Global Health Services Neg - SDI 5 Week

SDI 2007 5 Week
1 GHS Neg
GHS Neg SDI Strategy Forum

***Intel*** ............................................................ 3
Strategy Sheet ......................................................................4 Intel Heidt/Peterson Version......................................... 5-8 Intel Lee/Tallungen Version ....................................... 9-12
***AT: Bioterror Advantage***.......................86

1NC AT: Bioterror Advantage ......................................... 87 2NC Ext #1 SQ Solves Commitment .......................... 92 2NC Ext #2 SQ Solves Bioterror................................. 94 2NC Ext #3 SSA Not Key Terrorism .......................... 95 2NC Ext #3 SSA Not Key Terrorism Iraq................ 96 2NC Ext #4 Capacity Alt-Cause.................................. 97 2NC Ext #5 Failed States Alt-Causes.......................... 98 2NC Ext #5 Failed States Alt-Causes.......................... 99 2NC Ext #6 AT: Failed States Terrorism ............ 100 2NC Ext #7 No Bioterror Impact .............................. 101 AT: Nuclear Terrorism Impacts ..................................... 103 AT: Lashout Impacts ...................................................... 104 AT: Chemical Weapons Impact ..................................... 105
***Topicality*** ................................................. 13
Extra-T 1NC ......................................................................14 Extra-T Violations .............................................................16 Substantial T 1NC..............................................................18 Substantial T Violations.....................................................19 Increase T 1NC ..................................................................20 Increase T Violations .........................................................21
***AT: Disease Advantage***.......................... 22

1NC AT: Disease Advantage............................................23 2NC Ext #1 150 People................................................29 2NC Ext #1 150 People AT: Fellows = 1000 More .30 2NC Ext #2 US Shortage .............................................31 2NC Ext #2 US Shortage No US Expertise ..............33 2NC Ext #2 US Shortage AT: People = Interested ..34 2NC Ext #3 Capacity Alt-Causes.................................35 2NC Ext #3 Capacity Alt-Causes Culture.................38 2NC Ext #3 Capacity Alt-Causes Stigma .................39 2NC Ext #4 SQ Solves WHO ...................................40 2NC Ext #4 SQ Solves Africa...................................41 2NC Ext #5 SSA Not Key............................................43 2NC Ext #6 No SSA Aids............................................44 2NC Ext #7 GHS Fails IMF/Salary Caps..................45 2NC Ext #8 No AIDS Impact ......................................46 2NC Ext #8 No AIDS Impact AT: Mutation ...........47 2NC Ext #9 Yes AIDS Cure ........................................48 No Political Will To Fight AIDS .......................................49 Africa Says No To SHWs ..................................................50 Brain Drain Good...............................................................51 Aid Confusion Turn ...........................................................52
***Disease CPs*** ...........................................106

Domestic Health Care CP 1NC ....................................... 107 Domestic Health Care CP Solves .................................... 108 PSE CP 1NC.................................................................... 109 PSE CP Solves ................................................................ 110 AHCIA CP 1NC.............................................................. 111 AHCIA CP ...................................................................... 112 AHCIA = Bipart .............................................................. 113 2NC AHCIA CP Overview ............................................. 114 Burkhalter CP.................................................................. 115 Buy Local CP .................................................................. 116
***Soft Power CPs*** .....................................117

Rest Of The World CP 1NC............................................ 118 Public Diplomacy CP 1NC.............................................. 119 Public Diplomacy CP Solves .......................................... 120 Peace Corps CP 1NC (SSA)............................................ 121 Peace Corps CP 1NC (Non SSA).................................... 122 Funding Key to Peace Corps ........................................... 123 Peace Corps Solves Soft Power Face To Face ............. 124 Outsource Diplomacy CP Solves .................................... 125 GSF CP............................................................................ 126 AT: Soft Power CP Isnt Health Care ............................ 127
***Brain Drain Turn***.................................... 53

1NC Brain Drain Turn .......................................................54 Brain Drain Link................................................................55 Brain Drain Link Booster...................................................57 Brain Drain Impacts...........................................................58 SQ Brain Drain To U.S. Small...........................................60 AT: No Link SHWs Dont Migrate ..............................61 AT: Brain Drain Good Remittances...............................62
***Bioterror CPs***........................................128
Domestic Capacity CP 1NC ............................................ 129 Domestic Capacity CP Solves ......................................... 130 AT: Domestic CP Doesnt Learn About Africa ............. 133 Integration CP ................................................................. 134
***AT: Soft Power Advantage*** ................... 63

1NC AT: Soft Power Advantage ......................................64 2NC Ext #1 SQ Solves Soft Power ..............................67 2NC Ext #2 SSA Not Key Soft Power.........................70 2NC Ext #3 Soft Power Alt-Causes .............................71 2NC Ext #4 Aid Not Key Soft Power ..........................75 Diplomacy Not Key Soft Power ........................................77 Diplomacy Not Key Arab Anger .......................................84 AT: Ferguson Impact ........................................................85
***Agent CPs*** ...............................................135

EU CP.............................................................................. 136 China CP ......................................................................... 140 Canada CP ....................................................................... 142 WHO TTR CP................................................................. 143 WHO Solves Best............................................................ 144 Global Initiative CP......................................................... 145 Gates Foundation CP....................................................... 146
SDI 2007 5 Week
2 GHS Neg African Economy Key Public Health .............................. 203
***Africa CP*** ............................................... 147

Africa CP 1NC.................................................................148 Africa CP Solves..............................................................149
***Reverse Brain Drain DA*** .......................204

RBD 1NC ........................................................................ 205 RBD Link Booster........................................................... 208 RBD Link Doctors Key................................................ 209 RBD Link Health Care Key ......................................... 210 RBD Link Education Key ............................................ 213 RBD Link Science Key ................................................ 216 AT: GHS Doesnt Use U.S. Workers............................. 219 RBD Impact..................................................................... 220
***AT: US Key***........................................... 154

AT: AT: AT: AT: AT: AT: AT: US Key ....................................................................155 US Key Clearinghouse Solves..............................157 US Key AT: Mullan Evidence.............................158 US Key No US Expertise .....................................159 US Key AT: Donor Coordination........................160 US Key CP US Workers..................................161 Perm Solves Intl Cooperation ................................162
***Politics***.....................................................221
Bush Good Link Disease.............................................. 222 Bush Good Link Committee Proves............................. 223 Bush Good Link Key Senators ..................................... 224 Bush Bad Link Plan Popular ........................................ 225 Bush Bad Link Bipart................................................... 226 Plan = Win For Obama.................................................... 229
***Loan Repayment PIC*** ........................... 163

Loan Repayment PIC.......................................................164 Loan Repayment PIC Politics Net Benefits .....................165 AT: Each Part Key ..........................................................166 AT: Loan Repayment Key ..............................................167
***Tuition DA*** ............................................. 168

Tuition DA 1NC ..............................................................169 Med School Tuition Brink ...............................................173 No Tuition Hikes .............................................................174 No Federal Aid.................................................................176 Tuition Link .....................................................................177 Tuition Hikes Jack Competitiveness................................179 Tuition Hikes Debt......................................................180 Education Key Competitiveness ......................................181 Competitiveness Key To Heg ..........................................182 Federal Aid Violates Constitution....................................183 Federal Aid Jacks Democracy..........................................184
***Biodefense DA*** ........................................230

Biodefense DA 1NC........................................................ 231 Staff/Funding Key To Check Attack............................... 233 Yes Biodefense Funding ................................................. 234 2NC AT: GHS Is Funded From PEPFAR ...................... 236
***Domestic Wages DA*** ..............................238

Domestic Wage Link....................................................... 239 Domestic Wage Link Booster ......................................... 240 Wage Inflation Rate Hikes ......................................... 241 GHS Uses Government Employees................................. 242
***Spending DA***.......................................... 185

Spending Link..................................................................186 Spending Double Bind.....................................................187
***AT: Add-Ons***.........................................243
AT: Lashout Add-On...................................................... 244 AT: Domestic Health Add-On........................................ 245 AT: Free Trade Add-On ................................................. 246
***African Economy DA***............................ 188

African Economy 1NC ....................................................189 Yes African Economies ...................................................192 No African Inflation.........................................................194 African Economy Link ....................................................195 Inflation Jacks African Economies ..................................200 African Economy Impact .................................................201 South Africa Economy Impact.........................................202
***Misc*** .........................................................247
War Destroys Health Capacity ........................................ 248 Colonialism Links ........................................................... 249 Imperialism Links ........................................................... 250 Contact Theory Wrong.................................................... 251 Contact Theory Limited .................................................. 252
SDI 2007 5 Week
3 GHS Neg
***Intel***
SDI 2007 5 Week
4 GHS Neg
Strategy Sheet
Important notes:
1) You could piece together a large number of strategies from this file pick and choose which components of the aff you want to solve and combine a CP. 2) Most of your net benefits will be based on generic PHA to Africa links the aff is very similar to a stock middle of the road AIDS case, so all of your most generic link evidence will probably apply. Thats important, because there arent a ton of GHS specific politics links out there. This isnt a problem, because all of the CPs solve the whole case. 3) PEPFAR solves a majority of this affirmative in the status quo the internal link to both the soft power and bioterror advantages boils down to nothing more hi-tech than engagement with Africa. Keep in mind that even if the LINK card why GHS boosts soft power is specific, the INTERNAL link card is generic about Africa. That means that any CP which engages Africa solves, and that PEPFAR solves to a way larger degree than the aff. 4) Politics direction is probably Bush Bad though in reality, noone cares at all about the plan, and it would just be lost in the noise of PEPFAR 5) Dont go for spending the aff doesnt spend enough to win a link. You might, however, consider going for substantial or increase if they say the plan is funded out of PEPFAR
Recommended strategies
1) International Actor CP + Soft Power CP Theres not a warrant in the affirmative for why only the U.S. is capable of setting up a GHS. Even if they read evidence that the federal government should do it, they wont have a comparative card another actor couldnt. I dont think it matters which you pick the EU is probably fine. You can either win PEPFAR solves the other two advantage in the status quo, or run one of the soft power CPs to solve the rest of the aff. It competes on any disad which says U.S. action to Africa is bad basically, all of them except maybe Spending/Aid Tradeoff. You might consider reading one of the Bioterror CPs as a part of the CP as well, because boosting domestic health capacity helps against a lot of solvency arguments and add-ons. 2) Rest Of The World CP + International Actor CP.-- this CP does the GHS to the rest of the world other than SSA. Their solvency authors all assume doing a GLOBAL GHS (hence the name). They dont have a reason why acting to Africa is important for soft power or terrorism but youll need to solve Disease another way. This CP competes on any Africa based disad Politics, China, African Economy, any Africa K, etc 3) Exclude Loan Repayment the GHS does 6 things, one of which is provide loan repayment for doctors to do to Africa. The CP does the other 5, and offsets the lack of loan repayment with other funding mechanisms. It competes on the Tuition DA and (maybe) Politics, because loan repayment requires legislation, where everything else can be done administratively. If you need to compete on politics, you should probably specify an administrative actor in the CP text, like the Office of Global AIDS coordinator for PEPFAR. 4) AHCIA CP its a competing proposal with the GHS which does basically the exact same thing, except it doesnt send U.S. workers. Solvency cards are decent, competes off of U.S. workers bad (Reverse Brain Drain, African Economy, Wage Inflation, Imperialism K, etc) 5) I wouldnt be afraid to defend the status quo if youre good enough on how it solves the case. 6) The GDI has a critique version about contact theory. I didnt write a specific strategy. Its not topical, because it mandates that EVERYONE has to go to SSA before they can go to college. Which also strikes me as a bit, uhinsane? Just CP to send people to Africa with the Peace Corps instead of a GHS, and compete on any reason that health assistance is bad Brain Drain, African Economy DA, Politics, etc
SDI 2007 5 Week
5 GHS Neg
Intel Heidt/Peterson Version

Plan: The United States federal government should establish a Global Health Service to expand the capacity of community health workers in the Presidents Emergency Plan for AIDS Relief focus countries in sub-Saharan Africa. Contention 1 is Diseases Assistance is being increased but will be ineffective without a more robust health care workforce The Joint Learning Initiative, 4 (The Joint Learning Initiative is a consortium of over 100 global health leaders, Human resources for health: overcoming the crisis, The Lancet Vol 364 Iss 9449, pages 1984-1990, November 27- December 3, Science Direct database) Even so, dedicated health workers this minimum threshold. In particular, Africas poor health infrastructure cripples efforts to prevent disease spread Garret, 7 (Laurie, Senior Fellow for Global Health at the Council on Foreign Relations, Prepared Statement Before the Senate Subcommittee on State, Foreign Operations and Related Programs, 4-18-2007, www.cfr.org/publication/13130/) Public health systems keep babies and children alive public health and medical care. In the short term, there will be millions of preventable death EACH YEAR States News Service, 7 (Bipartisan Group of Senators Introduce African Health Capacity Investment of 2007, March 7, Lexis-Nexis Universe) Senators Dick Durbin (D-IL), Norm fight these diseases succeed." The impact outweighs any disadvantage AIDS kills hundreds of millions of people, causes genocide, ethnic cleansing and economic collapse this both makes war more likely and magnifies its impact Singer, 2 (Peter W., Senior Fellow at the Brookings Institution: Director of the 21st Century Defense Initiative, PhD in Government Harvard University, Department of Defense-Balkans Task Force, AIDS and International Security, Spring 2002, Survival Vol. 44, No. 1, Spring 2002, Pg. 145-148, www.brookings.edu/dybdocroot/views/articles/fellows/2002_singer.pdf) At the start of the new century, infected just by 2005.9 The cycle of AIDS transmission and war will allow the virus to mutate, become airborne and spread worldwide Singer, 2 (Peter W., Senior Fellow at the Brookings Institution: Director of the 21st Century Defense Initiative, PhD in Government Harvard University, Department of Defense-Balkans Task Force, AIDS and International Security, Spring 2002, Survival Vol. 44, No. 1, Spring 2002, Pg. 145-148, www.brookings.edu/dybdocroot/views/articles/fellows/2002_singer.pdf) Wars also lead to the uprooting ignored conflict elsewhere. The impact is extinction Muchiri, 2000 (Michael Kibaara; Staff Member at Ministry of Education in Nairobi; Will Annan finally put out Africas fires? Jakarta Post; March 6; Lexis-Nexis Universe) The executive director of UNAIDS, maybe the human race. A Global Health Service will mobilize thousands of health workers federal leadership is key Mullan, 7 (Fitzhugh, MD, Department of Health Policy, George Washington University, JAMA, Responding to the Global HIV/AIDS Crisis: A Peace Corps for Health, 2-21-2007, 297:744-746, American Medical Association Journals database) There can be no meaningful response to the world needs to hear. The Global Health Service will quickly serve as a catalyst to build new healthcare capacity Davis , 5 (Paul Davis, Director of Government Relations @ Health Global Access Project,Strategic US Initiatives for Health Workforce Self Sufficiency in Developing Nations, Health Gap Global Access Project, 12-1-2005, http://healthgap.org/HCWmemo.html) E. Use volunteers and imported health workers local health system.
SDI 2007 5 Week
6 GHS Neg

The plan will create a sustainable health system that is not susceptible to brain drain Davis , 5 (Paul Davis, Director of Government Relations @ Health Global Access Project,Strategic US Initiatives for Health Workforce Self Sufficiency in Developing Nations, Health Gap Global Access Project, 12-1-2005, http://healthgap.org/HCWmemo.html) B. Launch a new emergency drive to new healthcare professionals. Community health workers provide a long-term solution to Africas healthcare worker shortage they wont migrate from the country Dovio, 5 (Dr. Delanyo Dovlo, Chief of Party @ Population Council, Accra, Ghana and Former District Director of Medical Services, Former Regional Director in the Western Region, and the Former National Director of Human Resource Development. Filling the gaps: Introducing substitute health workers in Africa. id21 Insights Health, Vol 7, August 2005, www.id21.org/insights/insights-h07/insights-issh07-art05.html) Massive shortages in trained health care professionals staff they are replacing. Finally, action against AIDS in Africa will lay the groundwork for stemming the spread of the disease globally Morrison, 1 (J. Stephen, director of the Africa program at CSIS, The Washington Quarterly, Winter, The African Pandemic Hits Washington, http://www.twq.com/winter01/morrison.pdf) During the next administration, what is possible in Africa. Contention 2 is Public Health Diplomacy U.S. credibility is at an all time low a commitment to public health is necessary to repair Americas image Fortin, 7 (Fred, worked in health care delivery for over 35 years and his experience ranges from mental health crisis intervention, child abuse prevention, studying AIDS in Africa, to university teaching and corporate health care strategic policy development, World Health Care Blog, Soft Power and U.S. Health Care Revisited, 6-12-2007, www.worldhealthcareblog.org/2007/06/12/soft-power-and-us-health-care-revisited/) Ive argued previously that to make it work. Building upon the PEPFAR will help the U.S. rekindle international partnerships and create a sustainable foundation for benevolent hegemony The Lancet, 5 (Editorial, America at home and abroad, Jan 1-Jan 7, 2005, vol. 365, no. 945, Proquest) In international affairs, Bush's secure superpower. In particular, the Global Health Service will uniquely foster relationships and multicultural understanding to overwhelm anti-American abroad Mullan, et al, 5 (Fitzhugh Mullan, Professor of Prevention and Community Health at George Washington University, 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, 4-192005, www.nap.edu/catalog/11270.html#toc) Humanitarianism marks the recently augmented cross-border personal networks. This positive image of America promoted by the GHS will persist over time Mullan, et al, 5 (Fitzhugh Mullan, Professor of Prevention and Community Health at George Washington University, 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, 4-192005, www.nap.edu/catalog/11270.html#toc) The benefits of twinning extend of the area being addressed. A commitment to improving public health abroad is essential to reverse negative perceptions of the U.S. and sustain soft power leadership Benatar & Fox, 5 (Solomon R. Benatar Professor of Medicine and Bioethics at the University of Capetown, and Rene C. Fox Professor of Sociology and Bioethics at the University of Pennsylvania, Perspectives in Biology and Medicine, Meeting Threats to Global Health: A call for American leadership, 48.3 (2005) 344-361, Project Muse, JMP) Self-Interest as a Force for Improving Global Health the potential for global health.
SDI 2007 5 Week
7 GHS Neg

Soft power is key to hard power its decline will cause domestic isolationism Nye, 4 (Joseph, dean of the Kennedy School of Government at Harvard, Political Science Quarterly, Summer, ebsco) THE COSTS OF IGNORING SOFT POWER our common interests. The collapse of U.S. soft power will shatter global cooperation making nuclear proliferation, environmental destruction, failed states and diseases inevitable Reiffel, 5 (Lex, Visiting Fellow at the Global Economy and Development Center of the Brookings Institution, The Brookings Institution, Reaching Out: Americans Serving Overseas, 12-27-2005, www.brookings.edu/views/papers/20051207rieffel.pdf) The United States is struggling up to rely more on soft instruments.2 Finally, the collapse of U.S. leadership will unleash conflicts resulting great power wars Thayer, 6 (Bradley A., Assistant Professor of Political Science at the University of Minnesota, Duluth, The National Interest, November -December, In Defense of Primacy, lexis) A remarkable fact about international politics of solving the world's ills. Contention 3 is Terrorism Failed states in Sub-Saharan Africa will are becoming hubs for terrorists allowing for an attack against the U.S. Dempsey, 6 (Thomas, Director of African Studies @ U.S. Army War College and served as a strategic intelligence analyst for Africa at the John F. Kennedy Special Warfare Center and as Chief of Africa Branch for the Defense Intelligence Agency, Counterterrorism in African Failed States: Challenges and Potential Solutions, April, http://www.strategicstudiesinstitute.army.mil/pdffiles/pub649.pdf) Failed states offer attractive venues American national interests. There is an immediate and significant risk that these terrorist hubs will obtain nuclear weapons risking an attack on the U.S. homeland Dempsey, 6 (Thomas, Director of African Studies @ U.S. Army War College and served as a strategic intelligence analyst for Africa at the John F. Kennedy Special Warfare Center and as Chief of Africa Branch for the Defense Intelligence Agency, Counterterrorism in African Failed States: Challenges and Potential Solutions, April, http://www.strategicstudiesinstitute.army.mil/pdffiles/pub649.pdf) The threat that terrorist hubs based a complex and difficult task. U.S. lashout will kill hundreds of millions Easterbrook, 1 (Greg, Fellow at the Brookings Institute, CNN, America's New War: Nuclear Threats, 11-1-2001, http://transcripts.cnn.com/TRANSCRIPTS/0111/01/gal.00.html) EASTERBROOK: Well, what held through being in our interests. Nuclear terrorism will cause extinction Sid-Ahmed, 4 (Mohamed, Managing Editor for Al-Ahali, Extinction! August 26-September 1, Issue no. 705, http://weekly.ahram.org.eg/2004/705/op5.htm) A nuclear attack by terrorists we will all be losers. In addition, the lack of US involvement in African affairs has decreased US credibility within the continent reversal of this trend is crucial to prevent African instability, a collapse of free trade and hegemony, and environmental catastrophes Sisk, 96 (Timothy, Future U.S. Engagement in Africa Opportunities and Obstacles for Conflict Management United States Institute of Peace, July 1996, Special Report No. 17, http://www.usip.org/pubs/specialreports/early/USAfrica1.html) Africa's marginalization in U.S. foreign or in Africa as a whole, such as Nigeria and Sudan.
SDI 2007 5 Week
8 GHS Neg

The plan will build international cooperation to successful carry out the war on terror Senator Frist, 6 (Senator Bill Frist, Senate Majority Leader, National Review Online, Corps Diplomacy: A Healthy Approach, 2-7-2006, www.nationalreview.com/comment/frist200602070749.asp, JMP) Over the next few days, my staff and I cost-efficient weapon in the war on terror. Targeted public health assistance will improve the image of the U.S. in Africa and prevent terrorism from failed states Tsang, 6 (Steve, PhD Philosophy University of Oxford, Intelligence and Human Rights in the Are of Global Terrorism, Praeger Security International, Westport Connecticut, London, Pg. 162-163.) Intelligence on biorisk is only not about might find a material connection. The result is trust and dialogue with countries will pave the way for the resolution of conflicts Indianapolis Star quoting Former Senate Major Leader Bill Frist 2007 (Bill Theobald, Frist targets global health: Former Senate majority leader sees health care as the 'currency of peace' 6-3-2007, www.indystar.com/apps/pbcs.dll/article?AID=/20070603/NATIONWORLD/706030435/-1/LOCAL17) WASHINGTON -- Former Senate Majority Leader and hopelessness breeds extremism.
SDI 2007 5 Week
9 GHS Neg
Intel Lee/Tallungen Version

The Plan: The United States should establish a Global Health Service to mobilize, prepare, send, manage, and compensate U.S. health professionals to expand the capacity of community health workers in the Presidents Emergency Plan for AIDS Relief focus countries in sub-Saharan Africa. Contention ONE: Diseases In 2003, Bush and Congress passed into law the Presidents Emergency Plan for AIDS Relief, a multi-year program designed to curtail the spread of infectious diseases in Sub-Sahara Africa and other areas. Unfortunately, the program is doomed to failure without a reinforcement of human resources Mullan 05 Professor of Prevention & Community Health @ George Washington University [Fitzhugh Mullan (Editor), 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, (2005)]edlee In his State of the Union address of and efforts in other developing countries. Disease prevention is impossible without first reinforcing Africas healthcare infrastructure. Garrett 07 - Senior Fellow for Global Health @ Council on Foreign Relations [Laurie Garrett, Statement of Laurie Garrett Senior Fellow Global Health Council on Foreign Relations to the Committee on Senate Appropriations Subcommittee on State, Foreign Operations, and Related Programs, CQ Congressional Testimony, April 18, 2007 Wednesday, pg. lexis]edlee Systems: Not individual, disease-specific programs - survival declines proportionately." Inadequate health care delivery system is a major factor in the spread infectious diseases in Africa Noah & Fidas 00 - Infectious Disease Analyst @ the Armed Forces Medical Intelligence Center & Deputy National Intelligence Officer for Global and Multilateral Issues @ National Intelligence Council [Donald Noah (Lt. Col. And Dr.) & George Fidas, National Intelligence Estimate: The Global Infectious Disease Threat and Its Implications for the United States, ENVIRONMENTAL CHANGE & SECURITY PROJECT REPORT, ISSUE 6 (SUMMER 2000)]edlee Alone or in combination, war and natural disasters, the low end of the spectrum. Left unchecked, infectious diseases will kill over 13 Million people every year Smolinski et al. 03 - Director of the Global Health and Security Initiative @ Nuclear Threat Initiative [Mark S. Smolinski (Former Senior Program Officer at the Institute of Medicine of the National Academies of Science and Epidemic Intelligence Officer for the U.S. Centers for Disease Control and Prevention), Margaret A. Hamburg (Vice President for Biological Programs @ Nuclear Threat Initiative), & Joshua Lederberg (Directs the Laboratory of Molecular Genetics and Informatics @ The Rockefeller University) Editors, Board on Global Health at the Institute of Medicine of the National Academies, MICROBIAL THREATS TO HEALTH: EMERGENCE, DETECTION, AND RESPONSE, (2003)]edlee Microbial threats to health are tuberculosis (TB), malaria, and measles (see Table 2-1). AND Even conservative estimates place us on brink of a global pandemic that will kill over 100 million people. No other threat compares in liklihood and lethality Falkenrath 06 - Senior Fellow in Foreign Policy Studies @ The Brookings Institution [Richard A. Falkenrath, Former Special Assistant to the President and Senior Director for Policy, Former Plans within the Office of Homeland Security, and Former Director for Proliferation Strategy on the National Security Council, PUBLIC HEALTH MEDICAL PREPAREDNESS, Committee on Senate Health, Education, Labor and Pensions, CQ Congressional Testimony, March 16, 2006 Thursday, pg. l/n]edlee A catastrophic disease event is countermeasures, and consequence. ADDITIONALLY Extinction is a distinct possibility. US policies will determine our global fate Benatar and Fox 05 Professor of Medicine and Bioethics @ University of Cape Town and Professor of Sociology and Bioethics @ University of Pennsylvania [Solomon R. Benatar and Rene C. Fox, Meeting Threats to Global Health: A call for American leadership, Perspectives in Biology and Medicine 48.3 (2005) 344-361//Project Muse]edlee There is a "back to the future" irony in the in global health (Benatar 2003). Contention TWO: Public Health Diplomacy
SDI 2007 5 Week
10 GHS Neg

USs international credibility is plummeting. Public diplomacy is key to restoring it Smith 07 Professor of public diplomacy@ Georgetown Universitys School of Foreign Service [Ambassador Pamela Hyde Smith, Retired from the U.S. Foreign Service, having served as Ambassador to the Republic of Moldova. The Hard Road Back To Soft Power, Politics & Diplomacy, Winter/Spring 2007]edlee The Pew Research Centers would benefit the United States. Global Health Service will reverse this trend Mullan 05 Professor of Prevention & Community Health @ George Washington University [Fitzhugh Mullan (Editor), 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, (2005)]edlee .Healers Abroad is the product of that effort. compassion and civic spirit. And US supported medical training is a critical check against anti-Americanism Knobler et al. 06 - Former Director of the Institute of Medicines Forum on Microbial Threats [Stacey Knobler (Former Director of the Institute of Medicines Forum on Microbial Threats), Adel Mahmoud (President @ Merck Vaccines), Stanley Lemon (Dean of the University of Texas School of Medicine) Leslie Pray (Science Writer) Editors, Board of Global Health at the Institute of Medicine of the National Academies, THE IMPACT OF GLOBALIZATION ON INFECTIOUS DISEASE EMERGENCE AND CONTROL: Exploring the Consequences and Opportunities, (2006)]edlee DiplomacyPublic health is playing an diplomacy with tremendous economic potential. Additionally The medical profession has a huge reservoir of goodwill Benatar and Fox 05 Professor of Medicine and Bioethics @ University of Cape Town and Professor of Sociology and Bioethics @ University of Pennsylvania [Solomon R. Benatar and Rene C. Fox, Meeting Threats to Global Health: A call for American leadership, Perspectives in Biology and Medicine 48.3 (2005) 344-361//Project Muse]edlee Self-Interest as a Force for Improving Global Health - unified governmental health policy. Restoring US credibility is vital to preventing every major impact. Decline will trigger a catastrophic collapse of the global order. History is on our side Thayer 06 Professor of Defense and Strategic Studies @ Missouri State University [Thayer, Bradley A., In Defense of Primacy., National Interest; Nov/Dec2006 Issue 86, p32-37]edlee U.S. primacy--and the bandwagoning effect hope of solving the world's ills. The end result is global destruction via economic collapse, terrorism, and nuclear wars Ferguson 04 - Professor of history at NYU and a senior fellow of the Hoover Institution [Niall, The End of Power: Without American hegemony the world would likely return to the dark ages., Wall Street Journal, Monday, June 21, 2004 12:01 a.m. EDT, pg. http://www.opinionjournal.com/editorial/feature.html?id=110005244]edlee But what if this view is wrong? What if Be careful what you wish for. Contention THREE: Bioterrorism The threat of bioterrorism is real and growing O'Toole 07 Professor of Medicine @ University of Pittsburgh Medical School. [Tara O'Toole, Director and CEO of the Center for Biosecurity of the University of Pittsburgh Medical Center. The Center for Biosecurity is a nonprofit, multidisciplinary organization located in Baltimore which includes physicians, public health professionals, and biological and social scientists., BIOTERRORISM PREPAREDNESS, Committee on House Appropriations Subcommittee on Homeland Security, CQ Congressional Testimony, March 29, 2007 Thursday, pg. l/n]edlee Bioterrorism is an Urgent and Growing implications of this analysis.
SDI 2007 5 Week
11 GHS Neg

The Global Health Service will allow the CDC and NIH to maintain expertise in diseases that are potential bioterrorist agents Smolinski et al. 03 Director of the Global Health and Security Initiative at Nuclear Threat Initiative [Marks. Smolinski (Former Senior Program Officer at the Institute of Medicine of the National Academics of Science and Epidemic Intelligence Officer for the U.S. Centers for Disease Control and Prevention), Margaret A. Hamburg (Vice President for Biological Programs at Nuclear Threat Initiative), & Joshua Lederberg (Directs the Laboratory of Molecular Genetics and Informatics at The Rockefeller University) Editors, Board on Global Health at the institute of the National Academics, Microbial threats to Health: Emergence, Detection, and Response, 3-18-2003, http://www.nap.edu/catalog/10636.html] Improving the global capacity to respond to the microbial threats workforce). This expertise will lead to effective responses to both natural disease outbreaks and bioterrorist attacks Smolinski et al. 03 Director of the Global Health and Security Initiative at Nuclear Threat Initiative [Marks. Smolinski (Former Senior Program Officer at the Institute of Medicine of the National Academics of Science and Epidemic Intelligence Officer for the U.S. Centers for Disease Control and Prevention), Margaret A. Hamburg (Vice President for Biological Programs at Nuclear Threat Initiative), & Joshua Lederberg (Directs the Laboratory of Molecular Genetics and Informatics at The Rockefeller University) Editors, Board on Global Health at the institute of the National Academics, Microbial threats to Health: Emergence, Detection, and Response, 3-18-2003, http://www.nap.edu/catalog/10636.html] REBUILDING DOMESTIC PUBLIC HEALTH CAPACITY and laboratory capability. Response ability and situational awareness is the best defense against bioterrorist attacks O'Toole 07 Professor of Medicine @ University of Pittsburgh Medical School. [Tara O'Toole, Director and CEO of the Center for Biosecurity of the University of Pittsburgh Medical Center. The Center for Biosecurity is a nonprofit, multidisciplinary organization located in Baltimore which includes physicians, public health professionals, and biological and social scientists., BIOTERRORISM PREPAREDNESS, Committee on House Appropriations Subcommittee on Homeland Security, CQ Congressional Testimony, March 29, 2007 Thursday, pg. l/n] The ease with which bioweapons programs cooperation and collaboration of citizens in epidemic response. Having knowledge and experience with diseases is critical to stem the spread of an outbreak Katz doctoral candidate at the Woodrow Wilson School of Public and International Affairs and the Office of Population Research at Princeton University 2002 (Rebecca, The Washington Quarterly, Public Health Preparedness: The Best Defense against Biological Weapons, Summer, vol. 25, no. 3, p.69, Lexis-Nexis) When Hantavirus Pulmonary Syndrome and set up collaborative efforts. Biowarfare results in global extinction which outweighs all else Ochs 02 - MA Natural Resource Management at Rutgers University [Richard, Naturalist at Grand Teton National Park, June 9th, immediately," http://www.freefromterror.net/other_articles/abolish.html" target="_blank">"Biological Weapons must be abolished >immediately," http://www.freefromterror.net/other_articles/abolish.html] Of all the weapons of mass destruction, then patriotism is the highest of all crimes. Contention FOUR: Solvency Lots of people are interested in serving. Global Health Corps will successfully reform US image abroad Mullan 07 - Professor of Health Policy @ George Washington University [Fitzhugh Mullan, MD, Responding to the Global HIV/AIDS Crisis: A Peace Corps for Health, JAMA: Journal of the American Medical Association. Vol. 297 No. 7, February 21, 2007pg. 744-746.]edlee There can be no meaningful response a message the world needs to hear. The Corp will quickly multiply the number of healthcare workers in sub-Sahara Africa Davis 05 - Director of Government Relations @ Health GAP (Global Access Project) [Paul Davis, Strategic US Initiatives for Health Workforce Self Sufficiency in Developing Nations, Health Gap Global Access Project, 1 December 2005, pg. http://healthgap.org/HCWmemo.html]edlee B. Launch a new emergency drive to PEPFAR and other initiatives.
SDI 2007 5 Week
12 GHS Neg

Community health workers provide a long-term solution to Africas healthcare worker shortage. The lack of international demand for their service allows them to be easily retained within the country Dovio 05 - Chief of Party @ Population Council, Accra, Ghana [Dr. Delanyo Dovlo, Former District Director of Medical Services, Former Regional Director in the Western Region, and the Former National Director of Human Resource Development. Filling the gaps: Introducing substitute health workers in Africa. id21 Insights Health, Vol 7, August 2005, pg. http://www.id21.org/insights/insights-h07/insights-issh07-art05.html]edlee Massive shortages in trained health care staff they are replacing. US assistance is a matter of life & death for sub-Sahara. Developing a cadre of village health workers is a critical component to building a sustainable health system Sachs 07 - Professor of Health Policy and Sustainable Development at Columbia University [Jeffrey D. Sachs, Beware False Tradeoffs, January 23, 2007, pg. http://www.foreignaffairs.org/special/global_health/]edlee Let's recognize the iron laws of world can persevere.
SDI 2007 5 Week
13 GHS Neg
***Topicality***
SDI 2007 5 Week
14 GHS Neg
Extra-T 1NC
A Interpretation 1. Public health assistance is only treatment and prevention of communicable and immunizable diseases Claudia Schlosberg, Partner @ Blank and Rome, 1-12-1998, National Health Law Program,
http://www.healthlaw.org/library.cfm?fa=download&resourceID=67503&print V. PUBLIC HEALTH ASSISTANCE All aliens, regardless of immigration status, are eligible for public health assistance funded through sources other than the Medicaid program. The public health assistance is limited to immunizations with respect to immunizable diseases and for testing and treatment of symptoms of communicable diseases whether or not such symptoms are caused by a communicable disease. As with emergency Medicaid, providers are not required to, and should not, verify the citizenship, nationality and immigration status of applicants for these services. The above definition of public health assistance opens the door to a wide range of critical health services for immigrants and their families. Among the most important are: Immunizations for Children and Adolescents: All children and adolescents should be fully immunized according to the current standards of the Advisory Committee on Immunization Practices; AIDS and HIV services and treatment including screening and diagnosis, counseling, testing and treatment provided with Ryan White Act or other non-Medicaid funds, Tuberculosis services including screening, diagnosis and treatment. Sexually transmitted disease (SDT) screening, diagnosis and treatment. Additionally, treatment of symptoms of a wide range of other communicable diseases is also covered even if ultimately, a communicable origin is ruled out.
2. To means Expressing motion directed towards and reaching: governing a n. denoting the place, thing, or person approached and reached from the Oxford English Dictionary, 1989 B Violation the affirmative goes beyond just giving disease assistance to Africa and does a variety of exclusively domestic initiatives the GHS is much broader than just public health assistance and includes barrier removal like loan repayment Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Educational debts are a major problem for many U.S. health personnel, and are a substantial impediment to doctorsand others who accrue similarly large debtsin pursuing volunteer or low-remuneration opportunities such as service abroad in support of the PEPFAR goals. Loan repayment programs are often used to attract health professionals to practice in areas designated as having a shortage of such personnel. In return for service, loan repayment programs offer a percentage of repayment on qualified educational loans with outstanding balances. Federal programs follow guidelines set forth by the Office of Personnel Management, but each agency has specific requirements for service and repayment. Some of the more common loan repayment programs include the NHSC, the U.S. Army Medical Department, and HRSAs Nursing Education Program. Many states also offer loan repayment programs in exchange for service in areas of need (OPM, 2005b). Student loan payments are usually paid directly to the lender, but the payment is included in the employees gross income and wages for federal employment tax purposes.
SDI 2007 5 Week
15 GHS Neg
Extra-T 1NC
C Reasons to prefer 1. Limits failure to act directly to Africa with all parts of the plan makes anything effectually topical. This destroys predictable preparation and undermines education on the core of the topic. 2. Ground allowing exclusively domestic policies skirts central negative ground on whether foreign assistance is good or bad and allows the aff to claim unpredictable domestic advantages and add-ons. 3. Extra-topicality is bad it proves the resolution insufficient and means the negative would never be able to win. Severance doesnt check because its too late and forces us to make bad pre-round strategic decisions. D. Voter Fairness, Education, and Jurisdiction
SDI 2007 5 Week
16 GHS Neg
Extra-T Violations
The GHS includes 6 components not all of them are exclusively assistance Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 As noted above, the GHS envisioned by the committee encompasses six interconnected programs. The committee believes this package of programs would significantly augment human resource capacity in support of the PEPFAR goals outlined earlier. The six programs are as follows: * Global Health Service Corps * Health Workforce Needs Assessment * Fellowship Program * Loan Repayment Program * Twinning Program * Clearinghouse
( ) Twinning is extra-t it includes bringing Africans to the U.S., not just unidirectional assistance, and lets the aff claim domestic advantages Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Twinning is a potentially useful tool for building human health care resource capacity in resource-limited settings. It can be particularly helpful when a twinning partnership has been established in a country, and the skills of health professionals can be rapidly engaged through this instant infrastructure (USAID, 2001). Such rapid mobilization of U.S. health professionals can fill an immediate need for workers, educators, and trainers while at the same time building a long-term relationship through multiple exchanges over the years. Partnerships whose outcomes involve prevention, treatment, and care for HIV/AIDS can be extremely useful in helping to achieve the PEPFAR goals. These relationships can take many forms, including publicprivate partnerships, as well as arrangements that involve governments, public health agencies, NGOs, hospitals, and universities. Moving skilled personnel from the United States to organizations in the PEPFAR focus countries offers the potential to build human resource capacity. Likewise, moving health professionals from a host country to a U.S. organization for specific forms of training can result in multiplying the host countrys health workforce, provided the training received abroad is appropriate and directly applicable. Recommendation 7: Promote twinning as a mechanism to mobilize health personnel. The committee recommends long-term, targeted funding for innovative, institutional partnerships that would mobilize U.S. health personnel to work in PEPFAR countries. Often called twinning, these bidirectional partnerships (which encompass counterpart organizations ranging from hospitals and universities to nongovernmental organizations and public health agencies) develop institutional capacities and create a sustainable relationship between the partners that extends beyond the life of the defined project. It is a bilateral arrangement that can develop collaboration in many areas but stands to be a particularly helpful instrument to augment teaching, training, and service capacities in combating HIV/AIDS. Twinning should be supported between a variety of U.S. and PEPFAR country-based institutions that are most relevant to meeting PEPFAR targets and harmonizing with PEPFAR country operating plans, especially public-sector
SDI 2007 5 Week
17 GHS Neg
Extra-T Violations
( ) Their author concedes that twinning lets the aff claim advantages external to assistance Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The benefits of twinning extend well beyond the assistance provided to the receiving organization. For the United States, participation in balanced relationships with developing countries serves as a form of public health diplomacy and promotes a positive image of American citizens around the world. Twinning also promotes organizational understanding and cooperation that might otherwise not occur (ICAD and Health Canada, 1999; NASTAD, 2004). On an individual level, participating U.S. health professionals benefit from the opportunity to use their skills in challenging and innovative ways; they also develop skills needed to work in different cultures, as well as in resource-constrained settings (NASTAD, 2004). Moreover, they often gain greater sensitivity to and understanding of immigration and refugee issues in the United States and among their patients. Health professionals participating in twinning programs are in a position to share their experiences with various audiences, raising awareness of HIV/AIDS around the world and at home. Finally, returning health professionals bring with them new perspectives and guidance for their own HIV/AIDS programs, which could translate into improved HIV/AIDS care in the United States (NASTAD, 2004).
SDI 2007 5 Week
18 GHS Neg
Substantial T 1NC
A Interpretation 1. Substantial means to a great or significant extent New Oxford American Dictionary, 2007,
www.oxfordreference.com/views/ENTRY.html?entry=t183.c76181
2. 30% is a good benchmark Joseph Ferraro, Partner, Clifford Chance Rogers & Wells, April 2002, Am. U. L.R., p ln
The Federal Circuit noted that, in this case, the specification defines "substantially increased" as an increase of at least thirty percent and provides reasonable guidance through the examples of how the increase should be measured. 534 The court also observed that the specification discloses suggestions for how long a "period sufficient" might be, and the parties agreed that a "period sufficient" could be determined by doing activity checks. 535 The Federal Circuit noted that, "when a word of degree is used the district court must [*691] determine whether the patent's specification provides some standard for measuring that degree." 536 In this case, the specification provided guidance as to what was meant by "substantial absence" with a reasonable degree of particularity and definiteness. 537 Accordingly, the Federal Circuit reversed the summary judgment of invalidity and remanded the case to the Court of Federal Claims. 538
B Violation the GHS only sends 150 people Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Recommendation 3: Establish a U.S. Global Health Service Corps to send key health personnel to PEPFAR countries on a full-time/long-term basis. The committee recommends the establishment of a full-salaried/ long-term U.S. Global Health Service Corps for the recruitment, placement, and support of U.S. health, technical, and management professionals in PEPFAR countries. Because of the critical and highly visible nature of this Corps and the necessity for it to coordinate closely with PEPFAR, the committee further recommends that it be established and administered as a program of the federal government. U.S. Global Health Service Corps professionals should be selected and deployed based on the prioritized needs identified by ministries of health in conjunction with in-country PEPFAR teams. Assignments will be made for a minimum of 2 years with placements in areas and programs where Corps members presence would have maximum impact on enhancing the human capacity to prevent and treat HIV/AIDS. The committee proposes an initial deployment of 150 U.S. Global Health Service Corps professionals in the 15 PEPFAR countries based on needs assessment, placement development, and the availability of professionals with the required skills.
C Reasons to prefer 1) Limits The aff explodes the topic to include millions of different cases which just send a few experts to deal with a particular problem in Africa. 2) Ground The aff interpretation guts links to generics, because the affirmative doesnt have to be a large change from the status quo this is supercharged because of the high level of aid in the status quo if the aff isnt big enough, the neg doesnt have a shot. 3) Education We should be discussing major policy changes in the way the U.S. interacts with Africa, not the minutia of various small public health proposals the aff detracts attention from the core of the topic. D. Voter Fairness, Education, and Jurisdiction
SDI 2007 5 Week
19 GHS Neg
Substantial T Violations
( ) PEPFAR already gives 15 billion dollars Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 During his State of the Union address on January 28, 2003, President George W. Bush announced the $15 billion PEPFAR initiative, with the following 5-year goals: (1) providing antiretroviral therapy for 2 million people; (2) preventing 7 million new HIV infections; and (3) providing care to 10 million people infected with or affected by HIV/AIDS, including orphans and vulnerable children. In May 2003, the U.S. Congress passed authorizing legislation (United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003) for the plan. Legislative provisions recommended the following targeted distribution of funds: treatment (55 percent), prevention (20 percent), palliative care (15 percent), and care of orphans and vulnerable persons (10 percent). This unprecedented global health initiative placed the United States at the forefront of international efforts targeting HIV/AIDS. Today PEPFAR accounts for more than 50 percent of annual global funding.
( ) The plan is a drop in the bucket its only 3.8% of Bushs proposed Global AIDS initiative Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 To ensure maximum impact, both the corps of health professionals and the funding for private sector support programs should be managed as a single program with a clear mission and identity. The US Public Health Service in the US Department of Health and Human Services, which has a long record of deploying clinicians as well as managing scholarship and loan repayment programs, would be the ideal home for the initiative. The Institute of Medicine report, indeed, proposes that these programs be launched together as the US Global Health Service constructed on key principles that would include country responsiveness, interdisciplinary approaches to program delivery, and training for self-sufficiency. Ultimately, each country will have to educate and maintain its own health workforce, but the aid of US health professionals would be welcomed in many developing countries as help in the crisis and as foundational assistance for the future. The Institute of Medicine report9 estimated the cost of a start-up US Global Health Service to be approximately $150 million a year, roughly 3.8% of the $3.9 billion proposed budget of the President's Global AIDS initiative for 2007or the cost of 18 hours of the war in Iraq.
( ) Plan is only 1% of PEPFAR Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The lack of skilled and trained health professionals is one of the principal barriers to the rapid scale-up of HIV/AIDS prevention and treatment programs in the PEPFAR focus countries (Adano et al., 2004; Wyss, 2004a, b). A range of skills is needed, particularly at the level of key clinical, managerial, and technical leadership positions essential to developing the infrastructure of HIV/AIDS treatment systems (WHO, 2002). Because of the specialized nature of these positions and the long-term requirements of the work, volunteer health professionals and those with short-term availability will be of limited utility in addressing core country-level needs. It would be the role of the Global Health Service Corps, working with public health leaders in the PEPFAR focus countries, to provide specialized health personnel for extended assignments to fill these positions and accelerate program scale-up. These highly skilled professionals would be full-salaried employees working in the 15 focus countries for extended periods, yet the cost of their salary and benefits is estimated roughly at only 1 percent of the total PEPFAR budget.
( ) The plan would only cost 4% of the PEPFAR budget Brenda Wilson, NPR Reporter, 4-19-2005, All Things Considered, p ln
WILSON: The total cost of the program in the first year is about $150 million, just 4 percent of what the president has asked for, for his global AIDS relief plan this year. If approved by Congress and if it proves successful, the global health service would be expanded to other countries.
SDI 2007 5 Week
20 GHS Neg
Increase T 1NC
A. Interpretation Increase means to become greater or larger, from the American Heritage Dictionary, 1985 B. Violation the plan is funded out of PEPFAR, which means theres no net increase in assistance just a change of form Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The lack of skilled and trained health professionals is one of the principal barriers to the rapid scale-up of HIV/AIDS prevention and treatment programs in the PEPFAR focus countries (Adano et al., 2004; Wyss, 2004a, b). A range of skills is needed, particularly at the level of key clinical, managerial, and technical leadership positions essential to developing the infrastructure of HIV/AIDS treatment systems (WHO, 2002). Because of the specialized nature of these positions and the long-term requirements of the work, volunteer health professionals and those with short-term availability will be of limited utility in addressing core country-level needs. It would be the role of the Global Health Service Corps, working with public health leaders in the PEPFAR focus countries, to provide specialized health personnel for extended assignments to fill these positions and accelerate program scale-up. These highly skilled professionals would be full-salaried employees working in the 15 focus countries for extended periods, yet the cost of their salary and benefits is estimated roughly at only 1 percent of the total PEPFAR budget.
C. Reasons to Prefer -1. Limits The aff expands the topic to include all affirmatives which just tinker with how aid is currently given, devastating negative predictability 2. Ground Net increases in assistance are the vital link to all negative ground, like aid bad disads, spending, politics, aid critiques, and modification CPs 3. Education the central question in the topic is whether the U.S. is giving a sufficient amount of aid now the affirmative interpretation dodges the core of the topic D. Voter Fairness, Education, and Jurisdiction
SDI 2007 5 Week
21 GHS Neg
Increase T Violations
( ) The GHS is part of PEPFAR, and only 1% of its budget Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The committee discussed these costs at length, appreciating that the investment required for a fully salaried, full-time/long-term professional would be substantial, and that many other health-related goods and services could be purchased for the same sum. On balance, however, the committee concluded that the investment in a small and specialized Corps that would play a pivotal role in ART scale-up and global health development is an equally important commitment on the part of PEPFAR and the United States. The committee notes further that a $37.5 million aggregate yearly investment represents approximately 1 percent of the current annual PEPFAR budget.
( ) The plan comes out of PEPFAR its 3.8% of Bushs proposed Global AIDS initiative Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 To ensure maximum impact, both the corps of health professionals and the funding for private sector support programs should be managed as a single program with a clear mission and identity. The US Public Health Service in the US Department of Health and Human Services, which has a long record of deploying clinicians as well as managing scholarship and loan repayment programs, would be the ideal home for the initiative. The Institute of Medicine report, indeed, proposes that these programs be launched together as the US Global Health Service constructed on key principles that would include country responsiveness, interdisciplinary approaches to program delivery, and training for self-sufficiency. Ultimately, each country will have to educate and maintain its own health workforce, but the aid of US health professionals would be welcomed in many developing countries as help in the crisis and as foundational assistance for the future. The Institute of Medicine report9 estimated the cost of a start-up US Global Health Service to be approximately $150 million a year, roughly 3.8% of the $3.9 billion proposed budget of the President's Global AIDS initiative for 2007or the cost of 18 hours of the war in Iraq.
( ) The GHS report was commissioned as part of PEPFAR Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 In this context, this report explores potential strategies for mobilizing U.S. health personnel and technical experts to assist in the battle against HIV/AIDS in 15 African, Caribbean, and Southeast Asian countries highly affected by the disease. Commissioned by the U.S. Department of State as part of a historic global health initiativethe Presidents Emergency Plan for AIDS Relief (PEPFAR)the report presents the results of a study conducted by the Institute of Medicines Committee on the Options for Overseas Placement of U.S. Health Professionals. In carrying out this study, the committee:
SDI 2007 5 Week
22 GHS Neg
***AT: Disease Advantage***
SDI 2007 5 Week
23 GHS Neg
1NC AT: Disease Advantage

( ) GHS is wildly insufficient to solve African health capacity a) SSA needs 1 million more workers Lincoln Chen, MD, Global Equity Initiative, Harvard, et. al., 11-26-2004, Human resources for Health, Lancet,
v. 364, iss. 9449, p. sciencedirect We estimate the global health workforce to be more than 100 million people. Added to the 24 million doctors, nurses, and midwives who are recorded, there are at least three times more uncounted informal, traditional, community, and allied workers. The enumerated professionals are severely maldistributed between regions and countries. Sub-Saharan Africa has a tenth the nurses and doctors for its population that Europe has: Ethiopia has a fiftieth of the professionals for its population that Italy does. With such wide variation, every country must devise a workforce strategy suited to its health needs and human asset base. Here, we cluster 186 countries into five groups (figure 3). Countries are grouped into low, medium, and high worker density clusters (<25, 2550, and >50 workers per 1000 population, respectively). The lowdensity and high-density clusters are further subdivided according to high and low levels of under-five mortality. In low-density countries, 45 countries are in the low-density-high-mortality cluster; these are predominantly sub-Saharan countries with the double crisis of rising death rates overwhelming weak health systems. The remaining 30 low density countries are mostly in Asia and Latin America, which are also the predominant regions of the 42 moderate density countries. Among high-density countries, 34 are in the highdensity-low-mortality cluster; these are all wealthy countries, mostly members of the Organisation for Economic Co-operation and Development (OECD). The remaining 35 high-density countries are transitional economies or exporters of medical personnel. All these countries, rich and poor, have numeric, skill, and geographic imbalances in their workforce. And all countries can accelerate health gains by investing in and managing their health workforce more strategically. While maintaining a global perspective, we focus on low-density-high-mortality countries because of their dire health situations. For all countries, our outstanding global challenges are as listed below. Global shortage There is a massive global shortage of health workers. We estimate the global shortage at more than 4 million workers approximately. Sub-Saharan countries must nearly triple their current numbers of workers by adding the equivalent of 1 million workers through retention, recruitment, and training if they are to come close to approaching the MDGs for health.
b) The aff gives 150 you can do the math Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Recommendation 3: Establish a U.S. Global Health Service Corps to send key health personnel to PEPFAR countries on a full-time/long-term basis. The committee recommends the establishment of a full-salaried/ long-term U.S. Global Health Service Corps for the recruitment, placement, and support of U.S. health, technical, and management professionals in PEPFAR countries. Because of the critical and highly visible nature of this Corps and the necessity for it to coordinate closely with PEPFAR, the committee further recommends that it be established and administered as a program of the federal government. U.S. Global Health Service Corps professionals should be selected and deployed based on the prioritized needs identified by ministries of health in conjunction with in-country PEPFAR teams. Assignments will be made for a minimum of 2 years with placements in areas and programs where Corps members presence would have maximum impact on enhancing the human capacity to prevent and treat HIV/AIDS. The committee proposes an initial deployment of 150 U.S. Global Health Service Corps professionals in the 15 PEPFAR countries based on needs assessment, placement development, and the availability of professionals with the required skills.
SDI 2007 5 Week
24 GHS Neg

( ) The GHS couldnt get enough workers the US has a doctor shortage, which also means they cant stop brain drain AFP, 5-15-2007, Who targets health brain drain, ABSCBN, http://www.abscbnnews.com/storypage.aspx?StoryID=77378 The problem was compounded by a shortage of doctors and nurses in rich countries, partly caused by growing demand from aging populations. Robinson said that the United States would need some 800,000 more nurses and 200,000 doctors by 2020, but faced a shortage that was likely to be filled from abroad. "Sometimes rich countries are declining to educate enough of their health workers," she added. Many African and Asian nations have strong health training but end up losing their investment when workers migrate. Meanwhile rich countries end up saving on training costs by attracting migrants, according to the WHO.
SDI 2007 5 Week
25 GHS Neg

( ) GHS doesnt stop the laundry list of factors undermining African health capacity and encouraging brain drain underinvestment, HR policies, worker death, bad education, recruitment, poor wages, fear of infection, bad equipment, stigma, and workload Holly J. Burkhalter, U.S. Dir. Physicians for Human Rights, 4-13-2005, Testimony, Congressional Quarterly,
p. ln The health worker shortage has multiple origins, including massive underinvestment in health systems, inadequate attention to human resource policies, the death of health workers and enormous burden of care created by the HIV/AIDS pandemic, and deficits in the health worker education system. These problems, in turn, underlie the large-scale migration of health professionals from Africa to wealthier countries, such as the United States and United Kingdom. In some countries, the majority of physicians are leaving, and the number of nurses emigrating has skyrocketed in the past decade. In the absence of comprehensive data, country examples and anecdotes highlight the scope of this "brain drain." As of 2001, only 360 of the 1200 physicians trained in Zimbabwe during the 1990s were still practicing in the country. In 2002/2003, more than 3,000 nurses trained in South Africa, Zimbabwe, Nigeria, Ghana, Zambia, and Kenya registered in the United Kingdom. In 1999, about as many nurses left Ghana as were trained there. It is frequently stated that more Malawian doctors practice in Manchester, England, than in all of Malawi. Brain drain is accelerated as wealthy nations, facing shortages in their own health workforces, actively and aggressively recruit health professionals from some of the countries that can least afford to lose them. This migration, or brain drain, is part of a more complex flow of health workers from poorer to wealthier developing countries, from the public sector to the private sector, including for- profits as well as NGOs and vertical AIDS programs, and from rural to urban areas. This last flow creates disparities within countries that in some cases are so great that they mirror the global disparities. For example, two regions in Ghana have only 34 nurses per 100,000 population, whereas another region has 120 nurses per 100,000 population. The physician disparity is greater still. One region in Ghana has only one physician per 100,000 population, while another region has 30 physicians per 100,000 population. Health workers are leaving, in large part, because they are unable to meet their own needs or those of their patients. Their wages are inadequate, sometimes not even enough to cover their basic living expenses. They have few opportunities to develop themselves professionally, and fear contracting HIV and other infections on the job, especially because they often lack the gloves and other protective gear. Poor management and planning, leading to including inadequate supervision, enormous workloads, late paychecks, and inadequate training, further harms health worker morale. Health workers are trained to heal, but because they lack sufficient medicines, supplies, and equipment, all too often they can do little more than minister to death. A key factor in the continent's brain drain of skilled health workers is the fact that hospitals and clinics in much of sub- Saharan Africa lack basic infection control, sanitation, and occupational safety. A survey by Physicians for Human Rights of more than 1,000 health workers in Nigeria suggested that fear of occupational exposure to HIV/AIDS contributes to stigma and discrimination against people with AIDS because health workers are afraid they will contract the virus from them. Even in Free State, South Africa, a recent survey conducted at children and maternity units, including labor and pediatric wards, in 30 hospitals found that 49% of health workers reported shortages of protective gear at some point during the course of the year. In Uganda, the Mulago Hospital - the country's major referral hospital - did not launch a comprehensive program of universal post-exposure prophylaxis until last month, and other Ugandan government hospitals have yet to do so.
SDI 2007 5 Week
26 GHS Neg

( ) Status quo will ramp up health capacity major WHO programs and U.S. legislation Nations Health, 5-1-2007, WHO establishes global task force to address health worker shortage, p ln
Facing a shortage of 4.3 million health workers worldwide, the World Health Organization recently launched a new international task force charged with reinvigorating efforts to invest in health worker education and training. Gathering for the first time in early March, the task force is studying the scope of financial and technical supports needed to addressthe substantial health worker gap, the links between training institutions and universities in developed and developing nations, and the use of technology to promote distance-learning, among other topics. The task force will operate under the auspices of the Global Health Workforce Alliance, which is administered by WHO and represents a partnership of various stakeholders. "HIV/AIDS, malaria and TB and maternal and child mortality ... will not be significantly reduced unless the crisis in health workers istackled," said Nigel Crisp, former chief executive of England's National Health Service and co-chair of the new task force, in a prepared statement. "There is an urgent need for a massive international effort to train more health care workers, including doctors, nurses, managers and community health workers." In Africa alone, the health worker shortage tops 1 million, WHO reported, with 36 of the 57 countries reporting critical health worker shortages in sub-Saharan Africa. Some countries, however, are seeing success in their efforts to ramp up the ranks of health workers. For example in Malawi, a six-year Emergency Human Resources Program hopesto double the nation's nursing ranks and triple the number of doctors in training, according to WHO. Legislation recently introduced in the U.S. Senate is also targeting global health worker numbers. In early March, Sen. Richard Durbin,D-III., introduced the African Health Capacity Investment Act of 2007, also known as S. 805, which aims to assist programs working to improve health care capacity in sub-Saharan Africa. "Africa is estimated to have only 10 percent to 30 percent of the training capacity it will require," said Eric Friedman, JD, a board member of the Global Health Workforce Alliance as well as a member of APHA's International Health Section. "So finding ways to rapidly and effectively scale up health worker education demands urgent attention, innovative solutions, new funding and political will, all of which the new task force should help mobilize."
( ) Other countries make AIDS spread inevitable, Africa isnt key World Health Organization, 2-24-2004, AIDS threat growing throughout Europe,
http://www.who.int/mediacentre/news/releases/2004/pr14/en/ AIDS is rapidly spreading in Eastern Europe and is on the rise again in Western Europe because integrated prevention and treatment programmes have not been sustained or do not exist. Countries in Eastern Europe, home to the fastest-growing epidemic in the world, will soon be on Europes borders following the European Unions enlargement on 1 May 2004. The Baltic States, which will soon be part of the EU, are also experiencing a rapid rise in HIV infections. Leading UN agencies, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank are calling on European Ministers to urgently take decisive action to prevent the further spread of AIDS across Europe and to treat those in need. They warn that young people and other groups, such as sex workers, men who have sex with men and injecting drug users, are particularly at risk of HIV infection. The agencies are participating in a Ministerial Conference hosted by the Irish EU Presidency, Breaking the Barriers - Partnership to fight HIV/AIDS in Europe and Central Asia, which opens today in Dublin. "Europe and Central Asia are at the centre of the fastest-growing HIV epidemic in the world. There is no time to waste - European Ministers must urgently scale up and roll out effective HIV prevention and treatment programmes," said Dr Peter Piot, UNAIDS Executive Director. Given that the EU will form the biggest trading bloc in the world, covering more than 500 million people, it is in the EUs best interest to prevent the AIDS epidemic from crippling Europes social and economic development.
SDI 2007 5 Week
27 GHS Neg

( ) The Africa AIDS epidemic is a based on faulty statistics, inaccurate tests, and propaganda Townsend Letter for Doctors and Patients, April 1, 2002, p. lexis
In spite of the facts, the myth that Africa is suffering a catastrophic AIDS epidemic still persists. Last year Newsweek joined the incessant proclamations that Africa is being ravaged by AIDS, citing "2.2 million [AIDS deaths] in 1998 alone." (27) One might be astounded at this figure, given that only 876,009 actual cases have been reported in 19 years. However, Newsweek is merely doing their duty by mindlessly repeating the estimates promulgated by WHO. (34) According to Stewart, WHO bases its estimates on the numbers of both positive tests and of AIDS cases reported by member states, "accepted at face value and, with rare exceptions, unvalidated." Estimates are extrapolated from this data using flawed mathematical models. Christian Fiala, an Austrian doctor who has extensively researched the global epidemiological data on HIV and AIDS, states that WHO produces its estimates by multiplying reported cases by a certain factor (on the reasonable assumption that actual cases are more than reported cases). However, this multiplication factor arbitrarily and inexplicably increases every year. In 1996 it was 12; only a year and a half later it had increased to 38! (34) Fiala states: "The well-known horror scenarios about an epidemic of a new infectious disease exist exclusively in the heads of the statisticians through untenable and escalating multiplications." Conclusion The huge (and alleged) AIDS epidemic in Africa is based on several factors which simply have no scientific basis: 1) WHO's faulty estimates, 2) nonspecific clinical case definitions, and 3) grossly inaccurate HIV antibody tests which simply do not work in Africa. According to AIDS authorities, 25.3 million Africans are doomed to die, but in reality, no one knows if a single one of them is infected with HIV.
( ) GHS fails IMF caps on health worker spending and US salary limits prevent the actual expenditure of funds Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
IMF macroeconomic policies intended to safeguard against inflation have literally prohibited expenditures and halted implementation of desperately needed PEPFAR and GFATM programs, and make it extraordinarily difficult to implement measures to retain sufficient health workers necessary to provide quality health coverage and meet program targets. While new health spending could theoretically contribute to inflation in desperately poor countries, the certain economic impact of 20-30% infection rates greatly outweighs potential harm. The US Treasury Secretary should move strongly to abolish IMF public spending ceilings on health and education in countries heavily affected by the AIDS pandemic. Likewise, limits placed by Congress or US agencies on public sector and recurrent salary support cause undue burdens to US global health initiatives, requiring burdensome waivers, work-arounds and regular rule-bending. Congress should provide every flexibility to US agencies working to support strengthen health systems adequate to scale-up access to care, treatment and prevention on a scale to meet US program targets. Agencies should roll back antiquated internal policies limiting public sector investments and salary support.
SDI 2007 5 Week
28 GHS Neg

( ) AIDS cant cause extinction its not genetically possible Richard A. Posner, Judge, U.S. Court of Appeals, 7th Circuit, Chicago Law Prof, 1-1-2005, Catastrophie,
Skeptic, http://goliath.ecnext.com/coms2/gi_0199-4150331/Catastrophe-the-dozen-most-significant.html#abstract) Yet the fact that Homo sapiens has managed to survive every disease to assail it in the 200,000 years or so of its existence is a source of genuine comfort, at least if the focus is on extinction events. There have been enormously destructive plagues, such as the Black Death, smallpox, and now AIDS, but none has come close to destroying the entire human race. There is a biological reason. Natural selection favors germs of limited lethality; they are fitter in an evolutionary sense because their genes are more likely to be spread if the germs do not kill their hosts too quickly. The AIDS virus is an example of a lethal virus, wholly natural, that by lying dormant yet infectious in its host for years maximizes its spread. Yet there is no danger that AIDS will destroy the entire human race. The likelihood of a natural pandemic that would cause the extinction of the human race is probably even less today than in the past (except in prehistoric times, when people lived in small, scattered bands, which would have limited the spread of disease), despite wider human contacts that make it more difficult to localize an infectious disease. The reason is improvements in medical science. But the comfort is a small one. Pandemics can still impose enormous losses and resist prevention and cure: the lesson of the AIDS pandemic. And there is always a lust time. That the human race has not yet been destroyed by germs created or made more lethal by modern science, as distinct from completely natural disease agents such as the flu and AIDS viruses, is even less reassuring. We haven't had these products long enough to be able to infer survivability from our experience with them. A recent study suggests that as immunity to smallpox declines because people am no longer being vaccinated against it, monkeypox may evolve into "a successful human pathogen," (9) yet one that vaccination against smallpox would provide at least some protection against; and even before the discovery of the smallpox vaccine, smallpox did not wipe out the human race. What is new is the possibility that science, bypassing evolution, will enable monkeypox to be "juiced up" through gene splicing into a far more lethal pathogen than smallpox ever was.
( ) No risk of a catastrophic AIDS impact scientists will find a cure Daniel J DeNoon, AIDS Cure Possible, Aug. 11, 2005, WebMD News, http://www.webmd.com/hivaids/news/20050811/aids-cure-possible-study-suggests A small human study may point the way to a cure for AIDS. Behind the stunning results is a totally new approach to HIV treatment. It makes use of an epilepsy drug -- valproic acid -- that flushes HIV out of its most remote hiding places in the body. Combined with powerful HIV drugs, the approach might totally eliminate the AIDS virus from the body. That promises a cure for AIDS, says study leader David M. Margolis, MD.
SDI 2007 5 Week
29 GHS Neg
2NC Ext #1 150 People

