In the decade that the United States Agency for International Development began its work in global health, life expectancy in low-income countries averaged about 43 years, about 240 of every thousand children died before the age of five, and no records existed of maternal mortality rates. HIV was unheard of.
A half century later, with the world’s population more than doubled, average life expectancy in low income countries is a little over 60 and the rate of early childhood deaths has dropped by two-thirds. Data now show that of every hundred thousand women who give birth, more than 350 die as a result, and that represents halving of the maternal death rate from the 1980s, the first decade for which numbers are available. An estimated 34.9 million people live with HIV.
When an agency publishes an account of its own history, built-in limits to what it chooses to memorialize can keep the result from being a gripping page-turner. But the numbers alone make for a compelling story of a past that can serve as a prologue, and they provide the framework for USAID’s just issued 50 Years of Global Health.
Last week a group of people representing programs and decades of USAID’s work in global health got together at the Center for Strategic and International Studies in Washington, DC, to introduce the publication, and tell some of the stories behind the progress memorialized in its pages.
There was, for example the story of the agency’s family planning program, made possible under funding introduced by Rep. George H.W. Bush of Texas. (support for the program back then was “intensely bipartisan,” said Steve Sinding, who headed USAID’s Office of Population in the 1980s). All the same, it also was intensely sensitive. While the objective of the program explicitly was “population control,” that term went out of usage by the mid-70s in the face of backlash from countries indicating that was not a shared goal. “Beginning in the mid-70s, the tone softened,” Sinding said. “We talked about family planning as a social good.”
Then there was the story of the A, B, C approach to HIV prevention, with its recommendation of Abstinence, Being faithful to one partner, and Condom use as a final resort. “No surer prescription for being hit by both the left and the right!” recounted Dr. Kent Hill, who served as USAID’s assistant adminstrator of the Bureau for Global Health from 2005 and 2009, and who called the selling of A, B, C “one of the more unusual challenges of my life.”
These stories are not in the book, at least not the same way they were recounted last week. But the numbers behind the stories are, and the graphics provide a good record of what focus and funding can accomplish.
The launch of USAID coincided with the launch of another ambitious program, U.S Global AIDS Coordinator Ambassador Deborah Birx, in the audience last week, pointed out. “Like NASA you’ve worked in difficult places,” she said. “They went to the moon, but you’ve been to some difficult places.”