Professional Documents
Culture Documents
Global Health Services Neg - SDI 5 Week
Global Health Services Neg - SDI 5 Week
1 GHS Neg
***Topicality*** ................................................. 13
Extra-T 1NC ......................................................................14 Extra-T Violations .............................................................16 Substantial T 1NC..............................................................18 Substantial T Violations.....................................................19 Increase T 1NC ..................................................................20 Increase T Violations .........................................................21
***Bioterror CPs***........................................128
Domestic Capacity CP 1NC ............................................ 129 Domestic Capacity CP Solves ......................................... 130 AT: Domestic CP Doesnt Learn About Africa ............. 133 Integration CP ................................................................. 134
***Politics***.....................................................221
Bush Good Link Disease.............................................. 222 Bush Good Link Committee Proves............................. 223 Bush Good Link Key Senators ..................................... 224 Bush Bad Link Plan Popular ........................................ 225 Bush Bad Link Bipart................................................... 226 Plan = Win For Obama.................................................... 229
***AT: Add-Ons***.........................................243
AT: Lashout Add-On...................................................... 244 AT: Domestic Health Add-On........................................ 245 AT: Free Trade Add-On ................................................. 246
***Misc*** .........................................................247
War Destroys Health Capacity ........................................ 248 Colonialism Links ........................................................... 249 Imperialism Links ........................................................... 250 Contact Theory Wrong.................................................... 251 Contact Theory Limited .................................................. 252
3 GHS Neg
***Intel***
4 GHS Neg
Strategy Sheet
Important notes:
1) You could piece together a large number of strategies from this file pick and choose which components of the aff you want to solve and combine a CP. 2) Most of your net benefits will be based on generic PHA to Africa links the aff is very similar to a stock middle of the road AIDS case, so all of your most generic link evidence will probably apply. Thats important, because there arent a ton of GHS specific politics links out there. This isnt a problem, because all of the CPs solve the whole case. 3) PEPFAR solves a majority of this affirmative in the status quo the internal link to both the soft power and bioterror advantages boils down to nothing more hi-tech than engagement with Africa. Keep in mind that even if the LINK card why GHS boosts soft power is specific, the INTERNAL link card is generic about Africa. That means that any CP which engages Africa solves, and that PEPFAR solves to a way larger degree than the aff. 4) Politics direction is probably Bush Bad though in reality, noone cares at all about the plan, and it would just be lost in the noise of PEPFAR 5) Dont go for spending the aff doesnt spend enough to win a link. You might, however, consider going for substantial or increase if they say the plan is funded out of PEPFAR
Recommended strategies
1) International Actor CP + Soft Power CP Theres not a warrant in the affirmative for why only the U.S. is capable of setting up a GHS. Even if they read evidence that the federal government should do it, they wont have a comparative card another actor couldnt. I dont think it matters which you pick the EU is probably fine. You can either win PEPFAR solves the other two advantage in the status quo, or run one of the soft power CPs to solve the rest of the aff. It competes on any disad which says U.S. action to Africa is bad basically, all of them except maybe Spending/Aid Tradeoff. You might consider reading one of the Bioterror CPs as a part of the CP as well, because boosting domestic health capacity helps against a lot of solvency arguments and add-ons. 2) Rest Of The World CP + International Actor CP.-- this CP does the GHS to the rest of the world other than SSA. Their solvency authors all assume doing a GLOBAL GHS (hence the name). They dont have a reason why acting to Africa is important for soft power or terrorism but youll need to solve Disease another way. This CP competes on any Africa based disad Politics, China, African Economy, any Africa K, etc 3) Exclude Loan Repayment the GHS does 6 things, one of which is provide loan repayment for doctors to do to Africa. The CP does the other 5, and offsets the lack of loan repayment with other funding mechanisms. It competes on the Tuition DA and (maybe) Politics, because loan repayment requires legislation, where everything else can be done administratively. If you need to compete on politics, you should probably specify an administrative actor in the CP text, like the Office of Global AIDS coordinator for PEPFAR. 4) AHCIA CP its a competing proposal with the GHS which does basically the exact same thing, except it doesnt send U.S. workers. Solvency cards are decent, competes off of U.S. workers bad (Reverse Brain Drain, African Economy, Wage Inflation, Imperialism K, etc) 5) I wouldnt be afraid to defend the status quo if youre good enough on how it solves the case. 6) The GDI has a critique version about contact theory. I didnt write a specific strategy. Its not topical, because it mandates that EVERYONE has to go to SSA before they can go to college. Which also strikes me as a bit, uhinsane? Just CP to send people to Africa with the Peace Corps instead of a GHS, and compete on any reason that health assistance is bad Brain Drain, African Economy DA, Politics, etc
5 GHS Neg
6 GHS Neg
7 GHS Neg
8 GHS Neg
9 GHS Neg
10 GHS Neg
11 GHS Neg
12 GHS Neg
13 GHS Neg
***Topicality***
14 GHS Neg
Extra-T 1NC
A Interpretation 1. Public health assistance is only treatment and prevention of communicable and immunizable diseases Claudia Schlosberg, Partner @ Blank and Rome, 1-12-1998, National Health Law Program,
http://www.healthlaw.org/library.cfm?fa=download&resourceID=67503&print V. PUBLIC HEALTH ASSISTANCE All aliens, regardless of immigration status, are eligible for public health assistance funded through sources other than the Medicaid program. The public health assistance is limited to immunizations with respect to immunizable diseases and for testing and treatment of symptoms of communicable diseases whether or not such symptoms are caused by a communicable disease. As with emergency Medicaid, providers are not required to, and should not, verify the citizenship, nationality and immigration status of applicants for these services. The above definition of public health assistance opens the door to a wide range of critical health services for immigrants and their families. Among the most important are: Immunizations for Children and Adolescents: All children and adolescents should be fully immunized according to the current standards of the Advisory Committee on Immunization Practices; AIDS and HIV services and treatment including screening and diagnosis, counseling, testing and treatment provided with Ryan White Act or other non-Medicaid funds, Tuberculosis services including screening, diagnosis and treatment. Sexually transmitted disease (SDT) screening, diagnosis and treatment. Additionally, treatment of symptoms of a wide range of other communicable diseases is also covered even if ultimately, a communicable origin is ruled out.
2. To means Expressing motion directed towards and reaching: governing a n. denoting the place, thing, or person approached and reached from the Oxford English Dictionary, 1989 B Violation the affirmative goes beyond just giving disease assistance to Africa and does a variety of exclusively domestic initiatives the GHS is much broader than just public health assistance and includes barrier removal like loan repayment Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Educational debts are a major problem for many U.S. health personnel, and are a substantial impediment to doctorsand others who accrue similarly large debtsin pursuing volunteer or low-remuneration opportunities such as service abroad in support of the PEPFAR goals. Loan repayment programs are often used to attract health professionals to practice in areas designated as having a shortage of such personnel. In return for service, loan repayment programs offer a percentage of repayment on qualified educational loans with outstanding balances. Federal programs follow guidelines set forth by the Office of Personnel Management, but each agency has specific requirements for service and repayment. Some of the more common loan repayment programs include the NHSC, the U.S. Army Medical Department, and HRSAs Nursing Education Program. Many states also offer loan repayment programs in exchange for service in areas of need (OPM, 2005b). Student loan payments are usually paid directly to the lender, but the payment is included in the employees gross income and wages for federal employment tax purposes.
15 GHS Neg
Extra-T 1NC
C Reasons to prefer 1. Limits failure to act directly to Africa with all parts of the plan makes anything effectually topical. This destroys predictable preparation and undermines education on the core of the topic. 2. Ground allowing exclusively domestic policies skirts central negative ground on whether foreign assistance is good or bad and allows the aff to claim unpredictable domestic advantages and add-ons. 3. Extra-topicality is bad it proves the resolution insufficient and means the negative would never be able to win. Severance doesnt check because its too late and forces us to make bad pre-round strategic decisions. D. Voter Fairness, Education, and Jurisdiction
16 GHS Neg
Extra-T Violations
The GHS includes 6 components not all of them are exclusively assistance Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 As noted above, the GHS envisioned by the committee encompasses six interconnected programs. The committee believes this package of programs would significantly augment human resource capacity in support of the PEPFAR goals outlined earlier. The six programs are as follows: * Global Health Service Corps * Health Workforce Needs Assessment * Fellowship Program * Loan Repayment Program * Twinning Program * Clearinghouse
( ) Twinning is extra-t it includes bringing Africans to the U.S., not just unidirectional assistance, and lets the aff claim domestic advantages Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Twinning is a potentially useful tool for building human health care resource capacity in resource-limited settings. It can be particularly helpful when a twinning partnership has been established in a country, and the skills of health professionals can be rapidly engaged through this instant infrastructure (USAID, 2001). Such rapid mobilization of U.S. health professionals can fill an immediate need for workers, educators, and trainers while at the same time building a long-term relationship through multiple exchanges over the years. Partnerships whose outcomes involve prevention, treatment, and care for HIV/AIDS can be extremely useful in helping to achieve the PEPFAR goals. These relationships can take many forms, including publicprivate partnerships, as well as arrangements that involve governments, public health agencies, NGOs, hospitals, and universities. Moving skilled personnel from the United States to organizations in the PEPFAR focus countries offers the potential to build human resource capacity. Likewise, moving health professionals from a host country to a U.S. organization for specific forms of training can result in multiplying the host countrys health workforce, provided the training received abroad is appropriate and directly applicable. Recommendation 7: Promote twinning as a mechanism to mobilize health personnel. The committee recommends long-term, targeted funding for innovative, institutional partnerships that would mobilize U.S. health personnel to work in PEPFAR countries. Often called twinning, these bidirectional partnerships (which encompass counterpart organizations ranging from hospitals and universities to nongovernmental organizations and public health agencies) develop institutional capacities and create a sustainable relationship between the partners that extends beyond the life of the defined project. It is a bilateral arrangement that can develop collaboration in many areas but stands to be a particularly helpful instrument to augment teaching, training, and service capacities in combating HIV/AIDS. Twinning should be supported between a variety of U.S. and PEPFAR country-based institutions that are most relevant to meeting PEPFAR targets and harmonizing with PEPFAR country operating plans, especially public-sector
17 GHS Neg
Extra-T Violations
( ) Their author concedes that twinning lets the aff claim advantages external to assistance Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The benefits of twinning extend well beyond the assistance provided to the receiving organization. For the United States, participation in balanced relationships with developing countries serves as a form of public health diplomacy and promotes a positive image of American citizens around the world. Twinning also promotes organizational understanding and cooperation that might otherwise not occur (ICAD and Health Canada, 1999; NASTAD, 2004). On an individual level, participating U.S. health professionals benefit from the opportunity to use their skills in challenging and innovative ways; they also develop skills needed to work in different cultures, as well as in resource-constrained settings (NASTAD, 2004). Moreover, they often gain greater sensitivity to and understanding of immigration and refugee issues in the United States and among their patients. Health professionals participating in twinning programs are in a position to share their experiences with various audiences, raising awareness of HIV/AIDS around the world and at home. Finally, returning health professionals bring with them new perspectives and guidance for their own HIV/AIDS programs, which could translate into improved HIV/AIDS care in the United States (NASTAD, 2004).
18 GHS Neg
Substantial T 1NC
A Interpretation 1. Substantial means to a great or significant extent New Oxford American Dictionary, 2007,
www.oxfordreference.com/views/ENTRY.html?entry=t183.c76181
2. 30% is a good benchmark Joseph Ferraro, Partner, Clifford Chance Rogers & Wells, April 2002, Am. U. L.R., p ln
The Federal Circuit noted that, in this case, the specification defines "substantially increased" as an increase of at least thirty percent and provides reasonable guidance through the examples of how the increase should be measured. 534 The court also observed that the specification discloses suggestions for how long a "period sufficient" might be, and the parties agreed that a "period sufficient" could be determined by doing activity checks. 535 The Federal Circuit noted that, "when a word of degree is used the district court must [*691] determine whether the patent's specification provides some standard for measuring that degree." 536 In this case, the specification provided guidance as to what was meant by "substantial absence" with a reasonable degree of particularity and definiteness. 537 Accordingly, the Federal Circuit reversed the summary judgment of invalidity and remanded the case to the Court of Federal Claims. 538
B Violation the GHS only sends 150 people Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Recommendation 3: Establish a U.S. Global Health Service Corps to send key health personnel to PEPFAR countries on a full-time/long-term basis. The committee recommends the establishment of a full-salaried/ long-term U.S. Global Health Service Corps for the recruitment, placement, and support of U.S. health, technical, and management professionals in PEPFAR countries. Because of the critical and highly visible nature of this Corps and the necessity for it to coordinate closely with PEPFAR, the committee further recommends that it be established and administered as a program of the federal government. U.S. Global Health Service Corps professionals should be selected and deployed based on the prioritized needs identified by ministries of health in conjunction with in-country PEPFAR teams. Assignments will be made for a minimum of 2 years with placements in areas and programs where Corps members presence would have maximum impact on enhancing the human capacity to prevent and treat HIV/AIDS. The committee proposes an initial deployment of 150 U.S. Global Health Service Corps professionals in the 15 PEPFAR countries based on needs assessment, placement development, and the availability of professionals with the required skills.
C Reasons to prefer 1) Limits The aff explodes the topic to include millions of different cases which just send a few experts to deal with a particular problem in Africa. 2) Ground The aff interpretation guts links to generics, because the affirmative doesnt have to be a large change from the status quo this is supercharged because of the high level of aid in the status quo if the aff isnt big enough, the neg doesnt have a shot. 3) Education We should be discussing major policy changes in the way the U.S. interacts with Africa, not the minutia of various small public health proposals the aff detracts attention from the core of the topic. D. Voter Fairness, Education, and Jurisdiction
19 GHS Neg
Substantial T Violations
( ) PEPFAR already gives 15 billion dollars Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 During his State of the Union address on January 28, 2003, President George W. Bush announced the $15 billion PEPFAR initiative, with the following 5-year goals: (1) providing antiretroviral therapy for 2 million people; (2) preventing 7 million new HIV infections; and (3) providing care to 10 million people infected with or affected by HIV/AIDS, including orphans and vulnerable children. In May 2003, the U.S. Congress passed authorizing legislation (United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003) for the plan. Legislative provisions recommended the following targeted distribution of funds: treatment (55 percent), prevention (20 percent), palliative care (15 percent), and care of orphans and vulnerable persons (10 percent). This unprecedented global health initiative placed the United States at the forefront of international efforts targeting HIV/AIDS. Today PEPFAR accounts for more than 50 percent of annual global funding.
( ) The plan is a drop in the bucket its only 3.8% of Bushs proposed Global AIDS initiative Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 To ensure maximum impact, both the corps of health professionals and the funding for private sector support programs should be managed as a single program with a clear mission and identity. The US Public Health Service in the US Department of Health and Human Services, which has a long record of deploying clinicians as well as managing scholarship and loan repayment programs, would be the ideal home for the initiative. The Institute of Medicine report, indeed, proposes that these programs be launched together as the US Global Health Service constructed on key principles that would include country responsiveness, interdisciplinary approaches to program delivery, and training for self-sufficiency. Ultimately, each country will have to educate and maintain its own health workforce, but the aid of US health professionals would be welcomed in many developing countries as help in the crisis and as foundational assistance for the future. The Institute of Medicine report9 estimated the cost of a start-up US Global Health Service to be approximately $150 million a year, roughly 3.8% of the $3.9 billion proposed budget of the President's Global AIDS initiative for 2007or the cost of 18 hours of the war in Iraq.
( ) Plan is only 1% of PEPFAR Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The lack of skilled and trained health professionals is one of the principal barriers to the rapid scale-up of HIV/AIDS prevention and treatment programs in the PEPFAR focus countries (Adano et al., 2004; Wyss, 2004a, b). A range of skills is needed, particularly at the level of key clinical, managerial, and technical leadership positions essential to developing the infrastructure of HIV/AIDS treatment systems (WHO, 2002). Because of the specialized nature of these positions and the long-term requirements of the work, volunteer health professionals and those with short-term availability will be of limited utility in addressing core country-level needs. It would be the role of the Global Health Service Corps, working with public health leaders in the PEPFAR focus countries, to provide specialized health personnel for extended assignments to fill these positions and accelerate program scale-up. These highly skilled professionals would be full-salaried employees working in the 15 focus countries for extended periods, yet the cost of their salary and benefits is estimated roughly at only 1 percent of the total PEPFAR budget.
( ) The plan would only cost 4% of the PEPFAR budget Brenda Wilson, NPR Reporter, 4-19-2005, All Things Considered, p ln
WILSON: The total cost of the program in the first year is about $150 million, just 4 percent of what the president has asked for, for his global AIDS relief plan this year. If approved by Congress and if it proves successful, the global health service would be expanded to other countries.
20 GHS Neg
Increase T 1NC
A. Interpretation Increase means to become greater or larger, from the American Heritage Dictionary, 1985 B. Violation the plan is funded out of PEPFAR, which means theres no net increase in assistance just a change of form Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The lack of skilled and trained health professionals is one of the principal barriers to the rapid scale-up of HIV/AIDS prevention and treatment programs in the PEPFAR focus countries (Adano et al., 2004; Wyss, 2004a, b). A range of skills is needed, particularly at the level of key clinical, managerial, and technical leadership positions essential to developing the infrastructure of HIV/AIDS treatment systems (WHO, 2002). Because of the specialized nature of these positions and the long-term requirements of the work, volunteer health professionals and those with short-term availability will be of limited utility in addressing core country-level needs. It would be the role of the Global Health Service Corps, working with public health leaders in the PEPFAR focus countries, to provide specialized health personnel for extended assignments to fill these positions and accelerate program scale-up. These highly skilled professionals would be full-salaried employees working in the 15 focus countries for extended periods, yet the cost of their salary and benefits is estimated roughly at only 1 percent of the total PEPFAR budget.
C. Reasons to Prefer -1. Limits The aff expands the topic to include all affirmatives which just tinker with how aid is currently given, devastating negative predictability 2. Ground Net increases in assistance are the vital link to all negative ground, like aid bad disads, spending, politics, aid critiques, and modification CPs 3. Education the central question in the topic is whether the U.S. is giving a sufficient amount of aid now the affirmative interpretation dodges the core of the topic D. Voter Fairness, Education, and Jurisdiction
21 GHS Neg
Increase T Violations
( ) The GHS is part of PEPFAR, and only 1% of its budget Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The committee discussed these costs at length, appreciating that the investment required for a fully salaried, full-time/long-term professional would be substantial, and that many other health-related goods and services could be purchased for the same sum. On balance, however, the committee concluded that the investment in a small and specialized Corps that would play a pivotal role in ART scale-up and global health development is an equally important commitment on the part of PEPFAR and the United States. The committee notes further that a $37.5 million aggregate yearly investment represents approximately 1 percent of the current annual PEPFAR budget.
( ) The plan comes out of PEPFAR its 3.8% of Bushs proposed Global AIDS initiative Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 To ensure maximum impact, both the corps of health professionals and the funding for private sector support programs should be managed as a single program with a clear mission and identity. The US Public Health Service in the US Department of Health and Human Services, which has a long record of deploying clinicians as well as managing scholarship and loan repayment programs, would be the ideal home for the initiative. The Institute of Medicine report, indeed, proposes that these programs be launched together as the US Global Health Service constructed on key principles that would include country responsiveness, interdisciplinary approaches to program delivery, and training for self-sufficiency. Ultimately, each country will have to educate and maintain its own health workforce, but the aid of US health professionals would be welcomed in many developing countries as help in the crisis and as foundational assistance for the future. The Institute of Medicine report9 estimated the cost of a start-up US Global Health Service to be approximately $150 million a year, roughly 3.8% of the $3.9 billion proposed budget of the President's Global AIDS initiative for 2007or the cost of 18 hours of the war in Iraq.
( ) The GHS report was commissioned as part of PEPFAR Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 In this context, this report explores potential strategies for mobilizing U.S. health personnel and technical experts to assist in the battle against HIV/AIDS in 15 African, Caribbean, and Southeast Asian countries highly affected by the disease. Commissioned by the U.S. Department of State as part of a historic global health initiativethe Presidents Emergency Plan for AIDS Relief (PEPFAR)the report presents the results of a study conducted by the Institute of Medicines Committee on the Options for Overseas Placement of U.S. Health Professionals. In carrying out this study, the committee:
22 GHS Neg
23 GHS Neg
b) The aff gives 150 you can do the math Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Recommendation 3: Establish a U.S. Global Health Service Corps to send key health personnel to PEPFAR countries on a full-time/long-term basis. The committee recommends the establishment of a full-salaried/ long-term U.S. Global Health Service Corps for the recruitment, placement, and support of U.S. health, technical, and management professionals in PEPFAR countries. Because of the critical and highly visible nature of this Corps and the necessity for it to coordinate closely with PEPFAR, the committee further recommends that it be established and administered as a program of the federal government. U.S. Global Health Service Corps professionals should be selected and deployed based on the prioritized needs identified by ministries of health in conjunction with in-country PEPFAR teams. Assignments will be made for a minimum of 2 years with placements in areas and programs where Corps members presence would have maximum impact on enhancing the human capacity to prevent and treat HIV/AIDS. The committee proposes an initial deployment of 150 U.S. Global Health Service Corps professionals in the 15 PEPFAR countries based on needs assessment, placement development, and the availability of professionals with the required skills.
24 GHS Neg
25 GHS Neg
26 GHS Neg
( ) Other countries make AIDS spread inevitable, Africa isnt key World Health Organization, 2-24-2004, AIDS threat growing throughout Europe,
http://www.who.int/mediacentre/news/releases/2004/pr14/en/ AIDS is rapidly spreading in Eastern Europe and is on the rise again in Western Europe because integrated prevention and treatment programmes have not been sustained or do not exist. Countries in Eastern Europe, home to the fastest-growing epidemic in the world, will soon be on Europes borders following the European Unions enlargement on 1 May 2004. The Baltic States, which will soon be part of the EU, are also experiencing a rapid rise in HIV infections. Leading UN agencies, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank are calling on European Ministers to urgently take decisive action to prevent the further spread of AIDS across Europe and to treat those in need. They warn that young people and other groups, such as sex workers, men who have sex with men and injecting drug users, are particularly at risk of HIV infection. The agencies are participating in a Ministerial Conference hosted by the Irish EU Presidency, Breaking the Barriers - Partnership to fight HIV/AIDS in Europe and Central Asia, which opens today in Dublin. "Europe and Central Asia are at the centre of the fastest-growing HIV epidemic in the world. There is no time to waste - European Ministers must urgently scale up and roll out effective HIV prevention and treatment programmes," said Dr Peter Piot, UNAIDS Executive Director. Given that the EU will form the biggest trading bloc in the world, covering more than 500 million people, it is in the EUs best interest to prevent the AIDS epidemic from crippling Europes social and economic development.
27 GHS Neg
( ) GHS fails IMF caps on health worker spending and US salary limits prevent the actual expenditure of funds Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
IMF macroeconomic policies intended to safeguard against inflation have literally prohibited expenditures and halted implementation of desperately needed PEPFAR and GFATM programs, and make it extraordinarily difficult to implement measures to retain sufficient health workers necessary to provide quality health coverage and meet program targets. While new health spending could theoretically contribute to inflation in desperately poor countries, the certain economic impact of 20-30% infection rates greatly outweighs potential harm. The US Treasury Secretary should move strongly to abolish IMF public spending ceilings on health and education in countries heavily affected by the AIDS pandemic. Likewise, limits placed by Congress or US agencies on public sector and recurrent salary support cause undue burdens to US global health initiatives, requiring burdensome waivers, work-arounds and regular rule-bending. Congress should provide every flexibility to US agencies working to support strengthen health systems adequate to scale-up access to care, treatment and prevention on a scale to meet US program targets. Agencies should roll back antiquated internal policies limiting public sector investments and salary support.
28 GHS Neg
( ) No risk of a catastrophic AIDS impact scientists will find a cure Daniel J DeNoon, AIDS Cure Possible, Aug. 11, 2005, WebMD News, http://www.webmd.com/hivaids/news/20050811/aids-cure-possible-study-suggests A small human study may point the way to a cure for AIDS. Behind the stunning results is a totally new approach to HIV treatment. It makes use of an epilepsy drug -- valproic acid -- that flushes HIV out of its most remote hiding places in the body. Combined with powerful HIV drugs, the approach might totally eliminate the AIDS virus from the body. That promises a cure for AIDS, says study leader David M. Margolis, MD.
29 GHS Neg
30 GHS Neg
31 GHS Neg
( ) U.S. has a serious shortage of doctors Chad Lawhorn, Journal World, 11-27-2006, Hospital recruiting a whole new game, ln
And it is not a stretch to say that recruiting physicians has become as competitive as attracting top NCAA basketball prospects. "In most physician specialties, there are pretty significant shortages," Meyer said. "If a physician is looking at an opportunity in Lawrence, he or she probably has job opportunities in at least 10 to 12 other communities." Doctor demand There are a lot of factors leading to a tight supply of doctors, said Cindy Samuelson, spokeswoman for the Kansas Hospital Association. Some of them are obvious, such as an aging population that is creating more demand for health care services. Others, though, have more to do with a new generation of doctors. Both Samuelson and Meyer said it is a widely held belief in the industry that more young doctors are choosing to work less than full-time hours. "It is part of that whole generation of individuals coming out of school," Samuelson said. "They don't live to work; they work to live. It is different than the (baby) boomer generation that worked, worked, worked and that is all they wanted to do." Samuelson, though, said some young people also may be choosing to take a pass on the once highly prestigious career of medicine because it has become clearer that it isn't everything it is made out to be in television shows. "These have always been lucrative careers where everybody wanted to be," Samuelson said. "It may be that they are not quite as desirable as they used to be because there is an awful lot of red tape to deal with. There is a lot of regulation when it comes to getting payment and dealing with insurance companies." Signs of a doctor shortage are starting to show up in statistics. According to a report prepared for the Kansas Hospital Association this year, the consulting firm The MHA Group estimates that by 2020 the country will have 200,000 fewer physicians than are needed to provide service.
32 GHS Neg
33 GHS Neg
( ) US students arent trained in public health wouldnt be uniquely good teachers Mark S. Smolinski, Dir. Global Health and Security Init @ NTI, et. al., 2003, National Acadamies, Microbial
Threats, http://www.nap.edu/openbook.php?isbn=030908864X To rebuild the public health workforce needed to respond to microbial threats, health profession students (especially those in the medical, nursing, veterinary, and laboratory sciences) must be educated in public health as a science and as a career. Even for students within schools of public health, education has traditionally focused on academic research training, not public health practice. A 1988 IOM report notes that many observers feel that some [public health] schools have become somewhat isolated from public health practice and therefore no longer place a sufficiently high value on the training of professionals to work in health agencies (IOM, 1988:15). A more recent IOM report states that in 1998, only 56 of 125 medical schools required courses on such topics as public health, epidemiology, or biostatistics (IOM, 2002e). The report recommends that all medical students receive basic public health training. It also concludes that all nurses should have at least an introductory grasp of their role in public health, and that all undergraduates should have access to education in public health. Educational strategies in which applied epidemiology programs provide exposure to state and local health departments may help increase awareness of the role of public health in population-based infectious disease control and prevention, and provide for exposure to public health as a potential career choice (see the later discussion on educating and training the microbial threats workforce). Pg. 162
( ) The U.S. doesnt have even close to an adequate number of infectious disease specialists Mark S. Smolinski, Dir. Global Health and Security Init @ NTI, et. al., 2003, National Acadamies, Microbial
Threats, http://www.nap.edu/openbook.php?isbn=030908864X The number of qualified individuals in the workforce required for microbial threat preparedness is dangerously low. For example, in 2001 the need for at least 600 new epidemiologists in public health departments across the United States was identified because of the requirements for bioterrorism preparedness alone. Yet only 1,076 students graduated with a degree in epidemiology in the year 2000 and are potentially seeking employment in government, academia, or private industry, and the largest percentage are trained in chronic disease, not infectious disease epidemiology. According to the National Association of City and County Health Officers, the most needed occupations between 1999 and 2000 were public health nurses, environmental scientists and specialists, epidemiologists, health educators, and administrative staff.