( ) The GHS puts a maximum of 1150 people in Africa David Brown, staff writer, 4-20-2005, Global Health Corps, Washington Post,
http://www.washingtonpost.com/wp-dyn/articles/A2446-2005Apr19.html The GHS hopes to make it easier for American medical workers to work abroad for longer and more useful periods. In a 199-page report, "Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS," the panel proposed an initial Global Health Service Corps of 150 members. They would be government employees who would be sent to one of the 15 target countries in PEPFAR -- 12 nations of sub-Saharan Africa, plus Haiti and Guyana in the Caribbean and Vietnam in Southeast Asia -- and would work there for three years, primarily as advisers and trainers to health ministries and organizations. In addition, the plan envisions about 1,000 people from various health fields receiving fellowships to work abroad for at least one year for $35,000. While the stipend would be less than what a person's regular job pays, the program would be designed to make motivated people believe they can afford to interrupt their career for such work. Ideally, the fellowships would expand their skills and marketability. "I think this gives them [the employees] some leverage that they never had before," said Andre-Jacques Neusy, the director of the Center for Global Health at New York University School of Medicine. A third component would provide money to newly trained physicians, nurses and other health professionals to pay back school loans. One year of work in an approved overseas AIDS program would earn $25,000 in loan repayment. The minimum commitment would be two years.
SDI 2007 5 Week
30 GHS Neg
2NC Ext #1 150 People AT: But, Fellowships = 1000 More

( ) 1000 more is still a drop in the bucket our evidence indicates that SSA needs one MILLION more doctors. Even if the GHS spurs local capacity building, its still totally insufficient to solve ( ) Even the fellowship program would only involve 1000 people max their author Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Selection of Fellows. The GHS Fellowship Program is meant to be selective and competitive, and the point system described above would allow only the most qualified professionals to receive awards. The point system would also ensure the awarding of fellowships to applicants who most closely meet the needs of a specific country. The selection process for the GHS Fellowship Program was modeled on that of the Traditional Fulbright Scholar Program, which has eligibility criteria including U.S. citizenship, a Ph.D. or equivalent professional/terminal degree (for professionals outside of academia, recognized professional standing and substantial professional accomplishments), relevant experience that corresponds to the level of work in the field, foreign language proficiency as necessary, and sound physical and mental health (CIES, 2005). Since its inception in 1946, the Fulbright program has provided more than 255,000 participants the opportunity to study and teach in each others countries. The program awards about 4,500 grants a year, and its alumni include Nobel and Pulitzer Prize winners, ambassadors, governors, senators, artists, prime ministers and heads of state, professors, scientists, Supreme Court justices, and many others (CIES, 2005). Number of Fellows. As noted above, the committee agreed that the Fellowship Program should start with 100 awards in the first year (about 6 per country, prorated by need), increasing to 1,000 awards by the third year of the program. Starting small would allow the infrastructure of the program to develop and would enable feedback from the first set of fellows to be incorporated into the program. The proposal to scale up to 1,000 volunteers per year is based on the fact that the Peace Corps deploys around 4,000 volunteers per year (Rieffel, 2003). As of September 2004, the Peace Corps had 7,733 volunteers abroad, 20 percent of whom (1,546) worked in the health sector. With the advent of PEPFAR in 2003, the Peace Corps2 committed more than 1,000 new volunteers to work on HIV/AIDS education, but still has not made meaningful inroads in meeting human resource needs (IOM, 2005; United States Peace Corps, 2005a). Similarly for comparison, the IHS employs 900 doctors (out of a total workforce of 15,000), who provide health services to approximately 1.5 million American Indians and Alaska Natives in 35 states (IHS, 2005). Assuming that IHS doctors make at least the median salary for a GS-15 employee in 2005 ($103,071), this program spends more than $92,700,000 each year on doctors alone (OPM, 2005a).
SDI 2007 5 Week
31 GHS Neg
2NC Ext #2 US Shortage

( ) GHS wont get enough people the US has a massive doctor shortage Anthony Gottschlich, Dayton Daily News, 1-29-2007, Reports warn of doctor shortage, DDN, ln
Several reports in recent months have predicted there will be a physician shortage in the United States in the next 10 to 15 years, particularly in primary care fields, such as family medicine and geriatrics. Estimates of the potential shortage range between 85,000 and 200,000 doctors nationwide by the year 2020. A number of factors are at play - lifestyle issues, rising practice expenses, lower reimbursements from insurance companies - but the bottom line is the number of physicians won't be able to keep up with a population that is both growing and aging. Exploring the issue is the task of the Ohio Physician Supply & Demand Consultation, a group of doctors, academics and other health care experts convened last fall by the Ohio Board of Regents. The group next meets on Feb. 5 in Columbus.
( ) U.S. has a serious shortage of doctors Chad Lawhorn, Journal World, 11-27-2006, Hospital recruiting a whole new game, ln
And it is not a stretch to say that recruiting physicians has become as competitive as attracting top NCAA basketball prospects. "In most physician specialties, there are pretty significant shortages," Meyer said. "If a physician is looking at an opportunity in Lawrence, he or she probably has job opportunities in at least 10 to 12 other communities." Doctor demand There are a lot of factors leading to a tight supply of doctors, said Cindy Samuelson, spokeswoman for the Kansas Hospital Association. Some of them are obvious, such as an aging population that is creating more demand for health care services. Others, though, have more to do with a new generation of doctors. Both Samuelson and Meyer said it is a widely held belief in the industry that more young doctors are choosing to work less than full-time hours. "It is part of that whole generation of individuals coming out of school," Samuelson said. "They don't live to work; they work to live. It is different than the (baby) boomer generation that worked, worked, worked and that is all they wanted to do." Samuelson, though, said some young people also may be choosing to take a pass on the once highly prestigious career of medicine because it has become clearer that it isn't everything it is made out to be in television shows. "These have always been lucrative careers where everybody wanted to be," Samuelson said. "It may be that they are not quite as desirable as they used to be because there is an awful lot of red tape to deal with. There is a lot of regulation when it comes to getting payment and dealing with insurance companies." Signs of a doctor shortage are starting to show up in statistics. According to a report prepared for the Kansas Hospital Association this year, the consulting firm The MHA Group estimates that by 2020 the country will have 200,000 fewer physicians than are needed to provide service.
SDI 2007 5 Week
32 GHS Neg
2NC Ext #2 US Shortage

( ) Its impossible to boost indigenous health capacity as long as the US keeps siphoning workers Laurie Garett, senior fellow for Global Health @ CFR, Jan/Feb 2007, The Challenge of Global Health,
http://fullaccess.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html Jim Leach, an outgoing Republican member of the House of Representatives from Iowa, has proposed something called the Global Health Services Corps, which would allocate roughly $250 million per year to support 500 American physicians working abroad in poor countries. And outgoing Senator Bill Frist (RTenn.), who volunteers his services as a cardiologist to poor countries for two weeks each year, has proposed federal support for sending American doctors to poor countries for short trips, during which they might serve as surgeons or medical consultants. Although it is laudable that some American medical professionals are willing to volunteer their time abroad, the personnel crisis in the developing world will not be dealt with until the United States and other wealthy nations clean up their own houses. OECD nations should offer enough support for their domestic health-care training programs to ensure that their countries' future medical needs can be filled with indigenous personnel. And all donor programs in the developing world, whether from OECD governments or NGOs and foundations, should have built into their funding parameters ample money to cover the training and salaries of enough new local healthcare personnel to carry out the projects in question, so that they do not drain talent from other local needs in both the public and the private sectors.
SDI 2007 5 Week
33 GHS Neg
2NC Ext #2 US Shortage No US Expertise

( ) Only 387 doctors in the U.S. even have experience in tropical diseases Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 After the Institute of Medicine (IOM) announced in a 1987 report, U.S. Capacity to Address Tropical Infectious Disease Problems, that only 300 people in the United States had the capability to diagnose and treat tropical diseases, ASTMH formed a committee to formulate recommendations for remedying the situation (IOM, 1987).2 It was clear that the United States had no truly excellent program offering the kind of diploma training course, including laboratory and overseas experiences, called for by the IOM report. The ASTMH committee recommended that an examination in clinical tropic medicine be administered and that a diploma in tropical medicine and hygiene be offered. ASTMH distributed a request for proposal to 370 U.S. and Canadian medical schools; 22 schools responded, and the proposals from seven U.S. and five overseas medical schools were accepted. Today, there are strict requirements for a diploma course and a separate two-month overseas course. Since 1995, 619 individuals have taken the examination, 412 have passed, and 387 have had the overseas experience.
( ) US students arent trained in public health wouldnt be uniquely good teachers Mark S. Smolinski, Dir. Global Health and Security Init @ NTI, et. al., 2003, National Acadamies, Microbial
Threats, http://www.nap.edu/openbook.php?isbn=030908864X To rebuild the public health workforce needed to respond to microbial threats, health profession students (especially those in the medical, nursing, veterinary, and laboratory sciences) must be educated in public health as a science and as a career. Even for students within schools of public health, education has traditionally focused on academic research training, not public health practice. A 1988 IOM report notes that many observers feel that some [public health] schools have become somewhat isolated from public health practice and therefore no longer place a sufficiently high value on the training of professionals to work in health agencies (IOM, 1988:15). A more recent IOM report states that in 1998, only 56 of 125 medical schools required courses on such topics as public health, epidemiology, or biostatistics (IOM, 2002e). The report recommends that all medical students receive basic public health training. It also concludes that all nurses should have at least an introductory grasp of their role in public health, and that all undergraduates should have access to education in public health. Educational strategies in which applied epidemiology programs provide exposure to state and local health departments may help increase awareness of the role of public health in population-based infectious disease control and prevention, and provide for exposure to public health as a potential career choice (see the later discussion on educating and training the microbial threats workforce). Pg. 162
( ) The U.S. doesnt have even close to an adequate number of infectious disease specialists Mark S. Smolinski, Dir. Global Health and Security Init @ NTI, et. al., 2003, National Acadamies, Microbial
Threats, http://www.nap.edu/openbook.php?isbn=030908864X The number of qualified individuals in the workforce required for microbial threat preparedness is dangerously low. For example, in 2001 the need for at least 600 new epidemiologists in public health departments across the United States was identified because of the requirements for bioterrorism preparedness alone. Yet only 1,076 students graduated with a degree in epidemiology in the year 2000 and are potentially seeking employment in government, academia, or private industry, and the largest percentage are trained in chronic disease, not infectious disease epidemiology. According to the National Association of City and County Health Officers, the most needed occupations between 1999 and 2000 were public health nurses, environmental scientists and specialists, epidemiologists, health educators, and administrative staff.
SDI 2007 5 Week
34 GHS Neg
2NC Ext #2 US Shortage AT: People Are Interested

( ) Well concede this argument they dont have a single card that says people would only join the GHS if it started in the U.S. if the primary motivation is financial, our CP solves just as well. ( ) Students are motivated enough to find opportunities it doesnt matter if the GHS is based in the U.S. Claire Panosian, and Thomas J. Coates, Medicine professors @ UCLA, 4-27-2006, The new medical
missionaries, NEJM, v. 354, no. 17, http://content.nejm.org/cgi/content/full/354/17/1771 Both students are eager to return overseas once they have a few more courses and clinical skills under their belts. And they are not alone. In 2003, at least 20 percent of students graduating from U.S. medical schools had participated in overseas activities related to international health during medical school, as compared with 6 percent of 1984 graduates.1,2 On many U.S. medical campuses, introductory courses in global health and related student-run interest groups are flourishing. Since 1991, the Global Health Education Consortium (GHEC) has helped to foster this growth of interest. A nonprofit organization representing medical schools in the United States, Canada, and Central America, the GHEC held a conference in 2005 entitled "Training the Global Health Workforce," which brought together students, academic leaders, and professionals from the nonprofit sector and the World Bank. The 2005 conference of the Association of American Medical Colleges (AAMC) also highlighted global health and featured an address by former secretary of state Madeleine Albright. The GHEC and the AAMC, in collaboration with the Foundation for Advancement of International Medical Education and Research, are now conducting a survey to learn more about organized international opportunities at U.S. medical schools. Groups such as the GHEC and the American Society of Tropical Medicine and Hygiene (ASTMH) also are advocating an updated, standardized curriculum in global health. Back on their campuses, internationally minded students are often inspired by peers who have already rotated abroad. Tuddenham and Benzekri, for instance, may look to Sagar Vaidya, an M.D.Ph.D. candidate who has volunteered at a rural clinic in Mexico and has also completed clerkships in India and Vietnam. Or Shilpa Sayana and her husband, Rishi Manchanda, residents in internal medicine who recently participated in a rollout of antiretroviral drugs in Durban, South Africa. Sayana grew up in Botswana and studied women's reproductive health in Egypt. Manchanda's rsum includes clinical stints in Botswana and Mozambique, plus a year in India studying primary care services. Such trainees will always find exciting international medical opportunities if they search hard enough and are willing to pay their own expenses. But their schools and residency programs rarely give anything more than moral support and elective credit. As a result, the few travel fellowships available to medical trainees are flooded with applicants each year. Last year, an ASTMH-sponsored program received 130 applications and awarded 10 student fellowships for projects in a variety of venues, including an entomologic field site in Senegal, a war-torn setting in Uganda, and a mobile, railroad-based hospital in India (see graph).
SDI 2007 5 Week
35 GHS Neg
2NC Ext #3 Capacity Alt-Causes

( ) Even ending the brain drain wouldnt put a dent in the health care crisis in Africa its not that big a deal AFP, 6-25-2007, Migration of doctors has limited impact on health care in poor countries, Agence France Press,
p. ln The migration of doctors and nurses from the developing to the developed world has only a limited impact on the crisis in health care in poor countries, the OECD said in a report Monday. The Organisation for Economic Cooperation and Development noted that increased immigration of medical personnel to the 30 industrialised economies in the OECD had sparked fears of a "brain drain" that is depriving poor countries of critically needed health professionals. But the OECD, in its 2007 International Migration Outlook, said its research showed that the "global health workforce crisis goes far beyond the migration issue." It said the number of immigrant medical workers in OECD countries represents "only a small fraction" -- 12 percent in Africa, for example -- of the needs of health care sectors in developing countirs, as estimated by the World Health Organisation. "In short, although stopping the flow, if this were indeed possible, would alleviate the problem, it would not by itself solve the shortage issue," the OECD maintained. The report argued for increased financial assistance from the developed world to health care sectors in poor countries and backed a WHO initiative to draft a "global code of practice" governing the international recruitment of medical personnel. The OECD report challenged the perception that health professionals are over-represented among skilled immigrants, noting that in 2000, 11 percent of nurses and 18 percent of doctors employed on OECD countries were foreign-born. Half of the immigrant doctors and nurses working in OECD members are in the United States, 40 percent in Europe and the rest in Australia and Canada. Filipino-born nurses and Indian-born doctors each represent about 15 percrent of all nurses and doctors in the OECD. But the OECD maintained that in countries such as India, the Philippines and China, which are big suppliers of overseas medical personnel, "the number of health professionals working overseas, although high, is low relative to the domestic supply and the number of doctors per person has not been strongly affected." It said that while most OECD countries try to make it easier for highly skilled professionals to immigrate, there are few migration programs specifically targeting health care workers.
( ) Too many alt-causes to brain drain Dr. Kimberly Hamilton, and Jennifer Yau, Migration Policy Institute, December 2004, The Global Tug-ofWar, http://www.migrationinformation.org/Feature/display.cfm?id=271 Beyond the fundamental challenges facing many source countries of health care migrants, such as political and economic instability and poor governance, there are other starting points for appropriate policy responses. Salaries and benefits are an obvious factor, given extreme wage differentials across countries. A 2002 survey led by human resource management and development expert Tim Martineau listed monthly salaries for physicians that range from US$50 in Sierra Leone to US$1,242 in South Africa. Wages in Canada and Australia are approximately four times those in South Africa. However, many experts emphasize that pay is not the sole motive for leaving the country. Other factors include poor work environments characterized by heavy workloads, lack of supervision, and limited organizational capacity. There are also environmental considerations; workplaces may be dangerous due to lack of sanitation and supplies to protect workers from diseases like HIV/AIDS and tuberculosis. This is occurring when much of the current international funding is narrowly focused on disease-specific programs rather than capacitybuilding to improve salaries, human resource management, and the procurement of basic medical supplies and much-needed in-country training. In many developing countries, health care needs require a broad grounding in public health. Training, however, in some source countries for medical professionals especially for physicians has tended to focus on advanced medical techniques. Graduates are unlikely to use such training or to make professional advances in these areas without moving to countries where medical technology is more readily accessible and used. Other factors in destination countries act as magnets for health workers in the developing world. With fewer people having children and individuals living longer, there has been a profound change in the industrialized world's age distribution, from Japan to Italy. As a result, there is a growing demand for health care workers, especially those who can provide assistance to the elderly. The US Department of Health and Human Services projects a possible lack of 275,000 nurses by 2010 in the US, and the UK's National Health Service has a goal of adding 20,000 more nurses by 2004.
SDI 2007 5 Week
36 GHS Neg

( ) Too many alt-causes to brain drain for the aff to solve Wisdom J. Tettey, Assis. Prof Comm @ U. Calgary, May 2003, Africas Options, SciDev,
http://www.scidev.net/dossiers/index.cfm?fuseaction=policybrief&policy=20&section=29&dossier=10 Africas brain drain is the product of various factors, both economic and political. Without doubt, a major factor in many professionals' decision to emigrate despite regional differences is economic. As the Chairman of the Kenya Medical Association has noted, "working conditions and poor remuneration of healthcare workers is not good and has led to brain drain and very poor working morale in health institutions". Poor pay combines with another significant, though under-articulated, aspect: lack of job satisfaction. With the exception of South Africa and some North African countries particularly Tunisia and Morocco this psychological factor stems largely from the absence of proper facilities and limited professional mobility. This can lead to frustration and, ultimately, a move to more conducive environments abroad. The absence of adequate facilities for post-graduate education also compels students to go abroad, with many African graduates choosing to stay on in OECD countries after graduation. On the political side, some academics have been pushed out by the authoritarian climate present in many African countries. Those unwilling to tone down their critical views can find themselves intimidated and harassed, and may seek refuge elsewhere. It is estimated that the United States is home to about 10,000 "exiled Nigerian academics". Devastating civil wars have also contributed to the erosion of Africa's intellectual capital. Over the last five years alone 20 countries have been plagued with civil war, forcing many citizens to flee, including highly qualified professionals. For example, 30 per cent of engineers, 20 per cent of university lecturers and 17 per cent of doctors have now left Sudan in search of safer havens. Finally, a recent study by the University of South Africa found that violent crime is the reason why 60 per cent of emigrants leave [South Africa], though this does not appear to be a significant cause of the exodus from most countries.
( ) The GHS alone doesnt remedy the root causes of the health worker crisis low pay, morale, work conditions, and weak management Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 What underlies the health workforce crisis? In many countries, including those with a high prevalence of HIV/AIDS, the inability to recruit and retain an effective, well-motivated, appropriately skilled health workforce stems not only from HIV/AIDS itself, but from other problems as well, including low pay and morale, poor work conditions, and weak management. Some workers experience a combination of understaffed workplaces, low compensation, and civil service or public expenditure reforms that prevent recruitment of new staff. In recent years, these factors have fueled a trend for some health professionals to move from the public to the private sector, to migrate internationally in pursuit of more favorable opportunities, or to abandon their profession altogether.
( ) Low pay is the critical factor in boosting health capacity aff doesnt remedy Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 In many countries, including those with high HIV prevalence, the inability to recruit and retain an effective, well-motivated, appropriately skilled workforce stems from a range of additional problems that include low pay, poor work conditions, and weak management. Some workers experience a triple bind: their workplaces are understaffed and their compensation packages woefully inadequate, but civil service or public expenditure reforms prevent recruitment of new staff or substitutes for missing colleagues (sometimes called ghost workers). In recent years, these factors have fueled the trends for some health professionals to move from the public to the private sector or to leave their professions altogether, as well as the above-noted trend to migrate internationally in pursuit of more favorable opportunities. The most common grievance of health workers is poor pay. Wages are often insufficient to cover personal and family needs. In addition, salaries may not be adjusted for rising inflation and may not be paid on time.
SDI 2007 5 Week
37 GHS Neg

( ) Increased training is only a bandaid health workers still want to leave Africa because theyre demoralized Laurie Garett, senior fellow for Global Health @ CFR, 1-25-2007, CFR On-The-Record, FNS, ln
But let me step back and put this in the bigger picture. For example, we have a program under way operated by Cornell University, Pfizer Corporation, Cornell Weill University, and so on, doing doctor training in Tanzania. There are similar efforts under way for funding nursing schools in different parts of the world. The problem with all of that -- and by no means do I think those efforts should stop. But the problem with all of them is that we don't have enough time to create a pool of doctors and nurses on the ground to offset the drainage rate, both the drainage in brain drain to other countries, and the drainage literally in deaths and demoralization. You know, we have surgeons, trained surgeons from Nigeria, from Ghana, from Zimbabwe, who are driving taxi cabs in London today, and probably here in New York. And they're driving taxi cabs because they're so demoralized by the situation in their home countries, and so underpaid in their home countries, that they're willing to actually give up their entire professional training just to live someplace that feels, you know, like a more comfortable place to live, even if it means something like driving a taxi cab. And this is ridiculous, this is just horrible. So I don't think that increasing the rate of training alone, particularly for the higher skilled nurses and physicians, is going to come close to solving the problem. It's going to be a small Bandaid. And I do think, though, that the U.S. government, in our Pax Americana backyard, should take a good hard look at the lessons to be learned from how Cuba is operating in the region and how Cuba has used the whole issue of health as its number one drive for external diplomacy and friendship in the region.
SDI 2007 5 Week
38 GHS Neg
2NC Ext #3 Capacity Alt-Causes Culture

( ) Cultural attitudes cause AIDS spread, health workers arent sufficient to solve The New Atlantis, Editors, Summer 2003, NEW ATLANTIS, Number 2, p. 91
African culture has also contributed to the spread of AIDS. Traditional practices such as widow cleansing, polygamy, wife sharing, and female circumcision all increase the chances of an individual contracting HIV, as does a male-dominated sexual culture, which subjugates womens health to the sexual enjoyment of men. In some parts of Africa, men view women as chattel and consider promiscuity proof of virility. There is no concept of marital rape in many African cultures, and women find it near impossible to convince their partners to wear condoms. One practice common in much of sub-Saharan Africa, dry sex, encourages women to dry out their vaginas in order to please their partnersthus increasing the chance of vaginal lacerations through which HIV can pass, and suppressing the bodys natural STDfighting mechanisms. Worse still, some African men believe that having intercourse with a virgin will cure AIDS, leading to an increase in sexual violenceincluding the horrifying and rampant rape of children and infants in sub-Saharan Africa. Such attitudes on the part of men make women, who are already biologically more likely to contract HIV, all the more vulnerable. Indeed, according to Dr. Patrick Orege, Deputy Director of the National AIDS Control Council in Kenya, up to 80 percent of infections among women occur in stable relationships in which the man has contracted HIV from another partner.
( ) African patriarchy causes AIDS spread Jennifer Brower, RAND Co-Project Director and Peter Chalk, RAND Political scientist in disease, 2003, The
Global Threat, http://www.rand.org/pubs/monograph_reports/MR1602/ Further exacerbating the situation is the patriarchy inherent in black South African society. Women are commonly regarded as inferior and akin to property, and expectations are for sex to be given whenever and however demanded. Such a duty, entrenched in years of tribal tradition, remains an integral feature of many rural communities and is one that is rarely, if ever, questioned. This ingrained gender structure has negatively affected the empowerment of women and, in so doing, undermined female options for refusing intercourse and/or insisting on safe practices such as the use of condoms.24 The sex trade has also emerged as a major vector for the spread of HIV in South Africa. Prostitutes are used widely throughout the country, something that is particularly true of long-distance truck drivers and ruralurban migrant mine workersboth of whom are forced to spend long periods of time away from their homes and families.25 Viral infection rates among these segments of the population have skyrocketed in recent years, both on account of the inherent dangers of multiple partners and the African preference for unprotected sex (commercial truck drivers are known to pay double for intercourse without a condom).26 During the next three to four years, the prevalence of HIV in the transportation and migrantconcentrated mining (as well as construction) sectors is expected to soar to at least 23 percent, and possibly as high as 29 percent, with prostitution use remaining one of the primary causes of transmission.27 Sexual Abuse and Violence Added to these various factors is a culture of sexual abuse and violence, which is now entrenched in southern Africa and is, in many ways, a product of the lack of female empowerment noted above. Rape has become increasingly common, especially among teenage boys who suffer little, if any, social stigmatization from engaging in the practice. Indeed, in many rural schools, jock rolling (gang rape) is regarded as cool and generally associated with the most popular and socially confident members of the local community. There has also been a major increase in sexual victimization on account of urban legends and myths.28 One of the most alarming such myths is the widespread belief that an HIV-infected male can cure his disease by having sex with a virgin. Forced sex between older men and young girls has, as a result, become increasingly common, especially in the viral endemic belts of KwaZulu Natal and Mpumalanga provinces.29 Overall, roughly 50,000 women are raped every year in South Africathree times the figure for the United States.30
SDI 2007 5 Week
39 GHS Neg
2NC Ext #3 Capacity Alt-Causes Stigma

( ) Cant solve Stigma, Condoms, and War Peggy B. Sherman and Ellwood F. Oakley, Professors of Legal Studies at Georgia State University.
Pandemics and Panaceas: The World Trade Organization's Efforts to Balance Pharmaceutical Patents and Access to AIDS Drugs, American Business Law Journal Winter/Spring, 2004 Social and traditional practices create great hurdles to making medicines accessible to all. The availability of lowcost antiretrovirals will not impact social customs. In many developing nations, there is an incredible social stigma attached to the AIDS disease, which causes those infected to keep it hidden and not seek testing or treatment, for fear of losing jobs, families, and friends. 226 Even prevention programs suffer because of the stigma associated with the disease. 227 Many religious groups oppose the use of condoms and believe in abstinence as the only acceptable form of prevention. For this reason and issues related to
cost, condom usage in many African nations is extremely low. Although the average South African has their initial sexual encounter at approximately fourteen or fifteen years old, if
Lack of education about the disease is also a contributing factor to people not seeking treatment. Many women in rural African villages do not know the names or symptoms of many sexually transmitted diseases. 229 This is particularly disturbing when compounded with the fact that in many cultures, women are not educated and are illiterate. Finally, armed conflict and political unrest in parts of Africa also undermine the ability to provide access to anti-AIDS medicines. 230 [*404] Clearly, reducing the price of drugs alone is not the sole solution to the problem of access to
such a teenager were to ask for condoms in an average clinic, let alone anti-AIDS drugs, he or she would be chastised and told to practice abstention. 228 medicines in developing countries. A holistic approach that addresses all the relevant hurdles is required. Without such efforts, the recent concessions by the United States and the
pharmaceutical companies are not liable to impact the AIDS pandemic significantly.
SDI 2007 5 Week
40 GHS Neg
2NC Ext #4 SQ Solves WHO

( ) The WHO is addressing global health worker migration now, especially in Africa AFP, 5-15-2007, Who targets health brain drain, ABSCBN, http://www.abscbnnews.com/storypage.aspx?StoryID=77378 The World Health Organization and a group led by former UN human rights chief Mary Robinson on Tuesday launched an initiative to stem the 'brain drain' of doctors and nurses from poor countries. A recent study cited by the WHO showed that the number of foreign-trained doctors has tripled in several industrialized countries in the past three decades, often including many health workers from poor nations. The brain drain siphons away nearly one quarter of the few African doctors available in the poorest parts of the continent, according to WHO data. The initiative is aiming for an international code of practice to protect the rights of migrant health workers and to address the social and economic impact of the drain from countries where health staff are desperately needed. "You have international protocols relative the movement of pineapples and sardines but nothing for people," Labor Secretary Patricia Sto Tomas told journalists. Robinson, who is also a former Irish president and now runs human rights pressure group Realizing Rights, said there was an urgent need to improve working conditions and pay in poor countries to ensure that they could hold on to the health workers they trained. "We cannot continue to shake our heads and bemoan the devastating brain drain from some of the neediest countries on the planet without forcing ourselves to search for, and actively promote, practical solutions," she said. One of the cornerstones of the new WHO Director General Margaret Chan's agenda is to strengthen health services in Africa. "You can't do that if health workers are leaving, and leaving vulnerable health systems that are not functioning well," Robinson said.
SDI 2007 5 Week
41 GHS Neg
2NC Ext #4 SQ Solves WHO

( ) The WHOs Treat, Train and Retain plan will boost human resources for disease prevention in SSA WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf In devoting the 2006 World Health Report to human resources for health, the World Health Organization has demonstrated its recognition of the centrality of the health workforce in global strategies to reach health and development goals. The report highlights the growing crisis of human resources for health (HRH), particularly in sub-Saharan Africa where there is an estimated critical shortfall of 0.82 million health workers in 36 African countries. This situation is exacerbated by the weakness of the current training output for Africa which is only 10% of what is needed. The report challenges the global community to fi nd ways to work together through alliances and networks, across health problems, professions, disciplines, ministries, sectors and countries to meet health workforce challenges. The World Health Organization has played a key role in the formation of a Global Health Workforce Alliance that aims to bring relevant stakeholders together to accelerate core country programmes. In addition, the deepening AIDS crisis in many subSaharan African countries has catalysed a specifi c focus on health workforce defi cits which pose a challenge to effective delivery of HIV services. The 2005 global commitment to scale up HIV services, with the aim of as close as possible to universal access to treatment for all those who need it by 2010, has created new urgency for intensifying global action to strengthen the health workforce. Both the fi nal report of the 3 by 5 Initiative 1 and the assessment report of the Universal Access Global Steering Committee 2 list the human resource crisis as one of fi ve key challenges to scaling up HIV services. Against this backdrop, the need for an approach to strengthen the health workforce in the context of HIV and AIDSand one that is aligned with broader action for health systems strengtheninghas become clear. In May 2006, an international consultation, attended by 134 delegates representing governments, health workers and their organizations, international agencies, development agencies, academic institutions and civil society organizations active in the fi elds of HIV and HRH, was held in Geneva to discuss a plan which would fulfi l this ambitious goal. The consultation gave defi nition to a proposed AIDS and health workforce plan dubbed Treat, Train, Retain (TTR), which comprises three elements: Treat (prevent, care and support)a package of HIV treatment, prevention, care and support services for health workers in countries affected by HIV. Train (and planning for HRH)measures to empower health workers to deliver universal access to HIV services that include pre-service and in-service training for a public health approach. Retainstrategies to enable health systems to retain health workers, including incentives, measures to improve occupational health and safety and to improve the workplace as well as initiatives to manage the migration of health care workers. The elements, which are mutually reinforcing, have been grouped for conveniencethere is some overlap between them. TTR should be seen as a menu of options which builds upon existing work in the fi eld. Its main function is to catalyse, coordinate and maintain the momentum of the different actors and programmes in this broad fi eld. It recognizes that a coherent approach for scaling up towards Universal Access will need to be broad and multifaceted and will depend on the scaling up of current initiatives both within and outside the AIDS silo. Country leadership and country ownership, and the embedding of TTR plans into broader planning and processes in the areas of HRH, development and poverty reduction will be central to the success of TTR. By addressing both the causes and effects of HIV and AIDS in relation to the health workforce, TTR is both an essential component of the strategy to scaling up towards universal access and will make an important contribution to strengthening human resources for health in countries affected by the epidemic.
SDI 2007 5 Week
42 GHS Neg
2NC Ext #4 SQ Solves Africa

( ) Comprehensive indigenous approaches are already emerging in Africa to boost health capacity WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf There is much that source countries can do, and are doing, to retain health workers and reduce the push factors for migration. Some of these are broader incentive schemes and strategies to improve the lives and working conditions of health workers, others relate more specifi cally to HIV and AIDS. Strategies to provide prevention, treatment, care and support as well as training and career development may also be seen as important retention strategies and are discussed in accompanying papers (Treat and Train). To date, most initiatives at country-level have been piecemeal and ad hoc, but the growing urgency of the health workforce crisis is catalyzing a more comprehensive approach, where retention strategies are part of broader plans to strengthen health systems. For example, the Governments of Malawi and Zambia have devised bold national strategies that operate at national and district levels including massive increases to health budgets, supplementing the salaries of health professionals, and educational and other soft incentives to retain health workers. For comprehensive health system plans to be sustainable they must be costed and funded, and embedded in national development plans. The Malawi Emergency Plan, for example, is included in the national Poverty Reduction Strategy Paper. This will require joint planning, and cooperation between HRH teams, National AIDS authorities and the relevant government ministries.
SDI 2007 5 Week
43 GHS Neg
2NC Ext #5 SSA Not Key

( ) The aff is insufficient to stop global insecurity due to AIDS multiple other areas outside Africa have accelerating infection rates P.W. Singer, Brookings Institution, Spring 2002, AIDS and International Security, Survival, v. 44, no. 1,
http://www.brookings.edu/dybdocroot/views/articles/fellows/2002_singer.pdf However, the direct impact of AIDS will certainly not be limited to Africa. Rather, the continent provides the prelude to the diseases likely progression in Asia, Caribbean, Central and South America, and the countries of the former Soviet Union.13 In all of these areas, infection rates are rising at steep rates, showing patterns disturbingly similar to those in Africa five to ten years ago. A number of nations hover just below the 5% infection rate. Once this point is passed, past experience has shown that the diseases spread accelerates rapidly and becomes difficult to control.14 Within Asia and the Pacific, AIDS is growing at a rate that by 2010 could surpass Africa in the total number of infections. Already, many Indian cities are at the 5% infection figure, while China should have over 10 million cases by 2010.15 HIV/AIDS also is spreading rapidly in Latin America, placing it third behind Sub-Saharan Africa and Asia in prevalence, with infection rates particularly high in Brazil and the Caribbean. The former Soviet Union (FSU) is certainly also a high-risk zone, in fact, with infection rising faster than any other region in the world. Ukraine already has a 1% infection rate, while the HIV positive population in Russia has doubled in just the last two years. Data is not so good in the Central Asian states, but infection rates there are assumed to be similarly high, due to problems of poverty, poor health care systems, and significant populations of intravenous drug users.16 The only region other than North America and Western Europe that is expected to keep a cap on the disease is the Middle East, primarily due to conservative social mores, but it is also experiencing infection growth in high risk populations such as IV drug users.
( ) Only a global approach can solve AIDS focusing on sub-Saharan Africa is insufficient Peter Piot, Exec. Dir. of UNAID, 7-18-2005, HIV and National Security,
http://www.cfr.org/publication/8428/hiv_and_national_security.html PIOT: I would like to end with a far more optimistic note, frankly, not because we are all going off to dinner, now, but because I think really, after twenty-five years in this epidemic nearly, that for the first time, lets say the stars are getting into the right alignment; is that how you say it in English? What I mentioned, there is so much more political leadership, there is so much more going on at the community level, there is so much more money, the key issue now is that leadership. I come back to that. Without leadership, and that your dollar can buy leadership, without that, were not going to make it. And thats why its so important that you, all of you, and the Council and the security community and so on, that we continue to hammer on that. We cant let it go, and when a country doesnt respond to AIDS, there is something like an international responsibility to say, Look, AIDS will not be solved anywhere until its under control everywhere. If you have one country, lets take Myanmar, Burma, where they have the worst-stage epidemic in Asia at the moment. HOLBROOKE: And Papua, New Guinea. PIOT: And Papua, New Guinea, in the Pacific. And if Burma is not bringing AIDS under control, then the great efforts that all its neighbors are doing at the moment are useless, because there will be a continuous expansion, export, of HIV throughout the region. So whats why it really requires a global approach. If there is one issue today, its that.
SDI 2007 5 Week
44 GHS Neg
2NC Ext #6 No SSA Aids

( ) Sub-Saharan AIDS is on the decline Peter Piot, Executive Director United Nations Program on HIV/AIDS, May 2006, UNAIDS,
http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH02_en.pdf The growing number of population-based HIV prevalence surveys in sub-Saharan Africa, new and improved HIV surveillance data globally and improved analyses in countries indicate that HIV prevalence in several countries is lower than had previously been estimated. National population-based surveys have been conducted in 20 countries since 2000. Nineteen of these are in sub-Saharan Africa, and they include some of the regions most populous countries (such as Ethiopia and South Africa). In countries that have conducted such surveys, the survey results have been incorporated into our analysis to generate the updated estimates in this report.
( ) AIDS is exaggerated faulty statistics political agendas and the pressure for foreign aid. Michael Glueck, M.D. award winning writer, and Robert Cihak, MD Discovery Institute Senior Fellow, past
president of the Assoc. of American Physicians and Surgeons, both are Harvard trained diagnostic radiologists, African AIDS: A Phantom Epidemic? Jewish World Review, Nov 18, 2005, http://www.jewishworldreview.com/1105/medicine.men111805.php3 In Africa, poverty, distance and isolation make accurate, continent-wide diagnosis and statistics impossible. As a result, most health and population statistics are estimates or guesses, often driven by political and cultural agendas and always driven by the need to generate more outside funding from wealthier regions of the world. Thus, the severity of just about everything gets "oversold." This is especially true for AIDS. Proper diagnosis can require trained medical people, medical history, physical examination, blood tests and sophisticated facilities. These are rare in most parts of Africa, and few Africans can afford this level of medical care even where it is available.
SDI 2007 5 Week
45 GHS Neg
2NC Ext #7 GHS Fails IMF/Salary Caps

( ) IMF macroeconomic policies prevent effective disbursement of US aid Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
External: Macroeconomic policy changes at the IMF are necessary to create fiscal space for health sector capacity building and human resources for health. IMF policies greatly hinder the ability of the US and other donor governments to support public health systems at the scale necessary to succeed. IMF policies render it impossible for national governments or donors to provide salaries adequate to retain needed health workers or managers. Public sector wage spending limits directly impact health and education, and imposed and enforced directly and, increasingly, implicitly by the International Monetary Fund and the World Bank, are barriers to US diplomatic and global health goals and must be explicitly replaced. The US Treasury Department should urge the IMF to adopt new policies that exempt health and education budgets from spending ceilings, and place inflationary concerns more appropriately in the context of the human health disaster of HIV/AIDS. Policies that limit public sector wages must be replaced with proactive policies in support of increases in public wage spending.
( ) US policies limiting public sector salaries destroy the effectiveness of US aid Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
Internal: US policies that limit public sector and recurrent support hamper US aid efforts. Congress should take steps to allow OGAC and GHC Directors maximum flexibility to take actions deemed necessary without burdensome waiver processes, and US agencies should repeal in-house limitations. Momentum behind addressing health worker crises presents an opportunity to rectify sometimes-arbitrary congressional limits on public sector investment and recurrent salary support. These policies have hindered the capacity of the U.S. to achieve health improvements such as scale-up of AIDS treatment. US agencies doing country-level work are forced to routinely bend rules or laboriously work around prohibitions against salary or public sector support in order to retain personnel necessary to fulfill program requirements. Policy makers should grant US aid programs the flexibility needed to strengthen overall health development so that US treatment and prevention targets may be realized. Investments directly in a countrys public health infrastructure bolster the health system; extend the reach of United States public diplomacy; and supports country ownership of plans to address healthcare worker shortages and health systems development.
( ) Even their authors admit the GHS is insufficient to solve the health capacity crisis it lacks a permanent staff Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
The GHC authors have recognized that trained healthcare workers in isolation are insufficient to address health crises. One useful addendum to the technical assistance capacity and value of the Global Health Corps that addresses some of the weaknesses of sporadic volunteer programs would be to include a permanent staff of 100-200 systems builders posted in-country to solve implementation problems and provide sustained support for health system strengthening. Technicians and managers could work with ministries of health and finance to address the lack of capacity in newly coordinated public and private sector health programs by developing and implementing strategic plans to train and sustain adequate numbers and mixes of healthcare workers, lab technicians, IT managers and supply chain managers. These permanent GHC postings can help train-up or provide TA for fledgling in-country health administrators, and make use of existing or underway needs assessments performed by WHO, USAID, PEPFAR, national planning bodies and other actors. These health systems czars are needed by OGAG or by Country Action Teams, and are valuable with or without a Global Health Corps.
SDI 2007 5 Week
46 GHS Neg
2NC Ext #8 No AIDS Impact

Humanity does not face extinction from disease Malcolm Gladwell, The New Republic, July 17 and 24, 1995, excerpted in Epidemics: Opposing Viewpoints, 1999, p. 31-32
Every infectious agent that has ever plagued humanity has had to adapt a specific strategy but every strategy carries a corresponding cost and this makes human counterattack possible. Malaria is vicious and deadly but it relies on mosquitoes to spread from one human to the next, which means that draining swamps and putting up mosquito netting can all hut halt endemic malaria. Smallpox is extraordinarily durable remaining infectious in the environment for years, but its very durability its essential rigidity is what makes it one of the easiest microbes to create a vaccine against. AIDS is almost invariably lethal because it attacks the body at its point of great vulnerability, that is, the immune system, but the fact that it targets blood cells is what makes it so relatively uninfectious. Viruses are not superhuman. I could go on, but the point is obvious. Any microbe capable of wiping us all out would have to be everything at once: as contagious as flue, as durable as the cold, as lethal as Ebola, as stealthy as HIV and so doggedly resistant to mutation that it would stay deadly over the course of a long epidemic. But viruses are not, well, superhuman. They cannot do everything at once. It is one of the ironies of the analysis of alarmists such as Preston that they are all too willing to point out the limitations of human beings, but they neglect to point out the limitations of microscopic life forms.
There will he no pandemic humans will adapt Malcolm Gladwell, The New Republic, July 17 and 24, 1995, excerpted in Epidemics: Opposing Viewpoints, 1999, p. 29
In Plagues and Peoples, which appeared in 1977. William MeNeill pointed out thatwhile mans efforts to remodel his environment are sometimes a source of new disease. they are seldom a source of serious epidemic disease. Quite the opposite. As humans and new microorganisms interact, they begin to accommodate each other. Human populations slowly build up resistance to circulating infections. What were once virulent infections, such as syphilis become attenuated. Over time, diseases of adults, such as measles and chicken pox, become limited to children, whose immune systems are still nave.
SDI 2007 5 Week
47 GHS Neg
2NC Ext #8 No AIDS Impact AT: Mutation

( ) No chance for airborne HIV or extinction scenario it would require a mutation beyond physical capacity of the virus. The New Republic, 7-17-1995, lexis
Then there is the problem of mutation. To become airborne, HIV would have to evolve in such a way as to become more durable. Right now the virus is highly sensitive to changes in temperature and light. But it is hardly going to do any damage if it dies the moment it is coughed into the air and exposed to ultraviolet rays. HIV would have to get as tough as a cold virus, which can live for days on a countertop or a doorknob. At the same time HIV would have to get more flexible. Right now HIV mutates in only a limited manner. The virus essentially keeps changing its clothes, but its inner workings stay the same. It kills everyone by infecting the same key blood cells. To become airborne, it would have to undergo a truly fundamental transformation, switching to an entirely different class of cells. How can HIV make two contradictory changes at the same time, becoming both less and more flexible? This is what is wrong with the Andromeda Strain argument. Every infectious agent that has ever plagued humanity has had to adopt a specific strategy, but every strategy carries a corresponding cost, and this makes human counterattack possible. Malaria is vicious and deadly, but it relies on mosquitoes to spread from one human to the next, which means that draining swamps and putting up mosquito netting can all but halt endemic malaria. Smallpox is extraordinarily durable, remaining infectious in the environment for years, but its very durability, its essential rigidity, is what makes it one of the easiest microbes to create a vaccine against. aids is almost invariably lethal because its attacks the body at its point of great vulnerability, that is, the immune system, but the fact that it targets blood cells is what makes it so relatively uninfectious.
SDI 2007 5 Week
48 GHS Neg
2NC Ext #9 Yes AIDS Cure

( ) Scientists are making breakthroughs now on a vaccine Anne A. Oplinger, National Institute of Health, 2-14-2007, Scientists Unveil,
http://www3.niaid.nih.gov/news/newsreleases/2007/b12antibody.htm In a finding that could have profound implications for AIDS vaccine design, researchers led by a team at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), have generated an atomic-level picture of a key portion of an HIV surface protein as it looks when bound to an infection-fighting antibody. Unlike much of the constantly mutating virus, this protein component is stable andmore importantly, say the researchersappears vulnerable to attack from this specific antibody, known as b12, that can broadly neutralize HIV. Creating an HIV vaccine is one of the great scientific challenges of our time, says NIH Director Elias A. Zerhouni, M.D. NIH researchers and their colleagues have revealed a gap in HIVs armor and have thereby opened a new avenue to meeting that challenge. The research team was led by Peter Kwong, Ph.D., of NIAIDs Vaccine Research Center (VRC). His collaborators included other scientists from NIAID and the National Cancer Institute, NIH, as well as investigators from the Dana-Farber Cancer Institute, Boston, and The Scripps Research Institute in La Jolla, CA. Their paper appears in the February 15 issue of Nature and is now available online. This elegant work by Dr. Kwong and his colleagues provides us with a long-sought picture of the precise interaction between the HIV gp120 surface protein and this neutralizing antibody, says NIAID Director Anthony S. Fauci, M.D. This finding could help in the development of an HIV vaccine capable of eliciting a robust antibody response.
SDI 2007 5 Week
49 GHS Neg
No Political Will To Fight AIDS

( ) Political will in Africa is insufficient to fight AIDS The New Atlantis, Editors, Summer 2003, NEW ATLANTIS, Number 2, p. 91
So far, some African leaders have resisted attempts to address Africas AIDS troubles, partially due to their resentment of Western technological superiority and a deep suspicion of Western motives. South African President Thabo Mbeki has pushed for an African remedy to the AIDS epidemic and denigrated Western solutions. He has claimed that AZT is toxic and has questioned the relationship of HIV to AIDS. In 2000, during municipal elections, Mbeki told South Africans that the West was exploiting Africans, using them as guinea pigs for their research, and that AIDS medicines constituted biological warfare of the apartheid era. Just this year, South Africa delayed signing an agreement with the Global Fund worth $41 million in donations because the government claimed it had not been approved first by the South African National AIDS Council. Libyan leader Muammar Khaddafi sounded a similar note at the African Union summit in Mozambique on July 13. He declared that AIDS was a peaceful virus and, along with malaria, was one of Gods forces defending Africa from recolonization: AIDS, AIDS, AIDS. We hear about nothing else. This is terrorism. This is psychological warfare. AIDS is a peaceful virus. If you stay clean there is no problem, Khaddafi said.
SDI 2007 5 Week
50 GHS Neg
Africa Says No To SHWs

( ) African countries will resist training substitute health workers view it as an insult to their professional pride Delanyo Dovlo, physician and HR specialist for health in Ghana, May 2005, Taking more than a fair share,
PLoS Med, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1140940 Physician shortages exist worldwide, but this study shows that the numbers of medical schools are very low in sub-Saharan Africa. Conventional medical training in tertiary hospitals is very expensive. Yet, instead of training new types of workers to match local needs, many countries in sub-Saharan Africa continue to adhere to such training out of professional pridethey are reluctant to been seen to be using less than the best type of health worker. Furthermore, professionals in these countries wish to retain reciprocal recognition of their qualifications by the developed worldanother obstacle to training new types of workers, who may not be internationally recognized. Professional associations and regulatory councils have resisted or limited the introduction of substitute health workers. Production of enrolled and auxiliary nurses, for example, was banned in some of the poorest countries (such as Zambia and Ghana), ostensibly to enhance the status of the professions even as health and economic indices receded and remaining professionals fled.
SDI 2007 5 Week
51 GHS Neg
Brain Drain Good

( ) African brain drain is good creates an incentive to train more workers, and doesnt damage overall capacity Dhananjayan Sriskandarajah, Institute of Public Policy Research, August 2005,
http://www.migrationinformation.org/Feature/display.cfm?id=324 In other cases, the departure of skilled workers is compensated for by the arrival of skilled workers from another country. As described in a special chapter in the OECD's 2004 Trends in International Migration, the classic case of this domino effect is of South African doctors moving to developed countries while being replaced by Cuban doctors. At the theoretical level, economist Oded Stark and others have argued that brain drain may lead to positive results. Even in the poorest of countries (Cuba may well be a good example), the prospect of being able to emigrate may increase incentives to acquire education and skills and induce additional investment in education. When this domestic "brain gain" is greater than the "brain drain," the net impact on welfare and growth may well be positive. In other words, even in the presence of a brain drain, the average education level of those who remain may be higher than it would have been without migration. While economist Maurice Schiff and others have shown that Stark's thesis is by no means proven beyond doubt, it is important to note that brain drain need not have negative impacts on a sending country's stock of education and skills. In addition, it is important to understand that brain drain can only tell part of the story about migration's overall impact on an economy or society. When all the other impacts of migration such as remittances, inward investment, technology transfer, increased trade flows, and charitable activities of diaspora communities are taken into account, the net impact may actually be positive. As discussed below, there is a pressing need to develop a more comprehensive balance sheet that can take into account all of these factors.
( ) Brain drain doesnt have a negative impact on health capacity new studies prove emigration spurs more training Kerry Howley, Reason Magazine, 7-1-2007, Out of Africa, p ln
LAST YEAR, AS Congress was wrangling over immigration policy, Sen.Sam Brownback (R-Kan.) proposed a simple solution to the U.S. nursing shortage: lift the cap on nursing visas. The proposal fizzled, but not before critics charged that such a policy would be cruel and irresponsible. A news story in The New York Times asserted that "the exodus of nurses from poor to rich countries has strained health systems in the developing world," where countries "are already facing severe shortages of their own." A new study has turned this assumption on its head. To test whether health worker emigration is hurting developing countries, Michael Clemens, an economist at the Center for Global Development and an expert on international migration, created and analyzed a database of health worker emigrants from Africa. To his surprise, Clemens failed to detect "any negative impact of even massive movements of health professionals out of Africa upon health worker stocks, basic primary health care availability, and public health outcomes." The African countries that send the most workers abroad, it turnsout, are educating many more doctors and nurses than they are employing. It's a mistake to assume that an Ethiopian physician who takes ajob in New York would otherwise be seeing patients in Addis Ababa. The shortages of working medical professionals to which the Times referred are a reality, but they reflect systemic problems, not a lack ofhealth care workers. For some would-be physicians, the opportunity to emigrate may be the driving force behind the decision to seek training. Denying visas to nurses in Mozambique may just result in fewer nurses overall. "Punishing emigration, restricting quotas, and banning recruitment," Clemens concludes, "may at best make no one better off and at worst make everyone worse off."
SDI 2007 5 Week
52 GHS Neg
Aid Confusion Turn

( ) Giving more individual aid is net worse it undermines comprehensive national capacity programs High-Level Forum on Health MDG, 11-15-2005, Best Practice Principles for Global Health Partnership
Activities at Country Level, High Level Forum through WHO, http://www.hlfhealthmdgs.org/Documents/GlobalHealthPartnerships.pdf At the same time, the proliferation of global health partnerships and funds over the last few years - alongside traditional donor activity - has raised new issues. GHPs are highly diverse in nature, scope and scale, and any attempt to compare them with the same yardstick has considerable limitations. Most are relatively small or very specialised. The main concerns at country level relate to a few major global health partnerships. Overall the collective impact of GHPs has created or exacerbated a series of problems at country level including: poor coordination and duplication among GHPs; high transaction costs to government and donors from having to deal with multiple initiatives; variable degrees of country ownership; and lack of alignment with country systems. The cumulative effect of these problems is to risk undermining the sustainability of national development plans, distorting national priorities, diverting scarce human resources and/or establishing uncoordinated service delivery structures. In addition, without increased support to help build health system capacity in almost all developing countries, the resources mobilised by global health partnerships and initiatives are unlikely to achieve their full potential. Longer-term there will be need to sustain the achievements realized through shorter-term support from GHPs. Evidence from studies of GHPs1 suggests a gap between the overall practice of GHPs at country level and internationally-recognised principles of effective aid, as set out most recently in the Paris Declaration on Aid Effectiveness (March 2005). Successful scaling up will require more aligned and harmonised approaches (for example, in relation to GHP application procedures, transfer of funds, management, monitoring, reporting and auditing).
SDI 2007 5 Week
53 GHS Neg
***Brain Drain Turn***
SDI 2007 5 Week
54 GHS Neg
1NC Brain Drain Turn

( ) GHS would make brain drain net worse and its insufficient to solve the health worker crisis in Africa Holly J. Burkhalter, U.S. Dir. Physicians for Human Rights, 4-13-2005, Testimony, Congressional Quarterly,
p. ln Responding to the Shortage: Training Health Professionals Is Not Enough Ambassador Tobias and his associates are attempting to address the health worker shortage and have made some innovative grants, such as supporting a Zambian scheme to offer incentives for urban doctors to relocate to underserved rural areas. But to the best of our knowledge, the American contribution to the African health work force has largely been limited to the training of health workers. The $150 million "twinning center" managed by HRSA, for example, is aimed at linking U.S. and African institutions for purpose of training. And the Institute of Medicine's soon-to-be-released report on the overseas placement of US health professionals recommends that a global health service be principally for the purpose of training African counterparts. Numerous contracts and grants have been made to train doctors and nurses in the use of antiretroviral therapy. But training alone is not the answer to the health work force crisis in Africa; indeed, it may even accelerate health worker flight. If working conditions, salaries, benefits, management and opportunities for health workers in their own countries are not also addressed, additional training simply makes it more likely that the newly skilled nurse or doctor will be recruited or seek out a job in the U.S., Canada, or Europe at a vastly higher salary. As Dr. Elizabeth Madraa, who organizes anti-retroviral therapy training for health workers in Uganda, stated, "We keep training and they go to NGOs (nongovernmental organizations) or abroad where they can get better money, then we have to train [more people] again." To recruit the vast numbers of students to nursing and medical school and prevent new graduates from leaving, national governments, donors, and international institutions must join forces to eliminate the "push factors" that discourage trained workers from staying home - the unsafe working conditions, low pay, poor supervision, absence of benefits, staggering work loads, and dearth of supplies, medicines, and equipment that sabotages worker satisfaction and patient health.
( ) Brain Drain jacks solvency US will continue to siphon off workers to fill its health care shortages Laurie Garrett, senior fellow for Global Health @ CFR, Jan/Feb 2007, The Challenge of Global Health,
http://fullaccess.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html The fact that the world is now short well over four million health-care workers, moreover, is all too often ignored. As the populations of the developed countries are aging and coming to require ever more medical attention, they are sucking away local health talent from developing countries. Already, one out of five practicing physicians in the United States is foreign-trained, and a study recently published in JAMA: The Journal of the American Medical Association estimated that if current trends continue, by 2020 the United States could face a shortage of up to 800,000 nurses and 200,000 doctors. Unless it and other wealthy nations radically increase salaries and domestic training programs for physicians and nurses, it is likely that within 15 years the majority of workers staffing their hospitals will have been born and trained in poor and middle-income countries. As such workers flood to the West, the developing world will grow even more desperate.
SDI 2007 5 Week
55 GHS Neg
Brain Drain Link

( ) The GHS makes brain drain net worse doesnt boost local incentives Gregg Gonsalves, March/April 2005, Are we in it for the long haul, The Body,
www.thebody.com/content/art13394.html In several reports over the past year, the drastic shortage of doctors, nurses, clinical officers and community health workers, has been described as one of the key factors in slowing the scale-up of antiretroviral therapy. But this shortage is also being acknowledged as one of the broader problems facing the health sector in developing countries. It is here that the twin needs to roll out ART quickly and to strengthen the overall health sector is being recognized. The recommendations for dealing with the shortage of health care workers though are varied and some have the potential of once again distorting the health care environment in developing countries. In particular, a bill proposed by Senator Bill Frist would send doctors as U.S. federal employees and private sector professionals as volunteers to developing countries. This new Global Health Corps, instead of providing incentives for local health workers now migrating in droves to richer countries to stay home, is yet another way that the U.S. will further weaken local capacity. As UNAIDS' Peter Piot has said: "Isn't it a bit absurd that we then send nurses and doctors to fill slots in Africa that have been emptied by our recruitment policies?"
( ) The plan causes more brain drain Kaiser Daily Health Policy Report, 4-20-2005, Politics and Policy,
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=29463 Reaction: An unnamed spokesperson for Global AIDS Coordinator Ambassador Randall Tobias said that officials are reviewing the report and that it is too early to provide a "timetable for action," the Journal reports. "Since we requested this report and on a short time frame, we certainly will waste no time reviewing its findings," she said. Some international health workers have called the proposal a "positive step," but they also "expressed concern" that it would be available only to PEPFAR focus countries, according to the Journal. UNAIDS Executive Director Peter Piot said the program should be linked to broader policy objectives, such as ensuring decent wages for health care workers in developing countries. He added that the partnership component of the program could exacerbate the brain drain of doctors in the developing world by recruiting health care professionals to better-paying jobs. "Isn't it a bit absurd that we then send nurses and doctors to fill slots in Africa that have been emptied by our recruitment policies?" Piot asked. Nancy Padian, associate director of the UCSF Global Health Sciences program, said that PEPFAR itself could contribute to the drain on health care professionals from countries highly affected by HIV/AIDS. Padian said that new PEPFAR-funded programs in Zambia and Botswana are attracting nurses and physicians who are being trained in Zimbabwe, according to the Journal.
SDI 2007 5 Week
56 GHS Neg
Brain Drain Link

( ) International aid programs boost salaries and poach workers pay way more than government jobs Laurie Garrett, senior fellow for Global Health @ CFR, Jan/Feb 2007, The Challenge of Global Health,
http://fullaccess.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html Compounding the problem are the recruitment activities of Western NGOs and OECD-supported programs inside poor countries, which poach local talent. To help comply with financial and reporting requirements imposed by the IMF, the World Bank, and other donors, these programs are also soaking up the pool of local economists, accountants, and translators. The U.S. Congress imposed a number of limitations on PEPFAR spending, including a ceiling for health-care-worker training of $1 million per country. PEPFAR is prohibited from directly topping off salaries to match government pay levels. But PEPFAR-funded programs, UN agencies, other rich-country government agencies, and NGOs routinely augment the base salaries of local staff with benefits such as housing and education subsidies, frequently bringing their employees' effective wages to a hundred times what they could earn at government-run clinics. USAID's Kent Hill says that this trend is "a horrendous dilemma" that causes "immense pain" in poor countries. But without tough guidelines or some sort of moral consensus among UN agencies, NGOs, and donors, it is hard to see what will slow the drain of talent from already-stressed ministries of health.
SDI 2007 5 Week
57 GHS Neg
Brain Drain Link Booster

( ) Each doctor is key linear risk of brain drain Delanyo Dovlo, physician and HR specialist for health in Ghana, May 2005, Taking more than a fair share,
PLoS Med, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1140940 For source countries with few physicians, the loss of even a single doctor often has a major impact on the health service [6]. In their analysis of the impact of the migration of health professionals, Martineau and colleagues state: The ultimate losers tend to be health services (and their users) in the remoter rural areas, as they come lowest in the pecking order of people's preferred working location [6]. And since it is the poorest citizens who live in the remoter areas, say the authors, it is they who are affected most by migration.
SDI 2007 5 Week
58 GHS Neg
Brain Drain Impacts

( ) Brain drain prevents building effective health care capacity Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 A second way in which the United States could play a key role in creating stability in the health sector of developing countries is by helping to end the brain drain. Developing nations often experience a chronic and sometimes severe loss of physicians, nurses, and other professionals to developed nations. Among other factors, this migration out of the focus countries is triggered by the failure of the United States and other developed nations to educate sufficient health professionals to meet their domestic needs (Stilwell et al., 2004). The developed countries then must rely on foreign-trained physicians and nurses to close their gaps in service. The resultant exodus of scarce human health care resources is a prominent barrier to building clinical cadres in the PEPFAR focus countries to assume the increased demands of HIV/AIDS, prevention, treatment, and care.
SDI 2007 5 Week
59 GHS Neg
Brain Drain Impacts

( ) Solving brain drain is the critical factor for boosting sub-saharan Africas health capacity Dick Durbin, senator, et al, 8-2-2006, S. 3775: African Health Capacity Investment Act of 2006,
http://www.theorator.com/bills109/s3775.html (12) The emigration of significant numbers of trained health care professionals from sub-Saharan African countries to the United States and other wealthier countries exacerbates often severe shortages of health care workers, undermines economic development efforts, and undercuts national and international efforts to improve access to essential health services in the region. (13) Addressing this problem, commonly referred to as `brain drain', will require increased investments in the health sector by sub-Saharan African governments and by international partners seeking to promote economic development and improve health care and mortality outcomes in the region. (14) Virtually every country in the world, including the United States, is experiencing a shortage of health workers. The Joint Learning Initiative on Human Resources for Health and Development estimates that the global shortage exceeds 4,000,000 workers. Shortages in sub-Saharan Africa, however, are far more acute than in any other region of the world. The World Health Report, 2006, states that `[t]he exodus of skilled professionals in the midst of so much unmet health need places Africa at the epicentre of the global health workforce crisis.'. (15) Ambassador Randall Tobias, now the Director of United States Foreign Assistance and Administrator of the United States Agency for International Development, has stated that there are more Ethiopian trained doctors practicing in Chicago than in Ethiopia. (16) According to the United Nations Development Programme, Human Development Report 2003, approximately 3 out of 4 countries in sub-Saharan Africa have fewer than 20 physicians per 100,000 people, the minimum ratio recommended by the World Health Organization, and 13 countries have 5 or fewer physicians per 100,000 people.
( ) Any other foreign assistance will be totally ineffective without efforts to reverse African Brain Drain Dick Durbin, senator, et al, 8-2-2006, S. 3775: African Health Capacity Investment Act of 2006,
http://www.theorator.com/bills109/s3775.html (25) Foreign assistance by the United States that expands local capacities, provides commodities or training, or builds on and enhances community-based and national programs and leadership can increase the impact, efficiency, and sustainability of funded efforts by the United States. (26) African health care professionals immigrate to the United States for the same set of reasons that have led millions of people to come to this country, including the desire for freedom, for economic opportunity, and for a better life for themselves and their children, and the rights and motivations of these individuals must be respected. (27) Helping countries in sub-Saharan Africa increase salaries and benefits of health care professionals, improve working conditions, including the adoption of universal precautions against workplace infection, improve management of health care systems and institutions, increase the capacity of health training institutions, and expand education opportunities will alleviate some of the pressures driving the migration of health care personnel from sub-Saharan Africa. (28) While the scope of the problem of dire shortfalls of personnel and inadequacies of infrastructure in the sub-Saharan African health systems is immense, effective and targeted interventions to improve working conditions, management, and productivity would yield significant dividends in improved health care. (29) Failure to address the shortage of health care professionals and paraprofessionals, and the factors pushing individuals to leave sub-Saharan Africa will undermine the objectives of United States development policy and will subvert opportunities to achieve internationally recognized goals for the treatment and prevention of HIV/AIDS and other diseases, in the reduction of child and maternal mortality, and for economic growth and development in sub-Saharan Africa.
SDI 2007 5 Week
60 GHS Neg
SQ Brain Drain To U.S. Small

( ) The U.S. only accounts for 6% of the brain drain from SSA Delanyo Dovlo, physician and HR specialist for health in Ghana, May 2005, Taking more than a fair share,
PLoS Med, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1140940 What they found was that more than 23% of America's 771,491 physicians received their medical training outside the country, mostly (64%) in low-income or lower-middle-income countries. A total of 5,334 physicians from sub-Saharan Africa are in that group, a number that represents more than 6% of the physicians practicing in sub-Saharan Africa now. Nearly 86% of these Africans practicing in the US originate from only three countries: Nigeria, South Africa, and Ghana. Of these, 79% were trained at just ten medical schools.
SDI 2007 5 Week
61 GHS Neg
AT: No Link SHWs Dont Migrate

