Foreign Relations of the United States, 1977–1980, Volume II, Human Rights and Humanitarian Affairs

311. Memorandum From the Director of the Office of Management and Budget (McIntyre) and the President’s Special Assistant for Health Issues (Bourne) to President Carter¹

Washington, April 21, 1978

SUBJECT

• Status Report—World Health Strategy

As stated in our memorandum of February 1 to you, we have circulated a draft World Health Strategy to all of the interested agencies asking for comments on the overall approach and on each of the proposed initiatives.² Their responses indicate that work is underway and there is support for elements of the strategy; however, further analysis and joint discussion is needed to develop the program initiatives. The number of agencies involved, combined with the differing perspectives of health as a function of developmental assistance or of medical research, requires that we complete the policy review before we will be in a position to announce the details of a major initiative.

As a result of your continuing interest, the Departments and agencies have already initiated internal efforts to determine how they can support the initiatives.

—HEW is developing a draft message for Secretary Califano to deliver, as your personal representative, to the World Health Assembly in May. AID, State and others are involved in the planning.³

—AID has issued FY80 program guidance based on its draft strategy to promote health within a basic needs framework.

—Treasury has asked the World Bank to assess the Bank’s effectiveness in the health sector, and the possibilities for future lending.

—DOD has asked the military departments to identify specific projects in the areas of education, training and research.

In cooperation with the international organizations, we plan to consider giving special attention to the following:

—Basic health, nutrition and family planning measures particularly to improve maternal and child health;⁴

—Prevention of blindness;⁵

—Provision of safe water and basic sanitation; and

—Development of better ways to improve health.

“Basic needs” approaches to development must include health considerations. Decent health is essential to both labor productivity and learning ability. Young children and mothers suffer particularly poor health. Yet their suffering can be substantially alleviated through inexpensive, basic health programs in conjunction with measures to improve agriculture and expand education. Most third-world families lack the simplest means or information to deal effectively with the commonest health hazards. About 70 percent of the population lacks safe water, and even more do without adequate sanitation. Approximately 40 million people in the world are blind. We believe the American people will support initiatives to help provide families in developing countries with essential and inexpensive health care and immunizations, clean water, elementary sanitation and measures to prevent blindness.

There are no immediate reorganization implications which might create potential for conflict with your decision to create a new International Development Cooperation Administration⁶ and allied coordinating mechanisms. These initiatives will be developed in coordination with these mechanisms.

The review itself has generated sufficient momentum that we should again emphasize the identification of this effort as your initiative. Your Lagos speech⁷ contributed to this momentum by putting African health initiatives in the context of a broader U.S. international health effort and indicating further cooperation on African health problems. We propose three actions:

—Emphasis on Secretary Califano’s role as your personal representative to the World Health Assembly and your endorsement of Califano’s message spelling out the U.S. role. We will have his message by April 27 for final clearance.⁸

—Release of a Statement of Principles as the first step in a long-term effort over the next two years to establish a world health initiative. We recommend you announce this prior to Califano’s message on May 9. We have tentatively scheduled time for you in the press room.⁹

—Completion of the policy review, with an Administration strategy and detailed program initiatives by September 1, 1978, to support the development of the FY 1980 and subsequent budgets. A schedule is attached.¹⁰

1. Source: National Archives, RG 59, Central Foreign Policy File, P780120–2025. No classification marking. The President initialed the memorandum. Attached as Tab C of Blaney’s July 10 briefing memorandum to Cooper, Document 314.
2. See Document 309. The February 1 memorandum to Carter was not found.
3. The President placed a check mark next to this paragraph.
4. The President placed a check mark next to each of these points.
5. The President added next to this point: “Big prob. in Liberia.”
6. See footnote 17, Document 245.
7. The President departed Washington on March 28 for Venezuela, Brazil, Nigeria, and Liberia, returning to Washington on April 3. He spoke at the National Arts Theatre in Lagos, Nigeria, on April 1, commenting: “We are giving new priority to cooperating in international efforts to improve health around the world. We would like to study with you how we can best work with Nigeria and other nations of Africa to deal with the killing and the crippling diseases that still afflict this continent.” (Department of State Bulletin, May 1978, p. 13)
8. The President wrote “ok” next to this point.
9. The President wrote “See statement first” next to this paragraph. The White House released a Presidential statement on May 2, announcing the U.S. international health program. Califano delivered prepared remarks at the 31st World Health Assembly in Geneva on May 9. See Document 313.
10. The President wrote “ok” next to this paragraph. The April 20 “World Health Strategy Workplan Timetable” is attached but not printed.