Infrastructure Neg - 5th Week

SDI 2007 5 Week
1 Infrastructure Neg
Index
Index ..........................................................................................................................................1 Strategy Sheet ...........................................................................................................................2 Inherency Frontline ....................................................................................................................3 Infrastructure Now .....................................................................................................................5 Disease Frontline.......................................................................................................................6 DA turns the case- War .............................................................................................................8 Poverty Frontline........................................................................................................................9 Solvency Frontline ...................................................................................................................10 US aid fails...............................................................................................................................12 Alt Cause .................................................................................................................................13 Politics Links- Public support ...................................................................................................14 Politics Links- bipartisan ..........................................................................................................15 Spending Links ........................................................................................................................16 China CP .................................................................................................................................18 China solvency ........................................................................................................................19 Imperialism Net Benefit............................................................................................................20 China will spend money...........................................................................................................21 China is key to African economy .............................................................................................22 Reconstruct Northwestern 1AC- Infrastructure........................................................................23 Reconstruct Wake Fast Track 1AC- Infrastructure ..................................................................45
SDI 2007 5 Week
Strategy Sheet
Case- the AFF is on the right side of this debate by saying a decline in infrastructure in Africa therefore is hard to directly attack their advantages. The NEG should defend the status quo efforts to deal with Africas health care infrastructure problem. The NEG can also takeout their disease advantage, regardless of which plan text is being read. Counter Plan - The NEG SHOULD run an agent CP. It will solve 100%. It does not matter which country provides infrastructure. Make sure to answer their US key cards though. The agent counter plan in here is China. A net benefit should be politics. DAs- The NEG should run a spending DA, since the AFF spends a lot of money. If they tradeoff, then run a tradeoff DA.
NORTHWESTERN
Plan: The United States federal government should substantially increase its financial and technical support for the purpose of building public health infrastructure in sub-Saharan Africa Advantages Disease Global health credibility Market advantage
WAKEFOREST
Plan: The United States federal government should increase its public health assistance to PEPFAR focus countries in Sub-Saharan Africa by establishing the U.S. Global Health Service to expand health care infrastructure capacity, including community health personnel funding, training, professional development, and incentives. AdvantagesOut breaks- its pretty much the same thing as disease Poverty Public diplomacy Ethnic obligation
SDI 2007 5 Week
Inherency Frontline
( ) Many resources for public health now Garrett, Senior Fellow for Global Health Council on Foreign Relations, 07 (Laura,
http://www.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-globalhealth.html?mode=print, DY) Less than a decade ago, the biggest problem in global health seemed to be the lack of resources available to combat the multiple scourges ravaging the world's poor and sick. Today, thanks to a recent extraordinary and unprecedented rise in public and private giving, more money is being directed toward pressing heath challenges than ever before.
( ) HIV/AIDS has boosted public health assistance to Africa Garrett, Senior Fellow for Global Health Council on Foreign Relations, 07 (Laura,
http://www.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-globalhealth.html?mode=print, DY) What seemed a brazen request then has now, just five years later, actually been eclipsed. HIV/AIDS assistance has effectively spearheaded a larger global public health agenda. The Harvard group's claim that three million Africans could easily be put on ARVs by the end of 2005 proved overoptimistic: the WHO's "3 by 5 Initiative" failed to meet half of the three million target, even combining all poor and middleincome nations and not just those in Africa. Nevertheless, driven by the HIV/AIDS pandemic, a marvelous momentum for health assistance has been built and shows no signs of abating.
( ) Private donors have given millions for public health Garrett, Senior Fellow for Global Health Council on Foreign Relations, 07 (Laura,
http://www.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-globalhealth.html?mode=print, DY) In recent years, the generosity of individuals, corporations, and foundations in the United States has grown by staggering proportions. As of August 2006, in its six years of existence, the Bill and Melinda Gates Foundation had given away $6.6 billion for global health programs. Of that total, nearly $2 billion had been spent on programs aimed at TB and HIV/AIDS and other sexually transmitted diseases. Between 1995 and 2005, total giving by all U.S. charitable foundations tripled, and the portion of money dedicated to international projects soared 80 percent, with global health representing more than a third of that sum. Independent of their government, Americans donated $7.4 billion for disaster relief in 2005 and $22.4 billion for domestic and foreign health programs and research.
SDI 2007 5 Week
( ) Sub-Saharan African countries are increasing their spending on public health Garrett, Senior Fellow for Global Health Council on Foreign Relations, 07 (Laura,
http://www.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-globalhealth.html?mode=print, DY) And poor nations themselves, finally, have stepped up their own health spending, partly in response to criticism that they were underallocating public funds for social services. In the 1990s, for example, sub-Saharan African countries typically spent less than 3 percent of their budgets on health. By 2003, in contrast, Tanzania spent nearly 13 percent of its national budget on health-related goods and services; the Central African Republic, Namibia, and Zambia each spent around 12 percent of their budgets on health; and in Mozambique, Swaziland, and Uganda, the figure was around 11 percent.
SDI 2007 5 Week
Infrastructure Now
( ) Africa is already working on developing their infrastructure Wolfowitz, World Bank President, 06 (Paul, The World Bank,
http://web.worldbank.org/WBSITE/EXTERNAL/EXTABOUTUS/ORGANIZATION/EXTPRESIDE NT2007/EXTPASTPRESIDENTS/EXTOFFICEPRESIDENT/0,,contentMDK:21095642~menuPK :64343258~pagePK:51174171~piPK:64258873~theSitePK:1014541,00.html, DY) And fourth, in too many African nations, poor or non-existent infra-structure blocks the path out of poverty. Today an entrepreneur in Central Africa pays roughly three times what his Chinese counterpart pays to transport a container the same distance and the odds are that he has to transport his goods a good deal further than his Chinese competitor. For that entrepreneur, the path out of poverty is literally a paved road. Africans already know what infrastructure they need, they have innovative plans for building it, what they lack are the resources. Thats why weve been supporting our African partners by substantially increasing investment in Africas infrastructure. Just the last year alone, we increased our infrastructure lending by 15%; its still way short of the need
SDI 2007 5 Week
Disease Frontline
( ) WHO and UNAID have new innovative ways to solve for disease rather than infrastructure. Jong- Wook, International Trade, 04 (Lee, Harvard International Review,
http://hir.harvard.edu/articles/1274/, DY) Building health systems and other infrastructure in developing countries is a vital part of the 3-by-5 initiative. Without strengthened health systems, this target cannot be achieved. However, this does not mean that brand-new hospitals and clinics need to be built all across Africa. Instead, WHO, UNAIDS, and our other partners are working to find innovative ways to involve community and other health workers in the delivery and monitoring of antiretroviral treatment for AIDS. This approach also has major potential benefits for other health problems, which require the availability of regular treatment from within the community. In a sense, everything WHO does is aimed at building more effective health systems to deliver better prevention, treatment, and care to people who need it.
( ) Building infrastructure wont help solve disease Higbee, News Service, 00 (Rebecca, Daybreak News,
http://www.ucsf.edu/daybreak/2000/02/24_poornations.html, February 24, DY "In planning policy incentives and interventions to develop and distribute muchneeded drugs and vaccines in developing nations, decision makers must understand that no single strategy can solve the problem of under-investment in diseases of the poor," says Richard Feachem, PhD, DSc (Med), founding director of the UCSF Institute for Global Health and professor of international health at UCSF and UC Berkeley. "Interventions are needed all along the vaccine and drug development and delivery process," he said. "Simply increasing foreign aid budgets will not solve the dangerous structural problems with drug and vaccine delivery and development."
( ) AIDS is slowing in the status quo due to effective prevention movements. Work Bank News and Broadcast 07. [June 14 Africas AIDS Epidemic Slowing
http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,date:2007-0614~menuPK:34461~pagePK:34392~piPK:64256810~theSitePK:4607,00.html]
The pace of Africa's deadly AIDS epidemic is slowing as communities are empowered to help themselves in tandem with better delivery of condoms and livesaving treatments, a World Bank report [Condoms, Drugs, NGOs, Slow HIV in Africa] said on Wednesday. _Launched in Kigali, the study noted a marked increase in access to HIV prevention, care and treatment programs The World Bank report said the epidemic was showing signs of slowing in Uganda, Kenya and Zimbabwe, as well as in urban Ethiopia, Rwanda, Burundi, Malawi and Zambia. The mobilization of empowered 'grassroots' communities, along with delivering condoms and life-saving treatments, are beginning to slow the pace of the ... epidemic, the study said, without giving specific statistics for the decrease. Southern Africa, however, remains the epicenter of the disease with unprecedented infection rates, the report added.
SDI 2007 5 Week
( ) Vaccines cant solve HIV is too genetically diverse. Lewis 07. [Dorothy, Prof in Dept of Immunology Baylor College of Medicine. HIV Vaccines: the future looks promising Perspectives
Research Initiative/reatment Action. Jan1. Lexis]
There are several major reasons why we don't yet have a vaccine that meets our needs. The most basic reason is that HIV is a wily pathogen, with surprises at every turn. The genetic diversity of HIV is a big problem. HIV also conceals important regions in its proteins that would normally elicit a robust immune response. This concealment leads to a key problem in the development of neutralizing antibodies, both in infected human beings and in animal models of HIV. (1)
( ) Vaccines fail because of the nature of HIV. Lewis 07. [Dorothy, Prof in Dept of Immunology Baylor College of Medicine. HIV Vaccines: the future looks promising Perspectives
Research Initiative/reatment Action. Jan1. Lexis]
A live, attenuated vaccine is unlikely to be made against HIV because of worries about in vivo mutations and the fact that HIV integrates into cellular DNA. This means that once it's there, it's in the DNA for the life of the cell. The principle protective mechanism for live, attenuated vaccines is thought to be production of neutralizing antibodies. Unfortunately, the reality is that the actual mechanism of protection for any vaccine is seldom completely understood. Indeed, this is a crucial issue for the design of any vaccine. How do you know if you have the right antigen? How do you know if the immune responses you can easily measure are protective? Having a "challenge" animal model to test these ideas is extremely important. At this juncture,most agree that targeting both envelope and structural proteins fromthe virus will be necessary for an effective vaccine against HIV. Sterilizing immunity, however, has only been observed with antibodies given before or at the time of challenge with Simian Immunodeficiency Virus (SIV). (3) T-cell vaccines induce good T-cell responses, but ofcourse the animals still get infected with SIV. Thus far, the best control of virus replication occurred using an MVA (modified vaccinia virus Ankara) DNA prime/boost method. (2)
SDI 2007 5 Week
DA turns the case- War

( ) Violence spreads disease. Granger 02. [Visiting Prof for Infectious Disease and Intl Health, Superar La Violencia, Overcoming Violence January 2002 Issue 3
http://superarlaviolencia.org/es/resources/wcc-resources/dov-newsletter/issue-number-3-january-2002.html]
In addition to direct injury, the indirect impact of violence and conflict on health is enormous. For instance, in Africa, many more people are killed by malaria in the aftermath of conflict and war than as a direct result of conflict, with devastating human andeconomic consequences. Illness may be the cause as well as the result of violence. Thus, not only may women become infected by HIV as a result of violations of their sexual rights, but many around one-fifth of HIV-infected women the USA and Kenya experience violence as a result of their infected status. Indeed, the WHO has stressed that violence is a serious cause of ill-health among women world-wide. It is therefore clear that violence and conflict are major causes and consequences of poor health. Indeed, a vicious cycle of violence, poverty and illness exists in many parts of the world. Involvement of health care workers and national andinternational health-related agencies in the WCC Decade to Overcome Violence could therefore have an enormous impact on global health and contribute much towards the Who goal of Health For All.
( ) Conflict and war creates breeding grounds for violence Iraq proves. States News Service 07. [June 7 lexis]
"You can't imagine the amount of disease that has spread since the war. One of the largest issues is polluted water. It causes dysentery, cholera, typhoid, and there's a deficiency of water, so we don't have enough water to wash our hands every time they get dirty. "Children play together all the time, and they don't take the precautions like adults do. Plus, they have weaker immune systems and malnutrition or not enough food to fill their needs as growing kids. "With the low level of hygiene and the high level of malnutrition, any infection will start to grow and transmit very quickly.
SDI 2007 5 Week
Poverty Frontline
( ) Even if infrastructure solves, the government cannot solve on its own Financial Times, 07 (April 25, Pg Lexis)
Coordinating Minister for the People's Welfare Aburizal Bakrie said the government could not solve the poverty problem on its own, but in its capacity as regulator it could facilitate the empowerment of the poor and the unemployed through close cooperation with all relevant stake holders "The government has its own programs, the state and private enterprises should show their responsibility by putting aside a small part of their profits to solve poverty while non-governmental organizations take their own part to provide advocacy and education for the poor," Aburizal said in his keynote address to a conference on corporate social responsibility and poverty alleviation here Tuesday Besides national programs to alleviate poverty, the government has distributed a huge amount of funds directly to subdistricts and villages nationwide to help assist poor families, he said "Subdistricts received Rp 1.5 billion each this fiscal year and are expected to receive Rp 3 billion each in 2008 with the sole target of generating job opportunities for 24 million people," he added Aburizal said the government, corporations and civil groups should convince the people that poverty could be eliminated in phases He called on state and private corporations to produce cheap electricity and water for the least-developed villages as well as allocating a part of their profits for corporate social responsibility programs Suryana Royat, a deputy of the coordinating minister for the people's welfare on poverty alleviation affairs, warned of the basic problems behind the poverty issue, saying that partnership was required to create a secure, fair and prosperous environment
( ) Africa must get itself out of poverty- no one can do it for them. Banda, 03 (The Post Zambia, AAGM, l-n, June 15, DY)
"Africa must look to itself for raising itself out of the sorry and sick situation it is in today. Looking to aid, assistance and 'partnerships' with those whose wealthy condition depends on sustaining the current global distribution of poverty and incomes will not take us anywhere. And this, of course, demands that we, Africans, begin by sorting out our internal national political chaos and confusion."
SDI 2007 5 Week
Solvency Frontline
( ) Giving aid to other countries in order to change their economic structure is ineffective Martinussen & Pedersen, 03 ( John & Poul, Danish Association for International Cooperation,
JSTORE, pg 266 DY) Attempts were made to change aid policy's ex ante conditions to ex post conditions: more and more donors wanted to increase foreign aid only to those countries that could document that they had formulated and implemented 'correct' policies, which corresponded to a great extent to the Western model. This aid strategy was first developed towards the end of the 1990s, officially as a result of increasing concern about foreign aid's effectiveness. In 1997-98, the USA formulated legislation concerning cooperation with and aid to sub-Saharan Africa, for which President Clinton tried to gain support during his tour through Africa in March 1998. The philosophy was very simple: a few favoured African states would receive trade benefits, investments and aid, so that they could stimulate their economies and thereby serve as 'role models'-for the African countries that continued with other economic policies and society models. Aid should thus be used as an incentive to those in power to change the structure of their societies. This strategy suffers, however, from several weaknesses that are discussed further in Chapters 12 and 14. Ranking countries on the basis of economic and political criteria presents a major problem. The strategy builds on the assumption that aid is effective only when national policies are 'good and correct'. What would happen if social criteria were also used, asking how good countries were at reducing poverty? If developing countries were required to fulfil all three main criteria (economic, political and social) at the same time, only very few countries would qualify. This is the situation that has emerged since 1999 in connection with the emphasis on 'poverty reduction strategy papers'. On the other hand, if countries had to fulfil only one of the three criteria, then probably so many countries would qualify that aid would be neither concentrated nor effective.
( ) Infrastructure assistance is ineffective Martinussen & Pedersen, 03 (John & Poul, Danish Association for International Cooperation,
JSTORE, pg 266-267, DY) Capacity-building, understood as strengthening national organizations (and their interaction) in carrying out their normal functions, was placed on the agenda in the 1990s, when both donors and recipients demanded new cohesion between politics and economic and social development (OECD 1991, 1996). It was no longer sufficient for individuals to be well educated. Demands were now made for well-functioning, simple and transparent procedures and systems (UNDP 1997a, 1997b). Capacity now involved political legitimacy, economic resources, technical solutions and administrative procedures. Therefore, aid to capacity-building involved all the relevant actors in joint problem identification, formulation of solutions and political implementation. This presented both donor and recipient organizations with new demands for qualifications and expertise demands that according to most actors and observers are still only rarely.
SDI 2007 5 Week
( ) Health care facilities need major reform to be effective Brundtland, 01 (Gro Harlem, Former director of WHO, JSTORE, pg 24-36, DY)
In any event, a major transition in the way that health systems are structured and financed will have to take place in a very short space of time and often under very severe financial restraints. We need to develop ways in which the financial burdens of medical needs are more fairly shared, leaving no household without access to care or exposed to economic ruin as a result of health expenditure. Health systems will need to respond with greater compassion, quality, and efficiency to the increasingly diverse demands they face.
( ) African health sector difficult to reform Lasker, Weiss, and Miller, New York Academy of Medicine, 01 (Roz D., Elisa A., Rebecca,
Partnership Synergy, JSTORE, DY) Attempts at reforming the health sector in African countries have encountered many obstacles, especially tensions resulting from the conflicting claims of various interested parties. For example, communities have reacted negatively, even violently, when governments have introduced charges for services that were previously offered for free. Doctors and other professional groups often demand the acquisition of expensive high technologies in situations where basic needs have not been met. Public opinion also often favors investment in hospitals and other curative services but makes little demand for preventive services that are usually more cost-effective. The success of health reform in Africa will depend on the extent to which health planners can forge a clear consensus about goals and strategies. The ideal climate for reform of the health sector is one in which there is a strategic alliance among key stakeholders: the civil society, the government, the private sector, health professionals, and other partners including traditional healers.
( ) African governments have had no success with health care systems from external assistance Shaw and Elmendorf, 94 (Paul and Edward, Harvard Institute for International Development,
JSTORE, page 361, DY) African governments can reap far greater sustainable benefits through better use of available external funding. This study argues that donor initiatives and lending, while no doubt valuable, have produced few permanent successes thus far and have sometimes caused counterproductive imbalances in the operation of health systems without significantly enlarging national capacities.
SDI 2007 5 Week
US aid fails
( ) US does not have research capability to have effective assistance programs in Africa Brainard, Brookings Institute, 2007 (Lael, Brooklings Bookstore,
http://www.brookings.edu/press/books/securitybyothermeans.htm, DY) USAID and the MCC have inadequate capacity to support research and innovation on problems related to their mission. Similarly, the research budgets of the National Institutes of Health and the Department of Agriculture only allocate minimal funds for addressing the challenges facing developing countries. This deprives the U.S. government of the opportunity to foster groundbreaking research and to make potentially useful contacts with the research community in the U.S. and overseas. Such networks could provide valuable new ideas and feedbackas they did with the pathbreaking development of the Green Revolution."
SDI 2007 5 Week
Alt Cause
( ) Not dealing with small arms reallocated the resources that would go to infrastructure Stohl, no date cited (Rachel, British American Security Council, date accessed 7-07-2007, DY)
The presence of small arms can have a significant effect on future opportunities for children. T h e continued presence of these weapons in post-conflict societies not only undermines a countrys
ability to sustain peace but represents a major stumbling block to sustainable human d e v e l o p m e n t . Addressing the conflict, violence and insecurity
associated with small arms often necessitates the reallocation of resources that would otherwise go to rebuilding or developing key infrastructure, including political, legal, educational, and healthcare institutions and systems.
A1998 report by the Office for the Coordination of Humanitarian A ffairs in Latin A m e r i c a estimated the costs in terms of health and damage to person and property in Latin A m e r i c a , where SALW are easily available and the rates of weapon-related death and injury are high, at 14 per cent of gross domestic product (GDP). The Inter-America Development Bank estimates the regional economic costs of violence in Latin America, since the mid-1990s, which includes the costs of health, policing and value of lost life at US$140-170 billion per year. Small arms and light weapons make a significant contribution to these costs.
SDI 2007 5 Week
Politics Links- Public support

( ) Generally, many support international public health infrastructure programs
empirical examples prove. US Fed News, 06.20.2007, (U.S. HOUSE CONSIDERS FOREIGN ASSISTANCE BILL)
The House of Representatives is considering a $34-billion measure for U.S. international assistance programs and other foreign affairs priorities. VOA's Dan Robinson reports from Capitol Hill. Known as the foreign operations bill, the measure contains money for a range of global priorities, from AIDS treatment and prevention, and assistance to Darfur to peacekeeping and democracy-building. Likely to be approved on Thursday, it provides just over $5 billion for the president's HIV/AIDS prevention treatment and care program, along with $550 million for the Global Fund for grants to help prevent AIDS, tuberculosis and malaria, and hundreds of millions for child survival and health. More than $6 billion goes for efforts to strengthen the worldwide public health infrastructure, $750 million for grants to organizations supporting basic education programs and $300 million for safe water programs.
SDI 2007 5 Week
Politics Links- bipartisan