( ) Substitute workers are still susceptible to brain drain, and not accepted in Africa Celia W. Dugger, NYT, 11-23-2004, Where doctors are scarce, ln
Though these workers can help countries cope with the lack of doctors, they are not a panacea. Increasingly, they, too, are being lured away from public health by higher paying jobs in the private sector. And expanding their ranks will not be simple. Typically, they receive three to five years of training after high school, depending on their level of specialization. They are taught to tackle basic public health problems killing the most Africans. Such programs have often run into determined opposition from influential surgeons and obstetricians. The use of paraprofessionals in Africa is not new. In 1975, after Mozambique gained its independence from Portugal, there were only 2 surgeons, 4 obstetricians and 80 doctors in a country of 14 million people. The government put hundreds of high school graduates through three years of training and dispatched them to rural areas. Then, in the mid-1980's, it began giving some of them two extra years of training in surgery. Many women were dying in childbirth simply because there was no one to do emergency Caesarean sections, a simple operation easily mastered through repetition. In the past two decades, Mozambique has managed to produce only 60 surgical technicians, but they still do most of the surgical procedures in rural areas where most people live. Last year, the country began training 27 more. ''The majority of countries in Africa don't accept these kinds of workers,'' said Fernando Vaz, the surgeon in charge of their education. ''They have doubts about their capacity. But this is a solution for Mozambique.''
SDI 2007 5 Week
62 GHS Neg
AT: Brain Drain Good Remittances

( ) Remittances arent enough to offset economic losses Mohamed A. El-Khawas, History and Poly Sci Prof @ UDC, 2004, Brain Drain, Med. Quarterly, 15.4, p.
muse Migration is also beneficial for some African countries because of the sizable remittances that migrants send home every year. In 1996, Egypt received about $2.8 billion, Morocco $2.2 billion, Algeria $1 billion, Nigeria $947 million, and Tunisia $736 million in remittances from their citizens working overseas.15 This is one of the largest sources of foreign exchange earnings for these countries. However, gains from remittances are not enough to offset Africa's huge financial losses. Many African countries continue to suffer from the loss of revenues from the taxes the expatriates would have paid every year if they worked at home. For example, the loss to South Africa was estimated to be about $1.4 billion in terms of GDP between 1994 and 1997.16
( ) Remittances are vastly insufficient to check the impacts of brain drain, and exacerbate inequality Ted Schrecker, MA, and Ronald Labonte, PhD, Oct-Dec 2004, Taming the Brain Drain, Intl J. of
Occupational and Envtl Health, v. 10, iss. 4, p. pq This pattern of emigration not only compromises efforts to build health systems; it also has dramatic economic consequences. Direct financial losses for countries such as Zimbabwe and Nigeria from training doctors who rapidly emigrate exceed tens of millions of dollars per year,10,19 losses that these economies, and their health systems, can ill afford to absorb. A single recruiting effort by the Canadian province of Alberta led to the emigration of doctors whose training cost South Africa an estimated $12.6 million.20 The Deputy Director-General of the International Organization for Migration pointed out in 2002 that: "[AJt a cost of $60,000 to train a medical doctor in the South and $12,000 for a paramedical, it may be said that the developing countries are 'subsidising' the OECD countries to the tune of some $500 million per year, and what is more, largely financed by . .. development aid."21 Remittances from migrs are sometimes identified as an important benefit of migration to richer countries: a recent World Bank study pointed out that the value of such remittances ($72.3 billion) in 2001 was considerably higher than the value of official development assistance,22 and that remittances represent a relatively stable source of foreign exchange. Whatever the general merits of this argument, its relevance to the brain drain of health professionals from southern Africa (probably from most developing regions) is seriously limited. Of the top 20 recipient countries ranked by remittances as a percentage of GDP, only two (Lesotho and Uganda) were in southern Africa.22 The long period of training means that remittances from health professionals may flow disproportionately to relatively well-off households, thus paradoxically increasing inequality in the country of origin. In addition, the costs of health professionals' emigration are far greater than just the direct costs of their training; they also include the reduced ability of health systems in the country of origin to deliver services and reductions in training and research capacity,23 both of which undermine long-term domestic economic and social development. We are unaware of any empirical studies that have taken these broader and longer-term outcomes into consideration, but it is highly unlikely that remittances will be sufficient to offset their costs.
SDI 2007 5 Week
63 GHS Neg
***AT: Soft Power Advantage***
SDI 2007 5 Week
64 GHS Neg
1NC AT: Soft Power Advantage

( ) PEPFAR solves 100% of this advantage its the largest commitment EVER, indicates the U.S. cares about Africa, and is geared towards building capacity. They dont have any evidence which draws a distinction between the amount of aid given in the status quo and the aff PEPFAR.gov, 2007, Latest 2007 PEPFAR Treatment Results, http://www.pepfar.gov/press/85520.htm
The Presidents Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) has supported life-saving antiretroviral treatment for approximately 1,101,000 men, women and children through bilateral programs in the Emergency Plans 15 focus countries in sub-Saharan Africa, Asia and the Caribbean. * PEPFAR is on track to meet its five-year goal of support for treatment for 2 million HIV infected people. * Before President Bush announced PEPFAR in 2003, it is estimated that only 50,000 people in sub-Saharan Africa were receiving antiretroviral treatment. These latest results underscore Americas commitment to work in partnership with host nations to turn the tide against HIV/AIDS. * These results are not fundamentally the work of the American people, but represent the dedication and commitment of individuals, communities and nations to take control of the HIV/AIDS epidemics in their countries. * The Emergency Plan was the first quantum leap in Americas leadership on global HIV/AIDS. America has kept its promise, and continues to lead the world in its level of support for effective partnerships against HIV/AIDS. * PEPFAR works with host nations to build capacity in-country: more than 80 percent of partners are indigenous organizations. The U.S. Presidents Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) is the largest commitment ever by a single nation toward an international health initiative a five-year, $15-billion, multifaceted approach to combating HIV/AIDS around the world. PEPFAR employs the most diverse prevention, treatment and care strategy in the world, with an emphasis on transparency and accountability for results. The goals of the Emergency Plan include support for treatment for 2 million HIV infected people, support for prevention of 7 million new infections, and support for care for 10 million people infected or affected by HIV/AIDS.
( ) SSA isnt key to soft power theyre the only ones left that love the U.S. Jim Lobe, Washington Bureau Chief of IPS, 6-28-07, Survey: US Image Abroad Still Sinking, Antiwar.com,
Accessed on 7-12-07, http://www.antiwar.com/lobe/?articleid=11211 The survey, which included more than 45,000 respondents interviewed in 46 countries and the Palestinian Territories (PT) during April and early May, found that the U.S. retains great popularity (roughly twothirds or more rate it favorably) only in Israel and most of sub-Saharan Africa. But its standing among its western European allies, most of Central and Eastern Europe, Latin America, as well as the Islamic world and most of Asia, including China, has continued to fall, particularly compared to five years ago on the eve of its invasion of Iraq, according to the survey.
SDI 2007 5 Week
65 GHS Neg

( ) Soft power is irrecoverable plan is a drop in the bucket and cant stop Bushs ideology Strobe Talbott, President of Brookings, 12-18-2006, How Bush Can Fix His Policy Failures, Financial Times,
http://www.brookings.edu/views/op-ed/talbott/20061218.htm After the terrorist attacks of September 11 2001, the administration squandered an instantaneous, international outpouring of goodwill. It rejected an unprecedented offer from Nato to deploy troops alongside US forces in Afghanistan and used the 9/11 attacks on the US as a pretext for attacking Iraq, in part by "connecting the dots" between Afghan-based terrorism and Iraqi totalitarianism, even though the two phenomena were separate and hostile to each other. The Iraq invasion was the high-water mark of Bush unilateralism and the low-water mark of America's standing in the world's eyes. In the months and years ahead, the US will need maximum participation and trust from the international community, especially for the "diplomatic offensive" recommended by the Baker-Hamilton Study Group on Iraq. That will require not just a new approach to Iraq but an overhaul of US foreign policy. Yet the reluctance with which Mr Bush gave up on his effort to keep John Bolton as US ambassador to the United Nations suggests either that he does not understand the extent to which Mr Bolton personified the administration's contempt for the world bodyor, worse, does not care. Whatever course the president chooses in Iraq, he will need the UN. He should appoint a new UN ambassador who is both inclined and empowered to strengthen an institution that the US has systematically undercut in recent years. With this in mind, Mr Bush should early in the New Year meet Ban Ki-moon, incoming secretary-general, and help him establish, on behalf of the world body, the best possible relationship with the Congress. Another welcome step would be for the US to stop boycotting the new Human Rights Council at the UN, a successor toand improvement onthe old Human Rights Commission that Eleanor Roosevelt helped establish. The administration needs to find other ways of making clear that it respects international law. Mr Bush insulted many friends around the world by "unsigning" a treaty establishing the International Criminal Court. At a minimum, the administration should abandon efforts to flout the Geneva and torture conventions and deny habeas corpus to detainees. Having used Saddam Hussein's prisons to torture some prisoners captured by the coalition, and having sent others to countries where they were likely to be tortured, the US should close its detention facility in Guantnamo Bay, or make it Geneva-compliant. Along with the UN and other international institutions that the US played a key role in building after the second world war, the global arms control and nonproliferation regime is in jeopardyagain, in large measure because of Bush administration policies. Since 2001, the US has withdrawn from the Anti-Ballistic Missile Treaty, watered down the strategic arms reduction process, allowed the Comprehensive Test Ban Treaty to languish unratified and done considerable damage to the Nuclear Non-proliferation Treaty. Remedial steps could include: returning to negotiations with Russia on significantly lower levels of nuclear weapons; actively seeking a moratorium on the production of fissile material; and backing away from its flirtation with the idea of developing new bunker-busting warheads that would require testingand therefore breaking with the CTBT. The fate of the Kyoto Protocol on climate changewhich Mr Bush pronounced "dead" in 2001might seem extraneous to challenges such as dealing with terrorism, Iraq and the meltdown of US policy in the greater Middle East. In fact, however, the administration's obstructionism and obscurantism on global warming has, for more than five years, come to symbolise what much of rest of world resists in the style and substance of US leadership. Vigorous administration support for US legislation to limit heat-trapping gases would be a step towards a negotiated international agreement. Even the most determined optimist (and such are hard to find in Washington these days) realises that the challenge of Iraq and its region will be with usall of usfor years. Any steps Mr Bush can take to restore a form of American leadership that others are prepared to follow will not just be doing his successor a favour, but also the American people and his own legacy as well. Surely, if there is anything Mr Bush wants more than to stick by his guns, it is to avoid having his presidency end in unprecedented failure.
SDI 2007 5 Week
66 GHS Neg

( ) Aid to Africa is totally insufficient to boost US soft power its a form of traditional diplomacy that doesnt even make the radar screen of global publics who hate us Jeffrey Gedmin, director Aspen Inst., and Craig Kennedy, Pres. German Marshall Fund, Winter 2003,
Selling America, short, National Interest, http://findarticles.com/p/articles/mi_m2751/is_74/ai_112411720 Traditional diplomacy can only go so far. The United States must bring its case to European publics more effectively, both to advance their understanding of U.S. policies and to support those European political leaders and intellectuals who are willing to take the increasingly unpopular stand of backing America. In each of the ten countries that supported the U.S. position on Iraq, public opinion was mostly unified and strongly opposed to the U.S.-led intervention. It may be that more effective public diplomacy, increased shuttle visits by top officials and clearer, more cogent explanations of U.S. positions could at least mitigate the hostility that erupted recently against the United States. In the case of Iraq, a senior White House official conceded to one of us, "It was the American President versus Saddam Hussein, and the Iraqi dictator won in the court of world opinion." This was not for lack of ammunition on the American side. The United States has undertaken many "Europe-friendly" initiatives, and communicating them during this same period would surely have helped win the struggle for European public opinion. President Bush conferred with the Europeans on Bosnia and Kosovo during his first year in office and refrained from withdrawing American troops. He followed Europe's advice again with regards to Russia, pursuing greater partnershin and constructive dialogue with President Vladimir Putin. In addition, Bush has launched a major initiative to combat AIDS in Africa. He has called for a major increase in the foreign aid budget. He has worked assiduously to reach out to America's Muslim community, repeatedly declaring that the war on terror is not a conflict with Islam itself. The President has paid his country's UN arrears, announced the United States would rejoin UNESCO, tackled Afghanistan's problems with a multilateral coalition of ninety nations and sought, at least initially, to resolve the problem of Iraq at the UN Security Council. That little of this news has penetrated European debates was sorely evident when the Italian newspaper La Repubblica described President Bush as "Texas's 'eternal youngster'", arguing that he sees the world as "his family ranch, full of mustangs to tame with America's lasso." If there is a need to get good news out, there is an equally pressing need to knock down slander of the United States in a comprehensive and timely fashion. Misled by their own media and mischievous politicians, many Europeans still believe Americans have tortured prisoners at the Guantanamo Bay facility. European outrage exploded after the Pentagon mistakenly released a photo showing prisoners shackled and blindfolded--reasonable precautions taken while the detainees were being transported. Everyone seemed to hear voices like those of Spain's El Mundo, which decried Guantanamo as reminiscent "of the torture centers in Eastern Europe during the Cold War." No one seemed to hear the voices of Red Cross workers and French and British representatives who had visited the detainees and found no evidence of mistreatment at all, as Joshua Muravchik noted in the December 2002 issue of The American Enterprise. Even in influential European circles, considerable misinformation persists about America and the looting of the Iraqi National Museum, about alleged U.S. atrocities in Afghanistan and about America's role in Saddam Hussein's weapons of mass destruction program. When a Vanity Fair reporter mischaracterized an interview conducted with Deputy Secretary of Defense Paul Wolfowitz in May 2003, headlines around the world proclaimed that a top U.S. official had finally admitted the truth: the intervention in Iraq was really about American greed for oil. It should be the job of American public diplomacy to challenge such shoddy journalism before popular opinion on a given issue is allowed to solidify. TRADITIONAL diplomacy is not quick and deft enough to address these challenges, Foreign Service Officers frequently lack the necessary skills for such tasks, and institutional constraints often inhibit "rapid reaction." On a range of issues--such as the need for pre-emption, the development of international law, the prospect of reforming the UN Security Council and the idea of what precisely constitutes an "imminent" threat in the post-9/11 world--a substantive transatlantic debate is desperately needed and long overdue. These sorts of challenges require serious intellectual combatants. This means a critical mass of writers, thinkers and diplomats who can engage editorial boards, join the television talkshow circuits, participate in Internet chatrooms, operate websites--not to mention debate Europe's scholars, business leaders and university students alike. Above all, it means developing a broader, nonpartisan network of like-minded individuals on both sides of the Atlantic who are dedicated to the cause of keeping the idea of the West and its ever expanding community of liberal democracies alive. Though times have changed, and the context may be different, institutions like the Congress of Cultural Freedom once worked. Perhaps it is time to consider what additional lessons history can offer.
SDI 2007 5 Week
67 GHS Neg
2NC Ext #1 SQ Solves Soft Power

( ) The U.S. is already the world leader in boosting health capacity Jack C. Chow, MD, Dep. Assis. Sec. for Intl Health and Science, December 2001, Diplomacy is Central,
http://usinfo.state.gov/journals/itgic/1201/ijge/gj02.htm The U.S. government is the leading provider of direct assistance to developing countries in building health system capability. Several U.S. agencies, including the Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH), support the in-country training of doctors, researchers, epidemiologists, and health professionals, and provide technical assistance on establishing and maintaining systems. In the area of international health, the role of the Department of State is to advance U.S. objectives and interests in establishing a healthier world community through diplomacy. In recognition of the growing challenge in spurring action against HIV/AIDS and other major diseases, the department has created the new Office of International Health Affairs (IHA) within the Bureau of Oceans, International Environmental, and Scientific Affairs. This new office, building upon the previous Office of Emerging Infectious Diseases, is the State Department's focal point for global health affairs, linking and coordinating actions by governments, nongovernmental organizations (NGOs), private companies, and health communities.
SDI 2007 5 Week
68 GHS Neg

( ) U.S. is already using health diplomacy in Central America Eric Green, USINFO staff writer, March 2007, U.S. Health Diplomacy Advances Social Justice, USINFO,
http://usinfo.state.gov/xarchives/display.html?p=washfileenglish&y=2007&m=March&x=200703281104591xeneerg0.1764948 The United States is using health diplomacy to advance social justice in Central America. The goal is to give Central Americans in rural areas and poor neighborhoods the chance to receive better health care. The Bush administration says advancing social justice refers to helping the tens of millions of working poor in the Americas escape poverty. The administrations health diplomacy efforts include the creation of a U.S.-backed regional training center for medical personnel in Panama. Mike Leavitt, secretary of the U.S. Department of Health and Human Services, said the center is scheduled to be inaugurated formally in June. Leavitt signed a letter of intent March 20 with his Panamanian counterpart, Camilo Alleyne Marshall, for the training center. The centers faculty will consist of health care experts from Central America and Health and Human Services.
( ) PEPFAR already indicates U.S. commitment to health Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 During his State of the Union address on January 28, 2003, President George W. Bush announced the $15 billion PEPFAR initiative, with the following 5-year goals: (1) providing antiretroviral therapy for 2 million people; (2) preventing 7 million new HIV infections; and (3) providing care to 10 million people infected with or affected by HIV/AIDS, including orphans and vulnerable children. In May 2003, the U.S. Congress passed authorizing legislation (United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003) for the plan. Legislative provisions recommended the following targeted distribution of funds: treatment (55 percent), prevention (20 percent), palliative care (15 percent), and care of orphans and vulnerable persons (10 percent). This unprecedented global health initiative placed the United States at the forefront of international efforts targeting HIV/AIDS. Today PEPFAR accounts for more than 50 percent of annual global funding. PEPFAR now encompasses HIV/AIDS activities in more than 100 countries, but is focused on the development of comprehensive and integrated prevention, care, and treatment programs in 15 countries: Botswana, Cote dIvoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Vietnam. The original 14 countries in Africa and the Caribbean represent 50 percent of the worlds HIV/AIDS burden. Vietnam was added to the list in July 2004 as a result of its projected eight-fold rise in HIV infections from 2002 to 2010 (Office of National AIDS Policy, 2004).
SDI 2007 5 Week
69 GHS Neg

( ) Bushs plan to double PEPFAR funding would cost 30 billion dollars US Department of State, 8-6-2007, The United States and International Development: Partnering for
Growth, http://www.state.gov/r/pa/prs/ps/2007/aug/90348.htm President Bushs Emergency Plan for AIDS Relief (PEPFAR) continues to fight the pandemic around the world. Before the G8 Summit in June 2007, President Bush announced his intention to work with Congress to reauthorize PEPFAR. The five-year, $30 billion proposal would double the initial $15 billion commitment made in 2003, which is already the largest international health initiative dedicated to a specific disease. Building on prior success and in partnership with the host nations, PEPFAR has supported antiretroviral treatment for over 1.1 million people through March 2007. Additionally, in Fiscal Year 2006, PEPFAR supported prevention outreach to 61.5 million people, and cared for more than 4.5 million people living with HIV/AIDS worldwide, including over 301,000 who received treatment and care for tuberculosis and more than 2 million orphans and vulnerable children. These results demonstrate important progress towards the 5year goals of supporting antiretroviral therapy for at least two million people, supporting prevention of seven million new infections, and supporting care for 10 million people infected with or affected by HIV. The Emergency Plan works in over 120 countries worldwide with a focus on 15 of the most afflicted countries in Africa, Asia, and the Caribbean. In Fiscal Year 2007, the Emergency Plan is committing an additional $4.6 billion to the global fight against AIDS. If Congress supports the Presidents request for Fiscal Year 2008, for an additional $30 billion planned over the next five years, the American people will have committed $48.3 billion over 10 years to fight global HIV/AIDS.
SDI 2007 5 Week
70 GHS Neg
2NC Ext #2 SSA Not Key Soft Power

( ) Plan isnt big enough, and SSA isnt key their link evidence all assumes a GLOBAL GHS, not one narrowly targeted to sub-Saharan Africa. Nothing in the plan assuages people in Europe or the Middle East who hate us. ( ) Africans view the US much more favorably and like US foreign policy PBS, 6-27-2007, Global Discontent with US Increasing; US Works to Bolster Image, Online News Hour
Transcript, http://www.pbs.org/newshour/bb/politics/jan-june07/abroad_06-27.html JUDY WOODRUFF: And we want to make sure the audience knows this is not universal; there are parts of the world that see the U.S. more favorably, Africa. ANDREW KOHUT: Yes, what our conclusion is, that in many parts of the world, anti-Americanism has deepened, but it hasn't widened. In Africa, for example, we still see Africans expressing favorable views of the United States; in Ivory Coast, 88 percent; in Kenya, 87 percent. Large numbers of Africans saying good things about the United States generally, and when we ask them about the influence of the United States in their country, they say positive things. JUDY WOODRUFF: Talk about what's driving these attitudes. I mean, clearly everybody immediately thinks about the war in Iraq. But what is it? What do you see that's behind it? ANDREW KOHUT: Well, it's the war in Iraq, it's the war on terrorism, all of the cornerstones of American foreign policy are disapproved of in large parts of the world. We see ever smaller percentages of people in Europe, for example, supporting the war on terrorism. And that chart shows in Britain that the percentage fell from 69 percent in 2002 to 38 percent; in France, from 75 percent to 43 percent, and so on. And in the Muslim world, there's never been much support for the war on terrorism. You know, it manifests itself with respect to specific policies. We now not only see calls for withdraw from Iraq, but near majorities in most European countries and Canada saying we want our troops out of Afghanistan. There's great concern about American policies.
SDI 2007 5 Week
71 GHS Neg
2NC Ext #3 Soft Power Alt-Causes

( ) U.S. soft power is through the floor massive changes by the Bush administration are needed Pamela Hyde Smith, research assoc. @ GWU, Ambassador to Moldova, Winter/Spring 2007, The Hard Road
Back to Soft Power, Politics & Diplomacy, http://journal.georgetown.edu/72/smith.swf?INITIAL_VIEW=100 Much of the world today views the United States negatively, considering it dangerous and unpredictable. Recent polling overseas confirms the continuation of the downward slide in global public opinion that gathered force with the2000U.S. elections and accelerated sharply in 2003 with the invasion of Iraq. 1 Current approaches to building support for U.S. policies and American values, from the State Departments worldwide public diplomacy to the Defense Departments public affairs activities in war zones, have failed to reverse negative attitudes so severe that they thwart the United Statess ability to achieve its foreign policy objectives. Anti-American forces are taking advantage of the collapse of U.S. popularity across the globe, making anti-Americanism a national security threat. The U.S. government should take a series of immediate steps to regain American credibility overseas. The Bush administration must revise some of its signature policies and moderate its style of international discourse in order to regain the goodwill the United States previously earned. Much more emphasis on public diplomacy is essential. Additionally, Con- gress and the executive branch should use the next two years to restructure the apparatus of governmental soft power instruments, making them more effective and powerful.
SDI 2007 5 Week
72 GHS Neg

( ) Laundry list of other reasons tank soft power NPR, 3-23-2007, Bush Team Explores Use of 'Soft Power', p. pq
JACKIE NORTHAM: The new movement on the diplomatic front comes at a low point in the Bush administration. Many analysts say the quagmire in Iraq, U.S. saber rattling at Iran, and the controversial practices and policies employed at Guantanamo Bay have reduced the prestige of the U.S. and its leverage abroad. James Carafano, a senior research fellow with the Heritage Foundation, says shuttle diplomacy, like that now being pursued by Secretary of State Condoleezza Rice, is unlikely to reverse these problems.
( ) Tons of other reasons soft power is down Sankar Sen, Frmr. Dir. Indian Nat. Police Academy, Statesman, 4-5-2005, American Power, p ln
Indeed anti-American sentiment is sweeping the world after the Iraq war. It has, of course, been aggravated by the aggressive style of the present American President. Under George Bush, antiAmericanism is widely thought to have reached new heights. In the coming years the USA will lose more of its ability to lead others if it decides to act unilaterally. If other states step aside and question the USA's policies and objectives and seek to de-legitimise them, the problems of the USA will increase manifold. American success will lie in melding power and cooperation and generating a belief in other countries that their interests will be served by working with instead of opposing the United States. It is aptly said that use of power without cooperation becomes dictatorial and breeds resistance and resentment. But cooperation without power produces posturing and no concrete progress. There is also another disquieting development. It seems American soft power is waning and it is losing its allure as a model society. Much of the rest of the world is no longer looking up to the USA as a beacon. Rising religiosity, rank hostility to the UN, Bush's doctrine of preventive war, Guantanamo Bay etc are creating disquiet in the minds of many and turning them off America. This diminution of America's soft power will also create disenchantment and may gradually affect American pre-eminence.
SDI 2007 5 Week
73 GHS Neg

( ) Cant solve soft power only a complete revamp of Bushs policy can reverse antiamericanism Strobe Talbott, President of Brookings, 12-7-2006, Bush Foreign Policy, Brookings,
http://www.brookings.edu/views/speeches/talbott/20061207.htm The reason President Bush changed approach was, quite simply, that Iraq was going badly, Afghanistan seemed stuck, and support for his foreign policy was eroding at home. The administration also belatedly recognized how much help it need from rest of world. That was the backdrop for a trend toward restoration of more moderate, multilateralist foreign policy in the second term. But there has been a sense of tentativeness, of tactical fine-tuning rather than strategic readjustment, a sense of course-correction rather than course-reversal. We saw evidence of that in recent days in the
reluctance with which President Bush gave up on his determination to keep, as his ambassador to the UN, John Bolton, who has been the personification of in-your-face unilateralism. Let me give you my own view on what it would takenot to "solve," perhaps, but to managethe foreign policy problem from hell. Let me also be clear: this is not a prediction of what the administration will do; rather, it's a prescription for what I believe it should do. What's needed now is nothing less than a broad-gauge overhaul of American foreign policy commensurate with, necessary to, supportive of a change in policy on Iraq itself. It should start with recognitionand this is not a matter of semantics; it's a matter of political realismthat we're enmeshed in a civil war in Iraq and civil wars, by definition, require political solutions. The greater reliance on diplomacy that everyone seems to agree is necessary must include negotiation with regimes we don't like for good reasons, especially Syria and Iran, because we need them to rein in the militias. It must also include repairing relations with allies and friends. We must strengthen international institutions we have weakened, starting with the UN. Now that Mr. Bolton is out, the President should appoint someone who would personify respect for what is good and admirable and supportive of U.S. interests in the UN's legacy, its potential, and its utility I'd even say its indispensability to us in the years ahead. It should also not be someone closely identified with Iraq policy to date. The administration should conduct the earliest possible meetings at the highest possible level with new Secretary-General Ban Ki-moon, and help him establish the best possible relationship with the Congress. These are steps of immediate relevance to the challenge we face in Iraq and the Middle East. No less important is a range of other steps we should take to restore American leadership of the international system. We should do so in arms control and nonproliferation by strengthening treaty regimes which, like UN, we have weakened. I would stress the importance of the Strategic Arms Reduction process, the Nonproliferation Treaty, and the Comprehensive Test Ban Treaty. That would be: reducing our strategic arsenal as soon as possible to the limits set by the so called Moscow Treaty and returning to
negotiations with Russia on significantly lower levels of nuclear weapons and the elimination of tactical nuclear weapons. As for the NPT, we should work to get India, Pakistan, and the five Treaty-approved nuclear-weapon states to join in a moratorium on the production of fissile material pending verifiable Fissile Material Cutoff Treaty. Let me give extra attention to the CTBT. The refusal of the Republican-controlled Senate to ratify the CTBT in October 1999 was a dark day in the history of this country. That was seven years ago. Much has been written lamenting the irony and the folly of what happened then. But nothing is more eloquent or astute than what Johnny Applewhose memorial service took place two days agowrote for the front page of the New York Times at the time: "The Senate's decisive rejection tonight of the Comprehensive Test Ban Treaty was the most explicit American repudiation of a major international agreement in 80 years, and it further weakened the already shaky standing of the United States as a global moral leader. Not since the Versailles Treaty was voted down in November 1919, an action that was repeated in March 1920, has so far-reaching an accord been turned down." The Bush administration made clear, soon after coming into office, that it would let the CTBT languish. I realize the administration is, to put it mildly, unlikely now to embrace the treaty. But at least it should back off hints of that the U.S. may break out of the CTBTthat is, begin testing againin order to develop a new generation of nuclear weapons. And the new Congress, along with the NGO sector, should do everything possible to lay ground work for ratification of the CTBT early in next administration. That is a goal that I believe would have bipartisan support,
There should also be an unambiguous American endorsement of international lawnot later, but now. With regard to the International Criminal Court, the best thing would be to return to the U.S. position of September 2000. That would mean resigning the Rome treaty that Clinton signed and Bush "unsigned"a gratuitous insult to many of our friends around the world
since there are plenty of Republicans who recognize the importance of the treaty and the self-destructiveness of what the Senate did seven years ago.
whose help we are going to need. Again, that's unlikely to happen. But there should be no doubt about the damage we do ourselves by remaining outside the ICC. At a minimum, we should abandon efforts to negotiate immunity for U.S. forces, especially since we have, in those negotiations, little "leverage"to return to that word in the conference topicfor getting our way in that regard, as in so many others. Another salutary step would be to engage actively and constructively with the new Human Rights Council at the UN. We're in the position now of not even having a delegate on the council. The country of Eleanor Roosevelt is on the sidelines of the effort to breathe new life into the Human Rights Commission that she was so instrumental in establishing. This is not just a shameit's an absurdity. Speaking of international law and human rightsand coming back to Iraqthere's the question of treatment of prisoners. We should make a commitment to adhere to the Geneva Conventions and move affirmatively to restore habeas corpus rights to terrorist detainees. And since we're so focused on exit strategy for Iraq, let's have one for Guantanamo as well: either make it Geneva-compliant or close it down in way that ensures its inmates aren't sent to places, like Syria, where the conditions will be even worse. I'm now going to put one more issue on the table: climate change. That may seem extraneous to dealing with terrorism and Iraq and the meltdown of U.S. policy in the Greater Middle East. I include it on the list for two reasons: first, because a new policy on global warming is important in its own right; second, it's important as evidence of a new foreign policy in general. The Bush administration's obstructionism and obscurantism on global warming has become symbolic of what much of rest of world resents and resists about the substance and style of leadership. We can't launch an effective "diplomatic offensive" in the Middle East if a key aspect of our global diplomacy is offensive to much of the worldand, by the way, to many of our own citizens. We all understand that the administration doesn't like Kyoto. But you can't beat something with nothing, and at the national level, our policy on this issue is almost wholly negative. There should be an active search for successor to the Kyoto Protocolmaybe the Mumbai Protocol, or the Shanghai Protocol. It would be a step in a negotiated international agreement with binding limits for the administration to support, here at home, legislation to limit heat-trapping gases. It could do so by taking a page from what Governor Schwarzenegger is doing in California and what Senator McCain and Lieberman were able to get majority support for in the Senate with the GOP in control.
SDI 2007 5 Week
74 GHS Neg

( ) US credibility is irrecoverably shot laundry list of issues mean the damage is done, no matter what we do USA Today, 6-19- 2006, Bush coming to a Europe with an overwhelmingly negative view of America, AP,
http://www.usatoday.com/news/world/2006-06-19-bush-europe-trip_x.htm Abu Ghraib. Guantanamo. Haditha. America's problems with Iraq are casting a long shadow over President Bush's meeting with European Union leaders this week. The gathering is restricted to U.S. officials and the European Union leadership, and the agenda focuses on Iran's nuclear ambitions, agricultural subsidies and the West's dependence on imported oil and gas. But the United States' precarious world standing will be the unspoken theme of Wednesday's session in Vienna. Ahead of the visit, National Security Adviser Stephen Hadley said he doubted Bush would have much to say about the U.S. prison for terror suspects at Guantanamo Bay, allegations of prisoner abuse in Iraq and alleged killings of Iraqi civilians by Marines in Haditha. For millions of Europeans, however, these are the issues that matter and their concerns are shared by politicians. Austrian Chancellor Wolfgang Schuessel, whose country holds the rotating EU presidency, plans to urge Bush to close Guantanamo. Peter Pilz, a senior member of Austria's Green party, says Schuessel should tell Bush "that the criminal actions of his government will not be tolerated in Europe." Pilz is one of Austria's more outspoken public figures. Still, his sentiments that the U.S. is breaking the law in Iraq and in its larger fight against terror are shared by many Europeans angry over the Iraq invasion, recent suicides at Guantanamo and the reported existence of secret CIA prisons worldwide. Newspaper editorials reflect Europe's dismay with a partnership most here see as has having gone wrong. "Those who came as liberators, those who wanted to bring the rule of justice ... lost their moral credibility in Iraq," wrote the German weekly Die Zeit. "Not just a few soldiers have 'lost their control' as they like to say. America's entire Iraq policy is out of control." In France, the newspaper Le Monde wrote of the Guantanamo suicides: "We continue to ask by what heavenly decree America holds itself above the rule of law." Young people, like Andrej Mantei of Berlin, are even more scathing. "I don't think it's possible that anybody could make worse foreign policy than Bush," he says. And even many older people are critical, unlike a few decades ago, when they equated America with the war against Nazi Germany, postwar reconstruction and the shield against the Soviet Union. "I think Bush was wrong, and he should have remorse," said Rosa Sarrocco, 80, of Rome. "The recent events ... have had a further negative impact on my opinion of America." America's image problems in Europe are reflected by a survey done by the Pew Research Center for the People & the Press and released last week. Favorable opinions of the United States ranged from a high of 56% in Britain to a low of 23% in Spain. Even in Britain, support for Bush was only 30%, and 60% of British respondents said the Iraq war has made the world less safe. Pro-U.S. sentiment is stronger in much of formerly communist eastern Europe, where Washington's contribution to toppling Soviet dominance lingers in many minds. It peaks in Kosovo, whose ethnic Albanian majority gratefully remembers the U.S.-led bombing in 1999 that forced Serb troops from the province. "Till I die, I will support whatever America does, be it in Iraq, Afghanistan or elsewhere," says Arben Shaqiri, a 25-year-old bartender in Pristina, Kosovo's main city. But "Old Europe" is more critical. There have always been trans-Atlantic rivalries, but the divide has grown: The end of the Cold War removed the threat that had united America and Europe since World War II. It's partly a reflection of two societies drifting apart as the continent seeks to preserve its model of free college education, universal health care, seven-week holidays and other social programs that reflect a different emphasis from the American work ethic. In his book, "The European Dream," author Jeremy Rifkin outlines characteristics that push the two peoples apart. "The American Dream puts an emphasis on economic growth, personal wealth and independence," he writes. "The new European Dream focuses more on sustainable development, quality of life, and interdependence." A recent addition to the differences is widespread European dislike not just of the Iraq war but Bush's blunt style. Editorials often talk of the Texan as the "cowboy president." Washington's decision to work in concert with other world powers as it tries to engage Iran over its nuclear program shows America may have learned some lessons about the benefits of diplomacy. Still, the damage seems done. "Whatever the Bush administration does, it is automatically viewed with suspicion by the European population," says Steven Casey of the London School of Economics, an expert on American public opinion.
SDI 2007 5 Week
75 GHS Neg
2NC Ext #4 Aid Not Key Soft Power

The plan is NOT public diplomacy, its just aid good actions arent enough, the U.S. has to majorly ramp up education and PR efforts to reverse the laundry list damaging soft power Pamela Hyde Smith, research assoc. @ GWU, Ambassador to Moldova, Winter/Spring 2007, The Hard Road
Back to Soft Power, Politics & Diplomacy, http://journal.georgetown.edu/72/smith.swf?INITIAL_VIEW=100
The Pew Research Centers June 2006 Global Attitudes Project demonstrates what other polls have been saying in recent years: world public opinion has turned ferociously against the United States. 2 Favorable opinion has plummeted in nearly all countries surveyed in Europe, Asia, and especially the Middle East. The United States has never been as unpopular in Western Europe. Even in the United Kingdom 41 percent of those polled think the United States is a greater threat to world peace than Iran. Most countries polled now view China more favorably than the United States. In Turkey, a NATO ally country, only 12 percent of those polled have a favorable opinion of the United Statesdown from 52 percent in 2000. 3 In Indonesia favorable opinion declined from75per- cent in 2000 to 15percent in2003,and it has risen to 30 percent today chiefly because of our tsunami assistance. 4 In not a single majority-Muslim population country polled in 2002 did a majority believe that Arabs carried out the 9/11 attacks; these same majorities support Osama bin Laden and evince sympathy for suicide bombers. 5 Across the globe people believe that
the Iraq war makes the world more dangerous, and this perception undercuts support for the overall war on terrorism. 6 American actions at Abu Ghraib, Guan- tanamo, and Haditha combine with U.S. renditions, defense of torture, and violations of the Geneva Conventions to blacken the U.S.image. In the past, when foreign attitudes faulted the U.S. government, the American people still enjoyed favorable ratings,
but this has been changing:between2002and2005 favorability ratings of Americans fell in nine of twelve countries polled. 7 As Roger Cohen memorably put it, the world has stopped buying the American narrative. 8 A catalogue of further complaints completes the picture. World opinion faults the Bush administration for its unilateralism and preemption, unflinching support of Israel, and scorn for international organizations. The Bush administrations decision to withdraw from the Kyoto Protocol and its dismissal of the threat of global warming have been met with dismay by key Asian and European allies. Additional irritants include stingy assistance to the worlds poor in comparison with other wealthy countries and the slow and ineffective response to Katrina, which made the U.S. government appear less generous and even-handed than America claims to be. 9 Reservoirs of goodwill built up over decades have evaporated, as has the worldwide sympathy felt for the United States in the immediate aftermath of 9/11. Nevertheless the Bush administration portrays the United States as Presi- dent Ronald Reagans city on the hill, radiating hope, high principles, fairness, honesty, and opportunity while spreading democracy. Many Americans agree, arguing that anti-American sentiments historically run in cycles and are part of any great powers burden. However, the present antipathy toward the United States belies optimism and is unlikely to ebb without strong corrective measures. A mix of factors shapes public opinion about another country: the countrys foreign policy, its soft power, its official public diplomacy,and individual experiences with that country. A countrys policies exert the strongest influence; few foreign societies will approve of U.S. policies they believe to be against their own interests. In the Muslim world, for example, the U.S.war on terror is perceived to be directed against Islam and has exacerbated the antiWestern aspects of Islamic funda- mentalism. 10 Soft power, the concept created by Joseph Nye of Harvard University, is a nations ability to attract and persuade others in ways that conform to its ideals or objectives. 11 Soft power is derived from values, culture, institutions, and behavior, which emanate from both society and the government. The United States accrued soft power during the twentieth century because it adhered to its found- ing democratic ideals; demonstrated its values through such programs as the Marshall Plan; and propagated its appealing culture and lifestyle, both commercially and through government- sponsored programs and media such as the Voice of America and Radio Free Europe/Radio Liberty. U.S. soft power was strongest in strategically important Japan and Europe, though the phenomenon was global. Public diplomacy, a much-debated adjunct to traditional diplomacy, seeks to understand, inform, engage, and influence foreign societies friendly, hostile, and wavering through a variety of information, culture, education, and advocacy programs. Public diplomacy, unlike spin or propaganda, succeeds when it accurately reflects and advocates a governments polices and amplifies a nations soft power. 12 U.S. government enthusiasm for public diplomacy, having waxed and waned during the last one hundred years, is currently tepid, leaving the enterprise under-funded and understaffedyet charged with battling anti-Americanism almost single-hand- edly. Although the most expert public diplomacy in the world cannot alone restore a governments image any more than a brilliant advertising campaign can sell an inferior product, robust public diplomacy is one of the essential and most cost-effective tools of
modern diplomacy.
SDI 2007 5 Week
76 GHS Neg
2NC Ext #4 Aid Not Key Soft Power

( ) Assistance cant remedy hatred in the developing world David M. Edelstein, Assis. Prof Security Studies @ Georgetown, and Ronald R. Krebs, Assis. Prof. Poly Sci @ Minnesota, Spring 2005, Washingtons Troubling Obsession with Public Diplomacy, Survival, v. 47, no. 1,
www9.georgetown.edu/faculty/dme7/documents/public%20diplomacy.pdf With regard to the developing world, the United States options are limited. Socialised within a laissezfaire economic discourse, Americans typically view economic globalisation and the concomitant expansion of global markets as a trend to be embraced, not feared. From the American perspective, markets are the natural order of things, and other modes of economic organisation are doomed to obsolescence. Moreover, globalisation has made possible the US rise to hegemony, and few would support abandoning a project so intertwined with Americas values, its self-image and its material interests. Americans have, in recent years, become more sensitive to the human costs of globalisation, but, though welcome, increased development assistance to help cushion the blow cannot render globalisation any less threatening to cultural norms and practices. Insofar as globalisation has generated greater awareness of inequality, narrowing the gap between global rich and poor, between North and South, should become a priority. The United States has not historically made it so, but it is also not clear how it could use its extraordinary wealth to do so effectively. True, despite the Bush administrations increased commitment to overseas assistance, it remains less than 0.2% of US gross national product (GNP). By comparison, as a percentage of GNP, Japan and Germany give around twice as much, France and the United Kingdom almost three times as much, and the countries of Scandinavia around eight times as much.26 But even increased amounts of foreign aid would fall short. Foreign assistance is no substitute for private investment, and the private sector has understandably shown little inclination to invest in unstable countries that lack the infrastructure to support industry. Nurturing an environment attractive to private investment is essential, but foreign assistance can help bring this about only in the very long run, if at all. Nor can the United States do much to make regimes more responsive to their populations wishes. If the recent operations in Afghanistan and Iraq are typical and it is hardly clear that other authoritarian regimes have equally weak foundations deposing such regimes at relatively low cost is well within US capabilities. But it has now become commonplace to observe that winning the war is far easier than winning the peace. The American experiences in post-Taliban Afghanistan and post-Saddam Iraq make abundantly clear how daunting the challenge is to building a strong state and a working democracy. Though the record of occupation is not reason for optimism, its success rate still exceeds that of less ambitious alternatives.27 Further, the construction of democracy in the absence of the proper liberal foundation might bring to power leaders with illiberal agendas.28 The end result might be a regime that is not more responsive to its peoples needs, but less so.
SDI 2007 5 Week
77 GHS Neg
Diplomacy Not Key Soft Power

( ) Public diplomacy is totally insufficient to restore U.S. credibility abroad requires a sea change in U.S. conduct David M. Edelstein, Assis. Prof Security Studies @ Georgetown, and Ronald R. Krebs, Assis. Prof. Poly Sci @ Minnesota, Spring 2005, Washingtons Troubling Obsession with Public Diplomacy, Survival, v. 47, no. 1,
www9.georgetown.edu/faculty/dme7/documents/public%20diplomacy.pdf
Public diplomacy has become the holy grail of American foreign policy. In a Washington polarised by sharp partisan divisions, few issues have generated as much consensus.1 All have agreed that the United States has done a poor job of convincing the world, developed and developing alike, of its benevolence. But most seem equally convinced that it could be done right if only and here the agreement breaks down.2 Yet,
like the Holy Grail of legend, public diplomacy is the object of a neverending, ultimately futile quest. Other countries are not going to buy what the United States is selling. Its not the packaging that others dislike. Its the product. The Washington consensus Well before the attacks of 11
September, US government figures regularly noted the atrocious results of the countrys efforts to sway public opinion in the Muslim world.3 Afterwards, the United States redoubled its efforts in this regard. The Bush administration decided to establish a permanent White House office of global diplomacy. The State Department hired Charlotte Beers, who had headed two of the worlds ten largest advertising agencies and had been the first female product manager for Uncle Bens Rice, as Under-Secretary for Public Diplomacy and Public Affairs. However, the Pentagons ill-named Office of Strategic Influence was abandoned only after word leaked that, while waging information warfare, it might lie.4 Searching for a silver bullet to the dilemma of American power, the Bush administration thought it had found one in stepped-up public diplomacy that is, overt government sponsored programmes intended to shape public opinion in other countries.5 Though the practical impediments were known to be considerable, the theory was simple enough. As Beers put it in November 2001, in many countries Americas message is often distorted, one-dimensional, or simply not heard.6 If only the rest of the world enjoyed unfettered access to accurate information and independent media, they would understand that the United States does not seek an empire, that the war on terror is in every civilised nations interest, and that Americas values are universal. If only the United States clearly articulated its message, then surely the rest of the world would jump on the American bandwagon. As evidence of mounting anti-Americanism accumulated, Beers critics quickly pointed out that selling Uncle Bens was a lot easier than selling Uncle Sam. She resigned in frustration and under fire in March 2003 and was not replaced until ten months later by Margaret Tutwiler, an old Washington hand who had previously served, among other positions, as ambassador to Morocco and State Department spokesperson. But, regardless of who was at the helm, the fundamentals of the underlying theory were unchanged. Unfortunately, it has not worked. In
2003 the US General Accounting Office concluded that the almost $600 million the United States was spending annually to improve its image around the world was largely ineffectual.7 Surveys by the Pew Research Center have documented exhaustively the precipitous decline in favourable views and trust of the United States across large swathes of the globe. The downward drift was already under way before the invasion of Iraq, but that decision clearly gave the trend new impetus. US favourability ratings, which were above 60% in France and Germany as late as the summer of 2002, had plummeted to below 40% by March 2004; only a slim majority of Britons still looked favourably on the United States by this past spring. Views of the United States were already unfavourable in much of the Muslim world in the summer of 2002, and have only worsened since then. These same surveys, however, have found that Americans, as people, garner more favourable opinion than does their government and that many (though not all) American values as well as its democratic institutions are admired abroad, particularly among younger Muslims and Arabs.8 US public diplomacy has clearly failed to exploit these potential areas of agreement to forge mutual respect. Rather than reject public diplomacys premise, however, the Beltway response has been to criticise its implementation.9 Some have focused on the Bush administrations tendency to step needlessly on others toes, from Defense Secretary Donald Rumsfelds notoriously dismissive reference to old Europe to Secretary of State Colin Powells condescending, even emasculating, observation that French Foreign Minister Hubert Vedrine had developed a case of the vapours and whatnot in response to the 2002 State of the Union.10 Others have ridiculed the clumsiness and transparency of the American-sponsored media in Iraq and elsewhere in the Arab and Muslim world from the State Departments Shared Values television spots that many Arab countries refused to run to the one-sided reporting on the Americansponsored radio stations broadcasting in Arabic and Persian. Others have pointed to the absurdity of developing websites to influence people in regions with highly restricted Internet access, while others have called for making far greater use of satellite and information technologies, including the Internet. Still others have fingered the lack of continuous leadership, as Tutwiler herself, though an experienced Washington insider, lasted just five months before she announced that she would bolt to Wall Street. Others have called the nations public diplomacy programmes dangerously underfunded and understaffed, and have criticised the level of coordination among the many relevant arms of government. Others have noted the absence of solid measures of program effectiveness and have urged Washington to exploit private sector expertise more fully. And so on. Think tanks and government agencies have issued a stream of reports on how to fix American public diplomacy and boost Americas image abroad.11 Whatever the criticism du jour, the Washington consensus has survived, and the essence of the public diplomacy enterprise has remained intact.12 Some have recommended bureaucratic and procedural overhauls, such as the initiation of a Quadrennial Public Diplomacy Review and the formation of a not-for-profit Corporation for Public Diplomacy and a Public Diplomacy Reserve Corps. Others have advised more substantive reforms, including more training for ambassadors, greater reliance on local moderate voices to spread Americas message, the expansion of student and cultural exchange programmes and the creation of more accessible information centres. According to Democratic partisans, the problem has been as much stylistic and personal as anything else, and the election of Democratic presidential candidate Senator John Kerry, a New Englander less prone to shooting from the hip, would have given the United States a fresh start. Like other doctrines before it, persistent failure has done nothing to dull public diplomacys lustre. Better image management alone, however, will not allow the United States to exercise its power without provoking opposition abroad. It is substance that is at issue, not style: lasting change in image will come only with meaningful and difficult changes in the way that the United States conducts itself.
SDI 2007 5 Week
78 GHS Neg

( ) Public diplomacy only helps at the margin the root of anti-Americanism is U.S. unilateralism David M. Edelstein, Assis. Prof Security Studies @ Georgetown, and Ronald R. Krebs, Assis. Prof. Poly Sci @ Minnesota, Spring 2005, Washingtons Troubling Obsession with Public Diplomacy, Survival, v. 47, no. 1,
www9.georgetown.edu/faculty/dme7/documents/public%20diplomacy.pdf
The limits of public diplomacy One need not spend much time surfing the Internet to discover that misinformation about US foreign policy, past and present, is rife. But foreign critics are not buying what the United States is selling not because the message has failed to penetrate, but because it has come across all too clearly. Contrary to the Washington consensus, Americas detractors are not misled by ignorance or by a fixation on superficialities. Nor is it simply the fact of overwhelming American material power, both economic and military, that rankles though insecurity undoubtedly plays a significant role as well.13 What they find disturbing is this hegemons vision, its conception of what the rules of the international political and economic system should look like. Feelings about the United States run a truncated gamut from European distaste to Muslim rage, and Americas critics (and, more occasionally, its admirers) have united around the language of imperialism.14 But this term obscures more than it reveals. This is partly because it has become a slogan more than a tool for analysing contemporary global politics, and partly because it evokes the sprawling formal imperial projects of the late nineteenth century, and the United States today has neither the interest nor the will, nor likely the capacity, to erect such an empire.15 But, more importantly, it is because what one means by empire and what one finds threatening in an American empire depends on where one sits. While the American vision of world order looks very different when viewed through the separate prisms of the industrialised and developing worlds, many have agreed that it is deserving of their ire. Better public diplomacy might help
at the margins, but it should not be deemed a critical part of the solution to Americas problems abroad. For people in industrialised nations, the American quest for empire manifests itself in the United States penchant for unilateralism, in its pursuit of its own freedom of action as its highest priority. Whether this can properly
be called empire is certainly debatable, but it is not debatable that this is a very real trend though admittedly one that first budded in the Clinton administration before it fully bloomed under Bush. President Bill Clinton went to war in Kosovo without the UNs imprimatur; Bush arguably had a stronger legal basis for launching the invasion of Iraq. Clinton was at best equivocal about the International Criminal Court (ICC), a major sticking point in the Bush administrations relations with Europeans in particular. Other prominent international accords from the Kyoto Protocol to the land-mine ban have met with a cooler reception in the Bush White House than they did in its predecessor. Despite talk of the coalition of the willing, the sum total of the Bush administrations actions bespeaks a hegemon that is perfectly happy to collaborate when doing so furthers shortrun US interests but which does not see the nurturing of a cooperative international environment as valuable in the middle to long term. Nor would a Kerry administrations foreign policy likely have differed markedly, if the candidates pronouncements on issues from pre-emption to Kyoto to the ICC can be taken seriously. Americas troubled relationship
: the world today is unipolar and will probably remain so for the foreseeable future.16 The countries of the industrialised world, particularly Americas NATO allies, are used to, and feel entitled to, more influence than the United States has of late been willing to grant them. During the Cold War, the structure of the Atlantic Alliance ensured that allies would have some say in American foreign policy.17 They became accustomed to such consultation, and even after the Soviet Unions collapse, they still expect a seat at the table. Yet their aspirations do not accord with their capabilities.18 As much as the French or Germans dislike the United States decision to opt out of the Kyoto Protocol or oppose its commitment to develop a national missile defence, most conceivable strategies to counter American hegemony would hurt the Europeans more than they would hurt the United States. The formation of a traditional balance of power, the prescription of classical realpolitik, is out of the question. As their opposition crystallised over Iraq, they were limited to hindering the US quest for UN approval. Soft balancing perhaps. A weapon of the weak most certainly.19 They have found themselves in a position akin to that of the conspirators against Julius Caesar: as Cassius whispers in Brutus ear (in Shakespeares rendering), Why, man, he doth bestride the narrow world/Like a Colossus, and we petty men/Walk under his huge legs and peep about/To find ourselves dishonourable graves.20 But murdering or deposing this new Caesar is impossible. In contrast to the Europeans, the Russians and the Chinese have never expected a seat at the American table: they have either headed or desired their own table. With their power in decline but their pride intact, the Russians now want a seat as an honoured guest. As Americas only foreseeable peer competitor, the Chinese are reluctant to sit at any table where they cannot be at least co-host. While transatlantic relations have soured over the last three years, the opposite has occurred with these past, present, and perhaps future rivals persistent differences over key hot-spots, such as Iraq and Iran, aside. President Bush has been almost chummy with Russian President Vladimir Putin and, in exchange for the latters support in the war on terror, has turned a blind eye to Russian brutality in the Caucasus and to Putins antidemocratic arrogations of executive authority. A similar quid pro quo was arranged with China with regard to the separatist Uighurs, and the success of US efforts to bring North Korea into the non-nuclear fold hinges on Chinas special relationship with that country and on its taking a lead role in bringing Kim Jong Il to heel. Nevertheless, the Chinese have, as much as the French, decried the American hyper-power not its dominance per se, but the way in which it has exercised that power. Better image management cannot massage away fundamental tensions, though it would no doubt loosen some aggravating knots. Kind words and warm gestures will not make the Europeans forget that, at the end of the day, the United States need not show them the deference it displayed during the Cold War. Without a history of friendship with the United States, Russia and China are even more wary of American power and even less likely to be swayed. Only control over the unbridled exercise of American power could bring a measure of serenity to these
with the developed world is rooted in the problem of power
unsettled relationships. Rather than seek to maximise its autonomy in the short run, the United States could willingly bind itself, sacrificing shortrun gains for the creation of an international milieu from which it would in the long run profit, perhaps disproportionately. As John Ikenberry has argued, this is what American statesmen so wisely did in the wake of the Second World War.21 And it is the sort of visionary leadership so lacking in Washington today.
SDI 2007 5 Week
79 GHS Neg

( ) The broad trend of U.S. policy massively ouweighs the marginal increase in soft power from the aff the rest of the world latches on to everything negative Shibley Telhami, Anwar Sadat peace chair @ Maryland, Senior Fellow @ Brookings, 6-27-2007, U.S. works to
improve image in Muslim world, Online NewsHour, http://www.pbs.org/newshour/bb/politics/janjune07/opinions_06-27.html SHIBLEY TELHAMI, University of Maryland: Well, you know, let's put it in a little bit of perspective here. I think we're expecting too much of public diplomacy. Even if you put the best people in the world in charge of public diplomacy or all the resources in the world, if it's running against a policy, a foreign policy that's not working, a foreign policy that's unpopular, public diplomacy is going to lose every day of the week. You can tell people around the world through exchanges and media that we're for democracy and human rights, and you have one episode of Abu Ghraib prison that is going to outweigh everything that we do. You can tell them we're for democracy and stability, and then they see Iraq and the disaster that it is, and everything else they'll forget. You can have nice words like we just heard today from the president. They were wonderful words. But when they don't trust the United States, when the trust isn't there -- and the vast majority of people, according not only to the Pew, but also the polls that I've done with, with Zogby International -- do not trust the president. They dislike him. They think the United States is their number-one threat. Then, of course, they're not going to trust the words. So I think we're expecting too much of public diplomacy and, even under the best of circumstances, that's going to account for maybe 10 percent to 20 percent of the difference.
SDI 2007 5 Week
80 GHS Neg

( ) Public diplomacy cant check hatred of the U.S. its due to globalization and lack of democracy, neither of which the aff remedy David M. Edelstein, Assis. Prof Security Studies @ Georgetown, and Ronald R. Krebs, Assis. Prof. Poly Sci @ Minnesota, Spring 2005, Washingtons Troubling Obsession with Public Diplomacy, Survival, v. 47, no. 1,
www9.georgetown.edu/faculty/dme7/documents/public%20diplomacy.pdf The architects of international terrorism, however, hail not from Europe, but from the developing world. Poverty, both
absolute and relative, is not the key driving factor: the impoverished residents of urban slums are less militant and less capable of organised action than are the underemployed graduates of universities. Hatred of the United States among the denizens of developing countries is rooted in the conjunction of two all-too-real facts. First, globalisation has yielded an explosive love-hate relationship with the West. While people in developing nations admire the Wests economic prowess and its strong democratic institutions, globalisation poses a distinct threat to traditional ways of life, modes of economic organisation and politics, gender relations, and cultural practices. The transition to a market economy in Europe posed a similar threat; as Jews in industrialising Europe were the pre-eminent symbols of global capital, the late nineteenth and early twentieth centuries bore witness to the rise of virulent anti-Semitism. As other regions are today undergoing wrenching change, they focus their resentment on the West. And no nation better epitomises the neoliberal vision both its economic prescriptions and the attendant cultural patterns or has done more to spread it worldwide than the United States.22 Antipathy toward the United States is not the product of misunderstanding. Nor is it simply a sign of frustration, as people lash out against the leading symbol of economic and cultural change they feel powerless to slow. Advocates of globalisation today admit its human and cultural costs, but the conceit is that globalisation is an inexorable process, the product of no ones design. But globalisation is not the work of anonymous corporate agents.23 Since the end of the Second World War, the United States has been more responsible than any other country for shaping the global economy, deploying its economic and military might to sustain, deepen and extend it. Those whose
values and interests are threatened by the installation of a market economy know at whom to cast the first stone. Thanks to the information and telecommunications revolution, people in the developing world are today more aware than
ever of the chasm between their standard of living and that of the West, and they are consequently more aware than ever of their relative deprivation. Political violence often erupts not in poor egalitarian societies but in those that are deeply unequal, regardless of the absolute level of wealth. If all are poor, poverty is not cast in sharp relief, and the objective situation may not seem subjectively so dire. But inequality makes those who are poor in relative terms aware of their plight, and their mounting
frustration and wrath eventually bubble over in a paroxysm of violence directed against those with the capacity to close the gap.24 As a Gallup survey concluded in 2002, the citizens of Islamic nations are at least outwardly not
as much envious or covetous of the success of the West as they are resentful resentful that the powerful West does not help ... [and] seemingly does not care.25 Hegemony is a double-edged sword: with greater capability comes greater responsibility. As the leader of the West and as, far and away, the wealthiest and most militarily powerful country, the United States is seemingly most capable of narrowing inequity, yet it has been perhaps least willing to do so. Secondly, the prevalence of state authorities unresponsive to their populaces has also contributed to loathing of the United States. While the United States cannot be held mainly responsible for the Middle Easts and other regions democratic deficits, myopic American policies, both during and after the Cold War, have helped sustain illiberal client regimes, from Pakistan to Egypt, Saudi Arabia to Zaire. The promotion of democracy has been a regular feature of American presidents rhetoric, but the lack of actual promotion of
democracy, combined with tangible moves to undermine popular anti-American regimes, has bred cynicism. The past and present of US policy weigh heavily: even when replacing a brutal authoritarian regime with legitimate
democratic institutions has seemingly been a primary goal, as in the case of Iraq, the world doubts Americas sincerity. Americans generally see themselves as generous to a fault, tolerant of religious and cultural diversity, and supportive of the common mans ambition to boost his standard of living. They believe themselves to be exemplars of liberal and democratic values and that their countrys benign worldview is apparent to all. If others have failed to grasp this, Americans reason, it is because the United States in its navet and good faith has assumed that truth would win out in the end and has therefore failed to confront the sources of disinformation seeking to promote a clash of civilizations where none should exist. The ensuing recommendations come from the build-abetter-mousetrap school of public diplomacy: promote open access to multiple news sources as a corrective to government-sponsored organs that spew anti-American venom; design government institutions to project a unified voice, so that the American message is not drowned out by noise; be responsive to local mores and sensitivities; and draw on private sector know-how. But these proposed solutions misunderstand the sources of animosity toward the United States.
SDI 2007 5 Week
81 GHS Neg

( ) Public diplomacy doesnt remedy anti-Americanism requires a multifaceted approach David M. Edelstein, Assis. Prof Security Studies @ Georgetown, and Ronald R. Krebs, Assis. Prof. Poly Sci @ Minnesota, Spring 2005, Washingtons Troubling Obsession with Public Diplomacy, Survival, v. 47, no. 1,
www9.georgetown.edu/faculty/dme7/documents/public%20diplomacy.pdf The United States cannot afford to place all its eggs in the basket of public diplomacy: the challenges confronting the United States are multifaceted, and its foreign policy must be equally multidimensional. Thankfully, even public diplomacys most ardent advocates are not so narrowly focused. But the consensus on the need for more sophisticated, better targeted, more clever public diplomacy has only grown since 11 September. Like the call of the sirens, public diplomacy is alluring, yet it threatens so to mislead the countrys foreign-policy helmsmen that they crash the ship of state. Focusing on public diplomacy is comforting, for it allows Americans to believe that there is a technical fix to the countrys problems.30 But there is not. While the Bush administrations lack of tact has provoked unnecessary spats, style alone is not what offends. Indeed, Americas critics get the big picture right more often than they get the details wrong.31 While public diplomacy alone cannot transform rivalry and resentment into harmony and contentment, it does have a role in international politics. By publicly communicating their preferences, state leaders can make it more difficult for themselves to reverse course or renege and thus can improve their bargaining position. By publicising what they believe to be another countrys violation of an alleged international norm, governments (as well as non-state actors) seek to mobilise populaces to shame the miscreant into compliance. Nor is this to suggest that traditional diplomacy plays only a minor role in the management of international conflict. The tools in the ambassadors kit have been critical in preventing flareups, overcoming apparent deadlock, and even converting zero-sum games into win-win situations. States use their emissaries to communicate their intentions and desires, link seemingly disparate issues and clarify the meaning of international events. But selling foreign policy is harder than selling rice. Even the best marketing can accomplish only so much. Viewed from Paris or Berlin, or from Karachi or Tehran rather than from Washington or Peoria, Americas power and foreign policy seem deeply threatening. Changing others opinions of the United States requires not gestures and fine words but a transformation of Americas approach to the world. To be great, Ralph Waldo Emerson wrote, is to be misunderstood, but the United States cannot take consolation in this oft-quoted dictum. For while its power is great, it is certainly not misunderstood.
SDI 2007 5 Week
82 GHS Neg

( ) Public diplomacy cant remedy anti-Americanism Thomas P. M. Barnett, scholar @ U. Tennessee and senior managing director @ Enterra, 2007, Realistically
repairing Americas image abroad, Scripps Howard, http://www.scrippsnews.com/node/24803 First, while it's true that America has engaged in less-public diplomacy since the Cold War, linking that to rising anti-Americanism is specious. During the Cold War, efforts like Radio Free Europe were essential to providing populations trapped behind the Iron Curtain access to independent news sources. With today's globe-spanning 24-hour news cable networks and the Internet, nearly anyone can access any desired viewpoint. While it's true that radical extremists and their sympathizers flood global nets with slanted broadcasts and sheer propaganda, there's no shortage of mass-media venues through which any audience can access American perspectives. Indeed, the global reach of our mass media fuels an anti-Americanism all its own. Stacking a concerted U.S. strategic communications effort on top of that existing cacophony, already perceived by many as dominated by American voices, is unlikely to have a positive effect. Anyway, if Americans don't trust their own government's propaganda, why should anyone else? Second, nothing America says during this long war trumps our deeds. In that regard, it's fair to pin much of this rising anti-Americanism on the arrogantly dismissive, go-it-alone tenor of the Bush administration's foreign policy from day one. I guarantee you, the world's currently high threshold for cooperation with America will be cut in half the minute a new occupant walks into the White House come January 2009. It'll be 50 percent off the top simply because the rest of the world will be happy to have a more reasonable America back on the scene. We witness a similar phenomenon today with France since Nicolas Sarkozy replaced the rightly vilified Jacques Chirac. Third, it's obvious that a lot of this anti-Americanism stems from our current military operations in Iraq, which are simply unsustainable in political terms. The American public accepts sacrifice so long as progress is apparent and most of the world seems on our side. The Bush administration has failed on both counts: botching the postwar and isolating America from both traditional and potential allies. That means American troops must be pulled back soon from frontline activity in a big way. No, we won't leave Iraq anytime soon. This will be a Vietnam in reverse, moving from large-scale direct action to advisory roles and focused special operations. Why? Because we've engineered a Balkans-done-backwards by removing the dictator up front and then overseeing the agonizing plunge into sectarian strife. Iraq's inevitable "soft partition" is what pushes the Bush White House to repeatedly float the Korean War analogy: because our baby-sitting job is nowhere near over, American troops must assume a minimal combat profile. Beyond Bush, two historical trends remain crucial: A significant portion of anti-Americanism is driven by globalization's rapid advance around the planet. To many individuals challenged daily by this tumultuous process, globalization equals Americanization. Absent our efforts to make globalization less dislocating in the short term and more equitable in the long run, there's virtually no chance we'll get the world to like us better by explaining ourselves better. Frankly, we'd accomplish far more by curtailing our disastrous agricultural subsidies. Moreover, as China's stunning rise makes it a prime conveyor belt of globalization's benefits and ills, today's anti-Americanism segues into tomorrow's anti-Chinese sentiment. Beijing is already responding, mounting what Joshua Kurlantzick has dubbed -- in his excellent new book of the same name -a "charm offensive" designed to mollify critics of its mercantilist trade with underdeveloped regions, and to exert "soft power" in support of its foreign-policy goals. Add it up and there's little reason why America should launch some massive strategic communications campaign to improve its tattered image abroad. Instead, we must simply stop pretending that 9/11 was all about us when it remains really all about "them" and this frightening juggernaut called globalization.
SDI 2007 5 Week
83 GHS Neg

