America's Mission of Compassion Abroad

Thank you, Lee (Hamilton), for that kind introduction. Your leadership in Congress for thirty-four years, and now your private endeavors have never failed to enrich the nation, elevate our public discourse, and bring credit upon yourself and the great state of Indiana.

It’s truly a privilege to address such an august gathering this evening. The Woodrow Wilson International Center for Scholars does such outstanding work in educating, informing, and enlightening the public and policymakers. I am proud to be affiliated with it as a Public Member of the Board of Trustees, and I am especially proud to be affiliated with every one of you here.

Washington, D.C. is the land of partisan think tanks. And while they do tremendous and even indispensable work for their causes, we cannot forget that partisanship is not the fundamental quality of American leadership … American politics … or American policymaking. The idea of the democratic consensus demands, in the end, the capacity to rise above the bastion of party and summon the entire nation toward a common goal with common means.

And that’s why all Americans should be grateful for institutions like the Woodrow Wilson International Center for Scholars. As a nonpartisan institution, its work … its outreach … and its scholarship are models of democratic discourse and pragmatic bulwarks of our republic. The pursuit of excellence for its own sake … the practical, unselfish dissemination of ideas … and the idea of citizens uniting for the greater good of neighbor and nation are uniquely American traits. Of that, you may be justly proud.

Later this evening, I will board a flight to Frankfurt, Germany, en route to Geneva, where I will chair the Fifth Meeting of the Board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. I think it’s entirely appropriate and fitting that we precede this journey with a discussion of America’s mission of compassion abroad.

The first question we must ask is whether America has a mission abroad at all. With our armed forces flung from pole to pole in three quarters of all foreign lands … with aid and assistance flowing from the American taxpayer to the far reaches of distant continents … and with our trade and diplomacy penetrating even the most isolated nations … the answer may seem self-evident.

But the American tradition has not always been so unambiguous about the merits of our overseas mission. In the Founding generation of our nation, we won our independence with the indispensable assistance of a French squadron afloat off Yorktown — yet not so many years later, the victorious American general there, George Washington, was counseling against all “foreign alliances, attachments, and intrigues” for his new nation. For the next century, John Quincy Adams’s 1821 dictum that America “goes not abroad in search of monsters to destroy” was the guiding spirit of our foreign policy as our nation concentrated its energies upon continental expansion and trade.

It took the rise of the two Progressive giants of the early 20th century — Theodore Roosevelt and Woodrow Wilson — to set America irrevocably toward full engagement with the world … the former with newly-acquired island territories and the Panama Canal … the latter with a World War and a dream of a League of Nations. Americans stepped onto the world stage with ambivalence — the cooperative, international spirit that won two World Wars and the Cold War was accompanied by the America-Firsters of the ‘30s … the Bricker Amendment partisans of the ‘50s … and the inward-looking policies of the ‘90s.

Make no mistake: With every successive turn of events demanding American intervention — be it threats from militarism, Nazism, or Communism — the chorus preaching isolation and disengagement has grown progressively smaller. The dream that two oceans and goodwill is sufficient protection against an unpredictable world has grown more tenuous for the past one hundred years. It died forever on September 11th, 2001.

And so we find ourselves at the turn of the millennium the “indispensable nation.” Americans know that they are irreversibly part of the larger world, and all the world looks to see how we will play that part. We have that luxury — the luxury to choose how and when we engage. We possess preeminent power, incredible influence, and unmatchable reach. We can shape events as much as they shape us. We can be proactive rather than reactive.

We are free to act. And we are free to not act. Not acting is easy. But what is easy is not necessarily what is right.

This power — this freedom of action — is a gift. It is a blessing. It is a historical circumstance that we must seize and use with humility and resolution for the good of our nation — and all nations.

Does America have a mission abroad? Without question. What is that mission? President George W. Bush put it best in his State of the Union address:

“The qualities of courage and compassion that we strive for in America also determine our conduct abroad. The American flag stands for more than our power and our interests. Our founders dedicated this country to the cause of human dignity, the rights of every person, and the possibilities of every life. This conviction leads us into the world to help the afflicted, and defend the peace, and confound the designs of evil men.”