34 GHS Neg
35 GHS Neg
( ) Too many alt-causes to brain drain Dr. Kimberly Hamilton, and Jennifer Yau, Migration Policy Institute, December 2004, The Global Tug-ofWar, http://www.migrationinformation.org/Feature/display.cfm?id=271 Beyond the fundamental challenges facing many source countries of health care migrants, such as political and economic instability and poor governance, there are other starting points for appropriate policy responses. Salaries and benefits are an obvious factor, given extreme wage differentials across countries. A 2002 survey led by human resource management and development expert Tim Martineau listed monthly salaries for physicians that range from US$50 in Sierra Leone to US$1,242 in South Africa. Wages in Canada and Australia are approximately four times those in South Africa. However, many experts emphasize that pay is not the sole motive for leaving the country. Other factors include poor work environments characterized by heavy workloads, lack of supervision, and limited organizational capacity. There are also environmental considerations; workplaces may be dangerous due to lack of sanitation and supplies to protect workers from diseases like HIV/AIDS and tuberculosis. This is occurring when much of the current international funding is narrowly focused on disease-specific programs rather than capacitybuilding to improve salaries, human resource management, and the procurement of basic medical supplies and much-needed in-country training. In many developing countries, health care needs require a broad grounding in public health. Training, however, in some source countries for medical professionals especially for physicians has tended to focus on advanced medical techniques. Graduates are unlikely to use such training or to make professional advances in these areas without moving to countries where medical technology is more readily accessible and used. Other factors in destination countries act as magnets for health workers in the developing world. With fewer people having children and individuals living longer, there has been a profound change in the industrialized world's age distribution, from Japan to Italy. As a result, there is a growing demand for health care workers, especially those who can provide assistance to the elderly. The US Department of Health and Human Services projects a possible lack of 275,000 nurses by 2010 in the US, and the UK's National Health Service has a goal of adding 20,000 more nurses by 2004.
36 GHS Neg
( ) The GHS alone doesnt remedy the root causes of the health worker crisis low pay, morale, work conditions, and weak management Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 What underlies the health workforce crisis? In many countries, including those with a high prevalence of HIV/AIDS, the inability to recruit and retain an effective, well-motivated, appropriately skilled health workforce stems not only from HIV/AIDS itself, but from other problems as well, including low pay and morale, poor work conditions, and weak management. Some workers experience a combination of understaffed workplaces, low compensation, and civil service or public expenditure reforms that prevent recruitment of new staff. In recent years, these factors have fueled a trend for some health professionals to move from the public to the private sector, to migrate internationally in pursuit of more favorable opportunities, or to abandon their profession altogether.
( ) Low pay is the critical factor in boosting health capacity aff doesnt remedy Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 In many countries, including those with high HIV prevalence, the inability to recruit and retain an effective, well-motivated, appropriately skilled workforce stems from a range of additional problems that include low pay, poor work conditions, and weak management. Some workers experience a triple bind: their workplaces are understaffed and their compensation packages woefully inadequate, but civil service or public expenditure reforms prevent recruitment of new staff or substitutes for missing colleagues (sometimes called ghost workers). In recent years, these factors have fueled the trends for some health professionals to move from the public to the private sector or to leave their professions altogether, as well as the above-noted trend to migrate internationally in pursuit of more favorable opportunities. The most common grievance of health workers is poor pay. Wages are often insufficient to cover personal and family needs. In addition, salaries may not be adjusted for rising inflation and may not be paid on time.
37 GHS Neg
38 GHS Neg
( ) African patriarchy causes AIDS spread Jennifer Brower, RAND Co-Project Director and Peter Chalk, RAND Political scientist in disease, 2003, The
Global Threat, http://www.rand.org/pubs/monograph_reports/MR1602/ Further exacerbating the situation is the patriarchy inherent in black South African society. Women are commonly regarded as inferior and akin to property, and expectations are for sex to be given whenever and however demanded. Such a duty, entrenched in years of tribal tradition, remains an integral feature of many rural communities and is one that is rarely, if ever, questioned. This ingrained gender structure has negatively affected the empowerment of women and, in so doing, undermined female options for refusing intercourse and/or insisting on safe practices such as the use of condoms.24 The sex trade has also emerged as a major vector for the spread of HIV in South Africa. Prostitutes are used widely throughout the country, something that is particularly true of long-distance truck drivers and ruralurban migrant mine workersboth of whom are forced to spend long periods of time away from their homes and families.25 Viral infection rates among these segments of the population have skyrocketed in recent years, both on account of the inherent dangers of multiple partners and the African preference for unprotected sex (commercial truck drivers are known to pay double for intercourse without a condom).26 During the next three to four years, the prevalence of HIV in the transportation and migrantconcentrated mining (as well as construction) sectors is expected to soar to at least 23 percent, and possibly as high as 29 percent, with prostitution use remaining one of the primary causes of transmission.27 Sexual Abuse and Violence Added to these various factors is a culture of sexual abuse and violence, which is now entrenched in southern Africa and is, in many ways, a product of the lack of female empowerment noted above. Rape has become increasingly common, especially among teenage boys who suffer little, if any, social stigmatization from engaging in the practice. Indeed, in many rural schools, jock rolling (gang rape) is regarded as cool and generally associated with the most popular and socially confident members of the local community. There has also been a major increase in sexual victimization on account of urban legends and myths.28 One of the most alarming such myths is the widespread belief that an HIV-infected male can cure his disease by having sex with a virgin. Forced sex between older men and young girls has, as a result, become increasingly common, especially in the viral endemic belts of KwaZulu Natal and Mpumalanga provinces.29 Overall, roughly 50,000 women are raped every year in South Africathree times the figure for the United States.30
39 GHS Neg
Lack of education about the disease is also a contributing factor to people not seeking treatment. Many women in rural African villages do not know the names or symptoms of many sexually transmitted diseases. 229 This is particularly disturbing when compounded with the fact that in many cultures, women are not educated and are illiterate. Finally, armed conflict and political unrest in parts of Africa also undermine the ability to provide access to anti-AIDS medicines. 230 [*404] Clearly, reducing the price of drugs alone is not the sole solution to the problem of access to
such a teenager were to ask for condoms in an average clinic, let alone anti-AIDS drugs, he or she would be chastised and told to practice abstention. 228 medicines in developing countries. A holistic approach that addresses all the relevant hurdles is required. Without such efforts, the recent concessions by the United States and the
pharmaceutical companies are not liable to impact the AIDS pandemic significantly.
40 GHS Neg
41 GHS Neg
42 GHS Neg
43 GHS Neg
( ) Only a global approach can solve AIDS focusing on sub-Saharan Africa is insufficient Peter Piot, Exec. Dir. of UNAID, 7-18-2005, HIV and National Security,
http://www.cfr.org/publication/8428/hiv_and_national_security.html PIOT: I would like to end with a far more optimistic note, frankly, not because we are all going off to dinner, now, but because I think really, after twenty-five years in this epidemic nearly, that for the first time, lets say the stars are getting into the right alignment; is that how you say it in English? What I mentioned, there is so much more political leadership, there is so much more going on at the community level, there is so much more money, the key issue now is that leadership. I come back to that. Without leadership, and that your dollar can buy leadership, without that, were not going to make it. And thats why its so important that you, all of you, and the Council and the security community and so on, that we continue to hammer on that. We cant let it go, and when a country doesnt respond to AIDS, there is something like an international responsibility to say, Look, AIDS will not be solved anywhere until its under control everywhere. If you have one country, lets take Myanmar, Burma, where they have the worst-stage epidemic in Asia at the moment. HOLBROOKE: And Papua, New Guinea. PIOT: And Papua, New Guinea, in the Pacific. And if Burma is not bringing AIDS under control, then the great efforts that all its neighbors are doing at the moment are useless, because there will be a continuous expansion, export, of HIV throughout the region. So whats why it really requires a global approach. If there is one issue today, its that.
44 GHS Neg
( ) AIDS is exaggerated faulty statistics political agendas and the pressure for foreign aid. Michael Glueck, M.D. award winning writer, and Robert Cihak, MD Discovery Institute Senior Fellow, past
president of the Assoc. of American Physicians and Surgeons, both are Harvard trained diagnostic radiologists, African AIDS: A Phantom Epidemic? Jewish World Review, Nov 18, 2005, http://www.jewishworldreview.com/1105/medicine.men111805.php3 In Africa, poverty, distance and isolation make accurate, continent-wide diagnosis and statistics impossible. As a result, most health and population statistics are estimates or guesses, often driven by political and cultural agendas and always driven by the need to generate more outside funding from wealthier regions of the world. Thus, the severity of just about everything gets "oversold." This is especially true for AIDS. Proper diagnosis can require trained medical people, medical history, physical examination, blood tests and sophisticated facilities. These are rare in most parts of Africa, and few Africans can afford this level of medical care even where it is available.
45 GHS Neg
( ) US policies limiting public sector salaries destroy the effectiveness of US aid Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
Internal: US policies that limit public sector and recurrent support hamper US aid efforts. Congress should take steps to allow OGAC and GHC Directors maximum flexibility to take actions deemed necessary without burdensome waiver processes, and US agencies should repeal in-house limitations. Momentum behind addressing health worker crises presents an opportunity to rectify sometimes-arbitrary congressional limits on public sector investment and recurrent salary support. These policies have hindered the capacity of the U.S. to achieve health improvements such as scale-up of AIDS treatment. US agencies doing country-level work are forced to routinely bend rules or laboriously work around prohibitions against salary or public sector support in order to retain personnel necessary to fulfill program requirements. Policy makers should grant US aid programs the flexibility needed to strengthen overall health development so that US treatment and prevention targets may be realized. Investments directly in a countrys public health infrastructure bolster the health system; extend the reach of United States public diplomacy; and supports country ownership of plans to address healthcare worker shortages and health systems development.
( ) Even their authors admit the GHS is insufficient to solve the health capacity crisis it lacks a permanent staff Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
The GHC authors have recognized that trained healthcare workers in isolation are insufficient to address health crises. One useful addendum to the technical assistance capacity and value of the Global Health Corps that addresses some of the weaknesses of sporadic volunteer programs would be to include a permanent staff of 100-200 systems builders posted in-country to solve implementation problems and provide sustained support for health system strengthening. Technicians and managers could work with ministries of health and finance to address the lack of capacity in newly coordinated public and private sector health programs by developing and implementing strategic plans to train and sustain adequate numbers and mixes of healthcare workers, lab technicians, IT managers and supply chain managers. These permanent GHC postings can help train-up or provide TA for fledgling in-country health administrators, and make use of existing or underway needs assessments performed by WHO, USAID, PEPFAR, national planning bodies and other actors. These health systems czars are needed by OGAG or by Country Action Teams, and are valuable with or without a Global Health Corps.
46 GHS Neg
There will he no pandemic humans will adapt Malcolm Gladwell, The New Republic, July 17 and 24, 1995, excerpted in Epidemics: Opposing Viewpoints, 1999, p. 29
In Plagues and Peoples, which appeared in 1977. William MeNeill pointed out thatwhile mans efforts to remodel his environment are sometimes a source of new disease. they are seldom a source of serious epidemic disease. Quite the opposite. As humans and new microorganisms interact, they begin to accommodate each other. Human populations slowly build up resistance to circulating infections. What were once virulent infections, such as syphilis become attenuated. Over time, diseases of adults, such as measles and chicken pox, become limited to children, whose immune systems are still nave.
47 GHS Neg
48 GHS Neg
49 GHS Neg
50 GHS Neg
51 GHS Neg
( ) Brain drain doesnt have a negative impact on health capacity new studies prove emigration spurs more training Kerry Howley, Reason Magazine, 7-1-2007, Out of Africa, p ln
LAST YEAR, AS Congress was wrangling over immigration policy, Sen.Sam Brownback (R-Kan.) proposed a simple solution to the U.S. nursing shortage: lift the cap on nursing visas. The proposal fizzled, but not before critics charged that such a policy would be cruel and irresponsible. A news story in The New York Times asserted that "the exodus of nurses from poor to rich countries has strained health systems in the developing world," where countries "are already facing severe shortages of their own." A new study has turned this assumption on its head. To test whether health worker emigration is hurting developing countries, Michael Clemens, an economist at the Center for Global Development and an expert on international migration, created and analyzed a database of health worker emigrants from Africa. To his surprise, Clemens failed to detect "any negative impact of even massive movements of health professionals out of Africa upon health worker stocks, basic primary health care availability, and public health outcomes." The African countries that send the most workers abroad, it turnsout, are educating many more doctors and nurses than they are employing. It's a mistake to assume that an Ethiopian physician who takes ajob in New York would otherwise be seeing patients in Addis Ababa. The shortages of working medical professionals to which the Times referred are a reality, but they reflect systemic problems, not a lack ofhealth care workers. For some would-be physicians, the opportunity to emigrate may be the driving force behind the decision to seek training. Denying visas to nurses in Mozambique may just result in fewer nurses overall. "Punishing emigration, restricting quotas, and banning recruitment," Clemens concludes, "may at best make no one better off and at worst make everyone worse off."
52 GHS Neg
53 GHS Neg
54 GHS Neg
( ) Brain Drain jacks solvency US will continue to siphon off workers to fill its health care shortages Laurie Garrett, senior fellow for Global Health @ CFR, Jan/Feb 2007, The Challenge of Global Health,
http://fullaccess.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html The fact that the world is now short well over four million health-care workers, moreover, is all too often ignored. As the populations of the developed countries are aging and coming to require ever more medical attention, they are sucking away local health talent from developing countries. Already, one out of five practicing physicians in the United States is foreign-trained, and a study recently published in JAMA: The Journal of the American Medical Association estimated that if current trends continue, by 2020 the United States could face a shortage of up to 800,000 nurses and 200,000 doctors. Unless it and other wealthy nations radically increase salaries and domestic training programs for physicians and nurses, it is likely that within 15 years the majority of workers staffing their hospitals will have been born and trained in poor and middle-income countries. As such workers flood to the West, the developing world will grow even more desperate.
55 GHS Neg
( ) The plan causes more brain drain Kaiser Daily Health Policy Report, 4-20-2005, Politics and Policy,
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=29463 Reaction: An unnamed spokesperson for Global AIDS Coordinator Ambassador Randall Tobias said that officials are reviewing the report and that it is too early to provide a "timetable for action," the Journal reports. "Since we requested this report and on a short time frame, we certainly will waste no time reviewing its findings," she said. Some international health workers have called the proposal a "positive step," but they also "expressed concern" that it would be available only to PEPFAR focus countries, according to the Journal. UNAIDS Executive Director Peter Piot said the program should be linked to broader policy objectives, such as ensuring decent wages for health care workers in developing countries. He added that the partnership component of the program could exacerbate the brain drain of doctors in the developing world by recruiting health care professionals to better-paying jobs. "Isn't it a bit absurd that we then send nurses and doctors to fill slots in Africa that have been emptied by our recruitment policies?" Piot asked. Nancy Padian, associate director of the UCSF Global Health Sciences program, said that PEPFAR itself could contribute to the drain on health care professionals from countries highly affected by HIV/AIDS. Padian said that new PEPFAR-funded programs in Zambia and Botswana are attracting nurses and physicians who are being trained in Zimbabwe, according to the Journal.
56 GHS Neg
57 GHS Neg
58 GHS Neg
59 GHS Neg
( ) Any other foreign assistance will be totally ineffective without efforts to reverse African Brain Drain Dick Durbin, senator, et al, 8-2-2006, S. 3775: African Health Capacity Investment Act of 2006,
http://www.theorator.com/bills109/s3775.html (25) Foreign assistance by the United States that expands local capacities, provides commodities or training, or builds on and enhances community-based and national programs and leadership can increase the impact, efficiency, and sustainability of funded efforts by the United States. (26) African health care professionals immigrate to the United States for the same set of reasons that have led millions of people to come to this country, including the desire for freedom, for economic opportunity, and for a better life for themselves and their children, and the rights and motivations of these individuals must be respected. (27) Helping countries in sub-Saharan Africa increase salaries and benefits of health care professionals, improve working conditions, including the adoption of universal precautions against workplace infection, improve management of health care systems and institutions, increase the capacity of health training institutions, and expand education opportunities will alleviate some of the pressures driving the migration of health care personnel from sub-Saharan Africa. (28) While the scope of the problem of dire shortfalls of personnel and inadequacies of infrastructure in the sub-Saharan African health systems is immense, effective and targeted interventions to improve working conditions, management, and productivity would yield significant dividends in improved health care. (29) Failure to address the shortage of health care professionals and paraprofessionals, and the factors pushing individuals to leave sub-Saharan Africa will undermine the objectives of United States development policy and will subvert opportunities to achieve internationally recognized goals for the treatment and prevention of HIV/AIDS and other diseases, in the reduction of child and maternal mortality, and for economic growth and development in sub-Saharan Africa.
60 GHS Neg
61 GHS Neg
62 GHS Neg
( ) Remittances are vastly insufficient to check the impacts of brain drain, and exacerbate inequality Ted Schrecker, MA, and Ronald Labonte, PhD, Oct-Dec 2004, Taming the Brain Drain, Intl J. of
Occupational and Envtl Health, v. 10, iss. 4, p. pq This pattern of emigration not only compromises efforts to build health systems; it also has dramatic economic consequences. Direct financial losses for countries such as Zimbabwe and Nigeria from training doctors who rapidly emigrate exceed tens of millions of dollars per year,10,19 losses that these economies, and their health systems, can ill afford to absorb. A single recruiting effort by the Canadian province of Alberta led to the emigration of doctors whose training cost South Africa an estimated $12.6 million.20 The Deputy Director-General of the International Organization for Migration pointed out in 2002 that: "[AJt a cost of $60,000 to train a medical doctor in the South and $12,000 for a paramedical, it may be said that the developing countries are 'subsidising' the OECD countries to the tune of some $500 million per year, and what is more, largely financed by . .. development aid."21 Remittances from migrs are sometimes identified as an important benefit of migration to richer countries: a recent World Bank study pointed out that the value of such remittances ($72.3 billion) in 2001 was considerably higher than the value of official development assistance,22 and that remittances represent a relatively stable source of foreign exchange. Whatever the general merits of this argument, its relevance to the brain drain of health professionals from southern Africa (probably from most developing regions) is seriously limited. Of the top 20 recipient countries ranked by remittances as a percentage of GDP, only two (Lesotho and Uganda) were in southern Africa.22 The long period of training means that remittances from health professionals may flow disproportionately to relatively well-off households, thus paradoxically increasing inequality in the country of origin. In addition, the costs of health professionals' emigration are far greater than just the direct costs of their training; they also include the reduced ability of health systems in the country of origin to deliver services and reductions in training and research capacity,23 both of which undermine long-term domestic economic and social development. We are unaware of any empirical studies that have taken these broader and longer-term outcomes into consideration, but it is highly unlikely that remittances will be sufficient to offset their costs.
63 GHS Neg
64 GHS Neg
( ) SSA isnt key to soft power theyre the only ones left that love the U.S. Jim Lobe, Washington Bureau Chief of IPS, 6-28-07, Survey: US Image Abroad Still Sinking, Antiwar.com,
Accessed on 7-12-07, http://www.antiwar.com/lobe/?articleid=11211 The survey, which included more than 45,000 respondents interviewed in 46 countries and the Palestinian Territories (PT) during April and early May, found that the U.S. retains great popularity (roughly twothirds or more rate it favorably) only in Israel and most of sub-Saharan Africa. But its standing among its western European allies, most of Central and Eastern Europe, Latin America, as well as the Islamic world and most of Asia, including China, has continued to fall, particularly compared to five years ago on the eve of its invasion of Iraq, according to the survey.
65 GHS Neg
66 GHS Neg
67 GHS Neg
68 GHS Neg
( ) PEPFAR already indicates U.S. commitment to health Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 During his State of the Union address on January 28, 2003, President George W. Bush announced the $15 billion PEPFAR initiative, with the following 5-year goals: (1) providing antiretroviral therapy for 2 million people; (2) preventing 7 million new HIV infections; and (3) providing care to 10 million people infected with or affected by HIV/AIDS, including orphans and vulnerable children. In May 2003, the U.S. Congress passed authorizing legislation (United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003) for the plan. Legislative provisions recommended the following targeted distribution of funds: treatment (55 percent), prevention (20 percent), palliative care (15 percent), and care of orphans and vulnerable persons (10 percent). This unprecedented global health initiative placed the United States at the forefront of international efforts targeting HIV/AIDS. Today PEPFAR accounts for more than 50 percent of annual global funding. PEPFAR now encompasses HIV/AIDS activities in more than 100 countries, but is focused on the development of comprehensive and integrated prevention, care, and treatment programs in 15 countries: Botswana, Cote dIvoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Vietnam. The original 14 countries in Africa and the Caribbean represent 50 percent of the worlds HIV/AIDS burden. Vietnam was added to the list in July 2004 as a result of its projected eight-fold rise in HIV infections from 2002 to 2010 (Office of National AIDS Policy, 2004).
69 GHS Neg
70 GHS Neg
71 GHS Neg
72 GHS Neg
( ) Tons of other reasons soft power is down Sankar Sen, Frmr. Dir. Indian Nat. Police Academy, Statesman, 4-5-2005, American Power, p ln
Indeed anti-American sentiment is sweeping the world after the Iraq war. It has, of course, been aggravated by the aggressive style of the present American President. Under George Bush, antiAmericanism is widely thought to have reached new heights. In the coming years the USA will lose more of its ability to lead others if it decides to act unilaterally. If other states step aside and question the USA's policies and objectives and seek to de-legitimise them, the problems of the USA will increase manifold. American success will lie in melding power and cooperation and generating a belief in other countries that their interests will be served by working with instead of opposing the United States. It is aptly said that use of power without cooperation becomes dictatorial and breeds resistance and resentment. But cooperation without power produces posturing and no concrete progress. There is also another disquieting development. It seems American soft power is waning and it is losing its allure as a model society. Much of the rest of the world is no longer looking up to the USA as a beacon. Rising religiosity, rank hostility to the UN, Bush's doctrine of preventive war, Guantanamo Bay etc are creating disquiet in the minds of many and turning them off America. This diminution of America's soft power will also create disenchantment and may gradually affect American pre-eminence.
73 GHS Neg
There should also be an unambiguous American endorsement of international lawnot later, but now. With regard to the International Criminal Court, the best thing would be to return to the U.S. position of September 2000. That would mean resigning the Rome treaty that Clinton signed and Bush "unsigned"a gratuitous insult to many of our friends around the world
since there are plenty of Republicans who recognize the importance of the treaty and the self-destructiveness of what the Senate did seven years ago.
whose help we are going to need. Again, that's unlikely to happen. But there should be no doubt about the damage we do ourselves by remaining outside the ICC. At a minimum, we should abandon efforts to negotiate immunity for U.S. forces, especially since we have, in those negotiations, little "leverage"to return to that word in the conference topicfor getting our way in that regard, as in so many others. Another salutary step would be to engage actively and constructively with the new Human Rights Council at the UN. We're in the position now of not even having a delegate on the council. The country of Eleanor Roosevelt is on the sidelines of the effort to breathe new life into the Human Rights Commission that she was so instrumental in establishing. This is not just a shameit's an absurdity. Speaking of international law and human rightsand coming back to Iraqthere's the question of treatment of prisoners. We should make a commitment to adhere to the Geneva Conventions and move affirmatively to restore habeas corpus rights to terrorist detainees. And since we're so focused on exit strategy for Iraq, let's have one for Guantanamo as well: either make it Geneva-compliant or close it down in way that ensures its inmates aren't sent to places, like Syria, where the conditions will be even worse. I'm now going to put one more issue on the table: climate change. That may seem extraneous to dealing with terrorism and Iraq and the meltdown of U.S. policy in the Greater Middle East. I include it on the list for two reasons: first, because a new policy on global warming is important in its own right; second, it's important as evidence of a new foreign policy in general. The Bush administration's obstructionism and obscurantism on global warming has become symbolic of what much of rest of world resents and resists about the substance and style of leadership. We can't launch an effective "diplomatic offensive" in the Middle East if a key aspect of our global diplomacy is offensive to much of the worldand, by the way, to many of our own citizens. We all understand that the administration doesn't like Kyoto. But you can't beat something with nothing, and at the national level, our policy on this issue is almost wholly negative. There should be an active search for successor to the Kyoto Protocolmaybe the Mumbai Protocol, or the Shanghai Protocol. It would be a step in a negotiated international agreement with binding limits for the administration to support, here at home, legislation to limit heat-trapping gases. It could do so by taking a page from what Governor Schwarzenegger is doing in California and what Senator McCain and Lieberman were able to get majority support for in the Senate with the GOP in control.
74 GHS Neg
75 GHS Neg
the Iraq war makes the world more dan- gerous, and this perception undercuts support for the overall war on terrorism. 6 American actions at Abu Ghraib, Guan- tanamo, and Haditha combine with U.S. renditions, defense of torture, and viola- tions of the Geneva Conventions to blacken the U.S.image. In the past, when foreign attitudes faulted the U.S. gov- ernment, the American people still enjoyed favorable ratings,
but this has been changing:between2002and2005 favorability ratings of Americans fell in nine of twelve countries polled. 7 As Roger Cohen memorably put it, the world has stopped buying the American narrative. 8 A catalogue of further complaints completes the picture. World opinion faults the Bush administration for its unilateralism and preemption, unflinching support of Israel, and scorn for international organizations. The Bush administrations decision to with- draw from the Kyoto Protocol and its dismissal of the threat of global warming have been met with dismay by key Asian and European allies. Additional irritants include stingy assistance to the worlds poor in comparison with other wealthy countries and the slow and ineffective response to Katrina, which made the U.S. government appear less generous and even-handed than America claims to be. 9 Reservoirs of goodwill built up over decades have evaporated, as has the worldwide sympathy felt for the United States in the immediate aftermath of 9/11. Nevertheless the Bush administra- tion portrays the United States as Presi- dent Ronald Reagans city on the hill, radiating hope, high principles, fairness, honesty, and opportunity while spread- ing democracy. Many Americans agree, arguing that anti-American sentiments historically run in cycles and are part of any great powers burden. However, the present antipathy toward the United States belies optimism and is unlikely to ebb without strong corrective measures. A mix of factors shapes public opinion about another country: the countrys foreign policy, its soft power, its official public diplomacy,and individual experi- ences with that country. A countrys policies exert the strongest influence; few foreign societies will approve of U.S. policies they believe to be against their own interests. In the Muslim world, for example, the U.S.war on terror is perceived to be directed against Islam and has exacerbated the antiWestern aspects of Islamic funda- mentalism. 10 Soft power, the concept created by Joseph Nye of Harvard University, is a nations ability to attract and persuade others in ways that conform to its ideals or objectives. 11 Soft power is derived from values, culture, institutions, and behav- ior, which emanate from both society and the government. The United States accrued soft power during the twentieth century because it adhered to its found- ing democratic ideals; demonstrated its values through such programs as the Marshall Plan; and propagated its appealing culture and lifestyle, both commercially and through government- sponsored programs and media such as the Voice of America and Radio Free Europe/Radio Liberty. U.S. soft power was strongest in strategically important Japan and Europe, though the phenom- enon was global. Public diplomacy, a much-debated adjunct to traditional diplomacy, seeks to understand, inform, engage, and influ- ence foreign societies friendly, hostile, and wavering through a variety of infor- mation, culture, education, and advoca- cy programs. Public diplomacy, unlike spin or propaganda, succeeds when it accurately reflects and advocates a gov- ernments polices and amplifies a nations soft power. 12 U.S. government enthusiasm for public diplomacy, having waxed and waned during the last one hundred years, is currently tepid, leaving the enterprise under-funded and understaffedyet charged with battling anti-Americanism almost single-hand- edly. Although the most expert public diplomacy in the world cannot alone restore a governments image any more than a brilliant advertising campaign can sell an inferior product, robust public diplomacy is one of the essential and most cost-effective tools of
modern diplomacy.
