We must go further than Biden’s American Families Plan to address critical global infrastructure

President Biden’s recently-announced American Families Plan invests in expanded access to home care, improved wages and working conditions for those working in long-term care, and universal preschool. Biden and his team are calling (uncharacteristically for an American president) for us to see our cultural ethos of “self-reliance” as closer to myth than reality, and instead recognize that access to a certain degree of care and support is not a luxury but a necessity.  

The president and his allies are spot on from both economic and ethical perspectives. Investing in care and caregivers across policy domains makes good financial sense, as many other countries have already acknowledged. Accessible resources for families drive the economy, politics and technological and social innovation forward. Additionally, seeing care as an essential and also a public good helps uphold ideals such as equity and reciprocity for caregivers. But Biden could and should be bolder still.  

Global solutions are necessary for global problems, and the COVID-19 pandemic has underscored the interconnectivity of health and the global impact that government missteps can have. In addition to seeing care as critical domestic infrastructure and investing across policy sectors from education to health care to labor, the Biden administration should put care at the center of its foreign policy, evaluating a range of policies including those relating to immigration and intellectual property (IP). 

Our health and long-term care systems rely upon workers who are educated in other nations, including many low- or middle-income countries. In the United States, over a quarter of physicians and 15 percent of nurses are foreign-born. While this arrangement benefits the U.S. and other high-income countries with financial pull, it erodes the capacity of health systems abroad over time and can deepen global health disparities. In times of crisis, so-called source countries can be crushed when their health care systems see surges in patients. This is playing out now in India, which has been the world’s largest source for immigrant physicians for decades and is now struggling to cope with its own health crisis.  

As we draw health workers from countries in need of care, there are approximately 165,000 immigrants with health and health-related degrees from other countries living in the U.S. that are un- or under-employed. This is due to a range of barriers to obtaining required credentials and licensing. The pandemic has led to reforms in five U.S. states, but still a vast amount of knowledge and expertise go un- or under-utilized. Immigration and licensing reform would go a long way toward addressing health and care worker shortages and shoring up gaps in service delivery in underserved areas.

Another topic for the Biden administration to address is the IP protection rules that protect the profits of pharmaceutical companies and leave millions without access to life-saving medicines. This prioritization of profits over people puts health care workers in low-income countries in continued peril, threatens to push fragile health systems over the brink and places an unimaginable and often invisible burden of care on families. President Biden previously indicated that he would adjust IP laws and should follow through on that pledge.

To critics who say it is too costly or that care is not the responsibility of government: The UN High Level Commission on Health Employment and Economic Growth has concluded that investments in education and job creation in the health and social sectors result in a triple return of improved health outcomes, global health security and inclusive economic growth. There is now a decades-long body of economic research demonstrating without a doubt that these labors of love and care are what really generate productivity and innovation, not to mention sustain us day in and day out. 

Additionally, where people are unable to care for their loved ones, there is strife and instability. Fragile health systems and networks of care abroad threaten global economic stability and even national security. Smart foreign policy demands concern for strong and sustainable health systems around the world and investment in human health and resources.  

To see care as being at the heart of our global concerns and our national interests should lead us, urgently, to address the international policy that hoards care resources among select, already-advantaged groups. The American Families Plan is an excellent step towards establishing the right to care domestically, but more must be done. Global economic and trade policy is care policy; and currently, it is crafted in a way that threatens global health and justice, economic stability and potentially national security.

Lisa Eckenwiler, Ph.D., is professor of philosophy at George Mason University, vice president of the International Association of Bioethics and a member of the Independent Resource Group for Global Health Justice.