Though these are the current President’s words, they are ideals articulated by the namesake of this center, Woodrow Wilson himself. In a 1913 address on American relations with Latin America, he said:

“We must prove ourselves their friends and champions, upon terms of equality and honor … Human rights, national integrity, and opportunity as against material interests — that, ladies and gentlemen, is the issue which we now have to face.”

A century has passed between these two Presidents, yet the national mission remains the same. The ideals of freedom and equality enshrined in the Declaration of Independence are not simply for those lucky enough to live between the 49th parallel and the Rio Grande. Life, liberty, and the pursuit of happiness are the inherent rights of all men in all nations… from the Iraqi father who must support his family … to the Nigerian teenager casting his first vote … to the Afghan girl who wants a real education.

Time and again, we have advanced these ideals in foreign lands. Our men and women in uniform have often enough led the way. In the fifteenth chapter of the Gospel of John, we read that “Greater love hath no man than this, that a man lay down his life for his friends.” America’s armed forces demonstrated that “greater love” in the many lands they helped save from Fascism … from Communism … and in the modern day from Islamic extremism and Ba’athism. The overthrow of tyranny is assuredly part of our compassionate mission abroad, and all Americans should acknowledge with gratitude the role our armed forces play in making that happen.

As Secretary of Health and Human Services, it is my privilege to run a Department that performs an equally vital role in America’s mission of compassion abroad. It’s a role that stretches back to 1798, when the forerunner of the United States Public Health Service was established to render care to sick mariners, foreign and domestic who called on American ports. It’s a role that was further carved out by heroes of medicine like Walter Reed, whose discovery of the means of yellow fever transmission saved countless lives and made possible the construction of the Panama Canal. And it’s a role that’s further cemented today by my Department as personnel from the Centers for Disease Control and Prevention work in east Asia to fight SARS … as researchers from the National Institutes of Health cooperate on research with European counterparts … and as experts from the CDC through HHS bring hope and healing to women in Afghanistan.

When we think of our nation’s engagement abroad, we think of military aid and cooperation … economic exchange and assistance … and perhaps media interaction and cultural exports. Few think of public health — and yet, public health is among the most vital fronts along which America engages the world. Public health knows no borders — and no politics. In recent memory alone we have seen AIDS leap undetected from Africa into our own cities … we have seen SARS spread with shocking rapidity from southern China to North America … we have seen the West Nile virus somehow cross the Atlantic and begin a slow spread across our continent … and we have seen that a key to controlling tuberculosis in the United States is controlling it in potential emigrants abroad.

And so in public health our mission of compassion and our national interests coincide perfectly. I said that public health knows no politics — but that does not mean it has no political effects. I already mentioned how Walter Reed’s pioneering work on yellow fever made possible the Panama Canal. Today, the strain of dealing with SARS has brought civil unrest to parts of China … and AIDS in sub-Saharan Africa is eroding the very foundations of nations there as it wipes out entire generations and erases whole villages from existence.

These are serious issues meriting a serious response. The Department of Health and Human Services has stepped into the breach before to address them … it does so today … and it will continue to do so in the future. The international role of HHS is evolving and too-little-known. But it is rooted in the history of the Republic — and it is critical to ensuring the Republic’s future.

An example of this can be found in Afghanistan. America’s fight there didn’t end when the Taliban broke and ran — it only changed. Winning the war in Afghanistan was the easy part. Winning the peace is what matters — and that’s where HHS can do its part, for the Afghan people and for America.

The long-suffering Afghan nation has suffered revolution, invasion, tyranny, cruel occupation, civil war, and still more tyranny in a single generation. A prosperous, independent Afghanistan will only be truly secured when the Afghan people themselves assume the responsibilities of ordered society ... of equal justice ... and of equal rights. They can — and they will.