( ) Public diplomacy cant overcome anger at US policies and other countries can boost U.S. soft power Charles Wolf, Senior Economic Adviser and Corporate Fellow in Intl Econ. @ RAND, and Brian Rosen, Fellow @ RAND, 2004, Public Diplomacy, www.rand.org/pubs/occasional_papers/2004/RAND_OP134.pdf
Still, a reformed and enhanced public diplomacy should be accompanied by limited expectations about what it can realistically accomplish. U.S. policiesnotably in the Israel- Palestine dispute as well as in Iraqinevitably and inherently will arouse in the Middle East and Muslim worlds opposition and deafness to the public diplomacy message that the United States wishes to transmit. While these policies have their own rationale and logic, the reality is that they do and will limit what public diplomacy can or should be expected to accomplish. The antipathy for the United States that some U.S. policies arouse is yet another argument that supports outsourcing some aspects of public diplomacy. The message America is trying to sell about pluralism, freedom, and democracy need not be delivered by the U.S. government. The message itself may be popular among potential constituents who view the United States unfavorably, but if the government delivers the message, the message may go unheard. Nevertheless, even if outsourcing proves more effective, expectations should be limited. While outsourcing may put some distance between a potentially favorable message (pluralism, freedom, and democracy) and an unfavorable messenger (the United States government), inevitably the two will be linked.
SDI 2007 5 Week
84 GHS Neg
Diplomacy Not Key Arab Anger

( ) Demonstrating U.S. compassion does nothing to remedy Arab hatred of the U.S. its because of policies, not appearance Rami Khouri, Daily Star, 10-5-2005, Humility should be part, Common Ground News,
http://www.commongroundnews.org/article.php?mode=8&id=1033&sid=1 She has said in her spin-smooth manner that the U.S. approach to public diplomacy towards the Arab and Islamic world will comprise four E's: Education, Empowerment, Engagement and Exchanges. This sensible and useful approach will reinforce the mostly positive views of basic American values that a majority of Arabs and Muslims already hold. But it is unlikely on its own to make any significant dents in the widely critical views of American foreign policy held by most people in the Arab and Islamic world. I would humbly suggest that she expand her four E's with two P's: Policy and Perception, reflecting the two serious flaws that she should quickly fix in Washington's public diplomacy approach, if she expects her department to have any impact beyond her president's speeches on American military bases. The "perception" flaw is simply that U.S. public diplomacy efforts seem to rest heavily on the assumption that if Arabs and Muslims had a better knowledge of American values and foreign or domestic policies, they would have a more positive image of the U.S. If she has not done so already she should read the dozens of surveys and analyses of Arab and Islamic public opinion that repeatedly confirm how we Arabs and Muslims admire and even emulate most American values , including freedom, democracy, the rule of law and entrepreneurship. (If her staff do not have the Web sites for her to check out, I recommend she start by googling the work of Shibli Telhami, John Zogby, the Global Values Survey, and the Center for Strategic Studies at the University of Jordan, among many others.) She would quickly discover that the idea that the problem is mainly in how Arabs and Muslims perceive America is both wrong and insultingly racist. If this deep flaw is not corrected quickly, someone should hand Hughes a gun with which to shoot her horse and put it out if its imminent misery. The second problematic issue in the U.S. public diplomacy approach, "policy," is actually the apparent total absence of understanding as to how American foreign policy in the world impacts the minds and attitudes of Arabs and Muslims . The criticisms of the U.S. that dominate this region and most of the rest of the world reflect policy resentments, not perception problems. Dozens of good scholarly studies confirming this are also available .
SDI 2007 5 Week
85 GHS Neg
AT: Ferguson Impact

( ) Ferguson is wrong his scenario for heg decline is ridiculous Christopher Preble, CATO Dir. of Foreign Policy and Justin Logan, CATO, July 2006, Are Failed States a
Threat to America, Reason Magazine, http://www.reason.com/news/show/36859.html People who believe that failed states pose a threat to U.S. security and that nation building is the answer see the world as both simpler and more threatening than it is. Failed states generally do not represent security threats. At the same time, nation building in failed states is very difficult and usually unsuccessful. There is certainly a point at which Robert Kaplans coming anarchy, if it were to materialize, would threaten American interests. Heres how Ferguson, in Foreign Policy magazine, describes a world in which America steps back from its role as a global policeman: 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 quickly find itself reliving. Its telling that to find a historical precedent on which to base his argument, Ferguson has to reach back to the ninth century. His prediction of a Dark Age hinges on a belief that America will collapse (because of excessive consumption, an inadequate army, and an imperial attention deficit), the European Union will collapse (because of an inflexible welfare state and shifting demographics), and China will collapse (because of a currency or banking crisis). There is little reason to believe that if America refuses to administer foreign countries, the world will go down this path. The fact that advocates of fixing failed states have to rely on such outlandish scenarios to build their case tells us a good deal about the merit of their arguments.
SDI 2007 5 Week
86 GHS Neg
***AT: Bioterror Advantage***
SDI 2007 5 Week
87 GHS Neg
1NC AT: Bioterror Advantage

( ) PEPFAR solves 100% of this advantage its the largest commitment EVER, indicates the U.S. cares about Africa, and is geared towards building capacity PEPFAR.gov, 2007, Latest 2007 PEPFAR Treatment Results, http://www.pepfar.gov/press/85520.htm
The Presidents Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) has supported life-saving antiretroviral treatment for approximately 1,101,000 men, women and children through bilateral programs in the Emergency Plans 15 focus countries in sub-Saharan Africa, Asia and the Caribbean. * PEPFAR is on track to meet its five-year goal of support for treatment for 2 million HIV infected people. * Before President Bush announced PEPFAR in 2003, it is estimated that only 50,000 people in sub-Saharan Africa were receiving antiretroviral treatment. These latest results underscore Americas commitment to work in partnership with host nations to turn the tide against HIV/AIDS. * These results are not fundamentally the work of the American people, but represent the dedication and commitment of individuals, communities and nations to take control of the HIV/AIDS epidemics in their countries. * The Emergency Plan was the first quantum leap in Americas leadership on global HIV/AIDS. America has kept its promise, and continues to lead the world in its level of support for effective partnerships against HIV/AIDS. * PEPFAR works with host nations to build capacity in-country: more than 80 percent of partners are indigenous organizations. The U.S. Presidents Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) is the largest commitment ever by a single nation toward an international health initiative a five-year, $15-billion, multifaceted approach to combating HIV/AIDS around the world. PEPFAR employs the most diverse prevention, treatment and care strategy in the world, with an emphasis on transparency and accountability for results. The goals of the Emergency Plan include support for treatment for 2 million HIV infected people, support for prevention of 7 million new infections, and support for care for 10 million people infected or affected by HIV/AIDS.
( ) Massive anti-bioterror programs in the status quo Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 The threat of increased bioterrorism was made real by the terrorist attacks of September 11, 2001, and the subsequent mailing of letters laden with anthrax spores in October 2001. The challenges faced by international health programs have increased as a result. The current Bush Administration has responded with a 319 percent increase in spending on defense against bioterrorismto $5.9billion for fiscal year 2003. The funds will be used to improve detection and surveillance systems, strengthen medical capabilities, improve planning and coordination, foster research, expand training exercises and communication strategies, and address policies that create bureaucratic barriers to strengthening the U.S. capacity to address bioterrorism. The promised funding will potentially provide many new opportunities to strengthen the U.S. public health capacity to address multiple emerging infectious disease threats, both domestically and worldwide. This unprecedented level of funding offers a rare chance to make a difference in the surveillance and prevention of infectious diseases, although workshop participants expressed several concerns regarding the use and the sustainability of this funding.
( ) SSA isnt key to US image theyre the only ones left that love the U.S. Jim Lobe, Washington Bureau Chief of IPS, 6-28-07, Survey: US Image Abroad Still Sinking, Antiwar.com,
Accessed on 7-12-07, http://www.antiwar.com/lobe/?articleid=11211 The survey, which included more than 45,000 respondents interviewed in 46 countries and the Palestinian Territories (PT) during April and early May, found that the U.S. retains great popularity (roughly twothirds or more rate it favorably) only in Israel and most of sub-Saharan Africa. But its standing among its western European allies, most of Central and Eastern Europe, Latin America, as well as the Islamic world and most of Asia, including China, has continued to fall, particularly compared to five years ago on the eve of its invasion of Iraq, according to the survey.
SDI 2007 5 Week
88 GHS Neg

( ) The aff is totally insufficient to boost U.S. public health capacity theres a laundry list of shortcomings, and the 150 workers in the GHS is a drop in the bucket compared to the 15,000 needed just for emergency response Mark S. Smolinski, Senior Program Officer @ Inst. Of Medicine @ NAS, et al., 3-18-2003, Microbial Threats to
Health, http://www.nap.edu/catalog/10636.html The U.S. capacity to respond to microbial threats to health is contingent on a public health infrastructure that has suffered years of neglect. Upgrading current public health capacities will require considerably increased investments across differing levels of government. Most important, this support will have to be sustained over time. Such an investment will have lasting and measurable benefits for all humankind. With recent increased funding for bioterrorism preparedness, the United States has an opportunity to develop programs and policies that will both protect against acts of bioterrorism and improve the U.S. public health response to all microbial threats. However, it is alarming that some of these funds have been diverted from multipurpose infrastructure building to single-agent preparedness. The threat of bioterrorism is intimately related to that of naturally occurring infectious diseases. The response to bioterrorism is much like the response to any microbial threat to health, and the necessary resources for building the public health infrastructure are, in essence, the same as those needed to respond to bioterrorism. It would be counterproductive to develop an ancillary system for bioterrorist threats. Rather, such efforts must be integrated with those addressing the continuum of infectious disease concerns and potential disasters to which public health agencies are already charged to respond. While preparedness for bioterrorist-inflicted outbreaks will require certain specialized program elements and policies (related, e.g., to law enforcement, evidence collection), the human health aspects of this new challenge mirror many of the requirements for preventing and responding to a range of naturally occurring infectious disease threats. Wherever possible, therefore, effective strategies should build on existing systems that are used routinely and can be useful for both purposes. In short, the objectives of the funding that has been allocated for bioterrorism will be met only if the public health infrastructure is enhanced first and foremost. Otherwise, preparedness programs will be inadequate, and critical opportunities to protect both human populations and agriculture (food animals and plants) from a range of disease threats, both naturally occurring and maliciously caused, may be missed. Strong and well-functioning local, state, and federal public health agencies working together represent the backbone of effective response to a major outbreak of infectious disease, including a bioterrorist attack. How quickly public health agencies can recognize and respond to an emerging threat dramatically influences the ability to reduce casualties, control contagion, and minimize panic and disruption. Unfortunately, an overall shortage of qualified public health workers makes it difficult to meet this demand. Following the events of 2001, public health agencies were asked to develop new programs and add new staff despite the lack of available candidates. An estimated 3,200 to 4,000 new positions were requested in the bioterrorism cooperative agreements submitted to CDC. In addition, an estimated 13,000 to 15,000 persons are needed to provide 24-hour emergency coverage at the local level (Center for Infectious Disease Research and Policy, 2002). Yet a wide range of administrative barriers prevent public health agencies from obtaining qualified staff. These include non-competitive pay scales, cumbersome hiring procedures, lack of system flexibility, and inadequate incentives for retaining qualified personnel. Local health departments range in coverage from small areas served by part-time staff with little or no formal public health training to large urban health districts with inadequate resources to support the continuing education and training of their workforce. Some of the smaller local health departments could be consolidated and strengthened to ensure needed professional expertise and coverage on a more regional basis. To strengthen the public health infrastructure for infectious disease detection and response, it will be necessary to train, equip, and expand the workforce to provide both on-the-ground epidemiologic expertise and laboratory capability.
SDI 2007 5 Week
89 GHS Neg

( ) Public health capacity doesnt translate to democratic state capacity the aff does nothing to stop terrorism Greg Mills, Nat. Dir. of S.A. Inst. Of Intl Affairs, Autumn 2004, Africas New Strategic Significance, Wash.
Q., ln Ultimately, a truly effective campaign against the domestic sources of terrorism in Africa requires enhancing the ability of African states to wield authoritative force -- the very defining characteristic of the state. Fighting terrorism in Africa thus demands not only the capacity of the West to mount the occasional spectacular raid but also to manage the much more mundane task of rebuilding the police forces in African countries. African leaders are much more concerned about this issue than they are about the deployment of U.S. special operations units on their territory. Most African police forces are in dismal shape: they lack funding, have large cadres of untrained personnel, rely on outdated methods, are tasked with repression, and are intent on extortion rather than detection. Yet, local police are critical in the fight against terrorism, both to collect intelligence to prevent attacks and, if attacks do occur, as first responders. Western agencies have shied away from helping Africa's police forces because of their poor human rights records. Indeed, African statistical agencies, central banks, and trade ministries have often received far more Western assistance than local law enforcement agencies have, even though many of these agencies would be unable to function without police security protection against terrorist acts. More generally, the West finally will have to come to grips with the profound domestic and unique security threats that many African countries face. Africa's internal forms of terrorism require foreign engagement that builds the security forces of the state as the most effective responses to the problem of weak states in a time of global terrorism. Until peace in Africa can be secured and local government authority strengthened, global efforts to deal with terrorist networks will continue to toil. To avoid empowering states that might abuse their power to govern or to wield force, not just any capacity should be built; to rid the continent of the kinds of conditions that breed the societal alienation and radicalism that give rise to terrorism in the long term, democracy and civil society must be promoted in Africa. It is astonishing how quickly and with how comparatively little fanfare African states have embraced multiparty democracy as the only acceptable form of government over the last decade. More than 40 African countries regularly hold multiparty elections, although less than half this number has passed the ultimate test of democracy: a peaceful change in government through the polls. Indeed, Africa needs further democratization, a goal fully endorsed by the African polity but one that will meet with greater resistance from those elites who are either not elected or elected in contests that are obviously not fully free and fair.
SDI 2007 5 Week
90 GHS Neg

( ) State failure doesnt cause terrorism, and terrorists can easily operate out of developed countries their evidence is analytically bankrupt Christopher Preble, CATO Dir. of Foreign Policy and Justin Logan, CATO, July 2006, Are Failed States a
Threat to America, Reason Magazine, http://www.reason.com/news/show/36859.html Those arguments suffer not so much from inaccuracy as from analytical sloppiness. It would be absurd to claim that the ongoing state failure in Haiti poses a national security threat of the same order as would state failure in Indonesia, with its population of 240 million, or in nuclear-armed Pakistan. In fact, the overwhelming majority of failed states have posed no security threat to the United States. Take, for example, the list of countries identified as failed or failing by Foreign Policy magazine and the Fund for Peace in 2005. Using 12 different indicators of state failure, the researchers derived state failure scores, and then listed 60 countries whose cumulative scores marked them as critical, in danger, or borderline, ranked in order. If state failure is itself threatening, then we should get very concerned about the Democratic Republic of the Congo, Sierra Leone, Chad, Bangladesh, and on and on. In short, state failure ranks rather low as an accurate metric for measuring threats. Likewise, while the lists of failed states and security threats will no doubt overlap, correlation does not equal causation. The obvious nonthreats that appear on all lists of failed states undermine the claim that there is something particular about failed states that is necessarily threatening. The dangers that can arise from failed states are not the product of state failure itself. They are the result of other factors, such as the presence of terrorist cells or other malign actors. Afghanistan in the late 1990s met anyones definition of a failed state, and the chaos in Afghanistan clearly contributed to Osama bin Ladens decision to relocate his operations there from Sudan in 1996. But the security threat to America arose from cooperation between Al Qaeda and the Taliban government, which tolerated the organizations training camps. Afghanistan under the Taliban was both a failed state and a threat, but in that respect it was a rarity. More common are failed states, from the Ivory Coast to Burma, that pose no threat to us at all. Its true that Al Qaeda and other terrorist organizations can operate in failed states. But they also can (and do) operate in Germany, Canada, and other countries that are not failed states by any stretch of the imagination. Rather than making categorical statements about failed states, we should assess the extent to which any given state or nonstate actors within it intend and have the means to attack America. Afghanistan is a stark reminder that we must not overlook failed states, but it does not justify making them our top security concern.
SDI 2007 5 Week
91 GHS Neg

( ) A bioterror attack is impossible difficult to produce, no availability, no dispersal, and no interest New Statesman, October 8, 2001
In reality, however, bioweapons are difficult to produce, and their effects are not as devastating as many imagine. Take anthrax, which the United States Defence Department describes as '100,000 times more deadly than the deadliest chemical weapon'. The WHO estimates that
using 50kg of dry anthrax against a city of one million inhabitants would kill 36,000 people and incapacitate another 54,000. Anthrax is a rod-like bacterium that usually affects grazing animals such as cows, goats and deer that ingest bacterial spores naturally occurring in the soil. In humans, the illness is rare, but can be contracted in three ways: through bacteria infecting a wound, through eating infected meat, or by inhaling sufficient numbers of anthrax spores. For many years, anthrax was called 'wool-sorter's disease', because workers at wool mills were most at risk from naturally occurring spores. The danger, however, was relatively small. A 1960 study in a Pennsylvania goat-hair mill showed that workers inhaled more than 500 spores per eight-hour shift, and yet there were no cases of illness among the workers. Indeed, only 18 cases were reported in the whole of the US between 1900 and 1978. The US Defence Department estimates that an individual must inhale between 10,000 and 50,000 spores for the disease to take hold. This happens only if huge numbers of spores are dispersed in the air and kept there (in the absence of wind, the natural tendency of anthrax spores is to drift to the ground). Technically, this is extremely difficult to accomplish. First, anthrax spores need to be converted into a powder. Only the US and the Soviet Union, both of which expended millions of dollars on developing bioweapons during the cold war, have refined the means to do this.
Iraq was supposed to have a well-developed anthrax programme. United Nations weapons inspectors, however, discovered anthrax only in liquid form, which, according to one expert, 'is almost as safe as candy'. Having
turned anthrax into powder, a terrorist would have to find a way of dispersing it in the air. Again, this is much more difficult than might be imagined. There was
much alarm when the FBI revealed that some of the hijackers involved in the World Trade Center attacks had previously made inquiries about crop-dusting planes. According to Barbara Rosenberg, director of the chemical and biological weapons programme of the Federation of American Scientists, 'a crop duster would be very useful for a chemical and biological attack - if you wanted to attack crops'. But it would not be that useful in attacking humans. To get spores to lodge deeply enough in the human lung to cause damage, they must be extremely small, less than ten microns
in size. Crop dusters are fitted with much larger dispensers that target insects and plants. It would be possible to modify them, but such modifications would require considerable expertise. 'You can't go down to the store and buy one off the shelf,' observes Rosenberg. There are similar problems with another both the developed and the developing world. It is highly contagious, but also very fragile and difficult to manipulate. It is
Smallpox is a virus that can cause bleeding and lesions all over the body, and it used to devastate large parts of almost impossible to obtain: only two laboratories in the world still possess supplies of live smallpox virus - the Centers for Disease Control and Prevention in Atlanta and the high-security Russian installation in Novosibirsk. Neither is likely to provide handouts for terrorists.
imagined terrorist favourite - smallpox.
According to the FBI, there has been only one known case of bioterrorism in the US. It involved the Rajneeshee, members of a religious cult, who had established a large commune in Wasco County, a rural area east of Portland, Oregon. The cult decided to take over the county by manipulating the results of local elections in 1984. They planned to bus homeless people into their commune and register them as voters, while at the same time make opposing voters sick by infecting them with salmonella. Cult members contaminated food in ten salad bars with salmonella - resulting in the infection of 751 people, none of whom was seriously ill. The election outcome was unaffected - although two members of the cult were eventually convicted for their involvement in the plot. The 751 people infected by the Rajneeshee in this plot, more comic than tragic, are the only known American victims of bioterrorism. The only other group known to have dabbled with biological agents is the Aum Shinrikyo cult in Japan. In April 1990, the group tried to spread botulism through a car engine's exhaust; three years later, it attempted to spread anthrax by using a sprayer system on the roof of a building in eastern Tokyo. Neither incident resulted in a single casualty. In the end, the group abandoned its plans for biological warfare and turned to chemical weapons instead. In March 1995, the cult released sarin, a nerve toxin, into the Tokyo subway; $10m was apparently spent preparing the attack. Twelve people died in what remains the gravest non-military chemical attack ever. report on the threat of bioterrorism produced for the Strategic Forum of the Washington-based National Defence University,
All of which is why, according to a 'few terrorists have demonstrated real interest in bioterrorism and fewer still have made an attempt to acquire biological agents'.
SDI 2007 5 Week
92 GHS Neg
2NC Ext #1 SQ Solves Commitment

( ) PEPFAR already indicates U.S. commitment to health Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 During his State of the Union address on January 28, 2003, President George W. Bush announced the $15 billion PEPFAR initiative, with the following 5-year goals: (1) providing antiretroviral therapy for 2 million people; (2) preventing 7 million new HIV infections; and (3) providing care to 10 million people infected with or affected by HIV/AIDS, including orphans and vulnerable children. In May 2003, the U.S. Congress passed authorizing legislation (United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003) for the plan. Legislative provisions recommended the following targeted distribution of funds: treatment (55 percent), prevention (20 percent), palliative care (15 percent), and care of orphans and vulnerable persons (10 percent). This unprecedented global health initiative placed the United States at the forefront of international efforts targeting HIV/AIDS. Today PEPFAR accounts for more than 50 percent of annual global funding. PEPFAR now encompasses HIV/AIDS activities in more than 100 countries, but is focused on the development of comprehensive and integrated prevention, care, and treatment programs in 15 countries: Botswana, Cote dIvoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Vietnam. The original 14 countries in Africa and the Caribbean represent 50 percent of the worlds HIV/AIDS burden. Vietnam was added to the list in July 2004 as a result of its projected eight-fold rise in HIV infections from 2002 to 2010 (Office of National AIDS Policy, 2004).
SDI 2007 5 Week
93 GHS Neg
2NC Ext #1 SQ Solves Commitment

( ) Bush is already focused on Africa more than any previous administration including on health Linda Thomas-Greenfield, Principal Deputy Assistant Secretary, 2-15-2007, US Foreign Policy Priorities in
Africa for 2007, State Department, http://www.state.gov/p/af/rls/rm/80210.htm Good morning, and thank you, for your kind introduction. It is a pleasure to be here. Of all the times to work in the Bureau of African Affairs, this is an historic one. President Bush and Secretary Rice have made Africa a centerpiece of their foreign policy agenda. The President took an interest in Africa from the outset. It is integral to his commitment to make the world "safer, freer, and better." For example, he met with more African heads of state during his first two years of office than any previous U.S. president. U.S. foreign assistance, as a percentage of federal spending, increased about 70 percent between 2000 and 2004. Instead of short-term solutions, President Bush has focused on ways to reshape the landscape and reframe the debate. ***Continues*** Never one to shrink from a challenge, President Bush has also taken on Africa's most daunting health issues. He recently noted in his State of the Union Address, "Our work in the world is also based on a timeless truth: To whom much is given, much is required. ... We must continue to fight HIV/AIDS." Worldwide, more than 39 million people are living with HIV, and more than 25 million people have died from AIDS. According to UNAIDS, almost two-thirds of all HIV-positive individuals were living in sub-Saharan Africa last year. To meet the severe and urgent crisis, President Bush announced the President's Emergency Plan for AIDS Relief (PEPFAR) in 2003. PEPFAR is the largest commitment ever by a single nation toward an international health initiative -- a five-year, 15 billion dollar, multifaceted approach to combating the disease around the world. The program targets its resources to 15 focus countries, 12 of which are in sub-Saharan Africa. In addition, the United States is the largest contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
SDI 2007 5 Week
94 GHS Neg
2NC Ext #2 SQ Solves Bioterror

( ) US biodefense research program is sufficient to solve Richard A. Falkenrath, Sen. Fellow Foreign Policy @ Brookings, 3-16-2006, Public Health Medical
Preparedness, CQ Congressional Quarterly, p ln Two aspects of the U.S. strategy for acquiring biomedical countermeasures to pathogen threats seem to me to be essentially sound. The first is the multi-billion dollar NIAID biodefense research program. I believe this program is adequately funded, excellently led, has already yielded many important discoveries for reducing the catastrophic disease threat, and will continue to do so in the future. The second is the Department of Health and Human Service's program for procuring proven biomedical countermeasures against known pathogen threats, such as ordinary anthrax and smallpox. This effort has been funded through the $5.6 billion BioShield advance appropriation as well as the annual discretionary budget of the Department of Health and Human Services. Most observers would like to see this HHS procurement program move more swiftly, but in my estimation it is reasonably sized and directionally sound. Nonetheless, I see four general problems in the area of pathogen countermeasure availability.
SDI 2007 5 Week
95 GHS Neg
2NC Ext #3 SSA Not Key Terrorism

( ) They dont have any evidence doing the GHS to Africa is key to boost cooperation in the war on terror the only cards theyve read on this question assume the status quo PEPFAR engagement, and cards on GHS assume a GLOBAL GHS, not one to sub-saharan Africa ( ) Their evidence is biased and just rhetorical political posturing its all quoting a senator whos pushing his own bill, and doesnt even come close to having a warrant ( ) Africans view the US much more favorably and like US foreign policy PBS, 6-27-2007, Global Discontent with US Increasing; US Works to Bolster Image, Online News Hour
Transcript, http://www.pbs.org/newshour/bb/politics/jan-june07/abroad_06-27.html JUDY WOODRUFF: And we want to make sure the audience knows this is not universal; there are parts of the world that see the U.S. more favorably, Africa. ANDREW KOHUT: Yes, what our conclusion is, that in many parts of the world, anti-Americanism has deepened, but it hasn't widened. In Africa, for example, we still see Africans expressing favorable views of the United States; in Ivory Coast, 88 percent; in Kenya, 87 percent. Large numbers of Africans saying good things about the United States generally, and when we ask them about the influence of the United States in their country, they say positive things. JUDY WOODRUFF: Talk about what's driving these attitudes. I mean, clearly everybody immediately thinks about the war in Iraq. But what is it? What do you see that's behind it? ANDREW KOHUT: Well, it's the war in Iraq, it's the war on terrorism, all of the cornerstones of American foreign policy are disapproved of in large parts of the world. We see ever smaller percentages of people in Europe, for example, supporting the war on terrorism. And that chart shows in Britain that the percentage fell from 69 percent in 2002 to 38 percent; in France, from 75 percent to 43 percent, and so on. And in the Muslim world, there's never been much support for the war on terrorism. You know, it manifests itself with respect to specific policies. We now not only see calls for withdraw from Iraq, but near majorities in most European countries and Canada saying we want our troops out of Afghanistan. There's great concern about American policies.
SDI 2007 5 Week
96 GHS Neg
2NC Ext #3 SSA Not Key Terrorism Iraq

( ) Iraq is the biggest source of terrorist anger aff isnt sufficient to solve Patrick Walters, 6-2-2007, The conundrum of countering terrorism, Weekend Australian, p ln
Iraq remains the greatest single counter-terrorism challenge for the US. Resolving that conflict is the only way to make progress, he contends. ''One thing is indisputable: Iraq has become an enormous accelerant in radicalisation worldwide, and it's being used by our opponents as a rallying cry. No progress is going to be made without resolving Iraq,'' Hoffman says. ''Every martyrdom video talks about Iraq. It's become a very formidable propaganda tool.'' This week, al-Qa'ida in Iraq continued to mount spectacular bombing attacks, with coalition military commanders warning that the next few months could see a surge in the group's attacks as US and Iraqi forces try desperately to secure Baghdad. Hoffman doesn't like the phrase ''war on terror'', arguing the notion has been characterised very effectively by the US's adversaries as a war on Islam. ''Our involvement in Iraq and Afghanistan and elsewhere has given them the opportunity to capitalise on the war on terrorism as a rallying cry,'' he says.
SDI 2007 5 Week
97 GHS Neg
2NC Ext #4 Capacity Alt-Cause

( ) Lack of knowledge is endemic the aff doesnt produce enough trained US workers to fill in the gaps in US public health capacity Rebecca Katz, PhD candidate @ Princeton, Summer 2002, Public Health Preparedness, Wash. Q., ln
Not enough epidemiologists and public health officials are trained to investigate every suspected outbreak at the local, state, or federal level. Funding should be given to schools of public health and to fellowship programs to ensure that a cadre of highly trained professionals are available. Officials should also allocate portions of local and state budgets to the hiring of infectious disease epidemiologists. Federal programs should also expand so that more people will be trained in advanced outbreak investigation. Currently, the CDC places Epidemic Intelligence Service members (highly trained professionals) in state health departments around the country. On average, however, only one person is placed in each state, and at least 12 states have no representative. Fortunately, officials have slated this program to receive a significant increase in funding, which they will hopefully use to place at least one person in every state and large metropolitan region, with preferably a small team of professionals in each state to coordinate disease investigations and communication with federal authorities. In addition to training more epidemiologists, existing medical personnel must learn about the role they might play in a biological attack. Most U.S. physicians and first-responders today have never seen a case of smallpox or many of the other diseases listed as critical threats; an infection would thus challenge them to present a diagnosis of the disease without laboratory confirmation. Because rapid diagnosis and treatment is an essential component of bioterrorism response, physicians should become familiar with likely bioterrorist attack agents. Although some physicians initially resisted attending training sessions, they are becoming more willing participants as they perceive the threat of a bioterrorist attack and recognize the role they might play. In addition to the voluntary training of attending physicians, an organized, mandatory program should educate medical students, selected residents, and paramedics on the signs, symptoms, and treatment of agents identified by the CDC as possible biological weapons. Officials should also reinforce for these professionals the protocols for reporting diseases and the required actions in the event of a bioterrorist attack.
( ) The aff doesnt solve U.S. health capacity medical educational system is insufficient Mark S. Smolinski, Senior Program Officer @ Inst. Of Medicine @ NAS, et al., 3-18-2003, Microbial Threats to
Health, http://www.nap.edu/catalog/10636.html To rebuild the public health workforce needed to respond to microbial threats, health profession students (especially those in the medical, nursing, veterinary, and laboratory sciences) must be educated in public health as a science and as a career. Even for students within schools of public health, education has traditionally focused on academic research training, not public health practice. A 1988 IOM report notes that many observers feel that some [public health] schools have become somewhat isolated from public health practice and therefore no longer place a sufficiently high value on the training of professionals to work in health agencies (IOM, 1988:15). A more recent IOM report states that in 1998, only 56 of 125 medical schools required courses on such topics as public health, epidemiology, or biostatistics (IOM, 2002e). The report recommends that all medical students receive basic public health training. It also concludes that all nurses should have at least an introductory grasp of their role in public health, and that all undergraduates should have access to education in public health. Educational strategies in which applied epidemiology programs provide exposure to state and local health departments may help increase awareness of the role of public health in population-based infectious disease control and prevention, and provide for exposure to public health as a potential career choice (see the later discussion on educating and training the microbial threats workforce).
SDI 2007 5 Week
98 GHS Neg
2NC Ext #5 Failed States Alt-Causes

( ) Boosting public health capacity doesnt remedy the source of African terrorism they have massive state failure problems Greg Mills, Nat. Dir. of S.A. Inst. Of Intl Affairs, Autumn 2004, Africas New Strategic Significance, Wash.
Q., ln The defining characteristic of many African states, and a critical issue in combating terrorist activity, is their weakness. By the 1990s, reportedly one-third of sub-Saharan African states were afflicted by low state capacity,n10 an inability to exercise control and authority over their rural regions or to their borders. The boundaries of African countries have never been determined by how far these states can extend their power; they were imposed by colonial rulers and have been retained by African political elites.n11 Globalization has, at least temporarily, exacerbated the weakness of African states, not least because it has generated new debates within countries, exposing government failure and corruption, increasing pressure on government to reform, and creating a cause around which opposition can rally. The spread of such openness and transparency poses challenges to the client-oriented and autocratic nature of many African economies. Key to establishing a strong partnership between Western powers and African governments to combat terrorism is the fact that addressing the pervasiveness of state weakness on the continent tackles the conditions that give rise both to domestic and international terrorist movements. Yet, there is no exact correlation between state weakness or failure and terrorist activity; indeed, it may be argued that terrorism requires key governance and infrastructure attributes (such as regular air flights and reliable communications and banking systems) to operate effectively beyond just simply offering lawless safe havens. Moreover, the conventional wisdom that such states play host to terrorists beyond the reach of the law is subject to debate. Collapsed states also play host to drug lords and warlords who may be competitors rather than collaborators. Their lawlessness and violent nature makes them inevitably difficult environments from which and in which to operate. They are dangerous especially for foreigners, are exposed to international counterterrorist action, and are difficult settings in which to maintain neutrality and partisanship, without which outsiders can themselves become embroiled in local disputes and politics. n12 Although complete state failure can create anarchic environments that are not ideal for terrorists, weak states, quasi-states, or those in crisis can provide the ideal environment for terrorist organizations. In other words, working out of Nairobi is preferable to working out of Mogadishu, or Dakar to Monrovia.n13
SDI 2007 5 Week
99 GHS Neg
2NC Ext #5 Failed States Alt-Causes

( ) Giving aid isnt enough to boost state capacity that is the cause of terrorism in Africa Greg Mills, Nat. Dir. of S.A. Inst. Of Intl Affairs, Autumn 2004, Africas New Strategic Significance, Wash.
Q., ln How to toughen the African state remains problematic, particularly given the poor record of aid delivery on the continent and the resistance of Africans to external conditionalities. The fact that the weak nature of the African state and the corruptibility of the African political class have over time made the continent a soft target for all kinds of terrorist groups is further complicated in an environment where wars of liberation have left a certain residue of ambiguity about the distinction between terrorists and freedom fighters and a latent hostility toward the West over colonial and postcolonial policies. Whatever the debates about the links among weak states, poverty, and terrorism, can the policies of the Western and African states intersect to fight both local and global terrorism?
( ) Military and law enforcement action is key to stopping terrorism in failed states their author doesnt think plan is enough Thomas Dempsey, Dir. African Studies @ US Army War College, April 2006, Counterterrorism in African
Failed States, Strategic Studies Institute, http://www.strategicstudiesinstitute.army.mil/pdffiles/pub649.pdf Integrating the U.S. foreign intelligence community, U.S. military forces, and U.S. law enforcement offers a more effective strategy for countering terrorist hubs operating in failed states. The foreign intelligence community is best equipped to identify terrorist hubs in failed states that are developing global reach and threatening to acquire a nuclear dimension. Once those hubs have been identified, a synthesis of expeditionary military forces and law enforcement elements will be far more effective in dealing with those hubs than either element will be acting independently. The military force establishes access to the failed state for law enforcement officers, and provides a secure environment for those officers to perform their core function of identifying, locating, and apprehending criminal, in this case terrorist, suspects. Once terrorists have been identified, located, and apprehended, military tribunals should screen them individually to confirm that they are, indeed, who law enforcement officers believe them to be, and that they are, in fact, associated with the activities of the terrorist hubs in question. Upon confirmation of their status as participants in the operation of the terrorist hub, those tribunals should refer their cases to appropriate international tribunals for disposition. This strategy avoids legitimizing terrorist activity by treating them as military targets, and also addresses the limitations that U.S. criminal justice procedures place on prosecuting terrorists apprehended in failed states.
SDI 2007 5 Week
100 GHS Neg
2NC Ext #6 AT: Failed States Terrorism

( ) Failed states dont breed terrorism they dont have the necessary infrastructure Daniel Lambach, Research Assis. @ Phillips U., July 2004, The Perils of Weakness, http://www.staff.unimarburg.de/~lambach/discourse2004.pdf At first glance, failed states seem to offer favorable conditions for the activities of transnational terrorist networks. According to Ray Takeyh and Nikolas Gvosdev, a weak state cannot impede a groups freedom of action but has the veneer of state sovereignty that prevents other, stronger states from taking effective countermeasures.10 After it was revealed that Al-Qaeda found a safe haven in Afghanistan, this became a commonly held view. Similarly, the perpetrators of the Mombasa attacks in late 2002 operated out of neighboring Somalia.11 Apart from serving as safe havens and training grounds, failed states provided economic opportunities for Al-Qaeda. There is also some, though yet inconclusive, evidence that points to an involvement of Al-Qaeda in the trade in gemstones and minerals out of wartorn countries like Sierra Leone and the DR Congo.12 However, more recent research argues that this paints an incomplete picture. Ulrich Schneckener points out that while the idea for the September 11th attacks was hatched in Afghanistan, it was planned and developed in Germany, with contacts to terrorists operating in other developed nations (such as Spain). He disaggregates the functions that a terrorist networks has to fulfill in order to operate effectively. These include recruitment, training, planning, hiding, logistics and transit, communication and access to resources and financial assets. Each of these functions creates different requirements for an optimum operational base, not all of which are best served in failed states. He concludes that states on the brink of failure provide the optimum environment for terrorists to operate in, as these states are still able to offer a modicum of security without being able to effectively implement policy and without widespread support within their own populations.13 So, all in all, the empirical connection of state failure and terrorism is less clear-cut than is generally thought. Nevertheless, the impression that such a link exists has become very popular within international politics.
( ) Risk of terrorism in Africa is low Robert Guest, Wash. Correspondant for Economist, 6-30-2005, Africas Development Challenge, CATO
Institute, http://www.cato.org/pubs/edb/edb1.pdf I would like to turn to the subject of terrorism. There is a theory going around that Africa ought to be a breeding ground for terrorism, because of the large number of Muslims who live there. If by terrorism we mean terrorism that affects the West, I do not believe that that is the case. There simply is not any significant homegrown international black African terrorist movement. People have many grievances, but they tend to be locally directed. If you actually ask people about President George Bush and the invasion of Iraq, average Africans will say that it was an appalling thing and that they dislike him very much. But George Bushs foreign policy is very low on their list of grievances. Their main grievances are the policemen who sit by the road robbing them every time they try to take their crops to market.
SDI 2007 5 Week
101 GHS Neg
2NC Ext #7 No Bioterror Impact

( ) Unreliability of bioweapons prevents use and precludes impact Walter Laqueur, Cochairman, International Research Council, The Center for Strategic and International Studies, The New Terrorism, 1999, pg. 69
The attractions of biological weapons are obvious: easy access, low cost, toxicity, and the panic they can cause. But there are drawbacks of various kinds that explain why almost no successful attacks have occurred. While explosive or nuclear devices or even chemical agents, however horrific, affect a definite space,
biological agents are unpredictable: they can easily get out of control, backfire, or have no effect at all. They constitute a high risk to the attackers, although the same, of course, is true of chemical weapons. This consideration may not dissuade people willing to sacrifice their own lives, but the possibility that the attacker may kill himself before being able to launch an attack may make him hesitate to carry it out. Biological agents, with some notable exceptions, are affected by changes in heat or cold, and, like chemical agents, by changes in the direction of the wind. They have a limited life span, and their means of delivery are usually complicated. The process of contaminating water reservoirs or foodstuffs involves serious technical problems. Even if an agent survives the various purification systems in water reservoirs, boiling
the water would destroy most germs. Dispersing the agent as a vapor or via an aerosol system within a closed space-for instance, through the air conditioning system of a big building or in a subway-would ear to offer better chances of success, but it is by no mens foolproof.
( ) Technical barriers prevent use of bioweapons Jonathan Tucker, director of the CBW Nonproliferation Project at Center for Nonprolif Studies at Monterey Instit, Amy Sands, assoc director, July/August 1999, http://www.bullatomsci.org/issues/1999/ja99/ja99tucker.html
One reason there have been so few successful examples of chemical or biological terrorism is that carrying out an attack requires overcoming a series of major technical hurdles: gaining access to specialized chemical-weapon ingredients or virulent microbial strains; acquiring equipment and know-how for agent production and dispersal; and creating an organizational structure capable of resisting infiltration or early detection by law enforcement. Many of the microorganisms best suited to catastrophic terrorism-virulent strains of anthrax or deadly viruses such as smallpox and Ebola-are difficult to acquire. Further, nearly all viral and rickettsial agents are hard to produce, and bacteria such as plague are difficult to "weaponize" so that they will survive the process of delivery. As former Soviet bioweapons
scientist Ken Alibek wrote in his recent memoir, Biohazard, "The most virulent culture in a test tube is useless as an offensive weapon until it has been put through a process that gives it stability and predictability. The manufacturing technique is, in a sense, the real weapon, and it is harder to develop than individual agents." The
capability to disperse microbes and toxins over a wide area as an inhalable aerosol-the form best suited for inflicting mass casualties-requires a delivery system whose development would outstrip the technical capabilities of all but the most sophisticated terrorists. Not only is the dissemination process for biological agents inherently complex, requiring specialized equipment and expertise, but effective dispersal is easily disrupted by environmental and meteorological conditions. A large-scale attack with anthrax spores against a city, for example, would require the use of a crop duster with custom-built spray
nozzles that could generate a high-concentration aerosol cloud containing particles of agent between one and five microns in size. Particles smaller than one micron would not lodge in the victims' lungs, while particles much larger than five microns would not remain suspended for long in the atmosphere. To generate mass casualties, the anthrax would have to be dried and milled into a fine powder. Yet this type of processing requires complex and costly equipment, as well as systems for high biological containment. Anthrax is simpler to handle in a wet form called a "slurry," but the efficiency of aerosolization is greatly reduced.
( ) Technical difficulties prevent CBW attacksand even if they overcome them, authorities will be alerted Walter Laqueur, Cochairman, International Research Council, The Center for Strategic and International Studies, The New Terrorism, 1999, pg. 244
Ironically, the major factor retarding the use of gases and germs by states and terrorists is not revulsion or moral constraints but technical difficulties. "Ideal" conditions for an attack seldom if ever exist, and the possibility of things going wrong is almost unlimited: aerosols may not function, the wind may blow in the wrong direction, missiles carrying a deadly load may land in the wrong place or neutralize the germs on impact. In the course of time these technical difficulties may be overcome, but it is still very likely that roughly nine out of ten of the early attempts by terrorists to wage chemical or biological warfare will fail. But they will not pass unnoticed; the authorities and the public will be alerted, and the element of surprise lost. The search for the perpetrators may begin even before the first successful attack. And what has just been said with regard to terrorists may also be true with regard to state terrorism.
SDI 2007 5 Week
102 GHS Neg
2NC Ext #7 No Bioterror Impact

( ) Bioweapons are difficult to procure, difficult to deliver Stimson Center, 2007, Biological and Chemical Weapons,
http://www.stimson.org/cbw/?sn=CB2001121259#cwuse Oftentimes, obtaining biological agents is portrayed as being as easy as taking a trip to the country. The experience of the Japanese cult Aum Shinrikyo proves that this is not the case. Isolating a particularly virulent strain in nature---out of, for example, the roughly 675 strains of botulinum toxin that have been identified---is no easy task. Despite having skilled scientists among its members, Aum was unable to do so. Terrorists could also approach one of the five hundred culture collections worldwide, some of which carry lethal strains. Within the United States, however, much tighter controls have been placed on the shipment of dangerous pathogens from these collections in recent years. How easy would it be for terrorists to disperse a biological agent effectively? Terrorists cannot count on just filling the delivery system with agent, pointing the device, and flipping the switch to activate it. Facets that must be deciphered include the concentration of agent in the delivery system, the ways in which the delivery system degrades the potency of the agent, and the right dosage to incapacitate or kill human or animal targets. For open-air delivery, the meteorological conditions must be taken into account. Biological agents have extreme sensitivity to sunlight, humidity, pollutants in the atmosphere, temperature, and even exposure to oxygen, all of which can kill the microbes.
( ) Bioweapons dont kill anyone Japan proves Stimson Center, 2007, Biological and Chemical Weapons,
http://www.stimson.org/cbw/?sn=CB2001121259#cwuse The Japanese cult Aum Shinrikyo was brimming with highly educated scientists, yet the cult's biological weapons program turned out to be a lemon. While its poison gas program certainly made more headway, it was rife with life-threatening production and dissemination accidents. After all of Aum's extensive financial and intellectual investment, the Tokyo subway attack killed a dozen people, seriously injured just over fifty more, and mildly injured just under 1,000. In 96 percent of the cases worldwide where chemical or biological substances have been used since 1975, three or fewer people were injured or killed.
SDI 2007 5 Week
103 GHS Neg
AT: Nuclear Terrorism Impacts

( ) Terrorists cant get or build nuclear bombs Gary Milhollin, director of the Wisconsin Project on Nuclear Arms Control, 2/1/2002, Commentary
Despite the reports, and despite the attendant warnings, the risk that a terrorist group like al Qaeda could get the bomb (or a "dirty" substitute) is much lower than most people think. That is the good news. There is also bad
news: the risk is not zero. THERE ARE essentially two ways for a terrorist group to lay its hands on a nuclear weapon: either build one from scratch or somehow procure an already manufactured one or its key components. Neither of these is likely. Building a bomb from scratch would confer the most power: a group that could build one bomb could build several, and a nuclear arsenal would put it front and center on the world stage. But of all the possibilities, this is the unlikeliest--"so remote," in the words of a senior nuclear scientist at the Los Alamos National Laboratory, "that it can be essentially ruled out." The chief obstacle lies in producing the nuclear fuel--either bomb-grade uranium or plutonium--that actually explodes in a chain reaction. More than 80 percent of the effort that went into making America's first bombs was devoted to producing this fuel, and it is no easy task. To make bomb-grade uranium, a terrorist group would need thousands of high-speed gas centrifuges, machined to exact dimensions, arranged in series, and capable of operating under the most demanding conditions. If they wanted to produce the uranium by a diffusion process, they would need an even greater number of other machines, equally difficult to manufacture and operate. If they followed Saddam Hussein's example, they could try building a series of giant electromagnets, capable of bending a stream of electrically charged particles--a no less daunting challenge. For any of these, they would also need a steady supply of natural uranium and a specialized plant to convert it to a gaseous form for processing.
Who would sell these things to would-be nuclear terrorists? The answer is: nobody. The world's nuclearequipment makers are organized into a cooperative group that exists precisely to stop items like these from getting into unauthorized hands. Nor could a buyer disguise the destination and send materials through obliging places like Dubai (as Iran does with its hot cargoes) or Malta (favored by Libya's smugglers). The equipment is so specialized, and the suppliers so few, that a forest of red flags would go up. And even if the equipment could be bought, it would have to be operated in a place that the United States could not find. If manufacturing bomb-grade uranium is out of the picture, what about making plutonium, a
much smaller quantity of which is required to form a critical mass (less than fourteen pounds was needed to destroy Nagasaki in 1945)? There is, however, an inconvenient fact about plutonium, which is that you need a reactor to make enough of it for a workable bomb. Could terrorists buy one? The Russians are selling a reactor to Iran, but Moscow tends to put terrorist groups in the same category as Chechens. The Chinese are selling reactors to Pakistan, but Beijing, too, is not fond of terrorists. India and Pakistan can both build reactors on their own, but, for now, these countries are lined up with the U.S. Finally, smuggling a reactor would be no easier than buying one. Reactor parts are unique, so manufacturers would not be fooled by phony purchase orders. Even if
terrorists somehow got hold of a reactor, they would need a special, shielded chemical plant to chop up its radioactive fuel, dissolve it in acid, and then extract the plutonium from the acid. No one would sell them a plutonium extraction plant, either. It is worth remembering that Saddam Hussein tried the reactor road in the 1970's. He bought one from France-Jacques Chirac, in his younger days, was a key facilitator of the deal--hoping it would propel Iraq into the nuclear club. But the reactor's fuel was sabotaged in a French warehouse, the person who was supposed to certify its quality was murdered in a Paris hotel, and when the reactor was finally ready to operate, a squadron of Israeli fighter-bombers blew it apart. A similar fate would undoubtedly await any group that tried to follow Saddam's method today. IF MAKING nuclear-bomb fuel is a no-go, why not just steal it, or buy it on the black market? Consider plutonium. There are hundreds of reactors in the world, and they crank out tons of the stuff every year. Surely a dedicated band of terrorists could get their hands on some. This too is not so simple. Plutonium is only created inside reactor fuel rods, and the rods, after being irradiated, become so hot that they melt unless kept under water. They are also radioactive, which is why they
have to travel submerged from the reactor to storage ponds, with the water acting as both coolant and radiation shield. And in most power reactors, the rods are welded together into long assemblies that can be lifted only by crane. True, after the rods cool down they can be stored dry, but their radioactivity is still lethal. To prevent spent fuel rods from killing the people who come near them, they are transported in giant radiation-shielding casks that are not supposed
If terrorists managed to hijack one from a country that had reactors they would still have to take it to a plant in another country that could extract the plutonium from the rods. They would be hunted at every step of the way. Instead of fuel rods, they would be better advised to go after pure
to break open even in head-on collisions. The casks are also guarded. plutonium, already removed from the reactor fuel and infinitely easier to handle. This kind of plutonium is a threat only if you ingest or inhale it. Human skin blocks its radiation: a terrorist could walk around with a lump of it in his front trouser pocket and still have children. But where to get hold of it? Russia is the best bet: it has tons of plutonium in weapon-ready form, and the Russian nuclear-accounting system is weak. Russia also has underpaid scientists, and there is unquestionably some truth behind all the stories one hears about the smuggling that goes on in that country. But very little Russian plutonium has been in circulation, with not a single reported case of anything more than gram quantities showing up on the black market. This makes sense. Pure plutonium is used primarily for making nuclear warheads, it is in military hands, and military forces are not exactly keen to see it come back at them in somebody else's bombs. One source of pure plutonium that is not military is a new kind of reactor fuel called "mixed oxide." It is very different from the present generation of fuel because it contains weapon-ready material. But precisely because it is weapon-ready, it is guarded and accounted for, and a terrorist group would have to win a gun battle to get close to it. Then they would probably need a crane to move it, and would have to elude or fight off their pursuers. If terrorists did procure some weapon-ready plutonium, would their problems be over? Far from it:
plutonium works only in an "implosion"-type bomb, which is about ten times more difficult to build than the simple uranium bomb used at Hiroshima. In such a device, a spherical shock wave "implodes" inward and squeezes a
ball of plutonium at the bomb's center so that it explodes in a chain reaction. To accomplish all this, one needs precision machine tools to build the parts, special furnaces to melt and cast the plutonium in a vacuum (liquid plutonium oxidizes rapidly in air), and high-precision switches and capacitors for the firing circuit. Also
required are a qualified designer, a number of other specialists, and a testing program. Considering who the participating scientists are likely to be, the chances of getting an implosion bomb to work are rather small. THE ALTERNATIVE to plutonium is bomb-grade uranium--and here things would be easier. This is the fuel used in the Hiroshima bomb. Unlike the implosion bomb dropped on Nagasaki, this one did not have to be tested: the U.S. knew it would work. The South Africans built six uranium bombs without testing; they knew
their bombs would work, too. All these devices used a simple "gun" design in which one slug of uranium was shot down a barrel into another. The problem with buying bomb-grade uranium is that one would need a great deal of it--around 120 pounds for a gun-type bomb--and nothing near that amount has turned up in the black market.
SDI 2007 5 Week
104 GHS Neg
AT: Lashout Impacts

A terrorist attack would not cause a US lashout Ian Bremmer, president of Eurasia Group and senior fellow at the World Policy Institute, 9-13-04, New
Statesman What would happen if there were a new terrorist attack inside the United States on 11 September 2004? How would it affect
the presidential election campaign? The conventional wisdom is that Americans - their patriotic defiance aroused - would rally to President George W Bush and make him an all but certain winner in November. But consider the differences between the context of the original 9/11 and that of any attack which might occur this autumn. In 2001, the public reaction was one of disbelief and incomprehension. Many Americans realised for the first time that large-scale terrorist attacks on US soil were not only conceivable; they were, perhaps, inevitable. A majority focused for the first time on the threat from al-Qaeda, on the Taliban and on the extent to which Saudis were involved in terrorism. This time, the public response would move much more quickly from shock to anger; debate over how America should respond would begin immediately. Yet it is difficult to imagine how the Bush administration could focus its response on an external enemy. Should the US send 50,000 troops to the Afghan-Pakistani border to intensify the hunt for Osama Bin Laden and 'step up' efforts to attack
the heart of al-Qaeda? Many would wonder if that wasn't what the administration pledged to do after the attacks three years ago. The president would face intensified criticism from those who have argued all along that Iraq was a distraction from 'the real war on terror'. And what if a significant number of the terrorists responsible for the pre-election attack were again Saudis? The Bush
administration could hardly take military action against the Saudi government at a time when crudeoil prices are already more than $45 a barrel and global supply is stretched to the limit. While the Saudi royal family might support a co-ordinated
attack against terrorist camps, real or imagined, near the Yemeni border - where recent searches for al-Qaeda have concentrated - that would seem like a trivial, insufficient retaliation for an attack on the US mainland. Remember how the Republicans criticised Bill Clinton's administration for ineffectually 'bouncing the rubble' in Afghanistan after the al-Qaeda attacks on the US embassies in Kenya and Tanzania in the 1990s. So what kind of response might be credible? Washington's concerns about Iran are rising. The 9/11 commission report noted evidence of co-operation between Iran and al-Qaeda operatives, if not direct Iranian advance knowledge of the 9/11 hijacking plot. Over the past few weeks, US officials have been more explicit, too, in declaring Iran's nuclear programme 'unacceptable'. However, in the absence of an official Iranian claim of responsibility for this hypothetical terrorist
a decisive response from Bush could not be external. It would have to be domestic. Instead of Donald Rumsfeld, the defence secretary, leading a war effort abroad, Tom Ridge, the homeland security secretary, and John Ashcroft, the attorney general, would pursue an anti-terror campaign at home. Forced to use legal tools more controversial than
attack, the domestic opposition to such a war and the international outcry it would provoke would make quick action against Iran unthinkable. In short,
those provided by the Patriot Act, Americans would experience stepped-up domestic surveillance and border controls, much tighter security in public places and the detention of a large number of suspects. Many Americans would undoubtedly support such moves. But concern for civil liberties and personal freedom would ensure that the government would have nowhere near the public support it enjoyed for the invasion of Afghanistan.
SDI 2007 5 Week
105 GHS Neg
AT: Chemical Weapons Impact

( ) Chemical weapons are too difficult to produce in mass quantities and cant be delivered effectively Stimson Center, 2007, Biological and Chemical Weapons,
http://www.stimson.org/cbw/?sn=CB2001121259#cwuse However, two factors stand in the way of manufacturing chemical agents for the purpose of mass casualty. First, the chemical reactions involved with the production of agents are dangerous: precursor chemicals can be volatile and corrosive, and minor misjudgments or mistakes in processing could easily result in the deaths of would-be weaponeers. Second, this danger grows when the amount of agent that would be needed to successfully mount a mass casualty attack is considered. Attempting to make sufficient quantities would require either a large, well-financed operation that would increase the likelihood of discovery or, alternatively, a long, drawn-out process of making small amounts incrementally. These small quantities would then need to be stored safely in a manner that would not weaken the agent's toxicity before being released. It would take 18 years for a basement-sized operation to produce the more than two tons of sarin gas that the Pentagon estimates would be necessary to kill 10,000 people, assuming the sarin was manufactured correctly at its top lethality. How easy would it be for terrorists to disperse a chemical agent effectively? The options for delivering poison gas range from high to low tech. Theoretically, super toxic chemicals could be employed to foul food or water supplies, put into munitions, or distributed by an aerosol or spray method. Because of safeguards on both our food and water supplies as well as the difficulty of covertly disbursing sufficient quantities of agent, this method is unlikely to be an effective means to achieving terrorist aims. Chemical agents could also be the payload of any number of specially designed or modified conventional munitions, from bombs and grenades to artillery shells and mines. However designing munitions that reliably produce vapor and liquid droplets requires a certain amount of engineering skill. Finally, commercial sprayers could be mounted on planes or other vehicles. In an outdoor attack such as this, however, 90 percent of the agent is likely to dissipate before ever reaching its target. Effective delivery, which entails getting the right concentration of agent and maintaining it long enough for inhalation to occur, is quite difficult to achieve because chemical agents are highly susceptible to weather conditions.
SDI 2007 5 Week
106 GHS Neg
***Disease CPs***
SDI 2007 5 Week
107 GHS Neg
Domestic Health Care CP 1NC

The United States federal government should adopt a comprehensive policy to boost domestic health care capacity, including the expansion of training facilities and financial incentives for medical students. Boosting domestic health training is key to check brain drain discourages active recruitment Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
H. Measures to address brain drain should be adopted that increase health professional training opportunities in the United States and discourage active recruitment from poor countries. Selfsufficiency should also start at home. The US does not produce a sufficient number of medical school graduates to fill residency spaces, and is on track to be as many as 800,000 nurses and 200,000 doctors short by 2020. 20% of physicians in the United States are international medical graduates, and after India, the largest number of these are from the United States; Americans who trained abroad because of too few training slots. The shortage of health professional training in the United States greatly increases the drain of health professionals out of developing countries so that impoverished nations are subsidizing the training of doctors and nurses in rich countries while still being left without capacity. Increasing US medical school slots will be an important contribution towards slowing brain drain, and will serve as an important companion to a global initiative focusing on the supply side. Additionally, countries such as Canada and South Africa have established bilateral agreements to limit and compensate for health worker migration, which may present promising models. In addition to new measures to increase compensation and training in the developing world, the US should take steps to increase medical training slots available. The United States should promote international and bilateral agreements to financially compensate developing countries for losses incurred due to inadequate training capacity of industrialized nations.
SDI 2007 5 Week
108 GHS Neg
Domestic Health Care CP Solves