( ) There is bipartisan support for the African Health Capacity Investment Act which builds African public health infrastructure. Africa News, 03.07.2007, (U.S. Senators Introduce Health Capacity Investment Act of 2007)
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. Sub-Saharan 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.
SDI 2007 5 Week
Spending Links
( ) $200 billion to do the plan. Financial Times, 07 (Business Daily Update, June 27, DY)
It is obvious that the infrastructure gap between Africa and the more developed countries constitutes a serious handicap to Africa's improved productivity. It is estimated that the continent requires an investment of $20 billion annually in the next 10 years to improve infrastructure.
( ) It would cost at least $200 billion to solve infrastructure issues. Iweala, Finance Minister of Nigeria, 07 (Washington Post, http://newsweek.washingtonpost.com/postglobal/needtoknow/2007/02/last_week_paneli st_william_gum.html, February 20, DY) China's aid to Africa provides an alternative source of support and investment that the continent needs. China is willing to invest in infrastructure and other areas that are of limited interest to the West. Africa has enormous infrastructural investment needs in excess of $20 billion per year for the next decade without which development and poverty reduction cannot really happen. No serious foreign direct investment will come in to the continent to create jobs and create wealth without infrastructure. China should therefore be left alone to fill this gap. At the same time, Africans must be very clear what they want from China. They must ensure that the relationship this time around is on a more equal and balanced footing than before. That way the issue of colonialism will not arise. ( ) Infrastructure in Africa cost too much CTO, 02 (ICT Development Agency, September 9,
http://www.ictdevagenda.org/frame.php?dir=07&sd=10&sid=2&id=252, DY) Cutting through these infrastructure and services are a number of constraining factors on the growth of ICTs in Africa. Cost is one of the key constraints, creating irrational paradoxes: even though Africa has some of the poorest countries in the world, it has some of the highest costs for international calls, for mobile services, and for international bandwidth which consequently makes it more expensive for an African ISP to operate than its counterparts elsewhere in the developed world. Some of the new service offerings are based on new economic models which help to radically lower costs. Prepaid billing, for example, has brought great success for mobile services; the introduction of new low-cost satellite-based services to increase the availability of bandwidth, the increasing importance of voice over Internet protocol (VoIP) for international calls, and the first adopters of the free ISP model in the region. These models and technologies, in turn, present challenges to the established regulatory environment and to policy-makers at both the national and regional level.
( ) Infrastructure is high because of of communications and energy costs. Jopson, 07 (Barney, Financial Times, July 9, DY)
Brian Herlihy, an executive running Seacom, one of five projects racing to build fibre optic cables down the coast, says: "People think investing and operating a business in Africa will be cheap because it's poor. The reality is it's very expensive because communication and energy costs are high and the infrastructure is bad."
SDI 2007 5 Week
( ) Public health infrastructure is expensive. Donald B. Louria, Prof at Harvard, 08.2000, Emerging and re-emerging infections: the
societal determinants, Futures Second, having a well functioning public health infrastructure can prevent many infections, particularly those that are food or water borne. An adequate public health infrastructure allows primary and secondary prevention as well as therapeutic interventions. Primary prevention currently consists, for the most part, of vector eradication, immunizations, and provision of uncontaminated drinking water. Infrastructure inadequacies guarantee continuing epidemics of emerging and re-emerging diseases. The current diphtheria epidemic in Russia and a large cryptosporidium epidemic in the United States can be attributed, at least in part, to infrastructure breakdowns [7]. Effective infrastructure requires adequate funding, proper organization, and political will -- all of which are frequently in woefully short supply. Often the country's economy limits the resources that can be committed. Adequate infrastructure is relatively expensive. In the United States, annual government spending on health care exceeds US$1000 per capita. In the majority of countries of the world, annual government expenditures range from US$5.00 to 30.00 per capita. Where the total commitment is US$30.00 or less per capita, the funds usually are largely consumed by the bureaucracy and treatment of established disease. In such cases a public health infrastructure that could prevent emerging or re-emerging infections, or detect them in the earliest phases of an epidemic, will almost certainly be rudimentary and inadequate.
( ) Plan will cost about $27 billion dollars in 2007 for assistance such as research and development for diseases. Mackellar, 05 (Landis, economist specializing in economic demography, June, l/n DY)
But is the global community willing to act? The international assistance required to finance adequate levels of health in poor countries was estimated by the WHO Commission on Macroeconornics and Health (2001) to be $27 billion in 2007: $22 billion for in-country programs, $3 billion for research and development targeted at diseases of the poor, and $2 billion in classic global public goods such as collection and analysis of epidemiological data and surveillance of infectious disease.
SDI 2007 5 Week
China CP
( 1) Plan Text: The Republic of China should substantially increase its financial and technical support for the purpose of building public health infrastructure in sub-Saharan Africa. OR (2) Plan Text: The Republic of China should increase its public health assistance to PEPFAR focus countries in Sub-Saharan Africa by establishing the U.S. Global Health Service to expand health care infrastructure capacity, including community health personnel funding, training, professional development, and incentives.
Theoretical Concerns 1. The counter plan is non-topical. It does not use the United States Federal Government. 2. The counter plan is competitive. It competes through net benefits. 3. The counter plan is conditional
SDI 2007 5 Week
China solvency
( ) Chinas strategy to help development assistance is aid but without military assistance. Qian and Wu, 07 (Jason and Anne, Boston Globe World News, July 23,
http://www.boston.com/news/world/asia/articles/2007/07/23/chinas_delicate_role_on_darfur/, DY) China's strategy is one of humanitarian and development aid plus influence without interference, in contrast to the West's coercive approach of sanctions plus military intervention. Through high-level diplomacy -- such as Chinese President Hu Jintao's visit to Sudan in February and the dispatch of special envoys -- and multilateral platforms such as the United Nations and the China-Africa summit, China has been making tactical moves to press the Sudanese government to comply with the international community's requests. China deserves credit for securing Khartoum's agreement on allowing UN peacekeeping forces in Darfur. China's approach toward the Darfur crisis takes the long view. It perceives the root causes of the turmoil as poverty and a lack of resources, which have led to decades of fighting between local tribes and ethnic groups over basic necessities, such as water resources, land, and infrastructure. Therefore, China's approach to solve the long-lasting conflict in the Darfur region has been to provide comprehensive development assistance in addition to humanitarian aid.
( ) China solves for infrastructure- empirically proven Brookes and Shin 2006 (Peter and Ji Hye, Director of the Asian Studies Center and Research
Assistant in the Asian Studies Center, at The Heritage Foundation, February 22, http://www.heritage.org/Research/AsiaandthePacific/bg1916.cfm) China has also offered aid to its African partners, ranging from building infrastructure to treating infectious diseases such as malaria and HIV/AIDS. Since the 1960s, over 15,000 Chinese doctors have worked in 47 African states treating nearly 180 mil-lion patients.[32] Chinese-sponsored roads and rail-ways are under construction in Kenya, Rwanda, and Nigeria, and a mobile telephone network is being built in Tunisia. These projects are often con-tracted to Chinese firms rather than local busi-nesses, adding little to the local economy in terms of employment. State-run China Radio Interna-tional launched its first overseas radio station in Kenya in January 2006 to provide 2 million Ken-yans with 19 hours of daily programming on major news from China and around the world, including Chinas exchanges with African countries.[33] Moreover, the Chinese government has actively advocated a Chinese-style economic development model to African countries, based on a restricted market system constrained by the overarching pri-ority of maintaining a single-party, totalitarian gov-ernment. Many authoritarian African regimes, desperate to invigorate their fraying economies while maintaining a strong grip on political power, seem to find the Chinese economic development and reform model preferable to the free-market and representativegovernment policies promoted by the United States and the European Union.
SDI 2007 5 Week
Imperialism Net Benefit

( ) U.S. aid =s colonialism - China's wont. Iweala, Finance Minister of Nigeria, 07 (Washington Post, http://newsweek.washingtonpost.com/postglobal/needtoknow/2007/02/last_week_paneli st_william_gum.html, February 20, DY) China's aid to Africa provides an alternative source of support and investment that the continent needs. China is willing to invest in infrastructure and other areas that are of limited interest to the West. Africa has enormous infrastructural investment needs in excess of $20 billion per year for the next decade without which development and poverty reduction cannot really happen. No serious foreign direct investment will come in to the continent to create jobs and create wealth without infrastructure. China should therefore be left alone to fill this gap. At the same time, Africans must be very clear what they want from China. They must ensure that the relationship this time around is on a more equal and balanced footing than before. That way the issue of colonialism will not arise.
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China will spend money

( ) China will spend more money to Africa within the next 3 years- 50% more than the fund coming from the World Bank. Lerrick, Director for Gailliot Center for Public Policy, 07 (Adam, Committee on Senate Banking,
August 7, DY) As globalization transforms the world economy, the Bank is one of the losers. Its historic comparative advantage is gone and its role inevitably diminished. There are powerful new competitors in the market that do not exact the social and economic strictures the Bank has always sought to impose. Private capital now channels 300 times the funds offered by the Bank to the emerging world and will finance any project the Bank would consider. Nations moving up the economic ladder--China, Brazil, India and Russia--are funding and building infrastructure and industry for even the poorest nations in exchange for access to raw materials and export markets. China alone will send $25 billion to Africa over the next 3 years, 50% more than the funds coming from the Bank.
( ) China African development fund is sending money to increase infrastructure in Africa. Financial Times, 07 (Business Daily Update, June 27, DY)
The fund is part of China's commitment to help Africa. The fund's total $5 billion will also enable Chinese enterprises to get a foothold and invest in Africa. African countries have a huge demand for infrastructure, one of the major drivers for economic growth and poverty reduction. It is expected that this fund will largely bolster vital infrastructure construction. While both China and many African countries recognize the mutual benefits of such a development fund, unfortunately, some quarters have criticized China for investing in the continent. Some development experts have attacked the practice of tying economic assistance to the purchase of goods and services from the donor country as wasteful and inefficient. That may be true for many aid projects developed countries have launched in the past, but it does not necessarily apply to China's aid for and investment in Africa. As a developing country, China can share with African countries its own important, unique experience in reducing massive poverty. It was China's reform and opening-up that created the right policy condition for its economy to take off about three decades ago. However, the increasing availability of adequate infrastructure has also proved essential for economic development in China. It is obvious that the infrastructure gap between Africa and the more developed countries constitutes a serious handicap to Africa's improved productivity. It is estimated that the continent requires an investment of $20 billion annually in the next 10 years to improve infrastructure. The China-Africa Development Fund can directly help African countries address part of the problem of building much-needed infrastructure. If African countries can take lessons taught by China's experience in overcoming poverty and boost development during the course, these aid and investment projects will be more beneficial than those critics might have thought.
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China is key to African economy

( ) China is crucial to the African economy China Daily, 07 (Xinhua, May 14, http://www.chinadaily.net/china/200705/14/content_872292.htm, DY) SHANGHAI - China is an important factor in economic growth in Africa, Chinese and foreign experts say. Louka Katseli, director of the development center of the Organization of Economic Cooperation and Development (OECD), said there was definitely a link between economic development in Africa in recent years and economic growth in China. Katseli will attend the annual board meeting of the African Development Bank (ADB) scheduled to open in Shanghai on Wednesday. The volume of trade between China and Africa last year rose 40 percent to 55.5 billion US dollars. China's imports from Africa climbed to 28.8 billion US dollars, a rise of 43 percent on a year ago. In the framework of the Forum of Sino-African Cooperation, China has granted zero tariff to numerous commodities from the 28 least developed countries in Africa. "The preferential tax policy benefited Africa to the tune of 250 million US dollars in 2006 alone," said Katseli. Harry G. Broadman, advisor on the African economy at the World Bank and author of a book entitled "Africa's Silk Road: China and India's New Economic Frontier", claims that the Chinese market represents a new economic dawn for the African continent. The WB economic advisor reckoned that the rapid growth of Sino-African trade and sustained Chinese investment in the continent would boost the integration of the African economy with the world economy. China's economic activities in Africa will help the African Continent climb out of the doldrums, said Broadman. He Wenping, director of the African section of the Institute of West Asian and African Studies at the Chinese Academy of Social Sciences, said China has contributed an average of 14 percent to the growth of the world economy since the year 1979 when it began to adopt the policy of reform and opening up. "More and more African countries are sharing the benefits of China's economic growth with economic cooperation racing ahead," said He.
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Reconstruct Northwestern 1AC- Infrastructure

