Medical Diplomacy: a Ship of State Adrift

Medical diplomacy is the government-sponsored promotion of health and wellness in other countries with the aim of building relationships that will help the donor country get its way in world politics, or, less cynically, is a reflection of the core value of the citizens of the donor country for helping others.  Wealthy countries are able to practice this type of diplomacy better than less wealthy (with Cuba as a notable exception, see below) and the countries of the “global north” spend from $200 million (Denmark) to almost $6 billion (US) per year to improve health in the global south (Institute for Health Metrics and Evaluation 2009).  A wide range of groups and individuals in the US have advocated for a greater emphasis and role for US global health aid in foreign relations.  For example, an expert committee of the National Academies of Science, Institute of Medicine, in their “Recommendations to the New Administration,” called on the President to  “highlight health as a pillar of U.S. foreign policy” and establish an interagency committee to coordinate the effort, and stated that “long-term diplomatic, economic, and security benefits for the United States will follow” (IOM 2009).  In 2008, a DOD analyst, Donald Thompson, pointed out the critical role of medical diplomacy can have in the nation-building efforts in Afghanistan (Thompson 2008).  One of the earliest politicians to emphasize medical diplomacy is former Health and Human Services Secretary, Tommy Thompson, who in an 2004 article called for closer integration of US health and foreign policies (Thompson 2004) (and claimed to have invented the term [Big Think]).

While the current administration has made a major commitment of material aid to addressing the big three of global health infectious diseases (HIV/AIDS, TB, and malaria) through its Global Health Initiative (GHI) and the implementing programs are directed through the USAID within the State Department and, according Kerri-Ann Jones, Assistant Secretary, Bureau of Oceans and International Environmental and Scientific Affairs, “The GHI is under development with the State Department leading an active interagency process” (Remarks Nov 2009), there does not seem to be a senior official nor an office for global health diplomacy.  The 2009 Kaiser Family Foundation report on the US government global health “architecture” notes:  “Despite the growing engagement of the U.S. government in global health, there is currently no formal, authoritative, coordinating mechanism for the U.S. response” (KFF 2009).

Searching the State Department’s website for “global health” brings up a business-oriented effort call the “Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria” which is one of several programs of the Global Partnership Initiative (GPI).  According to remarks made to this group last month by the Special Representative for Global Partnerships, Elizabeth Frawley Bagley, who seems to have limited experience in global health (Bagley Bio), the aim of this program is to convene, catalyze, collaborate, and change for “Advocacy. Partnerships. Action. Results.” (Remarks Mar 2010).  The specific resources to be applied and expected results are yet to be determined, I guess.  In contrast, in another part of the State Department, a portion of our tax dollars supports an extensive information-gathering and analysis effort that does make specific recommendations.  In 2008 at the request of the Undersecretary of State for Democratization and Global Affairs, the National Intelligence Council published “Strategic Implications of Global Health,” a comprehensive assessment of the connection between global health and national interests which also describes county-by-country “potential opportunities” for the US to pursue that will result in improved health and better relationships (NCI 2008).  I hope the Undersecretary passes it along to Ms. Bagley.

In contrast to the diffuse and possibly undirected US State Department approach, the approach to medical diplomacy taken by the Cuban government, one of the longest-lived totalitarian regimes, has been focused and well-supported since the early 1960s.  According to an on-line article by researcher at the Council on Hemispheric Affairs, a “nonprofit, tax-exempt independent research and information organization,” the Cuban effort now has 35,000 personnel in medical missions in 68 countries providing service and training and hosts 10,000 scholarship students from developing countries in Cuban medical schools (COHA article).  The Cuban government has also consistently sent or offered medical assistance for disaster relief wherever in the world it has been needed, including to the US post-hurricane Gulf coast (it was declined).  As was reported recently by the Cuban government, 250 medical workers joined the 350 already in post-earthquake Haiti, and by February they had treated more than 60,000 people (Global Post article).

If the State Department looks for guidance internally for its nascent medical diplomacy effort, it could turn to the Office of Weapons Removal and Abatement within its Bureau of Political-Military Affairs (WRA).  This Office, in addition to sponsoring a number of ordnance removal and education programs, also sponsors NGOs that provide treatment and rehabilitation to persons injured by unexploded ordnance and small arms (Partnerships program).  One of the more than 50 organizations is the Prosthetics Outreach Foundation of Seattle, Washington (POF).  The POF emphasizes building the self–sufficiency of countries to care for the injured by setting up manufacture of prosthetic components with locally available materials and training of local practitioners in the fabrication and fitting of prostheses.  Clearly the scale of the treating of landmine victims differs vastly from treating those afflicted by the global infectious diseases, but Office has combined expertise, a variety of private groups, modest funding, and in-country programs to address a challenging public health threat, apparently effectively for both the recipients and the provider.  Who will captain this ship?

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