76 GHS Neg
77 GHS Neg
like the Holy Grail of legend, public diplomacy is the object of a neverending, ultimately futile quest. Other countries are not going to buy what the United States is selling. Its not the packaging that others dislike. Its the product. The Washington consensus Well before the attacks of 11
September, US government figures regularly noted the atrocious results of the countrys efforts to sway public opinion in the Muslim world.3 Afterwards, the United States redoubled its efforts in this regard. The Bush administration decided to establish a permanent White House office of global diplomacy. The State Department hired Charlotte Beers, who had headed two of the worlds ten largest advertising agencies and had been the first female product manager for Uncle Bens Rice, as Under-Secretary for Public Diplomacy and Public Affairs. However, the Pentagons ill-named Office of Strategic Influence was abandoned only after word leaked that, while waging information warfare, it might lie.4 Searching for a silver bullet to the dilemma of American power, the Bush administration thought it had found one in stepped-up public diplomacy that is, overt government sponsored programmes intended to shape public opinion in other countries.5 Though the practical impediments were known to be considerable, the theory was simple enough. As Beers put it in November 2001, in many countries Americas message is often distorted, one-dimensional, or simply not heard.6 If only the rest of the world enjoyed unfettered access to accurate information and independent media, they would understand that the United States does not seek an empire, that the war on terror is in every civilised nations interest, and that Americas values are universal. If only the United States clearly articulated its message, then surely the rest of the world would jump on the American bandwagon. As evidence of mounting anti-Americanism accumulated, Beers critics quickly pointed out that selling Uncle Bens was a lot easier than selling Uncle Sam. She resigned in frustration and under fire in March 2003 and was not replaced until ten months later by Margaret Tutwiler, an old Washington hand who had previously served, among other positions, as ambassador to Morocco and State Department spokesperson. But, regardless of who was at the helm, the fundamentals of the underlying theory were unchanged. Unfortunately, it has not worked. In
2003 the US General Accounting Office concluded that the almost $600 million the United States was spending annually to improve its image around the world was largely ineffectual.7 Surveys by the Pew Research Center have documented exhaustively the precipitous decline in favourable views and trust of the United States across large swathes of the globe. The downward drift was already under way before the invasion of Iraq, but that decision clearly gave the trend new impetus. US favourability ratings, which were above 60% in France and Germany as late as the summer of 2002, had plummeted to below 40% by March 2004; only a slim majority of Britons still looked favourably on the United States by this past spring. Views of the United States were already unfavourable in much of the Muslim world in the summer of 2002, and have only worsened since then. These same surveys, however, have found that Americans, as people, garner more favourable opinion than does their government and that many (though not all) American values as well as its democratic institutions are admired abroad, particularly among younger Muslims and Arabs.8 US public diplomacy has clearly failed to exploit these potential areas of agreement to forge mutual respect. Rather than reject public diplomacys premise, however, the Beltway response has been to criticise its implementation.9 Some have focused on the Bush administrations tendency to step needlessly on others toes, from Defense Secretary Donald Rumsfelds notoriously dismissive reference to old Europe to Secretary of State Colin Powells condescending, even emasculating, observation that French Foreign Minister Hubert Vedrine had developed a case of the vapours and whatnot in response to the 2002 State of the Union.10 Others have ridiculed the clumsiness and transparency of the American-sponsored media in Iraq and elsewhere in the Arab and Muslim world from the State Departments Shared Values television spots that many Arab countries refused to run to the one-sided reporting on the Americansponsored radio stations broadcasting in Arabic and Persian. Others have pointed to the absurdity of developing websites to influence people in regions with highly restricted Internet access, while others have called for making far greater use of satellite and information technologies, including the Internet. Still others have fingered the lack of continuous leadership, as Tutwiler herself, though an experienced Washington insider, lasted just five months before she announced that she would bolt to Wall Street. Others have called the nations public diplomacy programmes dangerously underfunded and understaffed, and have criticised the level of coordination among the many relevant arms of government. Others have noted the absence of solid measures of program effectiveness and have urged Washington to exploit private sector expertise more fully. And so on. Think tanks and government agencies have issued a stream of reports on how to fix American public diplomacy and boost Americas image abroad.11 Whatever the criticism du jour, the Washington consensus has survived, and the essence of the public diplomacy enterprise has remained intact.12 Some have recommended bureaucratic and procedural overhauls, such as the initiation of a Quadrennial Public Diplomacy Review and the formation of a not-for-profit Corporation for Public Diplomacy and a Public Diplomacy Reserve Corps. Others have advised more substantive reforms, including more training for ambassadors, greater reliance on local moderate voices to spread Americas message, the expansion of student and cultural exchange programmes and the creation of more accessible information centres. According to Democratic partisans, the problem has been as much stylistic and personal as anything else, and the election of Democratic presidential candidate Senator John Kerry, a New Englander less prone to shooting from the hip, would have given the United States a fresh start. Like other doctrines before it, persistent failure has done nothing to dull public diplomacys lustre. Better image management alone, however, will not allow the United States to exercise its power without provoking opposition abroad. It is substance that is at issue, not style: lasting change in image will come only with meaningful and difficult changes in the way that the United States conducts itself.
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at the margins, but it should not be deemed a critical part of the solution to Americas problems abroad. For people in industrialised nations, the American quest for empire manifests itself in the United States penchant for unilateralism, in its pursuit of its own freedom of action as its highest priority. Whether this can properly
be called empire is certainly debatable, but it is not debatable that this is a very real trend though admittedly one that first budded in the Clinton administration before it fully bloomed under Bush. President Bill Clinton went to war in Kosovo without the UNs imprimatur; Bush arguably had a stronger legal basis for launching the invasion of Iraq. Clinton was at best equivocal about the International Criminal Court (ICC), a major sticking point in the Bush administrations relations with Europeans in particular. Other prominent international accords from the Kyoto Protocol to the land-mine ban have met with a cooler reception in the Bush White House than they did in its predecessor. Despite talk of the coalition of the willing, the sum total of the Bush administrations actions bespeaks a hegemon that is perfectly happy to collaborate when doing so furthers shortrun US interests but which does not see the nurturing of a cooperative international environment as valuable in the middle to long term. Nor would a Kerry administrations foreign policy likely have differed markedly, if the candidates pronouncements on issues from pre-emption to Kyoto to the ICC can be taken seriously. Americas troubled relationship
: the world today is unipolar and will probably remain so for the foreseeable future.16 The countries of the industrialised world, particularly Americas NATO allies, are used to, and feel entitled to, more influence than the United States has of late been willing to grant them. During the Cold War, the structure of the Atlantic Alliance ensured that allies would have some say in American foreign policy.17 They became accustomed to such consultation, and even after the Soviet Unions collapse, they still expect a seat at the table. Yet their aspirations do not accord with their capabilities.18 As much as the French or Germans dislike the United States decision to opt out of the Kyoto Protocol or oppose its commitment to develop a national missile defence, most conceivable strategies to counter American hegemony would hurt the Europeans more than they would hurt the United States. The formation of a traditional balance of power, the prescription of classical realpolitik, is out of the question. As their opposition crystallised over Iraq, they were limited to hindering the US quest for UN approval. Soft balancing perhaps. A weapon of the weak most certainly.19 They have found themselves in a position akin to that of the conspirators against Julius Caesar: as Cassius whispers in Brutus ear (in Shakespeares rendering), Why, man, he doth bestride the narrow world/Like a Colossus, and we petty men/Walk under his huge legs and peep about/To find ourselves dishonourable graves.20 But murdering or deposing this new Caesar is impossible. In contrast to the Europeans, the Russians and the Chinese have never expected a seat at the American table: they have either headed or desired their own table. With their power in decline but their pride intact, the Russians now want a seat as an honoured guest. As Americas only foreseeable peer competitor, the Chinese are reluctant to sit at any table where they cannot be at least co-host. While transatlantic relations have soured over the last three years, the opposite has occurred with these past, present, and perhaps future rivals persistent differences over key hot-spots, such as Iraq and Iran, aside. President Bush has been almost chummy with Russian President Vladimir Putin and, in exchange for the latters support in the war on terror, has turned a blind eye to Russian brutality in the Caucasus and to Putins antidemocratic arrogations of executive authority. A similar quid pro quo was arranged with China with regard to the separatist Uighurs, and the success of US efforts to bring North Korea into the non-nuclear fold hinges on Chinas special relationship with that country and on its taking a lead role in bringing Kim Jong Il to heel. Nevertheless, the Chinese have, as much as the French, decried the American hyper-power not its dominance per se, but the way in which it has exercised that power. Better image management cannot massage away fundamental tensions, though it would no doubt loosen some aggravating knots. Kind words and warm gestures will not make the Europeans forget that, at the end of the day, the United States need not show them the deference it displayed during the Cold War. Without a history of friendship with the United States, Russia and China are even more wary of American power and even less likely to be swayed. Only control over the unbridled exercise of American power could bring a measure of serenity to these
unsettled relationships. Rather than seek to maximise its autonomy in the short run, the United States could willingly bind itself, sacrificing shortrun gains for the creation of an international milieu from which it would in the long run profit, perhaps disproportionately. As John Ikenberry has argued, this is what American statesmen so wisely did in the wake of the Second World War.21 And it is the sort of visionary leadership so lacking in Washington today.
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values and interests are threatened by the installation of a market economy know at whom to cast the first stone. Thanks to the information and telecommunications revolution, people in the developing world are today more aware than
ever of the chasm between their standard of living and that of the West, and they are consequently more aware than ever of their relative deprivation. Political violence often erupts not in poor egalitarian societies but in those that are deeply unequal, regardless of the absolute level of wealth. If all are poor, poverty is not cast in sharp relief, and the objective situation may not seem subjectively so dire. But inequality makes those who are poor in relative terms aware of their plight, and their mounting
frustration and wrath eventually bubble over in a paroxysm of violence directed against those with the capacity to close the gap.24 As a Gallup survey concluded in 2002, the citizens of Islamic nations are at least outwardly not
as much envious or covetous of the success of the West as they are resentful resentful that the powerful West does not help ... [and] seemingly does not care.25 Hegemony is a double-edged sword: with greater capability comes greater responsibility. As the leader of the West and as, far and away, the wealthiest and most militarily powerful country, the United States is seemingly most capable of narrowing inequity, yet it has been perhaps least willing to do so. Secondly, the prevalence of state authorities unresponsive to their populaces has also contributed to loathing of the United States. While the United States cannot be held mainly responsible for the Middle Easts and other regions democratic deficits, myopic American policies, both during and after the Cold War, have helped sustain illiberal client regimes, from Pakistan to Egypt, Saudi Arabia to Zaire. The promotion of democracy has been a regular feature of American presidents rhetoric, but the lack of actual promotion of
democracy, combined with tangible moves to undermine popular anti-American regimes, has bred cynicism. The past and present of US policy weigh heavily: even when replacing a brutal authoritarian regime with legitimate
democratic institutions has seemingly been a primary goal, as in the case of Iraq, the world doubts Americas sincerity. Americans generally see themselves as generous to a fault, tolerant of religious and cultural diversity, and supportive of the common mans ambition to boost his standard of living. They believe themselves to be exemplars of liberal and democratic values and that their countrys benign worldview is apparent to all. If others have failed to grasp this, Americans reason, it is because the United States in its navet and good faith has assumed that truth would win out in the end and has therefore failed to confront the sources of disinformation seeking to promote a clash of civilizations where none should exist. The ensuing recommendations come from the build-abetter-mousetrap school of public diplomacy: promote open access to multiple news sources as a corrective to government-sponsored organs that spew anti-American venom; design government institutions to project a unified voice, so that the American message is not drowned out by noise; be responsive to local mores and sensitivities; and draw on private sector know-how. But these proposed solutions misunderstand the sources of animosity toward the United States.
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( ) Massive anti-bioterror programs in the status quo Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 The threat of increased bioterrorism was made real by the terrorist attacks of September 11, 2001, and the subsequent mailing of letters laden with anthrax spores in October 2001. The challenges faced by international health programs have increased as a result. The current Bush Administration has responded with a 319 percent increase in spending on defense against bioterrorismto $5.9billion for fiscal year 2003. The funds will be used to improve detection and surveillance systems, strengthen medical capabilities, improve planning and coordination, foster research, expand training exercises and communication strategies, and address policies that create bureaucratic barriers to strengthening the U.S. capacity to address bioterrorism. The promised funding will potentially provide many new opportunities to strengthen the U.S. public health capacity to address multiple emerging infectious disease threats, both domestically and worldwide. This unprecedented level of funding offers a rare chance to make a difference in the surveillance and prevention of infectious diseases, although workshop participants expressed several concerns regarding the use and the sustainability of this funding.
( ) SSA isnt key to US image theyre the only ones left that love the U.S. Jim Lobe, Washington Bureau Chief of IPS, 6-28-07, Survey: US Image Abroad Still Sinking, Antiwar.com,
Accessed on 7-12-07, http://www.antiwar.com/lobe/?articleid=11211 The survey, which included more than 45,000 respondents interviewed in 46 countries and the Palestinian Territories (PT) during April and early May, found that the U.S. retains great popularity (roughly twothirds or more rate it favorably) only in Israel and most of sub-Saharan Africa. But its standing among its western European allies, most of Central and Eastern Europe, Latin America, as well as the Islamic world and most of Asia, including China, has continued to fall, particularly compared to five years ago on the eve of its invasion of Iraq, according to the survey.
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Iraq was supposed to have a well-developed anthrax programme. United Nations weapons inspectors, however, discovered anthrax only in liquid form, which, according to one expert, 'is almost as safe as candy'. Having
turned anthrax into powder, a terrorist would have to find a way of dispersing it in the air. Again, this is much more difficult than might be imagined. There was
much alarm when the FBI revealed that some of the hijackers involved in the World Trade Center attacks had previously made inquiries about crop-dusting planes. According to Barbara Rosenberg, director of the chemical and biological weapons programme of the Federation of American Scientists, 'a crop duster would be very useful for a chemical and biological attack - if you wanted to attack crops'. But it would not be that useful in attacking humans. To get spores to lodge deeply enough in the human lung to cause damage, they must be extremely small, less than ten microns
in size. Crop dusters are fitted with much larger dispensers that target insects and plants. It would be possible to modify them, but such modifications would require considerable expertise. 'You can't go down to the store and buy one off the shelf,' observes Rosenberg. There are similar problems with another both the developed and the developing world. It is highly contagious, but also very fragile and difficult to manipulate. It is
Smallpox is a virus that can cause bleeding and lesions all over the body, and it used to devastate large parts of almost impossible to obtain: only two laboratories in the world still possess supplies of live smallpox virus - the Centers for Disease Control and Prevention in Atlanta and the high-security Russian installation in Novosibirsk. Neither is likely to provide handouts for terrorists.
According to the FBI, there has been only one known case of bioterrorism in the US. It involved the Rajneeshee, members of a religious cult, who had established a large commune in Wasco County, a rural area east of Portland, Oregon. The cult decided to take over the county by manipulating the results of local elections in 1984. They planned to bus homeless people into their commune and register them as voters, while at the same time make opposing voters sick by infecting them with salmonella. Cult members contaminated food in ten salad bars with salmonella - resulting in the infection of 751 people, none of whom was seriously ill. The election outcome was unaffected - although two members of the cult were eventually convicted for their involvement in the plot. The 751 people infected by the Rajneeshee in this plot, more comic than tragic, are the only known American victims of bioterrorism. The only other group known to have dabbled with biological agents is the Aum Shinrikyo cult in Japan. In April 1990, the group tried to spread botulism through a car engine's exhaust; three years later, it attempted to spread anthrax by using a sprayer system on the roof of a building in eastern Tokyo. Neither incident resulted in a single casualty. In the end, the group abandoned its plans for biological warfare and turned to chemical weapons instead. In March 1995, the cult released sarin, a nerve toxin, into the Tokyo subway; $10m was apparently spent preparing the attack. Twelve people died in what remains the gravest non-military chemical attack ever. report on the threat of bioterrorism produced for the Strategic Forum of the Washington-based National Defence University,
All of which is why, according to a 'few terrorists have demonstrated real interest in bioterrorism and fewer still have made an attempt to acquire biological agents'.
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( ) The aff doesnt solve U.S. health capacity medical educational system is insufficient Mark S. Smolinski, Senior Program Officer @ Inst. Of Medicine @ NAS, et al., 3-18-2003, Microbial Threats to
Health, http://www.nap.edu/catalog/10636.html To rebuild the public health workforce needed to respond to microbial threats, health profession students (especially those in the medical, nursing, veterinary, and laboratory sciences) must be educated in public health as a science and as a career. Even for students within schools of public health, education has traditionally focused on academic research training, not public health practice. A 1988 IOM report notes that many observers feel that some [public health] schools have become somewhat isolated from public health practice and therefore no longer place a sufficiently high value on the training of professionals to work in health agencies (IOM, 1988:15). A more recent IOM report states that in 1998, only 56 of 125 medical schools required courses on such topics as public health, epidemiology, or biostatistics (IOM, 2002e). The report recommends that all medical students receive basic public health training. It also concludes that all nurses should have at least an introductory grasp of their role in public health, and that all undergraduates should have access to education in public health. Educational strategies in which applied epidemiology programs provide exposure to state and local health departments may help increase awareness of the role of public health in population-based infectious disease control and prevention, and provide for exposure to public health as a potential career choice (see the later discussion on educating and training the microbial threats workforce).
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( ) Military and law enforcement action is key to stopping terrorism in failed states their author doesnt think plan is enough Thomas Dempsey, Dir. African Studies @ US Army War College, April 2006, Counterterrorism in African
Failed States, Strategic Studies Institute, http://www.strategicstudiesinstitute.army.mil/pdffiles/pub649.pdf Integrating the U.S. foreign intelligence community, U.S. military forces, and U.S. law enforcement offers a more effective strategy for countering terrorist hubs operating in failed states. The foreign intelligence community is best equipped to identify terrorist hubs in failed states that are developing global reach and threatening to acquire a nuclear dimension. Once those hubs have been identified, a synthesis of expeditionary military forces and law enforcement elements will be far more effective in dealing with those hubs than either element will be acting independently. The military force establishes access to the failed state for law enforcement officers, and provides a secure environment for those officers to perform their core function of identifying, locating, and apprehending criminal, in this case terrorist, suspects. Once terrorists have been identified, located, and apprehended, military tribunals should screen them individually to confirm that they are, indeed, who law enforcement officers believe them to be, and that they are, in fact, associated with the activities of the terrorist hubs in question. Upon confirmation of their status as participants in the operation of the terrorist hub, those tribunals should refer their cases to appropriate international tribunals for disposition. This strategy avoids legitimizing terrorist activity by treating them as military targets, and also addresses the limitations that U.S. criminal justice procedures place on prosecuting terrorists apprehended in failed states.
( ) Risk of terrorism in Africa is low Robert Guest, Wash. Correspondant for Economist, 6-30-2005, Africas Development Challenge, CATO
Institute, http://www.cato.org/pubs/edb/edb1.pdf I would like to turn to the subject of terrorism. There is a theory going around that Africa ought to be a breeding ground for terrorism, because of the large number of Muslims who live there. If by terrorism we mean terrorism that affects the West, I do not believe that that is the case. There simply is not any significant homegrown international black African terrorist movement. People have many grievances, but they tend to be locally directed. If you actually ask people about President George Bush and the invasion of Iraq, average Africans will say that it was an appalling thing and that they dislike him very much. But George Bushs foreign policy is very low on their list of grievances. Their main grievances are the policemen who sit by the road robbing them every time they try to take their crops to market.
biological agents are unpredictable: they can easily get out of control, backfire, or have no effect at all. They constitute a high risk to the attackers, although the same, of course, is true of chemical weapons. This consideration may not dissuade people willing to sacrifice their own lives, but the possibility that the attacker may kill himself before being able to launch an attack may make him hesitate to carry it out. Biological agents, with some notable exceptions, are affected by changes in heat or cold, and, like chemical agents, by changes in the direction of the wind. They have a limited life span, and their means of delivery are usually complicated. The process of contaminating water reservoirs or foodstuffs involves serious technical problems. Even if an agent survives the various purification systems in water reservoirs, boiling
the water would destroy most germs. Dispersing the agent as a vapor or via an aerosol system within a closed space-for instance, through the air conditioning system of a big building or in a subway-would ear to offer better chances of success, but it is by no mens foolproof.
( ) Technical barriers prevent use of bioweapons Jonathan Tucker, director of the CBW Nonproliferation Project at Center for Nonprolif Studies at Monterey Instit, Amy Sands, assoc director, July/August 1999, http://www.bullatomsci.org/issues/1999/ja99/ja99tucker.html
One reason there have been so few successful examples of chemical or biological terrorism is that carrying out an attack requires overcoming a series of major technical hurdles: gaining access to specialized chemical-weapon ingredients or virulent microbial strains; acquiring equipment and know-how for agent production and dispersal; and creating an organizational structure capable of resisting infiltration or early detection by law enforcement. Many of the microorganisms best suited to catastrophic terrorism-virulent strains of anthrax or deadly viruses such as smallpox and Ebola-are difficult to acquire. Further, nearly all viral and rickettsial agents are hard to produce, and bacteria such as plague are difficult to "weaponize" so that they will survive the process of delivery. As former Soviet bioweapons
scientist Ken Alibek wrote in his recent memoir, Biohazard, "The most virulent culture in a test tube is useless as an offensive weapon until it has been put through a process that gives it stability and predictability. The manufacturing technique is, in a sense, the real weapon, and it is harder to develop than individual agents." The
capability to disperse microbes and toxins over a wide area as an inhalable aerosol-the form best suited for inflicting mass casualties-requires a delivery system whose development would outstrip the technical capabilities of all but the most sophisticated terrorists. Not only is the dissemination process for biological agents inherently complex, requiring specialized equipment and expertise, but effective dispersal is easily disrupted by environmental and meteorological conditions. A large-scale attack with anthrax spores against a city, for example, would require the use of a crop duster with custom-built spray
nozzles that could generate a high-concentration aerosol cloud containing particles of agent between one and five microns in size. Particles smaller than one micron would not lodge in the victims' lungs, while particles much larger than five microns would not remain suspended for long in the atmosphere. To generate mass casualties, the anthrax would have to be dried and milled into a fine powder. Yet this type of processing requires complex and costly equipment, as well as systems for high biological containment. Anthrax is simpler to handle in a wet form called a "slurry," but the efficiency of aerosolization is greatly reduced.
( ) Technical difficulties prevent CBW attacksand even if they overcome them, authorities will be alerted Walter Laqueur, Cochairman, International Research Council, The Center for Strategic and International Studies, The New Terrorism, 1999, pg. 244
Ironically, the major factor retarding the use of gases and germs by states and terrorists is not revulsion or moral constraints but technical difficulties. "Ideal" conditions for an attack seldom if ever exist, and the possibility of things going wrong is almost unlimited: aerosols may not function, the wind may blow in the wrong direction, missiles carrying a deadly load may land in the wrong place or neutralize the germs on impact. In the course of time these technical difficulties may be overcome, but it is still very likely that roughly nine out of ten of the early attempts by terrorists to wage chemical or biological warfare will fail. But they will not pass unnoticed; the authorities and the public will be alerted, and the element of surprise lost. The search for the perpetrators may begin even before the first successful attack. And what has just been said with regard to terrorists may also be true with regard to state terrorism.
( ) Bioweapons dont kill anyone Japan proves Stimson Center, 2007, Biological and Chemical Weapons,
http://www.stimson.org/cbw/?sn=CB2001121259#cwuse The Japanese cult Aum Shinrikyo was brimming with highly educated scientists, yet the cult's biological weapons program turned out to be a lemon. While its poison gas program certainly made more headway, it was rife with life-threatening production and dissemination accidents. After all of Aum's extensive financial and intellectual investment, the Tokyo subway attack killed a dozen people, seriously injured just over fifty more, and mildly injured just under 1,000. In 96 percent of the cases worldwide where chemical or biological substances have been used since 1975, three or fewer people were injured or killed.