Advantage 1 is diseaseAfrican spending on health care is being massively cut--the increasing collapse of infrastructure in SSA prevents effective disease interventions and any hope of treatmentchoking off drug access for the poor and exacerbating the AIDS pandemic Labonte et al (Ronald, Director Professor at the Universities of Saskatchewan and Regina in Canada, Ted Schrecker Associate Scientist with the Lawson Health
Research Institute in London, Ontario, Canada, David Sanders is Professor and Director of the School of Public Health at the University of the Western Cape, Cape Town, South Africa, Wilma Meeus, Research Associate at the School of Public Health, University of the Western Cape, Cape Town, South Africa.) FATAL INDIFFERENCE: The G8, Africa, and Global Health, University of Cape Town Press,
2004, http://www.idrc.ca/en/ev-45682-201-1-DO_TOPIC.html
lz
One of the reasons the IDG health targets are unlikely to be met is the increasing collapse of healthcare infrastructure in many countries, particularly in sub-Saharan Africa. Although there are a number of contributory factors, key has been reduced public expenditure on health in at least 29 of the poorest African countries (UNDP, 2000), with all but six countries falling below the US$60 per capita figure recently advocated by the WHO Director-General (Brundtland, 2000). Some analysts argue that public health systems have been undermined by a combination of structural adjustment policies and health sector reform; their impact on sub-Saharan Africa is reviewed in Chapter 9. Whatever the reason, public health spending in developing countries, both per capita and as a percentage of GDP, remains considerably lower than in G7 countries (see Figure 3.1, below).11 The persistence in health budgets of disproportionately high spending on tertiary and specialised services coexists with chronic underfunding of basic health services, which in many cases are unable to meet their running costs. Declining child vaccination coverage is just one indication of the deterioration of health
systems, albeit one with special significance in view of our earlier discussion of GPGs. Although coverage declined in all developing continents during the 1990s, the decline in Africa is particularly troubling (Sanders et al., 2002). Almost 50 per cent of African children are now not adequately vaccinated (Social Watch, 2002; Simms et al., 2001; UNICEF, 2000: 89; WHO, 2002b). Perhaps the most serious reflection of the collapse of African health systems lies in the situation regarding health personnel, a point we take up later in this chapter. It is fundamental to understand that the CMHs estimates of the minimum necessary increase in donor spending on health interventions assume that developing countries
Although developed countries generally do better than developing countries in ensuring that the poor obtain access to health care, health care in poorer countries still tends to favour the wealthy over the poor, and hospital care over primary care. Gains from ensuring health-care access for the poor in developing countries are much more substantial than they are for the poor in wealthier nations (Wagstaff, 2001). The absence of an effective public health-care system in poorer countries undermines the more technical disease interventions supported by the GFATM and the Global Alliance for Vaccines and Immunization (GAVI). Over 90 per cent of the first round of grants from GAVI went to research on new vaccines and injection equipment (Hardon, 2001). Although this is an important investment, an initial assessment of GAVI in four African countries reported that there are major inadequacies in health-system infrastructure, including poor staffing levels, infrequent supervision, insufficient transport and fuel, and poorly functioning refrigeration for vaccines (Brugha et al., 2002). Health officials in these countries expressed concern that they would be unable to sustain the cost of vaccines should GAVI funding stop after five years. There is worry that the GAVI funding proportions (where the bulk goes to pharmaceuticals and laboratory research) will be replicated by the GFATM, compounding a problem already identified in the funds initial assessment: The great burden of these three diseases [AIDS, tuberculosis and malaria] falls on Africa, and most especially on children and young adults living in sub-Saharan Africa. There, AIDS, and TB linked to AIDS, and malaria, are straining an already frayed public health infrastructure (WHO, 2002d: 6; emphasis added). Access to sufficient and affordable quantities of anti-retroviral drugs remains an issue, partly due to extended patent protection under the Agreement on Trade-Related Intellectual Property (TRIPS). As an indication of the potential gains, Brazils policy of free, publicly funded anti-retroviral therapy which relies as far as possible on locally manufactured drugs is credited with substantially reducing deaths from AIDS and the incidence of opportunistic infections, while improving patient quality of life (Galvo, 2002). But without adequate resources to support the delivery of basic health care, overcoming problems of treatment supply alone may do little to control the AIDS pandemic in Africa (Attaran & Gillespie-White, 2001).
have well-functioning, well-staffed health systems accessible to those in greatest need.
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1ac-disease adv 2/ First is drug resistance-The current lack of infrastructure in Africa encourages massive drug resistance and will wipe out the utility of current drugs in a few years. Tom Carter, staff writer "Docs Losing War on AIDS - in Africa - Brief Article". Insight on the News. July 2, 2001, http://findarticles.com/p/articles/mi_m1571/is_25_17/ai_76402700 lz
"The drugs are needed, and they will do a lot of good," says Ronald Gray, an epidemiologist at the Johns Hopkins University School of Public Health with 10 years' experience in Uganda. "But if this is not done properly, we are sitting on a powder keg. There is no infrastructure in Africa to deliver the care, and the nature of this complicated drug regime means that we will see treatment failure and drug resistance. Resistance could wipe out the utility of these drugs in a few years." In 1996, scientists introduced a complicated therapy of protease inhibitors and anti-retroviral drugs that required as many as 30 pills a day, each taken at different times -- some to be swallowed with food, some without, some with water, some without. Within six months of the introduction of the therapy in the United States, the mortality rates for AIDS plummeted. Optimism ran wild. Scientists talked of long-term management of the illness, as with diabetes, and of finding a cure for the deadly disease. But five years later, at the Seventh Conference on Retroviruses and Opportunistic Infections in Chicago in January, optimism had diminished. The highly toxic drugs were failing in as much as 50 percent of the infected population. The AIDS virus also was adapting, mutating into drug-resistant strains immune to some or all the drugs available. Researchers at the Infectious Disease Division of the University of North Carolina at Chapel Hill found that as many as 28 percent of new HIV infections exhibit some level of drug resistance. In the developing world, cheap or free drugs could create another set of problems, caution U.S. AIDS researchers. Africa has little or no health-care infrastructure, and while the drugs have been made more user-friendly, the therapy is still extremely difficult to follow. The side effects are real, and the risk of creating resistant virus strains in Africa is enormous. "Just parachuting anti-retrovirals into a country is not going to stop the AIDS epidemic," says Anthony Fauci of the National Institute of Allergy and Infectious Diseases, who just returned from a trip to Uganda.
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1ac-disease adv-lab testing 3/ Second, Lab testing-Current laboratory tools are insufficient in diagnosing diseasesthis results in overtreatment, increasing expenses and antimicrobial resistance Imelda Bates and Kathryn Maitland, Liverpool School of Tropical Medicine and Imperial
College of the UK and The Centre for Geographic Medicine Research, Kenya Medical Research Institute, Clinical Infectious Diseases; 2/1/2006, Vol. 42 Issue 3, p383-384, ebscohost lz
CLINICAL MISDIAGNOSIS For many common infections in sub-Saharan Africa, including severe and nonsevere malaria and septicemia, clinical diagnosis is not adequately sensitive or specific. Because malarial and bacterial infections share similar presenting features, syndromic management [2] results in overtreatment of both conditions, increasing the expense and threatening the longevity of the limited repertoire of inexpensive antimicrobials. Often, frontline medical personnel have to make immediate clinical decisions on the basis of a limited number of diagnostic tests. Equally important are the refinement of this initial diagnosis and the targeting of therapies over the ensuing hours and days, which is greatly facilitated by good diagnostic facilities; thus, the laboratory is the most important determinant in this process. Ideally, rapid and accurate diagnostic testing would be available at the first consultation, to enable personnel to make the correct diagnosis and to avoid the waste of resources and increased ill health associated with incorrect initial diagnoses. In some cases, such diagnostic tools are available but are not in routine use, because they are considered to be too expensive or because they have not been adequately evaluated in real-life situations. Such tools include rapid dipstick malaria tests, anemia and HIV tests, and fingerprick hemoglobinometric tests. Much more investment is needed to evaluate and adapt existing tools and to develop new diagnostic approaches for common conditions. This is likely to be most effectively
achieved through partnerships between researchers, policy makers, and commercial companies that are similar to the programs that have been used for drug development (e.g., Medicines for Malaria Venture). The availability of such diagnostic tools is not likely to greatly impact clinical care unless their use is underpinned by evidence-based guidelines that are implemented, supervised, audited, and embedded within local practice. The process of producing guidelines is based on the synthesis of published evidence from diverse sources and then adaptation to suit local circumstances, and it needs to involve collaboration between clinicians and laboratory professionals. A proposal to simplify the complex process of guideline development has been proposed recently by Raine et al. [3].
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1ac-disease adv-lab testing 4/ Building effective laboratory infrastructures key to reliable and affordable diagnostics thats essential to improving healthcare in Africa Petti et al (Cathy A., Christopher R. Polage, Thomas C. Queen, Allan R. Ronald, abd Merle A. Sande, Departments of Medicine and Pathology, University of Utah
School of Medicine, ARUP Laboratories, Salt Lake City, Utah; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Faculty of Medicine, University of Manitoba, Winnipeg, Canada), 20 December
2005, http://www.journals.uchicago.edu/CID/journal/issues/v42n3/37615/37615.web.pdf lz
FUTURE DIRECTIONS Strategic efforts to build laboratory capacity must be pursued urgently by partnerships between public (national and international), private, and commercial sectors to address this health care crisis. The current inequity in funding for laboratory diagnostics must be addressed, and funding organizations should be encouraged to balance the allocation of resources, with greater emphasis on laboratory diagnostics and supportive infrastructure. First, a paradigm shift that acknowledges the critical
importance of basic laboratory testing is necessary to impact the perceptions and priority settings of clinicians, health care policy makers, and donor organizations. Second, donor and public efforts should be more unified to address regionally defined needs, with the goal of sustainability. Third, public officials and health care professionals must be made aware of the necessity of laboratory services to differentiate between diseases indistinguishable by clinical syndrome, to direct antimicrobial therapy, and to improve patient care. In the short term
, there should be an increased focus on providing basic laboratory testing by accurate and reproducible methods. Initiatives should be created to ensure the accurate performance of malaria microscopic evaluation, hemoglobin testing, glucose
determination, HIV testing, acid-fast bacilli smear, urinalysis, blood culture, and CSF analysis. In parallel, increased introduction and utilization of new technologies, such as non culture-based methods (e.g., rapid malaria and HIV tests) for diagnosis of infectious diseases, offer the potential to overcome short-term logistical and educational barriers. These nonculture-based methodsmay (1) be performed on site in rural primary health care settings, (2) require minimal sample preparation or preservation, (3) be kit based (with reagents resistant to extremetemperatures), and (4) be performed with little technical expertise. Although somewhatc ostly and perhaps not sustainable in the long term, these approaches would allow more-widespread test availability and reproducibility without immediate infrastructure improvement. In the long term, international donor institutions, scientific investigators, and nongovernmental organizations should partner with the public sector to actively strengthen the existing health care infrastructure. These groups must participate in the local training and education of future health care personnel by demonstrating the role of laboratory diagnostic testing in everyday practice, particularly its use to support or exclude alternative clinical diagnoses (e.g., cerebral malaria vs. bacterial meningitis; enteric fever vs. Staphylococcus aureus bacteremia) and to better direct antimicrobial therapy. Improved communication between clinicians and laboratories is essential to change physicians perceptions and attitudes about the value of diagnostic tests, which, in turn, may lead to improved utilization. For example, many diagnostic procedures, including urinalysis, Gram stain and cell count in CSF samples, hemoglobin testing, microscopic evaluation for malaria, and microscopic evaluation of stool samples, can be performed in areas with limited resources, and their results can have im mediate impact on patient care. Finally, to ensure accurate and reproducible diagnostic testing (and thereby secure physicians confidence in applying laboratory results to their daily practice), private donor and public agencies should assist in laboratory training as well as in the establishment of external quality assessment and accreditation systems. Efforts by the Centers for Disease Control and Prevention and the WHO to develop strategies to address these issues are already underway [34, 35]. Admittedly, strengthening the existing infrastructure in sub-Saharan Africa is a daunting task that may not be politically or financially popular, particularly among government-funded or commercially funded investigators who focus on their research needs alone. Advocacy groups need to encourage donor organizations to incorporate regional and national agendas into their programs and to build within, rather than circumvent, the existing infrastructure, to avoid the creation of redundant parallel systems. Sustainable solutions should be driven by regional and district needs, not by donor agendas. Policy makers and health care providers must understand that accurate diagnosis is essential to the prevention and treatment of disease in sub-Saharan Africa, and, although the paradigm applied to this region must of necessity be different, it cannot, however, embrace a practice of medicine that routinely involves presumptive diagnosis based on clinical syndrome. No resource-plenty country
Advocacy is necessary to raise public expectation and the minimum standard of acceptable health care services. Building laboratory capacity to provide rapid, accurate, affordable, and reliable diagnostic tests will enable health care workers to deliver more-effective, life-saving treatment, thereby reducing mortality, optimizing the expenditure of health care resources, and improving the quality of health care for this dramatically underserved population.
would actively promote as part of national health care policy the routine use of empiricism without laboratory support in diagnosing disease.
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1ac-disease adv-brain drain 5/ Third, the brain drain-The shortage of medical staff in Africa prevents the development of effective health care systems
Financial Times, July 16, 2004, lexis lz
Africa's healthcare systems, already struggling with rising numbers of Aids patients, are being undermined by the "poaching" of nurses and doctors by developed countries, researchers said yesterday. The public health systems of most sub-Saharan African countries are suffering significant shortages of health professionals, because hospitals in Europe and the US have lured many trained African doctors and nurses with the prospect of higher wages and better working conditions. A report by Physicians for Human Rights, released at the International Aids Conference in Bangkok, notes that as many poor countries begin to roll out treatment programmes for Aids, the shortage of qualified staff is becoming one of the biggest obstacles to delivering the drugs to patients.
While Aids campaigners have complained that high costs were preventing patients in the developing world from obtaining life-saving drugs, sharp falls in drug prices over the last three years have brought the perilous state of many of Africa's healthcare systems to the top of the international agenda. "There was a time when there was no hope we could ever get affordable medication, so we didn't make any preparation," said Leonard Okello, a Ugandan who leads the HIV/Aids work of the British charity ActionAid in southern Africa. "Now the challenge is with us. We must prepare so it is worth asking for drugs." According to the report,
50 per cent of medical school graduates in Ghana emigrate within five years of qualifying and 75 per cent leave after 10 years. Zimbabwe trained 1,200 doctors in the 1990s, but only 360 were still there in 2001. The report said 5,334 doctors trained in African medical schools were practising in the US in 2002.
A US commitment to building medical infrastructure is key to solving that brain drain that is collapsing African healthcare and crippling current AIDS programs Holly Burkhalter, U.S. policy director of Physicians for Human Rights and its Health Action AIDS Campaign, May 30, 2004, The Star Ledger, lexis lz
When it comes to the HIV-AIDS pandemic, generosity isn't enough. Wealthy nations' contributions to fight the disease are unwittingly and unnecessarily exacerbating another crisis in some poor countries: the staggering shortage of health care personnel. African doctors and nurses are leaving public-sector jobs in droves for more lucrative positions in foreign-funded HIV-AIDS programs. Public hospitals and clinics are being stripped of staffers; rural and slum outposts are being abandoned. The United States, the world's largest donor in the HIV-AIDS crisis, must also take the lead in supporting primary health care infrastructure and nourishing Africa's overwhelmed, underpaid health workers. Malawi, a
painfully poor southern African country with upward of 850,000 HIV-infected people, shows what happens when well-meaning but myopic donors fund AIDS-only initiatives. Doctors from the capital's Lilongwe Central Hospital reported recently that the 970-bed facility employs only 169 nurses to staff 520 positions, and six laboratory technicians are doing the work of the 38 once employed there
. Where have all the health care workers gone? Tens of thousands have succumbed to a global "brain drain" and are working in clinics and hospitals in the United States, Britain
and Canada. But an increasing number have been hired by nongovernmental organizations or foreign universities that are setting up HIV-AIDS prevention and treatment projects in Africa. Programs to achieve universal access to AIDS treatment are desperately needed, and they do require trained medical staff. But if resources are drained from poor communities or diverted from other health priorities, deaths from different causes could mount, leaving some communities worse off. And the donor community itself is sometimes directly responsible for bone-deep cuts in health sector personnel and stringent caps on national health care budgets. In AIDS-stricken Kenya, for example, more than 4,000 nurses and several thousand other health workers are unemployed, thanks to macroeconomic constraints championed by the International Monetary Fund and foreign donors. President
Bush boldly committed to provide AIDS treatment to 2 million people over the next five years. But reaching that goal requires much more than buying drugs and training Africans to use them. The fact is, Africa doesn't have enough health care workers to meet even modest treatment goals. Consider Botswana, with a third of a million HIV-positive people. Several years ago the Gates Foundation and other donors provided resources to treat everyone in the country. But a crippling shortage of health care workers at every level, among other problems, has limited the rollout of antiretrovirals to only 21,000 of the 110,000 who need them now to stay alive. It won't be easy, but there is another way. First, U.S. AIDS czar Randall Tobias should announce his intention to meet not only
ambitious treatment objectives but goals of equity and sustainability. If treatment numbers alone drive AIDS policy, the United States could end up serving those easiest to reach - the urban well-to-do - while the few health services available to the poorest of the poor will be raided and degraded. Embedding AIDS programs into primary health care, adding basic health care to new free-standing treatment initiatives and keeping track of the distribution of resources among the poorest areas of AIDS-burdened countries would help reverse that
, the president should ask Congress for the additional billions of dollars required every year to help build the health care infrastructure needed for both HIV-AIDS treatment programs and overall public health. Third, Tobias should jettison an outworn axiom of development policy: that foreign donors should not provide remuneration for civil servants, including health care workers, because it inevitably fosters dependency and ultimately is unsustainable. The African AIDS pandemic is such a death spiral that entire countries have become unsustainable. It's past time for the United States to provide resources not just to American universities, contractors and nongovernmental organizations but to African health workers themselves in the form of health insurance and care, salary enhancements, school fees and housing allowances.
trend and provide resources for other health needs as well. Second
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1ac-disease adv-brain drain 6/ INCREASING HEALTH CARE PERSONNEL IS KEY TO EVERY TREATMENT DEALING WITH THE AIDS CRISES IS IMPOSSIBLE MINUS EFFECTIVE HEALTH SERVICES. Mullan et al, Professor of Prevention and Community Health at George Washington, 2005(Fitzhugh Mullan, Claire Panosian, Patricia Cuff, Editors, Board of Global
Health at the Institute of Medicine of the National Academies, Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS, 4-19-2005, Preface, www.nap.edu/catalog/11270.html#toc)
Throughout history, human beings have driven health care (Anand and Barnighausen, 2004; World Bank, 1993). Health workers are activenot passiveagents of change. Often commanding two-thirds of todays health budgets, they link together the many parts of the health system to spearhead the provision of health care (Berman et al., 1999). Why are health workers so important?
A quick look at success stories in disease controlfrom yellow fever, hookworm, and smallpox eradication; to the child health revolution in the 1980s; to the imminent eradication of polioreveals that all were built on human resource strategies. The formal, science-based education of physicians in the United States, first codified in the Flexner Report (Flexner, 1910), contributed to the doubling of life expectancy in the United States over the last century. In a recent analysis of the global health care workforce, the Joint Learning Initiativea consortium of more than 100 health leadersargues that mobilizing and strengthening human resources will be central to combating health crises in some of the worlds poorest countries and to building sustainable health systems in all countries (JLI, 2004). Yet nearly all nations today are challenged by worker shortages, skill mix imbalances, misdistribution of resources, negative work environments, and weak knowledge bases. This is particularly true in the poorest countries. In several of the most heavily impacted African countries, for example, the prevalence of HIV among adults approaching 40 percent. The health sector is doubly affected by the HIV/AIDS epidemic: it must respond to the crippling burden of ill health among the general population while simultaneously dealing with the impact of the epidemic on health professionals. This situation represents the most profound change in the burden of disease ever experienced by any health systemmuch less those systems already weak and underfinanced before the advent of HIV/AIDS. Added to this burden are new demands for diagnosis and treatment, including the challenges associated with provision of ART. Proper prescription of and monitoring of compliance with antiretroviral drug regimens are essential if patients are to benefit and if the grave possibility of emerging drug resistance is to be reduced. People living with HIV infection also require access to a wide range of carefrom primary, secondary, and tertiary health care; to social services; to community-based support and home care. Supervision and management skills and capacity are also critical to the effective delivery of all health care, including that focused on HIV/AIDS. In Tanzania and Chad, Kurowski and colleagues (2003) found evidence that improved staff management could result in substantial increases in staff productivity in the provision of HIV/AIDS care (Kurowski et al., 2003). Increased access to ART, voluntary counseling and testing, and prevention of mother-to-child transmission will require management as well as technical skills in relation to systems, administration, procurement, logistics, delivery, and referral; effective links between the formal and informal sectors will also be necessary.
This challenge of good management is especially timely and pertinent within the broader contexts of decentralization and health-sector reform. Despite general recognition of the crucial role of human resources in the provision of health care, the development of the health care workforce in low-income countries has suffered from years of national and international neglect (as discussed further below). Indeed, the dearth of qualified health care professionals in most low-income countries is the single most important constraint faced in responding to health care needs
(Narasimhan et al., 2004). The Commission on Macroeconomics and Health, for example, has advocated a greatly increased investment in health, rising in low-income countries to a
, the main problem in implementing this recommendation is not the difficulty in raising the additional funds but the capacity of the health sector itself to absorb them (Habte et al., 2004). Likewise, senior officials in Ethiopia, Nigeria, and Uganda have all cited the lack of health care personnel as a main constraint in responding to health challenges (WHO AFRO, 2002). And
per capita expenditure of $34 per year. According to the commission, however Botswana, a comparatively rich African country that has committed to providing free ART to all eligible citizens, is hindered in doing so principally by a lack of health personnel
As new resources are being mobilized to fight HIV/AIDS, tuberculosis, malaria, and other global diseases, the health workforce crisisespecially in Africais daily becoming more apparent and dire. External grants and funding to address global HIV/AIDS, estimated at $5 billion in 2003, could reach $20 billion by 2007 (UNAIDS, 2004). At present, however, there is simply insufficient human capacity in many developing countries to absorb, apply, and make efficient use of these new funds and critical health initiatives. The Current Global Health Care Workforce: After a century of the most spectacular health advances in human history, we confront unprecedented and interlocking health crises. Some of the worlds poorest countries face rising death rate and plummeting life expectancy, even as global pandemics threaten us all. Human survival gains are being lost because of feeble national health systems. On the front line of human survival, we see overburdened and overstressed health workers, too few in number, without the support they so badly needlosing the fight. Many are collapsing under strain; many are dying, especially from AIDS; and many are seeking a better life and more reward work by departing for richer countries (Chen et al., 2004). According to statistics compiled by WHO, the world had 9 million doctors and 15 million nurses in 2000 (WHO, 2004c), representing an average density of 1.6 doctors and 2.5 nurses per
(WHO, 2004b).
1,000 population. When compared with the results of the last published global survey in 1971 (which estimated a pool of 2.3 million doctors worldwide), the 2000 data suggest that the global supply of doctors is growing, on average, about 5 percent per year (Mejia and Pizurki, 1976). The total global health workforce is currently estimated at more than 100 milliona figure that includes 24 million recorded doctors, nurses, and midwives, plus another pool of uncounted informal, traditional, community, and allied workers (Chen et al., 2004).These numbers do not tell the whole story, however. There is an extreme imbalance in the distribution of credentialed professionals among regions and countries. The supply of nurses and doctors relative to the population of sub-
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supply of health professionals (Chen et al., 2004).
Saharan Africa, for instance, is one-tenth of that in Europe. To take an even more extreme case, Ethiopia has one-fiftieth of Italys
1ac-disease adv-impacts 7/ Effective AIDS programs and containment is essential to prevent extinction
Muchiri 2k [Michael Kibaara Staff Member at Ministry of Education in Nairobi, Will Annan finally put out Africas fires? Jakarta Post, March 6, LN]
The executive director of UNAIDS, Peter Piot, estimated that Africa would annually need between $ 1 billion to $ 3 billion to combat the disease, but currently receives only $ 160 million a year in official assistance. World Bank President James Wolfensohn lamented that Africa was losing teachers faster than they could be replaced, and that AIDS was now more effective than war in destabilizing African countries. Statistics show that AIDS is the leading killer in sub-Saharan Africa, surpassing people killed in warfare. In 1998, 200,000 people died from armed conflicts compared to 2.2 million from AIDS. Some 33.6 million people have HIV around the world, 70 percent of them in Africa, thereby robbing countries of their most productive members and decimating entire villages. About 13 million of the 16 million people who have died of AIDS are in Africa, according to the UN. What barometer is used to proclaim a holocaust if this number is not a sure measure? There is no doubt that AIDS is the most serious threat to humankind, more serious than hurricanes, earthquakes, economic crises, capital crashes or floods. It has no cure yet. We are watching a whole continent degenerate into ghostly skeletons that finally succumb to a most excruciating, dehumanizing death. Gore said that his new initiative, if approved by the U.S. Congress, would bring U.S. contributions to fighting AIDS and other infectious diseases to $ 325 million. Does this mean that the UN Security Council and the U.S. in particular have at last decided to remember Africa? Suddenly, AIDS was seen as threat to world peace, and Gore would ask the congress to set up millions of dollars on this case. The hope is that Gore does not intend to make political capital out of this by painting the usually disagreeable Republican-controlled Congress as the bad guy and hope the buck stops on the whole of current and future U.S. governments' conscience. Maybe there is nothing left to salvage in Africa after all and this talk is about the African-American vote in November's U.S. presidential vote. Although the UN and the Security Council cannot solve all African problems, the AIDS challenge is a fundamental one in that it threatens to wipe out man. The challenge is not one of a single continent alone because Africa cannot be quarantined. The trouble is that AIDS has no cure -- and thus even the West has stakes in the AIDS challenge. Once sub-Saharan Africa is wiped out, it shall not be long before another continent is on the brink of extinction. Sure as death, Africa's time has run out, signaling the beginning of the end of the black race and maybe the human race.
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1ac-global health cred adv 1/ Advantage two is global health credibilityTHE U.S. MUST TAKE THE LEAD IN GLOBAL HEALTH ESTABLISHING A GLOBAL POLICY THAT FOCUSES ON THE HEALTH OF THE PUBLIC is key to US global health leadership Council on Foreign Relations, 2001
(Why Health is Important to U.S. Foreign Policy, April 19, http://www.cfr.org/publication/8315/why_health_is_important_to_us_foreign_policy.html?excerpt=1)
Thus viewed, global health issues have a range of implications for U.S. foreign policy. First, there is a unique opportunity to lead in the area of cooperative international engagement by placing health on the agenda of global public goods. It is not beyond the reach of political will to tip the scales toward a healthier world. The history of the Marshall Plan, a clear example of how a balance of motives can underlie U.S. foreign policy, illustrates that political leadership is necessary to raise the salience of international issues and to galvanize public support for cooperative engagement. One essential ingredient of such an initiative is leadership to match our unprecedented technical capacity and to allow us to apply this capacity to its logical extent. That means providing health care as a global public good: one that benefits everyone, but that no single country yet has the incentive to provide. The provision of health as a global public good requires investment in basic public health infrastructure to detect threats and protect the population. Access to safe food and proper nutrition, clean water, and proper sewage disposal has been and will continue to be the major contributor to efforts to control endemic disease, along with efforts to control disease vectors. There is broad international agreement that a significant role for states is to ensure conditions that allow their citizens and other legitimate residents to enjoy the highest attainable level of health. This broad agreement acknowledges the variability in human capacity to achieve the WHO ideal of "complete physical, mental and social well being, not just the absence of disease." It also clarifies the principle that a nation's health policy must be focused more broadly than on access to health care and must accord high priority to population-oriented public health.
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1ac-global health cred adv 2/ US leadership on global health policy is key to preventing newly emerging diseases, like drug resistant TB and Bird Flu, by creating incentives for countries to abide by international norms Scott Barrett, Professor of Environmental Economics and International Political Economy, Director of the International Policy program, and Director of the Global Health and Foreign Policy Initiative at SAIS, 6/4/07 XDR-TB and U.S. Foreign Policy, http://blogs.saisjhu.edu/globalhealth/?cat=5
The story of Andrew Speaker, the handsome newlywed who put the publics health at risk by traveling to Europe to attend his wedding, has been headline news. Speaker has Extensively Drug-Resistant Tuberculosis (XDR TB), a form of TB resistant to nearly all drugs used to treat TB. In traveling, Speaker put other people at risk. That an educated person could do thisa person whose father-in-law is a TB expertonly adds to the vulnerability people feel now. The situation is not unique. Remember the SARS epidemic of 2002-2003? That disease was spread outside of China by a doctor who had been treating SARS patients in Guangdong province. He probably infected others by coughing. It is known that he infected at least 16 other people, all of whom spent at least some time on the ninth floor on the Metropole Hotel in Hong Kong. People are right to be worried about spread. As one passenger on board the same flight as Mr. Speaker put it, How many other people can do this or will do this? Its hard to think about what this means for the future of air travel. See full article here. Policy, however, has to think about much more than border controls, travel restrictions, and quarantine. How did Mr. Speaker get infected? How did the person who infected Mr. Speaker get infected? How, especially, did the first person to acquire XDR TB get the disease? This person is especially important. Epidemiologists call this person the index case. Newly emerging diseases can be preventedor at least their chance of emerging can be reduced. The exotic wildlife markets in China played a role in the emergence of SARS. Similarly, a mutation of the avian flu virus H5N1 capable of human-to-human transmission is more likely to emerge where large numbers of people come into contact with large numbers of birds. In the case of XDR TB, emergence is likely to have been made more likely because of inappropriate drug use. The index case for XDR TB has not been identified, but this disease is almost certain to have emerged outside the United States. There is a tendency for policy to respond to a situation like this by focusing on the need to throw up border controls. Such controls are needed, but so are other measures. In particular, we need better surveillance worldwide for emerging diseases like XDR TB. We also need policies that make emergence much less likely. Global standards for TB exist. Lacking are the carrots and sticks that create the incentives for countries worldwide to abide by these standards. To protect the U.S. population, United States policy needs to look outwards and not only inwards (border controls). The U.S. cannot address risks like this unilaterally. A global approach is needed, but that will not be forthcoming without U.S. leadershipa reason why the intriguing case of Mr. Speaker should be a priority for U.S. foreign policy.
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1ac-global health cred adv 3/ And, assitance to healthcare infrastructure buildings essential to prevent drug resistant TB Gary Cohen, President, Becton, Dickinson and Company Medical, January 5, 2007,
http://www.bd.com/press/newsroom/pdfs/3_HC_Infrastructure.pdf lz
A primary thrust of these interventions has been provision of vitally needed pharmaceuticals, such as antiretrovirals for HIV/AIDS, to people who otherwise had no access. This will remain critical, but it is far from sufficient. The lack of health care infrastructure and capacity in sub-Saharan Africa is a more fundamental barrier, one that may soon inhibit the ability to deploy further increases in funding. The series of interventions that occurred over the past six years need to be regarded as a first stage which addressed the symptoms of insufficient health care capacity in Africa. It is now time to begin addressing the causes. One example is laboratory services. The provision of drug therapy in the absence of diagnostic testing - used as a quality control to know when drugs should be administered and whether they are working -- is a potentially dangerous proposition. Already in sub-Saharan Africa there is widespread drug resistance among TB patients. But today, the methodology utilized most commonly in Africa to diagnose TB is over 120 years old. Resistance is also emerging to first line therapies for HIV/AIDS and Malaria. One can only imagine the consequences of massive drug resistance to these three diseases in Africa. Laboratory capabilities and infrastructure will be essential for preventing this. Among the mechanisms for building vitally needed infrastructure in Africa, public private sector partnerships (PPPs) can play a critical role. With this in mind, BD (Becton, Dickinson and Company) is responding through cross-sector collaboration in the areas of advocacy, knowledge transfer, training, funding, and volunteerism, and by creating access to vitally needed technology on an affordable and sustainable basis. This White Paper identifies additional opportunities for private sector engagement, and we encourage other companies to take similar measures. The goal of improving the health and well being of the citizens of Africa is achievable. In our view, there is no practical alternative other than to devote all necessary efforts across the public and private sectors toward this goal.
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1ac-global health cred adv 4/ Drug resistant TB kills billions

