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Obama and health: change can happen
Editorial
A palpable sense of optimism, “opportunity, and unyielding hope” has emanated from the USA since President-elect Barack Obama’s victory speech on the the historic night of Nov 4. With such great expectations comes huge responsibility. Obama deserves the support of everyone who yearns for a more equitable America and a fairer world. Health, currently one of the most divisive of political issues, could become a symbolic uniting force for the new administration. The leadership appointments to four key US health institutions will send crucial messages about what the Obama administration does, and does not, stand for. The next director of the National Institutes of Health should be an internationally renowned scientist passionate about putting science at the heart of government decision making. A public-health specialist who is committed to promoting public-health principles should take the helm at the Centers for Disease Control and Prevention. The new director of the Food and Drug Administration should be determined to take a robust safety approach to regulation. And the next Secretary of the Department of Health and Human Services (DHHS) must be ready, willing, and able to reach out to health policy makers. Health system strengthening must be a top priority for the new administration if 46 million uninsured US residents are to have access to health care. Obama’s plans to offer a range of payment choices, his commitment to ensure that all children have health insurance, and the requirement that insurance companies cover pre-existing conditions are positive steps towards an inclusive health system. In addition, Medicaid and Medicare must be rebuilt, reinforced, and fully supported. Michael Marmot and colleagues have shown that ill-health in US residents has a particularly strong socioeconomic gradient. The current state of migrant health in the USA is a notorious example of health and social injustice. The final report from WHO’s Commission on the Social Determinants of Health is a credible platform to address health and social inequalities. It was encouraging to hear UK Prime Minister Gordon Brown say at last week’s international conference on the Social Determinants of Health in London that Barack Obama is committed to tackling domestic and global inequality. The agenda for Obama on global health is complex and includes climate change, conflict—particularly the wars in www.thelancet.com Vol 372 November 15, 2008
Iraq and Afghanistan—and trade, including intellectual property rights on essential medicines. But there are several steps towards advancing global health that could be quickly implemented. First, health equity and human security should be a stated objective of foreign policy. Second, the DHHS Director of Global Health Affairs, Bill Steiger—who has badly hurt America’s reputation in global health—should be replaced with a more experienced and appropriate politician. Third, Mark Dybul, the head of PEPFAR—the President’s Emergency Plan for AIDS Relief, undoubtedly the biggest triumph of the Bush administration despite its controversies—will likely be swiftly replaced. Strong leadership from a respected international expert, such as Jim Kim, could help to negate PEPFAR’s dogmatic and damaging policies—for example, its preference for abstinence-until-marriage programmes. Fourth, just as George W Bush reinstated the global gag rule—a law that forces recipients of federal funding to agree that they will not perform or promote abortion as a method of family planning—in his first day in office, Obama could reverse this decision as soon as he is inaugurated and so improve women’s access to sexual and reproductive health in a single stroke. Fifth, a public commitment to agree to spend the internationally agreed target of 0·7% of gross national income on aid by 2015 would set a good example to the international community. Sixth, as a signal that the USA is committed to human rights, Obama could bring the USA in line with most other UN member states by ratifying the UN Convention on the Rights of the Child and the International Covenant on Economic, Social and Cultural Rights. The new administration must also reach out to the global community and rebuild damaged relationships caused by the antagonism and harassment shown towards the whole UN system by the previous administration. The choice of the next UN Ambassador is pivotal to improving these relationships, in health as well as in other domains. An increase in support—including financial support—for WHO would be a sign that the USA wishes to re-engage with the global health community. President-elect Obama is a reminder about what is great about the USA and that, indeed, “change can happen”. The fruits of that change will be judged by tangible improvements to the welfare and health of Americans—and those affected by American foreign policy. ■ The Lancet
Getty Images
Obama and health: change can happen
For Barack Obama’s victory speech see http://news.bbc. co.uk/1/hi/world/americas/us_ elections_2008/7710038.stm For Obama’s health plans see Editorial Lancet 2008 372: 1121 DOI:10.1016/S01406736(08)61455-5 For more on Obama’s health plans see World Report Lancet 2008 372: 521–522 DOI:10.1016/S01406736(08)61216-7 For the paper on the socioeconomic gradient in the USA see JAMA 2006; 295: 2037–2045 DOI:10.1001/jama.295.17.2037 For the Final report from the Commission on the Social Determinants of Health see http://www.who.int/social_ determinants/final_report/en/