But there will be many hurdles. In a land where murderous fanatics launch rocket attacks on schools that teach small girls to read ... in a land where some women and children die because their husbands and fathers will not allow them to seek medical treatment from the only available doctor because he is male ... the road from here to there seems very long. My friends, we are going to help them shorten it.

Helping Afghanistan means helping its women and children. And the plight of women in Afghanistan is dire indeed.

I’ve visited Kabul on several occasions, and it never fails to shock to see the living conditions of some of the Afghans that I meet. Decades of war, the cruelty of weather, and the blight of imposed ignorance have stripped away a proud people's humanity, too often reducing life to a brutal game of survival and chance. And it is the women — cloistered, powerless, often caring for families alone — who suffer most.

The situation of Afghan women’s and children’s health can only be described as wretched. The facts break your heart. Maternal mortality in Afghanistan is the worst in the world, with 17,000 mothers dying every year. In provinces outside Kabul, in places like Kandahar and Badakshan, the complications of childbirth are the principle cause of adult female deaths. Sixteen percent of children die in childbirth, and one in five children die before their fifth birthday. The vast majority of these deaths — not only from childbirth, but also from infection, disease, and trauma — are preventable.

But they're only preventable with the right equipment. They're only preventable with the right personnel. They're only preventable with the right education. And that's where we come in.

I’m proud to tell you that this past April, I was in Kabul to witness the opening of the newly-refurbished Rabia Balkhi Women’s Hospital. Rabia Balkhi is a critical facility for Afghan women — it admits nearly 36,000 patients each year and delivers over 40 babies a day. The refurbishment — a joint project of HHS, the Department of Defense, and the Afghan government — is only the first step toward bringing health and hope to all Afghan women.

President Bush's fiscal year 2004 budget includes $5 million for further work at Rabia Balkhi and expansion to four additional affiliated facilities outside of Kabul. We will provide training for the medical staff and help to improve the hospital operations at Rabia Balkhi and at the four satellite clinics once the initial needs of Rabia Balkhi have been met. Each one of these maternal and child health clinics will provide direct healthcare to patients, and training to health care workers at all levels, including physicians, nurses, midwives, and community health workers.

Our goal — which, I should add, we’re pursuing in cooperation with a truly tremendous group of Afghan-American physicians and other specialists — is to develop a team of trained health care workers who can address the maternal and child healthcare needs of the entire nation.

It's a small first step. But it is just the first.

When we put together those teaching clinics ... when we provide prenatal care to women in remote villages ... we won't be helping just the women of Afghanistan. We'll be helping every man, woman and child of that ancient land who ever looked at their country, loved it, and wanted to make it a better, freer, more decent place.

Does that advance America’s mission of compassion abroad? You bet it does. And it’s only one of many efforts HHS is making in Afghanistan:

 We’re also developing audio-visual health education materials to reach illiterate Afghans and teach them about basic women’s health … care of young children … and general health.

 We’re making plans to donate equipment to Indira Gandhi Children’s hospital in Kabul.

 We’re working with UNICEF to establish a Post Emergency Public Health Center Afghanistan. The Center will provide public health and epidemiological technical assistance and training to non-governmental organizations, United Nations agencies, and the Afghan government to help ensure that quality health and health services data are available to guide donors and reconstruction efforts.

 We’re providing a low-cost technology to produce safe drinking water and training in hand-washing to both staff and patients at Rabia Balkhi Hospital and other clinics in Afghanistan. This means that mothers and their newborn babies can go home to a safe water supply. This simple measure could decrease diarrheal illnesses in infants by 40 percent or more.

 We’ve completed an assessment with the Vietnam Veterans of America Foundation and the United Nations Mine Action Program Afghanistan related to contamination by landmines and unexploded ordnance.

 And we’re supporting polio eradication efforts in cooperation with UNICEF and the World Health Organization.

This isn’t mere altruism. This is building the foundation of the goodwill that will win us the peace as surely as we won the war. Our mission of compassion abroad is good for the nations we help — and it is good for America.