Bob Unruh, News Editor for Worldnetdaily, 6/24/07
Untreatable TB threat 'apocalyptic scenario': 30,000 infected annually now, but toll could become 8 million 'time bombs', http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=56340
The World Health Organization is appealing for billions of dollars in funding to avert the apocalypse en route if a virtually untreatable form of tuberculosis that already infects 30,000 people a year is left unchecked. The TB, called XDR-TB for extensively drug resistant, is virtually immune to currently available antibiotics, turning aside the effects of both front-line and secondary drugs, officials have said. It has been in the news of late because of an American airline passenger, Andrew Speaker, an Atlanta, Ga., lawyer, who was diagnosed, then traveled to Europe for his wedding, and returned, on commercial airliners, potentially exposing hundreds of people to the frequently fatal disease. He now is being treated at a special center in Denver that deals with cases of tuberculosis. "XDR-TB is a threat to the security and stability of global health. This response plan identifies costs, milestones and priorities for health services that will continue to have an impact beyond its two-year
time line," said WHO Director-General Dr. Margaret Chan. The organization is appealing for $2.15 billion in funding to develop a battle plan and tools to fight the drug-resistant TB. It is expected that it would save 134,000 lives over two years, and many more in the future. The extensively drug resistant TB has been reported in 37 countries in all parts of the world since it first was identified in 2006, the agency said. "There is somewhere between 25,000 and 30,000, we roughly estimate, cases of extensive drug resistant TB each year," Paul Nunn, coordinator of WHO's Stop TB Department, informed a recent meeting. The program, called "Global MDR-TB and XDR-TB Response Plan 2007-2008" sets out measures needed to prevent, treat and control those threats. MDR-TB is multipledrug resistant, while XDR-TB is extensively drug resistant. WHO officials said the plan also launches "actions" that would reach a 2015 goal of providing access to drugs and diagnostic tests to all MDR-TB and XDR-TB patients, "saving the lives of up to 1.2 million patients," officials said. Included will be investments in programs to treat patients,
"We have sounded the alarm on the potential for an untreatable XDR-TB epidemic. Today we issue our response on behalf of all patients and communities whose lives are most at risk. It is an ambitious plan that must be fully supported if we are to keep a stranglehold on drug-resistant TB," said Dr. Mario Raviglione, director of the WHO Stop TB Department. It was in March 2006 when researchers reported their encounter with the extensively resistant TB strains. Within a few months, a cluster of "virtually untreatable" XDR-TB cases was reported in South Africa, aggravated by a high prevalence of HIV. "All but one of the 53 patients died in an average of 25
building capacity in diagnostic laboratories, expanding infection control and surveillance, and funding research into new attacks on the disease. days after samples were taken for drug resistance tests," the agency said. Then Speaker's case, "focused attention on the need to address the TB epidemic as an immediate international priority." "A highly important element of the plan is a steady supply of quality drugs to treat MDR-TB and XDR-TB in underserved countries," said Dr. Marcos Espinale, executive secretary of the Stop TB Partnership. "The Partnership's Global Drug Facility is ensuring supply of these drugs to a growing number of countries, after our Green Light Committee has verified that applicant countries meet its technical standards and will use the drugs correctly." MDR-TB is defined as being resistant to main first-line drugs such as isoniazid and rifampicin. More than 400,000 such cases are reported each year, and it emerges generally when it is spread from one person to another, or the drugs used to battle ordinary TB are mismanaged, allowing a resistance to develop, officials said. The XDR-TB develops when there is resistance to all of the most effective anti-TB drugs, and the fluoroquinolone drugs as well as some of the second-line injectable drugs, amikacin, capromycin and kanamycin. The problem is with the tendency for such infections to grow exponentially, said Raviglione. "That is the big threat here. If you have more and more of these cases, you will automatically magnify the problem by having transmission going on to other individuals ... Once they become infected they are sort of a time bomb," he said. "If this is kept unchecked and goes on, then you may also see an apocalyptic scenario where the present epidemic of TB is replaced by an epidemic of TB which is now fully resistant to everything," he added. In such a situation, the toll could be massive. Currently 8.8 million people each year develop normal TB, a bacterial infection (Mycobacterium tuberculosis) that usually attacks the lungs. It already kills 1.6 million annually, WHO said. "The possibility is that you could replace that epidemic with a drugresistant epidemic, in other words you could have 8 million cases of drug-resistant TB wandering around. And then you will be back to the pre-antibiotic era," said Nunn. "We really now have to focus on problems of infection control. We can't allow drug-resistant MDR or XDR to get into populations of HIV-infected people," he added. Ordinary TB can be diagnosed with a microscope, but drug-resistant forms require much more sophisticated tests and labs, which are missing in many poor countries. And ordinary TB usually can be treated over a course of six months or so; the more drug-resistant varieties could take two years.
"It's basically a death sentence. If people are failing first- and second-line drugs and we don't have in the pipeline a new drug for immediate use, that's a crisis," said Espinale.
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1ac-market access adv 1/ Advantage three is market accessChinas current Africa policies are succeeding at gaining the support of developing countries and will inevitably diminish US hegemony by making China another global power Chinese aid is destroying African health systems The US must respond by increasing foreign aid to promote its interests on the continent Joshua Eisenman and Joshua Kurlantzick, a fellow in Asia studies at the American Foreign Policy Council and visiting scholar at the Carnegie Endowment, 2006 Chinas Africa Strategy
Chinese aid to the continent has become more sophisticated. While China once focused on large buildings-sports stadiums in Gambia and Sierra Leone, for example-it has increasingly used aid to support infrastructure creation that then also helps Chinese companies, and to directly woo African elites. In 2002, China gave $1.8 billion in
development aid to its African allies. (Beijing has since then stopped officially reporting its aid, making a complete and accurate tally impossible.) China has also used debt relief to assist African nations, effectively turning loans into grants. Since 2000, Beijing has taken significant steps to cancel the debt of 31 African countries. In 2000, China wrote off $1.2 billion in African debt; in 2003 it forgave another $750 million. Ethiopian Prime Minister Meles Zenawi has proclaimed that "China's exemplary endeavor to ease African countries' debt problem is indeed a true expression of solidarity and commitment." Debt relief has been an excellent public relations tool for Beijing because it not only garners popular support but also allows for two positive press events: the first to provide the loan, the second to relieve the debt. In addition to increased aid, China's outreach includes efforts to boost its soft power in Africa. This is evident in a growing focus on promoting Chinese cultural and language studies on the continent. In 2003, 1,793 African students studied in China, representing one-third of total foreign students that year. Indeed, China plans to train some 10,000 Africans per year, including many future African opinion leaders who once might have trained in the West. Beijing also seeks to establish "Confucius Institutes" in Africa-programs at leading local universities, funded by Beijing and devoted to China studies and Chinese language training. Already, in Asia, Confucius Institutes have proved effective in encouraging graduate students to focus on China studies and, ultimately, to study in China. Meanwhile, Chinese medical schools and physicians train African doctors and provide medicine and equipment free of charge to African countries. Through these programs and exchanges, China develops trust by investing in long-term relationships with African elites that formerly might have been educated in London or Washington. Beijing is also working to encourage tourism in Africa, partly in an effort to develop cultural ties. The government has approved 16 African countries as outbound destinations for Chinese tourists, including Ethiopia, Kenya, and Zimbabwe. This pushed the number of Africa's Chinese tourists to 110,000 in 2005, a 100 percent increase over 2004, according to Chinese government figures. TRADE SUMMITS AND ARMS DEALS On the trade front, Beijing has enacted policies to encourage greater Chinese investment in Africa. It has launched centers for "investment and trade promotion," providing business and consultation to Chinese enterprises in Africa. Beijing has also created special funds and simplified procedures to promote Chinese investment. As Chinese investment in the continent has grown, some 80,000 migrant workers from China have moved to Africa, creating a new Chinese diaspora that is unlikely to return home. (In some cases, this diaspora, along with imports of cheap Chinese goods, has sparked anger in Africa. Many African businesspeople believe that Chinese goods are unfairly undercutting them, and fear the diaspora is remitting nearly all of its money back to China rather than reinvesting it into local economies. These are the kinds of concerns that once led to anger against Indian populations on the continent.)
In a strategy Washington would be wise to emulate, China uses summits and informal meetings to reach out to African business leaders. The first Sino-African business conference was held in Ethiopia in December 2003. It resulted in agreements on 20 projects with a total value of $680 million. In August 2004, China held a China-Africa Youth Festival in Beijing, and in 2006 Beijing will host the third ministerial meeting of the China-
Africa Cooperation Forum. Events like these provide a venue for rolling out Beijing's technical assistance, and where the idea of China as a benign actor in Africa can be tacitly emphasized. Finally, Beijing increasingly views Africa as a center for military-military cooperation and a market for China's growing arms industry. Today, Chinese firms rank among the top suppliers of conventional arms in Africa. Between 1996 and 2003, Chinese arms sales to Africa were second only to Russia's. In particular, China has developed close military ties with Zimbabwe, Sudan, and Ethiopia, three of Africa's most strategically important states. In April 2005, Zimbabwe's air force received six jet aircraft for "low-intensity" military operations. The year before, a Chinese radar system was installed at President Robert Mugabe's mansion in the Harare suburbs. Most important, in June 2004, Zimbabwe reportedly purchased 12 jet fighters and 100 military vehicles, worth an estimated $240 million. This order, which had been kept secret, was also reported to have circumvented the state procurement board tasked with appropriating Zimbabwe's $136 million defense budget. China has become the largest supplier of arms to Sudan, according to a former Sudanese government minister. Chinese-made tanks, fighter planes, bombers, helicopters, machine guns, and rocket-propelled grenades supplied Khartoum's forces in the north-south civil war. And even as world leaders remain fearful of new conflict between Ethiopia and Eritrea, China has extended arms sales to both nations. (During the war between Ethiopia and Eritrea from 1998 to 2000, China bypassed a UN arms embargo and sold over $1 billion in weapons to both states.) Ethiopian Prime Minister Meles Zenawi and Chinese Lieutenant General Zhu Wenquan met in Addis Ababa in August 2005. They agreed that "Ethiopia and China shall forge mutual cooperation in military training, exchange of military technologies, and peacekeeping missions, among others." The previous week, Zhu had met with the commander of the Eritrean Air Force. At that gathering, Zhu had said it was China's desire "for the armies of the two sisterly countries to cooperate in various training." "NUMBER ONE FRIEND"
These tools and strategies have proved effective. China has gained access to sizable resources across the continent. It has been offered exploration rights to important Nigerian oil fields. Beijing already dominates Sudan's oil industry and has the inside track to Angola's and Algeria's oil
industries. More Chinese companies, too, are proving successful in mining African markets. The Chinese telecommunications giant Huawei, for instance, now holds contracts worth $400 million to provide mobile phone service in Kenya, Zimbabwe, and Nigeria. In Zambia, Chinese investors are working on a $600 million hydroelectric plant at Kafue Gorge. They are also active in South Africa and Botswana's hotel and construction industries. Chinese firms dominate the recovering economies of Sierra Leone and Angola, and China has become an increasingly close trade partner with South Africa, the region's largest economy. African
leaders are increasingly treating China like a great power on the continent, affording Chinese officials and businesspeople the type of welcome and access once reserved for Western leaders. Beijing's outreach has been well received by many African leaders, who welcome China's rhetoric of noninterference and constant inveighing against American "hegemonism." Just as Gabon, Sudan, Angola, and other nations now
look to China first, so too Mugabe now calls China his "number one friend," while the leaders of Rwanda, where the government is accused of rigging polls and locking up opposition leaders, have lavished praise on Beijing. "It's a different way of doing business," Rwanda's finance minister told reporters, pleased that China has offered aid without any preconditions, such as improving Rwanda's human rights record. Sudanese officials, too, give thanks to Beijing: "We have our supporters," the deputy head of Sudan's parliament said wryly after Washington attempted, with little luck, to sanction Sudan at the United Nations. As Mugabe put it, China is becoming "an alternative global power point." This growing influence comes at some US expense. Africa has not been a priority for US foreign
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policy, other than counterterrorism cooperation with states in North and East Africa. Meanwhile, in some democratic African nations, the war in Iraq, the use of the term "empire" in relation to elements of US foreign policy, and the American focus on transparency, sometimes seen as meddling, genuinely anger average citizens. The White House has held few bilateral meetings with the continent's most important players, and, according to a report on West Africa by the Center for Strategic and International Studies, it has cut back on American energy attachs to the continent, even as African oil becomes more important to the United States. CONTINUEDNO TEXT DELETED
At the same time, restrictive US policies on student visas have led many Africans studying abroad, historically a vanguard of pro-American sentiment, to look outside the United States for their education. Yet the fact that some African leaders welcome Beijing does not mean that average Africans will always benefit from China's
Although much of Africa has rid itself of dictators, the continent is still left with fragile, poor pseudo-democracies that lack strong civil societies, independent media, and other important pillars of democracy. These nations could go either way. Like Benin and Botswana, they could blossom into consolidated, mature democracies. Or, like Zimbabwe and Rwanda, they could deteriorate into oneparty states that hold elections but lack other essential elements of a democracy. SETTING A POOR EXAMPLE In this fragile environment, Chinese influence could complicate democratic consolidation and good governance. It might also undermine China's own efforts to be seen as a responsible global power. In Zimbabwe last year, the country held a dismal election; before the vote, candidates and poll workers from the Movement for Democratic Change, the leading opposition party, were threatened, beaten, and even killed. Mugabe had gerrymandered parliament so he would be guaranteed to start with more seats than the MDC before votes were even counted.
influence. On Election Day, when Mugabe unsurprisingly won a smashing victory, and the MDC unsurprisingly cried foul, no major international power would endorse the outcome-except China. In the run-up to the election, China had delivered to Zimbabwe agricultural equipment, electricity transformers, and planeloads of T-shirts bearing the insignia of Mugabe's party. Chinese businesses also reportedly offered the government jamming devices to be used against Zimbabwean opposition radio stations, and Beijing is said to have sent Harare riot control gear, in case of demonstrations. Mugabe was ecstatic at his good fortune. "The Chinese are our good friends, you see," he told a British interviewer. Beyond Zimbabwe, Beijing has been criticized for blocking Western efforts to isolate and punish the Sudanese government. In the fall of 2004, when the United States submitted draft resolutions to the United Nations that would have called for tough action against ethnic cleansing in Darfur, China's UN ambassador quietly defanged the drafts, rendering them useless. Chinese support also has helped African leaders maintain controls on information. Beijing aids African regimes with training on press and Internet monitoring. Tracing China's efforts in this area is difficult, but China's official press even alluded to these media initiatives. On November 11, 2005, the People's Daily proclaimed, "In the information sector, China has trained dozens of media from 35 African countries for the past two years." The day before, the group Reporters without Borders released an analysis of Mugabe's media activities, finding that "the use of Chinese technology in a totally hypocritical and non-transparent fashion reveals the government's iron resolve to abolish freedom of opinion in Zimbabwe."
China's unwillingness to put any conditions on its assistance to Africa could undermine years of international efforts to link aid to better governance. Already, international corruption watchdogs like Global Witness have warned that China's $2 billion aid to Angola, given in advance and without pressure for poverty reduction, will allow the Angolan government to revert to its old habits, skimming the petroleum cream for itself. Today, the majority of Angola's roughly 13 million people still live in poverty, while elites have siphoned off much
of the nation's oil wealth. Yet in November 2005, Jos Pedro de Morais, Angola's finance minister, said he expected future Chinese loans would exceed $2 billion.
More generally, the stateled business model that China suggests to visiting African leaders could prove problematic in Africa. Chinese firms with state links often have poor standards of corporate governance, including a lack of transparency. In Africa, Chinese firms, many of them owned by the
"When we ask our Chinese counterparts if they are willing to provide more loans, they say yes," he remarked. Chinese state, have been known to submit bids below cost in an effort to break into a market. Examples include Asmara's Oratta Hospital in Eritrea and a $300 million hydroelectric dam and power plant on Ethiopia's Tekeze River. Notably, the Tekeze project is behind schedule and the Ethiopian government is insisting the Chinese construction firm pay for the delays. Because of below-cost bids and a desire to save money, some of the buildings Chinese firms have built in Africa are already crumbling, leading to fears about whether much of the new Chinese-built infrastructure will stand the test of time. In China, this poor corporate
governance has led to fiscal meltdowns. Yet the Chinese government, constrained by its need to demonstrate some rule of law to foreign investors, has managed to prosecute the most egregious white-collar criminals, including some corrupt officials. In Africa, where the rule of law often does not exist, China's state-led business model could prove a disaster, an invitation for rapacious governments and companies.
COMPETING VALUES Ultimately, Africa will provide a test of whether Beijing can be a successful great power, exerting influence far from its borders. In some respects, China's influence may prove benign, as China shares burdens in Africa with other nations like the United States, becomes a greater source of investment in the continent, and funds much-needed aid programs.
Even as the United States has largely ignored African nations in UN forums, China has supported a range of proposals favored by African countries on UN Security Council reform, peacekeeping, and debt relief. In so doing, Chinese officials often portray Beijing as a champion of the developing world that listens to other countries, drawing an implicit contrast with the United States, which China portrays as uninterested in developing nations' needs. As Chinese
Prime Minister Wen Jiabao put it, "As a permanent member of the UN Security Council, China will always stand side by side with developing countries in Africa and other parts of the world." Yet Beijing's influence must be weighed in light of the fact that China, at least for now, does not share American values of democratization and good
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governance-in Africa or anywhere else. Because China's influence might constrain the existing powers in Africa, including the United States and France, the temptation may be to match some of China's efforts on the continent in order to win resources. But it is more important that the United States leverage its values, which are still more appealing to average Africans. For the United States, China's growing role in Africa should be a wakeup call. Washington needs to convince both average Africans and their leaders that their future is better served, over the long term, by working more closely with the United States, the European Union, and international financial institutions. After all, a Chinese victory on the continent could come back to haunt the struggling residents of Maputo and other African capitals.
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1ac-market access adv 2/ US health assistance to combat AIDS in Africa is essential to African economic developmentopening up US market access and oil resources. Johnnie Carson, Senior Vice President at the National Defense University and formerly served as U.S. Ambassador to Kenya, 2004
Africa is in danger of slipping further on the list of U.S. foreign policy priorities because of Washington's preoccupation with Iraq, Afghanistan, North Korea, and the war on
Yet Africa is a growing source of petroleum and raw materials, an important trading partner, and an enormous untapped market for American investment. The continent faces some serious problems and remains outside the mainstream of economic globalization and wide digital connectivity. Failure to address these problems will only increase the need for American assistance and involvement. With more focused U.S. engagement, Africa can become a stronger partner in addressing costly regional crises and mitigating global terrorism. The next administration has an opportunity to refocus U.S. engagement in Africa and articulate a
terrorism. policy that reflects American interests, values, and priorities. Such policy can leverage U.S. influence and enhance its image in Africa while boosting the continent's economic development and political stability. This policy should rest on seven pillars: * strengthening democratic institutions and the rule of law * encouraging economic reform and growth * building partnerships in the global war on terrorism * combating the HIV/AIDS epidemic * expanding American trade and investment * helping to prevent and resolve conflicts * fostering regional integration. It is also critical that Washington's relationship with various African states and
leaders not be viewed narrowly or exclusively through the prism of the growing U.S. concern with combating global terrorism. ********** In the four decades since most African states achieved independence, the continent has never been a foreign policy priority for the United States. During the early years of American engagement with Africa, Washington focused its attention on preventing communist countries from gaining major military bases or monopolistic concessions over any of the continent's important strategic minerals. Although the United States provided large amounts of development assistance and food aid to a number of African states, most American interest and support was directed toward African countries and leaders who were regarded as Cold War allies. In those countries still struggling for independence, the United States usually supported African insurgents who were pro-Western and anticommunist in their orientation. In South Africa and Namibia, Washington generally professed great sympathy for eventual majority rule and independence but largely supported the status quo out of fear that liberation groups allied with the Soviet Union or China would win power in any political transition. Throughout much of this era, scant attention was paid to promoting multiparty democracy, encouraging good human rights practices, or fighting corruption. With the appointment of Congressman Andrew Young as United Nations (UN) Ambassador, President Jimmy Carter energized America's engagement on the continent. With the British government, the Carter administration pushed for a UN-sponsored solution to Namibia's independence struggle and a diplomatic settlement of Rhodesia's 15-year-long unilateral declaration of independence. President Carter's creation of a new Department of State Bureau of Human Rights also gave greater prominence to the issue of torture and physical abuses in Africa. However, notwithstanding these positive developments, protecting America's pro-Western partners in Africa (such as Mobutu Sese Seko in the Congo, Daniel arap Moi in Kenya, and William Tolbert in Liberia) remained far more important than promoting democratic values, good governance, and improved human rights around the continent. During the Reagan administration, State Department officials spent substantial time on Africa, but the widely contested administration policy of constructive engagement concentrated largely on achieving independence for Namibia and resolving the problems of apartheid in South Africa in a manner that would limit Soviet advances in southern Africa. Outside of southern Africa, Reagan and his successor, George H.W. Bush, continued to support pro-Western states and leaders while giving relatively short shrift to the rest of the continent and to issues such as democracy, human rights, and corruption. In 1992, Bill Clinton came into office with a commitment to elevate U.S. involvement and interest in Africa. With two successful Presidential visits and numerous Cabinet-level trips to the continent, President Clinton inaugurated a new focus on Africa and elevated official U.S. involvement with the continent to a historically high level. In 8 years, the Clinton administration launched dozens of new programs and initiatives on the continent, including: * creation of the African Crisis Response Initiative to help train African peacekeepers * passage of the African Growth and Opportunity Act * a major program for the education of girls * implementation of a "Safe Skies for Africa" aviation and security program * expansion of Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) prevention programs * establishment of bilateral commissions with South Africa (led by Vice President Al Gore), the South African Development Coordination Conference, and the Economic Community of West African States. Despite its activism, the Clinton State Department team was frequently accused of abandoning its principles in favor of a new breed of young African leaders, even if these leaders did not pursue policies of good governance and human rights. During the past 3 years, the George W. Bush administration has retreated from the activism and engagement of the Clinton years. Although both President Bush and Secretary of State Colin Powell have visited Africa and met with dozens of African leaders in Washington, (1) the Bush administration has concentrated on implementing two ambitious programs: one on the prevention and spread of HIV/AIDS, and the other on the establishment of a new mechanism for channeling foreign assistance to some of the poorest nations in Africa--the Millennium Challenge Account. As the Bush administration concludes its term, the evolution and development of these programs are being watched, and it is too soon to predict whether they will be successful or enduring. Today, we have moved into a new global paradigm, and the need for an overarching set of principles that focuses U.S. engagement in Africa is essential to advance key American strategic priorities. As the United States approaches the 2004 Presidential election, public officials and policy thinkers across the political spectrum have an opportunity to think seriously about reshaping policy and building it around seven core values. Democracy and Law Africa's democratic track record has been spotty throughout much of its postcolonial history. The absence of democracy and the rule of law has been a primary reason for the civil strife, military conflict, and appalling human rights abuses that have plagued the continent. [ILLUSTRATION OMITTED] In the last decade, Africa has made impressive strides in establishing more responsible and representative governments. Military coups and extralegal changes of government have decreased in frequency, especially in the larger African states. More than half of the countries in sub-Saharan Africa now have democratic governments, and in the last 5 years, 6 major countries (Ghana, Kenya, Mali, Mauritius, Nigeria, and Senegal) have held successful multiparty elections that have resulted in peaceful and orderly changes of government. The African Union, the continent-wide organization that represents most African states, has made democracy and good governance a higher priority and passed a resolution prohibiting the seating of any government that comes to power through a military coup or extralegal transfer of power. Nevertheless, several large holes remain in the democratic canvas of Africa, and much remains to be done to promote and strengthen democracy on the continent. Far too many major countries remain outside of the democratic framework. Sudan and the Democratic Republic of the Congo, two of the largest and most populous states, are not yet democratic and are struggling to emerge from long periods of authoritarian rule, civil war, and serious human rights abuses. In other parts of Africa--the Republic of Guinea, Togo, Zimbabwe--aging and autocratic leaders hang on to power. Democratic institutions in Madagascar, Malawi, and Zambia remain fragile and subject to destructive political manipulation and coercion. Nigeria, Africa's most populous country and its largest democracy, is also confronted with deep cleavages between north and south, Christian and Muslim, a relatively small and politically corrupt elite and a growing number of impoverished and alienated citizens. Any one of these issues could boil over and bring Nigerian democracy to the breaking point. In the pivotal Central African state of Uganda, a return to full democracy has been stalled for the last decade because of the reluctance of President Yoweri Museveni to permit a rapid and complete return to genuine multiparty politics. Strengthening democratic institutions is vital. The United States has spent a great deal of time promoting elections, which, although essential to the democratic process, are not as important as a strong and robust judicial system. The pivotal role of the judiciary in creating an enabling environment for the development of democracy can no longer be ignored or minimized in efforts to promote democracy in Africa. An effective judiciary protects the civil liberties and human rights of individuals and interprets the constitution and laws. More needs to be done in this area. To fortify Africa's democratic gains, additional money and attention should be directed to strengthening its weak judicial systems, expanding the training of magistrates and judges, encouraging professional legal associations, and promoting legal aid societies. The promotion of democracy, the rule of law, good human rights practices, and free and impartial elections should be cornerstones of what the United States does in Africa, regardless of other American interests and concerns. The Economy Africa is a continent of great mineral wealth and agricultural potential, but economic growth and prosperity have proven extremely elusive for most states. According to the World Bank, Africa remains the poorest continent and the least integrated into the world economy--with slow growth rates, declining levels of per capita income, limited capital markets, and relatively small international and interregional trade flows. Many of these deficiencies are the result of bad economic and financial policies, bloated and inefficient government bureaucracies, and an overreliance on state-run marketing boards and cooperatives. In addition, many of the countries blessed with great mineral and oil wealth have squandered it. Substantial mineral earnings have frequently resulted in massive corruption and have often sparked political conflicts and civil war rather than economic growth and national prosperity. Diamonds, for example, have fueled civil wars in Angola, the Central African Republic, the Democratic Republic of the Congo, and Sierra Leone. Great oil wealth has resulted in violent conflict and recurring political tensions in Angola, Cameroon, Chad, and Nigeria. In the last decade, many African countries have started to change, and some critical reforms have been undertaken. A growing number of governments have adopted World Bank and International Monetary Fund reforms, privatized inefficient state-owned industries, floated currencies, and allowed the market to play a greater role in the economies of their countries. Governments have also become more aggressive in seeking better terms of trade, creating better conditions for their business communities, and courting foreign investment. If African countries are to realize long-term economic objectives, the United States must continue to encourage their governments to eliminate corruption and pursue economic policy reforms while using donor assistance more effectively. In a bold and widely applauded move, the Bush administration in March 2002 announced a new initiative to double the foreign aid budget by 2006 and to channel the additional funds through a new organization called the Millennium Challenge Account (since renamed the Millennium Challenge Corporation [MCC]). MCC funds would be directed toward countries that are governing justly, investing in people, and encouraging economic freedom. The Millennium Challenge Corporation announced the first 16 countries eligible for grants in May 2004. Eight of the 16 countries were in Africa, which surprised many people given the stiff criteria that had been put in place. (According to outside researchers and knowledgeable officials in the State Department, only 3 African countries came close to qualifying under the 16 specific performance indicators that MCC identified in the first year of the program.) The Millennium Challenge Corporation is a valuable new tool, but it is evolving slowly and will affect only a limited number of countries. Many development experts are deeply concerned that its growth and success will mean the decline of the U.S. Agency for International Development (USAID), its funding, and its direct involvement on the ground in Africa in promoting critical aid programs. Others are concerned that the Bush administration may never fulfill its multiyear, multibillion-dollar financial commitments to the MCC. To help the majority of African states, MCC resources should not become a substitute for USAID and its work. Traditional funding for that agency must remain in place and not decline. To accelerate African growth and development, the United States should also extend the benefits of the successful African Growth and Opportunity Act, expand debt forgiveness programs, and introduce more regional investment funds to encourage the growth of the private sector. The United States also needs to encourage greater trilateral private- public partnerships through the creation of endowed U.S.-host country development foundations, especially in those states where mineral and petroleum companies have a major stake and can play a vital role. The road to sustained and long-term economic growth in Africa will not be found in donor assistance and development aid alone. A robust, free market economy, based on equitable trading relationships and foreign investment, and coupled with the strategic use of foreign assistance, is the best way to achieve sustained economic growth and stability. The United States should redouble its efforts to encourage African governments to follow this path. Terrorism Global terrorism is the most serious national security threat to the United States and is one of the problems shared with Africans. The same terrorist group that destroyed the World Trade Center struck with equally deadly force in East Africa 3 years earlier. On August 7, 1998, U.S. Embassies in Nairobi, Kenya, and Dar es Salaam, Tanzania, were severely damaged in well-orchestrated al Qaeda attacks. The Nairobi bombing resulted in over 200 deaths and more than 5,000 wounded. Since the bombings in Kenya and Tanzania, new attacks and terrorist actions have been perpetrated in Africa against Israeli and other Western interests. Future terrorism in Africa is almost certain. Africa is a soft target, and most African states lack the security necessary to prevent well-coordinated terrorist attacks. This fact--coupled with the existence of several failed or weakened states in various parts of the continent with significant Muslim populations, the rise of conservative Islam in northern Nigeria (the most populous state in Africa and the eighth largest Muslim state in the world), and the continued growth and spread of Islam throughout much of west, central, and northeastern Africa--could see Africa emerge in the months and years ahead as a new regional battleground in the war on terrorism. Conservative and sometimes radical Islamic organizations have been able to make enormous headway among Muslim populations in some African states affected by poverty, economic deprivation, and political alienation. This has happened outside of Africa, and it can also happen on the continent. It is in the interest of both Africa and the United States to prevent this, but it can only be stopped through strong collaborative efforts, not through unilateral action. The United States has introduced two new antiterrorism programs in Africa--the Pan Sahel Initiative (to help Chad, Mali, Mauritania, and Niger deal with terrorism in West Africa) and the East African Counter Terrorism program (aimed largely at helping Djibouti, Ethiopia, Kenya, and Tanzania). These programs are primarily intended to strengthen the security forces and border control in the recipient countries. However, preventing and detecting terrorism in Africa will require robust and successful economic and social programs, not only new military security initiatives. If the United States is going to make headway against emerging terrorism in Africa, it will have to spend more money to strengthen its development assistance programs, diplomatic representation, and public diplomacy in those states where radical fundamentalism may take root.
The most serious HIV/AIDS challenge facing Africa is AIDS. If the syndrome is allowed to go unchecked, Africa will never realize its dream of economic prosperity and democratic stability. The magnitude of the AIDS problem is without precedent in the era of modern medicine, and Africa has been hit hardest. With roughly 700 million people, . On the continent as a whole, nearly 3,000 people die every day because of this disease, and in some African countries, the sheer size of the problem defies imagination. The dying frequently leave behind another burgeoning problem: orphans. More than 11 million orphans live in sub-Saharan Africa, and that number is expected to double by the end of this decade. The United States has taken the lead among Western governments in providing funding and assistance to fight AIDS in Africa. Working through the Centers for Disease Control, USAID, the National Institutes of Health, and
Africa has only 10 percent of the global population, but it has nearly two-thirds of the world's 40 million AIDS cases. Most of the top 15 countries in the world affected by HIV/AIDS are African. In Botswana and Swaziland, HIV infection rates hover close to 40 percent, and in South Africa, Zambia, and Zimbabwe, 20 percent or more of the people are infected. The situation in Kenya is not untypical of many other African countries. As a result of the AIDS epidemic, it is estimated that 36 Kenyans die every hour, 864 every day, 6,048 every week, 24,192 every month, and 290,304 every year. (2) The situation throughout Africa is equally grim
the U.S. Army Medical Research Unit, the U.S. Government has established a number of prevention programs built around information, education, counseling, and voluntary testing. The Bush administration has launched an initiative that would provide $15 billion in additional funding over 5 years to some of the most severely impacted African and Caribbean states. This program includes a significant amount of funding for the purchase of antiretrovirals. It is critical that this program be fully funded and implemented and that conservative American religious beliefs and moral attitudes do not limit the fight to stop AIDS.
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Focusing on abstention alone will not succeed. Organizations promoting condom use as a responsible behavior should be financed as well. Moreover, while it is extremely important to make antiretroviral drugs more readily available at affordable prices, it must be remembered that those countries that have made progress to date in reducing HIV infection rates have relied on four principles to do so: strong leadership from the president, the cabinet, and other influential national leaders; a broad-based and sustained information and education
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campaign; the availability of counseling and testing centers where people can find out their HIV status; and a willingness to talk openly about, and change, fundamental cultural traditions and habits that may unwittingly foster HIV/AIDS. The United States can help African leaders pursue these four principles by the provision of more antiretrovirals and expanded financing for the global fund for AIDS, tuberculosis, and malaria. But most importantly, America must remain a strong and unrelenting partner to all those fighting HIV/AIDS. American Trade
The importance of Africa as a critical economic partner is often denigrated; however, nothing could be further from the truth, especially in the oil and gas sector. Africa supplies just over 15 percent of U.S. fuel imports and the majority of its low sulfur "sweet" crude. African production is expected to rise dramatically over the next 10 years, and African petroleum exports to the United States will increase from 15 to 25 percent. Output in Nigeria, the largest oil-producing country on the continent, is continuing to expand, but
production in other parts of West Africa and the Gulf of Guinea are on the threshold of enormous growth. Angola, for example, is slated to increase its production from 750,000 barrels a day to nearly 2 million in the next 5 years, and Equatorial Guinea, which produced no petroleum a few years ago, will shortly become one of the most significant producers in the region. Many experts argue that Africa is the hottest oil
region in the world and that with the increasing turbulence in the Middle East, African crude will become an even more prized commodity. While Africa is not one of the largest U.S. trading partners, commerce with sub-Saharan Africa is consistently greater than it is with Russia and the other 14 states of the former Soviet Union. For American companies that manufacture products such as airplanes, diesel locomotives, electric generators, computers, and high-tech medical equipment, Africa has been a larger export market than many in Eastern Europe or some other parts of the developing world. Approximately 100,000 American jobs are directly linked to exports to Africa. If Africa continues to grow and prosper economically, American exports to that continent are also likely to expand. It is important to ensure that American companies and products are able to get into the market and have a level playing field when they do.
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1ac-market access adv 3/ US involvement in developing economic growth in Africa is essential to open up new export markets that sustains the US economyonly increased engagement in the African economy can crowd out competitors and ensure African success Susan Rice, Assistant Secretary for African Affairs, 1998 U.S. Interests in Africa: Today's
Perspective, http://findarticles.com/p/articles/mi_m1584/is_10_9/ai_53461437/print
Today, Africa stands at a crossroads--a decisive time when its future hangs in the balance. The challenges and opportunities facing the African people stand in stark relief. Africa can overcome its troubled past or lunge back into self-destructive conflict. The United States can stand on the sidelines, or we can recognize and act upon our growing interest in a thriving Africa that can take its rightful place on the world stage. Despite today's headlines, there is considerable reason for optimism about Africa's future. Economies that were growing at less than 2% at the beginning of the decade are registering growth at more than
twice that level. Some countries are recording double-digit growth rates. The citizens of over half of all Sub-Saharan African nations are choosing their own governments freely and holding their leaders accountable. Indeed, the number of democracies has more than quadrupled in less than a decade. Regional organizations such as ECOWAS and the Organization of African Unity are intensifying their efforts to prevent and resolve conflicts. Others, such as the Southern African Development Community and the revitalized East African Community, are moving toward the establishment of regional common markets that can become economic engines for the future. From the resurgence of war-torn Mozambique to the demise of apartheid in South Africa; from the budding democracies in Benin, Mali, and Namibia to a fresh start for the great people of Nigeria--there is reason for real hope for the people of Africa. Indeed, a politically reconciled, economically strong Nigeria would pay huge dividends for the entire African Continent. We thus hope Nigerians will stay the course. Let 1999 mark not only new South Africa's second democratic election but the true beginning of a lasting democracy in Nigeria. Yet, clearly, in Nigeria as elsewhere, Africa's progress has been neither linear nor universal. In recent months, we have witnessed significant setbacks in several regions. Some countries which were beginning to recover from conflict have picked up arms again; some societies which were rebuilding are tearing down; and some governments which had taken fragile steps toward democracy and reconciliation are drifting back toward tyranny and repression. At least eight African nations are involved in a bitter war in the Congo--potentially one of the most serious conflicts in the world today. Humanitarian crises in Sierra Leone, Somalia, and Sudan; resumed fighting in Guinea-Bissau; the face-off in the Horn of Africa; and the faltering Angolan peace process all must be of significant concern to the United States. Indeed, whether the challenge is adversity or opportunity, the reality is that the end of the Cold War calls for a new paradigm for U.S. policymakers in Africa. We must resist the temptation to dissipate our energies in responding solely to the crisis of the day. Our horizons must be longer term. First, as one of our two major policy goals, we must work in concert with Africans to combat the many transnational security threats that emanate from Africa just as they do from the rest of the world. These include not only terrorism but weapons proliferation, narcotics flows, the growing influence of rogue states, international crime, environmental degradation, and disease. Continued and closer collaboration with Africans to counter these threats to our mutual security should be an important priority for U.S. policymakers. Therefore, we must invest in new strategies in partnership with African countries, the G-8, and others to combat global threats effectively before they become more pernicious and pervasive. We have made a start along this path but, in truth, we have a long way to go. Two years ago, the U.S. signed the Africa Nuclear Weapons-Free Zone Treaty to eliminate nuclear weapons now and forever in Africa, but too few African countries have ratified the agreement. We have cleared thousands of acres of landmines in Africa, but thousands more acres remain. We have provided modest amounts of anti-terrorism training to African countries as well as information on the activities of terrorist groups, but we need congressional support to do much more. We have been working with law enforcement authorities from Nigeria to South Africa to interdict illicit drugs before they hit American streets. But the U.S. must go further to craft, fund, and implement a continent-wide counter-narcotics strategy. We have urged concerted international action to stem the flow of arms, ammunition, and explosives into Africa's conflict zones. But weapons sales, including from the United States, continue unabated. Finally, the Administration has recognized the risk to U.S. citizens and soil from inadequate aviation safety and security systems in Africa. Thus, we are launching an innovative "Safe Skies for Africa" initiative to increase the number of Sub-Saharan nations that meet international aviation standards. The initiative seeks to make air travel safer for Africans and Americans and to strengthen airport security to help interdict would-be criminals and their contraband.
The United States also is sharing our medical expertise through our Centers for Disease Control (CDC) to combat deadly diseases, like malaria and AIDS, that know no borders. For the protection of people everywhere, we cannot allow Africa to remain the world's soft and most accessible underbelly for terrorists and others determined to do evil. At the same time, we must press ahead to achieve our second principal policy goal in Africa; that is, accelerating Africa's full integration into the global economy. Increasingly, the U.S. economy is fueled by exports. As we grapple with the consequences of turmoil in both our traditional and emerging markets from Asia to Brazil to Russia, the United States cannot afford to write off any potential new export market. A vast and growing market of 700 million potential consumers, Africa is in many ways the last frontier for U.S. exporters and investors. For, despite areas of instability, Africa's economic trends remain positive. Two-thirds of African nations--roughly 3 dozen countries-have implemented economic reforms to open markets, stabilize currencies, and reduce inflation. African governments have privatized over 2,000 state enterprises in the past few years, raising over $2.3 billion in government revenue to invest in infrastructure, education, and health care. The U.S. relies heavily on the African Continent for petroleum and strategic minerals. In volume terms, nearly 14% of U.S. crude oil imports come from the continent, as compared to almost 18% from the Middle East. Within a decade, Africa is projected to be the source of well over 20% of our imported oil. America's commercial interests in Africa will deepen as U.S. companies continue to tap this nascent market. American businesses exported over $6 billion worth of goods last year to Africa and imported more than $16 billion. The U.S. is now Africa's second-largest industrial supplier. U.S. companies have edged out European and Asian competition to complete major deals in the region. Examples abound: Coca-Cola recently made a $35 million investment in a production and distribution facility in Angola; a consortium comprised of Enron and the Industrial Development Corporation signed a $2 billion agreement to construct a steel plant in Mozambique; and, in West Africa, Ghana's stock exchange--although tiny--is one of the top performers in the world. A visionary economic policy toward Africa is in our own long-term interest. Thus, we must continue and intensify our efforts to pass the African Growth and Opportunity Act. This landmark legislation remains key to establishing a mature trade and investment relationship with Africa just as we have with trading partners in other emerging markets. At the same time, we are implementing the President's own Partnership for Economic Growth and Opportunity in Africa. We are providing technical assistance to help liberalize trade and investment regimes, launching an anti-corruption initiative, extinguishing bilateral concessional debt, and organizing the first-ever U.S.-Africa Economic Cooperation Forum. This ministerial level consultative group is scheduled to meet for the first time late this year. These various steps are important because
sustained economic growth is key to eradicating Africa's endemic poverty--and the civil unrest which often accompanies it--and thus key to moving Africa toward lasting peace and prosperity. Democratic governance and respect for human rights are also crucial to the goal of integrating Africa into the global Peace and stability are essential to nurturing a civil society that protects democracy and human rights and fosters an enabling environment for economic growth and investment. Today, too many of Sub-Saharan Africa's 48 countries are involved in regional or civil wars, causing serious
humanitarian suffering and destroying the daily lives of millions of innocent civilians. U.S. leadership and resources were instrumental in bringing to an end the protracted conflicts in Mozambique and Liberia. We continue to work to encourage a peaceful solution to the standoff between Ethiopia and Eritrea and to avert the resumption of widespread conflict in Angola and Burundi. We are also pursuing an immediate cease-fire and a lasting solution to both the internal and external causes of the widening conflict in the Congo. As we work to address the crises of the day, we remain committed to helping Africans over the long-term to build their own capacity for peacekeeping and conflict resolution. President Clinton's African Crisis Response Initiative is designed specifically to train rapidly deployable, interoperable peacekeeping battalions across the continent. Indeed, African nations have already made important progress in safeguarding their own citizens and maintaining peace in their own backyards. West African ECOMOG peacekeepers, for example, helped restore the legitimate government in Sierra Leone in March and supported democratic elections in Liberia last summer. Peacekeeping units from West and Central Africa helped to secure the fragile peace in the Central African Republic. These are important efforts that we must help to continue. For in Africa, as elsewhere, there can be no progress where conflict is pervasive. There can be no freedom and respect for human rights where neighbor is pitted against neighbor. There can be no honest trade nor honest day's work where government budgets are diverted from development to destruction and no serious investment in the future where children are torn from schoolyards and forced to march in armies. Ultimately, Africans themselves must determine if their dreams for a better future will become a reality. We cannot make that choice for them. Africa is not--and has never been--the United States' own to "win" or to "lose." But the United States must continue to work in concert with Africans to help secure the continent's future if we are to be smart about securing our own. If Africa succeeds, we all--Africans and Americans--stand to benefit. If Africa fails, we will all pay the price. Still, we
economy. Recent history has taught us that governments which safeguard human rights as well as political and economic freedoms can more effectively establish the conditions for sustainable economic growth. Therefore, the Administration is actively supporting emergent democracies in Africa. We do so in full recognition that elections--although necessary--are not sufficient to sustain democratic change. As a result, we are investing also in the institutional foundations upon which lasting democracy thrives. We are helping to train legislators, foster independent judiciaries, encourage constitutional reforms, and establish genuine respect for human rights. We are active in newsrooms, universities, churches, community centers, and even army barracks to bolster press freedom, build strong civil societies, and teach African militaries the virtues of subordination to civilian leadership. Equally important, the United States continues to play an active role--diplomatically and operationally--to help prevent and resolve African conflicts.
would be foolish to measure Africa's progress in months or even a few short years. It would be naive to assume that deep-rooted problems that have plagued parts of Africa for decades will disappear with the quick wave of a diplomatic wand. Future progress, as in the present and the past, will be uneven and fitful. There will be rough patches and occasional reverses. In this regard, Africa's experience will be no different than that of Europe, Latin America, or Asia. The difference is: America has never debated whether our interests lie in remaining actively engaged, even in difficult times, in these other regions of the world. The dangers of taking a short-term approach to Africa policy--crisis by crisis, leader by leader, election by election--are akin to trying to make a fast buck in today's troubled stock market. If we seek quick returns over long-term gain, we will never be well-positioned to advance important U.S. economic and political interests in Africa.
We cannot stand idly by waiting for Africa to achieve perfection before we engage actively in helping to shape its future. If we temper our engagement or hold back until the whole of Africa is on even footing, we will concede important opportunities to our competitors and worse still, leave doors open to our adversaries.
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1ac-market access adv 4/ US infrastructure building efforts is essential to gain Chinese controlled markets and oil Anthony Lake and Christine Todd Whitman, Professor in the Practice of Diplomacy at Georgetown University and President of the Whitman Strategy Group, 2006
More than Humanitarianism: A Strategic U.S. Approach Toward Africa, Council on Foreign Relations, http://www.cfr.org/publication/9302/
Policy Response It would be easy, but mistaken, to consider China an adversary in Africa. Like other growing economies, China is a legitimate competitor for natural resources. It is necessary to recognize that the rise of China, India, and other Asian countries changes the strategic and economic environment in Africa. The United States and Europe cannot consider Africa their chasse garde, as the French once saw francophone Africa. The rules are changing as China seeks not only to gain access to The New Playing Field: Chinas Rising Role 53 resources, but also to control resource production and distribution, perhaps positioning itself for priority access as these resources become scarcer. In adapting to the changing circumstances, China has become a savvy competitor. The United States nevertheless retains many advantages on which to build. There is a large reservoir of good will toward the United States in Africa as well as recognition of the importance of the United States to Africas hopes for a larger role in the global economy. Despite new investment from Asia, the United States, the United Kingdom, and France still account for 70 percent of foreign direct investment in Africa. U.S. oil companies still lead in the offshore extraction technology critical to West Africas growing energy production. The United States continues to import substantially from African oil and gas producers, and the market is still controlled more by international supply and demand than by any individual countrys manipulations. These are assets on which to build positively. Thus, the answer is not for the United States to ignore issues of governance, transparency, or human rights, but to compete for the support and partnership of African leaders, in oil producing states and elsewhere on the continent, who also care about these issues and need U.S. support and encouragement to promote them. Such partners exist, but threats of divestment or cutting off of aid are not likely to be effective instruments for motivating them. Aid programs should not be distorted into vehicles for supporting U.S. companies abroad. TheOECDprinciples in this regard are sound. But the United States has instruments, such as the Export-Import Bank, OPIC, and the United States Trade and Development Agency (USTDA), which can be used more in a proactive and coordinated manner to assist U.S. companies to compete in this changing environment. Furthermore, U.S. aid programs should consider returning to investment in infrastructure projects, which are now identified to be of major importance to economic growth in Africa. In that sector, the potential for public-private partnerships, consistent with sound development principles, may well be possible. Finally, China is not impervious to world opinion or to its image as a world power. It has pulled back from unqualified support for Sudan 54 and Zimbabwe in the face of world opinion and bowed to UN sanctions against Liberia. It rarely uses its veto in the UN, and then mostly when the issue relates to Taiwan. It has become a significant contributor to UN peacekeeping. The door may well be open to a frank dialogue on the situation in Africa, including those differences and common interests that concern the United States. There are many ways in which the United States can compete more vigorously and effectively with China and other new players in Africa, both to preserve its influence and thwart deterrents to progress on economic and political reform. There is an urgent need to do so; to bet on Chinas influence simply waning over time would be a mistake.
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1ac-market access adv 5/ And, opening these markets now are essential to sustainable domestic economic growthabsent increasing market access in foreign countries, global economic collapse is inevitable NYT, May 14, 07 Rising Exports Putting Dent In Trade Gap
Over half of the 9.1 million vehicles General Motors produced last year were sold in foreign countries. More KFC fast food restaurants are opening in China now than in the United States. With the slumping housing market taking a toll on its business at home, Caterpillar is counting on sales of equipment and diesel engines in Europe, Asia and the Middle East to keep growing. American companies have been doing business abroad for a long time, but never before has it been so important. This year, for the first time, Standard & Poor's expects the 500 companies in its benchmark stock index to generate more than half of their sales in foreign countries. Even as companies in the United States are gaining ground overseas, they are also sending more American-made products abroad. A weaker dollar is adding to their good fortunes, helping to make American goods and services more competitive in foreign markets. As a result, it now looks as if the huge trade deficit, which swelled to a record $765.3 billion last year, could gradually decrease. The trade gap widened in March, mostly because of higher prices for imported oil, but the vast disparity between what Americans import and export is expected to narrow, which would allow trade to contribute to economic growth in the United States for the first time in more than a decade. The shift to a more export-driven economy, if it continues, could add more jobs at home and help the United States bounce back from its slowest economic expansion in four years. When the trade deficit shrinks, ''home-grown demand is being fed by home-grown production instead of foreign production,'' said Chris Varvares, the president of Macroeconomic Advisers, an economic research firm in St. Louis. ''That requires more domestic employment, and that's better for the domestic economy.'' Faster growth in Europe and Asia is helping to cushion the blow of a collapsing housing boom that has hampered domestic consumer spending, creating more demand from elsewhere for goods and services made in the United States. Rather than hurting many American companies, a weak dollar is actually providing a strong lift. The exchange rate difference stokes profits from earnings generated abroad, countering the adverse effects on importers who must pay more and Americans traveling abroad with a less valuable currency in their wallets. ''The old notion that if the dollar's bad, corporate profits have to go down is no longer correct,'' said Howard Silverblatt, a senior analyst at Standard & Poor's. ''There's a lot of growth going on in the rest of the world, and companies have to be there if they want to participate. There's a lot to be sold.'' At the same time, a number of American workers have lost their jobs as companies moved more business overseas. And there is always the risk that the dollar could suddenly plunge and set off a global economic crisis. But for now, the currency's weakness is encouraging American manufacturers to keep more production at home and sell more goods abroad, and is aiding the turnaround in trade. That, in turn, could lead to a more balanced global economy less dependent on the United States as the main engine of growth, economists say. This year, growth in the United States is again expected to lag global growth.
World war Walter Mead, Policy Analyst, World Policy Institute, 1992
Hundreds of millions - billions - of people have pinned their hopes on the international market economy. They and their leaders have embraced market principles -- and drawn closer to the west -- because they believe that our system can work for them. But what if it can't? What if the global economy stagnates - or even shrinks? In that case, we will face a new period of international conflict: South against North, rich against poor. Russia, China, India - These countries with their billions of people and their nuclear weapons will pose a much greater danger to world order than Germany and Japan did in the 30s.
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1ac-market access adv-impacts 6/ ACCESS TO AFRICAN OIL IS KEY TO AMERICAN ENERGY RESOURCES IN THE NEXT DECADE AFRICA WILL PROVIDE THE U.S. WITH AS MUCH OIL AS THE MIDDLE EAST. Council on Foreign Relations, 2006
(More Than Humanitarianism: A Strategic U.S. Approach Toward Africa, http://www.cfr.org/content/publications/attachments/Africa_Task_Force_Web.pdf)
Energy. Africa is becoming more important because of its growing role in supplying the world with oil, gas, and non-fuel minerals. Now supplying the United States with 15 percent of oil imports, Africas production may double in the next decade, and its capacity for natural gas exports will grow even more. In the next decade, Africa could be supplying the United States with as much energy as the Middle East. The United States is facing intense competition for energy and other natural resources in Africa. China, India, Malaysia, North Korea, and South Korea are all becoming active in the search for these resources and for both economic and political influence on the continent. European countries and Brazil are stepping up their aid and investments as well.
Sustainable oil resources are key to prevent extinction Dr. Malcolm Riddoch, Faculty of Communications and Creative Industries, Edith Cowan University, June 19, 2004,
http://www.melbourne.indymedia.org/news/2004/06/72000_comment.php
There are lots of recent 2004 reports speculating about the Saudi's ability to increase production suggesting that the peak plateau may already have arrived with midpoint by 2008. OPEC is apparently pumping at its full rate, while everyone else from the Russians, US, North Sea to our own oil fields are apparently depleting already. The first major oil shock could be as early as the fourth quarter of this year and some analysts suggest that the Saudi's are on the
verge of a collapse in their major Gawar oil field, the largest in the world. The oil Beyond the current oil wars and the short term economic effects of unstable oil supply and prices
over the next 5 years, peak oil threatens an irreversible global economic decline that will force a massive, radical and sustained change in our way of life as we transition to alternative energy sources and the economic/political order they support. The cost of everything will rise and rise with the poorest of us the first to start suffering. A terminal economic decline will begin with a recession in Australia the size of the one that occurred in WW2, and this possibility is already being discussed in our mainstream media. Think an end to public welfare across the board, food stamps and eventually food riots, massive rising unemployment, the collapse of Medicare and public hospitals, a severe crisis in the cost and delivery of water ... but at least the roads will be less congested, more room for the ultra wealthy and their gas guzzling limousines. At worst peak oil could mean a complete global economic collapse sometime after 2010, middle class poverty and the breakdown of law and order, truly gigantic starvation in the third world and the unrestrained outbreak of global warfare with the risk of numerous 'limited' nuclear conflagrations. It could ultimately mean the extinction of the human species through global nuclear war and its companions famine and pestilence.
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1ac-market access adv-impacts 7/ Chinese domination internationally marks a direct challenge to U.S. hegemony Abanti Bhattacharya 11/7/ 06 (Associate Fellow at the Institute for Defence Studies and
Analyses, "China's Power Projection in Africa," Institute for Defence Studies and Analysis, http://www.idsa.in/publications/stratcomments/AbantiBhattacharya071106.htm)
China's Africa policy is a part of its proactive foreign policy, which is aimed at not only protecting its security interests but also at shaping its security environment in a manner that is conducive to its national interests and growth. This strategy seeks to build up an alternative international order, which would distinctly pose a formidable challenge to US unilateralism and global hegemony. It also provides a new vision to developing countries, which wish to move away from the US-dominated world order to an alternative international order. China has entered in a big way in areas that have long been the domain of the United States. The recent high level visits by Chinese leaders to African countries testify China's expanding influence in the US's backyard. It is making inroads in a peaceful manner based on the strategy of a non-interventionist and non-ideological foreign policy. Some scholars are also talking about a 'great game' being enacted in Africa between China and the US for access to natural resources. China has already emerged as Africa 's third largest trading partner, next only to the United States and France. The first Africa-China-US dialogue held in South Africa in August 2005 is a reminder of the possible security implications of growing Chinese and US influence in Africa. Though the dialogue does not foresee a direct conflict of interests between China and the United States, China's rising commercial interests in Africa heighten the prospects of conflict in future. Statistics show that China imported 28 per cent of its oil from Africa in 2005, compared to the US import of only 15 per cent in the same year.
SDI 2007 5 Week
Collapse of US hegemony will result in an apolar world culminating in a new dark age and nuclear war
Niall Ferguson, Prof @ NYU, 2004 (When Empires Wane, http://www.opinionjournal.com/editorial/feature.html?id=110005244)
Yet universal claims were an integral part of the rhetoric of that era. All the empires claimed to rule the world; some, unaware of the existence of other civilizations, maybe even believed that they did. The reality, however, was political fragmentation. And that remains true today. The defining characteristic of our age is not a shift of power upward to supranational institutions, but downward. If free flows of information and factors of production have empowered multinational corporations and NGOs (to say nothing of evangelistic cults of all denominations), the free flow of destructive technology has empowered criminal organizations and terrorist cells, the Viking raiders of our time. These can operate wherever they choose, from Hamburg to Gaza. By contrast, the writ of the international community is not global. It is, in fact, increasingly confined to a few strategic cities such as Kabul and Sarajevo. Waning empires. Religious revivals. Incipient anarchy. A coming retreat into fortified cities. These are the Dark Age experiences that a world without a hyperpower might find itself reliving. The trouble is, of course, that this Dark Age would be an altogether more dangerous one than the one of the ninth century. For the world is roughly 25 times more populous, so that friction between the world's "tribes" is bound to be greater. Technology has transformed production; now societies depend not merely on freshwater and the harvest but also on supplies of mineral oil that are known to be finite. Technology has changed destruction, too: Now it is possible not just to sack a city, but to obliterate it. For more than two decades, globalization has been raising living standards, except where countries have shut themselves off from the process through tyranny or civil war. Deglobalization--which is what a new Dark Age would amount to-would lead to economic depression. As the U.S. sought to protect itself after a second 9/11 devastated Houston, say, it would inevitably become a less open society. And as Europe's Muslim enclaves grow, infiltration of the EU by Islamist extremists could become irreversible, increasing trans-Atlantic tensions over the Middle East to breaking point. Meanwhile, an economic crisis in China could plunge the Communist system into crisis, unleashing the centrifugal forces that have undermined previous Chinese empires. Western investors would lose out, and conclude that lower returns at home are preferable to the risks of default abroad. The worst effects of the Dark Age would be felt on the margins of the waning great powers. With ease, the terrorists could disrupt the freedom of the seas, targeting oil tankers and cruise liners while we concentrate our efforts on making airports secure. Meanwhile, limited nuclear wars could devastate numerous regions, beginning in Korea and Kashmir; perhaps ending catastrophically in the Middle East. The prospect of an apolar world should frighten us a great deal more than it frightened the heirs of Charlemagne. If the U.S. is to retreat from the role of global hegemon--its fragile self-belief dented by minor reversals--its critics must not pretend that they are ushering in a new era of multipolar harmony. The alternative to unpolarity may not be multipolarity at all. It may be a global vacuum of power. Be careful what you wish for.
SDI 2007 5 Week
Reconstruct Wake Fast Track 1AC- Infrastructure