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A palpable sense of optimism, “opportunity, and unyielding hope” has emanated from the USA since President-elect Barack Obama’s victory speech on the the historic night of Nov 4. With such great expectations comes huge responsibility. Obama deserves the support of everyone who yearns for a more equitable America and a fairer world. Health, currently one of the most divisive of political issues, could become a symbolic uniting force for the new administration. The leadership appointments to four key US health institutions will send crucial messages about what the Obama administration does, and does not, stand for. The next director of the National Institutes of Health should be an internationally renowned scientist passionate about putting science at the heart of government decision making. A public-health specialist who is committed to promoting public-health principles should take the helm at the Centers for Disease Control and Prevention. The new director of the Food and Drug Administration should be determined to take a robust safety approach to regulation. And the next Secretary of the Department of Health and Human Services (DHHS) must be ready, willing, and able to reach out to health policy makers. Health system strengthening must be a top priority for the new administration if 46 million uninsured US residents are to have access to health care. Obama’s plans to offer a range of payment choices, his commitment to ensure that all children have health insurance, and the requirement that insurance companies cover pre-existing conditions are positive steps towards an inclusive health system. In addition, Medicaid and Medicare must be rebuilt, reinforced, and fully supported. Michael Marmot and colleagues have shown that ill-health in US residents has a particularly strong socioeconomic gradient. The current state of migrant health in the USA is a notorious example of health and social injustice. The final report from WHO’s Commission on the Social Determinants of Health is a credible platform to address health and social inequalities. It was encouraging to hear UK Prime Minister Gordon Brown say at last week’s international conference on the Social Determinants of Health in London that Barack Obama is committed to tackling domestic and global inequality. The agenda for Obama on global health is complex and includes climate change, conflict—particularly the wars in www.thelancet.com Vol 372 November 15, 2008
Iraq and Afghanistan—and trade, including intellectual property rights on essential medicines. But there are several steps towards advancing global health that could be quickly implemented. First, health equity and human security should be a stated objective of foreign policy. Second, the DHHS Director of Global Health Affairs, Bill Steiger—who has badly hurt America’s reputation in global health—should be replaced with a more experienced and appropriate politician. Third, Mark Dybul, the head of PEPFAR—the President’s Emergency Plan for AIDS Relief, undoubtedly the biggest triumph of the Bush administration despite its controversies—will likely be swiftly replaced. Strong leadership from a respected international expert, such as Jim Kim, could help to negate PEPFAR’s dogmatic and damaging policies—for example, its preference for abstinence-until-marriage programmes. Fourth, just as George W Bush reinstated the global gag rule—a law that forces recipients of federal funding to agree that they will not perform or promote abortion as a method of family planning—in his first day in office, Obama could reverse this decision as soon as he is inaugurated and so improve women’s access to sexual and reproductive health in a single stroke. Fifth, a public commitment to agree to spend the internationally agreed target of 0·7% of gross national income on aid by 2015 would set a good example to the international community. Sixth, as a signal that the USA is committed to human rights, Obama could bring the USA in line with most other UN member states by ratifying the UN Convention on the Rights of the Child and the International Covenant on Economic, Social and Cultural Rights. The new administration must also reach out to the global community and rebuild damaged relationships caused by the antagonism and harassment shown towards the whole UN system by the previous administration. The choice of the next UN Ambassador is pivotal to improving these relationships, in health as well as in other domains. An increase in support—including financial support—for WHO would be a sign that the USA wishes to re-engage with the global health community. President-elect Obama is a reminder about what is great about the USA and that, indeed, “change can happen”. The fruits of that change will be judged by tangible improvements to the welfare and health of Americans—and those affected by American foreign policy. ■ The Lancet
Getty Images
Obama and health: change can happen
For Barack Obama’s victory speech see http://news.bbc. co.uk/1/hi/world/americas/us_ elections_2008/7710038.stm For Obama’s health plans see Editorial Lancet 2008 372: 1121 DOI:10.1016/S01406736(08)61455-5 For more on Obama’s health plans see World Report Lancet 2008 372: 521–522 DOI:10.1016/S01406736(08)61216-7 For the paper on the socioeconomic gradient in the USA see JAMA 2006; 295: 2037–2045 DOI:10.1001/jama.295.17.2037 For the Final report from the Commission on the Social Determinants of Health see http://www.who.int/social_ determinants/final_report/en/
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