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On Thursday, October 29, over 20 organizations (including my employer, Advocates for Youth) that work across the spectrum of global health advocacy and practice came together on Capitol Hill in partnership with the Congressional Global Health Caucus to offer support and recommendations for Members of Congress and the Obama Administration on how to best realize the goals of President Obama’s Global Health Initiative, announced last May with the release of his Fiscal Year 2010 budget request. (See: http://www.whitehouse.gov/the_press_office/Statement-by-the-President-on-Global-Health-Initiative/
 
During the briefing, Rep. Betty McCollum (D-4-MN) (Appropriator and Founding Chairman of the Congressional Global Health Caucus), Rep. Diane Watson (D-33-CA) (Member of the House Foreign Affairs Subcommittee on Africa and Global Health) and Rep. Jan Schakowsky (Democratic Chair of the Congressional Women’s Caucus) spoke to their commitment to the United States’ engagement with the rest of the world through investments in global health. 
 
Rep. Watson put this messaging in context when she noted that throughout the war in Iraq, the United States has spent approximately $15 billion per month. “You do the math,” she said, emphasizing the disparity between our expenditures on military engagement overseas and our expenditures on global health (which are by no means small, but in comparison to the military, are quite meager). Rep. Watson stressed the need for the United States to engage with the world not with a gun but with a supportive hand, noting especially the need to “train and educate young people,” while Rep. McCollum noted the need to offer young women access to education and health care services so they can make responsible decisions for their future.    
 
These points could not be more important to note in the entire reshuffling process that’s occurring right now in U.S. foreign assistance—from the Quadrennial Diplomacy and Development Review (QDDR) at the State Department, to the President’s Study on Development (PSD) and the President’s Global Health Initiative (GHI) at the White House, to the re-write of the U.S. Foreign Assistance Act of 1961 being ambitiously undertaken in the House and Senate. With so many moving parts, all with the intent of ensuring that U.S. engagement with low and middle income countries is responding to so-called “21st-century challenges,” policy makers must seize this opportunity to engage the world’s three billion young people under the age of 25 in their efforts to make the United States’ foreign assistance have a sustainable and deeply-seeded positive impact for the long term.
 
The engagement of Millennials in the United States in the future direction of U.S. foreign policy and global health policy is crucial. Young people in the United States, especially students, many of whom have taken to degrees or minors in international affairs and/or global health, have been a driving force in raising the profile of global health policy and programs among fellow Americans in recent years. (See organizations such as the Student Global AIDS Campaign, Global Justice, University Coalitions for Global Health, Globe Med, among many others.) In addition to those studying the subjects, according to the Chronicle of Higher Education, the number of American students studying abroad increased 150 percent from 1996 to 2006, and the number remains on the rise (though it has been constrained by a decreasing dollar value and increased higher education costs). Further, others fortunate to secure financial means to do so have participated in international volunteer trips and have contributed to development of healthcare infrastructure and provision of services in their volunteer work. Having been privileged enough to study abroad myself, this experience can transform one’s notion of what is “foreign,” making it clear that no matter where one was born, without health, it is very difficult to fully realize one’s dreams or one’s rights. 
 
For many Millennials, it should be noted, these opportunities—both to study international affairs/global health and/or participate in study/volunteer/work abroad programs—are out of reach, due to any number of obstacles. And for many young people, the challenges faced by their local community—ranging from lack of access to education, healthcare, and civic engagement, among others—can be more pressing than anything beyond our country’s borders. 
 
However, even these Millennials constitute part of the majority of young people who are making an indelible mark on the legal and philosophical and civic fabric of the U.S. approach to health policy through a strong belief in access to health care as a human right, not as a luxury good. According to a 2008 American National Election Study (ANES), “60 percent of 18- to 29-year olds support universal health care, compared to 48 percent of all other eligible voters.” In this sense, they are joining the leagues of young people around the world for whom healthcare is not perceived as a privilege, but as a right. This marks a sea change in American political thought and represents the emerging vision of the world that Millennials are building. 
 
That vision for universal access to quality, affordable health care is the basis of the recommendations laid out by the civil society organizations at Thursday’s briefing. (The details of the briefing panel and the full report and recommendations made by the civil society group are available at www.theglobalhealthinitiative.org.) To date, U.S. financial contributions to global health have been larger than any other country on earth in absolute terms. Through U.S. leadership, our country has helped turn the tide in access to healthcare services, information, and education in many places on the planet.
 
But we have also faltered in a few ways as our global health policies and programs have evolved:
 
1) our policies regarding that immense funding have, in certain instances, fallen prey to petty battles for political capital usually stemming from politically controversial issues within U.S. politics—notably resulting in policies which limit provision of sexual and reproductive health care and which limit comprehensive sex education for young people;
 
2) global health programs are appropriated by Congress according to different issue sets and conditions such as maternal and child health, reproductive health and family planning, HIV and AIDS, neglected tropical diseases, healthcare workforce, etc. While all of these issue areas and specific conditions need particular attention, people’s lives, just like ours here, do not revolve around one health condition—and therefore we have to ensure U.S. global health programs are linked on the ground to provide integrated service delivery;
 
3) given the amount of money we spend engaging with low- and middle-income countries, the proportion of our funding spent on global health is but a miniscule fraction of what we spend on other efforts to engage with the world, especially the military. This does not mean military spending is not important, but that investments in global health aimed at the reduction of despair and empowerment of local individuals and communities may support and actually reduce the need for military interventions over the long term through constructing environments where people are not driven to violence for survival. 
 
These faults are not unfixable. And in fact, a high-profile Senator from Maine said it well, “the consequences of inaction dictate the urgency of action.” Millennials get this. And we get that if we want our world to be more equitable, more secure, and more empowered when we’re no longer 18-29 year-olds, we have to act now to improve our policies and seriously invest in what works.