The HHS experience in Afghanistan is applicable anywhere a health system is crumbling … anywhere civil authority is weak … and anywhere America needs to project not just power, but compassion. In short, the HHS experience in Afghanistan prepares us well for the challenges of Iraq.

We’ve already been involved in several aspects of the Iraqi reconstruction:

 HHS had Public Health Service Commissioned Corps officers on the multi-agency Disaster Assistance Response Team that entered Iraq in the wake of the liberating armies. These personnel dealt with such issues as the appropriate distribution of World Health Organization health supplies … ensuring a continuous supply of chronic medications for Iraqis … and working with military Civil Affairs units to assess hospitals and clinics.

 An HHS water sanitation expert was instrumental in addressing the water needs of the cities of Umm Qasr and Basra.

 At the request of the Department of Defense, we’re going to be sending three more experts to join the team under Ambassador Bremer in Baghdad as he helps stand the Iraqi Ministry of Health back up on its feet.

 And here in Washington, HHS has worked to bring opposition Iraqi health specialists together to discuss key issues in rebuilding the health care infrastructure in Iraq.

That only scratches the surface of what we can do. I’m here to tell you tonight that the Department of Health and Human Services stands ready, willing and able to take on the total reconstruction of the Iraqi Health Ministry. We can do it professionally … we can do it thoroughly … and we can do it without being co-opted by the Ba’athist apparatchiks who ran the health bureaucracy under Saddam Hussein. In my Department, America has a tremendous tool to do good works in faraway lands that desperately need them.

My friends, we are ready for our country’s call in Iraq. We are ready to advance America’s mission of compassion abroad. With so much riding on the goodwill and gratitude of liberated Iraqis, we cannot afford to do any less.

I want to talk about one last facet of America’s mission of compassion abroad — the fight against global AIDS. It’s a mission that’s particularly important to the President and me — for reasons of simple humanity.

In the developing world, and particularly in Africa, AIDS threatens peace and stability as it wipes out entire generations, orphans whole communities, and cripples nations. Three million people died from AIDS last year, and it is estimated that at least another 68 million will die in the next two decades. Of those deaths, 55 million will be in Africa. Life expectancy is suffering concurrently. A child born in Botswana, for example, now cannot even expect to see his fortieth birthday — a level not seen there since 1950.

I've been to Africa and seen the damage wrought with my own eyes. The sorrow and the horror defy description — and, it sometimes seems, the powers of science. Where other illnesses fall to the efforts of modern medicine, AIDS marches on.

But we will stop it. We will stop it because we have the will, the means, and the compassion to do so. That’s why the nations of the world, in cooperation with non-governmental organizations and local community groups, have come together to establish the Global Fund to Fight AIDS, Tuberculosis and Malaria. The extraordinary demands of this crisis demand this extraordinary effort.

The Fund is an indispensable component of the worldwide struggle against AIDS. A true public-private partnership, it provides desperately needed financial assistance to nations and communities in desperate straits. This assistance shores up health and medical infrastructures, gives families a fighting chance, and most important, saves lives.

I was honored to be elected Chair of the Fund this past January. As Chair, I am happy to report the Fund has approved 154 projects in 92 countries and committed more than $1.5 billion since April 2002. The Fund has signed grant agreements with 32 countries amounting to almost $370 million. Of that, approximately $20 million has been disbursed so far, and the pace of disbursement is accelerating rapidly. Just a little over a year since the Fund was established, the first people are receiving anti-retroviral treatment under Global Fund grants in Haiti.

It will take the support and initiative of all nations to see it through. I’m proud to note that America is helping to lead the way.

For starters, we are the largest single contributor to the Global Fund. And that’s just the tip of the iceberg. In his State of the Union Address last January, President George W. Bush announced the Emergency Plan for AIDS Relief — a five-year, $15 billion initiative to turn the tide against the global HIV/AIDS pandemic. This commitment of resources will help the most afflicted countries in Africa and the Caribbean wage and win the war against HIV/AIDS.