Who would sell these things to would-be nuclear terrorists? The answer is: nobody. The world's nuclearequipment makers are organized into a cooperative group that exists precisely to stop items like these from getting into unauthorized hands. Nor could a buyer disguise the destination and send materials through obliging places like Dubai (as Iran does with its hot cargoes) or Malta (favored by Libya's smugglers). The equipment is so specialized, and the suppliers so few, that a forest of red flags would go up. And even if the equipment could be bought, it would have to be operated in a place that the United States could not find. If manufacturing bomb-grade uranium is out of the picture, what about making plutonium, a
much smaller quantity of which is required to form a critical mass (less than fourteen pounds was needed to destroy Nagasaki in 1945)? There is, however, an inconvenient fact about plutonium, which is that you need a reactor to make enough of it for a workable bomb. Could terrorists buy one? The Russians are selling a reactor to Iran, but Moscow tends to put terrorist groups in the same category as Chechens. The Chinese are selling reactors to Pakistan, but Beijing, too, is not fond of terrorists. India and Pakistan can both build reactors on their own, but, for now, these countries are lined up with the U.S. Finally, smuggling a reactor would be no easier than buying one. Reactor parts are unique, so manufacturers would not be fooled by phony purchase orders. Even if
terrorists somehow got hold of a reactor, they would need a special, shielded chemical plant to chop up its radioactive fuel, dissolve it in acid, and then extract the plutonium from the acid. No one would sell them a plutonium extraction plant, either. It is worth remembering that Saddam Hussein tried the reactor road in the 1970's. He bought one from France-Jacques Chirac, in his younger days, was a key facilitator of the deal--hoping it would propel Iraq into the nuclear club. But the reactor's fuel was sabotaged in a French warehouse, the person who was supposed to certify its quality was murdered in a Paris hotel, and when the reactor was finally ready to operate, a squadron of Israeli fighter-bombers blew it apart. A similar fate would undoubtedly await any group that tried to follow Saddam's method today. IF MAKING nuclear-bomb fuel is a no-go, why not just steal it, or buy it on the black market? Consider plutonium. There are hundreds of reactors in the world, and they crank out tons of the stuff every year. Surely a dedicated band of terrorists could get their hands on some. This too is not so simple. Plutonium is only created inside reactor fuel rods, and the rods, after being irradiated, become so hot that they melt unless kept under water. They are also radioactive, which is why they
have to travel submerged from the reactor to storage ponds, with the water acting as both coolant and radiation shield. And in most power reactors, the rods are welded together into long assemblies that can be lifted only by crane. True, after the rods cool down they can be stored dry, but their radioactivity is still lethal. To prevent spent fuel rods from killing the people who come near them, they are transported in giant radiation-shielding casks that are not supposed
If terrorists managed to hijack one from a country that had reactors they would still have to take it to a plant in another country that could extract the plutonium from the rods. They would be hunted at every step of the way. Instead of fuel rods, they would be better advised to go after pure
to break open even in head-on collisions. The casks are also guarded. plutonium, already removed from the reactor fuel and infinitely easier to handle. This kind of plutonium is a threat only if you ingest or inhale it. Human skin blocks its radiation: a terrorist could walk around with a lump of it in his front trouser pocket and still have children. But where to get hold of it? Russia is the best bet: it has tons of plutonium in weapon-ready form, and the Russian nuclear-accounting system is weak. Russia also has underpaid scientists, and there is unquestionably some truth behind all the stories one hears about the smuggling that goes on in that country. But very little Russian plutonium has been in circulation, with not a single reported case of anything more than gram quantities showing up on the black market. This makes sense. Pure plutonium is used primarily for making nuclear warheads, it is in military hands, and military forces are not exactly keen to see it come back at them in somebody else's bombs. One source of pure plutonium that is not military is a new kind of reactor fuel called "mixed oxide." It is very different from the present generation of fuel because it contains weapon-ready material. But precisely because it is weapon-ready, it is guarded and accounted for, and a terrorist group would have to win a gun battle to get close to it. Then they would probably need a crane to move it, and would have to elude or fight off their pursuers. If terrorists did procure some weapon-ready plutonium, would their problems be over? Far from it:
plutonium works only in an "implosion"-type bomb, which is about ten times more difficult to build than the simple uranium bomb used at Hiroshima. In such a device, a spherical shock wave "implodes" inward and squeezes a
ball of plutonium at the bomb's center so that it explodes in a chain reaction. To accomplish all this, one needs precision machine tools to build the parts, special furnaces to melt and cast the plutonium in a vacuum (liquid plutonium oxidizes rapidly in air), and high-precision switches and capacitors for the firing circuit. Also
required are a qualified designer, a number of other specialists, and a testing program. Considering who the participating scientists are likely to be, the chances of getting an implosion bomb to work are rather small. THE ALTERNATIVE to plutonium is bomb-grade uranium--and here things would be easier. This is the fuel used in the Hiroshima bomb. Unlike the implosion bomb dropped on Nagasaki, this one did not have to be tested: the U.S. knew it would work. The South Africans built six uranium bombs without testing; they knew
their bombs would work, too. All these devices used a simple "gun" design in which one slug of uranium was shot down a barrel into another. The problem with buying bomb-grade uranium is that one would need a great deal of it--around 120 pounds for a gun-type bomb--and nothing near that amount has turned up in the black market.
the heart of al-Qaeda? Many would wonder if that wasn't what the administration pledged to do after the attacks three years ago. The president would face intensified criticism from those who have argued all along that Iraq was a distraction from 'the real war on terror'. And what if a significant number of the terrorists responsible for the pre-election attack were again Saudis? The Bush
administration could hardly take military action against the Saudi government at a time when crudeoil prices are already more than $45 a barrel and global supply is stretched to the limit. While the Saudi royal family might support a co-ordinated
attack against terrorist camps, real or imagined, near the Yemeni border - where recent searches for al-Qaeda have concentrated - that would seem like a trivial, insufficient retaliation for an attack on the US mainland. Remember how the Republicans criticised Bill Clinton's administration for ineffectually 'bouncing the rubble' in Afghanistan after the al-Qaeda attacks on the US embassies in Kenya and Tanzania in the 1990s. So what kind of response might be credible? Washington's concerns about Iran are rising. The 9/11 commission report noted evidence of co-operation between Iran and al-Qaeda operatives, if not direct Iranian advance knowledge of the 9/11 hijacking plot. Over the past few weeks, US officials have been more explicit, too, in declaring Iran's nuclear programme 'unacceptable'. However, in the absence of an official Iranian claim of responsibility for this hypothetical terrorist
a decisive response from Bush could not be external. It would have to be domestic. Instead of Donald Rumsfeld, the defence secretary, leading a war effort abroad, Tom Ridge, the homeland security secretary, and John Ashcroft, the attorney general, would pursue an anti-terror campaign at home. Forced to use legal tools more controversial than
attack, the domestic opposition to such a war and the international outcry it would provoke would make quick action against Iran unthinkable. In short,
those provided by the Patriot Act, Americans would experience stepped-up domestic surveillance and border controls, much tighter security in public places and the detention of a large number of suspects. Many Americans would undoubtedly support such moves. But concern for civil liberties and personal freedom would ensure that the government would have nowhere near the public support it enjoyed for the invasion of Afghanistan.
***Disease CPs***
( ) Its impossible to boost indigenous health capacity as long as the US keeps siphoning workers Laurie Garrett, senior fellow for Global Health @ CFR, Jan/Feb 2007, The Challenge of Global Health,
http://fullaccess.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html Jim Leach, an outgoing Republican member of the House of Representatives from Iowa, has proposed something called the Global Health Services Corps, which would allocate roughly $250 million per year to support 500 American physicians working abroad in poor countries. And outgoing Senator Bill Frist (RTenn.), who volunteers his services as a cardiologist to poor countries for two weeks each year, has proposed federal support for sending American doctors to poor countries for short trips, during which they might serve as surgeons or medical consultants. Although it is laudable that some American medical professionals are willing to volunteer their time abroad, the personnel crisis in the developing world will not be dealt with until the United States and other wealthy nations clean up their own houses. OECD nations should offer enough support for their domestic health-care training programs to ensure that their countries' future medical needs can be filled with indigenous personnel. And all donor programs in the developing world, whether from OECD governments or NGOs and foundations, should have built into their funding parameters ample money to cover the training and salaries of enough new local healthcare personnel to carry out the projects in question, so that they do not drain talent from other local needs in both the public and the private sectors.
PSE CP 1NC
The United States federal government should pass the Physician Shortage Elimination Act. ( ) Solves domestic health care capacity empirically proven methods Ted Stevens, Alaska Senator, 3-15-2007, Murkowski,
http://stevens.senate.gov/public/index.cfm?FuseAction=NewsRoom.PressReleases&ContentRecord_id=56672bc4802a-23ad-4754-4c83aaea0eab&Region_id=&Issue_id= Noting that our Nation faces a severe shortage of primary care physicians, Senator Lisa Murkowski today joined Senators Ted Stevens (R-AK), Chuck Schumer (D-NY) and Bernie Sanders (I-VT) in introducing the Physician Shortage Elimination Act. The legislation provides additional funding and flexibility for existing residency programs, grants and services that have been successful in the past but have been underutilized. A dozen states have already reported significant physician shortages. There is insufficient availability of care in specialty areas like cardiology, radiology and neurology. However, the greatest shortages persistently have been in primary care. In rural areas of the country, where 50 million Americans live in areas that lack sufficient care, it represents one of the most intractable health policy problems of the past century. Unfortunately, it is a problem that is forecast to get worse. In just 20 years, 20 percent of the Nations population will be 65 years or older, a percentage larger than any other time in history. Just as this aging population places the highest demand on our health care system, some experts predict a national shortage of 200,000 physicians. If that becomes reality, 84 million patients could be left without a doctors care. The physician shortage facing Alaska and the nation as a whole - is intolerable, said Senator Murkowski. Congress cannot idly sit by while potentially millions of patients go without care. Advances in medicine have greatly improved the healthcare available throughout the country, said Senator Stevens. But today, as more and more patients seek treatment, fewer physicians are available to help meet their needs. It is imperative that Congress act now to address this growing problem facing Alaska and the nation. I applaud Senator Murkowski's leadership on this issue and look forward to working with her and my Senate colleagues to get this bill passed. National demand for physicians has grown to exceed the supply, particularly in upstate New York, said Senator Schumer. With general practitioners, surgeons, and specialty doctors leaving the area in record numbers, patients could see an erosion of access to care at the worst possible time. We need to provide direct incentives to train and retain physicians in order to keep our community and our overall economy healthy. Our country is currently facing a real health care crisis and the shortage of physicians in rural areas is a significant part of the problem, said Senator Sanders. This bill will go a long way toward improving health care access for all Americans. The Physician Shortage Elimination Act provides additional investments in programs that have been effective in attracting and retaining physicians to serve in our most underserved areas of the country. Specifically the bill will: * Double funding for the National Health Service Corp a program that is dedicated to meeting the needs of the underserved. Despite its success, it has been vastly under funded in fact 80% of the applicants must be turned away each year. * Allow rural and underserved physician residency programs to expand by removing barriers that prevent programs from developing rural training programs. * Double certain Title VII funding Create programs that target disadvantaged youth in rural and underserved areas and nurture them to create a pipeline to careers in healthcare; and * Bolster the cornerstone for health care in underserved areas, the community health center, through grants and by allowing them to expand their residency programs.
PSE CP Solves
( ) Passing the PSE would solve domestic physician shortages Molly OGorman, Dir. Public Relations @ AMSA, 7-28-2006, AMSA Endorses,
http://www.amsa.org/news/release2.cfx?id=271 The recent recommendation made by the Association of American Medical Colleges (AAMC) to increase medical school enrollment by 30 percent within the next decade has been endorsed by the American Medical Student Association (AMSA), the largest organization of physicians-in-training in the United States. AMSA agrees that the proposed AAMC strategy of expanding the physician workforce through both the expansion of existing schools and the creation of new allopathic medical schools is the most effective way to quickly and economically address the significant shortage of physicians expected early in this century. Several recent studies indicate that the United States will need an additional 90,000 physicians by 2020. In February 2005, before the full extent of the coming physician shortage was understood, the AAMC recommended a 15 percent increase in U.S. medical school enrollment. Subsequent studies and mounting evidence supported by the AAMCs Center for Workforce Studies persuaded the medical college group to recommend a larger increase in medical school enrollment to suitably address the needs of the nations steadily increasing and aging population. Adherence to AAMCs guidelines would result in 5,000 additional U.S. medical students a year. Our countrys medical education system must respond aggressively to this physician shortage crisis, says AMSA President Jay Bhatt. We need to respond by increasing diversity and the number of medical students in our country. Increased support for programs like the National Health Service Corps and State Loan Repayment for service would help students with rising levels of debt as well as encourage new physicians to practice primary care in our underserved communities. Recent federal legislation that AMSA was consulted on has been formally introduced before Congress. The U.S. Physician Shortage Elimination Act, H.R. 5770, will expand the depleting physician workforce, increase funding to medical facilities and remove barriers for minority participation in the medical profession efforts which are all big priorities for AMSA, presently and historically.
AHCIA CP 1NC
The United States federal government should pass the African Health Capacity Investment Act of 2007. ( ) Solves the case boosts African health care capacity without sending a Global Health Corp of U.S. workers States News Service, 3-7-2007, Bipartisan Group, p ln
A bipartisan group of Senators today introduced the African Health Capacity Investment Act of 2007, a comprehensive bill to help sub-Saharan African nations confront the alarming shortage of health workers; thirteen countries on the continent have fewer than 5 physicians per 100,000 people. The United States has 549 physicians per 100,000 people. "Increased funding from governments and private donors to expand health services holds the promise of saving millions of lives in Africa. But, a severe shortage of health workers on the ground represents a tight bottleneck slowing the flow of resources to patients who need them," said Dr. Paul Farmer, medical anthropologist and a founder of Partners In Health. "SubSaharan Africa faces a shortage of more than 800,000 doctors, nurses, and midwives and an overall shortage of 1.5 million healthcare workers. The bill introduced today, particularly with its focus on harnessing the power of paid community health workers, is a much needed step toward closing this gap." Senators Dick Durbin (D-IL), Norm Coleman (R-MN) and Russ Feingold (D-WI) called the lack of health care workers and capacity in many African nations a "critical obstacle" in the world's fight against HIV/AIDS and a potential outbreak of Avian Flu and in promoting economic development and growth. "With 11 percent of the world's population, 25 percent of the global disease burden and nearly half of the world's deaths from infectious diseases, sub-Saharan Africa has only 3 percent of the world's health workers." Senator Durbin said. "Personnel shortages are a global problem, but nowhere are these shortages more extreme, the infrastructure more limited and the health challenges graver than in sub-Saharan Africa, the epicenter of the HIV/AIDS pandemic. We will not win the war against AIDS or any other African health challenge without finding solutions to this crisis." "I am very proud to join my colleagues in introducing this bill as it is critical for bolstering our efforts to combat HIV/AIDS and other diseases in Africa," said Senator Coleman. "The lack of health care capacity in Africa imposes major constraints on the long term effectiveness of programs fighting HIV/AIDS and other diseases. For this reason, any forward-looking, comprehensive strategy to fight these terrible diseases must include elements that build African health care capacity." "One of the most critical issues facing Africans today is the massive shortage of health care workers," Senator Feingold said. "The United States has been a leader in addressing HIV/AIDS, malaria, tuberculosis, and other global health crises, but this assistance will only be sustainable with the establishment of a strong medical infrastructure. Bolstering health care capacity in Africa is essential for preventing millions of deaths each year and ensuring our efforts to fight these diseases succeed." The African Health Capacity Investment Act of 2007 seeks to help sub-Saharan African countries strengthen the capabilities of their health systems by: # Improving dangerous and sub-standard working conditions; # Addressing training, recruiting and retention concerns, especially in rural areas, for doctors, nurses, and paraprofessionals; # Developing better institutional management; and # Increasing productivity, reducing corruption and building public health infrastructure.
AHCIA CP
( ) The African Health Capacity Investment Act would boost African health care capacity Africa News, 3-7-2007, U.S. Senate to Tackle Massive Health Worker Shortage, ln
Physicians for Human Rights applauds today's Senate introduction of the African Health Capacity Investment Act of 2007, a bipartisan plan introduced by Senator Richard Durbin that would supply $600 million over three years to stem the flood of doctors and nurses out of African countries in the midst of the AIDS pandemic and other huge health issues. The bill's introduction is an important milestone in a nearly three-year effort spearheaded by Physicians for Human Rights, Health GAP, Partners In Health, the American Medical Student Association, and other groups to move the world to act on this problem. "The United States has recruited thousands of doctors and nurses out of African countries this bill would enable the next generation to treat their neighbors instead of our neighbors," said PHR Senior Global Health Policy Advisor and Global Health Workforce Alliance board member Eric A. Friedman, JD. Initial co-sponsors of the bill include Senators Durbin, Coleman, Feingold, Dodd, Kerry, and Bingaman. The bill would provide $150 million in FY 2008, $200 million in FY 2009, and $250 million in FY 2010 to pay for safer working conditions, training and recruitment of health workers (especially in underserved rural areas) and better health systems management. The World Health Organization estimates that sub-Saharan Africa is suffering a shortage of at least 800,000 doctors, nurses, and midwives, and an overall shortfall of nearly 1.5 million health workers of all kinds. Many receive salaries so low that they cannot afford to pay for rent even in their home country, let alone support a family. Some are forced to live in their own examination rooms. In 2004 Physicians for Human Rights and Health GAP started an advocacy campaign to address this problem and have been spurred on by our colleagues in Uganda and Kenya, where PHR supports large activist networks comprised of health professionals. PHR also wrote a seminal report in 2004 on the subject: An Action Plan to Prevent Brain Drain (see below), which was released at that year's Bangkok International AIDS conference. Since then, PHR, Health GAP and their allies have educated the US Office of the Global AIDS Coordinator, the Global Fund, leaders of G8 nations, and the U.S. Congress about the problem, and all have recognized the issue as a major obstacle to providing health care in the developing world, not only affecting AIDS but also maternal mortality and other pressing health issues. Senator Durbin's bill, however, is the first major US initiative aimed at solving the problem.
AHCIA = Bipart
( ) The AHCIA is bipartisan and supported by lobby groups PR Newswire, 3-7-2007, Healthcare Activists, ln
Internationally-renowned physician and public health activist Dr. Paul Farmer of Partners In Health (PIH) will join more than 1500 medical students and doctors from the American Medical Student Association (AMSA) and the National Physicians Alliance (NPA) to press for Congressional funding to overcome the critical shortage of health workers in Africa and to combat the ever-growing public health crisis in a region devastated by AIDS, tuberculosis and malaria. AMSA, NPA and PIH are asking for a commitment of $8 billion over five years, based on World Health Organization (WHO) cost estimates for health worker training and retention programs. "As healthcare workers and advocates, we cannot turn our backs on an entire continent," says AMSA President Jay Bhatt. "We call on Congress to keep the promises our country made to fight AIDS in Africa." The groups are pushing for rapid passage of and increased funding for the African Health Capacity Investment Act. This bipartisan bill, sponsored by Senators Richard Durbin (D-Ill.), Norm Coleman (R-Minn.) and Russell Feingold (D-Wisc.), was introduced during the week of the AMSA rally at the Capitol on March 8th, 2007. The proposed legislation authorizes funding for sub-Saharan African countries to train and retain doctors, nurses, pharmacists and community health workers critical to lessening the burden of AIDS. "Investing in health workers brings us closer to realizing the full potential of the commitments the U.S. has made to fighting global AIDS, malaria and tuberculosis," said Bhatt.
Burkhalter CP
( ) Stuff the U.S. could do to solve the health worker shortage Holly J. Burkhalter, U.S. Dir. Physicians for Human Rights, 4-13-2005, Testimony, Congressional Quarterly,
p. ln
Mitigation and eventual , and harder today than it ever was given the West's insatiable appetite for foreign nurses and the untold attrition of health workers, particularly nurses, due to illness, care giving at home, and death from HIV/AIDS. HIV prevalence in health workers is typically similar to that in the general population. In Malawi, 3% of health workers were dying annually by 1997, a fatality rate six times higher than it had been before the AIDS pandemic. In Lusaka, Zambia, in 1991-1992, the HIV- prevalence rate among midwives was 39%, and among nurses, 44%.20 Much as Malawi, HIV/AIDS has caused illness and death rates of Zambia's health workers to increase five- to six-fold. Resolving it requires an unprecedented degree of strategic planning and cooperation
between national governments, international agencies, and other donors. Recommendations: The Next Phase of US Support for Health in Africa
Greatly increased spending by national governments and by foreign donors and international organizations is required to enable countries to meet AIDS prevention, care, and especially treatment targets and to sustain a high level of coverage for these interventions. These
systemic improvements to what is typically the weakest part of health systems in Africa - personnel - will greatly enhance countries' capacity to improve health in all areas, from combating other major diseases such as tuberculosis and malaria to improving child survival and driving down unspeakable levels of maternal mortality that plague much of Africa. We envision an initiative with four main pillars: First, the United States should provide technical assistance to countries in assessing their current health workforce situations, in determining their health workforce needs to achieve health targets, such as the Millennium Development Goals, and in developing strategies to achieve those goals. The strategies should be linked to overall health system development
strategies so that health worker strengthening occurs in concert with the other aspects of health system strengthening require to achieve Millennium Development. So as to guide both national budgets and donor assistance, the strategies should include costing estimates. The strategies should also include coordination among donors and the national government to ensure that the full cost of implementing these strategies is covered. While the national government will determine the strategic process, the United States should encourage broad participation, including by health workers themselves and leaders of rural communities. This will help ensure both that the strategy is consistent with and informed by health workers' needs and the needs of communities, especially those in rural areas who presently have the least access to health services. The United States can also promote, or at least ensure that countries seriously consider, other examples of good practice, such as closing the gap between the pay for physicians and other health workers, promoting equity in the international distribution of health workers, and incorporating all sectors - public, non-for- profit private, NGO, faith-based, and for-profit private - in planning processes. Second,
the United States should help fund the implementation of these strategies. The activities funded should be determined by national
strategies, by the needs as expressed by the people of those countries. Based on strategies that countries have already begun to implement, as well the needs common to the region that will determine the strategies, elements that will likely be in most or all of these strategies include: -- Higher salaries for health workers -- Incentives for health workers to serve in rural areas -- Improved health worker safety, including full implementation of universal safety precautions, post-exposure prophylaxis for health workers potentially exposed to HIV, tuberculosis infection control, and hepatitis B vaccination -- Improved human resource management, including improving human resource policies and enhancing management skills of local health managers -- Increased capacity of health training institutions, such as medical, nursing, and pharmacy schools -Providing continuous learning opportunities to health workers -- Support for community health workers, including compensation, training, supervision, supplies, and linkages to health professional support and referral systems. Training, supporting and deploying people living with AIDS as counselors, prevention advocates, and care givers should be a priority. -- Re-hiring and rational deployment of retired or unemployed health professionals -- Health system improvements not specifically related to human resources for health, such as assuring adequate and dependable provision of supplies and essential drugs. Third, while it is necessary for countries to have human resources for health strategies, enough is known about what is needed to begin funding many interventions immediately, and indeed, the urgency of the crisis demands this. There is no need to wait for fully formed strategies for the United States to begin to provide financial and technical support that will actually begin to help retain health workers, train new ones, and increase health services in rural areas. Much of what is needed, such as ensuring health worker safety and improved human resource management, will be part of any comprehensive
. All health workers need the gloves and other gear to keep them safe. All human resource systems will have to provide health workers with sound supervision, career structures, clear job descriptions, and on- time pay. And all countries will need to have the capacity to know who their health workers are and where they are, which will require computerized databases of their health workforce. Furthermore, even where a complex strategy may be required, as for determining exact training needs or salary structures, pressing needs in such areas as training and salary support may be ripe for immediate funding, even before the strategies are fully established. For example, the nursing school that is part of the Harare Central Hospital in Zimbabwe had only three nurse tutors (professors) in the beginning of 2004, though the school officials say that at least fifteen are required. These posts need to be filled. As of 2003, Kenya had 4,000 nurses, 1,000 clinical officers, 2,000 laboratory staff, and 160 pharmacists or pharmacy technicians who were unemployed not because they were not needed, but because the government could not afford to pay them. These workers need to be hired. Fourth,
the United States should support efforts by the World Health Organization and others to collect and disseminate country lessons and experiences in human resource policies and efforts to recruit, retain, and equitably deploy their health workers. Information
of both successful and unsuccessful practices should be widely available so countries learn both from the experiences of other countries, adopting successes to their own circumstances and avoiding other countries' mistakes. One way that the United States do this is by supporting a regional observatory on human resources for health at WHO's African region headquarters. This observatory would promote evidence-based human resource policymaking, share experiences with human resources reforms among regional policymakers, and increase human resource policymaking capacity. Along with learning from experiences elsewhere, countries should also learn from their own experiences, and adjust their strategies based on those experiences. The United States should therefore help countries develop strong monitoring and evaluation capacities. Fortunately, this Administration and this Congress have shown that they are up to the task. The two major new foreign aid initiatives of the past several years, PEPFAR and the Millennium Challenge Account, both represent new ways of doing business. The adoption of the U.S. Leadership Against HIV/AIDS, TB, and Malaria Act of 2003 represents the vision of Members and Senators from across the political spectrum. It was the high-water mark of legislative and executive branch cooperation, and it made possible an unprecedented contribution to health in some of the poorest countries in the world. We believe that
with the leadership of the President and this Committee, you can make a new and desperately needed contribution in the form of direct support of African health workers that will sustain and broaden the programs you launched in 2003. We stand ready to work with you to reach that noble goal.
Buy Local CP
The United States federal government should require that indigenous health workers provide all prevention, care and treatment services supported by all current public health assistance to sub-Saharan Africa, including PEPFAR, without eroding the capacity of the health system to provide other essential health services. ( ) This solves health capacity without causing brain drain requiring the use of indigenous health workers would ensure sustainable capacity is built, without requiring U.S. workers. Their author. Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
assistance programs should seek health workforce additionality, adopting measures to train and retain new indigenous workers in sufficient numbers to meet program needs: Affirmative measures must be adopted by donorsespecially by disease-specific initiativesto avoid draining existing workers from primary health systems. While it may be relatively easy (in some locations) to attract needed local workers by
paying 50 cents an hour more than the public clinic, doing so leaves the overall health system less able to address general health needs and subsequently inadvertently erects new barriers to reaching US health targets. US aid programs could be required to cover their own costs; in countries facing a healthcare workforce shortages. That is, if PEPFAR needs 100 physicians and 450 nurses in a country to meet its goals, then PEPFAR should support the production and retention C. US
of that number of physicians and nurses, utilizing imported staff only as necessary to train replacements and fill gaps while taking steps to train new health workers. Programs in the health field in developing countriesespecially disease-specific initiatives such as PEPFARshould adopt new policies that support training and retention for at least the number of indigenous healthcare workers necessary to meet program goals, while taking proactive measures to avoid drawing from other health programs. Healthcare workforce additionality should become a core priority of PEPFAR. A groundbreaking target could be established requiring, over time, indigenous health workers to provide all prevention, care and treatment services supported by PEPFARwithout eroding the capacity of the health system to provide other essential health services. Utilization of local healthcare workers is already established as best practice for foreign assistance programs and agencies. By working toward 100% local, OGAC will enhance local ownership and the capacity of focus countries. However, adopting specific safeguards to protect
existing health systems and programs is absolutely central. From a health workforce perspective, one serious problem of PEPFAR at present is that the program adds significant new tasks on an already overburdened health workforce. Absent a scaled-up effort
to improve the size and efficiency of the health workforce, this creates two possibilities. Either PEPFAR is unable to achieve its goals, or it does achieve its goals but at the cost of reducing the capacity of the primary health system to provide other essential health services. This could happen by some
combination of drawing health workers away from other jobs, and by asking strapped health workers to perform additional tasks, which will reduce the time during which they can provide other health services and contribute to burnout. Setting a new indigenous health workforce target for PEPFAR is not merely an important moral principle regarding sustainable development. With a stronger overall health system, important disease-specific initiatives such as PEPFAR are able to fully and sustainably succeed. By
expanding the number of healthcare workers by a number sufficient to meet program needs, programs like PEPFAR can address the unintended harm and distortions that can be caused by donor-driven disease-specific initiatives that employ large percentages of a too-small health workforce, while avoiding the cost-and unsustainability of over-reliance on flown-in expatriates. OGAC progress reports
state that almost 80% of the staff hired are local workers in their country of origin. As PEPFAR heads towards renewal and revision, striving for 100% indigenous workers (with flexible deadlines) will use the platform of this already historic initiative to set an important new standard for local ownership and sustainability, while measures ensuring additionality will takr an important new step to address weak health systems that have stymied efforts to truly reach program goals. PEPFAR country teams, or new Country Action This could Teams (below) should include specialists with bottom-line responsibility for human resources for health issues.
take the form of an amendment to PEPFAR that could happen immediately either through US legislation or by adopting new policies administratively.