Contention 1 Health care systems in Sub-Saharan Africa are on the brink of collapse Status quo vertical approaches to assistance exacerbate health worker shortages, weakening health care systems
Physicians for Human Rights, 7-1-04
(An Action Plan to Prevent Brain Drain: Building Equitable Health Systems in Africa, PHR Library, http://physiciansforhumanrights.org/library/documents/reports/report-2004-july.pdf , p. 2 access: 7/3/07) Health systems cannot operate without the people who run them. As WHO states, health personnel are the people who make health care happen.3 Without adequate numbers of trained health personnel, both the quality and quantity of health services that a health system can deliver are reduced, limiting the number of people who receive care, and diminishing the quality of care for those who are able to receive it. About 38 of the approximately 47 countries in sub- Saharan Africa do not meet the WHO recommended minimum 20 physicians per 100,000 population; about 13 sub-Saharan countries have five or fewer physicians per 100,000 population.4 WHO recommends at least 100 nurses per 100,000 population for the least developed countries; about 17 sub-Saharan countries have 50 or fewer.5 Shortages in health management posts can hamper the ability of health ministries to develop and implement strategies necessary to improve health services. Donor preferences for vertical, single-disease programs can contribute to the shortage of personnel with the management skills required to run a health system by focusing training on clinical skills instead. Even health professionals that are practicing are often unable to work full-time, as they must care for family members with HIV/AIDS, attend funerals, and address their own health needs. Further, many public sector health professionals supplement their income with private sector work.6
SDI 2007 5 Week
Health workers are the foundation of stable health care system failure to address shortages risks spiraling health crises, and undermines effectiveness of all health assistance
Joint Learning Initiative Strategy Page, 2004
(Human Resources for Health: Overcoming the Crisis, Global Health Trust, http://www.globalhealthtrust.org/Report.html, p. 21-22 access: 7-2-07) Workers spearhead the performance of health systems, both curative and preventive. The number, quality, and configuration of human resourcesinformal and community workers, laboratory technicians, and professionalsshape the output and productivity of health systems. Most health workers are committed to social service, and their motivation can be harnessed to achieve better outcomes with limited resources. Often, they serve far beyond the call of duty. They alone have The number, quality, and configuration of human resources shape the output and productivity of health systems the capacity for communicating with patients and communitiesand thus the potential for catalyzing community-driven health transformations. The participation of health workers is especially important in health sector reform. Properly supported, they can be leaders and implement innovation. But treated badly, they can be insurmountable obstacles. When health workers fail, a community can spiral into a health crisis. They must be treated as partners in delivering health, not mere employees. 3. They manage all other health resources Workers are the ultimate resource in health because they manage and synchronize all other health resources, including financing, technology, information, and infrastructure. It is the health worker who glues these inputs together into a functioning health system (figure 1.2). Neglecting the workforce wastes all other resources. There are already informal reports of vaccines and drugs expiring in warehouses because there are too few workers to deliver the technologies. Of course, workers are not panaceas. They cannot operate effectively without a functioning system of drugs, transport, and support. Complementary inputs have to be synchronized into an operational system for workers to achieve their potential. But the workforce cannot be considered as simply another input. Health care is a service that is overwhelmingly worker-dependent. As a unique resource, health workers are active agents of health change. They require time and investment to build their capabilities. They are not as responsive to markets as other commodities. And as people they have mixed motivations, which include dedication to service, the desire to contribute to society, or wanting to advance their own interests. They are not fungible, optional, location neutral, or immediately available on demand.
SDI 2007 5 Week
Strained infrastructure has brought many African health care systems to the brink of collapse in Malawi, 10 people will die during this hour from AIDS alone
Physicians for Human Rights, 2005
(Africa Cannot Stop Poverty without More Health Workers, June 17, http://www.physiciansforhumanrights.org/library/news-2005-06-17.html, access: 7-5-07) Commented Hetherwick Ntaba, OBE, the Health Minister of the African nation of Malawi and a surgeon: Some countries' health delivery systems are in danger of collapsing because of this human resource crisis. The AIDS pandemic itself impacts negatively on our ability to deal with AIDS because of the toll it takes on our work force. In the middle of all this, the migration of health workers from poor to the rich countries is very unfortunate. It is like the biblical saying, For those who have more, more is being given; for those with less, even that is being taken away. We ask the G8 to really look at this issue very seriously and offer their support. Right now in Africa, a mere 1.3% of the worlds health workers struggle to care for people suffering 25% of the global disease burden. In Malawi, only 10% of the physician slots are filled, while 10 people die every hour of AIDS. Across Africa AIDS has killed thousands of health care workers, and large numbers of doctors and nurses are migrating to the West, driven out by impoverished health care systems and lured by elaborate recruiting packages by hospitals in G8 countries. For example, while 1200 physicians were trained in Zimbabwe during the 1990s, by 2001 only 360 remained. More than 3,000 nurses from African nations migrated to the United Kingdom in 2002-2003.
SDI 2007 5 Week
Contention 2 - Harms Scenario 1 - Outbreaks Weak infrastructure contributes to disease spread faltering systems facilitate emergence of resistant strains of disease
Dr. Mullan, George Washington University Department of Health Policy Prevention and Community Health Professor, 2007
(Fitzhugh, Responding to the Global HIV/AIDS Crisis: A Peace Corps for Health, Journal of the American Medical Association, 2-21-07, 297:744-746., http://jama.amaassn.org/cgi/content/full/297/7/744, accessed 7-13-07) HIV disease is essentially the Black Death of the 21st century, killing on a massive scale and threatening to cripple economies and topple governments. However, the continued spread of the HIV epidemic and the new availability of lifesaving antiretroviral drugs have triggered an extraordinary response by governments, international organizations, philanthropies, pharmaceutical companies, religious organizations, and individuals. Campaigning against HIV/AIDS has no precedent in the history of medicine. Smallpox was eliminated by a globally coordinated strategy that required a single patient encounter to deliver the vaccine. In contrast, the directly observed therapy strategy at the core of modern tuberculosis treatment necessitates daily patient contact over much of the treatment course and, therefore, a much larger health workforce. Treating AIDS requires the daily delivery of medications as well as the clinical management of patientsfor the rest of their lives. Antiretroviral medications can help control disease, but do not cure it. More problematic yet, stopping treatment once started promotes the emergence of resistant strains of the virus, making halfway programs hazardous to public health. The sheer volume of health workers needed to tackle HIV diseaseand the health systems to support their workis off the scale of any previous public health campaign. This challenge is compounded by the impoverished nature of the health systems in many countries where HIV/AIDS is rampant and, in particular, by the critical shortage of physicians, nurses, and other health workers in these nations. The 2006 World Health Report from the World Health Organization1 focuses the issue. Sub-Saharan Africa with 11% of the world's population has 24% of the world's burden of disease and more than 60% of the world's HIV/AIDS cases, but has only 3% of the world's health workforce.2 There is 1 physician for every 390 individuals in the United States compared with 1 for every 33 000 in Mozambique; 1 nurse for every 107 individuals in the United States, but only 1 for every 2700 in Tanzania. There are 24 pharmacists in Angola, a country of 12 million people.1
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Piecemeal approaches result in ineffective treatment, putting millions at risk from new viral strains
Dr. Mullan et al, George Washington University Department of Health Policy Prevention and Community Health Professor, 2005
(Fitzhugh Mullan, et al, Board on Global Health at the Institute of Medicine of the National Academies, Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS, Preface, p. 3-4, http://books.nap.edu/openbook.php?isbn=0309096162&page=3 accessed 7-11-07) The prevention, care, and treatment of HIV/AIDS in developing countries will require unprecedented health systems and human resources to deliver medications and oversee patients for the rest of their lives. Ideally, a comprehensive approach to HIV/AIDS includes a range of components, including the following: Community and national treatment, care, and prevention guidelines Education and awareness programs Programs to address stigma and discrimination Voluntary counseling and testing with informed consent in health facilities, along with services targeting vulnerable and difficult-to-reach populations Prevention of mother-to-child transmission Prevention and treatment of opportunistic and sexually transmitted infections Antiretroviral therapy and monitoring, including essential laboratory and clinical backup and drug management systems Embedded operations research programs designed to elucidate the most effective approaches to HIV/AIDS care and delivery in resource-limited settings Adherence support Social protection, nutrition, and welfare and psychosocial services Palliative and home-based care Bereavement support In reality, however, models of health care delivery for HIV/AIDS must first reflect the capacities of host countries. For example, antiretroviral therapy should be initiated only if certain minimum conditions are met, including community preparedness, counseling and testing with informed consent, training of personnel for provision of antiretroviral drugs and follow-up, clinical and laboratory monitoring, reliable drug delivery systems, and education to maximize adherence. Should these conditions not be met, one of the gravest outcomes could be the emergence and wide-scale spread of resistance to antiretroviral drugs, an occurrence that would ultimately jeopardize the future treatment of all infected persons and populations around the world. Preventing such a catastrophe will require appropriate training, support, accreditation, and quality control of providers in both the public and private sectors during the scale-up of antiretroviral therapy (WHO, 2003a).
SDI 2007 5 Week
A catastrophic disease event would wipe out hundreds of millions of lives worldwide and poses a greater risk than any disadvantage
Falkenrath, former Deputy Assistant to the President and Deputy Homeland Security Advisor, 2006
(Richard A., Brookings Senior Foreign Policy Fellow, Statement before the Senate Committee on Health, Education, Labor and Pensions, 3-16-06, p. 9-10, http://help.senate.gov/Hearings/2006_03_16/Falkenrath.pdf, accessed 7-11-07) A catastrophic disease event is admittedly an extreme scenario, residing at the very highest end of the threat spectrum. With respect to manmade threats bioterrorism I am not suggesting that such a scenario can be easily effectuated or is imminent. Nonetheless, I do not believe that the trends are in our favor. With every passing year, the latent technological potential of states and non-state actors to use disease effectively as a weapon rises inexorably. With respect to naturally occurring disease threats, no one can estimate precisely the likelihood, timing, or consequence of the appearance of a new human pathogen. 5 However, for at least one potentially catastrophic disease, even the conservative World Health Organization concludes that the world may be on the brink of another pandemic. 6 According to the WHO, a pandemic along the lines of the relatively mild pandemic of 1957 would result in 2 million to 7.4 million deaths worldwide. A pandemic with the death rate of the 1918 Spanish flu perhaps the most extreme human disease event in history could result in several million fatalities in the United States and perhaps over one hundred million abroad. In sum, when viewed in comparison to all other conceivable threats to U.S. national security, the catastrophic disease threat is and for the foreseeable future will remain the gravest danger we face. No state, no terrorist group, no ideology or system of government, no other tactic or target or category of weapons, no technological accident, and no other natural phenomenon, presents as terrifying a combination of likelihood, poor defenses and countermeasures, and consequence.
SDI 2007 5 Week
Scenario _______- Poverty Faltering health care systems exacerbate the poverty problem
Wagstaff, World Bank Development Research Group Lead Economist (Health), 2001
(Adam, Poverty and Health, Commission on Macroeconomics and Health, March, p.7, http://www.ksg.harvard.edu/CID/cidcmh/wg1_paper5.pdf, accessed 7/3/07) Income and assets are, of course, two reasons why constraints differ between the poor and better-off. But there are others. Poor and better-off households may also incur different costs when trying to restore and maintain their health. Health facilities in the developing world vary hugely in their quality. Some have medicines and drugs in stock, are run by well-trained, civil and motivated staff, are well maintained and are easily accessible. But many are not. They are often dilapidated and inaccessible, rarely have medicines in stock, and are run by poorly trained and rude medical staff, who frequently fail to turn up to work because they are too busy running their private practice (often selling drugs borrowed from their public facility). What emerges from the Bank's Voices of the Poor consultative exercise [21], as well as from quantitative studies, is that it is precisely the people who are materially disadvantaged who have to struggle with poor quality and inaccessible health facilities and many other factors that tighten even further the constraints facing a poor household. What this suggests is that the inequity of health inequalities between the poor and the better-off are likely to stem not simply from the income gaps between them but also from the gaps in the effective prices they face when maintaining and improving their health.
SDI 2007 5 Week
Millions are trapped in an unending cycle of disease and impoverishment, magnifying the harms and hampering progress
Sachs, Earth Institute at Columbia Professor and Director of Economics, 2001
(Jeffrey D., A New Global Commitment to Disease Control in Africa, Nature Medicine, Vol7, Num5, May 2001, www.nature.com/nm/journal/v7/n5/full/nm0501_521.html, access July 3, 2007). Africas health crises are both a cause and effect of its intense impoverishment. Poverty obviously affects health by limiting access to health services, sanitation and adequate nutrition and housing, but poor health also adversely impacts economic growth through a multiplicity of channels, a point being documented through scholarly studies of the Commission on Macroeconomics and Health of the World Health Organization (http://www.cid.harvard.edu/cidcmh). In stricken countries, worker productivity is reduced; foreign investors shun regions with high-disease burdens; poor families have large numbers of children in response to high rates of child mortality and so invest less in each childs health and education; and disease directly destabilizes societies. An academic study group supported by the Central Intelligence Agency, the State Failure Task Force, discovered that a high infant mortality rate was one of the most powerful predictors of subsequent governmental collapse in a worldwide study of political dynamics5. It is not surprising, then, that in a generation of surging infectious disease Africa has suffered outright declines in per capita national income despite rapid global economic growth. Donor programs suffer from more than financial neglect. The natural leadership of global public health by the WHO (World Health Organization) has been stymied by having its core budget, provided by member governments, frozen in dollar terms for a decade. And because of an insufficient prioritization on health, the World Bank made remarkably few grants or loans for AIDS, malaria or TB control in Africa during the Despite the availability of effective therapies in developed nations, infectious diseases continue to take a grave toll on the population and economy of sub-Saharan Africa. Aside from a few successes, the global donor community has not adequately helped African governments meet these health challenges. However, if annual donor contributions increased approximately 1020fold, millions of lives could be saved, helping Africa escape the cycle of disease and impoverishment. A new global commitment to disease control in Africa 1990s (http://www.worldbank.org/html/extdr/pb/pbAIDSactivities. htm). Until a recent revival of WHO leadership under Gro Harlem Brundtland, the international initiative lay mainly with national donor agencies and their own limited health budgets and limited expertise. The result has been a hodge-podge of pet projects, often without scientific input or sufficient scale of intervention to make much difference. Donor agencies generally lack mechanisms for ex ante scientific review of proposed projects and ex post evaluation. Bill Gates of Microsoft, more than any national leader, helped to redirect the course of global support for health in the past two years by putting down $750 million in a new Global Fund for Childrens Vaccines to reinvigorate programs for childhood immunization. The money mattered. Suddenly the international agencies came to attention and coalesced into a Global Alliance for Vaccines and Immunization (GAVI). Expert review was initiated and the pooling of resources in one fund rather than dozens of disparate efforts led to a coordinated global strategy. Backed by the new funding, the GAVI has recently made funding commitments to more than 20 countries (http://www.vaccinealliance. com)
SDI 2007 5 Week
Poverty destabilizes states, making conflict and violence inevitable