( ) US already has a massive shortage of health care workers its the root cause of brain drain from developing nations. Boosting domestic health care solves. Laurie Garrett, Senior Fellow for Global Health @ CFR, 4-18-2007, Prepared Statement, CFR,
http://www.cfr.org/publication/13130/ This is going to get much worse. Why? Because the wealthy world is aging, therefore requiring more health attention. At the same time, wealthy nations are trying to reduce rapidly inflating health costs by holding down salaries, and increasing work loads, making the practices of nursing and medicine less attractive. Unless radical changes are put in place swiftly in the United States and other wealthy nations the gap will soon become catastrophic. Studies show that the U.S. will in 13 years face a shortage of 800,000 nurses and 200,000 doctors. How are the United States and other wealthy nations filling that gap? By siphoning off doctors and nurses from the poor world. We are guilty of bolstering our healthcare systems by weakening those of poorer nations. Here is an example: due to healthcare worker shortages, 43 percent of Ghanas hospitals and clinics are unable to provide child immunizations and 77 percent cannot provide 24-hour obstetric services for women in labor. So the children die of common diseases, like measles, and the mothers die in childbirth. In all of Ghana there are only 2,500 physicians. Meanwhile, in New York City, alone, there are 600 licensed Ghanaian physicians.[vi] There are a number of bills pending in both the House and Senate that seek, in various ways, to increase domestic education and staffing of healthcare workers, and bolster training in poor countries. Though this committee deals with foreign operations, it is vital that you concern yourself with the progress of measures that would decrease the drive to drain the health brain power of the poor world by enhancing education and incentives here in the United States. In the House, for example, HR.410, the United States Physician Shortage Elimination Act of 2007, seeks to create incentives for physicians to serve in under-allocated areas of America.
( ) Its impossible to boost indigenous health capacity as long as the US keeps siphoning workers Laurie Garrett, senior fellow for Global Health @ CFR, Jan/Feb 2007, The Challenge of Global Health,
http://fullaccess.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html Jim Leach, an outgoing Republican member of the House of Representatives from Iowa, has proposed something called the Global Health Services Corps, which would allocate roughly $250 million per year to support 500 American physicians working abroad in poor countries. And outgoing Senator Bill Frist (RTenn.), who volunteers his services as a cardiologist to poor countries for two weeks each year, has proposed federal support for sending American doctors to poor countries for short trips, during which they might serve as surgeons or medical consultants. Although it is laudable that some American medical professionals are willing to volunteer their time abroad, the personnel crisis in the developing world will not be dealt with until the United States and other wealthy nations clean up their own houses. OECD nations should offer enough support for their domestic health-care training programs to ensure that their countries' future medical needs can be filled with indigenous personnel. And all donor programs in the developing world, whether from OECD governments or NGOs and foundations, should have built into their funding parameters ample money to cover the training and salaries of enough new local healthcare personnel to carry out the projects in question, so that they do not drain talent from other local needs in both the public and the private sectors.
SDI 2007 5 Week
109 GHS Neg
PSE CP 1NC
The United States federal government should pass the Physician Shortage Elimination Act. ( ) Solves domestic health care capacity empirically proven methods Ted Stevens, Alaska Senator, 3-15-2007, Murkowski,
http://stevens.senate.gov/public/index.cfm?FuseAction=NewsRoom.PressReleases&ContentRecord_id=56672bc4802a-23ad-4754-4c83aaea0eab&Region_id=&Issue_id= Noting that our Nation faces a severe shortage of primary care physicians, Senator Lisa Murkowski today joined Senators Ted Stevens (R-AK), Chuck Schumer (D-NY) and Bernie Sanders (I-VT) in introducing the Physician Shortage Elimination Act. The legislation provides additional funding and flexibility for existing residency programs, grants and services that have been successful in the past but have been underutilized. A dozen states have already reported significant physician shortages. There is insufficient availability of care in specialty areas like cardiology, radiology and neurology. However, the greatest shortages persistently have been in primary care. In rural areas of the country, where 50 million Americans live in areas that lack sufficient care, it represents one of the most intractable health policy problems of the past century. Unfortunately, it is a problem that is forecast to get worse. In just 20 years, 20 percent of the Nations population will be 65 years or older, a percentage larger than any other time in history. Just as this aging population places the highest demand on our health care system, some experts predict a national shortage of 200,000 physicians. If that becomes reality, 84 million patients could be left without a doctors care. The physician shortage facing Alaska and the nation as a whole - is intolerable, said Senator Murkowski. Congress cannot idly sit by while potentially millions of patients go without care. Advances in medicine have greatly improved the healthcare available throughout the country, said Senator Stevens. But today, as more and more patients seek treatment, fewer physicians are available to help meet their needs. It is imperative that Congress act now to address this growing problem facing Alaska and the nation. I applaud Senator Murkowski's leadership on this issue and look forward to working with her and my Senate colleagues to get this bill passed. National demand for physicians has grown to exceed the supply, particularly in upstate New York, said Senator Schumer. With general practitioners, surgeons, and specialty doctors leaving the area in record numbers, patients could see an erosion of access to care at the worst possible time. We need to provide direct incentives to train and retain physicians in order to keep our community and our overall economy healthy. Our country is currently facing a real health care crisis and the shortage of physicians in rural areas is a significant part of the problem, said Senator Sanders. This bill will go a long way toward improving health care access for all Americans. The Physician Shortage Elimination Act provides additional investments in programs that have been effective in attracting and retaining physicians to serve in our most underserved areas of the country. Specifically the bill will: * Double funding for the National Health Service Corp a program that is dedicated to meeting the needs of the underserved. Despite its success, it has been vastly under funded in fact 80% of the applicants must be turned away each year. * Allow rural and underserved physician residency programs to expand by removing barriers that prevent programs from developing rural training programs. * Double certain Title VII funding Create programs that target disadvantaged youth in rural and underserved areas and nurture them to create a pipeline to careers in healthcare; and * Bolster the cornerstone for health care in underserved areas, the community health center, through grants and by allowing them to expand their residency programs.
SDI 2007 5 Week
110 GHS Neg
PSE CP Solves
( ) Passing the PSE would solve domestic physician shortages Molly OGorman, Dir. Public Relations @ AMSA, 7-28-2006, AMSA Endorses,
http://www.amsa.org/news/release2.cfx?id=271 The recent recommendation made by the Association of American Medical Colleges (AAMC) to increase medical school enrollment by 30 percent within the next decade has been endorsed by the American Medical Student Association (AMSA), the largest organization of physicians-in-training in the United States. AMSA agrees that the proposed AAMC strategy of expanding the physician workforce through both the expansion of existing schools and the creation of new allopathic medical schools is the most effective way to quickly and economically address the significant shortage of physicians expected early in this century. Several recent studies indicate that the United States will need an additional 90,000 physicians by 2020. In February 2005, before the full extent of the coming physician shortage was understood, the AAMC recommended a 15 percent increase in U.S. medical school enrollment. Subsequent studies and mounting evidence supported by the AAMCs Center for Workforce Studies persuaded the medical college group to recommend a larger increase in medical school enrollment to suitably address the needs of the nations steadily increasing and aging population. Adherence to AAMCs guidelines would result in 5,000 additional U.S. medical students a year. Our countrys medical education system must respond aggressively to this physician shortage crisis, says AMSA President Jay Bhatt. We need to respond by increasing diversity and the number of medical students in our country. Increased support for programs like the National Health Service Corps and State Loan Repayment for service would help students with rising levels of debt as well as encourage new physicians to practice primary care in our underserved communities. Recent federal legislation that AMSA was consulted on has been formally introduced before Congress. The U.S. Physician Shortage Elimination Act, H.R. 5770, will expand the depleting physician workforce, increase funding to medical facilities and remove barriers for minority participation in the medical profession efforts which are all big priorities for AMSA, presently and historically.
SDI 2007 5 Week
111 GHS Neg
AHCIA CP 1NC
The United States federal government should pass the African Health Capacity Investment Act of 2007. ( ) Solves the case boosts African health care capacity without sending a Global Health Corp of U.S. workers States News Service, 3-7-2007, Bipartisan Group, p ln
A bipartisan group of Senators today introduced the African Health Capacity Investment Act of 2007, a comprehensive bill to help sub-Saharan African nations confront the alarming shortage of health workers; thirteen countries on the continent have fewer than 5 physicians per 100,000 people. The United States has 549 physicians per 100,000 people. "Increased funding from governments and private donors to expand health services holds the promise of saving millions of lives in Africa. But, a severe shortage of health workers on the ground represents a tight bottleneck slowing the flow of resources to patients who need them," said Dr. Paul Farmer, medical anthropologist and a founder of Partners In Health. "SubSaharan Africa faces a shortage of more than 800,000 doctors, nurses, and midwives and an overall shortage of 1.5 million healthcare workers. The bill introduced today, particularly with its focus on harnessing the power of paid community health workers, is a much needed step toward closing this gap." Senators Dick Durbin (D-IL), Norm Coleman (R-MN) and Russ Feingold (D-WI) called the lack of health care workers and capacity in many African nations a "critical obstacle" in the world's fight against HIV/AIDS and a potential outbreak of Avian Flu and in promoting economic development and growth. "With 11 percent of the world's population, 25 percent of the global disease burden and nearly half of the world's deaths from infectious diseases, sub-Saharan Africa has only 3 percent of the world's health workers." Senator Durbin said. "Personnel shortages are a global problem, but nowhere are these shortages more extreme, the infrastructure more limited and the health challenges graver than in sub-Saharan Africa, the epicenter of the HIV/AIDS pandemic. We will not win the war against AIDS or any other African health challenge without finding solutions to this crisis." "I am very proud to join my colleagues in introducing this bill as it is critical for bolstering our efforts to combat HIV/AIDS and other diseases in Africa," said Senator Coleman. "The lack of health care capacity in Africa imposes major constraints on the long term effectiveness of programs fighting HIV/AIDS and other diseases. For this reason, any forward-looking, comprehensive strategy to fight these terrible diseases must include elements that build African health care capacity." "One of the most critical issues facing Africans today is the massive shortage of health care workers," Senator Feingold said. "The United States has been a leader in addressing HIV/AIDS, malaria, tuberculosis, and other global health crises, but this assistance will only be sustainable with the establishment of a strong medical infrastructure. Bolstering health care capacity in Africa is essential for preventing millions of deaths each year and ensuring our efforts to fight these diseases succeed." The African Health Capacity Investment Act of 2007 seeks to help sub-Saharan African countries strengthen the capabilities of their health systems by: # Improving dangerous and sub-standard working conditions; # Addressing training, recruiting and retention concerns, especially in rural areas, for doctors, nurses, and paraprofessionals; # Developing better institutional management; and # Increasing productivity, reducing corruption and building public health infrastructure.
SDI 2007 5 Week
112 GHS Neg
AHCIA CP
( ) The African Health Capacity Investment Act would boost African health care capacity Africa News, 3-7-2007, U.S. Senate to Tackle Massive Health Worker Shortage, ln
Physicians for Human Rights applauds today's Senate introduction of the African Health Capacity Investment Act of 2007, a bipartisan plan introduced by Senator Richard Durbin that would supply $600 million over three years to stem the flood of doctors and nurses out of African countries in the midst of the AIDS pandemic and other huge health issues. The bill's introduction is an important milestone in a nearly three-year effort spearheaded by Physicians for Human Rights, Health GAP, Partners In Health, the American Medical Student Association, and other groups to move the world to act on this problem. "The United States has recruited thousands of doctors and nurses out of African countries this bill would enable the next generation to treat their neighbors instead of our neighbors," said PHR Senior Global Health Policy Advisor and Global Health Workforce Alliance board member Eric A. Friedman, JD. Initial co-sponsors of the bill include Senators Durbin, Coleman, Feingold, Dodd, Kerry, and Bingaman. The bill would provide $150 million in FY 2008, $200 million in FY 2009, and $250 million in FY 2010 to pay for safer working conditions, training and recruitment of health workers (especially in underserved rural areas) and better health systems management. The World Health Organization estimates that sub-Saharan Africa is suffering a shortage of at least 800,000 doctors, nurses, and midwives, and an overall shortfall of nearly 1.5 million health workers of all kinds. Many receive salaries so low that they cannot afford to pay for rent even in their home country, let alone support a family. Some are forced to live in their own examination rooms. In 2004 Physicians for Human Rights and Health GAP started an advocacy campaign to address this problem and have been spurred on by our colleagues in Uganda and Kenya, where PHR supports large activist networks comprised of health professionals. PHR also wrote a seminal report in 2004 on the subject: An Action Plan to Prevent Brain Drain (see below), which was released at that year's Bangkok International AIDS conference. Since then, PHR, Health GAP and their allies have educated the US Office of the Global AIDS Coordinator, the Global Fund, leaders of G8 nations, and the U.S. Congress about the problem, and all have recognized the issue as a major obstacle to providing health care in the developing world, not only affecting AIDS but also maternal mortality and other pressing health issues. Senator Durbin's bill, however, is the first major US initiative aimed at solving the problem.
SDI 2007 5 Week
113 GHS Neg
AHCIA = Bipart
( ) The AHCIA is bipartisan and supported by lobby groups PR Newswire, 3-7-2007, Healthcare Activists, ln
Internationally-renowned physician and public health activist Dr. Paul Farmer of Partners In Health (PIH) will join more than 1500 medical students and doctors from the American Medical Student Association (AMSA) and the National Physicians Alliance (NPA) to press for Congressional funding to overcome the critical shortage of health workers in Africa and to combat the ever-growing public health crisis in a region devastated by AIDS, tuberculosis and malaria. AMSA, NPA and PIH are asking for a commitment of $8 billion over five years, based on World Health Organization (WHO) cost estimates for health worker training and retention programs. "As healthcare workers and advocates, we cannot turn our backs on an entire continent," says AMSA President Jay Bhatt. "We call on Congress to keep the promises our country made to fight AIDS in Africa." The groups are pushing for rapid passage of and increased funding for the African Health Capacity Investment Act. This bipartisan bill, sponsored by Senators Richard Durbin (D-Ill.), Norm Coleman (R-Minn.) and Russell Feingold (D-Wisc.), was introduced during the week of the AMSA rally at the Capitol on March 8th, 2007. The proposed legislation authorizes funding for sub-Saharan African countries to train and retain doctors, nurses, pharmacists and community health workers critical to lessening the burden of AIDS. "Investing in health workers brings us closer to realizing the full potential of the commitments the U.S. has made to fighting global AIDS, malaria and tuberculosis," said Bhatt.
SDI 2007 5 Week
114 GHS Neg
2NC AHCIA CP Overview

The difference between the plan and the CP is that the plan builds African Capacity using US workers, while the CP just funds building indigenous African worker capacity. They dont have a single warrant why the workers have to come from the U.S. only why the US has to be involved and provide funding. A good chunk of their capacity key cards in the 1AC are even referencing the bill we pass in our CP this means we solve all of their US key cards, but avoid all our DAs to using US workers.
SDI 2007 5 Week
115 GHS Neg
Burkhalter CP
( ) Stuff the U.S. could do to solve the health worker shortage Holly J. Burkhalter, U.S. Dir. Physicians for Human Rights, 4-13-2005, Testimony, Congressional Quarterly,
p. ln
Mitigation and eventual , and harder today than it ever was given the West's insatiable appetite for foreign nurses and the untold attrition of health workers, particularly nurses, due to illness, care giving at home, and death from HIV/AIDS. HIV prevalence in health workers is typically similar to that in the general population. In Malawi, 3% of health workers were dying annually by 1997, a fatality rate six times higher than it had been before the AIDS pandemic. In Lusaka, Zambia, in 1991-1992, the HIV- prevalence rate among midwives was 39%, and among nurses, 44%.20 Much as Malawi, HIV/AIDS has caused illness and death rates of Zambia's health workers to increase five- to six-fold. Resolving it requires an unprecedented degree of strategic planning and cooperation
between national governments, international agencies, and other donors. Recommendations: The Next Phase of US Support for Health in Africa
resolution of Africa's health worker shortage is long overdue
Greatly increased spending by national governments and by foreign donors and international organizations is required to enable countries to meet AIDS prevention, care, and especially treatment targets and to sustain a high level of coverage for these interventions. These
systemic improvements to what is typically the weakest part of health systems in Africa - personnel - will greatly enhance countries' capacity to improve health in all areas, from combating other major diseases such as tuberculosis and malaria to improving child survival and driving down unspeakable levels of maternal mortality that plague much of Africa. We envision an initiative with four main pillars: First, the United States should provide technical assistance to countries in assessing their current health workforce situations, in determining their health workforce needs to achieve health targets, such as the Millennium Development Goals, and in developing strategies to achieve those goals. The strategies should be linked to overall health system development
strategies so that health worker strengthening occurs in concert with the other aspects of health system strengthening require to achieve Millennium Development. So as to guide both national budgets and donor assistance, the strategies should include costing estimates. The strategies should also include coordination among donors and the national government to ensure that the full cost of implementing these strategies is covered. While the national government will determine the strategic process, the United States should encourage broad participation, including by health workers themselves and leaders of rural communities. This will help ensure both that the strategy is consistent with and informed by health workers' needs and the needs of communities, especially those in rural areas who presently have the least access to health services. The United States can also promote, or at least ensure that countries seriously consider, other examples of good practice, such as closing the gap between the pay for physicians and other health workers, promoting equity in the international distribution of health workers, and incorporating all sectors - public, non-for- profit private, NGO, faith-based, and for-profit private - in planning processes. Second,
the United States should help fund the implementation of these strategies. The activities funded should be determined by national
strategies, by the needs as expressed by the people of those countries. Based on strategies that countries have already begun to implement, as well the needs common to the region that will determine the strategies, elements that will likely be in most or all of these strategies include: -- Higher salaries for health workers -- Incentives for health workers to serve in rural areas -- Improved health worker safety, including full implementation of universal safety precautions, post-exposure prophylaxis for health workers potentially exposed to HIV, tuberculosis infection control, and hepatitis B vaccination -- Improved human resource management, including improving human resource policies and enhancing management skills of local health managers -- Increased capacity of health training institutions, such as medical, nursing, and pharmacy schools -Providing continuous learning opportunities to health workers -- Support for community health workers, including compensation, training, supervision, supplies, and linkages to health professional support and referral systems. Training, supporting and deploying people living with AIDS as counselors, prevention advocates, and care givers should be a priority. -- Re-hiring and rational deployment of retired or unemployed health professionals -- Health system improvements not specifically related to human resources for health, such as assuring adequate and dependable provision of supplies and essential drugs. Third, while it is necessary for countries to have human resources for health strategies, enough is known about what is needed to begin funding many interventions immediately, and indeed, the urgency of the crisis demands this. There is no need to wait for fully formed strategies for the United States to begin to provide financial and technical support that will actually begin to help retain health workers, train new ones, and increase health services in rural areas. Much of what is needed, such as ensuring health worker safety and improved human resource management, will be part of any comprehensive
. All health workers need the gloves and other gear to keep them safe. All human resource systems will have to provide health workers with sound supervision, career structures, clear job descriptions, and on- time pay. And all countries will need to have the capacity to know who their health workers are and where they are, which will require computerized databases of their health workforce. Furthermore, even where a complex strategy may be required, as for determining exact training needs or salary structures, pressing needs in such areas as training and salary support may be ripe for immediate funding, even before the strategies are fully established. For example, the nursing school that is part of the Harare Central Hospital in Zimbabwe had only three nurse tutors (professors) in the beginning of 2004, though the school officials say that at least fifteen are required. These posts need to be filled. As of 2003, Kenya had 4,000 nurses, 1,000 clinical officers, 2,000 laboratory staff, and 160 pharmacists or pharmacy technicians who were unemployed not because they were not needed, but because the government could not afford to pay them. These workers need to be hired. Fourth,
strategy on strengthening the health workforce
the United States should support efforts by the World Health Organization and others to collect and disseminate country lessons and experiences in human resource policies and efforts to recruit, retain, and equitably deploy their health workers. Information
of both successful and unsuccessful practices should be widely available so countries learn both from the experiences of other countries, adopting successes to their own circumstances and avoiding other countries' mistakes. One way that the United States do this is by supporting a regional observatory on human resources for health at WHO's African region headquarters. This observatory would promote evidence-based human resource policymaking, share experiences with human resources reforms among regional policymakers, and increase human resource policymaking capacity. Along with learning from experiences elsewhere, countries should also learn from their own experiences, and adjust their strategies based on those experiences. The United States should therefore help countries develop strong monitoring and evaluation capacities. Fortunately, this Administration and this Congress have shown that they are up to the task. The two major new foreign aid initiatives of the past several years, PEPFAR and the Millennium Challenge Account, both represent new ways of doing business. The adoption of the U.S. Leadership Against HIV/AIDS, TB, and Malaria Act of 2003 represents the vision of Members and Senators from across the political spectrum. It was the high-water mark of legislative and executive branch cooperation, and it made possible an unprecedented contribution to health in some of the poorest countries in the world. We believe that
with the leadership of the President and this Committee, you can make a new and desperately needed contribution in the form of direct support of African health workers that will sustain and broaden the programs you launched in 2003. We stand ready to work with you to reach that noble goal.
SDI 2007 5 Week
116 GHS Neg
Buy Local CP
The United States federal government should require that indigenous health workers provide all prevention, care and treatment services supported by all current public health assistance to sub-Saharan Africa, including PEPFAR, without eroding the capacity of the health system to provide other essential health services. ( ) This solves health capacity without causing brain drain requiring the use of indigenous health workers would ensure sustainable capacity is built, without requiring U.S. workers. Their author. Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
assistance programs should seek health workforce additionality, adopting measures to train and retain new indigenous workers in sufficient numbers to meet program needs: Affirmative measures must be adopted by donorsespecially by disease-specific initiativesto avoid draining existing workers from primary health systems. While it may be relatively easy (in some locations) to attract needed local workers by
paying 50 cents an hour more than the public clinic, doing so leaves the overall health system less able to address general health needs and subsequently inadvertently erects new barriers to reaching US health targets. US aid programs could be required to cover their own costs; in countries facing a healthcare workforce shortages. That is, if PEPFAR needs 100 physicians and 450 nurses in a country to meet its goals, then PEPFAR should support the production and retention C. US
of that number of physicians and nurses, utilizing imported staff only as necessary to train replacements and fill gaps while taking steps to train new health workers. Programs in the health field in developing countriesespecially disease-specific initiatives such as PEPFARshould adopt new policies that support training and retention for at least the number of indigenous healthcare workers necessary to meet program goals, while taking proactive measures to avoid drawing from other health programs. Healthcare workforce additionality should become a core priority of PEPFAR. A groundbreaking target could be established requiring, over time, indigenous health workers to provide all prevention, care and treatment services supported by PEPFARwithout eroding the capacity of the health system to provide other essential health services. Utilization of local healthcare workers is already established as best practice for foreign assistance programs and agencies. By working toward 100% local, OGAC will enhance local ownership and the capacity of focus countries. However, adopting specific safeguards to protect
existing health systems and programs is absolutely central. From a health workforce perspective, one serious problem of PEPFAR at present is that the program adds significant new tasks on an already overburdened health workforce. Absent a scaled-up effort
to improve the size and efficiency of the health workforce, this creates two possibilities. Either PEPFAR is unable to achieve its goals, or it does achieve its goals but at the cost of reducing the capacity of the primary health system to provide other essential health services. This could happen by some
combination of drawing health workers away from other jobs, and by asking strapped health workers to perform additional tasks, which will reduce the time during which they can provide other health services and contribute to burnout. Setting a new indigenous health workforce target for PEPFAR is not merely an important moral principle regarding sustainable development. With a stronger overall health system, important disease-specific initiatives such as PEPFAR are able to fully and sustainably succeed. By
expanding the number of healthcare workers by a number sufficient to meet program needs, programs like PEPFAR can address the unintended harm and distortions that can be caused by donor-driven disease-specific initiatives that employ large percentages of a too-small health workforce, while avoiding the cost-and unsustainability of over-reliance on flown-in expatriates. OGAC progress reports
state that almost 80% of the staff hired are local workers in their country of origin. As PEPFAR heads towards renewal and revision, striving for 100% indigenous workers (with flexible deadlines) will use the platform of this already historic initiative to set an important new standard for local ownership and sustainability, while measures ensuring additionality will takr an important new step to address weak health systems that have stymied efforts to truly reach program goals. PEPFAR country teams, or new Country Action This could Teams (below) should include specialists with bottom-line responsibility for human resources for health issues.
take the form of an amendment to PEPFAR that could happen immediately either through US legislation or by adopting new policies administratively.
SDI 2007 5 Week
117 GHS Neg
***Soft Power CPs***
SDI 2007 5 Week
118 GHS Neg
Rest Of The World CP 1NC

The United States federal government should establish a Global Health Service to expand the capacity of community health workers in all countries which are not focus countries in sub-Saharan Africa in the Presidents Emergency Plan for AIDS Relief.
SDI 2007 5 Week
119 GHS Neg
Public Diplomacy CP 1NC

The United States federal government should devote 3% of the United States defense budget to public diplomacy, including international broadcasting and exchange programs. Boosting U.S. public diplomacy can restore U.S. soft power Pamela Hyde Smith, research assoc. @ GWU, Ambassador to Moldova, Winter/Spring 2007, The Hard Road
Back to Soft Power, Politics & Diplomacy, http://journal.georgetown.edu/72/smith.swf?INITIAL_VIEW=100 Several steps by the U.S. government, combined with more vigorous support from the American public, can begin to reverse the damage to the U.S. image overseas. Karen Hughess most pressing task is to persuade the president of the need for rebuilding credibility, an effort that will fail without his buy-in. Shifts in policy, the prime factor in forming public opinion, are the first priority. The Bush administrations marginal retreats from its first-term doctrines of preemption and unilateralism have failed to mollify our critics or nulli- fy the threat anti-Americanism poses to U.S. security. Consequently, further U.S. work within international institutions, treaties,and alliances will be helpful, along with conspicuous fair play
in trade relations. The U.S. government must take responsibility for mistakes it has made, punish those at fault, and move to rectify the consequences. Reviv- ing the U.S. role as honest broker between the Israelis and the Palestinians is also crucial. Ultimately, the U.S. government will bolster its image abroad by treating other nations with renewed respect; listening to world opinion; and matching policy more consistently with American ideals and values such as fairness, the rule of law, human rights, opportunity, and humility. To address the next priority, rebuilding soft power, the U.S. government should re-establish its good global citizenship by deploying American know- how to solve global problems: fighting poverty, disease, tyranny, and environmental degradation as well as terrorism. 24 Even where the United States finds few friends, American science, technology, medicine, and education earn respect and provide an entre for expanded hands-on programs. In the Muslim world education of the very young is critical, given the depth of suspicion and misunderstanding. Enhanced foreign assistance should be tailored to local milieux in order to leverage shared principles and help countries transform themselves rather than expecting them to transform in the U.S.image. People-to- people programs excel, demonstrating American diversity, generosity, and talent and exploding the deadly myths circulating about the United States, especially among people lacking personal experience with Americans. As its third priority,the U.S. government must combat anti-Americanism with as much energy and capital as it dedicated to winning hearts and minds during the Cold War. During that time the United States funded 50,000 Soviets and many more from Warsaw Pact countries to come here on exchange programs, which together with American broadcasting helped win the ideological battle. Given the Islamic worlds estimated population of 1.2 billion, the United States should start building relationships with 200,000 Muslim students, professors, teachers, journalists, political activists, and other influential people, not hand- fuls here and there as at present. Public diplomacy, consequently, needs more funding immediately, at least ten times the amount now allocated. Bigger budgets will mean far more public diplomacy deliverables: language- qualified officers on the ground; exchange programs; information programs; credible speakers discussing the United States warts and all; English- language teaching; cultural events; American Centers staffed with Ameri- cans; wide distribution of translated books and magazines; broadcasts in radio, TV, and new media; rapid- response units; involvement of the vibrant U.S. private sector; the revival of public-opinion polling; and the creation of new programs to suit todays times and places. The State Department must recruit more public diplomacy officers and train them quickly. Given the minuscule numbers of senior practitioners now in public diplomacy positions, State should season its staffing with experienced retirees. Hughes should get the support she needs to strengthen her strategic planning and coordination process by head- ing it with a National Security Council (NSC) deputy director responsible for strategic communications across government, including the Pentagon. Within the State Department the office of the under secretary for public diplomacy needs budgetary, personnel, and planning authority over all public diplomacy functions and the go-ahead to cut through States notorious red tape and let public diplomacy regain its agility. Broadcasting requires further modernizing, streamlining, and closer coordination with public diplomacy; needed language services including English should be restored and unneeded oneslike the expensive broadcasting to Cuba that few can accessdropped. Senior public diplomacy experts must be better integrated into the policymaking process at State and the NSC, explaining the consequences proposed actions would have on world opinion.
SDI 2007 5 Week
120 GHS Neg
Public Diplomacy CP Solves

( ) Boosting funding for public diplomacy solves soft power Joseph S. Nye, Prof and Fmr Dean Of Kennedy School of Govt @ Harvard, Can America Regain Its Soft Power After Abu Ghraib?, Yale Global, 7-29-2004, http://yaleglobal.yale.edu/display.article?id=4302
Can the United States regain its soft power? We have done it before. Anti-Americanism soared during the Vietnam War in the early 1970s, but we recovered within a decade. Not only did we change our policy in Vietnam, but the emphasis on human rights and freedom in Eastern Europe by Presidents Jimmy Carter and Ronald Reagan helped to emphasize attractive American values. We will need to do a much better job in presenting our case to the world. We spend only a billion dollars a year on international broadcasting and exchange programs, about the same as France and Britain though we are five times larger. A bipartisan advisory group reported last year that our expenditure on public diplomacy for the entire Islamic world came to $150 million, which is equal to a few lines on the defense budget. If we spent merely one percent of the defense budget on public diplomacy, that would quadruple our investment in the instruments of soft power. There is something wrong with our priorities when the worlds leading country in the information age is doing such a poor job of getting its message out.
( ) Public diplomacy is biggest factor in creating soft power Joseph S. Nye, soft power guy, The Decline of America's Soft Power, Foreign Affairs, May/June 2004
The United States' most striking failure is the low priority and paucity of resources it has devoted to producing soft power. The combined cost of the State Department's public diplomacy programs and U.S. international broadcasting is just over a billion dollars, about four percent of the nation's international affairs budget. That total is about three percent of what the United States spends on intelligence and a quarter of one percent of its military budget. If Washington devoted just one percent of its military spending to public diplomacy -- in the words of Newtonn Minow, former head of the Federal Communications Commission, "one dollar to launch ideas for every 100 dollars we invest to launch bombs" -- it would mean almost quadrupling the current budget.
( ) Public diplomacy needs funding Joseph S. Nye, soft power guy, The Decline of America's Soft Power, Foreign Affairs, May/June 2004
In 2003, a bipartisan advisory group on public diplomacy for the Arab and Muslim world found that the United States was spending only $150 million on public diplomacy in majority-Muslim countries, including $25 million on outreach programs. In the advisory group's words, "to say that financial resources are inadequate to the task is a gross understatement." They recommended appointing a new White House director of public diplomacy, building libraries and information centers, translating more Western books into Arabic, increasing the number of scholarships and visiting fellowships, and training more Arabic speakers and public relations specialists.
SDI 2007 5 Week
121 GHS Neg
Peace Corps CP 1NC (SSA)

The United States federal government should provide all necessary funding for the Peace Corps to substantially expand operations in sub-Saharan Africa. Peace Corps is the most effective avenue to promote soft power Lex Rieffel and Sarah Zalud, visiting fellow in the Global Economy and Development Center at the Brookings
Institution, and independent consultant for the Global Economy and Development Center at the Brookings Institution, International Volunteering: Smart Power, June, 2006 http://www.brookings.edu/comm/policybriefs/pb155.htm The face of America that has been welcomed most enthusiastically in the rest of the world for decades has been the face of a volunteer: assisting with disaster relief, building houses for poor families, teaching English to university students, and so much more. International volunteer programs contribute directly and indirectly to our nation's security and well-being. They represent one of the best avenues Americans can pursue to improve relations with the rest of the world. The scale of these programs, however, is far below the levels suggested by their benefits. The federal budget for FY 2006 supports 75,000 AmeriCorps volunteers working domestically but only 7,800 Peace Corps volunteers working in foreign countries. Reflecting the value that Americans see in volunteering overseas, programs in the private sector have grown rapidly in the past ten years. In 2005, at least 50,000 Americans participated in NGO and corporate programs. The number could be much higher, easily more than 100,000, with a program like AmeriCorps that leverages private funding. The number could be doubled again by offering additional options suitable to large pools of talent, such as retiring baby boomers. The potential dividends from scaling up international volunteer programs are impressive relative to most other "soft power" programs of the U.S. government. The time is ripe for a breakthrough in this area, with policies aimed at strengthening existing programs such as increased funding for the Peace Corps, raising the public awareness of volunteer programs overseas, linking service and studie, and measuring effectiveness. It is a smart way to knit the United States more effectively into the fabric of this rapidly changing world. The United States is seeking a leadership role that protects its vital national interests while effectively engaging other nations as willing partners. Global challenges such as terrorism, poverty, and HIV/AIDS call for new policies to promote mutual understanding and cooperation with the citizens of other countries. The disadvantages of acting alone or in small coalitions have become clearer in recent years. Furthermore, the experience in Iraq has made the American public more aware of the limitations of "hard power." Hard power can topple unfriendly regimes, but it cannot build stable and prosperous nations. The appointment of Karen Hughes as under secretary of state for public diplomacy and public affairs in March 2005 showed that the Bush Administration is committed to relying more on the kind of "soft power" that Harvard professor Joseph Nye has been advocating for more than a decade. Soft power is exercised through a vast array of public sector activities, from the Fulbright program of academic exchanges to the new Millennium Challenge Corporation. Secretary of State Condoleezza Rice underscored the move toward soft power in a speech on January 18, 2006, that highlighted the State Department's plan for a new "transformational diplomacy." Overseas volunteer work is a form of soft power that contributes measurably to the security and well-being of Americans. Volunteers working in other countries develop life-long relationships and promote crosscultural understanding in ways that few other federally funded programs can do. They bring home to the U.S. an understanding of foreign cultures that enriches our country and informs our policy choices. Volunteers also contribute to institutional capacity building, social capital, democratic governance, and a respect for human rights, all of which help to make the world a safer place for Americans both at home and abroad. International volunteer programs represent one of the best avenues Americans can pursue to improve relations with the rest of the world. Despite the obvious benefits, however, the scale and effectiveness of these programs remain far below their potential.
SDI 2007 5 Week
122 GHS Neg
Peace Corps CP 1NC (Non SSA)

The United States federal government should provide all necessary funding for the Peace Corps to substantially increase operations in every asking country other than sub-Saharan Africa. Peace Corps is the most effective avenue to promote soft power Lex Rieffel and Sarah Zalud, visiting fellow in the Global Economy and Development Center at the Brookings
Institution, and independent consultant for the Global Economy and Development Center at the Brookings Institution, International Volunteering: Smart Power, June, 2006 http://www.brookings.edu/comm/policybriefs/pb155.htm The face of America that has been welcomed most enthusiastically in the rest of the world for decades has been the face of a volunteer: assisting with disaster relief, building houses for poor families, teaching English to university students, and so much more. International volunteer programs contribute directly and indirectly to our nation's security and well-being. They represent one of the best avenues Americans can pursue to improve relations with the rest of the world. The scale of these programs, however, is far below the levels suggested by their benefits. The federal budget for FY 2006 supports 75,000 AmeriCorps volunteers working domestically but only 7,800 Peace Corps volunteers working in foreign countries. Reflecting the value that Americans see in volunteering overseas, programs in the private sector have grown rapidly in the past ten years. In 2005, at least 50,000 Americans participated in NGO and corporate programs. The number could be much higher, easily more than 100,000, with a program like AmeriCorps that leverages private funding. The number could be doubled again by offering additional options suitable to large pools of talent, such as retiring baby boomers. The potential dividends from scaling up international volunteer programs are impressive relative to most other "soft power" programs of the U.S. government. The time is ripe for a breakthrough in this area, with policies aimed at strengthening existing programs such as increased funding for the Peace Corps, raising the public awareness of volunteer programs overseas, linking service and studie, and measuring effectiveness. It is a smart way to knit the United States more effectively into the fabric of this rapidly changing world. The United States is seeking a leadership role that protects its vital national interests while effectively engaging other nations as willing partners. Global challenges such as terrorism, poverty, and HIV/AIDS call for new policies to promote mutual understanding and cooperation with the citizens of other countries. The disadvantages of acting alone or in small coalitions have become clearer in recent years. Furthermore, the experience in Iraq has made the American public more aware of the limitations of "hard power." Hard power can topple unfriendly regimes, but it cannot build stable and prosperous nations. The appointment of Karen Hughes as under secretary of state for public diplomacy and public affairs in March 2005 showed that the Bush Administration is committed to relying more on the kind of "soft power" that Harvard professor Joseph Nye has been advocating for more than a decade. Soft power is exercised through a vast array of public sector activities, from the Fulbright program of academic exchanges to the new Millennium Challenge Corporation. Secretary of State Condoleezza Rice underscored the move toward soft power in a speech on January 18, 2006, that highlighted the State Department's plan for a new "transformational diplomacy." Overseas volunteer work is a form of soft power that contributes measurably to the security and well-being of Americans. Volunteers working in other countries develop life-long relationships and promote crosscultural understanding in ways that few other federally funded programs can do. They bring home to the U.S. an understanding of foreign cultures that enriches our country and informs our policy choices. Volunteers also contribute to institutional capacity building, social capital, democratic governance, and a respect for human rights, all of which help to make the world a safer place for Americans both at home and abroad. International volunteer programs represent one of the best avenues Americans can pursue to improve relations with the rest of the world. Despite the obvious benefits, however, the scale and effectiveness of these programs remain far below their potential.
SDI 2007 5 Week
123 GHS Neg
Funding Key to Peace Corps

Funding key to Peace Corp demand to volunteer and have volunteers high Lex Rieffel non resident Guest Scholar at the Brookings Institution, The Peace Corps in a Turbulent World, October 27, 2003
http://www.brookings.edu/views/papers/rieffel20031015.pdf) The Peace Corps is now active in 71 countries. As noted above, the number of volunteers and the number of countries in which they serve are constrained primarily by the amount of funding requested by the President and appropriated by the Congress. The size of the unmet demand is reflected both in the Presidents proposal to double the number of volunteers to 14,000 by 2007, and by the number of countriesthirty-eightwithout volunteers now that have told the Peace Corps they would like to have some.35 Assuming twenty of these countries can meet the safety and security criteria, and that the average size of the new programs is roughly the same as for the existing programs (100 volunteers), this demand represents an additional 2,000 slots. This implies that most of the increase to 14,000 is likely to come from enlarging existing programs.
Funding key to Peace Corp congress is denying funding National Peace Corps Association, PEACE CORPS FUNDING FACTS, 3/16, 2006
http://www.rpcv.org/pages/sitepage.cfm?id=1210 While President Bush has proposed increased funding for Peace Corps in each of his annual budget recommendations, he is falling far short of his pledge during the 2002 State of the Union address to double the number of Peace Corps volunteers by 2007. While most members of Congress express support for the Peace Corps, Congress has often reduced the President's funding request, sometimes dramatically. For example, last year the President requested a nearly 9% increase in Peace Corps funding. Congress reduced that increase to less than 1%. While Peace Corps reports 7,800 volunteers in the field - a 30 year high - this is almost 50% below 1966 levels, when 15,000 volunteers were in the field. While volunteers are currently serving in 71 nations, Peace Corps has reported as many as 20 additional countries are requesting volunteers.
Funding key to Peace Corp budget constraints have biggest impact Lex Reiffel, Visiting Fellow at the Global Economy and Development Center of the Brookings Institution, REACHING OUT: AMERICANS SERVING OVERSEAS, 12/27, 2005
http://www.brookings.edu/views/papers/20051207rieffel.pdf) Behind all of these compensation components is the role of the federal government. Budget constraints have arguably had the biggest impact on the size of the Peace Corps program. Until this constraint is lifted or more catalytic forms of support for overseas service are adopted, the supply of American volunteers interested in serving overseas is likely to grow at a slow pace. An almost invisible but potentially important element is the tax treatment of volunteer service. At the present time, direct out-ofpocket costs are tax deductible but time on the job is not. The tax treatment of volunteer activity could change in either direction and could have a significant impact on the supply of volunteers.
SDI 2007 5 Week
124 GHS Neg
Peace Corps Solves Soft Power Face To Face

Increasing Peace Corp action creates face-to-face interaction which is key to soft power Joesph Nye, dean of the Kennedy School of Government at Harvard, Political Science Quarterly, Summer 2004
SOFT POWER AND POLICY Soft power grows out of our culture, out of our domestic values and policies, and out of our foreign policy. Many of the effects of our culture, for better or worse, are outside the control of government. But there is still a great deal that the government can do. Much more can be done to improve our public diplomacy in all dimensions. We can greatly improve our broadcast capabilities as well as our narrowcasting on the Internet. But both should be based on better listening as well. Newt Gingrich has written that "the impact and success of a new U.S. communication strategy should be measured continually on a country-by-country basis. An independent public affairs from should report weekly on how U.S. messages are received in at least the world's 50 largest countries."(FN32) Such an approach would help us to select relevant themes as well as to finetune our short-term responses. And we should greatly increase our investment in soft power. We could easily afford to double the budget for public diplomacy as well as raise its profile and direction from the White House. Equally important will be increasing the exchanges across societies that allow our rich and diverse nongovernmental sectors to interact with other countries. It was a great mistake for the Clinton administration and Congress to cut the budget and staff for cultural diplomacy and exchanges by nearly 30 percent after 1993.(FN33) And it is a mistake now to let visa policies curtail such contacts. The most effective communication often occurs not by distant broadcasts but in face-to-face contacts--what Edward R. Murrow called "the last three feet." Such programs were critical to winning the Cold War. The best communicators are often not governments but civilian surrogates, both from the United States We will need to be more inventive in this area, whether it be through finding ways to and from other countries. improve the visa process for educational exchanges, encouraging more American students to study abroad, rethinking the role of the Peace Corps, inventing a major program for foreigners to teach their languages in American schools, starting a corporation for public diplomacy that will help tap into the resources of the private and nonprofit sectors, or a myriad of other ways. As Michael Holtzman has observed about the Middle East, our public diplomacy must acknowledge a world that is far more skeptical of government messages than we have assumed. "To be credible to the so-called Arab street, public diplomacy should be directed mainly at spheres of everyday life. Washington should put its money into helping American doctors, teachers, businesses, religious leaders, athletic teams, and entertainers to go abroad and provide the sorts of services the people of the Middle East are eager for."(FN34) While the United States has a number of social and political
problems at home, many of these are shared with other postmodern societies, and thus invidious comparisons do not seriously undercut out soft power.
Peace Corp allows foreign countries to understand the US because of working together Tom Lantos, US Senator, FDCH Political Transcripts, 3/24 04
Mr. Chairman, the horrific attacks of September 11th, 2001, transformed how Americans viewed the world. The terrorist attacks also exposed many in our country to other people's perceptions or misperceptions about both our nation and our values. I've stated on numerous previous occasions before this committee my belief that we have been neglecting our many traditional public diplomacy efforts. In addition to repairing the damage to public diplomacy instruments of the State Department, I believe that the expansion of the Peace Corps, particularly in predominantly Muslim countries, can go a long way to helping the people of other nations achieve a better understanding of the United States. Mr. Chairman, as President Kennedy anticipated, life in the Peace Corps is not easy. Volunteers often live in simple huts with no electricity or running water, and the ever present possibility of unwelcome guests, like cobras and scorpions. They receive only a small stipend to meet their basic needs during their service abroad and a modest readjustment allowance after their duty is completed. Many times volunteers are posted in communities where the nearest American is hours or days away. Underlying these hardships is the belief that Americans and foreign people best understand one another when they work together on the same project, share the same food, and speak the same language. Although life in the Peace Corps is not easy, it at least should be made safe.
SDI 2007 5 Week
125 GHS Neg
Outsource Diplomacy CP Solves

( ) Public diplomacy cant overcome anger at US policies and other countries can boost U.S. soft power Charles Wolf, Senior Economic Adviser and Corporate Fellow in Intl Econ. @ RAND, and Brian Rosen, Fellow @ RAND, 2004, Public Diplomacy, www.rand.org/pubs/occasional_papers/2004/RAND_OP134.pdf
Still, a reformed and enhanced public diplomacy should be accompanied by limited expectations about what it can realistically accomplish. U.S. policiesnotably in the Israel- Palestine dispute as well as in Iraqinevitably and inherently will arouse in the Middle East and Muslim worlds opposition and deafness to the public diplomacy message that the United States wishes to transmit. While these policies have their own rationale and logic, the reality is that they do and will limit what public diplomacy can or should be expected to accomplish. The antipathy for the United States that some U.S. policies arouse is yet another argument that supports outsourcing some aspects of public diplomacy. The message America is trying to sell about pluralism, freedom, and democracy need not be delivered by the U.S. government. The message itself may be popular among potential constituents who view the United States unfavorably, but if the government delivers the message, the message may go unheard. Nevertheless, even if outsourcing proves more effective, expectations should be limited. While outsourcing may put some distance between a potentially favorable message (pluralism, freedom, and democracy) and an unfavorable messenger (the United States government), inevitably the two will be linked.
( ) Outsourcing public diplomacy solves short circuits criticism of the government Charles Wolf, Senior Economic Adviser and Corporate Fellow in Intl Econ. @ RAND, and Brian Rosen, Fellow @ RAND, 2004, Public Diplomacy, www.rand.org/pubs/occasional_papers/2004/RAND_OP134.pdf
Nancy Snow makes the point forcefully: Public diplomacy cannot come primarily from the U.S. government because it is our President and our government officials whose images predominate in explaining U.S. public policy. Official spin has its place, but it is always under suspicion or parsed for clues and secret codes. The primary source for Americas image campaign must be drawn from the American people.43 With these thoughts in mind, a few approachessome new, some retreadsare worth consideration: The tasks of public diplomacy and the obstacles confronting them are so challenging that the enterprise should seek to enlist creative talent and solicit new ideas from the private sector, through outsourcing of major elements of the public diplomacy mission. Whether the motivational skills and communicative capabilities of a King or a Mandela can be replicated though this process is dubious. In any event, government should not be the exclusive instrument of public diplomacy. Responsible business, academic, research, and other nongovernmental organizations could be enlisted and motivated through a competitive bidding process. Outsourcing should be linked to a regular mid-course assessment, with rebidding of outsourced contracts informed by the assessment.
SDI 2007 5 Week
126 GHS Neg
GSF CP
The United States federal government should establish a program of Global Service Fellowships, double the Peace Corps, provide support to Volunteers for Prosperity, and increase technical assistance and multilateral exchanges. ( ) Solves soft power and international support through public diplomacy David L. Caprara, Dir. Brookings Init. On Intl Volunteering and Service, John Bridgeland, co-chair Brookings Working Group on Intl Volunteering, and Harris Wofford, co-chair, March 2007, Global Service
Fellowships, Brookings Policy Brief #160, http://www.brook.edu/comm/policybriefs/pb160.htm
As policy-makers search for ways to share the best of America with the world, they should start with our international volunteers, who embody this country's spirit of generosity, resourcefulness and hope. With the support of Congress and the Bush Administration, volunteers can become the first face of America to communities in many nations, while advancing concrete initiatives that lift up the lives of the poor throughout the world. To maximize the potential of international volunteering, we propose that Congress establish a program of Global Service Fellowships to support American volunteersnominated by congressional membersserving abroad with qualifying nongovernmental organizations (NGOs), faithbased groups, and universities that are committed to advancing peace and development. Initial funding of $50 million would support approximately 10,000 fellowships annually averaging $5,000 each to pay for volunteers' travel, program costs, and minimal living expenses. In addition, Congress and the White House should work together to double the Peace Corps, authorize and provide support to Volunteers for Prosperity, and increase support of other efforts inside and outside government to enable global service and assess its impact. These efforts will empower a growing coalition of international volunteering organizations to help reach the goal of 100,000 Americans serving in developing countries each year. The role of international
volunteer service in building bridges across growing global divides has never been more critical to the future of our nation, and global peace and stability. Building on the exemplary work of the Peace Corps, a growing field of nongovernmental organizations, faithbased entities, universities, and corporate service programs seek to help communities abroad while enhancing the lives of volunteers. In addition to bringing tangible benefits to the people they serve,
members of this new cadre of international volunteers also tend to develop enduring habits of civic engagement and lasting appreciation of foreign partners and perspectives. This strengthens America's civil society, advances public diplomacy objectives abroad, and deepens American understanding of forces beyond our borders. This movement of international volunteers could be greatly enhanced by congressional leadership to provide America's volunteers with expanded service opportunities that would help improve perceptions of the United States abroad. To maximize the potential of international volunteering, we propose that Congress pursue a global service agenda centering on a new program of congressionally-nominated Global Service Fellowships, along with doubling the Peace Corps, authorizing and
supporting Volunteers for Prosperity, and increased support of technical assistance and multilateral exchanges. These efforts will empower a growing coalition of international volunteering organizations to
help reach the goal of 100,000 Americans serving in developing countries each year. The unique power of volunteer service has been key to the vitality of our nation since its birth. In the mid-nineteenth century, historian Alexis de Tocqueville noted the unique contributions of voluntary organizations as a core strength of our young democracy. In the following two centuries, presidents from John F. Kennedy to George W. Bush have recognized that volunteering is one of America's greatest exports. A longitudinal study conducted by Abt Associates for the Corporation for National and Community Service noted the profound long-term impact of extended service in domestic programs like AmeriCorps on participants' civic engagement. These benefits include increased volunteer connections and participation in their community, knowledge of local community challenges such as the environment, health, and crime, and personal growth through strengthened habits of citizenship and service. Service abroad brings the additional benefit of forging personal relationships between generous Americans and poor citizens of foreign lands. While American volunteers come home with a lifelong appreciation of the challenges faced by developing countries, citizens of those nations gain personal experience of American generosity and humanity. The potential power of these efforts are evidenced in the results of a recent Terror Free Tomorrow poll, which showed a markedly positive change in major Muslim nations' perceptions of the United States in response to humanitarian relief and service initiatives. Polling data indicated that nearly 60 percent of Indonesians and 75 percent of Pakistanis held more favorable views of the United States following humanitarian assistance after their tsunami and earthquake tragedies. Importantly, this change in perception lasted beyond the initial aid and service, underscoring that America's actions can have lasting impact.
SDI 2007 5 Week
127 GHS Neg
AT: Soft Power CP Isnt Health Care

( ) Irrelevant just because they have evidence that says health care is ONE way to restore the US image abroad doesnt mean its the only way our solvency evidence indicates that the CP is sufficient to bolster US soft power. If they win this argument, it just proves they dont solve the advantage they do nothing to remedy Iraq or inaction on warming ( ) Even if their link evidence is about health care, their INTERNAL LINK is about soft power in general which means we access the full weight of their impact
SDI 2007 5 Week
128 GHS Neg
***Bioterror CPs***
SDI 2007 5 Week
129 GHS Neg
Domestic Capacity CP 1NC

The United States federal government should establish a comprehensive program to boost domestic public health capacity to adequately deal with the prevention of and response to microbial threats, including training in microbial threats specific to developing countries.
SDI 2007 5 Week
130 GHS Neg
Domestic Capacity CP Solves

( ) Boosting domestic public health capacity is key to check microbial threats Mark S. Smolinski, Senior Program Officer @ Inst. Of Medicine @ NAS, et al., 3-18-2003, Microbial Threats to
Health, http://www.nap.edu/catalog/10636.html Strong and well-functioning local, state, and federal public health agencies working together represent the backbone of an effective response to infectious diseases. The U.S. capacity to respond to microbial threats is contingent upon a public health infrastructure that has suffered years of neglect. Upgrading current public health capacities will require considerably increased, sustained investments. U.S. federal, state, and local governments should direct the appropriate resources to rebuild and sustain the public health capacity necessary to respond to microbial threats to health, both naturally occurring and intentional. The public health capacity in the United States must be sufficient to respond quickly to emerging microbial threats and monitor infectious disease trends. Prevention and control measures in response to microbial threats must be expanded at the local, state, and national levels and be executed by an adequately trained and competent workforce. Examples of such measures include surveillance (medical, veterinary, and entomological); laboratory facilities and capacity; epidemiological, statistical, and communication skills; and systems to ensure the rapid utility and sharing of information.
SDI 2007 5 Week
131 GHS Neg

( ) Boosting domestic public health capacity is key to check microbial threats the U.S. needs more workers Mark S. Smolinski, Senior Program Officer @ Inst. Of Medicine @ NAS, et al., 3-18-2003, Microbial Threats to
Health, http://www.nap.edu/catalog/10636.html The U.S. capacity to respond to microbial threats to health is contingent on a public health infrastructure that has suffered years of neglect. Upgrading current public health capacities will require considerably increased investments across differing levels of government. Most important, this support will have to be sustained over time. Such an investment will have lasting and measurable benefits for all humankind. With recent increased funding for bioterrorism preparedness, the United States has an opportunity to develop programs and policies that will both protect against acts of bioterrorism and improve the U.S. public health response to all microbial threats. However, it is alarming that some of these funds have been diverted from multipurpose infrastructure building to single-agent preparedness. The threat of bioterrorism is intimately related to that of naturally occurring infectious diseases. The response to bioterrorism is much like the response to any microbial threat to health, and the necessary resources for building the public health infrastructure are, in essence, the same as those needed to respond to bioterrorism. It would be counterproductive to develop an ancillary system for bioterrorist threats. Rather, such efforts must be integrated with those addressing the continuum of infectious disease concerns and potential disasters to which public health agencies are already charged to respond. While preparedness for bioterrorist-inflicted outbreaks will require certain specialized program elements and policies (related, e.g., to law enforcement, evidence collection), the human health aspects of this new challenge mirror many of the requirements for preventing and responding to a range of naturally occurring infectious disease threats. Wherever possible, therefore, effective strategies should build on existing systems that are used routinely and can be useful for both purposes. In short, the objectives of the funding that has been allocated for bioterrorism will be met only if the public health infrastructure is enhanced first and foremost. Otherwise, preparedness programs will be inadequate, and critical opportunities to protect both human populations and agriculture (food animals and plants) from a range of disease threats, both naturally occurring and maliciously caused, may be missed. Strong and well-functioning local, state, and federal public health agencies working together represent the backbone of effective response to a major outbreak of infectious disease, including a bioterrorist attack. How quickly public health agencies can recognize and respond to an emerging threat dramatically influences the ability to reduce casualties, control contagion, and minimize panic and disruption. Unfortunately, an overall shortage of qualified public health workers makes it difficult to meet this demand. Following the events of 2001, public health agencies were asked to develop new programs and add new staff despite the lack of available candidates. An estimated 3,200 to 4,000 new positions were requested in the bioterrorism cooperative agreements submitted to CDC. In addition, an estimated 13,000 to 15,000 persons are needed to provide 24-hour emergency coverage at the local level (Center for Infectious Disease Research and Policy, 2002). Yet a wide range of administrative barriers prevent public health agencies from obtaining qualified staff. These include non-competitive pay scales, cumbersome hiring procedures, lack of system flexibility, and inadequate incentives for retaining qualified personnel. Local health departments range in coverage from small areas served by part-time staff with little or no formal public health training to large urban health districts with inadequate resources to support the continuing education and training of their workforce. Some of the smaller local health departments could be consolidated and strengthened to ensure needed professional expertise and coverage on a more regional basis. To strengthen the public health infrastructure for infectious disease detection and response, it will be necessary to train, equip, and expand the workforce to provide both on-the-ground epidemiologic expertise and laboratory capability.
SDI 2007 5 Week
132 GHS Neg

( ) Lack of knowledge is endemic filling the gaps in US public health capacity is key to solve bioterror Rebecca Katz, PhD candidate @ Princeton, Summer 2002, Public Health Preparedness, Wash. Q., ln
Not enough epidemiologists and public health officials are trained to investigate every suspected outbreak at the local, state, or federal level. Funding should be given to schools of public health and to fellowship programs to ensure that a cadre of highly trained professionals are available. Officials should also allocate portions of local and state budgets to the hiring of infectious disease epidemiologists. Federal programs should also expand so that more people will be trained in advanced outbreak investigation. Currently, the CDC places Epidemic Intelligence Service members (highly trained professionals) in state health departments around the country. On average, however, only one person is placed in each state, and at least 12 states have no representative. Fortunately, officials have slated this program to receive a significant increase in funding, which they will hopefully use to place at least one person in every state and large metropolitan region, with preferably a small team of professionals in each state to coordinate disease investigations and communication with federal authorities. In addition to training more epidemiologists, existing medical personnel must learn about the role they might play in a biological attack. Most U.S. physicians and first-responders today have never seen a case of smallpox or many of the other diseases listed as critical threats; an infection would thus challenge them to present a diagnosis of the disease without laboratory confirmation. Because rapid diagnosis and treatment is an essential component of bioterrorism response, physicians should become familiar with likely bioterrorist attack agents. Although some physicians initially resisted attending training sessions, they are becoming more willing participants as they perceive the threat of a bioterrorist attack and recognize the role they might play. In addition to the voluntary training of attending physicians, an organized, mandatory program should educate medical students, selected residents, and paramedics on the signs, symptoms, and treatment of agents identified by the CDC as possible biological weapons. Officials should also reinforce for these professionals the protocols for reporting diseases and the required actions in the event of a bioterrorist attack.
SDI 2007 5 Week
133 GHS Neg
AT: Domestic CP Doesnt Learn About Africa

( ) We fiat this the domestic program would include elements that teach U.S. professionals about diseases and threats in developing countries.
SDI 2007 5 Week
134 GHS Neg
Integration CP
( ) Integration of military and law enforcement for counterterrorism can solve the terrorist risk from failed states Thomas Dempsey, Dir. African Studies @ US Army War College, April 2006, Counterterrorism in African
Failed States, Strategic Studies Institute, http://www.strategicstudiesinstitute.army.mil/pdffiles/pub649.pdf The limitations of current counterterrorism strategies in failed states argue for an entirely new approach to the problem. The military and law enforcement communities bring very different core competencies to the table. Neither community, by itself, has the skill set to implement counterterrorism strategies in failed states effectively. Both communities working in tandem, however, offer capabilities that may prove effective in dealing with the complex failed state problem set. U.S. military forces may not be ideally suited to apprehending individual terrorists, but they are superb at carving out a secure area of operations in difficult and violent environments. Marine Expeditionary Forces and U.S. Army Brigade Task Forces, supported by Air Expeditionary Wings and Naval Amphibious Task Forces, are not only capable of establishing secure bases in the midst of the most violent and chaotic failed state, but they also are capable of projecting a secure presence into the most difficult and problematic areas of that state. Despite their failure, ultimately, to locate and take Mohammed Farrah Aideed into custody, the Army Rangers and Delta Force commandos of Black Hawk Down were able to penetrate into, and sustain themselves for an extended period of time within, the most dangerous area in all of Somalia. While the U.S. foreign intelligence community has not enjoyed much success in locating individual terrorists in failed states, it can identify terrorist hubs operating from failed states that are developing and exercising global reach. It is in exercising their connections with geographically distributed nodes that terrorist hubs will make themselves most vulnerable, as Sageman has pointed out. Those hubs that are close to achieving access to WMD will have the highest profile. Those organizations making up the U.S. foreign intelligence community are the agencies most likely to detect terrorist hubs developing global reach and WMD capability, and to identify the failed states that they are operating from. Having done so and having provided the basis for launching a military operation to obtain access to the failed state in question, the challenge of locating and apprehending individual terrorists on the ground remains. In confronting this challenge, the U.S. law enforcement community can make its greatest contribution. Locating, positively identifying, and apprehending dangerous individuals in the midst of a civilian community is a core competency of U.S. law enforcement. More specifically, it is a core competency of American law enforcement at the local, and particularly at the municipal, level. American law enforcement officers are among the best trained, best equipped, and most professional in the world. The level of sophistication and capability routinely present in larger metropolitan police departments in the United States exceeds the capabilities of most nation-states. Two strategic approaches to law enforcement, one pioneered by American police forces and one developed in the United Kingdom, can provide a framework for effectively locating and apprehending terrorist suspects in failed states. Those approaches are community policing and intelligenceled policing.
SDI 2007 5 Week
135 GHS Neg
***Agent CPs***
SDI 2007 5 Week
136 GHS Neg
EU CP
( ) The EU can solve for African health capacity shortages European Commission, 12-14-2005, EU Commission presents strategy, http://www.europa-euun.org/articles/en/article_5467_en.htm The Commission has adopted a strategy to combat the shortage of doctors and nurses, which has reached a crisis level in African countries most highly affected by AIDS, Tuberculosis and Malaria. This strategy comes fast on the heals of the European Union agreement on a Consensus on Development Policy and on a Strategy for Africa, where the Commission proposes coordinated action of the European Union to assist developing countries in building up viable health systems. With todays communication, the Commission proposes the EU a coherent and coordinated response to a major barrier in the fight for better health in developing countries and shows once more its commitment to the Millennium Development Goals (MDGs). In presenting the Communication, Commissioner Louis Michel said: With this strategy the Commission puts its finger on a critical issue: the public health situation in many developing countries is outrageous. In many regions in Africa, a whole generation is at risk because of AIDS. They need well-trained, equipped and motivated doctors and nurses. The Commission calls on the EU to act jointly and quickly. The reasons for the human resource crisis in the health systems in many developing countries are complex: Years of chronic under-investment in health services and training of personnel and the lack of even basic equipment and drugs have lead to a demoralisation of personnel and a dramatic deterioration of health services. In addition, many health workers have left rural and remote areas and moved to urban centres and abroad where conditions are better. As a result of the AIDS pandemic, TB and malaria and lack of access to health care, life expectancy has declined in 17 African countries during the last 25 years. With 25% of the global disease burden at a share of only 10% of the worlds population, Africa is ill equipped to deal with this challenge with just 0.8 health workers per 1000 head of population, the figure for Europe in comparison is 10.3 per 1000. The Commissions strategy also acts against the migration of health workers from the developing to the developed world. The Commission proposes a set of actions to keep health workers where they are needed most such as retention schemes, incentives to work in rural areas and support for training and career development. These schemes will improve the quality of the working environment and strengthen the overall health systems and thus act as an incentive for doctors and nurses to take up a local job. Direct investment into the health sectors of developing countries through budgetary support as proposed by the Commission is another effective means to prevent unwanted migration. Such funds do not only increase ownership and responsibility of developing countries administrations to respond to the crisis and improve coordination and predictability of funding, they can, for example, also improve local salary conditions and therefore provide an additional incentive to stay. However, benefits of managed migration for both sides should not be ignored. Commenting on the migration of health workers from developing countries to some EU Member States, Commissioner Louis Michel noted that well managed migration can be beneficial both to the EU and to the countries of origin as it promotes brain circulation, rather than brain drain. Using training and work opportunities abroad in the framework of specific programmes can help transfer skills and build capacity without draining poor countries of essential human resources.
SDI 2007 5 Week
137 GHS Neg
EU CP
( ) The EU is capable and politically willing to boost African health care capacity Caitlin Roman, AP Writer, 6-27-2007, Ethio Media, EU to help African workers return home,
http://www.ethiomedia.com/atop/eu_to_help_african_workers.html The European Union wants to encourage skilled African workers to return home, saying their countries need them to develop their own economies, the European Commission said Wednesday as part of a paper listing ways it can help African development. The EU's executive arm said it wanted to reduce problems African countries face when professionals -- particularly doctors and nurses -- leave to take up betterpaid jobs in Europe. "Africa and the EU will specifically address the issue of migration of skilled labor such as health care workers and seek to minimize the negative impact of European recruitment in Africa, with lack of health work force capacity now recognized as a major barrier to progress toward the (United Nations) Millennium Development Goals," it said. A recent World Bank survey said 70 percent of recently graduated doctors and 62 percent of recently graduated nurses in Ethiopia plan to leave the country "whenever they get the chance." An estimated 80,000 qualified people leave the African continent every year. The EU said it would work with African Union countries to promote "circular migration" to encourage African workers in Europe to find work at home. It did not set out any formal suggestions but mentioned better links between African and EU universities and hospitals as one way of helping this happen. EU and African Union leaders will meet in December to debate migration -- including ways to fight human trafficking and protect victims. They will also investigate ways to make it easier for migrants to send money back home -- a practice that can serve as a form of development aid. The summit will also cover efforts to halt deforestation, bringing developing countries into a cap-and-trade program for carbon emissions and encouraging them to use more greener technology. The EU paper said the block was planning to launch a global climate change alliance to help vulnerable countries cope with climate change. Africa is likely to suffer expanding deserts, water shortages and more floods and droughts that could undo years of development efforts, a January report by the United Nations Intergovernmental Panel on Climate Change found. Europe is a major donor to Africa, the world's poorest continent. The EU alone gave $64.6 billion last year, a figure that does not include donations from individual EU governments.
SDI 2007 5 Week
138 GHS Neg
EU CP
( ) The EU can boost African health capacity Africa News, 7-14-2003, Is Europe Doing Its Part in Africa, ln
Improving health The very first symptoms of poverty are run-down health-care systems that have proven incapable of halting the very rapid spread of AIDS and other communicable diseases. To improve health in Africa, the biggest challenge is therefore to develop and sustain the capacity of poor countries to deliver basic health services. Donors can best support this through general support for public finances, debt relief and good policies in the health sector. This is the basic policy stance of EU development aid. The EU has so far pledged $2.5 billion, or 54% of total pledges, to the Global Fund to Fight AIDS, TB and Malaria. For 2004 alone, current EU pledges to the Fund amount to $425 million. This means the EU pledge is more than twice as high as the US pledge of $200 million. We acknowledge, however, and welcome the US announcement of a $15 billion AIDS package, which demonstrates a growing understanding in the US administration and Congress.
SDI 2007 5 Week
139 GHS Neg
EU CP
( ) European health care is superior to the U.S. Kerry Capell, senior writer for Business Week, 6-14-2007, Is Europes Health Care Better, Spiegel,
http://www.spiegel.de/international/business/0,1518,488528,00.html Indeed, a May 15 study from the Commonwealth Fund study comparing the quality of the US system with five other countries found that despite spending twice as much per capita, the US ranks last or near last on basic performance measures of quality, access, efficiency, equity, and healthy lives. "The US stands out as the only nation in these studies that does not ensure access to health care through universal coverage," says Commonwealth Fund President Karen Davis. Gazing across the Atlantic won't lead Americans to a model that fits everyone's requirements. Britain, in particular, suffers myriad problems in its National Health Service. But in some respects, France comes pretty close to the ideal. Not only are its 62 million citizens healthier than the US population, but per capita spending on health care is also roughly half as much.
SDI 2007 5 Week
140 GHS Neg
China CP
( ) China has experience with infrastructure projects in Africa Peter Bosshard, Policy Dir., Intl Rivers Network, May 2007, Chinas role in Financing African Infrastructure,
http://www.irn.org/pdf/china/ChinaEximBankAfrica.pdf China has become a primary financier of infrastructure projects in Africa. China Exim Bank, the countrys official export credit agency, has approved at least $6.5 billion in loans for Africa, most of which is for infrastructure investments. China Exim Bank loans are often part of larger cooperative arrangements between China and African countries, which may include trade deals, arms exports, student exchanges, and the presence of peace keepers. The rapid emergence of Chinese infrastructure financiers in Africa has raised a variety of concerns among international financial institutions, non-governmental organizations, and Western governments. This report examines and discusses the impacts that Chinese financiers and particularly China Exim Bank have regarding debt creation, good governance, and environmental protection. It measures Chinas efforts not by Western standards, but by international standards which China has signed or helped to bring about.
SDI 2007 5 Week
141 GHS Neg
China CP
( ) China is better at providing health assistance than the US closer to Africa, similar health system, and better trust Peter Bosshard, Policy Dir., Intl Rivers Network, May 2007, Chinas role in Financing African Infrastructure,
http://www.irn.org/pdf/china/ChinaEximBankAfrica.pdf While the history of Africas relation with Europe and North America is checkered, African- Chinese relations have generally been friendly. Many African governments remember that China supported Africas liberation struggles against the colonial powers. In recent years, the political relations between China and Africa intensified quickly. President Hu Jintao and Premier Wen Jiabao visited no less than 18 African countries between April 2006 and February 2007, and 48 African governments sent high-level delegations to the FOCAC summit in Beijing. Many African leaders admire the tremendous economic success which China has achieved over the past decades. As a developing country, China can offer experiences and goods that are better suited to the needs of African societies than the policy advice and products from industrialized countries. For example, China and Africa both have dual health systems that rely on traditional as well as modern medicine. While Western pharmaceuticals are unaffordable for most African patients, China offers cheap and effective anti-malaria drugs based on the Artemisia shrub that are of great interest for African consumers. According to Chinas new African Policy of January 2006, China respects African countries independent choice of the road of development and will provide and gradually increase assistance to African nations with no political strings attached.20 Indeed, China extends loans with (almost) no strings attached. At the FOCAC summit of November 2006, President Hu Jintao pronounced that [t]reating each other as equals is crucial for ensuring mutual trust.21 At the same event, Premier Wen Jiabao stressed that Chinese assistance to Africa is sincere, unselfish and has no strings attached.22 Chinas only condition for political and economic cooperation is the one China principle, in that African partner governments may not have official contacts with Taiwan. African governments have hailed Chinas new role as a trade partner and financier as a major new opportunity for Africas development. [China] is cooperating with African countries on an equal basis without any desire to colonize Africa, Zimbabwes President Robert Mugabe said in October 2006.23 Around the same time, Sudans President Omar El-Bashir praised his countrys relations with China as exemplary in South-South cooperation.24 And a senior Nigerian government official was quoted by the Financial Times as follows: Being a developing country, they understand us better. They are also prepared to put more on the table. For instance, the western world is never prepared to transfer technology but the Chinese do.25
SDI 2007 5 Week
142 GHS Neg
Canada CP
( ) Canada imports a large number of doctors from SSA Ronald Labonte, South African Migration Project, 2006, The Brain Drain,
http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_2.pdf It is clear that unless Canada and source countries take some action, the brain drain of health care professionals from Sub-Saharan Africa to Canada will continue. The greater fear is that, as Canadas shortages in physicians and nurses are exacerbated (as predicted), so will the brain drain. Unless measures are adopted, there is no indication or reason why trends in the sources of the drain to Canada will change; Canada will continue to receive significant numbers of health care professionals from Sub-Saharan Africa, a region itself so desperate for their skills.
SDI 2007 5 Week
143 GHS Neg
WHO TTR CP
( ) The WHOs Treat, Train and Retain plan can boost human resources for disease prevention WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf In devoting the 2006 World Health Report to human resources for health, the World Health Organization has demonstrated its recognition of the centrality of the health workforce in global strategies to reach health and development goals. The report highlights the growing crisis of human resources for health (HRH), particularly in sub-Saharan Africa where there is an estimated critical shortfall of 0.82 million health workers in 36 African countries. This situation is exacerbated by the weakness of the current training output for Africa which is only 10% of what is needed. The report challenges the global community to fi nd ways to work together through alliances and networks, across health problems, professions, disciplines, ministries, sectors and countries to meet health workforce challenges. The World Health Organization has played a key role in the formation of a Global Health Workforce Alliance that aims to bring relevant stakeholders together to accelerate core country programmes. In addition, the deepening AIDS crisis in many subSaharan African countries has catalysed a specifi c focus on health workforce defi cits which pose a challenge to effective delivery of HIV services. The 2005 global commitment to scale up HIV services, with the aim of as close as possible to universal access to treatment for all those who need it by 2010, has created new urgency for intensifying global action to strengthen the health workforce. Both the fi nal report of the 3 by 5 Initiative 1 and the assessment report of the Universal Access Global Steering Committee 2 list the human resource crisis as one of fi ve key challenges to scaling up HIV services. Against this backdrop, the need for an approach to strengthen the health workforce in the context of HIV and AIDSand one that is aligned with broader action for health systems strengtheninghas become clear. In May 2006, an international consultation, attended by 134 delegates representing governments, health workers and their organizations, international agencies, development agencies, academic institutions and civil society organizations active in the fi elds of HIV and HRH, was held in Geneva to discuss a plan which would fulfi l this ambitious goal. The consultation gave defi nition to a proposed AIDS and health workforce plan dubbed Treat, Train, Retain (TTR), which comprises three elements: Treat (prevent, care and support)a package of HIV treatment, prevention, care and support services for health workers in countries affected by HIV. Train (and planning for HRH)measures to empower health workers to deliver universal access to HIV services that include pre-service and in-service training for a public health approach. Retainstrategies to enable health systems to retain health workers, including incentives, measures to improve occupational health and safety and to improve the workplace as well as initiatives to manage the migration of health care workers. The elements, which are mutually reinforcing, have been grouped for conveniencethere is some overlap between them. TTR should be seen as a menu of options which builds upon existing work in the fi eld. Its main function is to catalyse, coordinate and maintain the momentum of the different actors and programmes in this broad fi eld. It recognizes that a coherent approach for scaling up towards Universal Access will need to be broad and multifaceted and will depend on the scaling up of current initiatives both within and outside the AIDS silo. Country leadership and country ownership, and the embedding of TTR plans into broader planning and processes in the areas of HRH, development and poverty reduction will be central to the success of TTR. By addressing both the causes and effects of HIV and AIDS in relation to the health workforce, TTR is both an essential component of the strategy to scaling up towards universal access and will make an important contribution to strengthening human resources for health in countries affected by the epidemic.
SDI 2007 5 Week
144 GHS Neg
WHO Solves Best