( ) Public diplomacy is biggest factor in creating soft power Joseph S. Nye, soft power guy, The Decline of America's Soft Power, Foreign Affairs, May/June 2004
The United States' most striking failure is the low priority and paucity of resources it has devoted to producing soft power. The combined cost of the State Department's public diplomacy programs and U.S. international broadcasting is just over a billion dollars, about four percent of the nation's international affairs budget. That total is about three percent of what the United States spends on intelligence and a quarter of one percent of its military budget. If Washington devoted just one percent of its military spending to public diplomacy -- in the words of Newtonn Minow, former head of the Federal Communications Commission, "one dollar to launch ideas for every 100 dollars we invest to launch bombs" -- it would mean almost quadrupling the current budget.
( ) Public diplomacy needs funding Joseph S. Nye, soft power guy, The Decline of America's Soft Power, Foreign Affairs, May/June 2004
In 2003, a bipartisan advisory group on public diplomacy for the Arab and Muslim world found that the United States was spending only $150 million on public diplomacy in majority-Muslim countries, including $25 million on outreach programs. In the advisory group's words, "to say that financial resources are inadequate to the task is a gross understatement." They recommended appointing a new White House director of public diplomacy, building libraries and information centers, translating more Western books into Arabic, increasing the number of scholarships and visiting fellowships, and training more Arabic speakers and public relations specialists.
Funding key to Peace Corp congress is denying funding National Peace Corps Association, PEACE CORPS FUNDING FACTS, 3/16, 2006
http://www.rpcv.org/pages/sitepage.cfm?id=1210 While President Bush has proposed increased funding for Peace Corps in each of his annual budget recommendations, he is falling far short of his pledge during the 2002 State of the Union address to double the number of Peace Corps volunteers by 2007. While most members of Congress express support for the Peace Corps, Congress has often reduced the President's funding request, sometimes dramatically. For example, last year the President requested a nearly 9% increase in Peace Corps funding. Congress reduced that increase to less than 1%. While Peace Corps reports 7,800 volunteers in the field - a 30 year high - this is almost 50% below 1966 levels, when 15,000 volunteers were in the field. While volunteers are currently serving in 71 nations, Peace Corps has reported as many as 20 additional countries are requesting volunteers.
Funding key to Peace Corp budget constraints have biggest impact Lex Reiffel, Visiting Fellow at the Global Economy and Development Center of the Brookings Institution, REACHING OUT: AMERICANS SERVING OVERSEAS, 12/27, 2005
http://www.brookings.edu/views/papers/20051207rieffel.pdf) Behind all of these compensation components is the role of the federal government. Budget constraints have arguably had the biggest impact on the size of the Peace Corps program. Until this constraint is lifted or more catalytic forms of support for overseas service are adopted, the supply of American volunteers interested in serving overseas is likely to grow at a slow pace. An almost invisible but potentially important element is the tax treatment of volunteer service. At the present time, direct out-ofpocket costs are tax deductible but time on the job is not. The tax treatment of volunteer activity could change in either direction and could have a significant impact on the supply of volunteers.
problems at home, many of these are shared with other postmodern societies, and thus invidious comparisons do not seriously undercut out soft power.
Peace Corp allows foreign countries to understand the US because of working together Tom Lantos, US Senator, FDCH Political Transcripts, 3/24 04
Mr. Chairman, the horrific attacks of September 11th, 2001, transformed how Americans viewed the world. The terrorist attacks also exposed many in our country to other people's perceptions or misperceptions about both our nation and our values. I've stated on numerous previous occasions before this committee my belief that we have been neglecting our many traditional public diplomacy efforts. In addition to repairing the damage to public diplomacy instruments of the State Department, I believe that the expansion of the Peace Corps, particularly in predominantly Muslim countries, can go a long way to helping the people of other nations achieve a better understanding of the United States. Mr. Chairman, as President Kennedy anticipated, life in the Peace Corps is not easy. Volunteers often live in simple huts with no electricity or running water, and the ever present possibility of unwelcome guests, like cobras and scorpions. They receive only a small stipend to meet their basic needs during their service abroad and a modest readjustment allowance after their duty is completed. Many times volunteers are posted in communities where the nearest American is hours or days away. Underlying these hardships is the belief that Americans and foreign people best understand one another when they work together on the same project, share the same food, and speak the same language. Although life in the Peace Corps is not easy, it at least should be made safe.
( ) Outsourcing public diplomacy solves short circuits criticism of the government Charles Wolf, Senior Economic Adviser and Corporate Fellow in Intl Econ. @ RAND, and Brian Rosen, Fellow @ RAND, 2004, Public Diplomacy, www.rand.org/pubs/occasional_papers/2004/RAND_OP134.pdf
Nancy Snow makes the point forcefully: Public diplomacy cannot come primarily from the U.S. government because it is our President and our government officials whose images predominate in explaining U.S. public policy. Official spin has its place, but it is always under suspicion or parsed for clues and secret codes. The primary source for Americas image campaign must be drawn from the American people.43 With these thoughts in mind, a few approachessome new, some retreadsare worth consideration: The tasks of public diplomacy and the obstacles confronting them are so challenging that the enterprise should seek to enlist creative talent and solicit new ideas from the private sector, through outsourcing of major elements of the public diplomacy mission. Whether the motivational skills and communicative capabilities of a King or a Mandela can be replicated though this process is dubious. In any event, government should not be the exclusive instrument of public diplomacy. Responsible business, academic, research, and other nongovernmental organizations could be enlisted and motivated through a competitive bidding process. Outsourcing should be linked to a regular mid-course assessment, with rebidding of outsourced contracts informed by the assessment.
GSF CP
The United States federal government should establish a program of Global Service Fellowships, double the Peace Corps, provide support to Volunteers for Prosperity, and increase technical assistance and multilateral exchanges. ( ) Solves soft power and international support through public diplomacy David L. Caprara, Dir. Brookings Init. On Intl Volunteering and Service, John Bridgeland, co-chair Brookings Working Group on Intl Volunteering, and Harris Wofford, co-chair, March 2007, Global Service
Fellowships, Brookings Policy Brief #160, http://www.brook.edu/comm/policybriefs/pb160.htm
As policy-makers search for ways to share the best of America with the world, they should start with our international volunteers, who embody this country's spirit of generosity, resourcefulness and hope. With the support of Congress and the Bush Administration, volunteers can become the first face of America to communities in many nations, while advancing concrete initiatives that lift up the lives of the poor throughout the world. To maximize the potential of international volunteering, we propose that Congress establish a program of Global Service Fellowships to support American volunteersnominated by congressional membersserving abroad with qualifying nongovernmental organizations (NGOs), faithbased groups, and universities that are committed to advancing peace and development. Initial funding of $50 million would support approximately 10,000 fellowships annually averaging $5,000 each to pay for volunteers' travel, program costs, and minimal living expenses. In addition, Congress and the White House should work together to double the Peace Corps, authorize and provide support to Volunteers for Prosperity, and increase support of other efforts inside and outside government to enable global service and assess its impact. These efforts will empower a growing coalition of international volunteering organizations to help reach the goal of 100,000 Americans serving in developing countries each year. The role of international
volunteer service in building bridges across growing global divides has never been more critical to the future of our nation, and global peace and stability. Building on the exemplary work of the Peace Corps, a growing field of nongovernmental organizations, faithbased entities, universities, and corporate service programs seek to help communities abroad while enhancing the lives of volunteers. In addition to bringing tangible benefits to the people they serve,
members of this new cadre of international volunteers also tend to develop enduring habits of civic engagement and lasting appreciation of foreign partners and perspectives. This strengthens America's civil society, advances public diplomacy objectives abroad, and deepens American understanding of forces beyond our borders. This movement of international volunteers could be greatly enhanced by congressional leadership to provide America's volunteers with expanded service opportunities that would help improve perceptions of the United States abroad. To maximize the potential of international volunteering, we propose that Congress pursue a global service agenda centering on a new program of congressionally-nominated Global Service Fellowships, along with doubling the Peace Corps, authorizing and
supporting Volunteers for Prosperity, and increased support of technical assistance and multilateral exchanges. These efforts will empower a growing coalition of international volunteering organizations to
help reach the goal of 100,000 Americans serving in developing countries each year. The unique power of volunteer service has been key to the vitality of our nation since its birth. In the mid-nineteenth century, historian Alexis de Tocqueville noted the unique contributions of voluntary organizations as a core strength of our young democracy. In the following two centuries, presidents from John F. Kennedy to George W. Bush have recognized that volunteering is one of America's greatest exports. A longitudinal study conducted by Abt Associates for the Corporation for National and Community Service noted the profound long-term impact of extended service in domestic programs like AmeriCorps on participants' civic engagement. These benefits include increased volunteer connections and participation in their community, knowledge of local community challenges such as the environment, health, and crime, and personal growth through strengthened habits of citizenship and service. Service abroad brings the additional benefit of forging personal relationships between generous Americans and poor citizens of foreign lands. While American volunteers come home with a lifelong appreciation of the challenges faced by developing countries, citizens of those nations gain personal experience of American generosity and humanity. The potential power of these efforts are evidenced in the results of a recent Terror Free Tomorrow poll, which showed a markedly positive change in major Muslim nations' perceptions of the United States in response to humanitarian relief and service initiatives. Polling data indicated that nearly 60 percent of Indonesians and 75 percent of Pakistanis held more favorable views of the United States following humanitarian assistance after their tsunami and earthquake tragedies. Importantly, this change in perception lasted beyond the initial aid and service, underscoring that America's actions can have lasting impact.
***Bioterror CPs***
Integration CP
( ) Integration of military and law enforcement for counterterrorism can solve the terrorist risk from failed states Thomas Dempsey, Dir. African Studies @ US Army War College, April 2006, Counterterrorism in African
Failed States, Strategic Studies Institute, http://www.strategicstudiesinstitute.army.mil/pdffiles/pub649.pdf The limitations of current counterterrorism strategies in failed states argue for an entirely new approach to the problem. The military and law enforcement communities bring very different core competencies to the table. Neither community, by itself, has the skill set to implement counterterrorism strategies in failed states effectively. Both communities working in tandem, however, offer capabilities that may prove effective in dealing with the complex failed state problem set. U.S. military forces may not be ideally suited to apprehending individual terrorists, but they are superb at carving out a secure area of operations in difficult and violent environments. Marine Expeditionary Forces and U.S. Army Brigade Task Forces, supported by Air Expeditionary Wings and Naval Amphibious Task Forces, are not only capable of establishing secure bases in the midst of the most violent and chaotic failed state, but they also are capable of projecting a secure presence into the most difficult and problematic areas of that state. Despite their failure, ultimately, to locate and take Mohammed Farrah Aideed into custody, the Army Rangers and Delta Force commandos of Black Hawk Down were able to penetrate into, and sustain themselves for an extended period of time within, the most dangerous area in all of Somalia. While the U.S. foreign intelligence community has not enjoyed much success in locating individual terrorists in failed states, it can identify terrorist hubs operating from failed states that are developing and exercising global reach. It is in exercising their connections with geographically distributed nodes that terrorist hubs will make themselves most vulnerable, as Sageman has pointed out. Those hubs that are close to achieving access to WMD will have the highest profile. Those organizations making up the U.S. foreign intelligence community are the agencies most likely to detect terrorist hubs developing global reach and WMD capability, and to identify the failed states that they are operating from. Having done so and having provided the basis for launching a military operation to obtain access to the failed state in question, the challenge of locating and apprehending individual terrorists on the ground remains. In confronting this challenge, the U.S. law enforcement community can make its greatest contribution. Locating, positively identifying, and apprehending dangerous individuals in the midst of a civilian community is a core competency of U.S. law enforcement. More specifically, it is a core competency of American law enforcement at the local, and particularly at the municipal, level. American law enforcement officers are among the best trained, best equipped, and most professional in the world. The level of sophistication and capability routinely present in larger metropolitan police departments in the United States exceeds the capabilities of most nation-states. Two strategic approaches to law enforcement, one pioneered by American police forces and one developed in the United Kingdom, can provide a framework for effectively locating and apprehending terrorist suspects in failed states. Those approaches are community policing and intelligenceled policing.
***Agent CPs***
EU CP
( ) The EU can solve for African health capacity shortages European Commission, 12-14-2005, EU Commission presents strategy, http://www.europa-euun.org/articles/en/article_5467_en.htm The Commission has adopted a strategy to combat the shortage of doctors and nurses, which has reached a crisis level in African countries most highly affected by AIDS, Tuberculosis and Malaria. This strategy comes fast on the heals of the European Union agreement on a Consensus on Development Policy and on a Strategy for Africa, where the Commission proposes coordinated action of the European Union to assist developing countries in building up viable health systems. With todays communication, the Commission proposes the EU a coherent and coordinated response to a major barrier in the fight for better health in developing countries and shows once more its commitment to the Millennium Development Goals (MDGs). In presenting the Communication, Commissioner Louis Michel said: With this strategy the Commission puts its finger on a critical issue: the public health situation in many developing countries is outrageous. In many regions in Africa, a whole generation is at risk because of AIDS. They need well-trained, equipped and motivated doctors and nurses. The Commission calls on the EU to act jointly and quickly. The reasons for the human resource crisis in the health systems in many developing countries are complex: Years of chronic under-investment in health services and training of personnel and the lack of even basic equipment and drugs have lead to a demoralisation of personnel and a dramatic deterioration of health services. In addition, many health workers have left rural and remote areas and moved to urban centres and abroad where conditions are better. As a result of the AIDS pandemic, TB and malaria and lack of access to health care, life expectancy has declined in 17 African countries during the last 25 years. With 25% of the global disease burden at a share of only 10% of the worlds population, Africa is ill equipped to deal with this challenge with just 0.8 health workers per 1000 head of population, the figure for Europe in comparison is 10.3 per 1000. The Commissions strategy also acts against the migration of health workers from the developing to the developed world. The Commission proposes a set of actions to keep health workers where they are needed most such as retention schemes, incentives to work in rural areas and support for training and career development. These schemes will improve the quality of the working environment and strengthen the overall health systems and thus act as an incentive for doctors and nurses to take up a local job. Direct investment into the health sectors of developing countries through budgetary support as proposed by the Commission is another effective means to prevent unwanted migration. Such funds do not only increase ownership and responsibility of developing countries administrations to respond to the crisis and improve coordination and predictability of funding, they can, for example, also improve local salary conditions and therefore provide an additional incentive to stay. However, benefits of managed migration for both sides should not be ignored. Commenting on the migration of health workers from developing countries to some EU Member States, Commissioner Louis Michel noted that well managed migration can be beneficial both to the EU and to the countries of origin as it promotes brain circulation, rather than brain drain. Using training and work opportunities abroad in the framework of specific programmes can help transfer skills and build capacity without draining poor countries of essential human resources.
EU CP
( ) The EU is capable and politically willing to boost African health care capacity Caitlin Roman, AP Writer, 6-27-2007, Ethio Media, EU to help African workers return home,
http://www.ethiomedia.com/atop/eu_to_help_african_workers.html The European Union wants to encourage skilled African workers to return home, saying their countries need them to develop their own economies, the European Commission said Wednesday as part of a paper listing ways it can help African development. The EU's executive arm said it wanted to reduce problems African countries face when professionals -- particularly doctors and nurses -- leave to take up betterpaid jobs in Europe. "Africa and the EU will specifically address the issue of migration of skilled labor such as health care workers and seek to minimize the negative impact of European recruitment in Africa, with lack of health work force capacity now recognized as a major barrier to progress toward the (United Nations) Millennium Development Goals," it said. A recent World Bank survey said 70 percent of recently graduated doctors and 62 percent of recently graduated nurses in Ethiopia plan to leave the country "whenever they get the chance." An estimated 80,000 qualified people leave the African continent every year. The EU said it would work with African Union countries to promote "circular migration" to encourage African workers in Europe to find work at home. It did not set out any formal suggestions but mentioned better links between African and EU universities and hospitals as one way of helping this happen. EU and African Union leaders will meet in December to debate migration -- including ways to fight human trafficking and protect victims. They will also investigate ways to make it easier for migrants to send money back home -- a practice that can serve as a form of development aid. The summit will also cover efforts to halt deforestation, bringing developing countries into a cap-and-trade program for carbon emissions and encouraging them to use more greener technology. The EU paper said the block was planning to launch a global climate change alliance to help vulnerable countries cope with climate change. Africa is likely to suffer expanding deserts, water shortages and more floods and droughts that could undo years of development efforts, a January report by the United Nations Intergovernmental Panel on Climate Change found. Europe is a major donor to Africa, the world's poorest continent. The EU alone gave $64.6 billion last year, a figure that does not include donations from individual EU governments.
EU CP
( ) The EU can boost African health capacity Africa News, 7-14-2003, Is Europe Doing Its Part in Africa, ln
Improving health The very first symptoms of poverty are run-down health-care systems that have proven incapable of halting the very rapid spread of AIDS and other communicable diseases. To improve health in Africa, the biggest challenge is therefore to develop and sustain the capacity of poor countries to deliver basic health services. Donors can best support this through general support for public finances, debt relief and good policies in the health sector. This is the basic policy stance of EU development aid. The EU has so far pledged $2.5 billion, or 54% of total pledges, to the Global Fund to Fight AIDS, TB and Malaria. For 2004 alone, current EU pledges to the Fund amount to $425 million. This means the EU pledge is more than twice as high as the US pledge of $200 million. We acknowledge, however, and welcome the US announcement of a $15 billion AIDS package, which demonstrates a growing understanding in the US administration and Congress.
EU CP
( ) European health care is superior to the U.S. Kerry Capell, senior writer for Business Week, 6-14-2007, Is Europes Health Care Better, Spiegel,
http://www.spiegel.de/international/business/0,1518,488528,00.html Indeed, a May 15 study from the Commonwealth Fund study comparing the quality of the US system with five other countries found that despite spending twice as much per capita, the US ranks last or near last on basic performance measures of quality, access, efficiency, equity, and healthy lives. "The US stands out as the only nation in these studies that does not ensure access to health care through universal coverage," says Commonwealth Fund President Karen Davis. Gazing across the Atlantic won't lead Americans to a model that fits everyone's requirements. Britain, in particular, suffers myriad problems in its National Health Service. But in some respects, France comes pretty close to the ideal. Not only are its 62 million citizens healthier than the US population, but per capita spending on health care is also roughly half as much.
China CP
( ) China has experience with infrastructure projects in Africa Peter Bosshard, Policy Dir., Intl Rivers Network, May 2007, Chinas role in Financing African Infrastructure,
http://www.irn.org/pdf/china/ChinaEximBankAfrica.pdf China has become a primary financier of infrastructure projects in Africa. China Exim Bank, the countrys official export credit agency, has approved at least $6.5 billion in loans for Africa, most of which is for infrastructure investments. China Exim Bank loans are often part of larger cooperative arrangements between China and African countries, which may include trade deals, arms exports, student exchanges, and the presence of peace keepers. The rapid emergence of Chinese infrastructure financiers in Africa has raised a variety of concerns among international financial institutions, non-governmental organizations, and Western governments. This report examines and discusses the impacts that Chinese financiers and particularly China Exim Bank have regarding debt creation, good governance, and environmental protection. It measures Chinas efforts not by Western standards, but by international standards which China has signed or helped to bring about.
China CP
( ) China is better at providing health assistance than the US closer to Africa, similar health system, and better trust Peter Bosshard, Policy Dir., Intl Rivers Network, May 2007, Chinas role in Financing African Infrastructure,
http://www.irn.org/pdf/china/ChinaEximBankAfrica.pdf While the history of Africas relation with Europe and North America is checkered, African- Chinese relations have generally been friendly. Many African governments remember that China supported Africas liberation struggles against the colonial powers. In recent years, the political relations between China and Africa intensified quickly. President Hu Jintao and Premier Wen Jiabao visited no less than 18 African countries between April 2006 and February 2007, and 48 African governments sent high-level delegations to the FOCAC summit in Beijing. Many African leaders admire the tremendous economic success which China has achieved over the past decades. As a developing country, China can offer experiences and goods that are better suited to the needs of African societies than the policy advice and products from industrialized countries. For example, China and Africa both have dual health systems that rely on traditional as well as modern medicine. While Western pharmaceuticals are unaffordable for most African patients, China offers cheap and effective anti-malaria drugs based on the Artemisia shrub that are of great interest for African consumers. According to Chinas new African Policy of January 2006, China respects African countries independent choice of the road of development and will provide and gradually increase assistance to African nations with no political strings attached.20 Indeed, China extends loans with (almost) no strings attached. At the FOCAC summit of November 2006, President Hu Jintao pronounced that [t]reating each other as equals is crucial for ensuring mutual trust.21 At the same event, Premier Wen Jiabao stressed that Chinese assistance to Africa is sincere, unselfish and has no strings attached.22 Chinas only condition for political and economic cooperation is the one China principle, in that African partner governments may not have official contacts with Taiwan. African governments have hailed Chinas new role as a trade partner and financier as a major new opportunity for Africas development. [China] is cooperating with African countries on an equal basis without any desire to colonize Africa, Zimbabwes President Robert Mugabe said in October 2006.23 Around the same time, Sudans President Omar El-Bashir praised his countrys relations with China as exemplary in South-South cooperation.24 And a senior Nigerian government official was quoted by the Financial Times as follows: Being a developing country, they understand us better. They are also prepared to put more on the table. For instance, the western world is never prepared to transfer technology but the Chinese do.25
Canada CP
( ) Canada imports a large number of doctors from SSA Ronald Labonte, South African Migration Project, 2006, The Brain Drain,
http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_2.pdf It is clear that unless Canada and source countries take some action, the brain drain of health care professionals from Sub-Saharan Africa to Canada will continue. The greater fear is that, as Canadas shortages in physicians and nurses are exacerbated (as predicted), so will the brain drain. Unless measures are adopted, there is no indication or reason why trends in the sources of the drain to Canada will change; Canada will continue to receive significant numbers of health care professionals from Sub-Saharan Africa, a region itself so desperate for their skills.
WHO TTR CP
( ) The WHOs Treat, Train and Retain plan can boost human resources for disease prevention WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf In devoting the 2006 World Health Report to human resources for health, the World Health Organization has demonstrated its recognition of the centrality of the health workforce in global strategies to reach health and development goals. The report highlights the growing crisis of human resources for health (HRH), particularly in sub-Saharan Africa where there is an estimated critical shortfall of 0.82 million health workers in 36 African countries. This situation is exacerbated by the weakness of the current training output for Africa which is only 10% of what is needed. The report challenges the global community to fi nd ways to work together through alliances and networks, across health problems, professions, disciplines, ministries, sectors and countries to meet health workforce challenges. The World Health Organization has played a key role in the formation of a Global Health Workforce Alliance that aims to bring relevant stakeholders together to accelerate core country programmes. In addition, the deepening AIDS crisis in many subSaharan African countries has catalysed a specifi c focus on health workforce defi cits which pose a challenge to effective delivery of HIV services. The 2005 global commitment to scale up HIV services, with the aim of as close as possible to universal access to treatment for all those who need it by 2010, has created new urgency for intensifying global action to strengthen the health workforce. Both the fi nal report of the 3 by 5 Initiative 1 and the assessment report of the Universal Access Global Steering Committee 2 list the human resource crisis as one of fi ve key challenges to scaling up HIV services. Against this backdrop, the need for an approach to strengthen the health workforce in the context of HIV and AIDSand one that is aligned with broader action for health systems strengtheninghas become clear. In May 2006, an international consultation, attended by 134 delegates representing governments, health workers and their organizations, international agencies, development agencies, academic institutions and civil society organizations active in the fi elds of HIV and HRH, was held in Geneva to discuss a plan which would fulfi l this ambitious goal. The consultation gave defi nition to a proposed AIDS and health workforce plan dubbed Treat, Train, Retain (TTR), which comprises three elements: Treat (prevent, care and support)a package of HIV treatment, prevention, care and support services for health workers in countries affected by HIV. Train (and planning for HRH)measures to empower health workers to deliver universal access to HIV services that include pre-service and in-service training for a public health approach. Retainstrategies to enable health systems to retain health workers, including incentives, measures to improve occupational health and safety and to improve the workplace as well as initiatives to manage the migration of health care workers. The elements, which are mutually reinforcing, have been grouped for conveniencethere is some overlap between them. TTR should be seen as a menu of options which builds upon existing work in the fi eld. Its main function is to catalyse, coordinate and maintain the momentum of the different actors and programmes in this broad fi eld. It recognizes that a coherent approach for scaling up towards Universal Access will need to be broad and multifaceted and will depend on the scaling up of current initiatives both within and outside the AIDS silo. Country leadership and country ownership, and the embedding of TTR plans into broader planning and processes in the areas of HRH, development and poverty reduction will be central to the success of TTR. By addressing both the causes and effects of HIV and AIDS in relation to the health workforce, TTR is both an essential component of the strategy to scaling up towards universal access and will make an important contribution to strengthening human resources for health in countries affected by the epidemic.
Global Initiative CP
( ) A global initiative to boost healthcare worker densities would solve the types of assistance that need to be provided are clearly not things the U.S. is superior at Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
A. Lead a global initiative to achieve minimum healthcare worker densities, with a US focus in subSaharan PEPFAR countries: According to Ambassador Randall Tobias, the head of the Office of the Global AIDS Coordinator (OGAC), the biggest obstacle faced by the US is a shortage of healthcare workers. Similarly, the WHOs 3x5 initiative and many Global AIDS Fund grants have been stymied by health workforce shortages and weak overall health systems. New investments will be needed to meet US global health targets such as those sought by PEPFAR as well as international commitments like the Millennium Development Goals or the G8 commitment to provide universal treatment coverage by 2010. To share these additional costs while achieving established targets, the US should call for and support a global health
workforce self-sufficiency initiative, urging donor nations to provide assistance to developing countries to achieve minimum health workforce density [2]. The US could lead the way by taking responsibility for supporting adequate health workforce density in PEPFAR focus countries, working with Country Action
Teams of public and private actors on the ground to develop and implement plans. New money will be necessary to train and retain workers, but estimates indicate first year expenses of $650 million, scaling to $2 billion over five years time will be sufficient to double the healthcare workforce in target countries. A private analysis was prepared in spring of 2005 year for US officials en route to the G7 Summit by WHO Special Envoy on Human Resources for Health Lincoln C. Chen, Chair of the JLI and Director of the Global Equity Center at Harvard Kennedy School of Government (with support from Health GAP, Physicians for Human Rights and Global Health Council). This memo includes all of Dr. Chens findings, and his methodology is A global initiative for self-sufficiency in sub-Saharan Africa is urgently available as an appendix.
needed, and would consist of donor countries working with public and private actors in specific impoverished nations to establish and sustain minimum health worker densities the number of trained health
workers needed to achieve quality health coverage. The term minimum health worker densities should mean the minimum ratio of health workers (of a nationally-determined skills mix) to population size required in a particular country needed to achieve and sustain local health priorities, US HIV/AIDS treatment and prevention targets and international health goals. A starting source to determine minimum health worker densities is the WHOs Joint Learning Initiative. The JLI establishes 2.5 trained health workers per thousand residents as the minimum number necessary to achieve minimum health standards in sub-Saharan Africa. Logical choices for the US-specific focus of a global initiative may begin with LDC PEPFAR countries, where country-level planning and experience may be strongest. Other donor nations should be challenged to provide assistance to other countries. An initiative to attain health workforce self-sufficiency would convene teams of relevant public and private actors to rapidly develop and implement plans to achieve minimum healthcare worker density. The US should then facilitate access to all available sources of internal and external financing for appropriate components of the overall plan. Specific program components and an packages of health improvements should be developed New US money will be necessary, by teams at the country level. (see New models for technical assistance below)
but rough estimates indicate that even relatively modest new investments can double the healthcare workforce in target countries. This investment in health workforce strengthening is a necessary complement to ensure the success and sustainability of the historic U.S. investments to fight AIDS. $2 billion would be needed in the first year from African governments and the collective donor community to at least double sub-Saharan Africas health workforce. Over five years, the total global cost will gradually rise to $7.7 billion annually. The U.S. share of this total cost would be approximately $650
million for the first year, rising to $2.6 billion over five years. This 1/3rd percentage is commensurate with the U.S. percentage of the worlds economy and similar to the US contributions to food aid programs and the Global Fund to fight AIDS, Tuberculosis and Malaria. This investment will need to be accompanied by donor and country-level policies that increase the size, skill, motivation and support for health workforce, and the rapid launch of community health worker initiatives. The majority of the funds required will necessarily have to come from the donor community. The approximate breakdown of the $2.0 billion required worldwide in year 1: 35% for health worker compensation, including stipends for community health workers and raising health workers out of poverty wages[3] 10% for incentives to health workers to serve in rural areas 25% for health worker pre-service education and continuous learning[4] 30% for human resource management and planning; health workplace safety; training, supervision, and support for community health workers and caregivers; human resources support to the not-for-profit NGO and faith-based sectors; global and regional support and learning The approximate breakdown of the $7.7 billion required in year 5: * 45% for health worker compensation, including stipends for community health workers and raising health workers out of poverty wages * 15% for incentives to health workers to serve in rural areas * 15% for health worker pre-service education and continuous learning * 25% for human resource management and planning; health workplace safety; training, supervision, and support for community health workers and caregivers; human resources support for not-for-profit NGO and faith-based sectors; global and regional support and learning These are the categories of investments required to educate, recruit, and retain the numbers of health workers necessary to at least double the health workforce and progress towards minimum coverage densities; to enhance health worker coverage in rural and other under-served areas, and; to increase the effectiveness of the workforce by improving health worker motivation and making the best use of health workers skills. Contributions levels should be sustained over time, but may be assumed to be bell-shaped. Decreasing contribution levels over time should be accompanied by predictable measures to facilitate local continuation.