Rice, Senor Fellow, Foreign Policy Studies, 2006 (Susan E. "Africa's Strategic Importance to the U.S: Speech at Reed College, March 20, http://www.brookings.edu/views/speeches/srice/20060320.pdf, accessed 7/3/07) The spread of disease and environmental degradation are just two of the potential challenges that global poverty poses to U.S. national security. Weak states hobbled by poverty often lack effective control over substantial portions of their territory and resources. Ill -equipped and poorly-trained immigration and customs officials as well as under -resourced police, military, judiciary and financial systems create vacuums into which transnational predators can easily move. Conflict, difficult terrain and corruption render weak states particularly vulnerable to transnational criminal syndicates, smugglers, and pirates such as those operating in lawless zones from the Somali coast and Central Asia to the Tri -border region of South America. Where ecological conditions permit, poverty also fosters ideal socio -economic conditions for drug production, as in the Andes, parts of Mexico, and South Asia. Where production is difficult, drug trafficking may still thrive, as in Nigeria and Central Asia. Not surprisingly, the drug couriers, the human slaves, prostitutes, petty thieves, and others drawn into global criminal enterprises often come from the ranks of the unemployed or desperately poor. Transnational crime syndicates reap billions each year from illicit trafficking in drugs, hazardous waste, humans, endangered species, and weapons all of which reach American shores.
Weak state systems facilitate conditions of immeasurable suffering poverty, hunger, refugees, rights violations, and war all become more likely
Patrick, Center for Global Development Research Fellow, 2006
(Stewart, Weak States and Global Threats: Fact or Fiction? Washington Quarterly, Spring, volume 29 issue 2 page 27+) < Compared to other developing countries, weak and failing states are more likely to suffer from low or no growth and to be furthest away from reaching the Millennium Development Goals, a set of commitments made by UN member states in 2000 to make concrete progress by 2015 in critical development objectives, such as eradicating extreme poverty and hunger, achieving [End Page 30] universal primary education, and reducing child mortality. The inhabitants of these weak and failing states are likely to be poor and malnourished, live with chronic illness and die young, go without education and basic health care, suffer gender discrimination, and lack access to modern technology. Compared to OECD, or developed, countries, fragile states are 15 times more prone to civil war, with such violence both more extreme and longer lasting than even in other developing countries. Such states are the overwhelming source of the world's refugees and internally displaced peoples. Many are also among the world's worst abusers of human rights.13 The most comprehensive and well-respected system for evaluating state performance is the World Bank's "Governance Matters" data set. The most recent installment, in 2005, ranks 209 countries and territories along six dimensions: voice and accountability, political instability and violence, government effectiveness, regulatory burden, rule of law, and control of corruption.14 Table 2 lists the 44 countries that rest in the bottom quintile, ranked from weakest (Somalia) to strongest (Algeria). >
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Scenario _______ Public Diplomacy Sending health care workers abroad bolsters public health and public diplomacy
Dr. Mullan et al, George Washington University Department of Health Policy Prevention and Community Health Professor, 2005 (Fitzhugh Mullan, et al, Board on Global Health at the Institute of Medicine of the National Academies, "Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS", p. 93-4, http://books.nap.edu/openbook.php?isbn=0309096162 accessed 7-11-07)
THE GLOBAL HEALTH SERVICE AS STRATEGIC HUMANITARIANISM Humanitarianism marks the recently augmented public health programs of many international organizations, including the United Nations, the World Bank, and the European Union, all of which have placed questions of public health on their agendas and joined in collective efforts against HIV/AIDS, TB, and malaria. Health is a complex concept with many varying historical, cultural, and social associations depending on its geographic and economic context. In western countries, a commitment to international health also has security-related motivations, especially with respect to the control of global epidemics. The recent energized global campaign against severe acute respiratory syndrome (SARS) and the mounting concern over a new global pandemic of avian influenza can certainly be seen in this light. The GHS is proposed as a humanitarian program of the people of the United States at a time when the security of both PEPFAR countries and the United States is jeopardized by disease. In short, the GHS is a program of strategic humanitarianism. The committee believes that such a program will yield benefits in six key areas. Humanitarian benefit. The GHS will enhance health in underserved areas and demonstrate the compassion of the American people. Multicultural understanding. Like the U.S. Peace Corps, the GHS will foster relationships and multicultural understanding while mitigating anti-American sentiment overseas. It should also inspire a greater understanding of and commitment to global health on the part of the American people. Collegial support and capacity building in affected countries. The emergence of HIV/AIDS has desperately worsened Africas preexisting crisis in health manpower. Members and programs of the GHS will bring expertise, motivation, and muscle to longterm campaigns that might otherwise exhaust local human resources, despite enhanced access to new treatments. Their presence will also lead to the development of long-term cross-border personal networks.
SDI 2007 5 Week
Public health diplomacy will rebuild US global prestige, facilitating benevolent leadership
The Lancet editorial, 2005
(America at home and abroad, Jan. 1- Jan 7, 2005, Vol.365, Iss. 9453; pg. 1+, ProQuest, accessed 7-12-07) In international affairs, Bush's biggest task is to repair America's strained relations with its long-time allies. The war in Iraq demonstrated the "hard power" of America's military might; it has also revealed the limits of that power and the importance of "soft power". Joseph Nye, dean of the Kennedy School of Government at Harvard University, coined the term soft power to describe the influence a nation wields when its values, institutions, and culture are admired. Since the end of the Cold War, the USA has been increasingly unilateralist, advancing its narrow national interests to the detriment of international agreements and institutions. For example, the US government refused to join the international ban on land mines, it reneged on the Kyoto Protocol to control greenhouse gases, and it has withdrawn funds from international health programmes because of the administration's position on abortion. The attack on Iraq proved the last straw for many friends of America. International polls now find approval ratings of the USA at an all-time low. It is little wonder that the Bush administration is finding it so hard to garner support for its reconstruction effort in Iraq. America has lost much of its soft power and it cannot attain its international goals without it. Winning back America's friends will take a long time. In one area, the Bush administration has committed funds on which it could usefully build. Despite often angry disputes over the plan's implementation, the President's Emergency Plan for AIDS Relief, PEPFAR, which promises to provide $15 billion over 5 years for HIV prevention, treatment, and services is a potentially major contribution to the war against AIDS. While the USA remains one of the least generous donors given its wealth, Bush's Millennium Challenge Account is a substantial increase in US aid to developing nations. He could do much to rebuild America's prestige by expanding US support and participation in global health and development initiatives. But to succeed, Bush must decide to work as an equal with others, respecting the views and expertise of international partners. He must work to build a consensus on goals and approaches, and commit to provide steady funding over the long term. By building on global health and development initiatives launched in his first term, Bush can start to rebuild America's broken international partnerships and create a foundation on which to construct a benevolent, empathie, and secure superpower.
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Strengthened U.S. leadership key to maintaining global stability

