About four years ago, USAID started a program called Lessons Without Borders. It began during a conversation about the cost of health care in the United States, when an official from the Center for Disease Control commented, “If we could get oral rehydration salts used here in the U.S., we could save a half-billion dollars a year, because it’s very expensive to rehydrate people by putting them into hospitals.” It was evident that the use of these salts would be as appropriate in the United States as it is in the many places around the world where USAID has introduced this practice. From that observation came a discussion of other practices and strategies being used to help communities around the world that would also be applicable here. We have had follow-up discussions in a number of U.S. cities including Seattle, Washington, Baltimore, and Boston.
It should not surprise you that a number of practical lessons have emerged from our work with communities abroad that are relevant to our problems at home. For example, immunization coverage rates are not particularly high in the United States, nor is our infant mortality rate exemplary. The mayor of Baltimore recently sent a team to Kenya to look at how Kenyans were handling immunization coverage. As a result, over the last four years immunization coverage in Baltimore has gone from around 60 percent to above 90 percent, one of the highest in the nation. Baltimore’s mayor also sent a team to Bangladesh to learn how community health workers could disseminate practical information throughout a community. Other teams that have gone out to look at how gang violence is handled in the Caribbean, and how environmental health information is provided to some literate populations. I hasten to say that this is not being done with U.S. development assistance dollars. The cities are using their own municipal funds to go out and capture these lessons.
The problems are local, but the solutions often are global. The earlier successes of the Lessons Without Borders program are being replicated; now there is interest in expanding into new areas such as literacy training, microenterprise, and microlending programs in the inner cities. This program is shining a positive light on U.S. foreign assistance programs, improving their image in the eyes of many Americans.
For the most part, the American people do not think highly of U.S. foreign assistance. They also believe that it represents between 20 and 40 percent of the U.S. national budget, whereas in reality we spend less than 0.5 percent of our overall budget on foreign aid. In one poll of American opinion, people were asked, “What do you think of foreign assistance?” The response was right down there with tax collection. But when asked, “What do you think about having some of your tax dollars go to assist women’s literacy or children’s immunization programs or to reduce deforestation?” the respondents ranked these programs very high. There is a basis for stronger public support for these types of programs, but we need to deal with the gap between how people perceive foreign assistance in the abstract and how they feel about helping people around the globe to deal with concrete problems.