Gates Foundation CP
( ) The Gates foundation is the quickest and best actor for solving global disease problems Laurie Garett, senior fellow for Global Health @ CFR, 1-25-2007, CFR On-The-Record, FNS, ln
Yeah, the Gates Foundation is really the giant elephant in the room. And worse yet, it's a giant elephant that's given money to every single aspect of academic public health all over the world. So all of academic public health is talking about the room as if the elephant wasn't in it, because nobody wants to lose the money they're getting from the Gates Foundation. So we've actually reached a point where it's difficult to get objective critique. And I think that's hard for the Gates foundation. They don't like that. They want to be able to have critique and analysis of how they're moving this. You know, it's a very, very young foundation. It's only really been giving on any mega-scale the last five, six years. And the real scale of giving is about to start next year when the Buffett money kicks in and is required to be given away as received. It cannot go into the equity funds of the foundation. And there, you know, one can just imagine enormous mistakes being made. I think already two, maybe even three years ago, the Gates Foundation had become the dominant policy force, because it's agile. It can move very quickly. It doesn't have to convene a meeting, as WHO does, of 193 member states and lobby everybody and then try to get a vote passed. The Gates Foundation can hold a meeting of we don't even know who, utterly opaque, there's no transparency here, in a closed-door and change direction radically overnight. And as a result, they're in, on the one hand, a marvelous position to react to events on the ground, to see oncoming potential hazards, such as pandemic influenza, and shift funds very, very quickly. But on the downside, it makes it almost impossible to have any kind of accountability, feedback is difficult.
***Africa CP***
Africa CP 1NC
The African Union should adopt a binding policy devoting at least 15% of member states budgets to expanding health capacity, including the elimination of health worker shortages. This should include raising salaries and wages, improving worker safety and occupational safety, providing incentives for health worker retention, expansion of training facilities, and expanding the utilization of community health workers. African governments committing at least 15% of their budgets to health care is a vital prerequisite to solving the aff Africa News, January 25, 07, Africa; Health Promises, Time to Deliver, lexis nexis academic, ael
"The evidence suggests African Heads of State are not taking the Abuja 15% commitment as seriously as they should. 5 years after the pledge, the great majority of the AU s 53 member governments including those in southern Africa most hit by Africa s worsening Public Health crisis have not even begun the process of meeting this pledge." She emphasised that "it s almost as if African governments don t realise that without a healthy and active population especially in the key age groups and social groups most affected by the health crisis Africa has no future. Maternal mortality for instance is almost 100% preventable. The fact that the figures for Africa are the highest in the world suggest that our governments still think that reproductive health which applies to half the populations of our countries is a fringe service" The Petition also identifies key healthcare challenges which the resources from the 15% commitment should be focussed on resolving. One of them is Africa s health worker shortages that have been exacerbated by OE Brain Drain , which subsidises healthcare systems of more developed countries. Speaking on how brain drain has worsened Africa s public health crisis, Eric A. Friedman, Senior Global Health Policy Advisor of Physicians for Human Rights, a partner of the campaign, stated: "In country after country, the shortage of health care workers, along with the lack of support for health care workers who struggle heroically to save lives, is a central obstacle to delivering a wide range of critical health services. Simply put, without the health workers, health services can t be delivered, and horrific levels of death and disease will persist. Much of the shortage is due to brain drain, as health workers migrate to countries in the North. Many of these countries train too few health workers themselves, so rely on health professionals from abroad to help meet their health care needs. Wealthy nations special connection to the health worker crisis in Africa due to brain drain requires that they work on a variety of fronts to prevent brain drain and support the development of effective and equitable health systems in Africa. Moreover, their own human rights obligations demand an intensive and multi-faceted response to this crisis." Abiola Akiyode-Afolabi Director of Women Advocates Research and Documentation Centre and Chair of the Nigerian and West African Social Forums underlined the implication of African governments of meeting their 15% pledge: "Unless the 15% commitment is fully implemented, all of Africa s 2010 Universal Access targets for prevention, treatment and care for HIV/AIDS, TB and malaria will definitely not be met. Even worse the three 2015 health-related Millennium Development Goals - based on scaling up reproductive health, children s health, and tackling the monster killer diseases of HIV/AIDS, TB, malaria and other diseases may be an impossibility"
Africa CP Solves
( ) If African countries invest money, they will solve the health worker shortage Physicians for Human Rights, Mobilizes health professionals to advance health, dignity, and justice for all, 1-01-05, Cost Estimates: Doubling the Health Workforce Doubling the Health Workforce in Sub-Saharan Africa
by 2010 An initial investment of an estimated $2.0 billion in 2006, rising to an estimated $7.7 billion annually by 2010, is needed from African governments and the collective donor community to double sub-Saharan Africa's health workforce while increasing its effectiveness, thus making significant progress towards developing the workforces required for countries in sub-Saharan Africa to achieve national and global health goals.
( ) Only African countries can offer additional salary or other non-monetary bonuses to improve morale and increase retention Physicians for Humans Rights, Mobilizes health professionals to advance health, dignity, and justice for all, 6-04, An Action
Plan to Prevent Brain Drain: Building Equitable Healthy Systems in Africa,
http://physiciansforhumansrights.org/library/documents/reports/report-2004-july.pdf African countries, with assistance if necessary from the United States and other donors, should provide extra salaries and benefits to health workers who take posts in rural or other underserved areas. Health professionals working in especially remote or otherwise unpopular facilities should be eligible for extra incentives. Just as increased remuneration generally is a key strategy to recruiting and retaining health professionals in Africa and other low-income countries, additional increases in salary and benefits are likely to help attract health professionals to rural areas, or encourage those already posted in rural and other underserved areas to remain. These incentives may take many forms, and need not be monetary, or exclusively monetary. For example, they might include extra vacation or study time, employment assistance for health workers spouses, and assistance with accommodations and the education of health workers children.588
( ) Africa can stop brain drain itself by eliminating push factors Mohamed A. El-Khawas, History and Poly Sci Prof @ UDC, 2004, Brain Drain, Med. Quarterly, 15.4, p.
muse It has taken African leaders a long time to understand the relationship among the brain drain, the African diaspora, and capacity building in Africa. A long-term strategy to reverse the brain drain is for governments to improve domestic market conditions, which had previously made migration a necessity rather than a choice. As President Chissano put it in April 2004, "If Africa wants to develop with its own means, it must do all it can to eliminate the causes that drive skilled Africans to seek work in the industrialized world."45 The African Union has begun to address the push factors that have worked against Africa's interests. In March 2004, it held a two-day meeting in Addis Ababa to draft a policy to help reduce the number of skilled workers leaving the continent and to encourage governments to develop policies to encourage expatriates to return to their countries of origin.46 Holding meetings and talking about new policies, however, is not sufficient to reverse brain drain. Words must be turned into actions. A sense of urgency ought to be injected into the process and a bold program of action should be put into place right away.
Africa CP Solves
( ) Africa solves best for African problems they have the resources Ayittey 2005 (George) [Distinguished Economist at American University; President of the Free Africa
Foundation]. Africa Unchained: The Blueprint for Africas Future, pp. 417-418. In recent times, various people, including this author, have propagated the idea that the impetus for reform and change in Africa must come from within. Back in 1993, the $3.5 billion international peace mission into Somalia failed miserably. As a result, this author coined the expression African solutions for African problems. African solutions are less expensive, and, further, reform that is internally generated endures. Only Africans can save Africa. An international conference on Africas Imperative Agenda, held in Nairobi in January 1995, emphasized this new philosophy. Conference participants expressed strong support for the following priority propositions: 1. Africas human and natural resources are more than sufficient to revive progress if a concerted, determined effort is launched within each society, and coordinated regionally. 2. Such efforts will succeed only if Africans take full charge of them and formulate policies that are geared to meet national needs rather than win international approval. 3. Participatory political structures and good governance are essential preconditions for effective policymaking. 4. Only Africa can reverse its decline. 5. The criteria of success for economic policies must be the improved health and education of the population and increased employment and production. Therefore, the agricultural sector, which employs the vast majority of Africans, is central to economic revival. 6. The role of political leadership and government action has been downplayed and private sector efforts stressed in international debate. (Africa Recovery, June 1995; p.9) It may be recalled that this plan of action does not differ substantially from the Atinga development model we laid out in chapter 10. It requires the establishment of peace, the provision of some basic infrastructure, the mobilization of capital through the revolving rural credit schemes, and the investment of funds in agriculture or agriculture-related cottage industries. Agriculture is the main occupation of Africas peasant majority. Nothing complicated is envisioned just modernizing the existing indigenous institutions to generate economic prosperity. It is an African solution that returns to Africas roots and builds upon Africas own indigenous institutions. This blueprint is already there in Africa and does not require billions of dollars in Western aid. Nor does our plan envision extensive involvement of the state. In a sense, this approach may be characterized as the new African renaissance. Two African leaders Presidents Thabo Mbeki of South Africa and Isaias Afwerki of Eritrea have latched on to the African renaissance bandwagon. Let us briefly review their pronouncements.
( ) Comprehensive indigenous approaches are already emerging in Africa to boost health capacity just need to be better funded WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf There is much that source countries can do, and are doing, to retain health workers and reduce the push factors for migration. Some of these are broader incentive schemes and strategies to improve the lives and working conditions of health workers, others relate more specifi cally to HIV and AIDS. Strategies to provide prevention, treatment, care and support as well as training and career development may also be seen as important retention strategies and are discussed in accompanying papers (Treat and Train). To date, most initiatives at country-level have been piecemeal and ad hoc, but the growing urgency of the health workforce crisis is catalyzing a more comprehensive approach, where retention strategies are part of broader plans to strengthen health systems. For example, the Governments of Malawi and Zambia have devised bold national strategies that operate at national and district levels including massive increases to health budgets, supplementing the salaries of health professionals, and educational and other soft incentives to retain health workers. For comprehensive health system plans to be sustainable they must be costed and funded, and embedded in national development plans. The Malawi Emergency Plan, for example, is included in the national Poverty Reduction Strategy Paper. This will require joint planning, and cooperation between HRH teams, National AIDS authorities and the relevant government ministries.
Africa CP Solves
( ) 15% of national budgets would solve the health worker shortage - key to flexibility Global AIDS Alliance, 07, Strengthen Health Systems,
http://www.globalaidsalliance.org/issues/strengthen_health_systems/, ael Countries need the flexibility to increase the number of working health care personnel and to improve their salaries. A global advocacy campaign is underway to persuade the wealthiest countries, which largely control the policies of international lenders, to require these agencies to give countries the flexibility they need. The campaign is also encouraging countries to set their own path in making budgetary decisions, independently of the advice of the international lenders. People in many African countries are also pressing their governments to keep a promise made in 2005 to increase spending on health to 15% of the national budget.
( ) Increasing health care to 15% of the budget increases the number of health workers Tanzania Gender Networking Programme, June 16, 07, Tanzania: What kind of budget do feminist
and gender activists want?, http://www.ansa-africa.net/index.php/views/news_view/tanzania_what_kind_ of_budget_do_ feminist_and_gender_activists_want/, ael Maternal Health depends, in part, on all girls and women having access to quality health care, good nutrition and safe, clean water, from the time of their birth. According to the Budget Guidelines, the total allocations to health, water and agriculture will actually decline from last year, in spite of government promises to ensure that all of its citizens have access to basic social services. We call on our government to stay true to its pledge at Abuja to increase the Health Budget [including provisions to LGAs] to the 15% target figure by 2010, and begin with 12% of this years budget. Equally important, we expect that concrete measures will be taken to dramatically improve health delivery, beginning with a major increase in the number of qualified trained health workers, and in provision of drugs, equipment and other resources needed at the community level.
( ) The majority of the 15% goes to solving the health worker shortage Africa News, January 25, 07, Africa; Health Promises, Time to Deliver, lexis nexis academic, ael
The Petition also identifies key healthcare challenges which the resources from the 15% commitment should be focussed on resolving. One of them is Africa s health worker shortages that have been exacerbated by OE Brain Drain , which subsidises healthcare systems of more developed countries.
Africa CP Solves
( ) Recruiting from abroad is insufficient to provide enough health workers must build indigenous health capacity WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf Estimates and plans for enlarging the health workforce to meet the needs of the move towards universal access must be made at country level and integrated into overall education and human resources for health (HRH) planning, budgeting and national poverty reduction strategies. Plans to enlarge the health workforce will often need to include the expansion of training facilities to support the production of greater numbers of health workers. These include doctors, clinical offi cers, nurses, pharmacists, trained counsellors, laboratory staff and community health workers. The particular service delivery model deployed will infl uence both the numbers and the training of additional health workers. While the public health approach allows for fewer doctors, it requires a larger number of nurses and lower level cadres who will need additional training. Limited shortages may be met by strategies to increase class size or reduce training time at training institutions. Widespread shortages, as exist in most sub-Saharan African countries, will require more comprehensive strategies such as the development of new training institutions and regional cooperation. In some countries, the AIDS and HRH crisis has led to emergency strategies to recruit medical workers from abroad. Members of the diaspora could be engaged to contribute to the expansion of the workforce, through short- or longterm voluntary return schemes, when the expertise does not exist locally. Increasing graduate numbers or recruiting new health workers from abroad are not the only ways of increasing human resources for health. The World Health Report 2006 also discusses broader strategies to maximize effi ciency and performance of the existing health workforce. Strategies to eliminate corruption and ghost and absentee workers may also expand resources for health.
Africa CP Solves
( ) Providing financial incentives is key to retain workers in Africa WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf Financial incentives The need for better remuneration ranks as the primary reason for health worker migration from many countries5. It is also a major cause of exit to private and NGO AIDS programmes and jobs outside the health sector. Raising salaries in the public sector can be diffi cult and costly. In some cases ministries of fi nance set public expenditure ceilings. In others, salary levels may be set for all civil servants by public service commissions, who may not wish to raise salaries in only one sector. Despite these diffi culties, some low-income countries have dramatically increased the pay of public sector health workers in recent years. In some countries, such as Kenya, Malawi and Uganda, salary increases have been applied across the board. In others, such as South Africa and the United Republic of Tanzania, they have been awarded to particular priority groups such as those with scarce skills, or rural health professionals. Selective application of fi nancial incentives may create inequalities that lead to demoralization in the workforce, and must be carefully considered. Objectives and target groups need to be carefully defi ned. Ideally, health workers and their representatives should be part of any fi nancial incentive scheme. Calculating the size of the salary increase (incentives, grants or top-ups) to stem migration is challenging. Health workers salaries in most low-income countries are so low that they cannot realistically be brought into line with those in rich countries. Other sorts of allowances are valued by health workers and may be used in combination with salaries and nonfi nancial incentives to retain valuable human resources. These include bonuses, travel and housing subsidies, loan schemes, child care allowances, school fees and social protection packages. The urgency of the health workforce crisis in worst-affected countries has prompted various agencies to discuss top-up grants or wage benefi ts for those delivering AIDS services. For example, UNAIDS has calculated for wage benefi ts (for nurses and doctors) of fi ve times higher to reduce the wage differential with middleincome countries6 . The challenges this creates must be discussed at global level as well as country level. The AIDS emergency in itself has fuelled action on the part of national governments and donors as regards the fi nancial implications of retention programmes and this should be maximized by all players.
***AT: US Key***
AT: US Key
( ) The requisite community health workers and WHO protocols are already in place their author agrees. Just because their card is suggesting the US do something doesnt mean another country couldnt provide the funding. Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
It takes a long time to train the numbers of doctors and nurses necessary to meet US policy goals such as those established by PEPFAR or other US-endorsed targets such as the Millennium Development Goals. However, the low hanging fruit of the healthcare worker shortage can be found in every village and community where people with AIDS live, or have families and care givers. Untrained community members women and people with HIVare already providing the bulk of care in many areas. A tremendous labor force is already in the field and can be quickly harnessed with modest investments in training and compensation for currently untrained, unpaid community caregivers at the village level. Community health workers can be deployed very quickly (versus the time it takes to train and graduate a professional) and at modest expense. Village-level health workers can quickly be trained to provide basic care, treatment and prevention services while serving as the first line of referral to health professionals. Community health workers can operate as satellites of clinics to extend coverage to remote areas. Community health workers are less susceptible to be lost to wealthier nations. Moreover, robust community health worker initiatives that substantially recognize, accredit, compensate and deploy this largely female and HIV+ workforce will reduce womens vulnerability to infection while contributing visibility that destigmatizes individuals living HIV. Simple and accelerated training criteria have already been developed by WHO and OGAC. Expanded US support for such training programs could quickly certify and equip tens of thousand of peer educators to provide voluntary counseling and testing, prevention education, treatment literacy, adherence counseling, symptoms monitoring, and basic care and prevention services. Community health workers can quickly extend basic health services to underserved rural areas, linking remote locations to regional clinics in a decentralized referral and supervision system that sends complex or severe cases to regional teaching hubs. Economic empowerment of women through paid healthcare labor is important in breaking the cycle of vulnerability that women face. Increased social status and economic resources, and increased knowledge about health will reduce womens personal and collective vulnerability to infection. Openly HIV-positive community-based health workers enhance the efficacy of AIDS programs as peer educators teaching treatment literacy and prevention skills while serving to destigmatize living with AIDS. Key elements in the success of community-level health workers include compensation, proper and ongoing training, continued supervision, and close linkages to health professionals within the broader health system. New health workforce initiatives should supply funding to train and support community health workers while working with governments, professional associations and PWA groups to ensure rapid deployment and coherent integration of community care workers into local health systems. Support for training and funding community health workers should be included as core components of programs such as the Global Health Corps, as well as PEPFAR and other initiatives.
AT: US Key
( ) US isnt necessary African governments just need capital to boost health workers Commission for Africa, UK Commission, March 2005, Our Common Interest,
http://www.commissionforafrica.org/english/report/thereport/english/11-03-05_cr_report.pdf Recommendation: Second, donors and African governments should urgently invest in training and retention to ensure there are an additional one million health workers by 2015. African governments and donors should ensure the health workforce in sub-Saharan Africa is tripled through the training and retention of an additional one million workers over a decade99. This will require sustained leadership on both parts100: by African governments, in the development of radical investment programmes; and by donors to provide predictable funding in the region of US$0.5 billion in 2006, rising to about US$6 billion each year by 2011101. The WHO should lead at the global level to coordinate and ensure effective action by all stakeholders. This requires strong collaboration to ensure technical assistance in this effort is harmonised with overall health system strengthening (as described in the above recommendation) and broader public sector reform. Where countries have human resource plans in place already, these should be identified and receive immediate donor support through existing financing mechanisms, including budget support and global health partnerships. But strategies must also be formed for fragile states, recognising the challenges of the lack of accountability of service providers to the service users because of ethnic, religious, linguistic and gender schisms. Human resource plans should also consider improvements to the salaries and conditions of government health and management staff to ensure that staff are retained and have access to professional development. AU/NEPAD is exploring innovative approaches to training and accreditation of health workers102. Regional and country strategies must recognise the major service delivery role of the private and not-for-profit sectors, and plan for the natural movement of health workers in and out of the public sector. Finally, donor countries must increase transparency about where their health workers were trained. But rather than restrict hiring, they should be challenged to reciprocate through supporting training and retention in the countries of origin.
( ) GHS Clearinghouse ensures info is available to doctors globally Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Recommendation 4: Undertake a uniform health workforce needs assessment. The committee recommends that the PEPFAR country teams, in collaboration with ministries of health, initiate assessments of in-country requirements for health personnel to achieve PEPFAR goals. These assessments should form the basis for national human resources for health plans. These assessments would also generate a valuable baseline inventory for all mobilization programs and subsequent evaluation activities. The data from all countries should be collected in a standardized fashion, updated regularly, and maintained in the electronic database of the U.S. Global Health Service Clearinghouse Opportunity Bank, available to professionals interested in service in PEPFAR countries. Timely and accurate information on workforce needs will be essential to maximize the impact of programs designed to mobilize health personnel to achieve PEPFAR goals. Current national needs assessments are irregular, nonstandardized, and not available at any single site. Local placement strategies and global recruitment efforts would be greatly strengthened by a regularized needs assessment and dissemination initiative.
( ) US students arent trained in public health wouldnt be uniquely good teachers Mark S. Smolinski, Dir. Global Health and Security Init @ NTI, et. al., 2003, National Acadamies, Microbial
Threats, http://www.nap.edu/openbook.php?isbn=030908864X To rebuild the public health workforce needed to respond to microbial threats, health profession students (especially those in the medical, nursing, veterinary, and laboratory sciences) must be educated in public health as a science and as a career. Even for students within schools of public health, education has traditionally focused on academic research training, not public health practice. A 1988 IOM report notes that many observers feel that some [public health] schools have become somewhat isolated from public health practice and therefore no longer place a sufficiently high value on the training of professionals to work in health agencies (IOM, 1988:15). A more recent IOM report states that in 1998, only 56 of 125 medical schools required courses on such topics as public health, epidemiology, or biostatistics (IOM, 2002e). The report recommends that all medical students receive basic public health training. It also concludes that all nurses should have at least an introductory grasp of their role in public health, and that all undergraduates should have access to education in public health. Educational strategies in which applied epidemiology programs provide exposure to state and local health departments may help increase awareness of the role of public health in population-based infectious disease control and prevention, and provide for exposure to public health as a potential career choice (see the later discussion on educating and training the microbial threats workforce). Pg. 162
( ) The U.S. doesnt have even close to an adequate number of infectious disease specialists Mark S. Smolinski, Dir. Global Health and Security Init @ NTI, et. al., 2003, National Acadamies, Microbial
Threats, http://www.nap.edu/openbook.php?isbn=030908864X The number of qualified individuals in the workforce required for microbial threat preparedness is dangerously low. For example, in 2001 the need for at least 600 new epidemiologists in public health departments across the United States was identified because of the requirements for bioterrorism preparedness alone. Yet only 1,076 students graduated with a degree in epidemiology in the year 2000 and are potentially seeking employment in government, academia, or private industry, and the largest percentage are trained in chronic disease, not infectious disease epidemiology. According to the National Association of City and County Health Officers, the most needed occupations between 1999 and 2000 were public health nurses, environmental scientists and specialists, epidemiologists, health educators, and administrative staff.
***Tuition DA***
Tuition DA 1NC
( ) Currently, med students can handle debt load with loans further tuition hikes deter enrollment in med school and jack student quality Paul Jolly, PhD, Sen. Assoc. VP @ Div. of Medical School Services, April 2005, Medical School Tuition,
Health Affairs 24, no. 2, Project Hope, http://content.healthaffairs.org/cgi/content/abstract/24/2/527 The leadership of American medical education would like to have diverse classes of medical students, including members of racial and ethnic minority groups underrepresented in medicine, and including students from a broad spectrum of socioeconomic class. A serious concern is that the high cost of medical education may deter applicants, particularly applicants from racial and ethnic minority groups underrepresented in medicine and from lower socioeconomic classes. In a recent national survey conducted for AAMC by a national polling organization, students who appeared to be qualified for medical school on the basis of academic achievement were asked why they did not apply to medical school. A number of reasons were given, including the cost of attending medical school, the time it takes to become a doctor, and the demands of the physician lifestyle. As Figure 22 shows, cost was a major deterrent for all students, and it was the number one deterrent for minority students Over the past two decades and especially in recent years, tuition in both private and public medical schools has very substantially increased. Indebtedness among graduating medical students has increased even faster. Loans are readily available, however, and repayment terms are generous. It seems clear that medical school graduates can repay the loans. If they stretch out the payments over thirty years, the payments can be accommodated within the income of even primary care physicians. A medical education remains an excellent investment. Students graduating with a high level of indebtedness will need to take future income potential into account when choosing a specialty, a practice location and a type of practice. This may lead to an inclination toward specialty practice in areas where remuneration is highest and may worsen the distribution problems that already exist Service related scholarships and service related loan repayment plans are one avenue of relief for some students. Unfortunately, the availability of these alternatives is limited, and not all students who would like to take advantage of these alternatives can do so. Increases in tuition seem likely to continue, and increasing indebtedness is almost a certainty. While loan repayment is not yet a serious hardship for most physicians, continued increases in tuition and fees may hinder recruitment of a diverse class and may eventually even lead to difficulty in filling the entering classes with well qualified students.
Tuition DA 1NC
( ) Increased student aid spurs tuition hikes schools can get away with it Brian M. Riedl, Heritage Foundation Fellow, 1-16-2007,
http://www.heritage.org/Research/Education/wm1308.cfm However, endless student aid increases may not only fail to deal with rising tuition; evidence suggests they actually contribute to tuition increases. Richard Vedder, among other economists, has shown that college tuition increases follow student aid increases.[9] Colleges, like businesses, charge as much as their customers are able to pay. So when student aid increases, colleges raise tuition accordingly to capture the additional aid. This suggests that increases in federal student aid effectively subsidize colleges, not students.