Khalilzad, RAND policy analyst, 95
(Zalmay, WASHINGTON QUARTERLY, Spring 1995, p. 84+) 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.
SDI 2007 5 Week
Scenario _______ Ethical Obligation Widening gap between health care haves and have nots is an unmitigated disaster, putting the survival of nations and civilizations at risk
Joint Learning Initiative Strategy Page, 2004 (Human Resources for Health: Overcoming the Crisis, Global Health Trust, http://www.globalhealthtrust.org/Report.html p. 14-15 access: 7-2-07) Todays global health picture is one of great diversity, with lifes chances and healths inequities sharply polarized. Poverty and inequality are both causes and symptoms of the crisis in health. Average life expectancy in many societies is less than half that of the privileged. And the gaps are widening. The wealthy continue to enjoy longevity up to and beyond 80 years, but life expectancy at birth is less than 40 in more than a dozen countries, nearly all in sub-Saharan Africa (figure 1.1). And hot spots of healths stagnation or reversal are found in all world regions. These disparities are not just threats to global human securitythey are moral and ethical affronts. The HIV/AIDS pandemic is plunging sub-Saharan Africa into a profound crisis of survival. In countries severely hit, life expectancy is down sharply, and infant and child mortality is rising. Young women are dying in unprecedented numbers. Yet we are still in the early stages of this crisis. A decade after HIV prevalence climbs, AIDS deaths will rise, leading to a third waveof devastating societal impactfamilies dissolved, children orphaned, education and health disrupted,economic growth impeded, and political governance challenged. This is a confluence of unmitigated disaster without historical precedence. Already AIDS has increased hunger and food insecurity in Southern Africa.1 In the worst scenarios, the very survival of people, nations, and civilizations is under siege.
SDI 2007 5 Week