( ) WHO solves best at boosting human resources for health in Africa they have the best technical skills and resources WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf WHO has been an active player in the recent initiatives around human resources for health, and has made this issue the subject of the World Health Report 2006 and World Health Day. In particular, the Evidence and Information for Policy Cluster (EIP) in WHO has played a leading role in the global dialogue around HRH and has also housed and led the African Working Group on African Regional HRH Observatory for the fi rst year. The Human Resources Department of the EIP cluster has also led the Transitional HRH Working Group, which has reported to the High Level Forum on HRH in Paris in 2005. WHO/EIP and the WHO Regional Offi ce for Africa HRH division have also worked closely with the African Union/Nepad to advance HRH action on the continent. At country level, the WHO Regional Offi ce for Africa HRH division has been working with Member States to analyse their HRH situation and plan new strategies. Thus WHO expertise will be essential in ensuring that the AIDS Health Workforce plan is aligned with the current global HRH movement, and that new activities will be integrated into ongoing activities. The WHO/HIV department is widely acknowledged as the technical leader in the fi eld of HIV and AIDS treatment and care. Experience gained in rolling out ART during the 3 by 5 programme has provided both the impetus and expertise for scaling up and enhancing human resources for AIDS. Based on the experience of 3 by 5 and in particular the lessons learnt from district-level implementation of the IMAI package, the WHO/HIV department has a comparative advantage in several areas. Many of these are the new or neglected elements, such as: Advocacy, design and implementation of priority prevention, treatment and care programmes for health workers; Advocacy, policy and implementation of a public health approachinvolving decentralization and integration as well as task-shifting, which will be central to expanding human resources for AIDS. Revision of current training programmesat pre-service and inservice levels to include modules that will empower health workers to care for their own health in a time of AIDS.
SDI 2007 5 Week
145 GHS Neg
Global Initiative CP
( ) A global initiative to boost healthcare worker densities would solve the types of assistance that need to be provided are clearly not things the U.S. is superior at Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
A. Lead a global initiative to achieve minimum healthcare worker densities, with a US focus in subSaharan PEPFAR countries: According to Ambassador Randall Tobias, the head of the Office of the Global AIDS Coordinator (OGAC), the biggest obstacle faced by the US is a shortage of healthcare workers. Similarly, the WHOs 3x5 initiative and many Global AIDS Fund grants have been stymied by health workforce shortages and weak overall health systems. New investments will be needed to meet US global health targets such as those sought by PEPFAR as well as international commitments like the Millennium Development Goals or the G8 commitment to provide universal treatment coverage by 2010. To share these additional costs while achieving established targets, the US should call for and support a global health
workforce self-sufficiency initiative, urging donor nations to provide assistance to developing countries to achieve minimum health workforce density [2]. The US could lead the way by taking responsibility for supporting adequate health workforce density in PEPFAR focus countries, working with Country Action
Teams of public and private actors on the ground to develop and implement plans. New money will be necessary to train and retain workers, but estimates indicate first year expenses of $650 million, scaling to $2 billion over five years time will be sufficient to double the healthcare workforce in target countries. A private analysis was prepared in spring of 2005 year for US officials en route to the G7 Summit by WHO Special Envoy on Human Resources for Health Lincoln C. Chen, Chair of the JLI and Director of the Global Equity Center at Harvard Kennedy School of Government (with support from Health GAP, Physicians for Human Rights and Global Health Council). This memo includes all of Dr. Chens findings, and his methodology is A global initiative for self-sufficiency in sub-Saharan Africa is urgently available as an appendix.
needed, and would consist of donor countries working with public and private actors in specific impoverished nations to establish and sustain minimum health worker densities the number of trained health
workers needed to achieve quality health coverage. The term minimum health worker densities should mean the minimum ratio of health workers (of a nationally-determined skills mix) to population size required in a particular country needed to achieve and sustain local health priorities, US HIV/AIDS treatment and prevention targets and international health goals. A starting source to determine minimum health worker densities is the WHOs Joint Learning Initiative. The JLI establishes 2.5 trained health workers per thousand residents as the minimum number necessary to achieve minimum health standards in sub-Saharan Africa. Logical choices for the US-specific focus of a global initiative may begin with LDC PEPFAR countries, where country-level planning and experience may be strongest. Other donor nations should be challenged to provide assistance to other countries. An initiative to attain health workforce self-sufficiency would convene teams of relevant public and private actors to rapidly develop and implement plans to achieve minimum healthcare worker density. The US should then facilitate access to all available sources of internal and external financing for appropriate components of the overall plan. Specific program components and an packages of health improvements should be developed New US money will be necessary, by teams at the country level. (see New models for technical assistance below)
but rough estimates indicate that even relatively modest new investments can double the healthcare workforce in target countries. This investment in health workforce strengthening is a necessary complement to ensure the success and sustainability of the historic U.S. investments to fight AIDS. $2 billion would be needed in the first year from African governments and the collective donor community to at least double sub-Saharan Africas health workforce. Over five years, the total global cost will gradually rise to $7.7 billion annually. The U.S. share of this total cost would be approximately $650
million for the first year, rising to $2.6 billion over five years. This 1/3rd percentage is commensurate with the U.S. percentage of the worlds economy and similar to the US contributions to food aid programs and the Global Fund to fight AIDS, Tuberculosis and Malaria. This investment will need to be accompanied by donor and country-level policies that increase the size, skill, motivation and support for health workforce, and the rapid launch of community health worker initiatives. The majority of the funds required will necessarily have to come from the donor community. The approximate breakdown of the $2.0 billion required worldwide in year 1: 35% for health worker compensation, including stipends for community health workers and raising health workers out of poverty wages[3] 10% for incentives to health workers to serve in rural areas 25% for health worker pre-service education and continuous learning[4] 30% for human resource management and planning; health workplace safety; training, supervision, and support for community health workers and caregivers; human resources support to the not-for-profit NGO and faith-based sectors; global and regional support and learning The approximate breakdown of the $7.7 billion required in year 5: * 45% for health worker compensation, including stipends for community health workers and raising health workers out of poverty wages * 15% for incentives to health workers to serve in rural areas * 15% for health worker pre-service education and continuous learning * 25% for human resource management and planning; health workplace safety; training, supervision, and support for community health workers and caregivers; human resources support for not-for-profit NGO and faith-based sectors; global and regional support and learning These are the categories of investments required to educate, recruit, and retain the numbers of health workers necessary to at least double the health workforce and progress towards minimum coverage densities; to enhance health worker coverage in rural and other under-served areas, and; to increase the effectiveness of the workforce by improving health worker motivation and making the best use of health workers skills. Contributions levels should be sustained over time, but may be assumed to be bell-shaped. Decreasing contribution levels over time should be accompanied by predictable measures to facilitate local continuation.
SDI 2007 5 Week
146 GHS Neg
Gates Foundation CP
( ) The Gates foundation is the quickest and best actor for solving global disease problems Laurie Garett, senior fellow for Global Health @ CFR, 1-25-2007, CFR On-The-Record, FNS, ln
Yeah, the Gates Foundation is really the giant elephant in the room. And worse yet, it's a giant elephant that's given money to every single aspect of academic public health all over the world. So all of academic public health is talking about the room as if the elephant wasn't in it, because nobody wants to lose the money they're getting from the Gates Foundation. So we've actually reached a point where it's difficult to get objective critique. And I think that's hard for the Gates foundation. They don't like that. They want to be able to have critique and analysis of how they're moving this. You know, it's a very, very young foundation. It's only really been giving on any mega-scale the last five, six years. And the real scale of giving is about to start next year when the Buffett money kicks in and is required to be given away as received. It cannot go into the equity funds of the foundation. And there, you know, one can just imagine enormous mistakes being made. I think already two, maybe even three years ago, the Gates Foundation had become the dominant policy force, because it's agile. It can move very quickly. It doesn't have to convene a meeting, as WHO does, of 193 member states and lobby everybody and then try to get a vote passed. The Gates Foundation can hold a meeting of we don't even know who, utterly opaque, there's no transparency here, in a closed-door and change direction radically overnight. And as a result, they're in, on the one hand, a marvelous position to react to events on the ground, to see oncoming potential hazards, such as pandemic influenza, and shift funds very, very quickly. But on the downside, it makes it almost impossible to have any kind of accountability, feedback is difficult.
SDI 2007 5 Week
147 GHS Neg
***Africa CP***
SDI 2007 5 Week
148 GHS Neg
Africa CP 1NC
The African Union should adopt a binding policy devoting at least 15% of member states budgets to expanding health capacity, including the elimination of health worker shortages. This should include raising salaries and wages, improving worker safety and occupational safety, providing incentives for health worker retention, expansion of training facilities, and expanding the utilization of community health workers. African governments committing at least 15% of their budgets to health care is a vital prerequisite to solving the aff Africa News, January 25, 07, Africa; Health Promises, Time to Deliver, lexis nexis academic, ael
"The evidence suggests African Heads of State are not taking the Abuja 15% commitment as seriously as they should. 5 years after the pledge, the great majority of the AU s 53 member governments including those in southern Africa most hit by Africa s worsening Public Health crisis have not even begun the process of meeting this pledge." She emphasised that "it s almost as if African governments don t realise that without a healthy and active population especially in the key age groups and social groups most affected by the health crisis Africa has no future. Maternal mortality for instance is almost 100% preventable. The fact that the figures for Africa are the highest in the world suggest that our governments still think that reproductive health which applies to half the populations of our countries is a fringe service" The Petition also identifies key healthcare challenges which the resources from the 15% commitment should be focussed on resolving. One of them is Africa s health worker shortages that have been exacerbated by OE Brain Drain , which subsidises healthcare systems of more developed countries. Speaking on how brain drain has worsened Africa s public health crisis, Eric A. Friedman, Senior Global Health Policy Advisor of Physicians for Human Rights, a partner of the campaign, stated: "In country after country, the shortage of health care workers, along with the lack of support for health care workers who struggle heroically to save lives, is a central obstacle to delivering a wide range of critical health services. Simply put, without the health workers, health services can t be delivered, and horrific levels of death and disease will persist. Much of the shortage is due to brain drain, as health workers migrate to countries in the North. Many of these countries train too few health workers themselves, so rely on health professionals from abroad to help meet their health care needs. Wealthy nations special connection to the health worker crisis in Africa due to brain drain requires that they work on a variety of fronts to prevent brain drain and support the development of effective and equitable health systems in Africa. Moreover, their own human rights obligations demand an intensive and multi-faceted response to this crisis." Abiola Akiyode-Afolabi Director of Women Advocates Research and Documentation Centre and Chair of the Nigerian and West African Social Forums underlined the implication of African governments of meeting their 15% pledge: "Unless the 15% commitment is fully implemented, all of Africa s 2010 Universal Access targets for prevention, treatment and care for HIV/AIDS, TB and malaria will definitely not be met. Even worse the three 2015 health-related Millennium Development Goals - based on scaling up reproductive health, children s health, and tackling the monster killer diseases of HIV/AIDS, TB, malaria and other diseases may be an impossibility"
SDI 2007 5 Week
149 GHS Neg
Africa CP Solves
( ) If African countries invest money, they will solve the health worker shortage Physicians for Human Rights, Mobilizes health professionals to advance health, dignity, and justice for all, 1-01-05, Cost Estimates: Doubling the Health Workforce Doubling the Health Workforce in Sub-Saharan Africa
by 2010 An initial investment of an estimated $2.0 billion in 2006, rising to an estimated $7.7 billion annually by 2010, is needed from African governments and the collective donor community to double sub-Saharan Africa's health workforce while increasing its effectiveness, thus making significant progress towards developing the workforces required for countries in sub-Saharan Africa to achieve national and global health goals.
( ) Only African countries can offer additional salary or other non-monetary bonuses to improve morale and increase retention Physicians for Humans Rights, Mobilizes health professionals to advance health, dignity, and justice for all, 6-04, An Action
Plan to Prevent Brain Drain: Building Equitable Healthy Systems in Africa,
http://physiciansforhumansrights.org/library/documents/reports/report-2004-july.pdf African countries, with assistance if necessary from the United States and other donors, should provide extra salaries and benefits to health workers who take posts in rural or other underserved areas. Health professionals working in especially remote or otherwise unpopular facilities should be eligible for extra incentives. Just as increased remuneration generally is a key strategy to recruiting and retaining health professionals in Africa and other low-income countries, additional increases in salary and benefits are likely to help attract health professionals to rural areas, or encourage those already posted in rural and other underserved areas to remain. These incentives may take many forms, and need not be monetary, or exclusively monetary. For example, they might include extra vacation or study time, employment assistance for health workers spouses, and assistance with accommodations and the education of health workers children.588
( ) Africa can stop brain drain itself by eliminating push factors Mohamed A. El-Khawas, History and Poly Sci Prof @ UDC, 2004, Brain Drain, Med. Quarterly, 15.4, p.
muse It has taken African leaders a long time to understand the relationship among the brain drain, the African diaspora, and capacity building in Africa. A long-term strategy to reverse the brain drain is for governments to improve domestic market conditions, which had previously made migration a necessity rather than a choice. As President Chissano put it in April 2004, "If Africa wants to develop with its own means, it must do all it can to eliminate the causes that drive skilled Africans to seek work in the industrialized world."45 The African Union has begun to address the push factors that have worked against Africa's interests. In March 2004, it held a two-day meeting in Addis Ababa to draft a policy to help reduce the number of skilled workers leaving the continent and to encourage governments to develop policies to encourage expatriates to return to their countries of origin.46 Holding meetings and talking about new policies, however, is not sufficient to reverse brain drain. Words must be turned into actions. A sense of urgency ought to be injected into the process and a bold program of action should be put into place right away.
SDI 2007 5 Week
150 GHS Neg
Africa CP Solves
( ) Africa solves best for African problems they have the resources Ayittey 2005 (George) [Distinguished Economist at American University; President of the Free Africa
Foundation]. Africa Unchained: The Blueprint for Africas Future, pp. 417-418. In recent times, various people, including this author, have propagated the idea that the impetus for reform and change in Africa must come from within. Back in 1993, the $3.5 billion international peace mission into Somalia failed miserably. As a result, this author coined the expression African solutions for African problems. African solutions are less expensive, and, further, reform that is internally generated endures. Only Africans can save Africa. An international conference on Africas Imperative Agenda, held in Nairobi in January 1995, emphasized this new philosophy. Conference participants expressed strong support for the following priority propositions: 1. Africas human and natural resources are more than sufficient to revive progress if a concerted, determined effort is launched within each society, and coordinated regionally. 2. Such efforts will succeed only if Africans take full charge of them and formulate policies that are geared to meet national needs rather than win international approval. 3. Participatory political structures and good governance are essential preconditions for effective policymaking. 4. Only Africa can reverse its decline. 5. The criteria of success for economic policies must be the improved health and education of the population and increased employment and production. Therefore, the agricultural sector, which employs the vast majority of Africans, is central to economic revival. 6. The role of political leadership and government action has been downplayed and private sector efforts stressed in international debate. (Africa Recovery, June 1995; p.9) It may be recalled that this plan of action does not differ substantially from the Atinga development model we laid out in chapter 10. It requires the establishment of peace, the provision of some basic infrastructure, the mobilization of capital through the revolving rural credit schemes, and the investment of funds in agriculture or agriculture-related cottage industries. Agriculture is the main occupation of Africas peasant majority. Nothing complicated is envisioned just modernizing the existing indigenous institutions to generate economic prosperity. It is an African solution that returns to Africas roots and builds upon Africas own indigenous institutions. This blueprint is already there in Africa and does not require billions of dollars in Western aid. Nor does our plan envision extensive involvement of the state. In a sense, this approach may be characterized as the new African renaissance. Two African leaders Presidents Thabo Mbeki of South Africa and Isaias Afwerki of Eritrea have latched on to the African renaissance bandwagon. Let us briefly review their pronouncements.
( ) Comprehensive indigenous approaches are already emerging in Africa to boost health capacity just need to be better funded WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf There is much that source countries can do, and are doing, to retain health workers and reduce the push factors for migration. Some of these are broader incentive schemes and strategies to improve the lives and working conditions of health workers, others relate more specifi cally to HIV and AIDS. Strategies to provide prevention, treatment, care and support as well as training and career development may also be seen as important retention strategies and are discussed in accompanying papers (Treat and Train). To date, most initiatives at country-level have been piecemeal and ad hoc, but the growing urgency of the health workforce crisis is catalyzing a more comprehensive approach, where retention strategies are part of broader plans to strengthen health systems. For example, the Governments of Malawi and Zambia have devised bold national strategies that operate at national and district levels including massive increases to health budgets, supplementing the salaries of health professionals, and educational and other soft incentives to retain health workers. For comprehensive health system plans to be sustainable they must be costed and funded, and embedded in national development plans. The Malawi Emergency Plan, for example, is included in the national Poverty Reduction Strategy Paper. This will require joint planning, and cooperation between HRH teams, National AIDS authorities and the relevant government ministries.
SDI 2007 5 Week
151 GHS Neg
Africa CP Solves
( ) 15% of national budgets would solve the health worker shortage - key to flexibility Global AIDS Alliance, 07, Strengthen Health Systems,
http://www.globalaidsalliance.org/issues/strengthen_health_systems/, ael Countries need the flexibility to increase the number of working health care personnel and to improve their salaries. A global advocacy campaign is underway to persuade the wealthiest countries, which largely control the policies of international lenders, to require these agencies to give countries the flexibility they need. The campaign is also encouraging countries to set their own path in making budgetary decisions, independently of the advice of the international lenders. People in many African countries are also pressing their governments to keep a promise made in 2005 to increase spending on health to 15% of the national budget.
( ) Increasing health care to 15% of the budget increases the number of health workers Tanzania Gender Networking Programme, June 16, 07, Tanzania: What kind of budget do feminist
and gender activists want?, http://www.ansa-africa.net/index.php/views/news_view/tanzania_what_kind_ of_budget_do_ feminist_and_gender_activists_want/, ael Maternal Health depends, in part, on all girls and women having access to quality health care, good nutrition and safe, clean water, from the time of their birth. According to the Budget Guidelines, the total allocations to health, water and agriculture will actually decline from last year, in spite of government promises to ensure that all of its citizens have access to basic social services. We call on our government to stay true to its pledge at Abuja to increase the Health Budget [including provisions to LGAs] to the 15% target figure by 2010, and begin with 12% of this years budget. Equally important, we expect that concrete measures will be taken to dramatically improve health delivery, beginning with a major increase in the number of qualified trained health workers, and in provision of drugs, equipment and other resources needed at the community level.
( ) The majority of the 15% goes to solving the health worker shortage Africa News, January 25, 07, Africa; Health Promises, Time to Deliver, lexis nexis academic, ael
The Petition also identifies key healthcare challenges which the resources from the 15% commitment should be focussed on resolving. One of them is Africa s health worker shortages that have been exacerbated by OE Brain Drain , which subsidises healthcare systems of more developed countries.
SDI 2007 5 Week
152 GHS Neg
Africa CP Solves
( ) Recruiting from abroad is insufficient to provide enough health workers must build indigenous health capacity WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf Estimates and plans for enlarging the health workforce to meet the needs of the move towards universal access must be made at country level and integrated into overall education and human resources for health (HRH) planning, budgeting and national poverty reduction strategies. Plans to enlarge the health workforce will often need to include the expansion of training facilities to support the production of greater numbers of health workers. These include doctors, clinical offi cers, nurses, pharmacists, trained counsellors, laboratory staff and community health workers. The particular service delivery model deployed will infl uence both the numbers and the training of additional health workers. While the public health approach allows for fewer doctors, it requires a larger number of nurses and lower level cadres who will need additional training. Limited shortages may be met by strategies to increase class size or reduce training time at training institutions. Widespread shortages, as exist in most sub-Saharan African countries, will require more comprehensive strategies such as the development of new training institutions and regional cooperation. In some countries, the AIDS and HRH crisis has led to emergency strategies to recruit medical workers from abroad. Members of the diaspora could be engaged to contribute to the expansion of the workforce, through short- or longterm voluntary return schemes, when the expertise does not exist locally. Increasing graduate numbers or recruiting new health workers from abroad are not the only ways of increasing human resources for health. The World Health Report 2006 also discusses broader strategies to maximize effi ciency and performance of the existing health workforce. Strategies to eliminate corruption and ghost and absentee workers may also expand resources for health.
SDI 2007 5 Week
153 GHS Neg
Africa CP Solves
( ) Providing financial incentives is key to retain workers in Africa WHO, May 12, 2006, Treat, Train, Retain, World Health Organization,
http://www.who.int/hiv/pub/meetingreports/TTRmeetingreport2.pdf Financial incentives The need for better remuneration ranks as the primary reason for health worker migration from many countries5. It is also a major cause of exit to private and NGO AIDS programmes and jobs outside the health sector. Raising salaries in the public sector can be diffi cult and costly. In some cases ministries of fi nance set public expenditure ceilings. In others, salary levels may be set for all civil servants by public service commissions, who may not wish to raise salaries in only one sector. Despite these diffi culties, some low-income countries have dramatically increased the pay of public sector health workers in recent years. In some countries, such as Kenya, Malawi and Uganda, salary increases have been applied across the board. In others, such as South Africa and the United Republic of Tanzania, they have been awarded to particular priority groups such as those with scarce skills, or rural health professionals. Selective application of fi nancial incentives may create inequalities that lead to demoralization in the workforce, and must be carefully considered. Objectives and target groups need to be carefully defi ned. Ideally, health workers and their representatives should be part of any fi nancial incentive scheme. Calculating the size of the salary increase (incentives, grants or top-ups) to stem migration is challenging. Health workers salaries in most low-income countries are so low that they cannot realistically be brought into line with those in rich countries. Other sorts of allowances are valued by health workers and may be used in combination with salaries and nonfi nancial incentives to retain valuable human resources. These include bonuses, travel and housing subsidies, loan schemes, child care allowances, school fees and social protection packages. The urgency of the health workforce crisis in worst-affected countries has prompted various agencies to discuss top-up grants or wage benefi ts for those delivering AIDS services. For example, UNAIDS has calculated for wage benefi ts (for nurses and doctors) of fi ve times higher to reduce the wage differential with middleincome countries6 . The challenges this creates must be discussed at global level as well as country level. The AIDS emergency in itself has fuelled action on the part of national governments and donors as regards the fi nancial implications of retention programmes and this should be maximized by all players.
SDI 2007 5 Week
154 GHS Neg
***AT: US Key***
SDI 2007 5 Week
155 GHS Neg
AT: US Key
( ) The requisite community health workers and WHO protocols are already in place their author agrees. Just because their card is suggesting the US do something doesnt mean another country couldnt provide the funding. Paul Davis, Health GAP, 12-1-2005, Strategic US Initiatives, http://healthgap.org/HCWmemo.html
It takes a long time to train the numbers of doctors and nurses necessary to meet US policy goals such as those established by PEPFAR or other US-endorsed targets such as the Millennium Development Goals. However, the low hanging fruit of the healthcare worker shortage can be found in every village and community where people with AIDS live, or have families and care givers. Untrained community members women and people with HIVare already providing the bulk of care in many areas. A tremendous labor force is already in the field and can be quickly harnessed with modest investments in training and compensation for currently untrained, unpaid community caregivers at the village level. Community health workers can be deployed very quickly (versus the time it takes to train and graduate a professional) and at modest expense. Village-level health workers can quickly be trained to provide basic care, treatment and prevention services while serving as the first line of referral to health professionals. Community health workers can operate as satellites of clinics to extend coverage to remote areas. Community health workers are less susceptible to be lost to wealthier nations. Moreover, robust community health worker initiatives that substantially recognize, accredit, compensate and deploy this largely female and HIV+ workforce will reduce womens vulnerability to infection while contributing visibility that destigmatizes individuals living HIV. Simple and accelerated training criteria have already been developed by WHO and OGAC. Expanded US support for such training programs could quickly certify and equip tens of thousand of peer educators to provide voluntary counseling and testing, prevention education, treatment literacy, adherence counseling, symptoms monitoring, and basic care and prevention services. Community health workers can quickly extend basic health services to underserved rural areas, linking remote locations to regional clinics in a decentralized referral and supervision system that sends complex or severe cases to regional teaching hubs. Economic empowerment of women through paid healthcare labor is important in breaking the cycle of vulnerability that women face. Increased social status and economic resources, and increased knowledge about health will reduce womens personal and collective vulnerability to infection. Openly HIV-positive community-based health workers enhance the efficacy of AIDS programs as peer educators teaching treatment literacy and prevention skills while serving to destigmatize living with AIDS. Key elements in the success of community-level health workers include compensation, proper and ongoing training, continued supervision, and close linkages to health professionals within the broader health system. New health workforce initiatives should supply funding to train and support community health workers while working with governments, professional associations and PWA groups to ensure rapid deployment and coherent integration of community care workers into local health systems. Support for training and funding community health workers should be included as core components of programs such as the Global Health Corps, as well as PEPFAR and other initiatives.
SDI 2007 5 Week
156 GHS Neg
AT: US Key
( ) US isnt necessary African governments just need capital to boost health workers Commission for Africa, UK Commission, March 2005, Our Common Interest,
http://www.commissionforafrica.org/english/report/thereport/english/11-03-05_cr_report.pdf Recommendation: Second, donors and African governments should urgently invest in training and retention to ensure there are an additional one million health workers by 2015. African governments and donors should ensure the health workforce in sub-Saharan Africa is tripled through the training and retention of an additional one million workers over a decade99. This will require sustained leadership on both parts100: by African governments, in the development of radical investment programmes; and by donors to provide predictable funding in the region of US$0.5 billion in 2006, rising to about US$6 billion each year by 2011101. The WHO should lead at the global level to coordinate and ensure effective action by all stakeholders. This requires strong collaboration to ensure technical assistance in this effort is harmonised with overall health system strengthening (as described in the above recommendation) and broader public sector reform. Where countries have human resource plans in place already, these should be identified and receive immediate donor support through existing financing mechanisms, including budget support and global health partnerships. But strategies must also be formed for fragile states, recognising the challenges of the lack of accountability of service providers to the service users because of ethnic, religious, linguistic and gender schisms. Human resource plans should also consider improvements to the salaries and conditions of government health and management staff to ensure that staff are retained and have access to professional development. AU/NEPAD is exploring innovative approaches to training and accreditation of health workers102. Regional and country strategies must recognise the major service delivery role of the private and not-for-profit sectors, and plan for the natural movement of health workers in and out of the public sector. Finally, donor countries must increase transparency about where their health workers were trained. But rather than restrict hiring, they should be challenged to reciprocate through supporting training and retention in the countries of origin.
SDI 2007 5 Week
157 GHS Neg
AT: US Key Clearinghouse Solves

( ) The inclusion of a clearinghouse in GHS ensures international cooperation Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Many organizations currently send health professionals to work in the PEPFAR focus countries. Given their experience, these groups are well poised to assist in HIV/AIDS treatment, prevention, and care, thus helping to achieve the PEPFAR goals. A virtual network of such organizations could provide and receive relevant information and regularly reach thousands of volunteers. Recommendation 8: Develop a U.S. Global Health Service Clearinghouse. There are many organizations currently mobilizing health personnel to work in PEPFAR countries. These organizations could be powerful allies in meeting PEPFAR goals. Therefore the committee recommends a multifaceted Clearinghouse for the U.S. Global Health Service that would facilitate information exchange, enhance access to program data, and provide opportunity information for interested health professionals. The proposed Clearinghouse would include the following: Program Resource Directory and Networksa searchable, web-based directory that would provide screened, reliable links enabling interested volunteers to view sending organizations websites, thus facilitating organizational recruitment. Opportunity Banka job bank of available host-country positions that would be a valuable tool for U.S. professionals wishing to work in the PEPFAR focus countries as a volunteer or a paid employee. Cultural and Strategic Issues Reference Sitea virtual warehouse of information pertinent to all health professionals planning to work in the PEPFAR focus countries, including those seeking a GHS Fellowship, loan repayment, or assignments to the GHS Corps. Country Credentials and Travel Guidelines Repositorya compendium of updated virtual information designed to assist prospective volunteers in applying for work in the global arena.
( ) GHS Clearinghouse ensures info is available to doctors globally Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Recommendation 4: Undertake a uniform health workforce needs assessment. The committee recommends that the PEPFAR country teams, in collaboration with ministries of health, initiate assessments of in-country requirements for health personnel to achieve PEPFAR goals. These assessments should form the basis for national human resources for health plans. These assessments would also generate a valuable baseline inventory for all mobilization programs and subsequent evaluation activities. The data from all countries should be collected in a standardized fashion, updated regularly, and maintained in the electronic database of the U.S. Global Health Service Clearinghouse Opportunity Bank, available to professionals interested in service in PEPFAR countries. Timely and accurate information on workforce needs will be essential to maximize the impact of programs designed to mobilize health personnel to achieve PEPFAR goals. Current national needs assessments are irregular, nonstandardized, and not available at any single site. Local placement strategies and global recruitment efforts would be greatly strengthened by a regularized needs assessment and dissemination initiative.
SDI 2007 5 Week
158 GHS Neg
AT: US Key AT: Mullan Evidence

( ) Their Mullan evidence is biased and not exclusive its unwarranted rhetoric from the guy who thought up the GHS it just says that the USFG could play an important role, NOT that our CP doesnt also solve. The vital internal link to their advantage is boosting African health care capacity, which we do just as well as the aff. ( ) The only reason that things like prestige or recruiting are important is because they get more people on board we fiat through those barriers, which means we solve ( ) The reason their evidence says the U.S. is important is just because it was written in a report for PEPFAR on what the U.S. should do its not comparative in any way with the CP
SDI 2007 5 Week
159 GHS Neg
AT: US Key No US Expertise

( ) Only 387 doctors in the U.S. even have experience in tropical diseases Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 After the Institute of Medicine (IOM) announced in a 1987 report, U.S. Capacity to Address Tropical Infectious Disease Problems, that only 300 people in the United States had the capability to diagnose and treat tropical diseases, ASTMH formed a committee to formulate recommendations for remedying the situation (IOM, 1987).2 It was clear that the United States had no truly excellent program offering the kind of diploma training course, including laboratory and overseas experiences, called for by the IOM report. The ASTMH committee recommended that an examination in clinical tropic medicine be administered and that a diploma in tropical medicine and hygiene be offered. ASTMH distributed a request for proposal to 370 U.S. and Canadian medical schools; 22 schools responded, and the proposals from seven U.S. and five overseas medical schools were accepted. Today, there are strict requirements for a diploma course and a separate two-month overseas course. Since 1995, 619 individuals have taken the examination, 412 have passed, and 387 have had the overseas experience.
( ) US students arent trained in public health wouldnt be uniquely good teachers Mark S. Smolinski, Dir. Global Health and Security Init @ NTI, et. al., 2003, National Acadamies, Microbial
Threats, http://www.nap.edu/openbook.php?isbn=030908864X To rebuild the public health workforce needed to respond to microbial threats, health profession students (especially those in the medical, nursing, veterinary, and laboratory sciences) must be educated in public health as a science and as a career. Even for students within schools of public health, education has traditionally focused on academic research training, not public health practice. A 1988 IOM report notes that many observers feel that some [public health] schools have become somewhat isolated from public health practice and therefore no longer place a sufficiently high value on the training of professionals to work in health agencies (IOM, 1988:15). A more recent IOM report states that in 1998, only 56 of 125 medical schools required courses on such topics as public health, epidemiology, or biostatistics (IOM, 2002e). The report recommends that all medical students receive basic public health training. It also concludes that all nurses should have at least an introductory grasp of their role in public health, and that all undergraduates should have access to education in public health. Educational strategies in which applied epidemiology programs provide exposure to state and local health departments may help increase awareness of the role of public health in population-based infectious disease control and prevention, and provide for exposure to public health as a potential career choice (see the later discussion on educating and training the microbial threats workforce). Pg. 162
( ) The U.S. doesnt have even close to an adequate number of infectious disease specialists Mark S. Smolinski, Dir. Global Health and Security Init @ NTI, et. al., 2003, National Acadamies, Microbial
Threats, http://www.nap.edu/openbook.php?isbn=030908864X The number of qualified individuals in the workforce required for microbial threat preparedness is dangerously low. For example, in 2001 the need for at least 600 new epidemiologists in public health departments across the United States was identified because of the requirements for bioterrorism preparedness alone. Yet only 1,076 students graduated with a degree in epidemiology in the year 2000 and are potentially seeking employment in government, academia, or private industry, and the largest percentage are trained in chronic disease, not infectious disease epidemiology. According to the National Association of City and County Health Officers, the most needed occupations between 1999 and 2000 were public health nurses, environmental scientists and specialists, epidemiologists, health educators, and administrative staff.
SDI 2007 5 Week
160 GHS Neg
AT: US Key AT: Donor Coordination

( ) The aff doesnt do donor coordination thats not built into the plan ( ) No need for donor coordination the CP is so massive that it doesnt require working with multiple groups ( ) No impact the internal link to the advantage is just boosting capacity, not donor coordination
SDI 2007 5 Week
161 GHS Neg
AT: US Key CP US Workers

( ) We access all their US key warrants US volunteers could just join the counterplans program overseas ( ) Students are motivated enough to find opportunities it doesnt matter if the GHS is based in the U.S. Claire Panosian, and Thomas J. Coates, Medicine professors @ UCLA, 4-27-2006, The new medical
missionaries, NEJM, v. 354, no. 17, http://content.nejm.org/cgi/content/full/354/17/1771 Both students are eager to return overseas once they have a few more courses and clinical skills under their belts. And they are not alone. In 2003, at least 20 percent of students graduating from U.S. medical schools had participated in overseas activities related to international health during medical school, as compared with 6 percent of 1984 graduates.1,2 On many U.S. medical campuses, introductory courses in global health and related student-run interest groups are flourishing. Since 1991, the Global Health Education Consortium (GHEC) has helped to foster this growth of interest. A nonprofit organization representing medical schools in the United States, Canada, and Central America, the GHEC held a conference in 2005 entitled "Training the Global Health Workforce," which brought together students, academic leaders, and professionals from the nonprofit sector and the World Bank. The 2005 conference of the Association of American Medical Colleges (AAMC) also highlighted global health and featured an address by former secretary of state Madeleine Albright. The GHEC and the AAMC, in collaboration with the Foundation for Advancement of International Medical Education and Research, are now conducting a survey to learn more about organized international opportunities at U.S. medical schools. Groups such as the GHEC and the American Society of Tropical Medicine and Hygiene (ASTMH) also are advocating an updated, standardized curriculum in global health. Back on their campuses, internationally minded students are often inspired by peers who have already rotated abroad. Tuddenham and Benzekri, for instance, may look to Sagar Vaidya, an M.D.Ph.D. candidate who has volunteered at a rural clinic in Mexico and has also completed clerkships in India and Vietnam. Or Shilpa Sayana and her husband, Rishi Manchanda, residents in internal medicine who recently participated in a rollout of antiretroviral drugs in Durban, South Africa. Sayana grew up in Botswana and studied women's reproductive health in Egypt. Manchanda's rsum includes clinical stints in Botswana and Mozambique, plus a year in India studying primary care services. Such trainees will always find exciting international medical opportunities if they search hard enough and are willing to pay their own expenses. But their schools and residency programs rarely give anything more than moral support and elective credit. As a result, the few travel fellowships available to medical trainees are flooded with applicants each year. Last year, an ASTMH-sponsored program received 130 applications and awarded 10 student fellowships for projects in a variety of venues, including an entomologic field site in Senegal, a war-torn setting in Uganda, and a mobile, railroad-based hospital in India (see graph).
SDI 2007 5 Week
162 GHS Neg
AT: Perm Solves Intl Cooperation

( ) No it doesnt even if cooperation mechanisms are built into PEPFAR, the perm cant fiat those mechanisms are used. That adds on to the ACTIONS that are taken in the plan and CP ( ) Still links to the DA cooperating with another country doesnt mean they dont still have the U.S. set up the GHS and act to Africa, which triggers our links
SDI 2007 5 Week
163 GHS Neg
***Loan Repayment PIC***
SDI 2007 5 Week
164 GHS Neg
Loan Repayment PIC

The United States federal government should establish a program to expand the capacity of community health workers in the Presidents Emergency Plan for AIDS Relief focus countries in sub-Saharan Africa, consisting of a Global Health Corps, a Health Workforce Needs Assessment, a Fellowship Program, a Twinning Program, and a Clearinghouse. The Program should ensure that the Global Health Service Corps and Fellowship Program have sufficient resources and offer sufficient financial incentive to financially accommodate all interested volunteers. Clarifying Note Our intention is to set up the 5 components of the Global Health Service described by the affirmative, but not the Loan Repayment Program. ( ) CP is plan minus the Global Health Service is 6 things, we only do 5. Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 As noted above, the GHS envisioned by the committee encompasses six interconnected programs. The committee believes this package of programs would significantly augment human resource capacity in support of the PEPFAR goals outlined earlier. The six programs are as follows: * Global Health Service Corps * Health Workforce Needs Assessment * Fellowship Program * Loan Repayment Program * Twinning Program * Clearinghouse
SDI 2007 5 Week
165 GHS Neg
Loan Repayment PIC Politics Net Benefits

( ) The loan repayment part of the plan requires legislation Marilyn Chase, WSJ, 4-20-2005, Panel Suggests, http://www.aegis.com/news/wsj/2005/WJ050407.html
The State Department's Office of the Global AIDS Coordinator requested the report. Certain aspects, such as loan repayment, would require legislation, Dr. Mullen said, but legislation probably wouldn't be needed to send health workers overseas. "If the administration took this seriously, within a year or two you could have a substantial part of this in the field," he said.
SDI 2007 5 Week
166 GHS Neg
AT: Each Part Key

( ) This evidence is WAY too generic its just rhetoric from the author of the GHS that each piece is important well win the CP does enough to ensure volunteers and solve the advantage. We fiat that the Corps and the Fellowship program are massively expanded to offset not doing loan repayment. They havent read a SINGLE CARD that defends loan repayment as the only mechanism to provide financial incentives
SDI 2007 5 Week
167 GHS Neg
AT: Loan Repayment Key

( ) None of their evidence assumes the CP its just generic rhetoric that all pieces are important we offer enough financial incentive for anyone who wants to go overseas to get paid, but dont do it through loan repayment programs. Even if you think their evidence is good vs. the status quo, they have to read a comparative card that the CP isnt sufficient before you should vote on this as a solvency deficit
SDI 2007 5 Week
168 GHS Neg
***Tuition DA***
SDI 2007 5 Week
169 GHS Neg
Tuition DA 1NC
( ) Currently, med students can handle debt load with loans further tuition hikes deter enrollment in med school and jack student quality Paul Jolly, PhD, Sen. Assoc. VP @ Div. of Medical School Services, April 2005, Medical School Tuition,
Health Affairs 24, no. 2, Project Hope, http://content.healthaffairs.org/cgi/content/abstract/24/2/527 The leadership of American medical education would like to have diverse classes of medical students, including members of racial and ethnic minority groups underrepresented in medicine, and including students from a broad spectrum of socioeconomic class. A serious concern is that the high cost of medical education may deter applicants, particularly applicants from racial and ethnic minority groups underrepresented in medicine and from lower socioeconomic classes. In a recent national survey conducted for AAMC by a national polling organization, students who appeared to be qualified for medical school on the basis of academic achievement were asked why they did not apply to medical school. A number of reasons were given, including the cost of attending medical school, the time it takes to become a doctor, and the demands of the physician lifestyle. As Figure 22 shows, cost was a major deterrent for all students, and it was the number one deterrent for minority students Over the past two decades and especially in recent years, tuition in both private and public medical schools has very substantially increased. Indebtedness among graduating medical students has increased even faster. Loans are readily available, however, and repayment terms are generous. It seems clear that medical school graduates can repay the loans. If they stretch out the payments over thirty years, the payments can be accommodated within the income of even primary care physicians. A medical education remains an excellent investment. Students graduating with a high level of indebtedness will need to take future income potential into account when choosing a specialty, a practice location and a type of practice. This may lead to an inclination toward specialty practice in areas where remuneration is highest and may worsen the distribution problems that already exist Service related scholarships and service related loan repayment plans are one avenue of relief for some students. Unfortunately, the availability of these alternatives is limited, and not all students who would like to take advantage of these alternatives can do so. Increases in tuition seem likely to continue, and increasing indebtedness is almost a certainty. While loan repayment is not yet a serious hardship for most physicians, continued increases in tuition and fees may hinder recruitment of a diverse class and may eventually even lead to difficulty in filling the entering classes with well qualified students.
SDI 2007 5 Week
170 GHS Neg
Tuition DA 1NC
( ) Increased student aid spurs tuition hikes schools can get away with it Brian M. Riedl, Heritage Foundation Fellow, 1-16-2007,
http://www.heritage.org/Research/Education/wm1308.cfm However, endless student aid increases may not only fail to deal with rising tuition; evidence suggests they actually contribute to tuition increases. Richard Vedder, among other economists, has shown that college tuition increases follow student aid increases.[9] Colleges, like businesses, charge as much as their customers are able to pay. So when student aid increases, colleges raise tuition accordingly to capture the additional aid. This suggests that increases in federal student aid effectively subsidize colleges, not students.
( ) Increased medical school tuition raises debt, jacking the entire health care system AMA, 2006, Medical student debt, http://www.ama-assn.org/ama/pub/category/5349.html
The increase in debt not only burdens medical students, but can have effects on the entire health care system. Some of correlations found include: * Decrease in primary care physicians o Students with high debt are less likely to pursue family practice and primary care specialties and instead seek specialties with higher income or more leisure time * Decreased diversity of physician workforce o The cost of tuition can prevent students from low-income/minority and those with other financial responsibilities from attending medical school o Physician diversity is necessary to address the needs of heterogeneous, multicultural patient populations * Promoting unsafe physician behaviors o Residents with high debt are more likely to moonlight + Increases fatigue and may contribute to medical errors (see Figure 4 (PDF, 39KB) o Increasing debt leads to more cynicism and depression among residents (see Figure 5 (PDF, 41KB)
SDI 2007 5 Week
171 GHS Neg
Tuition DA 1NC
( ) Health care is key to competitiveness Business Wire, 10-12-2005, High-Tech Leaders, ln
Chief executives from the nation's leading high-tech companies today declared that building a networked health-care system is a national imperative and called on policymakers, U.S. businesses and health-care providers to develop the policies, standards and systems needed to make it a reality. The Technology CEO Council said that modernizing our health-care system by connecting health information between doctors, patients, pharmacies and labs is critical to not only improving our nation's health-care system, but our global competitiveness. The Technology CEO Council's "A Healthy System" Report and e-Health Readiness Guide provides a road map and policy recommendations on how to implement information management into the health-care system and milestones to measure progress. "Many of the problems with the U.S. healthcare system were exposed after Hurricanes Katrina and Rita when paper health records were lost and victims were unable to access their health information or provide complete medical histories to caregivers," said Craig Barrett, Chairman of the Board of Intel Corporation and Chairman of the Technology CEO Council. "It's clear that establishing a healthcare network that utilizes information technology to improve care, reduce errors and cut costs is critical. An effective, efficient system is not only important to advancing the health of our society, but also to our economic well-being and long-term competitiveness."
SDI 2007 5 Week
172 GHS Neg
Tuition DA 1NC
( ) Competitiveness is key to heg Zalmay Khalilzad, RAND, Losing the Moment? The Washington Quarterly 1995
U.S. superiority in new weapons and their use would be critical. U.S. planners should therefore give higher priority to research on new technologies, new concepts of operation, and changes in organization, with the aim of U.S. dominance in the military technical revolution that may be emerging. They should also focus on how to project U.S. systems and interests against weapons based on new technologies. The Persian Gulf War gave a glimpse of the likely future. The character of warfare will change because of advances in military technology, where the [US] United States has the lead, and in corresponding concepts of operation and organizational structure. The challenge is to sustain this lead in the face of the complacency that the current U.S. lead in military power is likely to engender. Those who are seeking to be rivals to the United States are likely to be very motivated to explore new technologies and how to use them against it. A determined nation making the right choices, even though it possessed a much smaller economy, could pose an enormous challenge by exploiting breakthroughs that made more traditional U.S. military methods less effective by comparison. For example, Germany, by making the right technical choices and adopting innovative concepts for their use in the 1920s and 1930s, was able to make a serious bid for world domination. At the same time, Japan, with a relatively small GNP compared to the other major powers, especially the United States, was at the forefront of the development of naval aviation and aircraft carriers. These examples indicate that a major innovation in warfare provides ambitious powers an opportunity to become dominant or near-dominant powers. U.S. domination of the emerging military-technical revolution, combined with the maintenance of a force of adequate size, can help to discourage the rise of a rival power by making potential rivals believe that catching up with the United States is a hopeless proposition and that if they try they will suffer the same fate as the former Soviet Union.
( ) Nuclear war Zalmay Khalilzad, RAND, The Washington Quarterly, Spring 1995
Under the third option, the United States would seek to retain global leadership and to preclude the rise of a global rival or a return to multipolarity for the indefinite future. On balance, this is the best long-term guiding principle and vision. Such a vision is desirable not as an end in itself, but because a world in which the United States exercises leadership would have tremendous
advantages. First, the global environment would be more open and more receptive to American values -democracy, free markets, and the rule of law. Second, such a world would have a better chance of dealing cooperatively with the world's major problems, such as nuclear proliferation, threats of regional hegemony by renegade states, and low-level conflicts. Finally, U.S. leadership would help preclude the rise of another hostile global rival, enabling the United States and the world to avoid another global cold or hot war and all the attendant dangers, including a global nuclear exchange. U.S. leadership would therefore be more conducive to global stability than a bipolar or a multipolar balance of power system.
SDI 2007 5 Week
173 GHS Neg
Med School Tuition Brink

( ) Med school tuition is high, but not too high any further hikes will put med school out of reach, hurting overall student quality Paul Jolly, PhD, Sen. Assoc. VP @ Div. of Medical School Services, April 2005, Medical School Tuition,
Health Affairs 24, no. 2, Project Hope, http://content.healthaffairs.org/cgi/content/abstract/24/2/527 Medical school tuition and medical student debt have increased dramatically during the past two decades, but loans are available on favorable a term, which makes it possible for students without personal or family, means to get a medical education. As an investment, medical education is an excellent choice; its net present value is more than a million dollars. Cost is nevertheless a strong deterrent to potential applicants, especially minority applicants. If tuition and indebtedness continue to increase while physician incomes do not, there may come a time when only the wealthy can finance a medical education, and medical schools may have increasing difficulty recruiting qualified students.
SDI 2007 5 Week
174 GHS Neg
No Tuition Hikes
( ) Tuition costs are steadily falling, ensuring a well-educated population Neal McCluskey, Cato Policy Analyst, 7-8-2004, The Sky Is Not Falling!,
http://www.cato.org/pub_display.php?pub_id=2727 The first came out the day before Kerry's Chicago speech, when USA Today published the results of a college affordability analysis it had conducted using data from the College Board, the Office of Management and Budget, and the Internal Revenue Service. The findings - at least if one were to listen to Kerry, or the rhetoric that has surrounded the on-going reauthorization of the federal Higher Education Act - were shocking: "Contrary to the widespread perception that tuition is soaring out of control," the newspaper revealed, "what students actually pay in tuition and fees -- rather than the published tuition price -- has declined for a vast majority of students attending four-year public universities. In fact, today's students have enjoyed the greatest improvement in college affordability since the GI bill..."But wait, there's more. The day after USA Today published its news, further evidence of college affordability became public, this time from the U.S. Census Bureau. "The population of the United States is becoming more educated," starts the Bureau's report, Educational Attainment in the United States: 2003, which declares that though large gaps still exist between different groups, "the educational attainment of young adults (25 to 29 years), which provides a glimpse of our country's future, indicates dramatic improvement by groups who have historically been less educated." Indeed, the Census Bureau found that nationwide over 27 percent of adults possessed at least a bachelor's degree -- a record high.
SDI 2007 5 Week
175 GHS Neg
No Tuition Hikes
( ) Their evidence is all media hype colleges are affordable Neal McCluskey, Cato Policy Analyst, 7-8-2004, The Sky Is Not Falling!,
http://www.cato.org/pub_display.php?pub_id=2727 Despite the timely the release of the USA Today and Census Bureau reports, there's little reason to believe that Kerry's doom and gloom message -- or similar themes we've heard for years from politicians of all stripes -- will disappear. For one thing, whenever there's a choice between good news and bad, the media seem to pick bad every time. That's why newspaper headlines like "Private college tuition soars" in the June 28 Des Moines Register, and "Tuition hikes add to the grind: College costs soaring every year as students scramble to help pay the bills" in the same day's Cincinnati Enquirer, continue to be commonplace, despite recent reports from the Congressional Budget Office and the National Center for Education Statistics, as well as USA Today and the Census Bureau, having shown that higher education is readily accessible.
( ) Their evidence assumes sticker price, not what students pay Adrienne Aldredge, 8-19-2004, National Center for Policy Analysis, No. 482, Is College Too Expensive, Or
More Affordable Than Ever? http://www.ncpa.org/pub/ba/ba482/ The true price of a college education is much like the sticker price on a new car window: few people really pay it. According to a recent USA Today analysis, students pay only a fraction of the tuition sticker price at four-year public universities when grants and tax breaks are counted. Keep in mind that nearly three-fourths of full-time students attend public colleges and universities. Students last year paid an average of just 27 percent of the tuition sticker price at four-year public universities. Between the 199798 and 2002-03 academic years, the published tuition price at public universities rose 18 percent to an average of $4,202 (see the Figure). Average tuition paid at those schools, however, fell 32 percent during the same period, from $1,636 to $1,115.
SDI 2007 5 Week
176 GHS Neg
No Federal Aid
( ) Federal financial aid is declining Marc Silver, 10-24-2006, How to Earn a Degree Without Going Broke,
http://www.npr.org/templates/story/story.php?storyId=6376591 The amount of money devoted to need-based aid seems to be on the decline. Total federal spending on Pell grants is down by $900 million from $13.6 billion to $12.7 billion for the 2005-06 academic year. The average Pell went down by about $120 per student to $2,474. At the same time, colleges are diverting more and more of their own aid to so-called merit scholarships.
SDI 2007 5 Week
177 GHS Neg
Tuition Link
( ) Loan programs encourage tuition hikes Charlie Smith, Straight.com, 4-27-2006, Student-loan change feared, http://www.straight.com/article/studentloan-change-feared-0 Saul Schwartz, an economist at Carleton University, has researched income-contingent student-loan programs. In a phone interview with the Straight, Schwartz said that tuition tripled from 1,000 to 3,000 across Britain after an income-contingent student-loan program was introduced there last January. It's basically like a licence to raise tuition because you make it possible for students to pay it, Schwartz said. You can raise tuition to whatever you want because nobody pays up front. You just pay four or five years later, and then only if you make enough money.
( ) The plan spurs further tuition increases its a vicious cycle John A. Boehner, R-OH, 4-19-2005, Comments on College Access, US Fed News, ln
As many of you have heard me say before, it sometimes seems the more we spend in higher education, the further we fall behind. In fact, some believe government spending may be a hidden culprit in the ongoing inflation of college costs. They point to what seems to be a vicious cycle: colleges increase tuition; government responds by increasing spending; and colleges respond by increasing tuition again.
( ) Federal loan assistance causes tuition hikes colleges know they can get away with it Richard K. Vedder, Econ Prof @ Ohio, 4-19-2005, Statement, CQ Congressional Testimony, l n
There are arguments for or against each approach, but what is critical that some approach be adopted that puts brakes on the growth in student loan expenditures. At the present, universities set their tuition fees each year at ever higher levels and you, the federal government, respond by increasing assistance. You enable the tuition explosion to persist. If you stop providing assistance, in the short run there will be a rise in financial pain to college students, but in the long run you will help break the vicious circle of rising fees followed by rising loans, grants and now tuition tax credits. Universities raise their tuition a lot because they can get away with it. Make it difficult for them to do that.
SDI 2007 5 Week
178 GHS Neg
Tuition Link
( ) Volunteer programs cause entitlement mentality, raising tuition costs Doug Bandow, Hoover Inst, Sep/Oct 1996, National Service or Government Service?
http://www.hoover.org/publications/policyreview/3574457.html Indeed, government-funded service plays into what some national-service proponents have denounced as an entitlement mentality -- the idea that, for instance, students have a right to a taxpayer-paid education. Some advocates of national service have rightly asked: Why should middle-class young people be able to force poor taxpayers to help put them through school? But public "service" jobs sweetened with a salary and an educational grant are no solution: they merely transform the kind of employment that a young person seeks to help cover his educational expenses. Some AmeriCorps volunteers do sacrifice, but there is no real sacrifice involved in, say, informing people about the availability of Federal Emergency Management Agency service centers, maintaining vehicles, surveying residents about recreational interests, cutting vegetation, and changing light bulbs in dilapidated schools -- all activities funded by the Corporation. In contrast, consider the sort of tasks envisioned by William James: young laborers would be sent off "to coal and iron mines, to freight trains, to fishing fleets in December." The real solution to the entitlement mentality is not to say that students are entitled to taxpayer aid as long as they work for the government for a year or two, but to rethink who deserves the subsidy. We also need to explore how federal educational assistance may have actually made it harder for students to afford college by fueling tuition hikes (the schools, of course, are the ultimate beneficiaries of most student aid). And we have to address the host of other "entitlements" that riddle the federal budget and sap people's independence.
SDI 2007 5 Week
179 GHS Neg
Tuition Hikes Jack Competitiveness

( ) High costs decrease college graduates, hurting competitiveness Sandy Baum, Econ Prof @ Skidmore, November 2003, CQ Researcher 13, p. 1013
College attendance rates disturbingly correlate with family income. While virtually all high-income students with the highest test scores go to college, about a quarter of those from low-income families with the same test scores do not. And those low-income students who do go to college disproportionately attend two-year colleges and are much less likely to earn bachelor's degrees. Denying educational opportunity to qualified students not fortunate enough to be born into comfortable financial circumstances is unfair under almost any reasonable definition of equity, but it also reduces our economy's productive capacity. College graduates earn more than high-school graduates, contribute more to society and receive fewer social services.
SDI 2007 5 Week
180 GHS Neg
Tuition Hikes Debt

( ) Increased tuition causes more debt Paul Jolly, PhD, Sen. Assoc. VP @ Div. of Medical School Services, April 2005, Medical School Tuition,
Health Affairs 24, no. 2, Project Hope, http://content.healthaffairs.org/cgi/content/abstract/24/2/527 It is reasonable to assume that higher tuition costs will lead to higher debt. This years entering class is facing median levels for tuition and fees $5,381 higher in public medical schools and $5,741 higher in private medical schools than did the class who graduated in 2003. If all of the increases in tuition and fees lead to increased debt, and if the fraction of graduates with educational debt remains the same, public and private medical school graduates of the class of 2007 will have median educational debt levels of $117,000 and $150,000, respectively, even if tuition does not increase at all beyond this years level. If it continues to increase over the next four years as it did over the past four, median debt levels will be $122,000 and $158,000, respectively (Figure 5). If expenses other than tuition also increase, indebtedness may be higher yet.
SDI 2007 5 Week
181 GHS Neg
Education Key Competitiveness

( ) Education is key to U.S. competitiveness John P. Morgridge, Chair of Cisco, 7-21-2005,
http://www.house.gov/science/hearings/full05/july%2021/morgridge.pdf Education is the foundation to all innovation and the engine to economic growth. We must advocate policies that will create an educated workforce to match America's future employment needs, specifically an educated workforce trained in math and science which is critical to the innovation economy. In order for America's high tech industry to stay competitive throughout the 21st Century and beyond, we need to invest in our workforce of tomorrow by giving them the tools necessary to compete for postsecondary education programs or careers in science, math or engineering. We need to make America's educational system the best in the world by making math and science teaching a priority for our children and support efforts on the state and federal levels to accomplish this objective. I applaud what this Committee has done to recognize the finest math and science teachers in this country their work is vital to our future competitiveness.
SDI 2007 5 Week
182 GHS Neg
Competitiveness Key To Heg

( ) Competitiveness is key to U.S. hegemony Dr. Jing-dong Yuan, PhD, Center for Nonprolif. Studies, June 2002, International Politics
In sum, a country's political and military prowess is based ultimately on its economic base in terms of industrial competitiveness and technological leadership. While good strategy and skillful diplomacy can be important and, indeed, crucial under certain circumstances,11 diplomatic possibilities remain predicated on overall economic and military capabilities. In the final analysis, such capabilities provide the foundation of a country's ability to carry out its various domestic and foreign policy objectives and protect a country's security interests over the long run. The shift from the traditional control of territories and resources to the mastery of industrial competitiveness and technological leadership testifies that security has changed from a narrow, one-dimensional concern over peace and war to a more diffuse worry about the ability to determine one's own agenda rather than to face adverse consequences resulting from decisions made abroad.12 In this regard, the weakening of the state's economic base evident by the loss of industrial competitiveness and technological leadership, can have adverse effects on long-term security interests.13
SDI 2007 5 Week
183 GHS Neg
Federal Aid Violates Constitution

( ) Federal financial aid violates the constitution Gary Wolfram, Pol. Econ. Prof @ Hillsdale, 1-25-2005, Making College More Expensive, CATO,
http://www.cato.org/pub_display.php?pub_id=3344 The Tenth Amendment to the United States Constitution reads: The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the states respectively, or to the people. Search as one might through the Constitution, one will not find the power to provide for higher education granted to the federal government. Because of that, the federal government should not be providing financial assistance to induce people to obtain higher education. Such activity should be left to the states and to individuals.61HEA costs taxpayers more than $22 billion per year.
SDI 2007 5 Week
184 GHS Neg
Federal Aid Jacks Democracy

( ) Increasing tuition aid threatens college independence, undermining democracy and increasing state control Gary Wolfram, Pol. Econ. Prof @ Hillsdale, 1-25-2005, Making College More Expensive, CATO,
http://www.cato.org/pub_display.php?pub_id=3344 In addition to raising tuition costs, government tuition and institutional aid threatens the independence of higher education.56 For many Americans, the point at which they begin to develop their opinion about the role of government and possible solutions to public policy problems is in college. For democracy to work, it is important that the institutions that educate those who will participate in the democratic system be truly independent of the government. As Friedrich Hayek points out in the Constitution of Liberty: The conception that government should be guided by majority opinion makes sense only if that opinion is independent of government. The ideal of democracy rests on the belief that the view that will direct government emerges from an independent and spontaneous process. It requires, therefore, the existence of a large sphere independent of majority control in which the opinions of individuals are formed.
SDI 2007 5 Week
185 GHS Neg
***Spending DA***
SDI 2007 5 Week
186 GHS Neg
Spending Link
( ) The GHS would cost 150 million a year Fitzhugh Mullan, MD Health Policy @ GWU, 2-21-2007, Responding to the Global HIV/AIDS Crisis, JAMA,
v. 297, no. 7, p. jama archives To ensure maximum impact, both the corps of health professionals and the funding for private sector support programs should be managed as a single program with a clear mission and identity. The US Public Health Service in the US Department of Health and Human Services, which has a long record of deploying clinicians as well as managing scholarship and loan repayment programs, would be the ideal home for the initiative. The Institute of Medicine report, indeed, proposes that these programs be launched together as the US Global Health Service constructed on key principles that would include country responsiveness, interdisciplinary approaches to program delivery, and training for self-sufficiency. Ultimately, each country will have to educate and maintain its own health workforce, but the aid of US health professionals would be welcomed in many developing countries as help in the crisis and as foundational assistance for the future. The Institute of Medicine report9 estimated the cost of a start-up US Global Health Service to be approximately $150 million a year, roughly 3.8% of the $3.9 billion proposed budget of the President's Global AIDS initiative for 2007or the cost of 18 hours of the war in Iraq.
( ) The GHS Corp alone costs 300K PER PERSON Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 Salaries, benefits, and travel would account for most of the costs of the Global Health Service Corps. Projecting the exact cost of the Corps is not possible without making a series of assumptions about the personnel system to be used, the disciplines and seniority of the personnel involved, and the details of the approaches to orientation and supervision to be used for the Corps. A reasonable estimate of costs for the Corps can be derived from CDC, which deploys health professionals abroad using government personnel systems; its rough estimate for sending a skilled professional overseas is $250,000 per year per person.1 Using this yardstick, the deployment of an initial Corps of 150 individuals as recommended by the committee would require a budget of $37.5 million (150 $250,000). 1The total can be $300,000 or more depending on certain factors, such as whether the country is more expensive; the base salary is higher (e.g., a medical epidemiologist compared with a junior administrator); how many children the person has (the government pays school fees at $10,00015,000 per child per year); whether the total tour is shorter (because the costs of the move and set-up [e.g., housing] are amortized over fewer years); or security-related costs are increased (Personal Communication, Michael St. Louis, CDC, February 23, 2005).
SDI 2007 5 Week
187 GHS Neg
Spending Double Bind

( ) Theyre in a double bind either they only fund 1000 people and cant solve, or the cost of the program will skyrocket because even 1000 people already costs 35 million Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The committee recommends that the GHS Fellowship Program start small with 510 participants in 15 countries in order to pilot the programs infrastructure. At the level of awards envisioned, the cost of the program would start at $3.5 million ($35,000 100 awards) and grow to $35 million ($35,000 1,000 awards) by the third year of the program, representing about 0.1 percent of the current PEPFAR budget and 1 percent of the projected PEPFAR budget, respectively.
( ) SSA needs 1 million more workers thats billions of dollars Lincoln Chen, MD, Global Equity Initiative, Harvard, et. al., 11-26-2004, Human resources for Health, Lancet,
v. 364, iss. 9449, p. sciencedirect We estimate the global health workforce to be more than 100 million people. Added to the 24 million doctors, nurses, and midwives who are recorded, there are at least three times more uncounted informal, traditional, community, and allied workers. The enumerated professionals are severely maldistributed between regions and countries. Sub-Saharan Africa has a tenth the nurses and doctors for its population that Europe has: Ethiopia has a fiftieth of the professionals for its population that Italy does. With such wide variation, every country must devise a workforce strategy suited to its health needs and human asset base. Here, we cluster 186 countries into five groups (figure 3). Countries are grouped into low, medium, and high worker density clusters (<25, 2550, and >50 workers per 1000 population, respectively). The lowdensity and high-density clusters are further subdivided according to high and low levels of under-five mortality. In low-density countries, 45 countries are in the low-density-high-mortality cluster; these are predominantly sub-Saharan countries with the double crisis of rising death rates overwhelming weak health systems. The remaining 30 low density countries are mostly in Asia and Latin America, which are also the predominant regions of the 42 moderate density countries. Among high-density countries, 34 are in the highdensity-low-mortality cluster; these are all wealthy countries, mostly members of the Organisation for Economic Co-operation and Development (OECD). The remaining 35 high-density countries are transitional economies or exporters of medical personnel. All these countries, rich and poor, have numeric, skill, and geographic imbalances in their workforce. And all countries can accelerate health gains by investing in and managing their health workforce more strategically. While maintaining a global perspective, we focus on low-density-high-mortality countries because of their dire health situations. For all countries, our outstanding global challenges are as listed below. Global shortage There is a massive global shortage of health workers. We estimate the global shortage at more than 4 million workers approximately. Sub-Saharan countries must nearly triple their current numbers of workers by adding the equivalent of 1 million workers through retention, recruitment, and training if they are to come close to approaching the MDGs for health.
SDI 2007 5 Week
188 GHS Neg
***African Economy DA***
SDI 2007 5 Week
189 GHS Neg
African Economy 1NC

