progress2 and 7#d7 it is the duty of the ,federal ,government to issue reparations1 containing multiple elements1 including apology1 award1 and guarantees of non-repetition of harms1 for-- 7,a7 the institution of slavery1 the subsequent racial and economic discrimination against ,african ,americans that resulted from the institution of slavery1 and the impact of these forces on living ,african ,americans1 following the establishment of a commission substantively similar to the commission established under the ,commission to ,study ,reparation ,proposals for ,african ,americans ,act1 ,h4,r4 #dj1 as introduced on ,january #d1 #bjba2 7,b7 the harms of colonialism and subsequent forms of imperialism1 which have undermined sovereignty1 democracy1 self-determination1 social and economic rights1 and human and ecological well-being in both the colonial and post-colonial eras2 and 7,c7 the disproportionate responsibility of the ,federal ,government for climate breakdown1 the burden of which unjustly and overwhelmingly falls on the global ,south4