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In 1961 President Kennedy declared a historic opportunity for industrialized nations to help lessdeveloped nations obtain sustained economic growth and development. The 1961 Foreign Assistance Act (FAA) created the United States Agency for International Development (USAID), and empowered it with a mission of long-range economic and social development assistance and a hope to improve lives of many vulnerable people around the world.

Unfortunately, we have strayed from that vision of 48 years ago. USAID has been under-funded and over-taxed. It now has only 2200 employees down from 4700 at its height, only 5 engineers for example, and merely 1 officer in all of Helmand province currently. Additionally, U.S. funding for health is divided across vertical programs. Two-thirds of foreign aid to Rwanda, a country where I have long worked, is dedicated to HIV/AIDS though the country has only 3% HIV/AIDS prevalence and is aching for increased infrastructure and resources for primary care, maternal/child health, or surgery. Much of the funding is also through tied aid; PEPFAR, the U.S.’s main HIV/AIDS fund, permits the purchase of FDAapproved HIV medicines only, the majority of which are patented and thus more expensive. If the U.S. is serious about global health, it must become serious about USAID and its mission established in 1961.

Revitalization of USAID serves as a critical step to changing U.S. outlook and efficacy in global health. The U.S. government must invest in global health as its own entity and in its entirety, where development and health are critically intertwined, and one is prerequisite for the other. Global health must be valued as not just HIV/AIDS, TB, and Malaria but also the core of development, economic growth, climate change and its effects, and for the more hawkish, even national security; we must embrace globalization and the loss of traditional borders that accompanies it. USAID could be configured and reinvigorated to lead on the full breadth of issues pertaining to global health and development. How to do it?

One: Increase and consolidate funding for global health and development, and empower USAID with discretion in its spending. USAID should serve as the umbrella for all health and development projects. PEPFAR or the President’s Malaria Initiative, for example, should be under the agency. Much of these funds could be integrated into reinforcing primary care infrastructure, a prerequisite for adequate HIV/AIDS prevention and treatment, or malaria prevention programs.

Two: Increase the workforce. USAID needs the authority and support to augment the number of personnel able to go abroad, build capacity, and advise local governments, projects and collaborations overseas. Currently, the US is forced to pay markedly higher amounts for private contractors to complete work previously done by USAID itself. Additionally, USAID could create a service corps through scholarship; students and graduates of medical, nursing, engineering, law, business, architecture schools would receive loan forgiveness in exchange for service to USAID.

Three: Change USAID’s national and international prominence. The Administrator of USAID needs a cabinet level position to prioritize global health and development in the U.S. agenda. Currently, the tenets of U.S. foreign policy are “defense, diplomacy and development.” We have Departments of Defense and State, but we need a true, effective Department of Development into which with some restructuring, USAID, could and should emerge. Development is the underpinning of much of our defense and diplomacy. Population health permits economic growth, which in turn is critical to stability. In today’s world, immigration, commerce, and technology are merging cultures and with it the basic needs and demands of each. Pressures in Pakistan are very much pressures on the United States.

Four: Redefine the mission. USAID could become a leader on issues of not only health and development, but of global climate change, of trade, or of food security – issues deeply related to global health and well-being. Consider global climate change. Current predictions estimate melting of the Himalayan Glacier by 2035; the glacier serves a water source for China, India, Pakistan, Bangladesh and a multitude of other countries. Its loss will impact agriculture, livestock, nutrition, and sanitation of an entire vast region. Or consider trade issues, where global patent laws affect access to affordable medicines for many developing countries.

We have incredible opportunity in this country, but with it comes responsibility. Even in the age of Blackberries, there are 2.7 million people living on less than $2 per day. Health cannot exist without development, eradication of poverty, education, infrastructure, good government or a safe environment. The United States could meaningfully change not only the outcomes needed in the world, but the rate at which we achieve those outcomes. To do so will require a major paradigm shift about how the US views global health and development. A potent, relevant, and empowered USAID could become an incredible global example, and a backbone of health, development, and diplomacy.