( ) African economies are doing well and keeping inflation in check but aid for health capacity which exceeds absorptive capacity could still derail reforms Abdoulaye Bio-Tchane, Director @ IMF African Department, Benedicte Vibe Christensen, Dep. Dir., December 2006, Right Time for Africa, Finance and Development, v. 43, no. 4,
http://www.imf.org/external/pubs/ft/fandd/2006/12/biotchane.htm The challenge for African policymakers now is to carry this vision forward. While economic growth has accelerated in many countries, it still needs to translate into greater improvement in the living standards of the broader population. Governments face a dilemma. With unprecedented amounts of debt relief from multilateral and bilateral donors and promises of a scaling up of aid from the international community, which have yet to materialize, the populations hold great expectations for better education and health services, as well as for improvements in infrastructure such as roads, ports, and energy. At the same time, governments have to make sure that increased spending is consistent with absorptive capacity and with maintaining the progress in macroeconomic stability and low inflation, and they must avoid a repetition of past mistakes of misallocation of budgetary resources. This requires a tightrope balancing act.
( ) Infusing foreign capital into Africa through increasing salaries causes rampant inflation, crushing their economies Laurie Garett, senior fellow for Global Health @ CFR, Jan/Feb 2007, The Challenge of Global Health,
http://fullaccess.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html Some analysts, meanwhile, insist that massive infusions of foreign cash into the public sector undermine local manufacturing and economic development. Thus, Arvind Subramanian, of the IMF, points out that all the best talent in Mozambique and Uganda is tied up in what he calls "the aid industry," and, he says, foreign-aid efforts suck all the air out of local innovation and entrepreneurship. {See Footnote 1} A more immediate concern is that raising salaries for health-care workers and managers directly involved in HIV/AIDS and other health programs will lead to salary boosts in other public sectors and spawn inflation in the countries in question. This would widen the gap between the rich and the poor, pushing the costs of staples beyond the reach of many citizens. If not carefully managed, the influx of cash could exacerbate such conditions as malnutrition and homelessness while undermining any possibility that local industries could eventually grow and support themselves through competitive exports.
SDI 2007 5 Week
190 GHS Neg
African Economy 1NC

( ) Weak African economies are the root cause of civil wars on the continent - strongest data proves Collier, Professor of Economics and Director of the Centre for the Study of African Economies at Oxford University. 04 Paul, October, "Natural Resources and Conflict in Africa." Crimes of War Project, the Magazine.
http://www.crimesofwar.org/africa-mag/afr_04_collier.html <http://www.crimesofwar.org/africamag/afr_04_collier.html> Why has Africa had so much civil war? In all other regions of the world the incidence of civil war has been on a broadly declining trend over the past thirty years: but in Africa the long term trend has been upwards. Of course, every civil war has its 'story' - the personalities, the social cleavages, the triggering events, the inflammatory discourse, the atrocities. But is there anything more? Are there structural conditions - social, political or economic - which make a country prone to civil war? Might it be that the same inflammatory politician, playing on the same social cleavages, and with the same triggering events, might 'cause' war under one set of conditions and merely be an ugly irritant in another? Although I am an Africanist, I like to set Africa in comparative perspective. If Africa is different - as it clearly seems to be in respect of civil war - there are two possible types of explanation. Africans could simply behave differently from others when faced with the same situation. Alternatively, for a given situation their behaviour could be much like anyone else's, but the situations they face could be systematically different. To sort this out we need to look globally, not just regionally. Together with Anke Hoeffler, I have analyzed global data covering the last forty years, trying to see why most countries at most times have avoided civil war, while others have not. Our approach has been statistical - trying to see whether any characteristics of a society could account for a subsequent eruption into war. Within the limits of data availability, we have tried to include social factors (such as inequality, and the ethnic and religious composition of a society), history (such as the time since decolonization), and politics (such as the extent of democratic political rights) as well as economic characteristics. We find a pattern and we find that Africa fits that pattern. Economic Roots of Civil War Surprisingly, the dominant factors are economic. Three factors matter a lot for the risk of civil war: the level of income, its rate of growth, and its structure. If a country is poor, in economic decline, and is dependent upon natural resource exports, then it faces a substantial risk that sooner or later it will experience a civil war. Typically, such a country runs a risk of around one-in-seven every five years. Like Russian roulette, things might go well for a while, but then some conjunction of circumstances - the personalities, the triggering events - ignite violent conflict. Of course, when this happens, the media focus on the personalities and the triggering events. These are indeed the proximate 'cause' of the conflict. But the big brute fact is that civil war is heavily concentrated in countries with low income, in economic decline, and dependent upon natural resources. Africa is the one region where such economic characteristics are the norm and this fully explains Africa's distinctive incidence of civil war. Yes, Africa is riven by ethnic differences, so that where civil wars flare up they will invariably be fought along ethnic lines. But this does not mean that the ethnic differences are 'causing' the conflict. Globally, ethnically diverse societies are no more at risk of civil war than other societies. The only exception to this pattern is where the largest ethnic group is in a majority - that does indeed increase risks and we can think of examples in Africa. But Africa is so ethnically diverse that in most societies no group is in a majority. Fewer African societies have ethnic majorities than other regions.
SDI 2007 5 Week
191 GHS Neg
African Economy 1NC

( ) African civil wars draw in outside powers and risk nuclear war Dr. Jeffrey Deutsch, Founder of the Rabid Tiger Project: An Organization Devoted to Political Risk Consulting and Related Research, Contributing Editor for Russian Politics, and PHD in Economics from GMU, 11-18-2002,
http://www.rabidtigers.com/rtn/newsletterv2n9.html The Rabid Tiger Project believes that a nuclear war is most likely to start in Africa. Civil wars in the Congo (the country formerly known as Zaire., Rwanda, Somalia and Sierra Leone, and domestic instability in Zimbabwe, Sudan and other countries, as well as occasional brushfire and other wars (thanks in part to "national" borders that cut across tribal ones, turn into a really nasty stew. We've got all too many rabid tigers and potential rabid tigers, who are willing to push the button rather than risk being seen as wishy-washy in the face of a mortal threat and overthrown. Geopolitically speaking, Africa is open range. Very few countries in Africa are beholden to any particular power. South Africa is a major exception in this respect - not to mention in that she also probably already has the Bomb. Thus, outside powers can more easily find client states there than, say, in Europe where the political lines have long since been drawn, or Asia where many of the countries (China, India, Japan. are powers unto themselves and don't need any "help," thank you. Thus, an African war can attract outside involvement very quickly. Of course, a proxy war alone may not induce the Great Powers to fight each other. But an African nuclear strike can ignite a much broader conflagration, if the other powers are interested in a fight. Certainly, such a strike would in the first place have been facilitated by outside help - financial, scientific, engineering, etc. Africa is an ocean of troubled waters, and some people love to go fishing.
SDI 2007 5 Week
192 GHS Neg
Yes African Economies

( ) Africa is taking steps to reform their economies Juma Calestous, International Development Professor at Harvard, July 18, 2007, African Food Security, CQ
CONGRESSIONAL TESTIMONY, p ln Africa's food security can only be guaranteed through long-term economic growth, not by emergency interventions alone. This shift in policy will entail placing emphasis on renewing infrastructure, building human capabilities, stimulating business development, and increasing participation in the global economy through export of manufactured goods. These areas that constitute what can be called "the learning economy" should be the foundation upon which to base international development partnerships. This view is already informing the reformulation of Africa's foreign policy. African countries are increasingly paying attention to the role of science and innovation in diplomatic interactions and are already starting to assign technology- related tasks to their key missions to countries such as the US and Japan. Others are revising their foreign policies to make economic cooperation a centerpiece of their diplomatic interactions. Part of Africa's growing cooperation with China, for example, is influenced by the higher technical education opportunities granted to African students. In 2006 China admitted nearly 2,000 African students, mostly in science and engineering. The number of African students admitted to Chinese university will double by 2009 and the long-term diplomatic benefits of such arrangements are immeasurable.
( ) African economies are currently doing well Juma Calestous, International Development Professor at Harvard, July 18, 2007, African Food Security, CQ
CONGRESSIONAL TESTIMONY, p ln Although Africa's economies are currently growing strongly, continuing these trends will require adjustments in the structure and functions of government to make them more entrepreneurial.26 More fundamentally, science and innovation must be integrated at the highest possible levels in government. This change will be facilitated by creating science and innovation into policy analysis capacity in universities, scientific academies and government departments. Which in turn may have political benefits: good governance and good engineering are not so different, after all. Both involve working to achieve objectives guided by care, diligence, and data.
( ) African economies are outstirpping global growth Angela Barnes, Investment Reporter, July 25, 2007, Africa offers final frontier for investors, GLOBE AND
MAIL, p. ln Economic growth in Africa - a diverse continent with more than 50 different countries - has outpaced global growth since the start of the bull market in commodities in late 2001, with an annual growth rate of 5 per cent, against the 4.2 per cent for the global economy. And the International Monetary Fund expects the performance to continue with African growth coming in at 5.6 per cent a year on average through 2012, well above the 4.8 per cent forecast for the global economy.
( ) African economies are making progress All Africa, July 23, 2007, Africa, AFRICA NEWS, p. ln
Annan also pointed to progress in economic and social development, and in respect for the rule of law. "Today, inflation is at historic lows in many countries, and 27 African economies are projected to grow by more than five percent this year. Direct investment has increased more than 200 per cent in the past five years. Exports are also rising... "Africa has also made headway toward the UN Millennium Development Goals. The latest report from the UN shows that today, halfway to the 2015 target date, we've achieved positive change in several crucial areas. We are not excelling, but we are advancing."
SDI 2007 5 Week
193 GHS Neg
Yes African Economies

( ) African economies are growing at record pace and inflation is low World Economic Forum on Africa, 6-2-2006, Boosting African Growth,
http://www.weforum.org/pdf/SummitReports/africa2006/boostingafrica.htm Africa is experiencing record growth rates in many countries in a new era of peace, political stability and macroeconomic reform. But the challenge is to ensure that this growth is sustainable and reduces poverty, and is not only driven by high oil and commodity prices and windfall investments from China. Increased revenues must be used to address problems in the business environment, build infrastructure, increase access to finance for entrepreneurs and improve health and education. These measures will help to unlock growth right down to the bottom of the pyramid the rural poor. Growth in sub-Saharan Africa reached an eight-year high of 5% in 2005, while average inflation fell to its lowest rate in 25 years. About 20 countries achieved growth of more than 5%. Coupled with surging commodity prices, improved governance and reduced conflict, Africa's fortunes seem to have changed for the better, with experts noting that the outlook is the best it has been for decades. Growth has become Africa's new development strategy, which can be sustained through political stability and sound macroeconomic policies.
SDI 2007 5 Week
194 GHS Neg
No African Inflation
( ) African inflation is low, despite growth Abdoulaye Bio-Tchane, Director @ IMF African Department, Benedicte Vibe Christensen, Dep. Dir., December 2006, Right Time for Africa, Finance and Development, v. 43, no. 4,
http://www.imf.org/external/pubs/ft/fandd/2006/12/biotchane.htm Fortunately, growth has not come at the expense of macroeconomic stability. Inflation has been trending downward in SSA since early in this decadean achievement that is especially noteworthy considering that oil prices have been rising steadily the whole time (see Chart 5). Inflation of about 12 percent is expected for the region as a whole in 2006and just 7 percent if Zimbabwe is excluded from the calculation. True, inflation has edged up a little from its low in 2004 because of the pass-through impact of higher oil prices. But the past plague of persistently rising inflation has been avoideda major benefit also to the poorest segments of the population. Oil exporters are saving a relatively high proportion of the increased oil revenue; given the limits on domestic capacity to absorb large inflows effectively, saving is prudent. Oil importers still have deficitsthe average deficit in 2006 is expected to be 4 percent of GDP but the deficits have been consistent with improved macroeconomic stability because of a switch to concessional financing. When grants or concessional loans have been available, countries have had room to substantially increase deficits to achieve spending priorities. For example, Burundi, The Gambia, and Madagascar have seen deficits increase since 2002, but without the additional inflation or crowding out that sole reliance on domestic deficit financing would have implied. Had governments chosen to spend more on subsidies for petroleum products rather than allow price rises to pass through to retail prices, the fiscal space (that is, the government's leeway to spend on health care, education, and other social indicators) would have been substantially compressed.
( ) African inflation is down Abdoulaye Bio-Tchane, Director @ IMF African Department, Benedicte Vibe Christensen, Dep. Dir., December 2006, Right Time for Africa, Finance and Development, v. 43, no. 4,
http://www.imf.org/external/pubs/ft/fandd/2006/12/biotchane.htm Yet things seem to be changing for the better throughout the subcontinent. In most African countries, leaders are now selected through democratic elections. The decision-making process is becoming more participatory and involving greater segments of civil society. The number of countries in crisis has declined, although conflict persists in some countries and regions. The pursuit of strong macroeconomic policies and economic reforms is bearing fruit: economies are growing faster and more steadily than before, and inflation is falling. Record levels of reserves in both oil-producing and oil-importing countries act as a cushion against external shocks, such as the recent increase in oil prices. Countries pursuing economic reforms have benefited from unprecedented amounts of debt relief from a wide variety of sources. In addition, the international community has promised a significant scaling up of aid resources in the years to come, offering African countries a fresh chance to free up resources and invest in human and fixed capital to promote sustainable growth. These changes have not gone unnoticed abroad. Foreign investors are showing increasing interest in the African continent, both in the domestic debt markets and in direct investment in the extraction of natural resources.
SDI 2007 5 Week
195 GHS Neg
African Economy Link

( ) International aid programs boost salaries and poach workers pay way more than government jobs Laurie Garrett, senior fellow for Global Health @ CFR, Jan/Feb 2007, The Challenge of Global Health,
http://fullaccess.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html Compounding the problem are the recruitment activities of Western NGOs and OECD-supported programs inside poor countries, which poach local talent. To help comply with financial and reporting requirements imposed by the IMF, the World Bank, and other donors, these programs are also soaking up the pool of local economists, accountants, and translators. The U.S. Congress imposed a number of limitations on PEPFAR spending, including a ceiling for health-care-worker training of $1 million per country. PEPFAR is prohibited from directly topping off salaries to match government pay levels. But PEPFAR-funded programs, UN agencies, other rich-country government agencies, and NGOs routinely augment the base salaries of local staff with benefits such as housing and education subsidies, frequently bringing their employees' effective wages to a hundred times what they could earn at government-run clinics. USAID's Kent Hill says that this trend is "a horrendous dilemma" that causes "immense pain" in poor countries. But without tough guidelines or some sort of moral consensus among UN agencies, NGOs, and donors, it is hard to see what will slow the drain of talent from already-stressed ministries of health.
SDI 2007 5 Week
196 GHS Neg

( ) Increasing aid to Africa causes inflation and appreciation, destroying economies linear risk as aid increases Maureen Lewis, Senior Fellow @ Center for Global Development, 4-26-2005, Addressing the Challenge of
HIV/AIDS, http://www.cgdev.org/content/publications/detail/2730 The macroeconomic effects obviously depend on the size of the economy and on the level of imports, with smaller economies being more vulnerable to the external environment. However, The larger the aid dependence relative to GDP, the greater the vulnerability to unanticipated shifts in donor flow. Major macroeconomic risks include appreciation of the exchange rate, sustainability of aid flows, inflation and absorptive capacity. The latter stem from inadequate capacity, aid dependence and weak accountability (Heller and Gupta, 2000). Of these effects, the potential appreciation of the exchange rate and inflationary tendencies are closely related. As an illustration, suppose that aid is spent either on domestic services (say, doctors) or imported goods (say, drugs). In the former case, the domestic demand for labor rises, which will result in an increase in wage rates and thus inflation. At the same time, there is an upward pressure on the exchange rate, as the inflow of foreign currency is not offset by a corresponding increase in the demand for imports. As a result, there is an excess supply of foreign currency (and excess demand for domestic currency), resulting in an appreciation of the exchange rate. Alternatively, if the external aid is spent on imported drugs, there is little effect on domestic demand (and thus no inflationary impact), and as the incoming funds are used to purchase imported goods there is no net effect on the current account and hence no pressure on the exchange rate.2 Thus, large increases in aid have the potential for leading to an appreciated exchange rate and a drop in exports, which can compromise economic growth. Between 1995 and 2000 Ugandas ODA grants grew by 3.5 percent of GDP, and despite prudent fiscal management, exchange rate appreciation led to dampened exports, a phenomenon known as Dutch disease.3 Moreover, the Central Bank was unable to sterilize adequately to compensate for the foreign exchange increases. As a result of this and other factors, growth slowed, at least in the short run.
SDI 2007 5 Week
197 GHS Neg

( ) Plan has to raise wages or they link to brain drain Marilyn Chase, WSJ, 4-20-2005, Panel suggests a Peace Corps to Fight AIDS, UCSF,
http://www.globalhealthsciences.ucsf.edu/news/padianwallst.aspx Peter Piot, director of the Joint United Nations Programme on HIV/AIDS, known as UNAIDS, called the proposal "welcome and timely" but urged that the volunteers work in teams led locally. He said the corps should be linked to broader policy objectives, for example to ensure health-care workers in poor countries get decent wages. The recruitment of the developing world's doctors to better-paying jobs in North America and Europe contributes to the brain drain in the developing world. "Isn't it a bit absurd," Dr. Piot said, "that we then send nurses and doctors to fill slots in Africa that have been emptied by our recruitment policies?" Nancy Padian, associate director of the Global Health Sciences Program at the University of California San Francisco, said Pepfar itself could exacerbate the drain of medical personnel in some countries hit hard by AIDS.
SDI 2007 5 Week
198 GHS Neg

( ) Aid to Africa empirically causes economic distortion, driving up salaries Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 Another participant pointed out that the economic imbalance existing in war-torn areas is not limited to peacekeepers. The United Nations and other nongovernmental organizations and bilateral agencies pay their international staff five to 20 times more than is customary in the local economy, creating massive economic distortion. Anyone who can speak English or the most common language in the given location is drawn from the local labor market, a talent drain that can take years to redress. This is happening in the Balkans, for example, as well as in Afghanistan, and has occurred in the past in many parts of Africa, including Angola and Sudan. A participant suggested that perhaps the United Nations could address this issue if and when the humanitarian community becomes more organized.
SDI 2007 5 Week
199 GHS Neg

( ) Aid empirically undercuts work effort and causes resource misallocation, jacking growth Dr. Tomi Ovaska, Econ. Prof @ Regina, 2005, More Aid, Less Growth, Cato Journal, v. 23, no. 2
This study examined the effect of development aid on economic growth for the years 197598. The sample covered up to 86 developing countries, used two alternative data sets for aid, and compared with previous studies of aid effectiveness, used a more advanced measure of the quality of governance. Contrary to some previous findings in the development aid literature, the results from the fixed effect (FE) model with group dummy variables and period effects indicated a negative relationship between development aid and economic growth. In particular, it was found that a 1 percent increase in aid as a percent of GDP decreased annual real GDP per capita growth by 3.65 percent. Furthermore, aid given to countries with a better quality of governance was not found to improve the effectiveness of aid, contrary to the suggestion in Burnside and Dollar (2000). Indeed, it was suggested that their results may emanate from the negative effects of aid on work effort and from the stipulated end uses of aid, which may lead to misallocation of scarce resources in the recipient country. Overall, the results of this study do not provide support for the notion that international development aid at least as in practice between 1975 and 1998 helps developing countries to higher growth trajectories. The study also pointed out that the level of governance as measured by the EFW index was a considerable factor in explaining growth in the sample. This was not the case when it was coupled with development aid. Thus, the current role of western governments is not easily justifiable if the objective of aid disbursement is to foster economic growth. This does not, of course, exclude any other rationale that may be behind development aid, such as providing humanitarian aid in case of emergencies. However, if the objective of development aid is to foster growth, the current donor governments may be well advised, as the importance of the economic freedom index in the regressions suggested, to move their development policy focus from cash grants to programs that help create sound institutional environments in recipient countries. Helping and encouraging developing countries to create business environments that are compatible with free markets is a promising and a potentially cost- effective way to unleash the individual effort and creativity in those countries.
SDI 2007 5 Week
200 GHS Neg
Inflation Jacks African Economies

( ) Inflation would destroy growth in sub-Saharan Africa Anupam Basu, Dep. Dir. IMF Africa, Evangelos A. Calamitsis, Dir. IMF Africa, and Dhaneshwar Ghura, Dep. Division Chief IMF Africa, August 2000, Promoting Growth in Sub-Saharan Africa, IMF,
http://www.internationalmonetaryfund.com/external/pubs/ft/issues/issues23/index.htm#author Several underlying factors can affect the rate of output change. Key among these are the rate of investment, increase in the size of the workforce, and changes in economic policies. A country's macroeconomic policies will affect its growth performance through their impact on certain economic variables. For example, a high rate of inflation is generally harmful to growth because it raises the cost of borrowing and thus lowers the rate of capital investment; but at low, single-digit levels of inflation, the likelihood of such a trade-off between inflation and growth is minimal. At the same time, highly variable inflation makes it difficult and costly to forecast accurately costs and profits, and hence investors and entrepreneurs may be reluctant to undertake new projects. Likewise, given that financial resources in the form of domestic savings and foreign grants and loans are limited, a larger budget deficit will mean that more of those limited resources must be devoted to financing the budget deficit. Fewer resources will thus be available for the private sector. If the fiscal deficit increases to an unsustainable level, private investors' perception of country risk is likely to become increasingly negative and hurt private investment. Finally, outward-oriented trade polices are conducive to faster growth because they promote competition, encourage learning-by-doing, improve access to trade opportunities, and raise the efficiency of resource allocation. The evidence for sub-Saharan Africa suggests that the recent economic recovery was underpinned by a positive economic environment influencedeither directly or indirectlyby improvements in macroeconomic policies and structural reforms. The estimated growth equation indicates that per capita real GDP growth is positively influenced by economic policies that raise the ratio of private investment to GDP, promote human capital development, lower the ratio of the budget deficit to GDP, avoid overvalued exchange rates, and stimulate export volume growth. The key results are the following: * The effect of an increase in the private investment-GDP ratio on economic growth is large and statistically significant; also this effect is larger than that of an increase in the government investment-GDP ratio. * The policy environment matters for growth. Per capita real GDP growth is positively influenced by reductions in the budget deficit-GDP ratio, enhancements in external competitiveness, and expansions of export volume. * The results support the view that countries that implemented IMF-supported programs on a sustained basis were able to achieve faster rates of growth than others. The fact that this effect is significant after controlling for the effects of the macroeconomic policyrelated variables suggests that it is most likely capturing the independent effects of structural reforms. * The effect of an increase in human capital is positive, but not robust, when other factors affecting growth are taken into account. * These results suggest that macroeconomic stability, the implementation of structural reforms, and increases in private investment are necessary for boosting growth in sub-Saharan Africa.
SDI 2007 5 Week
201 GHS Neg
African Economy Impact

( ) Even small declines in African economies empirically cause failed states and war Jeffery D. Sachs, Dir. Center for Intl Dev. @ Harvard, Econ Prof, 2001, The Strategic Significance of Global
Inequality, Washington Quarterly, 24.3, p. muse Americans would dearly love to believe that the United States can be an island of stability and prosperity in a global sea of poverty and unrest. History, however, continues to prove otherwise. One common occurrence has been an economic crisis abroad that leads to a collapse of state authority abroad, which in turn has adverse consequences for the United States. The examples are legion. The rise of the Bolsheviks to power in 1917 took place in the wake of an economic collapse of wartime czarist Russia. The rise of Hitler in 1933 occurred in the midst of the Great Depression that affected Germany especially hard because of its large foreign debt. More recently, Yugoslavia disintegrated into regional war not only because of interethnic conflicts, but also because of an economic collapse and the descent of the former federal state into hyperinflation in the late 1980s. Political adventurers such as Slobodan Milosevic in turn used the economic collapse to grab power. Iraq's declining economic fortunes and rising debt burdens following the Iran-Iraq War of the 1980s prompted, at least in part, Saddam Hussein's invasion of Kuwait in 1990. In the 1990s, most of the world's violent conflicts, which have been related in one form or another to deep economic crises and their attendant state failures, have occurred in Africa. 2 I do not want to commit the elementary fallacy of attributing all political failures to economic crises. The shah of Iran was knocked from power in 1979 in the midst of an oil boom. Tracing the rise of Lenin or Hitler to power on the basis of economics alone would be fatuous. Yet, in practice, economic failure abroad undoubtedly matters greatly and can translate into very large costs for the United States in many spheres. The most comprehensive study of state failure, carried out by the State Failure Task Force established by the Central Intelligence Agency in 1994, confirms the importance of economic underpinnings to state failure. 3 The [End Page 188] task force gave formal definition to state failure (as a case of revolutionary war, ethnic war, genocides or politicides, and adverse or disruptive regime changes) and counted all cases during 1957-1994 in countries of 500,000 people or more. The Task Force identified 113 cases of state failure. Of all the explanatory variables examined, three were most significant: infant mortality rates, suggesting that overall low levels of material well-being are a significant contributor to state failure; openness of the economy, in that more economic linkages with the rest of the world diminish the chances of state failure; and democracy, with democratic countries showing less propensity to state failure than authoritarian regimes. The linkage to democracy has another strong economic aspect, however, because other research has shown strongly that the probability of a country being democratic rises significantly with its per capita income level. 4 In refinements of the basic study, the task force found that in sub-Saharan Africa, where many societies live on the edge of subsistence, temporary economic setbacks (measured as a decline in Gross Domestic Product per capita) were significant predictors of state failure. They also found that "partial" democracies, usually in transition from authoritarian to fully democratic institutions, were particularly vulnerable to collapse. Similar conclusions have been reached in studies on African conflict, which find that poverty and slow economic growth raise the probability of conflict. 5
SDI 2007 5 Week
202 GHS Neg
South Africa Economy Impact

( ) Collapse of the South African economy causes African conflict Senator Barack Obama (D-IL), and Ms. Nancy Birdsall, Pres. Center for Global Dev., et al, 5-17-2005,
Testimony, CQ, p ln OBAMA: Thank you, Mr. Chairman. Let me pick up on something that was mentioned earlier, and that is the issue of regional cooperation. And I thought you had, Ms. Birdsall, you had a wonderful reminder that if you combine the entire economy of the continent, it's slightly smaller than the city of Chicago, which says something. Now, Illinois is famous for having too many governments, by the way, mayors and townships and all kinds of stuff. So, part of what we have to do is to figure out how do we concentrate resources in ways that give us some economies of scale and go forward? So, I guess I'm wondering if any of the three of you, I'd be interested in your opinions -- as the commission was doing its work, was there some sense strategically that we should focus our resources on some key regional powers and what is happening with them as anchors to overall development strategies? I'm thinking that if Nigeria had its act together, and South Africa is the linchpin of the southernmost portion of the continent, whether it's Kenya or Uganda, that you have a couple of the stronger countries on the east, just creating some spaces in which transparency and economic growth are taking place would then have spillover effects in other parts of the region. I'm wondering, is that something that's been discussed, talked about, does that make sense? BIRDSALL: Do you want me to try to say something about that? I think it's a critical question. We do know that some of the conflicts in some parts of Africa are exacerbated because of what's called the neighborhood effect, and that could be offset if there were these anchors. Let me say a word in particular about Nigeria, because South Africa is already quite an effective anchor ... OBAMA: Serving that function. BIRDSALL: Including for a subregional group in the southern part of the continent that is working reasonably well. But, on Nigeria, I think it's an interesting example of the potential for the U.S. to take some leadership. Nigeria has now had for several years under the second Obasanjo regime, a reforming cabinet. In particular, the minister of finance and the head of the central bank are both working very hard, with very effective teams, to deal with corruption problems. The Nigerian government in the last year has saved a substantial portion of the windfall it has received because of the high oil price. And there is a problem of debt in Nigeria, which is creating an internal political problem in which the parliament is resisting some of the reforms because of its agitation over the long history of the way debt was accumulated in Nigeria. Nigeria actually only bothered about 3 or $4 billion during its early democratic government in the '80s, but the military government subsequently didn't pay, and as a result the interest on that debt and that 2 or 3, $4 billion, has now accumulated to almost $40 billion because of arrears and penalties. And this debt is owed mostly to Europe -France, Germany, the U.K., a little bit still to the U.S. and Japan ... OBAMA: Were they operating, I guess, on a credit card? That sounds familiar to ... BIRDSALL: They weren't borrowing more. They just stopped paying back these bilaterals. So the cost of the cost of that debt ballooned because of interest and penalties. As some of us might know, if you don't pay your credit cards. OBAMA: That's the thing. BIRDSALL: Right, they were having a credit card problem. So here's a case where the U.S., including possibly at Gleneagles, could signal that it would support a risky -- it would be risky, as Senator Kassebaum referred in an earlier concept, to the logic of taking risks when there are opportunities. We could take leadership on the Europeans in particular, moving ahead and saying, OK, we will write off this debt. In fact, the Nigerians could offer to use some of their excess reserves, because of the oil windfall, to buy back the debt at a reduced rate, and there is discussion of that going on between the Nigerians and some of the debtors. So this is one in our security interests, as well as in terms of improving management in Nigeria, exploiting an opportunity to create an anchor -- and, by the way, of course, Obasanjo has shown great responsibility already in terms of the situation in Sierra Leone, in Togo, elsewhere, in helping out when there are neighborhood conflicts. Here is an opportunity for the OECD countries, the advanced countries, with some risk, admittedly, but to shore up a reforming government and to ensure that, at least in the next election, the efforts of Obasanjo's government to undertake economic and political and social reforms, are not undermined because the popular vote goes against their inability to have dealt with the debt. OBAMA: Senator? KASSEBAUM: It was another subject. Thank you. THIAM: I'd just like to build on that, because I strongly support what Nancy Birdsall had just said, but I think it's not an either or. You do have to support the Nigerias, the South Africas, and to have regional powerhouses, but it's like a chain, you're as weak as your weakest link. And, as I say, the problem is often that we share the same geographic space. It's as if a teacher in a classroom says, well, I'm only going to focus on my good pupils. The problem is, there is a contagious disease in the classroom, and it's going to spread.
SDI 2007 5 Week
203 GHS Neg
African Economy Key Public Health

( ) Improvements in public health are impossible without African economic growth outweighs the affs internal link Harold M. Koenig, and Ronald R. Blanck, Former Surgeon Generals, 2006, Economic Growth and Low-Cost
Energy, Annapolis Center, An adage of early 20th Century economics was that you could have defense spending or domestic spending (i.e., guns or butter), but not both. Economic resources and public health have been similarly linked, with some public health practitioners stressing governmental policies that directly or indirectly redistribute economic resources (e.g., taxes) toward public health goals (McMichael, 2000; Szreter, 2003). Redistributive policies include traditional health and welfare programs, social programs, and environmental health regulations that increase costs to both the producer and the consumer. However, a large and growing body of literature suggests that economic growth-betterment, in and of itself, improves public health. In fact, much of the improvement in health, average lifespan, and decreased mortality over the past 100 years has been linked to economic growth and the subsequent improved standard of living (Preston, 1985; Bhopal, 1994; Subramanian, 2002; McKeown, 2004; Brenner, 2005a; 2005b). Noted demographic historian Thomas McKeown (2004) put forward the theory that the consistent reduction in mortality (and the longer lifespan) since the Industrial Revolution has been driven largely by the rising standard of living associated with economic growth. This theory was seen as the force behind public health improvements in nutrition and sanitation, and was thought to have a much larger role than individual medical or regulatory achievements. Critics of McKeown have argued that political and social interventions had a larger role than economic ones in creating the modern public health infrastructure. However, most experts agree that some degrees of economic development and improved standard of living were necessary precursors to these societal successes (McMichael, 2000; Colgrove, 2002; Link, 2002; Szreter, 2002). In fact, the literature suggests that both sustained, measured economic growth and political stability are necessary for improved health and standard of living.
SDI 2007 5 Week
204 GHS Neg
***Reverse Brain Drain DA***
SDI 2007 5 Week
205 GHS Neg
RBD 1NC
( ) The U.S. economy is currently competitive but still on the brink Diana Furchtgott-Roth, Senior Fellow @ Hudson Inst., Chief Economist @ US Dep. Of Labor,11-10-2006,
Keeping America Competitive, NY Sun, http://www.nysun.com/article/43318?page_no=1 Senator Clinton and President Bush may not always see eye to eye, but keeping America globally competitive is a shared goal. Since the election, much of the talk has been about the gridlock that will result from political "cohabitation," as the French call it. But there's much the two parties can agree on to improve or reduce our competitiveness, at no cost to the federal budget. Next Monday, well-timed to come out after the election, the Council on Competitiveness will release the 20th edition of "Competitiveness Index 2006," a publication tracking matters influencing American prosperity and economic growth. Ripe with bipartisan ideas, the report will present the major factors enabling America to compete in the global economy. And, earlier this fall, New York's Commission on Independent Colleges and Universities published a report titled "How States Can Enhance Innovation Through the Support of Higher Education and Research," focusing on how to increase science education in New York's primary and secondary schools and colleges. The American economy's recent performance is almost enough to make us forget about global competitiveness. Since the beginning of 2003, the annualized real GDP growth rate has averaged 3.5%. Aside from the tech bubble of the late 1990s, that's one of the best rates in over 30 years. Analysts forecast that our weak third-quarter growth rate will be followed by a pickup in the fourth quarter. But that does not mean that we can become complacent, or that our new Congress should lose sight of one of its main goals building a bigger, stronger America. We do not face much economic competition from Europe, with its low GDP growth, aging population, high unemployment, and excessive taxes, but we face strong competition from Asian countries such as China, India, and Singapore.
SDI 2007 5 Week
206 GHS Neg
RBD 1NC
( ) Sending more doctors and scientists to Africa will cause reverse brain drain, destroying U.S. competitiveness and hegemony Alan M Webber, ed. Fast Company, 2-23-2004, Reverse Brain Drain threatens U.S. Economy, USA Today,
http://www.usatoday.com/news/opinion/editorials/2004-02-23-economy-edit_x.htm Today, while many of these conditions still apply, Americans are starting to hear a ew term: "reverse brain drain." What it suggests is the United States is pursuing government and private-sector policies that, over the long run, could lead to a significant shift in the world's balance of brainpower. Recently, President Bush's chief economic adviser, Gregory Mankiw, touted the advantages for U.S. firms of outsourcing jobs overseas. But that trend, if left unattended, could have serious implications for this country's economic competitiveness. For its part, the federal government seems intent on letting "controversial" scientists for example, those dealing with research that touches on the issue of abortion go to other countries and keeping foreign talent out. U.S. companies are happy to outsource knowledge work while, at the same time, buying out the contracts of their most experienced workers all in the name of reducing costs. And the one sure way to grow new brains a high-quality educational system has failed to produce enough homegrown talent. As the economy globalizes, and as first-class creative minds go abroad, stay abroad or are produced abroad, other nations may challenge the United States' role as the leader in innovation and creativity. The prospect of that challenge tomorrow more than the loss of jobs today is what the debate over America's economic future ought to be about. First, recent government policies are sending talented U.S.-based researchers overseas and clamping down on the arrival of new researchers to this country. A recent article by Carnegie Mellon professor Richard Florida in The Washington Monthly magazine makes a persuasive case that the Bush administration's policies are shooting this country's economy in the, well, the brain. Florida's book, The Rise of the Creative Class, demonstrates that the most competitive communities are those that have the highest concentration of talented individuals, a high degree of technological innovation and a high level of tolerance for diverse lifestyles.
SDI 2007 5 Week
207 GHS Neg
RBD 1NC
( ) Competitiveness is key to heg Zalmay Khalilzad, RAND, Losing the Moment? The Washington Quarterly 1995
U.S. superiority in new weapons and their use would be critical. U.S. planners should therefore give higher priority to research on new technologies, new concepts of operation, and changes in organization, with the aim of U.S. dominance in the military technical revolution that may be emerging. They should also focus on how to project U.S. systems and interests against weapons based on new technologies. The Persian Gulf War gave a glimpse of the likely future. The character of warfare will change because of advances in military technology, where the [US] United States has the lead, and in corresponding concepts of operation and organizational structure. The challenge is to sustain this lead in the face of the complacency that the current U.S. lead in military power is likely to engender. Those who are seeking to be rivals to the United States are likely to be very motivated to explore new technologies and how to use them against it. A determined nation making the right choices, even though it possessed a much smaller economy, could pose an enormous challenge by exploiting breakthroughs that made more traditional U.S. military methods less effective by comparison. For example, Germany, by making the right technical choices and adopting innovative concepts for their use in the 1920s and 1930s, was able to make a serious bid for world domination. At the same time, Japan, with a relatively small GNP compared to the other major powers, especially the United States, was at the forefront of the development of naval aviation and aircraft carriers. These examples indicate that a major innovation in warfare provides ambitious powers an opportunity to become dominant or near-dominant powers. U.S. domination of the emerging military-technical revolution, combined with the maintenance of a force of adequate size, can help to discourage the rise of a rival power by making potential rivals believe that catching up with the United States is a hopeless proposition and that if they try they will suffer the same fate as the former Soviet Union.
( ) Nuclear war Zalmay Khalilzad, RAND, The Washington Quarterly, Spring 1995
Under the third option, the United States would seek to retain global leadership and to preclude the rise of a global rival or a return to multipolarity for the indefinite future. On balance, this is the best long-term guiding principle and vision. Such a vision is desirable not as an end in itself, but because a world in which the United States exercises leadership would have tremendous
advantages. First, the global environment would be more open and more receptive to American values -democracy, free markets, and the rule of law. Second, such a world would have a better chance of dealing cooperatively with the world's major problems, such as nuclear proliferation, threats of regional hegemony by renegade states, and low-level conflicts. Finally, U.S. leadership would help preclude the rise of another hostile global rival, enabling the United States and the world to avoid another global cold or hot war and all the attendant dangers, including a global nuclear exchange. U.S. leadership would therefore be more conducive to global stability than a bipolar or a multipolar balance of power system.
SDI 2007 5 Week
208 GHS Neg
RBD Link Booster

( ) Keeping immigrants is key to U.S. competitiveness the threshold of the link is small, hanging on to every person matters David Heenan, leading expert on globalization, 2007, Wake Up, America, Am. Manag. Assoc.,
http://www.amanet.org/movingahead/editorial.cfm?Ed=151&BNKNAVID=23&display=1 For many years, the United States benefited from minimal competition in stockpiling talent. But in the ebb and flow of globalization, attractive alternatives are available elsewhere. We are losing our lead every day, warns Andrew S. Grove, the Hungarian migr who co-founded Intel and made Silicon Valley all but synonymous with the entrepreneurial spirit that drives the Innovation Economy. The distance between us and the rest of the world is eroding every day, because knowledge doesnt stay confined and people dont stay confined. How Can the U.S. Stop the Reverse Drain? The United States is between Scylla and Charybdis. It has two choices: Develop more home-grown talent or import more talented workers from abroad. The first option is unlikely to produce results, at least in the short term. Therefore, the nation will have to attract and retain more immigrants, while holding on to its existing pool of native- and foreignborn brainpower. Simply put, America can no longer afford to see its human capital voluntarily abandon ship. Of course, any serious effort to break the reverse brain drain is not a cure-all for the nations burgeoning talent deficit. However, spurring immigration reform, extending the welcome mat, and targeting high-potential foreigners can help strengthen Americas knowledge-oriented workforce. But attracting and retaining imported brainpower is only half the loaf; the other half is upgrading the quantity and quality of our native-born sons and daughters. Therefore, the United States must place equal attention on thorny problems, such as reforming public education, upgrading universities, stimulating science and technology and a good deal more. America cannot afford to equivocate. For centuries, our leaders have responded to similar challenges. Yet, history offers many examples of other great countries that came to catastrophic ends because of their unwillingness to respond to change. Nothing short of meeting this threat will safeguard Americas talent base and shape the kind of society in which our children and their children will prosper. The time to act is now.
SDI 2007 5 Week
209 GHS Neg
RBD Link Doctors Key

( ) Keeping as many doctors and nurses as possible is key to remaining competitive Business World, 4-26-2007, Skills upgrade in key fields, p ln
While he noted that these key sectors could generate as many as 9.6 million jobs until 2010, he noted the lack of takers of a number of jobs in these fields due to lack of skills and education. Hard-to-fill jobs were listed as: * * geologists, mining and metallurgical engineers for the mining industry; * * cooks, tour guides, reservations officers for hotels and travel agencies; * * butlers and baristas for the hotel and restaurant industry; * * welders, fabricators, pipe fitters, and marine electricians in the shipbuilding industry; * * marine officers, seafarers and culinary chefs for the maritime industry; * * agribusiness entrepreneurs; * * doctors, nurses, massage and spa therapists for the health, wellness and medical tourism industry; * * construction workers; and * * engineers, accountants, software developers, medical transcriptionists and call center agents for the cyber services sector. Labor Secretary Arturo D. Brion said in his speech that "it is ... imperative that we exert all efforts to preserve and even improve on... our human resources... in the race to competitiveness." For his part, Trade Secretary Peter B. Favila said that, for this year, state agencies involved in raising workers' skills will continue to focus on improving existing education and vocational training systems, ranging from improving schools governance, to better on-the-job training programs, to upgrading the English, Science and Math skills of students.
SDI 2007 5 Week
210 GHS Neg
RBD Link Health Care Key

( ) Health care is key to competitiveness Business Wire, 10-12-2005, High-Tech Leaders, ln
Chief executives from the nation's leading high-tech companies today declared that building a networked health-care system is a national imperative and called on policymakers, U.S. businesses and health-care providers to develop the policies, standards and systems needed to make it a reality. The Technology CEO Council said that modernizing our health-care system by connecting health information between doctors, patients, pharmacies and labs is critical to not only improving our nation's health-care system, but our global competitiveness. The Technology CEO Council's "A Healthy System" Report and e-Health Readiness Guide provides a road map and policy recommendations on how to implement information management into the health-care system and milestones to measure progress. "Many of the problems with the U.S. healthcare system were exposed after Hurricanes Katrina and Rita when paper health records were lost and victims were unable to access their health information or provide complete medical histories to caregivers," said Craig Barrett, Chairman of the Board of Intel Corporation and Chairman of the Technology CEO Council. "It's clear that establishing a healthcare network that utilizes information technology to improve care, reduce errors and cut costs is critical. An effective, efficient system is not only important to advancing the health of our society, but also to our economic well-being and long-term competitiveness."
SDI 2007 5 Week
211 GHS Neg

( ) Health care is key to the economy and competitiveness largest sector Newt Gingrich, Former House Speaker, 6-21-2006, Accelerating the Adoption of Health Information
Technology, CQ Congressional Quarterly, ln Most policy debates frame healthcare as a problem whether a matter of financing, provision, equity, or quality. While important, these discussions ignore that the health sector is not only the largest sector of the U.S. economy, but it is a vibrant and quickly growing sector as well. The position of Undersecretary of Commerce for Health should be created within the Department of Commerce, and should be charged with ensuring that domestic and international policies do not stifle the innovation and competitiveness of this increasingly vital sector of the economy. The Undersecretary would be charged with ensuring that: (1) regulations do not place unwarranted burdens on healthcare companies; (2) foreign governments protect the intellectual property rights of U.S. companies and allow these companies fair access to their domestic markets; and (3) the U.S. government enthusiastically and meaningfully promote the U.S. health sector in the international marketplace. The Undersecretary of Commerce for Health would be the sole undersecretary within Commerce charged with representing the interests of a specific sector of the U.S. economy. This attention is warranted for two reasons. First, the healthcare sector is subject to greater government regulation than any other leading sector of the U.S. economy. Thus, it follows that at least one senior official within the U.S. government be explicitly charged with ensuring that these domestic and international regulations do not place an undue burden on the sector. Second, the healthcare sector is of vital importance to all Americans, as the following points make clear: .. Economic Engine. The healthcare sector is the largest component of the U.S. economy, accounting for one seventh of U.S. economic activity. Composed of 8,500 firms (mostly employing fewer than 50 people), the U.S. medical technology industry already sustains 350,000 high-value manufacturing jobs paying an average of 49 percent more than those in other manufacturing sectors and accounts for roughly half of the $175 billion global production of medical products and supplies. .. Job Creation. The healthcare industry is the largest high- value job-creating sector in the United States in 2002, health services accounted for 12.9 million American jobs. The Department of Labor projects that by 2012, one out every six new jobs will be created within the healthcare sector. A 2003 New England Health Care Institute study showed that every job in the medical technology sector generates another 2.5 jobs elsewhere in the economy. .. International Competitiveness. Boasting the world's leading pharmaceutical companies, medical device manufacturers, and treatment facilities, the U.S. health sector hold tremendous potential for significantly reducing the U.S. current account deficit. However, the $3 billion trade surplus the United States has historically enjoyed in this sector has recently vanished, prompting serious questions about the fairness of overseas markets. .. Quality of Life. The most significant output of U.S. health sector increased quality of life for Americans, as well as for beneficiaries of U.S. innovation throughout the world is not captured by conventional economic measures. Yet it is of fundamental importance to all Americans. Health information technology and the Undersecretary of Commerce for Health go hand- in-hand: without technology, there will be little innovation, and the deliver of care will continue to lag behind other nations. Technology, innovation, and better quality care will be a magnet for people from all over world to visit our country and utilize our system.
SDI 2007 5 Week
212 GHS Neg

( ) US health care is key to the economy Michael S. Christian, Survey of Current Business, 6-1-2007, Measuring the output of health care, ln
THE HEALTH sector is one of the largest sectors of the U.S. economy. In 2004, the U.S. economy produced $1.855 trillion in health-related goods and services, accounting for 15.8 percent of gross domestic product. (1) A sector of this size must be accurately measured and appropriately understood if national economic accounts are to be credible.
( ) US health care is key to the economy largest sector Business Wire, 11-15-2006, Some of the Highest Standards, ln
The US healthcare market is the world's largest in terms of total expenditure. In 2003, US health expenditure reached US$1,678.9 billion, equal to US$5,670 per capita. The importance of the health sector to the US economy is immense, being one of the largest individual industry sectors, providing employment to over ten million people and equal to 15.3% of GDP.
( ) The US health sector is key to the economy bigger than the whole Canadian economy Julie Kosterlitz, National Journal, 7-22-1989, But Not For Us, ln
These groups not only exert influence in Washington but also have economic roots that sink deep into the American economy. "We have a health sector that is very large and very economically oriented -- very entrepreneurial," said health consultant Etheredge, who noted that "16-17 per cent of the expansion of GNP comes from the growth of the health sector. Hospitals are the largest employers in most metropolitan areas. U.S. health care is the eighth-largest economy in the world, with $ 500 billion a year in revenues, [and] the health sector is lots larger than the whole Canadian economy."
SDI 2007 5 Week
213 GHS Neg
RBD Link Education Key

( ) The health of the U.S. educational system is key to check reverse brain drain were on the brink, but its not too late Alan M Webber, ed. Fast Company, 2-23-2004, Reverse Brain Drain threatens U.S. Economy, USA Today,
http://www.usatoday.com/news/opinion/editorials/2004-02-23-economy-edit_x.htm Finally, the problem of a reverse brain drain is exacerbated by the continuing crisis in American education. A recent column by Nicholas Kristof in The New York Times makes the point that U.S. education simply is doing a lousy job in math and science. The most recent international ranking of eighth-graders from around the world in math and science put the United States 19th, just after Latvia. India and China were not included in that trends survey but it's a safe bet that if they had been, the U.S. would have slid to 21st. Why does this matter? Consider Federal Reserve Chairman Alan Greenspan's testimony this month before the Senate Banking Committee. When asked about outsourcing and the rising U.S. trade deficit, Greenspan sagely commented that education, not trade or outsourcing, would determine the fate of U.S. workers. No one disputes the fact that, when it comes to economic dynamism, the United States still ranks at the top. But the combination of these "reverse brain drain" policies presents a clear danger to America's future competitiveness. The long-term trends in the world economy are clear: We are shifting inexorably toward a knowledge economy, where productive, well-paid work is based on ideas, information and adaptive thinking. Work involves more intangibles (brains) and fewer tangibles (muscles). The country and the companies with the best brains will win. The only way for the United States to out-think, outsmart and out-innovate the competition, is to look hard at government policies that either send our best brains overseas or discourage more brains from coming here; to question business practices that increase reliance on foreign brains while "buying out" our own; and to demand more from our education system. It's not too late to stanch the reverse brain drain. But first we have to put our own brains to work on the problem.
SDI 2007 5 Week
214 GHS Neg

( ) Education is key to competitiveness drives innovation John P. Morgridge, Chair Cisco, 7-21-2005, U.S. Competitiveness, Hearing,
http://www.house.gov/science/hearings/full05/july%2021/morgridge.pdf Education is the foundation to all innovation and the engine to economic growth. We must advocate policies that will create an educated workforce to match Americas future employment needs, specifically an educated workforce trained in math and science which is critical to the innovation economy. In order for Americas high tech industry to stay competitive throughout the 21st Century and beyond, we need to invest in our workforce of tomorrow by giving them the tools necessary to compete for post-secondary education programs or careers in science, math or engineering. We need to make Americas educational system the best in the world by making math and science teaching a priority for our children and support efforts on the state and federal levels to accomplish this objective. I applaud what this Committee has done to recognize the finest math and science teachers in this country their work is vital to our future competitiveness. A domestic workforce educated in science, math or engineering will ensure that the American high tech industry continues to lead the world in terms of innovation and entrepreneurship. Moreover, an educated workforce will enable Cisco and other job producing innovative companies to meet our human resource needs by attracting domestic talent, unencumbered by immigration restrictions. Unfortunately, Americas children are not receiving the necessary training in math and science to compete for high-paying technology jobs of the future. For example, only 24 states require secondary students to take at least three years of math, and only 21 states require students to take at least three years of science.
SDI 2007 5 Week
215 GHS Neg

( ) Education is key to competitiveness Ted C. Fishman, graduate of Princeton University, former floor trader and member of the Chicago Mercantile Exchange and author. China, Inc. 2005 p 277-278
Competitiveness requires a highly educated workforce. On that score, the news in America is not promising, especially when one looks at grade schools and high schools where the vast majority of American students are not getting the skills they will need to be sharp enough to flourish in a future informed by China. In 2004, ACT, the independent organization that administers academic assessment tests to millions of American schoolchildren every year, took stock of American schools overall. Of the 1.2 million graduating high school students in 2004 who took ACTs college admission test, only one in five had scores showing they were ready for college courses in English, math, and science. Only a quarter had scores that predicted they would get a C or higher in their first college biology course. The numbers were slightly better in math, but still dismal, showing that only two in five American high school graduates could earn at least a C in a first-year college algebra course.4 The plain fact is that a lot of American public schools are pretty lousy, despite decades of earnest effort to improve them. Americans never tire of schemes to correct their schools, focusing in one place on an open cur- -riculum, in another on test scores, and in still another on self-esteem. These may all be worthy ideas, but are rarely effective enough by themselves. Local, ideological, cultural-religious, and special interest politics also cloud reform. The freedom of Americans to overspend on unproductive consumption at the expense of education leaves schools underfunded. (In many places around the country, property owners militantly oppose efforts to raise property taxes to improve the local schools. Californias Bay Area, land of the tech millionaires and knowledge workers, cannot afford routine maintenance for its schools and has had to ask teachers to take pay cuts.) To make matters worse, the higher-wage attractions of the private workforce for people with even modest science and math skills, or those possessing marketable creativity who might otherwise be teachers, keep essential talent out of the classroom. American high school teachers of science and math too rarely have university degrees in science or math. One can only despair about the education system until there is a fundamental shift in the public will so that schools become the top national priority of a people firm in the knowledge that every lesson not learned will equal a job not earned. If American primary and secondary schools fall short, is not American higher education still far superior to that of any other country? Yes for now. But the comparative strengths of American universities to turn out the worlds highest skilled workers are fading. The challenge to Americas engineering programs to produce American engineers has already been covered. Equally threatening, however, is the decreasing ability of American universities to attract the best and the brightest foreign students. Part of the problem may be short-lived, as foreign students who were denied visas because of security concerns following 9/11 begin to gain entry once the United States has a faster screening system in place. In the short time since 9/11, however, other countries have learned how to attract the worlds best students, and the United States is just one of several destinations the bright can choose.
( ) Quality of the science and engineering talent pool is key to competitiveness and growth William B Bonvillian legislative director and chief counsel to Sen. Joseph I. Lieberman Fall 2004 Meeting the
New Challenge to U.S. Economic Competitiveness Issues in Science and Technology. Washington: .Vol. 21 , Iss. 1 pg. 75 , 8 pgs Talent. Growth economist Paul Romer of Stanford University has long argued that talent is essential for growth. His "prospector theory" posits that the number of capable prospectors a nation or region fields corresponds to its level of technological discovery and innovation. Talent must be understood as a dynamic factor in innovation. A nation or region shouldn't try to fit its talent base to what it estimates will be the size of its economy. Instead, its talent base, because of its critical role in innovation, will determine the size the economy. In the simplest terms, the more prospectors there are, the more discoveries and the more growth there will be. Other nations are not standing still. The forty leading developed economies have increased their science and engineering research jobs at twice the rate that the United States has. U.S. universities train an important segment of the science and engineering talent base of the nation's developing country competitors, and those nations are encouraging a larger proportion to return. Their own universities in many cases are also rapidly improving. China graduates over three times as many engineers as does the United States, with engineering degrees accounting for 38.6 percent of all undergraduate degrees in China compared to 4.7 percent in the United States. The United States now ranks seventeenth in the proportion of college age population earning science and engineering degrees, down from third place several decades ago. Talent is now understood globally as a contributor to growth, and a global competition has begun. Yet, despite decades of discussion about the importance of educating more scientists and engineers, the percentage of U.S. students entering these fields is not increasing.
SDI 2007 5 Week
216 GHS Neg
RBD Link Science Key

Science and Tech are key to US competitiveness Audrey T. Leath, Media and Gov @ Am. Inst. Of Phsyics, 7-13-2004, FYI Number 94, AIP Bulletin of Science
Policy News, http://www.aip.org/fyi/2004/094.html Speakers at a June 24 congressional briefing sounded a wake-up call that increasing competition from the rest of the world threatens America's preeminence in innovation. The speakers reported that the U.S. science and innovation system is seen as a model; many countries are investing significant amounts to imitate it, and are making strides in scientific advances, developing scientific talent, and attracting outside business and investment. The briefing was kicked off by Senators Lamar Alexander (R-TN) and Jeff Bingaman (DNM), who have both demonstrated recognition of the role that science and technology play in the nation's competitiveness. Bingaman commented that the U.S. has not been "as focused" on S&T investment in recent years as have many other countries, and Alexander pointed out that federal funding in many areas of the physical sciences and engineering has been flat or declining for years. Council on Competitiveness President Deborah Wince-Smith defined innovation as the ability to keep productivity growing by creating new knowledge and quickly turning it into products. With more nations at the cutting edge of innovation, capital increasingly free to flow around the world, S&T talent and knowledge creation centers available globally, and greater separation of design and production, she stated, the nature of innovation is changing and the U.S. is at an "inflection point." She added that certain aspects of this change are not yet well understood, including the shift from technology-driven markets to a greater "pull" from consumers. Wince-Smith and international trade expert Thomas Howell emphasized that other governments are determined to replicate the U.S.'s formula for success. The U.S. system, Howell said, comprises outstanding research universities; a good industry-government-university working relationship; "Silicon Valley" clusters of venture capital, companies, and universities; successful consortia; the welcoming of foreign talent; and dynamic programs at the state level. Alan Rapoport of NSF cited statistics indicating that other countries, especially many Asian countries, are succeeding in efforts to increase their S&T and innovation capacity. While the U.S. is still the world leader in high-tech industries and has the greatest number of international technology alliances, he said, some Asian nations have nearly doubled their share in global high-tech markets over the past several decades and have almost tripled their share of high-tech exports. The U.S. share of total articles in science and engineering publications has been declining since 1988, while that of many countries is growing, and indicators of bachelors-degree production in the natural sciences and engineering show the U.S. far behind many other nations. In addition, Rapoport said that R&D expenditures of OECD countries (countries in the Organisation for Economic Co-operation and Development) has been rising consistently for years, while, as may speakers noted, the U.S.'s investment in physical sciences and engineering has been flat or in decline. This country is "living off of past efforts," Howell declared. What is needed for the U.S. to stay on top, Wince-Smith suggested, is to restore emphasis on the sciences that drive innovation, develop better metrics for the results of innovation, and transition away from disciplinary "stovepipes" in education and research to a multi-disciplinary, cross-sector model. Policymakers must also recognize the importance of tax and fiscal policies, she said, and deal with the deficit and entitlement spending, high corporate tax rates, and intellectual property and piracy issues. When asked whether business regulations affect the U.S.'s creativity and ability to innovate, Wince-Smith agreed that many regulations and policies could act as "a drag" on innovation, including employee healthcare, environmental regulations, and agricultural subsidies. These are "choices we make as a nation," she stated. She cited the healthcare industry as one area in which efficiency and productivity could be vastly improved.
SDI 2007 5 Week
217 GHS Neg

( ) Boosting US science and tech educational achievement is key to competitiveness Chair Boehlert, Congressperson, 7-21-2005, U.S. Competitiveness, House Hearing,
http://www.house.gov/science/hearings/full05/july%2021/charter.pdf While the supply and demand of future scientists and engineers is notoriously difficult to predict, most experts believe that the transition to a knowledge-based economy will demand an increased quality and quantity of the worlds scientific and technical workforce. As is the case with R&D figures, trends in the distribution of the worlds science and engineering workforce are also unfavorable to long-term U.S. competitiveness. The world is catching up and even surpassing the U.S. in higher education and the production of science and engineering specialists. China now graduates four times as many engineering students as the U.S., and South Korea, which has one-sixth the population of the U.S., graduates nearly the same number of engineers as the U.S. Moreover, most Western European and Asian countries graduate a significantly higher percentage of students in science and engineering. At the graduate level, the statistics are even more pronounced. In 1966, U.S. students accounted for approximately 76 percent of worlds s science and engineering PhDs. In 2000, they accounted for only 36 percent. In contrast, China went from producing almost no science and engineering PhDs in 1975 to granting 13,000 PhDs in 2002, of which an estimated 70 percent were in science and engineering. Meanwhile, the achievement and interest levels of U.S. students in science and engineering are quite low. According to the most recent international assessment, U.S. twelfth graders scored below average and among the lowest of participating nations in math and science general knowledge, and the comparative data of math and science assessment revealed a nearmonopoly by Asia in the top scoring group for students in grades 4 and 8. These students are not on track to study college level science and engineering and, in fact, are unlikely ever to do so. Of the 25 30 percent of entering college freshmen with an interest in a science or engineering field, less than half complete a science or engineering degree in five years. All of this is happening as the U.S. scientific and technical workforce is about to experience a high rate of retirement. One quarter of the current science and engineering workforce is over 50 years old. At the same time, the U.S. Department of Labor projects that new jobs requiring science, engineering and technical training will increase four times higher than the average national job growth rate. Industry Concerns and Reports As a result of the aforementioned trends, U.S. businesses have become increasingly vocal about concerns that the U.S. is in danger of losing its competitive advantage. In an effort to call attention to these concerns, several industry organizations have independently produced reports specifically examining the new competitiveness challenge and recommending possible courses of action to address it. Prominent among these efforts is the National Innovation Initiative (NII), a comprehensive undertaking by industry and university leaders (including those representing IBM, Cisco, and The Johns Hopkins University) to identify the origins of Americas innovation challenges and prepare a call to action for U.S. companies to innovate or abdicate. The December 2004 NII final report, Innovate America: Thriving in a World of Challenge and Change, intends to serve as a roadmap for policymakers, industry leaders, and others working to help America remain competitive in the world economy.
SDI 2007 5 Week
218 GHS Neg

( ) Science and tech lead are key to future competiveness and manufacturing Thomas J. Duesterburg, PhD, Pres and CEO Manufac. Alliance, 12-9-03, FDCH, p ln
These additional costs more than offset the gains made by U.S. manufacturers over the past two decades in unit labor costs relative to our major competitors. (Chart 7 shows that U.S. unit labor costs have declined by about 10 percent over this time relative to competitors, largely thanks to productivity gains.) Such a cost burden is exacerbated by the problem of competing with many East Asian industrial giants (China, Japan, Korea, and Taiwan) which artificially lower the value of their currencies in global markets,14 and must be addressed for the longterm health of U.S. manufacturing. Before turning to ways to address these problems, I would like to focus on another challenge to the competitiveness and job creation potential of
this sector. This concerns the ability to sustain the current advantage of U.S. science, engineering, and technology in global markets which in turn allows us to compete successfully in advanced manufacturing sectors which are the key to the future of the manufacturing sector. Government policy can play an important role in meeting this challenge as well.
According to the independent World Economic Forum, the United States is still the world leader in technology, based both on its commitment to research and its ability to bring innovative products to market. Table 2 gives the most recent rankings of this Swiss-based organization and shows that this lead is the key factor in keeping the United States near the top in global competitiveness rankings. Importantly, this group ranks the United States first in its Technology Index, due especially to its strong innovation performance. The NSF concurs that ". . . the United States continues to lead, or be among the leaders, in all major technology areas . . .,"and rates ". . . the United States as the world's leading producer of high-technology products . . . ."One measure cited by the NSF as a sign of the resurgence of U.S. technology was the increase in the share of U.S. patents granted to U.S. nationals. Since peaking in 1989, the share of patents granted to foreign nationals in the United States has fallen from 48 percent to 44 percent. Additionally, "U.S. inventors led all other foreign inventors [in patenting their products] not only in countries bordering the United States but also in markets such as Germany, Japan, France, Italy, Brazil, Russia, Malaysia, and Thailand." The United States is especially active and leads the world in some bright new areas for growth such as DNArelated patents and patents related to development of the Internet. Nonetheless, despite this position of leadership, there are some signs that the dominant position held by the United States is beginning to slip. We have already mentioned the recent trade deficit in advanced technology products. While this is due in large part to the strong dollar, severe cost pressures on domestic producers and increased competition, some data indicates that our science and technology lead is not as secure as it was a few years ago, and that our
commitment to funding the required research and education is not quite as solid as needed to maintain our competitive edge. In the first place, national funding for R&D and basic science from all sources, especially that related to manufacturing such as the
physical sciences and engineering, has been flat to slightly declining as a proportion of national output. Chart 8 reviews the historical pattern of R&D expenditures as a proportion of GDP. While the United States still leads all industrial nations except Japan in this measure of support for R&D, there seems to be a waning in the willingness or ability to maintain vigorous growth. Chart 9, for instance, chronicles a modest slowdown in the growth rate of R&D during the long boom of the 1990s, which was of course dominated by the technologyintensive fields such as communications and information technology, when compared to the two previous periods of expansion. Most of this decline is attributable to lower federal support in the 1990s. The manufacturing share of R&D, while still above 60 percent of the total, has also declined in the past few decades as a proportion of total industrial R&D, as Chart 10 shows. This may be due in part to the rise of spending on related areas such as research on software and IT systems related to manufacturing, and the growth of research spending by the services sector. The steady decline in cash flow of the manufacturing sector may also explain some of the lack of dynamism in manufacturing R&D. Since 1990, the cash flow of U.S. manufacturers has fallen from 37.2 percent of total corporate cash flow to 25.3 percent in 2001, reflecting the cost pressures and global competition affecting this sector.17 Federal government expenditures for basic science and
R&D, especially those areas directly related to manufacturing, have also failed to keep pace with the overall growth of the economy. Some growth in the past two years in R&D outlays only allowed the real level of support to return to 1987 levels. The most
spectacular example of this long and steady erosion of support is for space research. While no one would want to recreate the circumstances of the 1960s, namely the threat from the Soviet Union, that motivated much of the spending for the Apollo program, the benefits to high tech manufacturing from the space and national defense programs of the times were large and extended into the 1990s at the very least. In 1965, federal R&D (including plant and equipment) for the National Aeronautics and Space Administration (NASA) was three- quarters of one percent of total GDP. Combined with Department of Defense (DOD) expenditures, R&D in 1965 supported by these two agencies was equal to fully 1.7 percent of GDP. By 2002, NASA research was down to .09 percent of GDP and the combined NASA/national defense expenditures totaled only .42 percent of GDP, less than one-quarter the rate of 1965. 18 Federal spending in basic sciences related to manufacturing have also trended downward over the past three decades. In 1976, fully 43 percent of all federal expenditures for research, largely conducted by universities and federal labs, was devoted to engineering and the physical sciences. In 2002, that proportion had fallen to 26.8 percent. At the same time, research in the life sciences grew from 43 percent to 48 percent of the total. Overall, federal support for basic research has increased as a proportion of all federal science spending in recent years. In 2002, about .43 percent of GDP was devoted to all scientific research supported by the federal government. The training of scientists and engineers too has fallen from its levels three decades ago. In the 1960s and 1970s, there was a palpable sense of excitement, adventure, and a clear national purpose associated with scientific and engineering projects such as the Apollo program, development of large commercial aircraft, the early development of robotics and automation equipment, and the nascent industry of computing. This inspired students to enroll in related educational fields, and students were assisted by generous federal programs such as the fellowships awarded by the NSF and under the National Defense Education Act. Chart 11 depicts the slow decline in engineering enrollment in the United States since peaking in the early 1980s. Chart 12 shows slippage in graduate enrollment in advanced U.S. science and engineering programs over the past two decades. Undergraduate degrees awarded in engineering have fallen by almost 20 percent since 1987, those in the physical sciences by about 5 percent, and those in the critical-related area of mathematics by over 20 percent in the same timeframe. On a brighter note, degrees in the biological sciences, a potential source of technological strength and new products in the 21st century, have grown by nearly 70 percent since 1986, as Chart 13 shows.
The overall decline in the education of mathematicians, physical scientists, and engineers is cause for concern because demand for these skills is outpacing the economy-wide growth in demand for all workers, according to the U.S.
Department of Labor. The latest projections (again, these are somewhat dated) are for overall employment to grow by 0.3 percent per year in the first decade of the new millennium, while that for computer- and math- related occupations grows 2.6 percent, architecture and engineering jobs by 0.4 percent, and those in the life, physical, and social sciences by 0.9 percent.19
SDI 2007 5 Week
219 GHS Neg
AT: GHS Doesnt Use U.S. Workers

