Some 170 heads of state are gathering today in New York for the first day of the United Nations Millennium Summit. Along with debating UN reform, they will discuss how to achieve the Millennium Development Goals (MDGs), a set of eight policy objectives aimed at stepping up global efforts to lessen poverty, gender inequality, illiteracy, environmental degradation and disease by 2015. In 2000, the Bush administration joined with governments across the world in expressing its support for these aims.
But just a few weeks ago, United States Ambassador John Bolton called for the elimination of nearly all references to the MDGs from the summit document, including a pledge to take part in a concerted international response to HIV/AIDS, malaria, and other diseases. This was puzzling. The Bush administration clearly agrees that to eliminate these deadly diseases would be a great achievement. And President Bush has made “accountability” a watchword of his flagship development-assistance programs, including his Emergency Plan for AIDS Relief (PEPFAR) and the Millennium Challenge Account. Yet, having agreed to the MDGs in principle, it appeared that the administration objected to the indicators set up to guide the coordinated efforts needed to achieve them. In other words, this administration does not wish to be held accountable for actual implementation of the MDGs
This is a poor reflection of the collective commitment and compassion of millions of Americans and hundreds of nongovernmental organizations across the political spectrum. For example, the Open Society Institute (OSI) supported the development of the first “Global Plan to Stop Tuberculosis” and spends millions of dollars every year to assist tuberculosis and HIV/AIDS prevention and treatment efforts. OSI's Public Health Watch, for example, is helping civil-society groups hold their governments accountable for implementing international health commitments such as the MDGs.
Americans recognize that their position of relative wealth and power obliges them to act. But, even though initiatives led by civil-society groups do have a significant impact, they cannot alone stem the tide of epidemic diseases. Only governments can legitimately agree on national policies, take decisions to implement those policies, and ensure the level of investment necessary for their success. And the sheer scale of the TB and HIV co-epidemic -- for these diseases feed off of each other -- demands not only that governments act, but that they act in concert.
Though the U.S. administration may share basic health-related goals with other governments across the world, its recent statements and actions suggest that it in fact prefers a go-it-alone approach. Yet it is clear that the dynamics of disease doom single-nation solutions to failure. The TB/AIDS co-epidemic has destabilized the entire sub-Saharan African region; the spread of drug-resistant strains of tuberculosis proves that the United States can neither insulate itself from global diseases nor address their complex causes on its own. Pursuing a foreign health policy in isolation from global efforts simply will not work. Disease does not respect borders or politics; it is a common threat, and fighting it requires common resolve and a common strategy.
If the United States does assert differences between its position and the summit document over the next few days, it should be by demanding an expansion of the MDGs. Tuberculosis, for example, which kills two million people a year and is one of the leading causes of death among people with AIDS, is not currently included among the diseases that the MDG signatories pledged to fight. Yet the disease is curable at a cost of just $15 per patient. With U.S. leadership, eradicating tuberculosis could be clearly identified as a common MDG strategy, and it could be achieved.
But this summit is about more than health. It's also about global security and reform of the U.N. Some Americans believe in the UN as a source of stability and a force for justice. Others believe just as strongly that it is irrelevant or even harmful to U.S. interests. These debates are important, but the United States should not – now or in future -- politicize support for a common strategy toward fighting global epidemics, gender inequalities, poverty, and lack of education. It should not hold these goals hostage to the need for U.N. reforms, however necessary those might be. Nations must surely unite in a common strategy to act with urgency and generosity in response to the suffering caused by AIDS, tuberculosis, malaria, and other diseases.
Hurricane Katrina gave Americans a rude awakening to the importance of holding our government accountable for what it does -- and doesn't do -- to help the poor, the sick, the dispossessed. Pledging publicly to support the Millennium Development Goals and then acting to scuttle them was misguided, and poor policy besides. The U.S. government's commitment to the MDGs will be revealed not by a last-minute compromise on the summit document, but in its concrete actions over the coming months and years. And showing visible support for MDG implementation will help determine U.S. credibility in calling for greater governmental accountability around the world.
Rachel Guglielmo is director of the Open Society Institute's Public Health Watch.