Wagstaff, World Bank Development Research Group Lead Economist (Health), 2001
Widening inequality makes solving health a social justice imperative

(Adam, Poverty and Health, Commission on Macroeconomics and Health, March, p.5, http://www.ksg.harvard.edu/CID/cidcmh/wg1_paper5.pdf, accessed 7/3/07) The growing interest within the international development community in improving the health of the worlds poor reflects the ever broader interpretation being given to the term poverty. This, in turn, reflects trends within the academic literature [7] and the increasing tendency of aid agencies and nongovernmental organisations to define their goals in terms of poverty-reduction. This is much in evidence in the World Banks own work. Poverty-reduction was adopted during the 1990s as the overriding mission of the organisation, and especially following the publication of the latest World Development Report [8] has been interpreted broadly in multidimensional terms. Key amongst these dimensions of poverty are health levels and the risk of ill health. One important implication of this shift to multidimensionality is that raising the incomes of the poor may not be enough to reduce poverty if it does not guarantee that the health of the poor is also improved. But the increasing focus on the health of the worlds poor also reflects a growing consensus that inequalities in health outcomes between rich and poor are unjustwhether they be between the people of Sierra Leone and Sweden, or between poor Bolivians and better-off Bolivians [9]. Closing inter-country and intra-country gaps between the poor and better off, by securing greater proportional improvements amongst poorer groups, is not simply a poverty issueit is also a question of social justice and equity. Indeed, it is this, rather than the emphasis on poverty-reduction, that has kept the debate on socio-economic inequalities in health so buoyant in many of the HICs.
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The United States unique position in the world mandates an ethical obligation to alleviate disparities in global health care
Benatar and Fox, Professor Medicine and Bioethics at University of Cape Town and Professor of Sociology and Bioethics at University of Pennsylvania, 2005
[Slomon R Benatar and Renee C Fox, "Meeting Threats to Global Health: A call for American leadership," Perspectives in Biology and Medicine 48.3 (2005) 334-36 Access: 6/20/07, Project Muse] There is a "back to the future" irony in the fact that the eruption and spread of a multitude of "old" and "new" infectious diseases has become the most serious global threat to the health of humankind (Benatar 2001a; Garrett 1994). The current epidemics of infectious diseasesincluding the "white plague" of tuberculosis that was supposed to have yielded to the powers of antibioticstake their greatest toll on populations of so-called developing countries, and also among disadvantaged groups in privileged "developed" societies (Benatar 2001b; Gandy and Zumla 2003). The recent epidemic of severe acute respiratory syndrome (SARS; Lee et al. 2003) is a small-scale example of the new, acute, rapidly fatal infectious diseases that may, like the 19181919 flu epidemic, sweep through the world with high mortality rates in all countries, with accompanying profound social and economic implications. This paper, by a South African physician and an American medical sociologist, considers challenges that face global health, health care professionals, and governments at the beginning of the 21st century. Our reflections rest on three major premises: that global health problems pose major medical, social, and economic threats to all countries; that it is in the long-term self-interest of wealthy nations to address the forces that significantly affect the health of whole populations; and that at this historical juncture, the United States is the country with the most potential for favorably influencing global health trends. In addition to discussing the nature of threats to global health, we explore some of the major impediments to efforts that could be undertaken to foster alterations in policies that would effectively address the tragic discrepancies in health care and research that currently exist, and to overcome global apathy to the HIV/AIDS pandemic (Hogg et al. 2002). These obstacles involve a confluence of important American values, exemplified by political ideologies that have global as well as national health import; the prevailing ethos of bioethics in the United States; and the current views of many other countries towards the international policies and actions of the United States. As sociologist Robert N. Bellah (2002) has provocatively stated, in and through the "relentless" process of globalization, the United States has become a "cultural model and economic dynamo" as well as a military superpower, and more "by default" than by intention, a country with "imperial power." In our view, because of its singularity in these respects (for better or for worse), the United States not only has the scientific, political, and economic capacity to assume major responsibility for improving world health, but also the moral obligation to exemplify and implement values in action that are conducive to this advancement. We make this statement with two caveats. First, we are wary about [End Page 345] unduly promoting the dominance of American influence in the world by encouraging its moral hegemony in global health. Second, as noted above, we are mindful of the cultural and political factors that curtail the readiness and willingness of the United States to assume such a leadership role, and that contribute to health inequities in the American health care system that call for reform rather than emulation. We believe, however, that these caveats should be superseded by the moral imperative of facing up to national and global threats posed by disparities in health and emerging epidemics. Moreover, we believe that the long-term interests of Americans, and indeed of all privileged people and their societies, will be served by major improvements in global health (Benatar 2003).
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Ethics discourse builds connections needed to combat disease, and is necessary to avoid extinction.
Benatar and Fox, Professor Medicine and Bioethics at University of Cape Town and Professor of Sociology and Bioethics at University of Pennsylvania, 2005
[Slomon R Benatar and Renee C Fox, "Meeting Threats to Global Health: A call for American leadership," Perspectives in Biology and Medicine 48.3 (2005) 334-36 Access: 6/20/07, Project Muse] Current and widening disparities in health around the worldeven within many countries, including the United Statesand the particular plight of Africa during the HIV/AIDS pandemic, together with the implications of new threats from the natural or deliberate spread of infectious diseases (bioterrorism), demonstrate the pressing need for more attention both to moral responsibilities and their underlying values, and to the long-term national interest of wealthy nations in a complex interdependent world. In the visionary words of former President of the Czech Republic, Vclav Havel (2002): "If humanity is to survive and avoid new catastrophes, then the global political order has to be accompanied by a sincere and mutual respect among the various spheres of civilization, culture, nations, or continents, and by honest efforts on their part to seek and find the values or basic moral imperatives they have in common, and to build them into the foundations of their coexistence in this globally connected world." Extending the ethics discourse beyond interpersonal relationships to institutional interactions, national approaches to health care, and international relations that have profound effects on population health could help promote the new mindset needed to narrow disparities in health and reduce the potential for new infectious diseases to emerge and rapidly spread globally. Such a mindset requires the realization that health, human rights, economic opportunities, good governance, peace, and development are all intimately linked. The challenges we face in the 21st century are to explore these links, to understand their implications, and to develop processes that could harness economic growth to sustainable human development, progressively narrow global disparities in health, and promote peaceful coexistence (Benatar, Daar, and Singer 2003; Lee, Walt, and Haines 2004). Strategies to effect a new approach to dealing with global health problems will have to address the difficult task of ameliorating constraints that impede the medical profession and other possible change agents from taking an active leadership role in such an effort. These constraints, as we have suggested, include the strong adherence to individualism as a principal cultural value; the types of powerful ideological, political, and economic forces that have perpetuated inequities in access to health care and derailed efforts to develop national health care coverage in the United States; and the fears of many nations about American imperialism.
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Contention 3 Solvency Action now can jump-start the workforce US commitment will provide crucial leverage to reverse the spiral of death, sickness, and suffering
Physicians for Human Rights, 2005
(Cost Estimates: Doubling the Health Workforce, January 1, http://www.physiciansforhumanrights.org/library/costestimates.html, access: 7-3-07) Urgent action is needed to overcome the crisis of health workers. None of the global health goals, especially tackling HIV/AIDS, will make headway without massive mobilization of an adequately motivated, skilled, and supported workforce. For subSaharan Africa, it is within our reach to double the health workforce by 2010i, including by expanding training capacity, deploying trained and supervised community-based workers, extending coverage in under-served communities, and strengthening management, planning, safety, and support systems. An immediate infusion of resources could jumpstart the workforce to reverse the spiral of avoidable death, sickness, and human suffering. The G8 Summit presents a key opportunity for the United States to commit to this goal, and leverage financial support from other nations. This investment in health workforce strengthening is a necessary complement to ensure the success and sustainability of historic U.S. investments to fight AIDS. Health workforce strengthening can be a cornerstone of an expanded U.S. initiative for health in Africa.
Better allocation of assistance to local health care personnel bolsters infrastructure, preventing collapse
Garrett, Council on Foreign Relations Senior Fellow for Global Health, 2007
(Laurie, The Challenge of Global Health, Foreign Affairs, January/February, http://www.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-globalhealth.html, accessed 6-20-07) 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 health-care 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.
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Establishment of U.S. Global Health Service will trigger massive mobilization of health care workers here and abroad. The plan has a massive multiplier effect.
Dr. Mullan, George Washington University Department of Health Policy & MD, 2007
(Fitzhugh, Responding to the Global HIV/AIDS Crisis: A Peace Corps for Health, Journal of the American Medical Association, 2-21-07, 297:744-746., http://jama.amaassn.org/cgi/content/full/297/7/744, accessed 7-13-07) There can be no meaningful response to HIV/AIDS without sufficient health workers to plan, implement, and sustain the effort. Educating and retaining an adequate number of health workers is ultimately a nation-by-nation challenge. But the severity of the human resource gap and the urgency of the epidemic have focused global attention, and international organizations, donor governments, and private philanthropies are making investments in workforce scale-up strategies through programs such as the World Health Organization's Treat, Train and Retain initiative.3 What role is the United States playing in providing health personnel to help respond to the global HIV/AIDS epidemic? A relatively small number of US health professionals are currently in developing countries treating patients with HIV/AIDS. Some clinicians volunteer with faith-based or secular nongovernmental organizations (NGOs.) A few universities and corporations support health personnel in high prevalence HIV/AIDS countries. The government sends small numbers of physicians through the Centers for Disease Control and Prevention and United States Agency for International Development projects. Peace Corps sponsorship is limited to AIDS education initiatives. The principal US program to address HIV disease globally, the $15 billion President's Emergency Plan for AIDS Relief (PEPFAR),4 has done little to date to send US physicians and nurses abroad. This modest level of mobilization is in sharp contrast to the clear interest among young Americans in medicine, nursing, and public health in taking on the world's toughest health problems. In 2006, 27.2% of graduating US medical students had worked abroaddouble the number of a decade earlier.5 When Baylor Medical College and Bristol-Myers Squibb launched a "Pediatric AIDS Corps" last year to work in Southern Africa, they were overwhelmed by applications from pediatricians to fill their 50 positions and have had to turn away dozens of qualified candidates (oral communication, July 28, 2006, Mark Kline, MD, Baylor AIDS Corps director).6 At George Washington University (my own medical school), incoming medical students select electives in global health by a rate of 2 to 1 over other opportunities in areas such as research and teaching. Global medical need linked to the readiness of US health professionals to help presents an opportunity both for humanitarian service and for an extraordinary brand of public diplomacy. A commitment by the United States to mobilize health workers for service abroad would provide benefit well beyond the patients treated, the health workers trained, or the medical schools staffed. This commitment would be a highly tangible manifestation of US generosity, a contribution by gifted and trained Americans, a restatement of the US commitment to the global community. Other nations have earned reputations for generosity abroad. The Netherlands provides the most international aid of any nation on a per citizen basis.7 The Doctors Without Borders movement (Medecins Sans Frontieres) was launched in France. Cuba has sent medical personnel to dozens of countries in the developing worldsome 100 000 over the past 4 decades, a huge contribution for a small country (written communication, June 26, 2006, Efren Acosta, MD, Director de la Unidad Central de Cooperacion Medica, Ministry of Health, Havana, Cuba). The potential power of health as public diplomacy was seen in the dispatch of the US Navy hospital ship Mercy to Indonesia and Bangladesh in 2005 staffed by physicians and nurses organized by a US NGO, Project HOPE. Subsequent surveys in the respective countries showed 63% and 95% approval ratings for the medical mission, with 53% and 87% of respondents reporting an improvement in their impression of the United States.8 Health professional
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volunteerism is good but not sufficient for the massive challenge of helping to scale up threadbare workforces and as yet nonexistent programs in countries with high HIV prevalence. Responding to the global HIV/AIDS problem substantially differs from previous international responses, such as single contact vaccination campaigns or brief high-intensity surgical clinics. Long-term placements are needed to help build training programs, create pharmacy distribution networks, monitor patients, and maintain treatmentfor years. But physicians, nurses, and pharmacists have debts, mortgages, and career commitments that can deter even the most determined. Relocating to the developing world for 2 or more years is not an easyor even plausibleoption for most. A bold national program similar to one proposed in a recent Institute of Medicine report entitled "Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS"9 is needed to help mobilize the numbers of US health workers ready to commit to working abroad in the long-term battle against HIV/AIDS and other diseases of poverty. The federal government, both as a source of finance and as the principal expression of the United States abroad, should play a robust leadership role in this ***Card Continues on Next Page No Text Removed*** ***Card Continues from Previous Page No Text Removed*** [Cite: Establishment of U.S. Global Health Service will trigger massive mobilization of health care workers here and abroad. The plan has a massive multiplier effect. Dr. Mullan, George Washington University Department of Health Policy & MD, 2007 (Fitzhugh, Responding to the Global HIV/AIDS Crisis: A Peace Corps for Health, Journal of the American Medical Association, 2-21-07, 297:744-746., http://jama.amaassn.org/cgi/content/full/297/7/744, accessed 7-13-07)] campaign. The centerpiece of a US global health initiative should be a dedicated, federally funded corps of health professionals with public health as well as clinical skills working in collaboration with host governmentsa conceptual blend of the Peace Corps and the National Health Service Corps. Placements for these individuals should focus on the multiplier effect they would bring in regard to health system development and capacity building. Specific assignments should be carefully chosen with host governments in areas such as teaching, training, system design, and informatics. Private organizations and individuals stand to play a crucial role in a new US global health initiative. In fact, most US health professionals who currently work in the developing world do so on their own, working for NGOs. Public funding in support of volunteerism would do a great deal to increase the number of US personnel working in epidemic areas. In 2006, the average debt of medical school graduates was $130 000,10 a huge barrier to recent graduates considering work abroad. The Baylor Pediatric AIDS Corps pioneered the use of loan repayment incentives offering up to $40 000 per year in addition to a modest stipenda package that has drawn hundreds of applications. Loan repayments in return for extended service in health and development would be a powerful barrier reduction strategy to encourage professionals to work abroad as part of a national program. General support also would help because few NGOs can afford to offer much in the way of salaries. In this spirit, a competitive Fulbright-type fellowship program that would provide stipends and career prestige for physicians, nurses, and other health personnel for service in health and development settings would assist many considering international work. Every placement abroad requires a connection, a matchup between the individual health professional and the clinic, training program, laboratory, or ministry office in which he or she will work. An electronic clearinghouse with information on programs, organizations, and placement opportunities for health professionals considering work in developing countries would streamline the system and facilitate health workers finding optimum sites.
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Universities, medical schools, religious organizations, and health departments could play a greater role in facilitating the movement of health professionals. "Twinning" is the term used for partnerships between US institutions and counterparts in developing nations, a strategy that has proved effective elsewhere in the world for launching health professionals into international work while simultaneously training host country colleagues in the United States.11 Funding that primes the twinning pump in regard to the developing world would be money well spent. 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.12-13 The direct assistance to nations that would be beneficiaries of US Global Health Service personnel as well as the program's stimulant effect on private initiatives could be enormous. Over time its alumnae would populate the ranks of US medical and public health leadership bringing with them field-tested perspectives on health, poverty, and global involvement that would influence the health and foreign policies of the United States. In addition to mobilizing thousands of health care personnel to work abroad, the program would symbolize the commitment of the United States to the global treatment of HIV/AIDS and the diseases of poverty. These US health professionals working in countries from which physicians and nurses have immigrated to the United States would represent a measure of recompense for the enormous benefits that the United States has derived from foreign-trained health workers. The US Global Health Service would be a small program with a big footprint. Like the Peace Corps, it would say something about the United Statesa message the world needs to hear.
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Professional development programs and incentives can slow the brain drain and ensure better public health infrastructure in Africa
Niyonzima, Makerere Medical School in Kampala Uganda student and Student for Equity in Health Care leader, 06/6/07 (Nixon, Governance and Corruption in the African Public Health Sector. PHRblog.org, http://phrblog.org/braindrain/2007/06/06/10/ , accessed 7/3/07) <On the issue of health workers spending only a fraction of their contracted time in the public health facilities, that too is absolutely true. In Uganda, this practice is quite well established and is called rather interestingly moonlighting - perhaps taken from the fact that one may have to work nights to make ends meet. In Uganda, a doctor on average earns between 300 and 500 dollars a month. These doctors (health workers) have dependents; children, parents, wives, husbands and sometimes whole villages to look after. They have to pay housing, feeding, transportation and pay for other social utilities. When you calculate the cost of living and compare it to the income of these doctors then you may understand why these doctors moonlight. To live, you need to supplement the income from the public with that from the private sector. But of course, moonlighting has its consequences; the fact that patients in public health facilities have no doctor and will have to suffer long queues to be seen by one. However, this can be remedied. Uganda, and perhaps other African countries, have tried legislation that aims at barring this practice of moonlighting. But legislation alone cannot eliminate this. What is important is to improve the wages of the health workers so to give them a comfortable livelihood. With improved salaries and remuneration, there will be no need to moonlight. And this is where the G8 comes in, they need to support the health workers in Africa if there is to be any reasonable improvement in health care. This improvement of course should also check the brain drain which is one of the causes of the health workforce attrition. The health worker should also be supported in terms of opportunities for continued professional development which is one of the reasons why in Africa many health workers prefer to work in cities where there is easy access to such opportunities. Still on the human resources for health crisis, it is important that we improve and strengthen medical education in Africa. Uganda has now four medical schools but the total out put per year is no more than 150 doctors presently (and many migrate). It is imperative that the output of these medical schools be increased. However, this should not compromise quality. Quality of training should be maintained at whatever cost. Makerere Medical School, where I am a student, introduced the Problem Based Model of learning about four years ago. This a novel learning model that besides problem solving skills (which teaches students to be creative, even in scarcity) involves training students in the communities in which they will eventually serve. Now I should expect this to make better doctors, but there is no support forthcoming from the government and this should not be the trend. The previous point takes me to your first issue of governance and corruption. Like you say, there is need for a breed of leaders that are people oriented. Leaders that look to improving the livelihood and health of their people. This has still eluded us in Africa but despair should not eclipse the hope we have that change in the African health care system is going to take place and should take place. With the right checks and controls, with aid pegged to results, I believe that we can improve the African health care system.>
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Deploying US medical professionals bolsters the fight against global poverty and disease plan multiplies services
Dr. Mullan et al, George Washington University Department of Health Policy Prevention and Community Health Professor, 2005 (Fitzhugh Mullan, et al, Board on Global Health at the Institute of Medicine of the National Academies, "Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS", p. 98, http://books.nap.edu/openbook.php?isbn=0309096162 accessed 7-11-07, Pg 24) By offering support and expertise to counterparts overseas and assist- ing in the training of new generations of desperately needed health workers, American health professionals can bring help and hope to those parts of the world where HIV/AIDS, malaria, and tuberculosis are laying the greatest waste to human life and spirit. In so doing, these healers abroad can also fight poverty and help sustain the long-term global health effort by multi- plying essential skills and services. As citizens of a small world, we must acknowledge that in the end, such efforts benefit us all.
Action now will shape global health in the 21st century failing to confront the health worker shortage puts our very survival at risk
Joint Learning Initiative Strategy Page, 2004
(Human Resources for Health: Overcoming the Crisis, Global Health Trust, http://www.globalhealthtrust.org/Report.html p. 13 access: 7-2-07) After a century of the most spectacular health advances in human history, we are confronting unprecedented and interlocking health crises. We face rising death rates and plummeting life expectancy in some of the worlds poorest countries, and new global pandemics that threaten us all. Human survival gains are being lost because extremely feeble national health systems are unable to cope and respond. Todays dramatic health reversals threaten not only human survival in affected countries but also development and security in an interdependent world. How the global community responds to these challenges will shape the course of global health for the entire 21st century. People deliver health. It was investment in the worlds health workersfrom community workers and barefoot doctors to nurses and physiciansthat made possible the science-based health revolution of the 20th century. Todays crisis reflects both new and resurgent diseases as well as neglect of human resources in the health sector, so critical for effective response. At the frontline of human survival in affected countries, we see overburdened and overstressed health workers, few in number and without the support they so badly need, losing the fight. Many are collapsing under the strain, many are dying, especially from AIDS, and above all, many are seeking a better life and a more rewarding work environment by leaving for richer countries.

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DA turns the case- War

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Politics Links- Public support

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Politics Links- bipartisan

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Imperialism Net Benefit

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China will spend money

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China is key to African economy

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Reconstruct Northwestern 1AC- Infrastructure

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1ac-global health cred adv 4/ Drug resistant TB kills billions

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Reconstruct Wake Fast Track 1AC- Infrastructure

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