Thats a lie The plan uses the phrase Global Health Service which is the name for a specific program suggested by their solvency authors. The whole POINT of the program is to encourage US workers to volunteer abroad. Even if the Global Health Service eventually boosts community health capacity, it does so using U.S. workers. The GHS would only use American trained workers David Brown, staff writer, 4-20-2005, Global Health Corps, Washington Post,
http://www.washingtonpost.com/wp-dyn/articles/A2446-2005Apr19.html The GHS hopes to make it easier for American medical workers to work abroad for longer and more useful periods. In a 199-page report, "Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS," the panel proposed an initial Global Health Service Corps of 150 members. They would be government employees who would be sent to one of the 15 target countries in PEPFAR -- 12 nations of sub-Saharan Africa, plus Haiti and Guyana in the Caribbean and Vietnam in Southeast Asia -- and would work there for three years, primarily as advisers and trainers to health ministries and organizations.
SDI 2007 5 Week
220 GHS Neg
RBD Impact
( ) Reverse brain drain sparks a global nuclear war David Heenan, leading expert on globalization, 2007, Wake Up, America, Am. Manag. Assoc.,
http://www.amanet.org/movingahead/editorial.cfm?Ed=151&BNKNAVID=23&display=1 Forget terrorism. Forget weapons of mass destruction. The next global war will be fought over human capital. For years, immigrants provided a constant pipeline of brainpower to the United States. From Albert Einstein to Alfred Hitchcock, a steady stream of energetic and highly skilled newcomers yearning to breathe free propelled Americas ascendancy. Today, the country continues to benefit enormously by being a magnet for inventive and ambitious people who stimulate the economy, create wealth and improve overall living standards. Chinese and Indian immigrants run nearly a quarter of Silicon Valleys high-tech firms. Eight of the 11 Americans who shared Nobel prizes in physics and chemistry in the past three years were born elsewhere. Nearly 40 percent of MIT graduate students are from abroad. More than half of all PhDs working here are foreign-born, as are 45 percent of physicists, computer scientists and mathematicians. One-third of all physics teachers and one-quarter of all women doctors immigrated to this country. However, the United States can no longer live off of its transplanted foreigners. Beginning in the 1990s, a giant sucking sound could be heard as their native countries improved economically and politically. Many of Americas best and brightest began hotfooting it home in search of another promised land. Foreign Techies Are Returning Home in Record Numbers A decade ago, Edward Tian said goodbye to Lubbock, Texas, his pickup truck, horseback riding and seven years of studying brown snakeweed to return to Beijing. He took home a Texas Tech doctorate in ecology and a small Internet software company he co-founded in Dallas. That business, Nasdag-listed AsiaInfo, went on to become Chinas premier systems-integration company, creating as much as 70 percent of Chinas Internet infrastructure. I wanted to do something to change peoples lives in the next five years, not the next 200 years, says the 41-year-old entrepreneur. (On the heels of AsiaInfos success, Tian went on to found telecom giant China Netcom, where he serves as chief executive.) After centuries of importing brainpower, the United States is now a net exporter. In the past few years, nearly 200,000 foreign-born Americansmany of them, like Dr. Tian, highly talented techieshave returned to their motherlands every year. This reverse brain drain, or flight capital, stimulated in part by lucrative government incentives, has spawned flourishing new scientific havens from South Asia to Scandinavia. Given the departure of Tian and many others, it was perhaps inevitable that the land of opportunity would turn its back on newcomers. In the aftermath of the Sept. 11, 2001, terrorist attacks, more and more Americans have sought to pull up the drawbridge. U.S. Citizenship and Immigration Services has issued fewer temporary H1 B work and student visas and applied much stiffer requirements for newcomers. The anti-immigrant sentiment could not have come at a worse time. Survey after survey reveals that the United States faces a massive labor shortage, particularly for knowledge-oriented workers. The same is true for Germany, Japan and the other industrial powers. But while many countries are extending the welcome mat to gifted outsiders, the United States is taking the opposite tack. On its present course, our nation of immigrants could become a nation of emigrants.
SDI 2007 5 Week
221 GHS Neg
***Politics***
SDI 2007 5 Week
222 GHS Neg
Bush Good Link Disease

( ) Congress opposes fighting diseases recent funding cuts prove Desmond Tutu, Archbishop Emeritus, Chair Global AIDS Alliance, 1-15-2007, New Congress Can Save Lives,
Washington Post, http://www.washingtonpost.com/wp-dyn/content/article/2007/01/13/AR2007011300496.html The new Congress, led in the House by Speaker Nancy Pelosi, is about to make its first decision regarding how America's money should be spent - a decision that leaves millions of lives hanging in the balance. Congress's choice to bypass 2007 appropriations legislation and extend fiscal 2006 funding levels into the new year will mean, in effect, cuts of almost $1billion in funding for programs to combat AIDS, tuberculosis and malaria. If not reversed, the lack of funds will force hundreds of thousands of people to forgo prevention, treatment, care and support for the three most deadly infectious diseases in the world. Many of the people most affected by Congress's decision will be my fellow Africans. Around the world, the most poor and marginalized men, women and children will suffer the consequences of flat-lined funding. AIDS, TB and malaria are diseases of poverty; to truly address them, sufficient aid must be reliably and properly channeled in solidarity with the people who will receive it. In bipartisan action last year, Congress approved as much as $4.37 billion for programs to fight AIDS, tuberculosis and malaria in 2007. This increase would have given much-needed hope and opportunity to those at risk of and suffering from these diseases. However, the joint funding resolution (or "continuing resolution") the new Congress is expected to pass would keep spending at 2006 levels, which would mean only $3.43 billion for AIDS, TB and malaria efforts - $940 million less. My heart aches to think of the lives that could be saved with nearly $1 billion - but there is still time for Speaker Pelosi, a longtime leader in the fight against HIV-AIDS, to do something about it. The U.S. government has repeatedly promised to combat HIV-AIDS, tuberculosis and malaria: At the United Nations Millennium Summit in 2000 and as a member of the Group of Eight the United States committed to the goal of universal access for HIV-AIDS prevention and treatment by 2010. However, the funding resolution Congress is considering would shortchange and potentially sabotage every American program to address these diseases, leaving innocent people in its wake.
SDI 2007 5 Week
223 GHS Neg
Bush Good Link Committee Proves

( ) The GHS bill only had 4 sponsors and hasnt even left committee cant be that popular American Society for Microbiology, 7-2-2007, Global Health Corps Act of 2005,
http://www.asm.org/Policy/index.asp?bid=34592 Summary: The Global Health Corps Act of 2005 (S. 850) was introduced by Senator William Frist (R-TN) and proposes the establishment of an Office of the Global Health Corps within the Office of the Secretary at the Department of Health and Human Services (DHHS). The new office would focus on improving the health, welfare and development of communities in foreign countries and regions through the provision of health care personnel, items and related services. The Global Health Corps Office would be responsible for expanding the availability of health personnel and related services to select foreign countries and promoting United States diplomacy in those countries. The Office would be responsible for managing and administering the Global Health Corps personnel, and for coordinating the health services provided by the Corps in foreign countries. The legislation proposes that the Global Health Corps be made up of employees of the Federal Government, Peace Corps volunteers, and volunteers not already employed by either the Federal Government or Peace Corps, in addition to the Corps Office Director and staff, and anyone determined by the Global Health Corps Director deemed appropriate. Note: the bill does not specifically state clinical laboratory personnel in its description of trained health care professionals, practitioners or individuals, however, there is a provision which does allow the Secretary of DHHS to consider other professionals that meet certain educational requirements and who are deemed to be appropriate for the Global Health Corps. Status: S. 850 was introduced on April 19, 2005 and referred to the Senate Committee on Foreign Relations. The bill has 4 co-sponsors. S. 850 Bill Text
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224 GHS Neg
Bush Good Link Key Senators

( ) Brownback and Collins refuse to sponsor a bill similar to the plan Physicians for Human Rights Action Center, July 6, 07, Support the African Health Capacity
Investment Act, http://actnow-phr.org/campaign/cosponsor_durbin_bill, ael Because of their positions on key committees, Senators Sam Brownback (R-KS) and Susan Collins (RME) can ensure that the bill comes to a vote and passes swiftly. Ask Senators Collins and Brownback to: Co-sponsor the African Health Capacity Investment Act of 2007. Work with Senate colleagues to pass the bill quickly and ensure that Congress appropriates at least $150 million for the health workforce this year.
( ) Biden and Brownback dont support the bill Physicians for Human Rights, June 15, 07, G8 Summit: Results and Reactions,
http://www.phrweekofaction.org/?cat=9, ael Students have been playing a crucial role in encouraging the US to act on its promises to address the African health worker crisis. Senators Joseph Biden and Sam Brownback have still not co-sponsored The African Health Capacity Investment Act. Their support is critical to ensure passage of this bill because of their important roles on key committees. Contact them today and ask them for their support, even if they are not your Senator.
SDI 2007 5 Week
225 GHS Neg
Bush Bad Link Plan Popular

( ) Bush has committed PEPFAR to trying to deal with the health worker shortage hed push the plan and garner support Keith Alcorn, 5-31-2007, President Bush Asks for doubling of PEPFAR funds, AIDSMap News,
http://www.aidsmap.com/en/news/D288DC39-382F-483C-AFD2-021460D6D410.asp President George Bush has asked the US Congress to double US support for HV treatment and prevention overseas through the PEPFAR programme to $6 billion a year until 2013, with the aim of providing HIV treatment for 2.5 million people. Launched in 2003, the Presidents Emergency Plan for AIDS Relief is designed to scale up HIV treatment, prevention and care in southern and eastern Africa plus Nigeria, Haiti, Guyana and Vietnam. As of last September the programme was paying for antiretroviral treatment for 822,000 people in the 15 target countries plus 165,000 people in other countries. We believe strongly that to whom much is given, much is required. Much has been given to the United States of America. Therefore, I believe strongly that much is required of us in helping solve this problem, said President Bush yesterday, announcing his request in the White House Rose Garden. This investment has yielded the best possible return: saved lives, he said. The US is the world's largest bilateral donor of financial support for HIV treatment, prevention and care. Religious leaders, who had provided a strong impetus for the Bush administration to launch PEPFAR in 2003, welcomed the increase in funds. It also found support in Congress. The call to double the budget for this vital effort is music to my ears, and I will do all I can to ensure harmonious support for it, said Rep. Tom Lantos (D-California), chairman of the House Foreign Affairs Committee. The increase was also welcomed by Ileana Ros-Lehtinen, the highest ranking Republican member on the committee, indicating bipartisan support for the measure. However the scale of increase was criticised by the activist group Health GAP. $30 billion over five years would actually result in an overall decrease in the percentage of people with HIV on treatment because of U.S. investments. This announcement, while an increase in funding for an historic programme, is not on the scale that is so desperately needed from the U.S, said Paul Davis of Health GAP. Paul Zeitz of the Global AIDS Alliance questioned whether the sums requested represented a doubling, or merely the maintenance of a steady level of funding. For fiscal year 2007 Congress approved $4.5 billion for AIDS, TB and malaria programmes (excepting the new bilateral malaria initiative). For fiscal year 2008 the President requested $5.4 billion, which Congress seems likely to approve. If the next phase of the US global AIDS response simply held to this 2008 level over a five year period it would cost $27 billion, or nearly what the President proposed today. In practice, Congresss vote of $4.5 billion for fiscal year 2007 allocated only $3.2 billion to the PEPFAR programme, with the rest of the money distributed between the Global Fund to Fight AIDS, TB and Malaria, the US Centers for Disease Control, and USAIDs Child Survival and Health Program. He argued that the US appeared to be scaling back its commitment to funding treatment; at present one-third of those in need of treatment receive it because of US funds, but at the current projected rate of growth in PEPFAR funds and numbers on treatment, only 20% of the 12 million people expected to need treatment in 2013 will receive it due to US aid. The US government says that the increase in funding is required in order to continue existing programmes while at the same time expanding those efforts. Global AIDS Coordinator Dr Mark Dybul told the San Francisco Chronicle: "The most common question we get from Africa is What happens next? We won't save as many lives in 2008 unless people know that the commitment beyond that date is moving forward." Money will also be invested in expanding health care worker capacity, and in accompanying information, the US State Department said: PEPFAR will further expand efforts to strengthen health systems, and to leverage programs that address malaria, tuberculosis, child and maternal health, clean water, food and nutrition, education and other needs, evidently a recognition that a vertical approach to HIV programmes will not be sustainable, and that massive investment in health systems will be necessary. "There is a catastrophic shortage of health workers in Africa, and unless PEPFAR commits to spending new money to address this crisis, the U.S. will not be able to meet its treatment and prevention goals - or sustain its progress over the next phase of this program," said Asia Russell of Health GAP. At least $5.5 billion in additional spending by the U.S. is needed to invest in training and retaining health professionals during the next four years of PEPFAR, according to Health GAP.
SDI 2007 5 Week
226 GHS Neg
Bush Bad Link Bipart

( ) Bills on health worker shortage in SSA are bipartisan States News Service, 3-7-2007, Bipartisan Group of Senators, p ln
A bipartisan group of Senators today introduced the African Health Capacity Investment Act of 2007, a comprehensive bill to help sub-Saharan African nations confront the alarming shortage of health workers; thirteen countries on the continent have fewer than 5 physicians per 100,000 people. The United States has 549 physicians per 100,000 people. "Increased funding from governments and private donors to expand health services holds the promise of saving millions of lives in Africa. But, a severe shortage of health workers on the ground represents a tight bottleneck slowing the flow of resources to patients who need them," said Dr. Paul Farmer, medical anthropologist and a founder of Partners In Health. "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."
( ) Solving the health worker shortage in SSA is bipartisan African Business News, 8-4-2006, US Senators introduce African Health Capacity Investment Act,
http://www.mbendi.co.za/a_sndmsg/news_view.asp?I=76842&PG=35 A bipartisan group of Senators has introduced the African Health Capacity Investment Act of 2006, S.3775, a comprehensive bill to help sub-Saharan African nations confront the alarming shortage of health workers; thirteen countries on the continent have fewer than 5 physicians per 100,000 people. The United States has 549 physicians per 100,000 people. Senators Dick Durbin (D-IL), Norm Coleman (R-MN), Russ Feingold (D-WI) and Mike DeWine (R-OH) called the lack of health care workers and capacity in many African nations a "critical obstacle" in the world's fight against HIV/AIDS and a potential outbreak of Avian Flu and in promoting economic development and growth. "With 11 percent of the world's population, 25 percent of the global disease burden and nearly half of the world's deaths from infectious diseases, subSaharan Africa has only 3 percent of the world's health workers." Senator Durbin said. "Personnel shortages are a global problem, but nowhere are these shortages more extreme, the infrastructure more limited and the health challenges graver than in sub-Saharan Africa, the epicenter of the HIV/AIDS pandemic. We will not win the war against AIDS or any other health challenge without finding solutions to this crisis," Durbin said. "I am very proud to join my colleagues in introducing this bill as it is critical for bolstering our efforts to combat HIV/AIDS and other diseases in Africa," said Senator Coleman. "The lack of health care capacity in Africa imposes major constraints on the long term effectiveness of programs fighting HIV/AIDS and other diseases. For this reason, any forward-looking, comprehensive strategy to fight these terrible diseases must include elements that build African health care capacity." "The massive shortage of healthcare workers may be the most critical issue facing health care systems in Africa, contributing to millions of preventable deaths each year," Senator Feingold said. "I am proud of the leadership role the United States has taken in addressing HIV/AIDS, malaria, tuberculosis, and other global health crises. However, the resources we have invested in Africa will ultimately be fruitless unless we establish an infrastructure to ensure their effectiveness in the long-term." "I am proud to join my colleagues in supporting this worthy bill that will help millions of people in Africa get the basic health services they need. A coordinated strategy for healthcare workers would ultimately help combat the HIV/AIDS epidemic by increasing treatment and education about the disease. This, coordinated with infrastructure improvements, will also give much needed doctors and nurses access to more patients," said Senator DeWine. "In addition, these measures will help these developing nations to support economic growth and create jobs for their citizens."
SDI 2007 5 Week
227 GHS Neg

( ) Plan is popular Bipartisan support for similar acts Kate Krauss, Physicians for Human Rights, 3-7-2007, Senator Durbin,
http://physiciansforhumanrights.org/library/news-2007-03-07.html Physicians for Human Rights (PHR) applauds today's Senate introduction of the African Health Capacity Investment Act of 2007, a bipartisan plan introduced by Senator Richard Durbin that would supply $600 million over three years to stem the flood of doctors and nurses out of African countries in the midst of the AIDS pandemic and other huge health issues. The bill's introduction is an important milestone in a nearly three-year effort spearheaded by Physicians for Human Rights and Health GAP to move the world to act on this problem. "The United States has recruited thousands of doctors and nurses out of African countriesthis bill would enable the next generation to treat their patients instead of our patients," said PHR Senior Global Health Policy Analyst and Global Health Workforce Alliance board member Eric A. Friedman, JD. Initial co-sponsors of the bill include Senators Durbin, Coleman, Feingold, Dodd, Kerry, and Bingaman. The bill would provide $150 million in FY 2008, $200 million in FY 2009, and $250 million in FY 2010 to pay for safer working conditions, training and recruitment of health workers (especially in underserved rural areas) and better health systems management. The World Health Organization estimates that sub-Saharan Africa is suffering a shortage of at least 800,000 doctors, nurses, and midwives, and an overall shortfall of nearly 1.5 million health workers of all kinds. Many receive salaries so low that they cannot afford to pay for rent even in their home country, let alone support a family. Some are forced to live in their own examination rooms. In 2004 Physicians for Human Rights and Health GAP started an advocacy campaign to address this problem and have been spurred on by our colleagues in Uganda and Kenya, where PHR supports large activist networks comprised of health professionals. PHR also wrote a seminal report in 2004 on the subject: An Action Plan to Prevent Brain Drain, which was released at that year's Bangkok International AIDS conference. Since then, PHR, Health GAP and their allies have educated the US Office of the Global AIDS Coordinator, the Global Fund, leaders of G8 nations, and the U.S. Congress about the problem. "The US and other donor countries have all recognized the health worker shortage as a major obstacle to better health in the developing world, not only affecting AIDS but also maternal mortality and other pressing health issues. Senator Durbin's bill, however, is the first major US initiative aimed at solving the problem," said Friedman.
SDI 2007 5 Week
228 GHS Neg

( ) Foreign assistance to African public health unites democrats and republicans Star Tribune, February 5, 07, Good bipartisanship on global health issues; Bush, Congress join forces to fight
AIDS in Africa, lexis nexis academic, ael Although President Bush and Congress are at odds over the nation's most pressing international issue the Iraq war - they are collaborating well on an equally important foreign policy issue. At last, the stars of public opinion and political will seem aligned to put more monetary muscle into fighting preventable global health problems. We have long argued that the United States can and should do more to assist global development and health. Investments in those types of nation-building efforts do more to promote international security than military efforts ever will. To that end, the Democratic-led House wisely rescued Bush's fight against AIDS, malaria and tuberculosis, diseases that kill millions in Africa every year. Parts of the president's appropriation for last year got hung up in the unfinished budget business of the 2006 Congress. The new leadership agreed last week to allocate $4.5 billion this year to address the three global pandemics, $500 million more than the president requested. The House approved the aid Wednesday, and the Senate is expected to approve a similar bill this week. In his recent State of the Union address, Bush asked Congress to provide at least $1.2 billion over five years to fight malaria in Africa alone, as part of his overall request to spend $15 billion through the President's Emergency Plan for AIDS Relief (PEPFAR) and the Millennium Challenge Fund. Although concerns remain about some strings attached to getting those funds, the administration is moving in the right direction. Since 2001, developmental and humanitarian aid to Africa has grown from $1.4 billion to $4 billion annually. That Democrats have embraced Bush's global health plans is worth applauding. As Rep. Nita Lowey, the Democratic chair of the foreign aid appropriations subcommittee, said, "We're in a different world now. This is the first time since Sept. 11 that we've had a power split in Washington (combined with) recognition that foreign assistance is critical to stability around the world.''
SDI 2007 5 Week
229 GHS Neg
Plan = Win For Obama

( ) Obama supports boosting African health capacity passing it would be perceived as a win Docs for Barack, May 15, 07, Obama Sign on to the African Health Capacity Investment Act,
http://docsforbarack.blogspot.com/2007/05/obama-sign-on-the-african-health.html, ael Senator Obama's office tells me he has signed on to the African Health Capacity Investment Act. I briefly blogged on this about a month ago, when Sen. Durbin first brought it to committee, and the issues addressed in the bill clearly haven't abated since then, so I'm extremely pleased to see Senator Obama on board. He could give the legislation just the kick-start it needs to make it out of committee and into law.
SDI 2007 5 Week
230 GHS Neg
***Biodefense DA***
SDI 2007 5 Week
231 GHS Neg
Biodefense DA 1NC
( ) Funding and human resources for bio-defense are stretched now the plan would require sending the few experts we have to Africa, devastating our capacity to respond to bioterror or infectious disease Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 Furthermore, while preparing for future biodefense efforts and addressing bioterrorism-related issues, it is essential that policy makers, scientists, and others consider not only which biological weapons terrorists are developing to use against the United States and other countries, but also the underlying ways in which globalization is creating the distress and fury that cause them to do so. The political and social capacity to understand and address these underlying issues is essential. Participants also cautioned that the flow of money to combat bioterrorism could disappear as quickly as it appeared. It is unclear whether funding of the current magnitude can be sustained over the long term, as it must be if it is to make a real difference in controlling either intentionally or naturally introduced infectious diseases. For example, although the recent budgetary changes may allow the establishment of several new staff positions in a single public health office, the positions may last only one or two years, depending on the sustainability of the funds. In light of the issue of long-term sustainability, the need for clear communication is, again, paramount. A participant suggested that one of the basic priorities for action should be educating individuals and groups that are responsible for distributing the funds. It is critical for those in decision-making positions to understand how globalization increases the vulnerability not only of the developing world but also of the United States to infectious disease threats. Otherwise, the United States may find itself in the position of having seen the handwriting on the wall without having done anything about it. For example, the reintroduction of mosquito vectors worldwide and the resurgence of TB both illustrate the consequences of the complacency that results when the numbers of cases of a particular disease decrease and its visible manifestations disappear. When resources, attention, and capability are prematurely redirected, the world suffers long-term consequences. One possibility would be for the public health community to develop a congressional fellowship program similar to that of the American Association for the Advancement of Science. Public health congressional fellows could help draft policy and provide the knowledge base needed by legislators to make informed decisions. Finally, several participants expressed concern that the new biodefense efforts are creating a serious capacity challenge in the United States and worldwide. The existing expertise in the relatively few diseases that are being targeted is limited, and intellectual interests will likely be diverted toward certain diseases, at least temporarily. Management oversight is equally limited, as the United States is faced with the dilemma of massive increases in demand on federal agencies to manage funds at a time when the general administrative and governmental trend is to downsize. This disjunction between supply and demand could potentially devastate the long-term capacity of the federal government to manage the response to intentionally or unintentionally introduced infectious diseases. The problem is compounded by the fact that great sums of money are being directed toward academic centers and other nongovernmental organizations, which could result in a brain drain from the federal sector and leave it at grave risk of managing the funds inappropriately. It is unclear how these problems should be addressed. Despite the challenges and concerns outlined above, workshop participants suggested that if problems related specifically to the development of countermeasures for bioterrorism can be solved, the country will at least have begun to address some of the crucial issues related to the control and prevention of infectious diseases generally, such as access to medicines. It is hoped that over the next year there will be many such positive changes.
SDI 2007 5 Week
232 GHS Neg
Biodefense DA 1NC
( ) Biodefense is key to stop the release of bioweapons that kill millions John D. Steinbruner, Director @ CISSM, and Elisa D. Harris, Senior Research Scholar, Spring 2003,
Controlling Dangerous Pathogens, Issues in Science & Tech., v. 19, Iss.3, p. ebsco More systemic protection is needed to guard against the deliberate or inadvertent creation of advanced disease agents. Remarkable advances are underway in the biological sciences. One can credibly imagine the eradication of a number of known diseases, but also the deliberate or inadvertent creation of new disease agents that are dramatically more dangerous than those that currently exist. Depending on how the same basic knowledge is applied, millions of lives might be enhanced, saved, degraded, or lost. Unfortunately, this ability to alter basic life processes is not matched by a corresponding ability to understand or manage the potentially negative consequences of such research. At the moment, there is very little organized protection against the deliberate diversion of science to malicious purposes. There is even less protection against the problem of inadvertence, of legitimate scientists initiating chains of consequence they cannot visualize and did not intend. Current regulation of advanced biology in the United States is concerned primarily with controlling access to dangerous pathogens. Only very limited efforts have been made thus far to consider the potential implications of proposed research projects before they are undertaken. Instead, attention is increasingly being directed toward security classification and expanded biodefense efforts to deal with concerns about the misuse of science for hostile purposes. Few U.S. officials appear to recognize the global scope of the microbiological research community, and thus the global nature of the threat. We believe that more systematic protection, based on internationally agreed rules, is necessary to prevent destructive applications of the biological sciences, and we have worked with colleagues to develop one possible approach.
SDI 2007 5 Week
233 GHS Neg
Staff/Funding Key To Check Attack

( ) Expert staff and adequate funding are key to bioterror preparedness and countermeasure development companies wont develop biodefense products Peter F. Young, Pres. And CEO AlphaVax, 4-6-2006, Project Bioshield Reauthorization, CQ Congressional
Quarterly, ln Second, strong leadership, coordination, and sufficient funding and flexibility in staffing are essential to success. The public/private partnership required for successful countermeasure development includes numerous government departments and agencies, each playing a key role in the process. The objectives and requirements of the various agencies must be aligned and coordinated with solicitation terms and must be part of the early dialogue. These activities include funding for early and late stage research and development, regulatory support, and contract management. For example, production and delivery of products are inherently affected by regulatory requirements. The expectations of regulators for licensure and emergency use authorization should be coordinated with the contract terms. Ambiguous, additional and unforeseen requirements that arise outside of contract terms magnify companies' financial risk. Strong and clear leadership is required to coordinate the many agencies and objectives. Also, the challenges and complex nature of countermeasure development, coupled with the urgent need to prepare, require that critical staff level positions be adequately funded and staffed. In order to sufficiently expedite the procurement processes, HHS needs sufficient resources. Flexible hiring authorities can also help ensure that key positions are staffed with expertise and understanding of the biopharmaceutical industry and the functioning of both small and large companies. In order for a true public/private partnership to succeed, both sides must be resourced to rapidly address the full array of development issues with experienced judgment to reach effective, expeditious outcomes. Third, the funding for biodefense and pandemic countermeasures must be strong and consistent, and should recognize the shared- risk of a public/private partnership. A comprehensive preparedness strategy is needed that addresses the various threats for which we must prepare, and sufficient funding to achieve their commercialization. Potentially life-saving products are at risk of dying in the gap between the "push" of early stage development and "pull" of commercialization - a gap referred to as the "Valley of Death". Shared risk in advanced development should be incorporated into the funding plans, as it is another important element of a successful public/private partnership, and critical to bridging the "Valley of Death". Biopharmaceutical development is inherently risky, and as noted earlier, costs go up significantly through each development phase. Because of this, companies carefully evaluate investment decisions at each phase. Important products for biodefense and pandemic preparedness may not survive these risk calculations without sufficient government partnering and transparency in interactions with government entities. In non-biodefense/non-pandemic markets, in which there is a "natural" market for products without government participation, venture capitalists, partnering companies, and company equity are vehicles used to fuel the development of these expensive phases based on marketing and risk-assessment forecasts. It is very difficult to attract and justify these vehicles for biodefense and pandemic products in the absence of a predictable and robust market. Even with clear and predictable identification of government needs, the reality is that the overall market for many of these life-saving products that are essential to national security may be relatively small. Because of this, many promising technologies stall in early and mid-stage development, not due to technical failure, but because the market "pull" is not sufficient. Again, it is important to recall that biodefense and pandemic countermeasures must compete for investment dollars that can be directed to other markets. Funding of advanced development to bridge the "Valley of Death" is a key element in a successful and meaningful effort to produce countermeasures essential for our national security.
SDI 2007 5 Week
234 GHS Neg
Yes Biodefense Funding

( ) Funding for biodefense is solid in 2008 Gerald W. Parker, Principal Dep. Assis. Sec. Preparedness and Response @ HHS, 4-18-2007, Effectiveness of
Bioshield, CQ Congressional Testimony, ln The fiscal year (FY) 2008 request for advanced development will help to bridge the gap between NIH research and development programs and Project BioShield, and it is critical to BARDA implementation. It is helpful to review briefly the development and acquisition of public health medical countermeasures, which involve three broad steps. First, in the research phase, early studies are conducted to discover how disease occurs, and to identify candidate products to prevent or treat it. Second, during the advanced development stage candidate products must successfully navigate animal studies, several stages of clinical studies for safety and efficacy, and manufacturing scale-up leading to approval and licensure of a product. Third is acquisition, the stage in which a product is purchased by the federal government through Project BioShield. Traditionally, basic research activities have been supported by research grants, primarily through the NIH. Acquisition is supported by the Special Reserve Fund (SRF) under Project BioShield and traditional SNS procurement mechanisms. It is important to understand that prior to the enactment of the Pandemic and AllHazards Preparedness Act, the SRF payment was conditioned upon delivery of a product to the stockpile. There was no defined mechanism to support advanced development. For small biotechnology companies, this stage of development, an inherently risky endeavor, usually relies on funding from venture capital or stock offerings. Unfortunately, for biodefense medical products this stage has often proved challenging. We are pleased that Congress has recognized the importance of advanced development in the establishment of BARDA. The President's FY 2008 Budget Request includes $189 million for advanced development that is critical to ensuring that Project BioShield is effective in making available appropriate medical countermeasures to protect against the most serious threats. Advanced development funding could help move promising MCM candidate products from research through the rigorous advanced development pipeline, to become eligible for procurement under the Project BioShield SRF.
( ) Funding for biodefense is high in the status quo Tara OToole, Dir. and CEO Center for Biosecurity, 3-29-2007, Bioterrorism Preparedness, CQ Congressional
Testimony, ln Biodefense Rests on Capacity to Mitigate Consequences of Attack The extreme difficulty of detecting or interdicting bioterrorist efforts means that defense against covert bioterror attacks must rest on the nation's ability to diminish the death, suffering, and economic and social disruption that could result from bioattacks. This harsh truth is presumably the insight behind the dramatic increase in biodefense spending that began in 2002-- federal spending on civilian biodefense went from approximately $250 million in FY2002 to nearly $4 billion in FY2003; funding levels overall have remained more or less constant since. These sums are significant when measured against other spending programs in the Department of Health and Human Services, which presides over most "biodefense" initiatives. Four billion dollars per year does not seem like so much money if one compares this amount to sums routinely spent on national security programs in the Department of Defense. The important questions, of course, are: Is the country getting the defense against bioattacks that we need with the programs we have? Could we do better?
SDI 2007 5 Week
235 GHS Neg
Yes Biodefense Funding

( ) Massive anti-bioterror programs in the status quo Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 The threat of increased bioterrorism was made real by the terrorist attacks of September 11, 2001, and the subsequent mailing of letters laden with anthrax spores in October 2001. The challenges faced by international health programs have increased as a result. The current Bush Administration has responded with a 319 percent increase in spending on defense against bioterrorismto $5.9billion for fiscal year 2003. The funds will be used to improve detection and surveillance systems, strengthen medical capabilities, improve planning and coordination, foster research, expand training exercises and communication strategies, and address policies that create bureaucratic barriers to strengthening the U.S. capacity to address bioterrorism. The promised funding will potentially provide many new opportunities to strengthen the U.S. public health capacity to address multiple emerging infectious disease threats, both domestically and worldwide. This unprecedented level of funding offers a rare chance to make a difference in the surveillance and prevention of infectious diseases, although workshop participants expressed several concerns regarding the use and the sustainability of this funding. Pg. 12
( ) US biodefense research program is sufficient to solve Richard A. Falkenrath, Sen. Fellow Foreign Policy @ Brookings, 3-16-2006, Public Health Medical
Preparedness, CQ Congressional Quarterly, p ln Two aspects of the U.S. strategy for acquiring biomedical countermeasures to pathogen threats seem to me to be essentially sound. The first is the multi-billion dollar NIAID biodefense research program. I believe this program is adequately funded, excellently led, has already yielded many important discoveries for reducing the catastrophic disease threat, and will continue to do so in the future. The second is the Department of Health and Human Service's program for procuring proven biomedical countermeasures against known pathogen threats, such as ordinary anthrax and smallpox. This effort has been funded through the $5.6 billion BioShield advance appropriation as well as the annual discretionary budget of the Department of Health and Human Services. Most observers would like to see this HHS procurement program move more swiftly, but in my estimation it is reasonably sized and directionally sound. Nonetheless, I see four general problems in the area of pathogen countermeasure availability
SDI 2007 5 Week
236 GHS Neg
2NC AT: GHS Is Funded From PEPFAR

( ) Our link isnt just about funding our 1NC Knobler evidence says that human expertise on bioterror and infectious disease is incredibly limited in the U.S. The plan would require giving away our best and brightest to Africa ( ) The GHS would require sending elite experts thats the whole point Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270 The Global Health Service Corps could be established as a program of the federal government. This strategic positioning of the program would allow coordination of the Corps mission with the PEPFAR program and U.S. government country teams both abroad and domestically. As the committee envisions the Corps, health professionals, as well as experts in management and technical matters related to health, would be dispatched for extended periods of service to PEPFAR focus countries. The primary purpose of these placements would be to advance the PEPFAR goals by assigning highly qualified personnel to key positions in newly expanding national programs of HIV/AIDS prevention and treatment. The Corps specialized professionals would be deployed on a full-time basis for a minimum of 2 years to provide technical assistance for scale-up of these programs. Given the heterogeneous needs of the 15 PEPFAR focus countries, the Corps should encompass a similarly diverse range of expertise, from clinicians and clinician trainers to experts in such nonclinical areas as information technology, health systems management, and laboratory and pharmaceutical management. Deployed U.S. professionals would be expected to work side-by-side with their host country counterparts to maximize the transfer of their skills and to help to develop the next generation of local health leadership. Priority would be given to positions and roles with the greatest potential to have a multiplier effect in promoting indigenous skills and capacity.
SDI 2007 5 Week
237 GHS Neg
2NC AT: GHS Is Funded From PEPFAR

( ) The GHS is designed to send the best experts available Fitzhugh Mulan, Prevention and Community Health Prof @ GWU, 2005, Board of Global Health, Healers
Abroad, ed. Mulan, http://books.nap.edu/openbook.php?record_id=11270
This chapter describes six independent programs proposed for the Global Health Service (GHS). Each program would make a unique contribution to the mission of the GHS as discussed in Chapter 4; that is, to be flexible and responsive to target countries needs for human resources for health to combat HIV/AIDS; to provide expertise in the form of caregivers, technical advisers, trainers, and mentors; and to sustain enduring relationships after U.S. health professionals work with colleagues on the ground. Taken together, the committee believes this set of programs can significantly augment human resource capacity in seeking to acheive the PEPFAR goals (see Chapter 1). The six programs are as follows: * Global Health Service Corps * Health Workforce Needs Assessment * Fellowship Program * Loan Repayment Program * Twinning Program * Clearinghouse In brief, the committee envisions the Global Health Service Corps as the elite, anchor resource of the GHS, playing a far-reaching role in increasing the effectiveness of current in-country health personnel and expanding the future pool of resident health care assets. Corps members would serve for a minimum of 2 years overseas. The Fellowship and Loan Repayment Programs would provide incentives and reduce barriers to participation by qualified and motivated professionals serving for 1 and 2 years, respectively, overseas. The Twinning Program would mobilize health professionals for short- and long-term deployments keyed to specific needs of host countries and/or organizations. In addition, the committee proposes that gaps in human resources for health be evaluated for each PEPFAR focus country through formal needs assessments that could double as a baseline for follow-up evaluation of workforce capacity and distribution. Once these needs assessments had been carried out, uniform data for all countries could be compiled in a central electronic clearinghouse to enable the recruitment of other skilled health professionals. This virtual clearinghouse would thereby utilize information posting and global networking to further support the work of many other organizations and professionals contributing to the fight against global HIV/AIDS. The committee believes that all six programs proposed for the GHS would be helpful in meeting the prevention, treatment, and care goals of PEPFAR. At the same time, some countries might choose to avail themselves of one resource more than another based on their individual needs. The remainder of this chapter is divided into six sections, each describing one of the six proposed GHS programs (for a summary, see Table 5-1). Each section presents in turn background information (often echoing themes and evidence presented earlier in this report), the committees recommendation for that program, a fuller description of the program, and the rationale and evidence behind the committees recommendation. In some cases, there is also a discussion of deployment, public versus private placement of the program, and program costs. GLOBAL HEALTH SERVICE CORPS If the PEPFAR goals are to be achieved, HIV/AIDS prevention and treatment programs will likely need cadres of health personnel far larger than those currently available in most PEPFAR focus countries (USAID, 2003; USAID Guyana, 2003; WHO, 2003). In addition, the rapid scale-up of antiretroviral therapy (ART) will require expertise and knowledge in a variety of medical and nonmedical areas often unavailable in resource-constrained settings. Indeed, as discussed earlier, there is broad recognition that the limited stock of health workers in many of the PEPFAR focus countries alone could spell failure for the scale-up effort (Kober and Van Damme, 2004). Factors contributing to profound shortages of health workers in these countries are limited baseline educational capacity; the active emigration of many newly trained health personnel; low pay and morale, poor working conditions, and inadequate management, encouraging the departure of health workers; movement of other workers to the private sector; and HIV/AIDS-related attrition of existing staff (WHO, 2004). Additional problems at the health services delivery level include not only shortages and poor distribution of doctors and nurses, but also weak program management, poor technical support, inadequate supplies of drugs, and lack of equipment and infrastructure (HLF, 2004; WHO, 2004). In sum, inadequacies of both health care delivery and infrastructure pose extraordinary challenges to building a sustainable workforce. To address the critical need in all PEPFAR focus countries for key specialized health, management, and technical professionals, the committee proposes the establishment of a Global Health Service Corps. This cadre of specialists would be available to assist with and support the implementation of national strategic HIV/AIDS programs. Its members would work in such areas as medical and nursing education, information technology for health systems, health systems design and management, and laboratory and pharmaceutical management. The common purpose of the Corps would be to enhance the effectiveness of current health personnel and support efforts to expand the health workforce of the future. Thus, the Corps would play a key role in the GHSs overall contribution to the successful realization of PEPFAR goals.
SDI 2007 5 Week
238 GHS Neg
***Domestic Wages DA***
SDI 2007 5 Week
239 GHS Neg
Domestic Wage Link

( ) Boosting public employment crowds out private employment, raising wages Celine Choulet, Economics @ Sorbonne, 2004, Public jobs creation and Unemployment dynamics,
http://eurequa.univ-paris1.fr/membres/choulet/public3.pdf The idea that government intervention acts as a stimulus for economic activity in the short run is popular in traditional Keynesian analysis whereas in the long run, public spending is viewed as an inefficient policy. In this regard, the question of the dynamic effects of public jobs creation on labor market performance is relevant. In the short run, public jobs offset the scarcity of private jobs and reduce unemployment. By offering public infrastructures, the government can exert a positive externality on the productivity of the private sector, increasing labor demand in that sector. However, public jobs creation is also expected to crowd-out private employment, as it increases labor taxes, produces substitutable goods for private ones and exerts wage pressure. This crowding-out effect can be more than complete, leading to an increase in unemployment. Thus, in the long run, public job creation can have no significant effect. In this paper, we propose to study its dynamic effects on unemployment.
( ) Causing worker shortages raises wages Donald M. Atwater, PhD, and Aisha Jones, Graziado Business Report, 2007, Preparing for a future labor
shortage, http://gbr.pepperdine.edu/042/laborshortage.html The consequences of such a skilled worker shortage at the national level would be substantial. Results would include: reduction of the growth in the standard of living, compared to historical trends; higher wage-push inflation; potential decreases in international competitiveness, and even the erosion of future domestic production capacity.
SDI 2007 5 Week
240 GHS Neg
Domestic Wage Link Booster

( ) Threshold for the link is low perception of wage inflation sparks further inflation and rate hikes Joe Richter, Bloomberg, 7-18-2007, U.S. Consumer Prices Rose 0.2% in June,
http://www.bloomberg.com/apps/news?pid=20601087&sid=ayMdjV4tRd_s&refer=home Even with the improved inflation outlook, the Fed's Yellen said ``robust'' employment gains raise the risk that inflation won't decline as expected. Southwest Airlines Co. this month led the seven largest U.S. carriers in boosting round-trip fares as much as $20. In addition of the inflation figures, Fed policy makers are focused on how consumers perceive inflation will unfold, fearing heightened expectations will foster demands for wage increases that will fuel even faster price increases. On that score, a report last week may have raised some concern. Consumers projected this month that inflation will rise 3.1 percent on average over the next five years, up from 2.9 percent in June, according to a survey by Reuters/University of Michigan
SDI 2007 5 Week
241 GHS Neg
Wage Inflation Rate Hikes

( ) Wage inflation causes rate hikes Scott Lanman, Bloomberg, 2-14-2007, Bernanke says Inflation Slowing,
http://www.bloomberg.com/apps/news?pid=20601087&sid=avsqzz0QUdAk&refer=home ``The core inflation rate remains somewhat elevated,'' Bernanke said. ``If activity expands over the next year or so at the moderate pace anticipated by the FOMC, pressures in both labor and product markets should ease modestly.'' The ``low'' unemployment rate, in Bernanke's words, has been keeping the inflation alert flashing for Fed policy makers, who fear that faster wage growth could push up inflation. The FOMC predicted today that the U.S. jobless rate will average 4.5 percent to 4.75 percent in the fourth quarter of 2007, compared with 4.6 percent last month. The committee's February 2006 forecast for an unemployment rate ranging from 4.75 percent to 5 percent turned out to be higher than the end result of 4.5 percent in last year's fourth quarter. In the statement after the FOMC's most recent meeting on Jan. 31, the Fed said that recent data suggest ``somewhat firmer economic growth,'' while the housing market is showing ``some tentative signs of stabilization.''
SDI 2007 5 Week
242 GHS Neg
GHS Uses Government Employees

( ) The GHS would be government employees, boosting public employment David Brown, staff writer, 4-20-2005, Global Health Corps, Washington Post,
http://www.washingtonpost.com/wp-dyn/articles/A2446-2005Apr19.html The GHS hopes to make it easier for American medical workers to work abroad for longer and more useful periods. In a 199-page report, "Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS," the panel proposed an initial Global Health Service Corps of 150 members. They would be government employees who would be sent to one of the 15 target countries in PEPFAR -- 12 nations of sub-Saharan Africa, plus Haiti and Guyana in the Caribbean and Vietnam in Southeast Asia -- and would work there for three years, primarily as advisers and trainers to health ministries and organizations.
SDI 2007 5 Week
243 GHS Neg
***AT: Add-Ons***
SDI 2007 5 Week
244 GHS Neg
AT: Lashout Add-On

( ) CP solves, and all our case defense still applies its just an impact to AIDS ( ) Wrong direction governments think terrorist attacks are natural outbreaks Jessica Stern, Public Policy Lecturer @ Harvard, 2003, Dreaded Risks and the Control of Biological Weapons,
International Security, 27.3, p. muse On the rare occasions when biological weapons were used or accidentally released, scientists and government officials often first assumed that the epidemics were natural outbreaks. For instance, when 751 people in Oregon became infected with salmonella in 1984, public health authorities suspected a natural outbreak, not bioterrorism. A year later, an unrelated law-enforcement investigation revealed that the Rajneeshee cult had deliberately spread pathogens causing the disease. 43 And when Robert Stevens, an avid outdoorsman and a photo editor for the supermarket tabloid The Sun, was found to have contracted anthrax, Florida State health officials initially attributed the source of the disease to a naturally occurring strain of the bacteria found in some soils. 44
( ) Theres no internal link to the impact their link assumes bioterrorism, but the impact is about a nuclear attack on Washington
SDI 2007 5 Week
245 GHS Neg
AT: Domestic Health Add-On

( ) CP solves this the internal link is just giving U.S. workers experiences abroad no reason the GHS is uniquely key ( ) Plan doesnt solve the whole impact its not like they solve all AIDS in the U.S. or magically invent a cure just because 150 people come back from Africa ( ) Massive alt-causes to the U.S. health system the aff doesnt overcome Stephen H. Gorin, Health and Social Work, 2-1-2002, The crisis of public health,
http://goliath.ecnext.com/coms2/gi_0199-1534575/The-crisis-of-public-health.html The February 2001 National Health Line addressed the growing crisis in the nation's public health system (Gorin, 2001). As the article noted, concerns about the state of public health are not new. In 1988 the Institute of Medicine stated that our public health system was in disarray (cited in Gorin). Six years later, a group of experts noted that budget restrictions had limited severely the ability of public health departments to respond to infectious disease (cited in Ryan, 1997). More recently, the Institute for the Future (2000) stated that during the past 30 years the public health system has operated under pressure of resource scarcity; limits in leadership, and organizational fragmentation (pp. 8--9). Similarly, in a massive study of the public health system, Laurie Garrett (2000), a Pulitzer Prizewinning journalist, described the U.S. system as being in shambles.
SDI 2007 5 Week
246 GHS Neg
AT: Free Trade Add-On

( ) CP solves, and all our case defense still applies its just an impact to AIDS ( ) Their impact makes no sense developing countries in SSA dont have nuclear weapons, which means even if we have trade disputes with them, they dont escalate ( ) No internal link their impact assumes a complete breakdown of trade relations that escalates to a shooting war they have no scenario for that happening just because AIDS causes us to trade less with SSA ( ) Free trade doesnt deter warmost conclusive studies Katherine Barbieri, Department of Political Science, University of North Texas, February 1996, Journal of Peace
Research, p. 42-43 This study provides little empirical support for the liberal proposition that trade provides a path to interstate peace. Even after controlling for the influence of contiguity, joint democracy, alliance ties, and relative capabilities, the evidence suggests that in most instances trade fails to deter conflict. Instead, extensive economic interdependence increases the likelihood that dyads engage in militarized dispute; however, it appears to have little influence on the incidence of war. The greatest hope for peace appears to arise from symmetrical trading relationships. However, the dampening effect of symmetry is offset by the expansion of interstate linkages. That is, extensive economic linkages, be they symmetrical or asymmetrical, appear to
pose the greatest hindrance to peace through trade. Although this article focuses exclusively on the pre-WWII period, elsewhere I provide evidence that the relationships revealed here are also observed in the postWWII period and more extended period, 18701985 (Barbieri, 1995). Why do the findings differ from those presented in related studies of the tradeconflict relationship, which reveal an inverse relationship between trade and conflict? Several explanations, other than the temporal domain, can be offered. First, researchers differ in the phenomena they seek to explain, with many studies incorporating both conflictual and cooperative interstate behavior (e.g., Gasiorowski, 1986a, b; Gasiorowski & Polachek, 1982; Polachek, 1980, 1992; Polachek & McDonald, 1992). Studies that focus exclusively on extreme forms of conflict behavior, including disputes and wars, differ in their spatial and temporal domains, their level of analysis, and their measurement of central constructs. Preliminary tests reveal that the composition of dyads in a given sample may have a more dramatic impact on the empirical findings than variations in measurement. For example, the decision to focus exclusively on politically relevant dyads may be one source of difference (Oneal et al., 19%). Perhaps the primary component missing from this and related research is the inclusion of a more adequate assessment of the costs and benefits derived from interdependence. I have repeatedly argued that the conflictual or pacific elements of interdependence are directly related to perceptions about trades costs and benefits. Yet, a more comprehensive evaluation of these costs and benefits is needed to see whether a link truly exists between the benefits enjoyed in a given trading relationship and the inhibition of conflict in that relationship, or conversely, the presence of net costs for at least one trading partner and the presence of conflict in that relationship. For example, are trading relationships that contain two partners believed to benefit from trade less conflict-prone than those containing at least one partner perceived to be worse off from trade? I have merely outlined the types of relationships believed to confer the greatest benefits, but such benefits and costs require a more rigorous investigation.
SDI 2007 5 Week
247 GHS Neg
***Misc***
SDI 2007 5 Week
248 GHS Neg
War Destroys Health Capacity

( ) War destroys health capacity Jordan S. Kassalow, lecturer @ Columbia Med, 4-19-2001, Why health is important to U.S. foreign policy,
CFR, http://www.cfr.org/publication/8315/why_health_is_important_to_us_foreign_policy.html A fourth way in which health affects the international system is through the direct links between health and war. The link from war to health is clearer: wars kill and injure soldiers and civilians, but they also destroy infrastructure and social structures, in both cases with adverse effects on the population's general health. In the eastern Democratic Republic of Congo, for example, war and ill health are tightly entwined. Of 1.7 million excess deaths between August 1998 and May 2000, only 200,000 were attributable to acts of violence, and wherever the war worsened, infectious disease and malnutrition followed (International Rescue Committee 2000). Medical facilities are often singled out for attack in "new wars" because they provide valuable loot, easy victims, and a way to demoralize civilian populations. War also causes exceptional mobility, and armies, peacekeepers, and refugees act as vectors for the transmission of disease.
( ) War devastates health infrastructure, turning the case Stacey Knobler, Former Director of the Institute of Medicines Forum on Microbial Threats, et. al., 2006, The
Impact of Globalization on Infectious Disease, National Acadamies, http://www.nap.edu/catalog.php?record_id=11588 Communal conflicts are characterized by the massive dislocation of populations and extensive destruction of infrastructure. An estimated 50 million people worldwide are forcibly displaced from their homes each year; this displaced population includes migrants who move regularly to find work and refugees who flee to a foreign country to escape danger. The United States alone receives an average of 90,000 refugees annually. Refugee populations are among the most vulnerable to emerging infectious diseases, even more so than migrants (see Chapter 1). For example, on the basis of preliminary data from a 2000 International Organization for Migration assessment of the health of more than 76,000 mobile people (44.7 percent migrants, 55.3 percent refugees), refugees are more likely than migrants to be HIV-positive (representing 65 percent of HIV-positive individuals in the database) (Grondin, 2002). The breakdown of public health systems and the public sector generally in areas that are experiencing war or receiving migrants can be profound. In many war-torn areas, public health systems are so severely affected that they do not have the capacity to provide adequate services. The rates of death and disease in Afghanistan, for example, are among the highest in the world. The maternal mortality rate in Afghanistan is on the order of 1,700 maternal deaths per 10,000 live birthsclose to what one would expect if there were no health care at all. Fully 25 percent of children in Afghanistan die before the age of five years, and about 20 percent before their first birthday. The country is experiencing a breakdown at all levels of health care, and immunization is almost nonexistent. Although there is little concern about a mass epidemic in Afghanistan since the country is not densely populated, its dire situation illustrates the devastating effects war can have on public health.
SDI 2007 5 Week
249 GHS Neg
Colonialism Links
( ) Western volunteers extend the legacy of colonialism, entrenching cultural hegemony Thomas Roberts, MA Development Studies @ Manchester, 2004, Are Western Volunteers Reproducing and
Reconstructing the Legacy of Colonialism in Ghana, www.gapyearresearch.org/TomMA.pdf Volunteers may not necessarily have the same influence as permanent staff working for major NGDOs but they certainly spend considerable amounts of time living, working and interacting with local people. Furthermore, they often undertake jobs for which they have little if any previous experience, such as teaching, but can wield considerable influence over the people they are working with. Regardless of good intentions and a desire to help less fortunate people, Western volunteers are still heavily influenced by their education and general life experiences, making them excellent transmitters of Western cultural hegemony. Clearly, it is not possible to describe volunteer programmes as job creation for the middle classes, as the participants are unpaid. It may, however, be possible to suggest that many volunteers travel to developing countries and gain valuable skills and experience which potentially increasing their employability and earning power once they return to their home countries. Thus, essentially re- creating the imperial practice of exploiting the colonies for the benefit of the West.
SDI 2007 5 Week
250 GHS Neg
Imperialism Links
( ) Health assistance is paternalistic and hegemonic western agencies and governments decide what is best for african health Collins O. Airhihenbuwa, Professor Biobehavioral Health, Pennsylvania State University, 2006, Healing
Our Differences: the crisis of global health and the politics of identity, p. 5-6 The debate about the potentials and pitfalls on the health and cultural implications of globalization has become even more critical. Discourse on transcultural health and behavior has entered a new phase as the boundaries of identity (individual and collective) and cultural sovereignty are increasingly being questioned and redefined. The new language of this debate necessitates and interrogation of some hitherto exalted notions of globalization that cast a shadow on the voices of scholars and cultural agencies in regions and cultures of the world that are considered to be marginal. By this I refer not only to scholars from nonWestern countries but also to scholars from Western countries who are engaged in the struggle to transform certain dominant but retrogressive languages for health behavior. The pursuit of a common global mission has slowly been translated to mean an expectation of unquestioning cooperation (in the name of partnership) from, for example, African colleagues in addressing what has been determined in the Westernized academies to be issues of health priority. This hegemonic policy of determining African health priorities outside Africa is even more evident in the work of some experienced and productive African researchers whose scholarship serves to promote the health issues and priorities that are determined outside their resource-poor environment. These health priorities and issues are often determined by funding agencies of government and major philanthropic foundations in the West. A resulting Western hegemonic blow received by Africans was to be softened by the United Nations corporate language. Technical cooperation, for example, is considered to be a preferred term to technical assistance (more on this in chapter 3), even though the latter better reflects the relationship between Western ideology and recipient partners. Technical assistance conveys language of paternalism and is thus too revealing of its intent to be acceptable in the discourse on partnership for global health with no serious interests in questions of identity and cultures as determinants of health behavior. The Malin sage/thinker Amadu Hampate Ba once noted that the hand that gives always stays on top. In a partnership that separates a giver from a receiver, the receiver must interrogate his or her voiceless position if his or her cultural identity is to have any role in the meaning of such partnership.
SDI 2007 5 Week
251 GHS Neg
Contact Theory Wrong

( ) Study proves that the contact theory is wrong- diversity only causes isolation and distrust Michael Jonas, acting editor of CommonWealth magazine, published by MassINC, a nonpartisan public-policy think tank in Boston, August 5, 07, The downside of diversity - A Harvard political scientist finds that diversity hurts civic life. What
happens when a liberal scholar unearths an inconvenient truth? lexis nexis academic, ael The results of his new study come from a survey Putnam directed among residents in 41 US communities, including Boston. Residents were sorted into the four principal categories used by the US Census: black, white, Hispanic, and Asian. They were asked how much they trusted their neighbors and those of each racial category, and questioned about a long list of civic attitudes and practices, including their views on local government, their involvement in community projects, and their friendships. What emerged in more diverse communities was a bleak picture of civic desolation, affecting everything from political engagement to the state of social ties. Putnam knew he had provocative findings on his hands. He worried about coming under some of the same liberal attacks that greeted Daniel Patrick Moynihan's landmark 1965 report on the social costs associated with the breakdown of the black family. There is always the risk of being pilloried as the bearer of "an inconvenient truth," says Putnam. After releasing the initial results in 2001, Putnam says he spent time "kicking the tires really hard" to be sure the study had it right. Putnam realized, for instance, that more diverse communities tended to be larger, have greater income ranges, higher crime rates, and more mobility among their residents -- all factors that could depress social capital independent of any impact ethnic diversity might have. "People would say, 'I bet you forgot about X,'" Putnam says of the string of suggestions from colleagues. "There were 20 or 30 X's." But even after statistically taking them all into account, the connection remained strong: Higher diversity meant lower social capital. In his findings, Putnam writes that those in more diverse communities tend to "distrust their neighbors, regardless of the color of their skin, to withdraw even from close friends, to expect the worst from their community and its leaders, to volunteer less, give less to charity and work on community projects less often, to register to vote less, to agitate for social reform more but have less faith that they can actually make a difference, and to huddle unhappily in front of the television." "People living in ethnically diverse settings appear to 'hunker down' -- that is, to pull in like a turtle," Putnam writes. In documenting that hunkering down, Putnam challenged the two dominant schools of thought on ethnic and racial diversity, the "contact" theory and the "conflict" theory. Under the contact theory, more time spent with those of other backgrounds leads to greater understanding and harmony between groups. Under the conflict theory, that proximity produces tension and discord. Putnam's findings reject both theories. In more diverse communities, he says, there were neither great bonds formed across group lines nor heightened ethnic tensions, but a general civic malaise. And in perhaps the most surprising result of all, levels of trust were not only lower between groups in more diverse settings, but even among members of the same group. "Diversity, at least in the short run," he writes, "seems to bring out the turtle in all of us." (Robert Putnam is a Harvard political scientist famous for "Bowling Alone," his 2000 book on declining civic engagement)
SDI 2007 5 Week
252 GHS Neg
Contact Theory Limited

( ) Contact theory is limited in application and assumes a questionable link between attitude and behavior Michael O. Emerson and Rachel Tolbert Kimbro, September 1, 02, Social Science Quarterly, Contact
theory extended: the effects of prior racial contact on current social ties, lexis nexis academic, ael Though contact theory and its empirical tests have illuminated discourse about race, they have nagging limitations. Empirical tests of contact theory have suffered from problems of causality, limited generalizability, and other data limitations, such as studying only white Americans (e.g., Hanssen, 2001; Powers and Ellison, 1995). Just as important as the empirical problems is that contact theory has been limited to explaining changes in attitudes. This is problematic for understanding race and ethnic relations. Contact theory was developed during a time when
racism and racial tension were thought to derive from irrationally held beliefs and attitudes of individuals. Bringing people together, the theory argued, would demonstrate to individuals that their attitudes were irrational and would lead to attitudinal change. Contact theory also operated under the assumption that attitudes and behaviors are causally connected. It was assumed that if attitudes were changed, behavioral changes would follow. This assumed linkage between attitudes and behaviors clearly is questionable (Clark, 1992; Farley and Frey, 1994; Hanssen, 2001; Jackman and Crane, 1986; Jaynes and Williams, 1989; Massey and Gross, 1991; Pettigrew, 1971; Schaefer, 1996; Schuman and Johnson, 1976).
( ) 3 conditions must be met for the contact theory to work Judith Nihill DeRicco and Daniel T. Scicarra, January 1, 05, Journal of Multicultural Counseling and
Development, The immersion experience in multicultural counselor training: confronting covert racism, lexis nexis academic, ael
The value of the immersion experience is based upon the concept of the Contact Hypothesis (Brown, 1995). This hypothesis rests upon the belief that contact between divergent social groups is the best means toward reducing tensions and misunderstandings. Allport's (1954) comprehensive studies of the contact theory of intergroup relations have provided the framework for many interventions designed to reduce racism. Allport's findings were not a patent endorsement of simple contact theory, however. He was quick to point to data derived from the study of Blacks and Whites living in close proximity in Chicago to prove that proximity alone did not eradicate racial bias. In fact, the data presented showed that just the opposite was true, that proximity led to a clearer manifestation of racial prejudice. Rather than dismissing the social contact theory completely, Allport and others identified conditions of contact that must be met in order to bring about the reduction of prejudice. Three of these conditions relevant to the present experience were 1.
Contact must be of sufficient frequency, duration, and closeness to permit the development of meaningful relationships between and among members of the groups concerned. 2. Contact should take place, as much as possible, between and among participants of equal status. 3. Contact should be based on a necessity for cooperation so that all members of the different groups are mutually dependent upon one another for the attainment of a desired outcome. A need for cooperation provides an instrumental reason for the participants to
be motivated to develop better relationships with each other (Allport, 1954; Amir, 1969; Cook, 1962, 1978; Pettigrew, 1971).
( ) Contact theory has numerous requirements and is reverse causal Jeffrey C. Dixon, June 06, MIT Sloan Management, The ties that bind and those that dont: toward reconciling
group threat and contact theories of prejudice, http://socialissues.wiseto.com/Articles/147666262/, ael
Despite their contributions, group threat and contact theories have been criticized. One criticism of both theories is their almost complete focus on black-white race relations, assuming that threat and contact operate similarly across all racial/ethnic groups. Additionally, empirical studies largely test these theories in isolation from one another. Criticisms of research in the group threat tradition include its heavy reliance on measures of racial/ethnic composition as indicators of threat, which neglects economic and political measures that Blalock (1967) assumed were important. This research also uses measures of racial/ethnic composition at broad levels of analysis (Oliver and Mendelberg 2000). Moreover, this research does not measure or only indirectly measures perceptions of threat and the size of minority populations, which assume importance in contemporary variants of group threat theory (Bobo and Hutchings 1996; Glaser 2003). Contact theory is criticized because its numerous conditions of contact may make it unfalsifiable, and it is somewhat ambiguous regarding the quality of contact needed to reduce prejudice. The theory is also potentially
prone to self-selection bias and reverse causality: contact may reduce prejudice, but prejudiced people may avoid contact (Pettigrew 1998).

Global Health Services Neg - SDI 5 Week

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SDI 2007 5 Week

GHS Neg SDI Strategy Forum

***AT: Bioterror Advantage***.......................86

***AT: Disease Advantage***.......................... 22

***Disease CPs*** ...........................................106

***Soft Power CPs*** .....................................117

***Brain Drain Turn***.................................... 53

***AT: Soft Power Advantage*** ................... 63

***Agent CPs*** ...............................................135

SDI 2007 5 Week

2 GHS Neg African Economy Key Public Health .............................. 203

***Africa CP*** ............................................... 147

***Reverse Brain Drain DA*** .......................204

***AT: US Key***........................................... 154

***Loan Repayment PIC*** ........................... 163

***Tuition DA*** ............................................. 168

***Biodefense DA*** ........................................230

***Domestic Wages DA*** ..............................238

***Spending DA***.......................................... 185

***African Economy DA***............................ 188

SDI 2007 5 Week

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Intel Heidt/Peterson Version

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Intel Heidt/Peterson Version

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Intel Lee/Tallungen Version

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Intel Lee/Tallungen Version

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Intel Lee/Tallungen Version

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***AT: Disease Advantage***

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1NC AT: Disease Advantage

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2NC Ext #1 150 People

SDI 2007 5 Week

AT: Bioterror Advantage.......................86

AT: Disease Advantage.......................... 22

Disease CPs ...........................................106

Soft Power CPs .....................................117

Brain Drain Turn.................................... 53

AT: Soft Power Advantage ................... 63

Agent CPs ...............................................135

Africa CP ............................................... 147

Reverse Brain Drain DA .......................204

AT: US Key........................................... 154

Loan Repayment PIC ........................... 163

Tuition DA ............................................. 168

Biodefense DA ........................................230

Domestic Wages DA ..............................238

Spending DA.......................................... 185

African Economy DA............................ 188

AT: Disease Advantage

Brain Drain Turn

AT: Soft Power Advantage