( ) Increased medical school tuition raises debt, jacking the entire health care system AMA, 2006, Medical student debt, http://www.ama-assn.org/ama/pub/category/5349.html
The increase in debt not only burdens medical students, but can have effects on the entire health care system. Some of correlations found include: * Decrease in primary care physicians o Students with high debt are less likely to pursue family practice and primary care specialties and instead seek specialties with higher income or more leisure time * Decreased diversity of physician workforce o The cost of tuition can prevent students from low-income/minority and those with other financial responsibilities from attending medical school o Physician diversity is necessary to address the needs of heterogeneous, multicultural patient populations * Promoting unsafe physician behaviors o Residents with high debt are more likely to moonlight + Increases fatigue and may contribute to medical errors (see Figure 4 (PDF, 39KB) o Increasing debt leads to more cynicism and depression among residents (see Figure 5 (PDF, 41KB)
Tuition DA 1NC
( ) Health care is key to competitiveness Business Wire, 10-12-2005, High-Tech Leaders, ln
Chief executives from the nation's leading high-tech companies today declared that building a networked health-care system is a national imperative and called on policymakers, U.S. businesses and health-care providers to develop the policies, standards and systems needed to make it a reality. The Technology CEO Council said that modernizing our health-care system by connecting health information between doctors, patients, pharmacies and labs is critical to not only improving our nation's health-care system, but our global competitiveness. The Technology CEO Council's "A Healthy System" Report and e-Health Readiness Guide provides a road map and policy recommendations on how to implement information management into the health-care system and milestones to measure progress. "Many of the problems with the U.S. healthcare system were exposed after Hurricanes Katrina and Rita when paper health records were lost and victims were unable to access their health information or provide complete medical histories to caregivers," said Craig Barrett, Chairman of the Board of Intel Corporation and Chairman of the Technology CEO Council. "It's clear that establishing a healthcare network that utilizes information technology to improve care, reduce errors and cut costs is critical. An effective, efficient system is not only important to advancing the health of our society, but also to our economic well-being and long-term competitiveness."
Tuition DA 1NC
( ) Competitiveness is key to heg Zalmay Khalilzad, RAND, Losing the Moment? The Washington Quarterly 1995
U.S. superiority in new weapons and their use would be critical. U.S. planners should therefore give higher priority to research on new technologies, new concepts of operation, and changes in organization, with the aim of U.S. dominance in the military technical revolution that may be emerging. They should also focus on how to project U.S. systems and interests against weapons based on new technologies. The Persian Gulf War gave a glimpse of the likely future. The character of warfare will change because of advances in military technology, where the [US] United States has the lead, and in corresponding concepts of operation and organizational structure. The challenge is to sustain this lead in the face of the complacency that the current U.S. lead in military power is likely to engender. Those who are seeking to be rivals to the United States are likely to be very motivated to explore new technologies and how to use them against it. A determined nation making the right choices, even though it possessed a much smaller economy, could pose an enormous challenge by exploiting breakthroughs that made more traditional U.S. military methods less effective by comparison. For example, Germany, by making the right technical choices and adopting innovative concepts for their use in the 1920s and 1930s, was able to make a serious bid for world domination. At the same time, Japan, with a relatively small GNP compared to the other major powers, especially the United States, was at the forefront of the development of naval aviation and aircraft carriers. These examples indicate that a major innovation in warfare provides ambitious powers an opportunity to become dominant or near-dominant powers. U.S. domination of the emerging military-technical revolution, combined with the maintenance of a force of adequate size, can help to discourage the rise of a rival power by making potential rivals believe that catching up with the United States is a hopeless proposition and that if they try they will suffer the same fate as the former Soviet Union.
( ) Nuclear war Zalmay Khalilzad, RAND, The Washington Quarterly, Spring 1995
Under the third option, the United States would seek to retain global leadership and to preclude the rise of a global rival or a return to multipolarity for the indefinite future. On balance, this is the best long-term guiding principle and vision. Such a vision is desirable not as an end in itself, but because a world in which the United States exercises leadership would have tremendous
advantages. First, the global environment would be more open and more receptive to American values -democracy, free markets, and the rule of law. Second, such a world would have a better chance of dealing cooperatively with the world's major problems, such as nuclear proliferation, threats of regional hegemony by renegade states, and low-level conflicts. Finally, U.S. leadership would help preclude the rise of another hostile global rival, enabling the United States and the world to avoid another global cold or hot war and all the attendant dangers, including a global nuclear exchange. U.S. leadership would therefore be more conducive to global stability than a bipolar or a multipolar balance of power system.
No Tuition Hikes
( ) Tuition costs are steadily falling, ensuring a well-educated population Neal McCluskey, Cato Policy Analyst, 7-8-2004, The Sky Is Not Falling!,
http://www.cato.org/pub_display.php?pub_id=2727 The first came out the day before Kerry's Chicago speech, when USA Today published the results of a college affordability analysis it had conducted using data from the College Board, the Office of Management and Budget, and the Internal Revenue Service. The findings - at least if one were to listen to Kerry, or the rhetoric that has surrounded the on-going reauthorization of the federal Higher Education Act - were shocking: "Contrary to the widespread perception that tuition is soaring out of control," the newspaper revealed, "what students actually pay in tuition and fees -- rather than the published tuition price -- has declined for a vast majority of students attending four-year public universities. In fact, today's students have enjoyed the greatest improvement in college affordability since the GI bill..."But wait, there's more. The day after USA Today published its news, further evidence of college affordability became public, this time from the U.S. Census Bureau. "The population of the United States is becoming more educated," starts the Bureau's report, Educational Attainment in the United States: 2003, which declares that though large gaps still exist between different groups, "the educational attainment of young adults (25 to 29 years), which provides a glimpse of our country's future, indicates dramatic improvement by groups who have historically been less educated." Indeed, the Census Bureau found that nationwide over 27 percent of adults possessed at least a bachelor's degree -- a record high.
No Tuition Hikes
( ) Their evidence is all media hype colleges are affordable Neal McCluskey, Cato Policy Analyst, 7-8-2004, The Sky Is Not Falling!,
http://www.cato.org/pub_display.php?pub_id=2727 Despite the timely the release of the USA Today and Census Bureau reports, there's little reason to believe that Kerry's doom and gloom message -- or similar themes we've heard for years from politicians of all stripes -- will disappear. For one thing, whenever there's a choice between good news and bad, the media seem to pick bad every time. That's why newspaper headlines like "Private college tuition soars" in the June 28 Des Moines Register, and "Tuition hikes add to the grind: College costs soaring every year as students scramble to help pay the bills" in the same day's Cincinnati Enquirer, continue to be commonplace, despite recent reports from the Congressional Budget Office and the National Center for Education Statistics, as well as USA Today and the Census Bureau, having shown that higher education is readily accessible.
( ) Their evidence assumes sticker price, not what students pay Adrienne Aldredge, 8-19-2004, National Center for Policy Analysis, No. 482, Is College Too Expensive, Or
More Affordable Than Ever? http://www.ncpa.org/pub/ba/ba482/ The true price of a college education is much like the sticker price on a new car window: few people really pay it. According to a recent USA Today analysis, students pay only a fraction of the tuition sticker price at four-year public universities when grants and tax breaks are counted. Keep in mind that nearly three-fourths of full-time students attend public colleges and universities. Students last year paid an average of just 27 percent of the tuition sticker price at four-year public universities. Between the 199798 and 2002-03 academic years, the published tuition price at public universities rose 18 percent to an average of $4,202 (see the Figure). Average tuition paid at those schools, however, fell 32 percent during the same period, from $1,636 to $1,115.
No Federal Aid
( ) Federal financial aid is declining Marc Silver, 10-24-2006, How to Earn a Degree Without Going Broke,
http://www.npr.org/templates/story/story.php?storyId=6376591 The amount of money devoted to need-based aid seems to be on the decline. Total federal spending on Pell grants is down by $900 million from $13.6 billion to $12.7 billion for the 2005-06 academic year. The average Pell went down by about $120 per student to $2,474. At the same time, colleges are diverting more and more of their own aid to so-called merit scholarships.
Tuition Link
( ) Loan programs encourage tuition hikes Charlie Smith, Straight.com, 4-27-2006, Student-loan change feared, http://www.straight.com/article/studentloan-change-feared-0 Saul Schwartz, an economist at Carleton University, has researched income-contingent student-loan programs. In a phone interview with the Straight, Schwartz said that tuition tripled from 1,000 to 3,000 across Britain after an income-contingent student-loan program was introduced there last January. It's basically like a licence to raise tuition because you make it possible for students to pay it, Schwartz said. You can raise tuition to whatever you want because nobody pays up front. You just pay four or five years later, and then only if you make enough money.
( ) The plan spurs further tuition increases its a vicious cycle John A. Boehner, R-OH, 4-19-2005, Comments on College Access, US Fed News, ln
As many of you have heard me say before, it sometimes seems the more we spend in higher education, the further we fall behind. In fact, some believe government spending may be a hidden culprit in the ongoing inflation of college costs. They point to what seems to be a vicious cycle: colleges increase tuition; government responds by increasing spending; and colleges respond by increasing tuition again.
( ) Federal loan assistance causes tuition hikes colleges know they can get away with it Richard K. Vedder, Econ Prof @ Ohio, 4-19-2005, Statement, CQ Congressional Testimony, l n
There are arguments for or against each approach, but what is critical that some approach be adopted that puts brakes on the growth in student loan expenditures. At the present, universities set their tuition fees each year at ever higher levels and you, the federal government, respond by increasing assistance. You enable the tuition explosion to persist. If you stop providing assistance, in the short run there will be a rise in financial pain to college students, but in the long run you will help break the vicious circle of rising fees followed by rising loans, grants and now tuition tax credits. Universities raise their tuition a lot because they can get away with it. Make it difficult for them to do that.
Tuition Link
( ) Volunteer programs cause entitlement mentality, raising tuition costs Doug Bandow, Hoover Inst, Sep/Oct 1996, National Service or Government Service?
http://www.hoover.org/publications/policyreview/3574457.html Indeed, government-funded service plays into what some national-service proponents have denounced as an entitlement mentality -- the idea that, for instance, students have a right to a taxpayer-paid education. Some advocates of national service have rightly asked: Why should middle-class young people be able to force poor taxpayers to help put them through school? But public "service" jobs sweetened with a salary and an educational grant are no solution: they merely transform the kind of employment that a young person seeks to help cover his educational expenses. Some AmeriCorps volunteers do sacrifice, but there is no real sacrifice involved in, say, informing people about the availability of Federal Emergency Management Agency service centers, maintaining vehicles, surveying residents about recreational interests, cutting vegetation, and changing light bulbs in dilapidated schools -- all activities funded by the Corporation. In contrast, consider the sort of tasks envisioned by William James: young laborers would be sent off "to coal and iron mines, to freight trains, to fishing fleets in December." The real solution to the entitlement mentality is not to say that students are entitled to taxpayer aid as long as they work for the government for a year or two, but to rethink who deserves the subsidy. We also need to explore how federal educational assistance may have actually made it harder for students to afford college by fueling tuition hikes (the schools, of course, are the ultimate beneficiaries of most student aid). And we have to address the host of other "entitlements" that riddle the federal budget and sap people's independence.
***Spending DA***
Spending Link
( ) The GHS would cost 150 million a year Fitzhugh Mullan, MD Health Policy @ GWU, 2-21-2007, Responding to the Global HIV/AIDS Crisis, JAMA,
v. 297, no. 7, p. jama archives To ensure maximum impact, both the corps of health professionals and the funding for private sector support programs should be managed as a single program with a clear mission and identity. The US Public Health Service in the US Department of Health and Human Services, which has a long record of deploying clinicians as well as managing scholarship and loan repayment programs, would be the ideal home for the initiative. The Institute of Medicine report, indeed, proposes that these programs be launched together as the US Global Health Service constructed on key principles that would include country responsiveness, interdisciplinary approaches to program delivery, and training for self-sufficiency. Ultimately, each country will have to educate and maintain its own health workforce, but the aid of US health professionals would be welcomed in many developing countries as help in the crisis and as foundational assistance for the future. The Institute of Medicine report9 estimated the cost of a start-up US Global Health Service to be approximately $150 million a year, roughly 3.8% of the $3.9 billion proposed budget of the President's Global AIDS initiative for 2007or the cost of 18 hours of the war in Iraq.
( ) The GHS Corp alone costs 300K PER PERSON Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Salaries, benefits, and travel would account for most of the costs of the Global Health Service Corps. Projecting the exact cost of the Corps is not possible without making a series of assumptions about the personnel system to be used, the disciplines and seniority of the personnel involved, and the details of the approaches to orientation and supervision to be used for the Corps. A reasonable estimate of costs for the Corps can be derived from CDC, which deploys health professionals abroad using government personnel systems; its rough estimate for sending a skilled professional overseas is $250,000 per year per person.1 Using this yardstick, the deployment of an initial Corps of 150 individuals as recommended by the committee would require a budget of $37.5 million (150 $250,000). 1The total can be $300,000 or more depending on certain factors, such as whether the country is more expensive; the base salary is higher (e.g., a medical epidemiologist compared with a junior administrator); how many children the person has (the government pays school fees at $10,00015,000 per child per year); whether the total tour is shorter (because the costs of the move and set-up [e.g., housing] are amortized over fewer years); or security-related costs are increased (Personal Communication, Michael St. Louis, CDC, February 23, 2005).
( ) SSA needs 1 million more workers thats billions of dollars Lincoln Chen, MD, Global Equity Initiative, Harvard, et. al., 11-26-2004, Human resources for Health, Lancet,
v. 364, iss. 9449, p. sciencedirect We estimate the global health workforce to be more than 100 million people. Added to the 24 million doctors, nurses, and midwives who are recorded, there are at least three times more uncounted informal, traditional, community, and allied workers. The enumerated professionals are severely maldistributed between regions and countries. Sub-Saharan Africa has a tenth the nurses and doctors for its population that Europe has: Ethiopia has a fiftieth of the professionals for its population that Italy does. With such wide variation, every country must devise a workforce strategy suited to its health needs and human asset base. Here, we cluster 186 countries into five groups (figure 3). Countries are grouped into low, medium, and high worker density clusters (<25, 2550, and >50 workers per 1000 population, respectively). The lowdensity and high-density clusters are further subdivided according to high and low levels of under-five mortality. In low-density countries, 45 countries are in the low-density-high-mortality cluster; these are predominantly sub-Saharan countries with the double crisis of rising death rates overwhelming weak health systems. The remaining 30 low density countries are mostly in Asia and Latin America, which are also the predominant regions of the 42 moderate density countries. Among high-density countries, 34 are in the highdensity-low-mortality cluster; these are all wealthy countries, mostly members of the Organisation for Economic Co-operation and Development (OECD). The remaining 35 high-density countries are transitional economies or exporters of medical personnel. All these countries, rich and poor, have numeric, skill, and geographic imbalances in their workforce. And all countries can accelerate health gains by investing in and managing their health workforce more strategically. While maintaining a global perspective, we focus on low-density-high-mortality countries because of their dire health situations. For all countries, our outstanding global challenges are as listed below. Global shortage There is a massive global shortage of health workers. We estimate the global shortage at more than 4 million workers approximately. Sub-Saharan countries must nearly triple their current numbers of workers by adding the equivalent of 1 million workers through retention, recruitment, and training if they are to come close to approaching the MDGs for health.
( ) Infusing foreign capital into Africa through increasing salaries causes rampant inflation, crushing their economies Laurie Garett, senior fellow for Global Health @ CFR, Jan/Feb 2007, The Challenge of Global Health,
http://fullaccess.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html Some analysts, meanwhile, insist that massive infusions of foreign cash into the public sector undermine local manufacturing and economic development. Thus, Arvind Subramanian, of the IMF, points out that all the best talent in Mozambique and Uganda is tied up in what he calls "the aid industry," and, he says, foreign-aid efforts suck all the air out of local innovation and entrepreneurship. {See Footnote 1} A more immediate concern is that raising salaries for health-care workers and managers directly involved in HIV/AIDS and other health programs will lead to salary boosts in other public sectors and spawn inflation in the countries in question. This would widen the gap between the rich and the poor, pushing the costs of staples beyond the reach of many citizens. If not carefully managed, the influx of cash could exacerbate such conditions as malnutrition and homelessness while undermining any possibility that local industries could eventually grow and support themselves through competitive exports.
( ) African economies are currently doing well Juma Calestous, International Development Professor at Harvard, July 18, 2007, African Food Security, CQ
CONGRESSIONAL TESTIMONY, p ln Although Africa's economies are currently growing strongly, continuing these trends will require adjustments in the structure and functions of government to make them more entrepreneurial.26 More fundamentally, science and innovation must be integrated at the highest possible levels in government. This change will be facilitated by creating science and innovation into policy analysis capacity in universities, scientific academies and government departments. Which in turn may have political benefits: good governance and good engineering are not so different, after all. Both involve working to achieve objectives guided by care, diligence, and data.
( ) African economies are outstirpping global growth Angela Barnes, Investment Reporter, July 25, 2007, Africa offers final frontier for investors, GLOBE AND
MAIL, p. ln Economic growth in Africa - a diverse continent with more than 50 different countries - has outpaced global growth since the start of the bull market in commodities in late 2001, with an annual growth rate of 5 per cent, against the 4.2 per cent for the global economy. And the International Monetary Fund expects the performance to continue with African growth coming in at 5.6 per cent a year on average through 2012, well above the 4.8 per cent forecast for the global economy.
( ) African economies are making progress All Africa, July 23, 2007, Africa, AFRICA NEWS, p. ln
Annan also pointed to progress in economic and social development, and in respect for the rule of law. "Today, inflation is at historic lows in many countries, and 27 African economies are projected to grow by more than five percent this year. Direct investment has increased more than 200 per cent in the past five years. Exports are also rising... "Africa has also made headway toward the UN Millennium Development Goals. The latest report from the UN shows that today, halfway to the 2015 target date, we've achieved positive change in several crucial areas. We are not excelling, but we are advancing."
No African Inflation
( ) African inflation is low, despite growth Abdoulaye Bio-Tchane, Director @ IMF African Department, Benedicte Vibe Christensen, Dep. Dir., December 2006, Right Time for Africa, Finance and Development, v. 43, no. 4,
http://www.imf.org/external/pubs/ft/fandd/2006/12/biotchane.htm Fortunately, growth has not come at the expense of macroeconomic stability. Inflation has been trending downward in SSA since early in this decadean achievement that is especially noteworthy considering that oil prices have been rising steadily the whole time (see Chart 5). Inflation of about 12 percent is expected for the region as a whole in 2006and just 7 percent if Zimbabwe is excluded from the calculation. True, inflation has edged up a little from its low in 2004 because of the pass-through impact of higher oil prices. But the past plague of persistently rising inflation has been avoideda major benefit also to the poorest segments of the population. Oil exporters are saving a relatively high proportion of the increased oil revenue; given the limits on domestic capacity to absorb large inflows effectively, saving is prudent. Oil importers still have deficitsthe average deficit in 2006 is expected to be 4 percent of GDP but the deficits have been consistent with improved macroeconomic stability because of a switch to concessional financing. When grants or concessional loans have been available, countries have had room to substantially increase deficits to achieve spending priorities. For example, Burundi, The Gambia, and Madagascar have seen deficits increase since 2002, but without the additional inflation or crowding out that sole reliance on domestic deficit financing would have implied. Had governments chosen to spend more on subsidies for petroleum products rather than allow price rises to pass through to retail prices, the fiscal space (that is, the government's leeway to spend on health care, education, and other social indicators) would have been substantially compressed.
( ) African inflation is down Abdoulaye Bio-Tchane, Director @ IMF African Department, Benedicte Vibe Christensen, Dep. Dir., December 2006, Right Time for Africa, Finance and Development, v. 43, no. 4,
http://www.imf.org/external/pubs/ft/fandd/2006/12/biotchane.htm Yet things seem to be changing for the better throughout the subcontinent. In most African countries, leaders are now selected through democratic elections. The decision-making process is becoming more participatory and involving greater segments of civil society. The number of countries in crisis has declined, although conflict persists in some countries and regions. The pursuit of strong macroeconomic policies and economic reforms is bearing fruit: economies are growing faster and more steadily than before, and inflation is falling. Record levels of reserves in both oil-producing and oil-importing countries act as a cushion against external shocks, such as the recent increase in oil prices. Countries pursuing economic reforms have benefited from unprecedented amounts of debt relief from a wide variety of sources. In addition, the international community has promised a significant scaling up of aid resources in the years to come, offering African countries a fresh chance to free up resources and invest in human and fixed capital to promote sustainable growth. These changes have not gone unnoticed abroad. Foreign investors are showing increasing interest in the African continent, both in the domestic debt markets and in direct investment in the extraction of natural resources.
RBD 1NC
( ) The U.S. economy is currently competitive but still on the brink Diana Furchtgott-Roth, Senior Fellow @ Hudson Inst., Chief Economist @ US Dep. Of Labor,11-10-2006,
Keeping America Competitive, NY Sun, http://www.nysun.com/article/43318?page_no=1 Senator Clinton and President Bush may not always see eye to eye, but keeping America globally competitive is a shared goal. Since the election, much of the talk has been about the gridlock that will result from political "cohabitation," as the French call it. But there's much the two parties can agree on to improve or reduce our competitiveness, at no cost to the federal budget. Next Monday, well-timed to come out after the election, the Council on Competitiveness will release the 20th edition of "Competitiveness Index 2006," a publication tracking matters influencing American prosperity and economic growth. Ripe with bipartisan ideas, the report will present the major factors enabling America to compete in the global economy. And, earlier this fall, New York's Commission on Independent Colleges and Universities published a report titled "How States Can Enhance Innovation Through the Support of Higher Education and Research," focusing on how to increase science education in New York's primary and secondary schools and colleges. The American economy's recent performance is almost enough to make us forget about global competitiveness. Since the beginning of 2003, the annualized real GDP growth rate has averaged 3.5%. Aside from the tech bubble of the late 1990s, that's one of the best rates in over 30 years. Analysts forecast that our weak third-quarter growth rate will be followed by a pickup in the fourth quarter. But that does not mean that we can become complacent, or that our new Congress should lose sight of one of its main goals building a bigger, stronger America. We do not face much economic competition from Europe, with its low GDP growth, aging population, high unemployment, and excessive taxes, but we face strong competition from Asian countries such as China, India, and Singapore.
RBD 1NC
( ) Sending more doctors and scientists to Africa will cause reverse brain drain, destroying U.S. competitiveness and hegemony Alan M Webber, ed. Fast Company, 2-23-2004, Reverse Brain Drain threatens U.S. Economy, USA Today,
http://www.usatoday.com/news/opinion/editorials/2004-02-23-economy-edit_x.htm Today, while many of these conditions still apply, Americans are starting to hear a ew term: "reverse brain drain." What it suggests is the United States is pursuing government and private-sector policies that, over the long run, could lead to a significant shift in the world's balance of brainpower. Recently, President Bush's chief economic adviser, Gregory Mankiw, touted the advantages for U.S. firms of outsourcing jobs overseas. But that trend, if left unattended, could have serious implications for this country's economic competitiveness. For its part, the federal government seems intent on letting "controversial" scientists for example, those dealing with research that touches on the issue of abortion go to other countries and keeping foreign talent out. U.S. companies are happy to outsource knowledge work while, at the same time, buying out the contracts of their most experienced workers all in the name of reducing costs. And the one sure way to grow new brains a high-quality educational system has failed to produce enough homegrown talent. As the economy globalizes, and as first-class creative minds go abroad, stay abroad or are produced abroad, other nations may challenge the United States' role as the leader in innovation and creativity. The prospect of that challenge tomorrow more than the loss of jobs today is what the debate over America's economic future ought to be about. First, recent government policies are sending talented U.S.-based researchers overseas and clamping down on the arrival of new researchers to this country. A recent article by Carnegie Mellon professor Richard Florida in The Washington Monthly magazine makes a persuasive case that the Bush administration's policies are shooting this country's economy in the, well, the brain. Florida's book, The Rise of the Creative Class, demonstrates that the most competitive communities are those that have the highest concentration of talented individuals, a high degree of technological innovation and a high level of tolerance for diverse lifestyles.
RBD 1NC
( ) Competitiveness is key to heg Zalmay Khalilzad, RAND, Losing the Moment? The Washington Quarterly 1995
U.S. superiority in new weapons and their use would be critical. U.S. planners should therefore give higher priority to research on new technologies, new concepts of operation, and changes in organization, with the aim of U.S. dominance in the military technical revolution that may be emerging. They should also focus on how to project U.S. systems and interests against weapons based on new technologies. The Persian Gulf War gave a glimpse of the likely future. The character of warfare will change because of advances in military technology, where the [US] United States has the lead, and in corresponding concepts of operation and organizational structure. The challenge is to sustain this lead in the face of the complacency that the current U.S. lead in military power is likely to engender. Those who are seeking to be rivals to the United States are likely to be very motivated to explore new technologies and how to use them against it. A determined nation making the right choices, even though it possessed a much smaller economy, could pose an enormous challenge by exploiting breakthroughs that made more traditional U.S. military methods less effective by comparison. For example, Germany, by making the right technical choices and adopting innovative concepts for their use in the 1920s and 1930s, was able to make a serious bid for world domination. At the same time, Japan, with a relatively small GNP compared to the other major powers, especially the United States, was at the forefront of the development of naval aviation and aircraft carriers. These examples indicate that a major innovation in warfare provides ambitious powers an opportunity to become dominant or near-dominant powers. U.S. domination of the emerging military-technical revolution, combined with the maintenance of a force of adequate size, can help to discourage the rise of a rival power by making potential rivals believe that catching up with the United States is a hopeless proposition and that if they try they will suffer the same fate as the former Soviet Union.
( ) Nuclear war Zalmay Khalilzad, RAND, The Washington Quarterly, Spring 1995
Under the third option, the United States would seek to retain global leadership and to preclude the rise of a global rival or a return to multipolarity for the indefinite future. On balance, this is the best long-term guiding principle and vision. Such a vision is desirable not as an end in itself, but because a world in which the United States exercises leadership would have tremendous
advantages. First, the global environment would be more open and more receptive to American values -democracy, free markets, and the rule of law. Second, such a world would have a better chance of dealing cooperatively with the world's major problems, such as nuclear proliferation, threats of regional hegemony by renegade states, and low-level conflicts. Finally, U.S. leadership would help preclude the rise of another hostile global rival, enabling the United States and the world to avoid another global cold or hot war and all the attendant dangers, including a global nuclear exchange. U.S. leadership would therefore be more conducive to global stability than a bipolar or a multipolar balance of power system.
( ) US health care is key to the economy largest sector Business Wire, 11-15-2006, Some of the Highest Standards, ln
The US healthcare market is the world's largest in terms of total expenditure. In 2003, US health expenditure reached US$1,678.9 billion, equal to US$5,670 per capita. The importance of the health sector to the US economy is immense, being one of the largest individual industry sectors, providing employment to over ten million people and equal to 15.3% of GDP.
( ) The US health sector is key to the economy bigger than the whole Canadian economy Julie Kosterlitz, National Journal, 7-22-1989, But Not For Us, ln
These groups not only exert influence in Washington but also have economic roots that sink deep into the American economy. "We have a health sector that is very large and very economically oriented -- very entrepreneurial," said health consultant Etheredge, who noted that "16-17 per cent of the expansion of GNP comes from the growth of the health sector. Hospitals are the largest employers in most metropolitan areas. U.S. health care is the eighth-largest economy in the world, with $ 500 billion a year in revenues, [and] the health sector is lots larger than the whole Canadian economy."
