Health, currently one of the most divisive of political issues in the US, could become a symbolic uniting force for President-elect Barack Obama's new administration, says the lead Editorial in this week's edition of the Lancet. It says: "Health system strengthening must be a top priority for the new administration if 46 million uninsured US residents are to have access to health care. Obama's plans to offer a range of payment choices, his commitment to ensure that all children have health insurance, and the requirement that insurance companies cover pre-existing conditions are positive steps towards an inclusive health system. In addition, Medicaid and Medicare must be rebuilt, reinforced, and fully supported," and adds: "It was encouraging to hear UK Prime Minister Gordon Brown say at last week's international conference on the Social Determinants of Health in London that Barack Obama is committed to tackling domestic and global inequality."
The Editorial says that Obama's agenda for global health is complex, and includes climate change, two ongoing wars, and trade. But it proposes several steps that can be made quickly: "First, health equity and human security should be a stated objective of foreign policy. Second, the DHHS Director of Global Health Affairs, Bill Steiger—who has badly hurt America's reputation in global health—should be replaced with a more experienced and appropriate politician. Third, Mark Dybul, the head of PEPFAR—the President's Emergency Plan for AIDS Relief, undoubtedly the biggest triumph of the Bush administration despite its controversies—will likely be swiftly replaced. Strong leadership from a respected international expert, such as Jim Kim, could help to negate PEPFAR's dogmatic and damaging policies—for example, its preference for abstinence-until-marriage programmes. Fourth, just as George W Bush reinstated the global gag rule—a law that forces recipients of federal funding to agree that they will not perform or promote abortion as a method of family planning—in his first day in office, Obama could reverse this decision as soon as he is inaugurated and so improve women's access to sexual and reproductive health in a single stroke. Fifth, a public commitment to agree to spend the internationally agreed target of 0•7% of gross national income on aid by 2015 would set a good example to the international community. Sixth, as a signal that the USA is committed to human rights, Obama could bring the USA in line with most other UN member states by ratifying the UN Convention on the Rights of the Child and the International Covenant on Economic, Social and Cultural Rights."
Also criticised in the Editorial is the antagonism and harassment shown towards the whole UN system by the Bush administration. It concludes: "The choice of the next UN Ambassador is pivotal to improving these relationships, in health as well as in other domains. An increase in support—including financial support—for WHO would be a sign that the USA wishes to re-engage with the global health community. President-elect Obama is a reminder about what is great about the USA and that, indeed, 'change can happen'. The fruits of that change will be judged by tangible improvements to the welfare and health of Americans—and those affected by American foreign policy."
For full Editorial, please see: http://press.thelancet.com/editorialp11511.pdf
Lancet Press Office T) +44 (0) 20 7424 4949 E) pressoffice@lancet.com
Journal
The Lancet