The Emergency Plan is the logical culmination of American anti-AIDS efforts that accelerated significantly last year.

As the first stage of this unprecedented commitment, the President in July 2002 announced his $500 million international Mother and Child HIV Prevention Initiative. We expect that this initiative will target one million HIV-infected women annually within five years or less, and reduce mother-to-child HIV transmission by 40 percent in 14 targeted countries in Africa and the Caribbean. A second goal of the initiative is to improve health care systems that provide care and treatment not only to mothers and babies — but to fathers, children, and their communities.

The Mother to Child HIV Prevention Initiative will provide the foundation for implementation of the President’s Emergency Plan for AIDS Relief in the same 14 countries. These countries account for nearly 50 percent of all HIV infections in the world — and nearly 70 percent of HIV infections in Africa and the Caribbean.

We expect to accomplish a lot with the Emergency Plan:

 First, we want to prevent 7 million new infections, representing 60 percent of the projected new infections in target countries. The initiative will involve large-scale prevention efforts, including voluntary testing and counseling. The availability of treatment will enhance prevention efforts by providing an incentive for individuals to be tested.

 Second, we want to treat 2 million HIV-infected people. Capitalizing on recent advances in anti-retroviral treatment, the President’s Emergency Plan for AIDS Relief will be the first global effort to provide advanced antiretroviral treatment on a large scale in the poorest, most afflicted countries.

 Finally, we want to provide care for 10 million HIV-infected individuals and AIDS orphans.

The President’s $15 Billion, five-year plan, of which $10 billion is new money, will virtually triple our commitment to international HIV/AIDS assistance, which now stands at a government-wide base of $1 billion a year.

Implementation will be adapted to local circumstances and based on a “network model” employed in countries such as Uganda. This model consists of a layered network of central medical centers that support satellite centers and mobile units, with varying levels of medical expertise as treatment moves from urban areas to rural communities. It will build directly on clinics, sites, and programs established through HHS, USAID, non-governmental organizations, faith-based groups, and willing host governments. Over 50 percent of the resources will directly support treatment, and more than a third will expand prevention activities. We will have the flexibility to adjust resource allocation based on scientific data as it becomes available.

Since the impact of HIV/AIDS in the world is so severe, we need to be flexible and generous with this program. As an example, we have decided that while our projected figure for anti-retroviral treatment is two million people, all persons who receive HIV diagnostic testing through the President’s plan and who meet the medical criteria for anti-retroviral therapy will receive it.

Let me emphasize that the President’s Plan directly assists the mission of the Global Fund. The Plan includes an additional billion dollars for the Global Fund, bringing the U.S. pledge up to $1.65 billion. Our efforts, and the bilateral efforts of other nations, provide the foundations for the Global Fund’s work. We are all attacking the same problem, we are all serving the same people, and we are doing it together.

Let me add one last thing about the Emergency Plan — at the G-8 summit this weekend, French President Jacques Chirac praised President Bush’s vision for fighting AIDS as “historic.” I’m happy to achieve bipartisanship, myself, but when the French are on board, you know you’ve reached consensus.

The best part, though, is that President Chirac then vowed to triple France’s commitment to the Global Fund. Let me say that again — he tripled it. Does American leadership matter? Is the American example having a positive effect? Does the American mission of compassion abroad strike a chord with our friends and allies?

Absolutely.

My friends, thank you so very much for being a wonderful audience tonight. Our vision for the world, like our vision for our nation, is expansive, optimistic, and exciting. And our mission of compassion abroad is nothing less and nothing more than the simple impulse of human kindness writ large. History, conscience, and our precious heritage as Americans demand no less from us. As Ronald Reagan once said:

“It is up to us...to work together for progress and humanity so that our grandchildren, when they look back at us, can truly say that we not only preserved the flame of freedom, but cast its warmth and light further than those who came before us.”

May God bless you all.