( ) Quality of the science and engineering talent pool is key to competitiveness and growth William B Bonvillian legislative director and chief counsel to Sen. Joseph I. Lieberman Fall 2004 Meeting the
New Challenge to U.S. Economic Competitiveness Issues in Science and Technology. Washington: .Vol. 21 , Iss. 1 pg. 75 , 8 pgs Talent. Growth economist Paul Romer of Stanford University has long argued that talent is essential for growth. His "prospector theory" posits that the number of capable prospectors a nation or region fields corresponds to its level of technological discovery and innovation. Talent must be understood as a dynamic factor in innovation. A nation or region shouldn't try to fit its talent base to what it estimates will be the size of its economy. Instead, its talent base, because of its critical role in innovation, will determine the size the economy. In the simplest terms, the more prospectors there are, the more discoveries and the more growth there will be. Other nations are not standing still. The forty leading developed economies have increased their science and engineering research jobs at twice the rate that the United States has. U.S. universities train an important segment of the science and engineering talent base of the nation's developing country competitors, and those nations are encouraging a larger proportion to return. Their own universities in many cases are also rapidly improving. China graduates over three times as many engineers as does the United States, with engineering degrees accounting for 38.6 percent of all undergraduate degrees in China compared to 4.7 percent in the United States. The United States now ranks seventeenth in the proportion of college age population earning science and engineering degrees, down from third place several decades ago. Talent is now understood globally as a contributor to growth, and a global competition has begun. Yet, despite decades of discussion about the importance of educating more scientists and engineers, the percentage of U.S. students entering these fields is not increasing.
this sector. This concerns the ability to sustain the current advantage of U.S. science, engineering, and technology in global markets which in turn allows us to compete successfully in advanced manufacturing sectors which are the key to the future of the manufacturing sector. Government policy can play an important role in meeting this challenge as well.
According to the independent World Economic Forum, the United States is still the world leader in technology, based both on its commitment to research and its ability to bring innovative products to market. Table 2 gives the most recent rankings of this Swiss-based organization and shows that this lead is the key factor in keeping the United States near the top in global competitiveness rankings. Importantly, this group ranks the United States first in its Technology Index, due especially to its strong innovation performance. The NSF concurs that ". . . the United States continues to lead, or be among the leaders, in all major technology areas . . .,"and rates ". . . the United States as the world's leading producer of high-technology products . . . ."One measure cited by the NSF as a sign of the resurgence of U.S. technology was the increase in the share of U.S. patents granted to U.S. nationals. Since peaking in 1989, the share of patents granted to foreign nationals in the United States has fallen from 48 percent to 44 percent. Additionally, "U.S. inventors led all other foreign inventors [in patenting their products] not only in countries bordering the United States but also in markets such as Germany, Japan, France, Italy, Brazil, Russia, Malaysia, and Thailand." The United States is especially active and leads the world in some bright new areas for growth such as DNArelated patents and patents related to development of the Internet. Nonetheless, despite this position of leadership, there are some signs that the dominant position held by the United States is beginning to slip. We have already mentioned the recent trade deficit in advanced technology products. While this is due in large part to the strong dollar, severe cost pressures on domestic producers and increased competition, some data indicates that our science and technology lead is not as secure as it was a few years ago, and that our
commitment to funding the required research and education is not quite as solid as needed to maintain our competitive edge. In the first place, national funding for R&D and basic science from all sources, especially that related to manufacturing such as the
physical sciences and engineering, has been flat to slightly declining as a proportion of national output. Chart 8 reviews the historical pattern of R&D expenditures as a proportion of GDP. While the United States still leads all industrial nations except Japan in this measure of support for R&D, there seems to be a waning in the willingness or ability to maintain vigorous growth. Chart 9, for instance, chronicles a modest slowdown in the growth rate of R&D during the long boom of the 1990s, which was of course dominated by the technologyintensive fields such as communications and information technology, when compared to the two previous periods of expansion. Most of this decline is attributable to lower federal support in the 1990s. The manufacturing share of R&D, while still above 60 percent of the total, has also declined in the past few decades as a proportion of total industrial R&D, as Chart 10 shows. This may be due in part to the rise of spending on related areas such as research on software and IT systems related to manufacturing, and the growth of research spending by the services sector. The steady decline in cash flow of the manufacturing sector may also explain some of the lack of dynamism in manufacturing R&D. Since 1990, the cash flow of U.S. manufacturers has fallen from 37.2 percent of total corporate cash flow to 25.3 percent in 2001, reflecting the cost pressures and global competition affecting this sector.17 Federal government expenditures for basic science and
R&D, especially those areas directly related to manufacturing, have also failed to keep pace with the overall growth of the economy. Some growth in the past two years in R&D outlays only allowed the real level of support to return to 1987 levels. The most
spectacular example of this long and steady erosion of support is for space research. While no one would want to recreate the circumstances of the 1960s, namely the threat from the Soviet Union, that motivated much of the spending for the Apollo program, the benefits to high tech manufacturing from the space and national defense programs of the times were large and extended into the 1990s at the very least. In 1965, federal R&D (including plant and equipment) for the National Aeronautics and Space Administration (NASA) was three- quarters of one percent of total GDP. Combined with Department of Defense (DOD) expenditures, R&D in 1965 supported by these two agencies was equal to fully 1.7 percent of GDP. By 2002, NASA research was down to .09 percent of GDP and the combined NASA/national defense expenditures totaled only .42 percent of GDP, less than one-quarter the rate of 1965. 18 Federal spending in basic sciences related to manufacturing have also trended downward over the past three decades. In 1976, fully 43 percent of all federal expenditures for research, largely conducted by universities and federal labs, was devoted to engineering and the physical sciences. In 2002, that proportion had fallen to 26.8 percent. At the same time, research in the life sciences grew from 43 percent to 48 percent of the total. Overall, federal support for basic research has increased as a proportion of all federal science spending in recent years. In 2002, about .43 percent of GDP was devoted to all scientific research supported by the federal government. The training of scientists and engineers too has fallen from its levels three decades ago. In the 1960s and 1970s, there was a palpable sense of excitement, adventure, and a clear national purpose associated with scientific and engineering projects such as the Apollo program, development of large commercial aircraft, the early development of robotics and automation equipment, and the nascent industry of computing. This inspired students to enroll in related educational fields, and students were assisted by generous federal programs such as the fellowships awarded by the NSF and under the National Defense Education Act. Chart 11 depicts the slow decline in engineering enrollment in the United States since peaking in the early 1980s. Chart 12 shows slippage in graduate enrollment in advanced U.S. science and engineering programs over the past two decades. Undergraduate degrees awarded in engineering have fallen by almost 20 percent since 1987, those in the physical sciences by about 5 percent, and those in the critical-related area of mathematics by over 20 percent in the same timeframe. On a brighter note, degrees in the biological sciences, a potential source of technological strength and new products in the 21st century, have grown by nearly 70 percent since 1986, as Chart 13 shows.
The overall decline in the education of mathematicians, physical scientists, and engineers is cause for concern because demand for these skills is outpacing the economy-wide growth in demand for all workers, according to the U.S.
Department of Labor. The latest projections (again, these are somewhat dated) are for overall employment to grow by 0.3 percent per year in the first decade of the new millennium, while that for computer- and math- related occupations grows 2.6 percent, architecture and engineering jobs by 0.4 percent, and those in the life, physical, and social sciences by 0.9 percent.19
RBD Impact
( ) Reverse brain drain sparks a global nuclear war David Heenan, leading expert on globalization, 2007, Wake Up, America, Am. Manag. Assoc.,
http://www.amanet.org/movingahead/editorial.cfm?Ed=151&BNKNAVID=23&display=1 Forget terrorism. Forget weapons of mass destruction. The next global war will be fought over human capital. For years, immigrants provided a constant pipeline of brainpower to the United States. From Albert Einstein to Alfred Hitchcock, a steady stream of energetic and highly skilled newcomers yearning to breathe free propelled Americas ascendancy. Today, the country continues to benefit enormously by being a magnet for inventive and ambitious people who stimulate the economy, create wealth and improve overall living standards. Chinese and Indian immigrants run nearly a quarter of Silicon Valleys high-tech firms. Eight of the 11 Americans who shared Nobel prizes in physics and chemistry in the past three years were born elsewhere. Nearly 40 percent of MIT graduate students are from abroad. More than half of all PhDs working here are foreign-born, as are 45 percent of physicists, computer scientists and mathematicians. One-third of all physics teachers and one-quarter of all women doctors immigrated to this country. However, the United States can no longer live off of its transplanted foreigners. Beginning in the 1990s, a giant sucking sound could be heard as their native countries improved economically and politically. Many of Americas best and brightest began hotfooting it home in search of another promised land. Foreign Techies Are Returning Home in Record Numbers A decade ago, Edward Tian said goodbye to Lubbock, Texas, his pickup truck, horseback riding and seven years of studying brown snakeweed to return to Beijing. He took home a Texas Tech doctorate in ecology and a small Internet software company he co-founded in Dallas. That business, Nasdag-listed AsiaInfo, went on to become Chinas premier systems-integration company, creating as much as 70 percent of Chinas Internet infrastructure. I wanted to do something to change peoples lives in the next five years, not the next 200 years, says the 41-year-old entrepreneur. (On the heels of AsiaInfos success, Tian went on to found telecom giant China Netcom, where he serves as chief executive.) After centuries of importing brainpower, the United States is now a net exporter. In the past few years, nearly 200,000 foreign-born Americansmany of them, like Dr. Tian, highly talented techieshave returned to their motherlands every year. This reverse brain drain, or flight capital, stimulated in part by lucrative government incentives, has spawned flourishing new scientific havens from South Asia to Scandinavia. Given the departure of Tian and many others, it was perhaps inevitable that the land of opportunity would turn its back on newcomers. In the aftermath of the Sept. 11, 2001, terrorist attacks, more and more Americans have sought to pull up the drawbridge. U.S. Citizenship and Immigration Services has issued fewer temporary H1 B work and student visas and applied much stiffer requirements for newcomers. The anti-immigrant sentiment could not have come at a worse time. Survey after survey reveals that the United States faces a massive labor shortage, particularly for knowledge-oriented workers. The same is true for Germany, Japan and the other industrial powers. But while many countries are extending the welcome mat to gifted outsiders, the United States is taking the opposite tack. On its present course, our nation of immigrants could become a nation of emigrants.
***Politics***
( ) Biden and Brownback dont support the bill Physicians for Human Rights, June 15, 07, G8 Summit: Results and Reactions,
http://www.phrweekofaction.org/?cat=9, ael Students have been playing a crucial role in encouraging the US to act on its promises to address the African health worker crisis. Senators Joseph Biden and Sam Brownback have still not co-sponsored The African Health Capacity Investment Act. Their support is critical to ensure passage of this bill because of their important roles on key committees. Contact them today and ask them for their support, even if they are not your Senator.
( ) Solving the health worker shortage in SSA is bipartisan African Business News, 8-4-2006, US Senators introduce African Health Capacity Investment Act,
http://www.mbendi.co.za/a_sndmsg/news_view.asp?I=76842&PG=35 A bipartisan group of Senators has introduced the African Health Capacity Investment Act of 2006, S.3775, a comprehensive bill to help sub-Saharan African nations confront the alarming shortage of health workers; thirteen countries on the continent have fewer than 5 physicians per 100,000 people. The United States has 549 physicians per 100,000 people. Senators Dick Durbin (D-IL), Norm Coleman (R-MN), Russ Feingold (D-WI) and Mike DeWine (R-OH) called the lack of health care workers and capacity in many African nations a "critical obstacle" in the world's fight against HIV/AIDS and a potential outbreak of Avian Flu and in promoting economic development and growth. "With 11 percent of the world's population, 25 percent of the global disease burden and nearly half of the world's deaths from infectious diseases, subSaharan Africa has only 3 percent of the world's health workers." Senator Durbin said. "Personnel shortages are a global problem, but nowhere are these shortages more extreme, the infrastructure more limited and the health challenges graver than in sub-Saharan Africa, the epicenter of the HIV/AIDS pandemic. We will not win the war against AIDS or any other health challenge without finding solutions to this crisis," Durbin said. "I am very proud to join my colleagues in introducing this bill as it is critical for bolstering our efforts to combat HIV/AIDS and other diseases in Africa," said Senator Coleman. "The lack of health care capacity in Africa imposes major constraints on the long term effectiveness of programs fighting HIV/AIDS and other diseases. For this reason, any forward-looking, comprehensive strategy to fight these terrible diseases must include elements that build African health care capacity." "The massive shortage of healthcare workers may be the most critical issue facing health care systems in Africa, contributing to millions of preventable deaths each year," Senator Feingold said. "I am proud of the leadership role the United States has taken in addressing HIV/AIDS, malaria, tuberculosis, and other global health crises. However, the resources we have invested in Africa will ultimately be fruitless unless we establish an infrastructure to ensure their effectiveness in the long-term." "I am proud to join my colleagues in supporting this worthy bill that will help millions of people in Africa get the basic health services they need. A coordinated strategy for healthcare workers would ultimately help combat the HIV/AIDS epidemic by increasing treatment and education about the disease. This, coordinated with infrastructure improvements, will also give much needed doctors and nurses access to more patients," said Senator DeWine. "In addition, these measures will help these developing nations to support economic growth and create jobs for their citizens."
***Biodefense DA***
Biodefense DA 1NC
( ) Funding and human resources for bio-defense are stretched now the plan would require sending the few experts we have to Africa, devastating our capacity to respond to bioterror or infectious disease Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 Furthermore, while preparing for future biodefense efforts and addressing bioterrorism-related issues, it is essential that policy makers, scientists, and others consider not only which biological weapons terrorists are developing to use against the United States and other countries, but also the underlying ways in which globalization is creating the distress and fury that cause them to do so. The political and social capacity to understand and address these underlying issues is essential. Participants also cautioned that the flow of money to combat bioterrorism could disappear as quickly as it appeared. It is unclear whether funding of the current magnitude can be sustained over the long term, as it must be if it is to make a real difference in controlling either intentionally or naturally introduced infectious diseases. For example, although the recent budgetary changes may allow the establishment of several new staff positions in a single public health office, the positions may last only one or two years, depending on the sustainability of the funds. In light of the issue of long-term sustainability, the need for clear communication is, again, paramount. A participant suggested that one of the basic priorities for action should be educating individuals and groups that are responsible for distributing the funds. It is critical for those in decision-making positions to understand how globalization increases the vulnerability not only of the developing world but also of the United States to infectious disease threats. Otherwise, the United States may find itself in the position of having seen the handwriting on the wall without having done anything about it. For example, the reintroduction of mosquito vectors worldwide and the resurgence of TB both illustrate the consequences of the complacency that results when the numbers of cases of a particular disease decrease and its visible manifestations disappear. When resources, attention, and capability are prematurely redirected, the world suffers long-term consequences. One possibility would be for the public health community to develop a congressional fellowship program similar to that of the American Association for the Advancement of Science. Public health congressional fellows could help draft policy and provide the knowledge base needed by legislators to make informed decisions. Finally, several participants expressed concern that the new biodefense efforts are creating a serious capacity challenge in the United States and worldwide. The existing expertise in the relatively few diseases that are being targeted is limited, and intellectual interests will likely be diverted toward certain diseases, at least temporarily. Management oversight is equally limited, as the United States is faced with the dilemma of massive increases in demand on federal agencies to manage funds at a time when the general administrative and governmental trend is to downsize. This disjunction between supply and demand could potentially devastate the long-term capacity of the federal government to manage the response to intentionally or unintentionally introduced infectious diseases. The problem is compounded by the fact that great sums of money are being directed toward academic centers and other nongovernmental organizations, which could result in a brain drain from the federal sector and leave it at grave risk of managing the funds inappropriately. It is unclear how these problems should be addressed. Despite the challenges and concerns outlined above, workshop participants suggested that if problems related specifically to the development of countermeasures for bioterrorism can be solved, the country will at least have begun to address some of the crucial issues related to the control and prevention of infectious diseases generally, such as access to medicines. It is hoped that over the next year there will be many such positive changes.
Biodefense DA 1NC
( ) Biodefense is key to stop the release of bioweapons that kill millions John D. Steinbruner, Director @ CISSM, and Elisa D. Harris, Senior Research Scholar, Spring 2003,
Controlling Dangerous Pathogens, Issues in Science & Tech., v. 19, Iss.3, p. ebsco More systemic protection is needed to guard against the deliberate or inadvertent creation of advanced disease agents. Remarkable advances are underway in the biological sciences. One can credibly imagine the eradication of a number of known diseases, but also the deliberate or inadvertent creation of new disease agents that are dramatically more dangerous than those that currently exist. Depending on how the same basic knowledge is applied, millions of lives might be enhanced, saved, degraded, or lost. Unfortunately, this ability to alter basic life processes is not matched by a corresponding ability to understand or manage the potentially negative consequences of such research. At the moment, there is very little organized protection against the deliberate diversion of science to malicious purposes. There is even less protection against the problem of inadvertence, of legitimate scientists initiating chains of consequence they cannot visualize and did not intend. Current regulation of advanced biology in the United States is concerned primarily with controlling access to dangerous pathogens. Only very limited efforts have been made thus far to consider the potential implications of proposed research projects before they are undertaken. Instead, attention is increasingly being directed toward security classification and expanded biodefense efforts to deal with concerns about the misuse of science for hostile purposes. Few U.S. officials appear to recognize the global scope of the microbiological research community, and thus the global nature of the threat. We believe that more systematic protection, based on internationally agreed rules, is necessary to prevent destructive applications of the biological sciences, and we have worked with colleagues to develop one possible approach.
( ) Funding for biodefense is high in the status quo Tara OToole, Dir. and CEO Center for Biosecurity, 3-29-2007, Bioterrorism Preparedness, CQ Congressional
Testimony, ln Biodefense Rests on Capacity to Mitigate Consequences of Attack The extreme difficulty of detecting or interdicting bioterrorist efforts means that defense against covert bioterror attacks must rest on the nation's ability to diminish the death, suffering, and economic and social disruption that could result from bioattacks. This harsh truth is presumably the insight behind the dramatic increase in biodefense spending that began in 2002-- federal spending on civilian biodefense went from approximately $250 million in FY2002 to nearly $4 billion in FY2003; funding levels overall have remained more or less constant since. These sums are significant when measured against other spending programs in the Department of Health and Human Services, which presides over most "biodefense" initiatives. Four billion dollars per year does not seem like so much money if one compares this amount to sums routinely spent on national security programs in the Department of Defense. The important questions, of course, are: Is the country getting the defense against bioattacks that we need with the programs we have? Could we do better?
( ) US biodefense research program is sufficient to solve Richard A. Falkenrath, Sen. Fellow Foreign Policy @ Brookings, 3-16-2006, Public Health Medical
Preparedness, CQ Congressional Quarterly, p ln Two aspects of the U.S. strategy for acquiring biomedical countermeasures to pathogen threats seem to me to be essentially sound. The first is the multi-billion dollar NIAID biodefense research program. I believe this program is adequately funded, excellently led, has already yielded many important discoveries for reducing the catastrophic disease threat, and will continue to do so in the future. The second is the Department of Health and Human Service's program for procuring proven biomedical countermeasures against known pathogen threats, such as ordinary anthrax and smallpox. This effort has been funded through the $5.6 billion BioShield advance appropriation as well as the annual discretionary budget of the Department of Health and Human Services. Most observers would like to see this HHS procurement program move more swiftly, but in my estimation it is reasonably sized and directionally sound. Nonetheless, I see four general problems in the area of pathogen countermeasure availability
( ) Causing worker shortages raises wages Donald M. Atwater, PhD, and Aisha Jones, Graziado Business Report, 2007, Preparing for a future labor
shortage, http://gbr.pepperdine.edu/042/laborshortage.html The consequences of such a skilled worker shortage at the national level would be substantial. Results would include: reduction of the growth in the standard of living, compared to historical trends; higher wage-push inflation; potential decreases in international competitiveness, and even the erosion of future domestic production capacity.
***AT: Add-Ons***
( ) Theres no internal link to the impact their link assumes bioterrorism, but the impact is about a nuclear attack on Washington
***Misc***
( ) War devastates health infrastructure, turning the case Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 Communal conflicts are characterized by the massive dislocation of populations and extensive destruction of infrastructure. An estimated 50 million people worldwide are forcibly displaced from their homes each year; this displaced population includes migrants who move regularly to find work and refugees who flee to a foreign country to escape danger. The United States alone receives an average of 90,000 refugees annually. Refugee populations are among the most vulnerable to emerging infectious diseases, even more so than migrants (see Chapter 1). For example, on the basis of preliminary data from a 2000 International Organization for Migration assessment of the health of more than 76,000 mobile people (44.7 percent migrants, 55.3 percent refugees), refugees are more likely than migrants to be HIV-positive (representing 65 percent of HIV-positive individuals in the database) (Grondin, 2002). The breakdown of public health systems and the public sector generally in areas that are experiencing war or receiving migrants can be profound. In many war-torn areas, public health systems are so severely affected that they do not have the capacity to provide adequate services. The rates of death and disease in Afghanistan, for example, are among the highest in the world. The maternal mortality rate in Afghanistan is on the order of 1,700 maternal deaths per 10,000 live birthsclose to what one would expect if there were no health care at all. Fully 25 percent of children in Afghanistan die before the age of five years, and about 20 percent before their first birthday. The country is experiencing a breakdown at all levels of health care, and immunization is almost nonexistent. Although there is little concern about a mass epidemic in Afghanistan since the country is not densely populated, its dire situation illustrates the devastating effects war can have on public health.
Colonialism Links
( ) Western volunteers extend the legacy of colonialism, entrenching cultural hegemony Thomas Roberts, MA Development Studies @ Manchester, 2004, Are Western Volunteers Reproducing and
Reconstructing the Legacy of Colonialism in Ghana, www.gapyearresearch.org/TomMA.pdf Volunteers may not necessarily have the same influence as permanent staff working for major NGDOs but they certainly spend considerable amounts of time living, working and interacting with local people. Furthermore, they often undertake jobs for which they have little if any previous experience, such as teaching, but can wield considerable influence over the people they are working with. Regardless of good intentions and a desire to help less fortunate people, Western volunteers are still heavily influenced by their education and general life experiences, making them excellent transmitters of Western cultural hegemony. Clearly, it is not possible to describe volunteer programmes as job creation for the middle classes, as the participants are unpaid. It may, however, be possible to suggest that many volunteers travel to developing countries and gain valuable skills and experience which potentially increasing their employability and earning power once they return to their home countries. Thus, essentially re- creating the imperial practice of exploiting the colonies for the benefit of the West.
Imperialism Links
( ) Health assistance is paternalistic and hegemonic western agencies and governments decide what is best for african health Collins O. Airhihenbuwa, Professor Biobehavioral Health, Pennsylvania State University, 2006, Healing
Our Differences: the crisis of global health and the politics of identity, p. 5-6 The debate about the potentials and pitfalls on the health and cultural implications of globalization has become even more critical. Discourse on transcultural health and behavior has entered a new phase as the boundaries of identity (individual and collective) and cultural sovereignty are increasingly being questioned and redefined. The new language of this debate necessitates and interrogation of some hitherto exalted notions of globalization that cast a shadow on the voices of scholars and cultural agencies in regions and cultures of the world that are considered to be marginal. By this I refer not only to scholars from nonWestern countries but also to scholars from Western countries who are engaged in the struggle to transform certain dominant but retrogressive languages for health behavior. The pursuit of a common global mission has slowly been translated to mean an expectation of unquestioning cooperation (in the name of partnership) from, for example, African colleagues in addressing what has been determined in the Westernized academies to be issues of health priority. This hegemonic policy of determining African health priorities outside Africa is even more evident in the work of some experienced and productive African researchers whose scholarship serves to promote the health issues and priorities that are determined outside their resource-poor environment. These health priorities and issues are often determined by funding agencies of government and major philanthropic foundations in the West. A resulting Western hegemonic blow received by Africans was to be softened by the United Nations corporate language. Technical cooperation, for example, is considered to be a preferred term to technical assistance (more on this in chapter 3), even though the latter better reflects the relationship between Western ideology and recipient partners. Technical assistance conveys language of paternalism and is thus too revealing of its intent to be acceptable in the discourse on partnership for global health with no serious interests in questions of identity and cultures as determinants of health behavior. The Malin sage/thinker Amadu Hampate Ba once noted that the hand that gives always stays on top. In a partnership that separates a giver from a receiver, the receiver must interrogate his or her voiceless position if his or her cultural identity is to have any role in the meaning of such partnership.
( ) 3 conditions must be met for the contact theory to work Judith Nihill DeRicco and Daniel T. Scicarra, January 1, 05, Journal of Multicultural Counseling and
Development, The immersion experience in multicultural counselor training: confronting covert racism, lexis nexis academic, ael
The value of the immersion experience is based upon the concept of the Contact Hypothesis (Brown, 1995). This hypothesis rests upon the belief that contact between divergent social groups is the best means toward reducing tensions and misunderstandings. Allport's (1954) comprehensive studies of the contact theory of intergroup relations have provided the framework for many interventions designed to reduce racism. Allport's findings were not a patent endorsement of simple contact theory, however. He was quick to point to data derived from the study of Blacks and Whites living in close proximity in Chicago to prove that proximity alone did not eradicate racial bias. In fact, the data presented showed that just the opposite was true, that proximity led to a clearer manifestation of racial prejudice. Rather than dismissing the social contact theory completely, Allport and others identified conditions of contact that must be met in order to bring about the reduction of prejudice. Three of these conditions relevant to the present experience were 1.
Contact must be of sufficient frequency, duration, and closeness to permit the development of meaningful relationships between and among members of the groups concerned. 2. Contact should take place, as much as possible, between and among participants of equal status. 3. Contact should be based on a necessity for cooperation so that all members of the different groups are mutually dependent upon one another for the attainment of a desired outcome. A need for cooperation provides an instrumental reason for the participants to
be motivated to develop better relationships with each other (Allport, 1954; Amir, 1969; Cook, 1962, 1978; Pettigrew, 1971).
( ) Contact theory has numerous requirements and is reverse causal Jeffrey C. Dixon, June 06, MIT Sloan Management, The ties that bind and those that dont: toward reconciling
group threat and contact theories of prejudice, http://socialissues.wiseto.com/Articles/147666262/, ael
Despite their contributions, group threat and contact theories have been criticized. One criticism of both theories is their almost complete focus on black-white race relations, assuming that threat and contact operate similarly across all racial/ethnic groups. Additionally, empirical studies largely test these theories in isolation from one another. Criticisms of research in the group threat tradition include its heavy reliance on measures of racial/ethnic composition as indicators of threat, which neglects economic and political measures that Blalock (1967) assumed were important. This research also uses measures of racial/ethnic composition at broad levels of analysis (Oliver and Mendelberg 2000). Moreover, this research does not measure or only indirectly measures perceptions of threat and the size of minority populations, which assume importance in contemporary variants of group threat theory (Bobo and Hutchings 1996; Glaser 2003). Contact theory is criticized because its numerous conditions of contact may make it unfalsifiable, and it is somewhat ambiguous regarding the quality of contact needed to reduce prejudice. The theory is also potentially
prone to self-selection bias and reverse causality: contact may reduce prejudice, but prejudiced people may avoid contact (Pettigrew 1998).