Must-read: presentation by HHS Secretary Leavitt on Health Diplomacy

On December 12, HHS Secretary Michael Leavitt gave a really terrific presentation on the importance of health diplomacy for the CSIS speakers series (http://www.globalhealth.gov/news/news/121208b.html). His discussion was one of the best that I have considered recently. I recently put on a symposium for the Asst Secretary of Defense for Health Affairs called Culture, Health and Human Security where Dr. Steve Morrison spoke about the DoD's role in foreign policy. He too made similarly powerful points. (I'm struggling to get a web page up with the video of the presentation, but will post a link once I'm successful.) They seem to share a similar vision about the nature of health diplomacy, the challenges and the solutions. I'm glad to read such sophisticated and interesting analysis and wish it were wide-spread.

One of the more important points, to my mind, that Secretary Leavitt made was this:

Health is a legitimizer of governments and of
ideologies....(p. 13) The fact is in many regions of the world, democracies
are in a test-drive status, if you will. Healthcare is a
litmus test for these governments on whether they are
legitimate and whether they are affective. Using healthcare to
discredit democracy and the ideologies of liberty is a tactic
that is right out of the insurrectionist’s handbook. (p.15)

Secretary Leavitt describes how Castro exports poorly-trained doctors all over the world to under-served areas. The doctors fill a void (tho perhaps not very well) for medical services, and as an added bonus assist with political agitation. Castro makes money off the exportation of these doctors which furthers his ability to create more. According to Secretary Leavitt, Hugo Chavez is starting the same model.

In Central America, I believe we’re at some risk of
seeing 30 years of progress toward democracy erode. In country
after country in Latin America, leftist governments are being
elected. Healthcare is being used by their left-leaning
candidates to stir up discontentment among the people.
The first time I met Hugo Chavez, he said to me, “So,
what is the infant mortality rate there in Washington D.C.? In
Cuba, he said, it’s about six out of 1,000.” Now, I have no
idea whether what he said about Cuba is accurate, neither does
he. But the fact that he used Washington D.C. where it’s a
little higher around the rest of the United States demonstrated
to me that he was using this simply as a means of comparing
their capacity as a socialist government with ours as a
democracy. (p. 15)

Secretary Leavitt addressed the concerns of some who feel that health should not be mired in self-interested policy equations of the federal government. He explains (as did Dr. Steve Morrison from CSIS in his introduction) that the world is smaller now and the health of everyone is our business because illness knows no borders, and because health services can be used by governments:

This isn’t just about getting our approval ratings up.
This is about benefiting from our benevolence. A few weeks
later, I read in the paper about American and NATO troops
entering Pakistan territory, seeking to root out a high-profile
Al Qaeda leader who had been hiding in their mountains. It was
a necessary use of hard power, one that would ultimately and
obviously created a sense of controversy among our critics in
Pakistan. I’m guessing the reaction in the earthquake area
wasn’t quite as quick or quite as severe. This is what Bob
Gates has been talking about. It’s the integration of our hard
power and our soft power, benevolence and benefit. (p 22)

He hits the nail on the head when he describes the abysmal job the federal agencies and other U.S. organizations do 'branding' themselves:

The most significant deficiency in U.S. government
foreign assistance delivery is the rather abysmal job that we
do in branding ourselves and our activities.
This is not only true of health alone. It’s true
across the board. Every agency of the federal government has
its own focus and jealously guards its own turf. Often there
are contests that have to be resolved by putting all of the
participating agencies are having their seals and their symbols
on the same material. Many of you who work in the
international arena have seen this.
Routinely, one can see printed material with up to six
different logos from six different departments or agencies of
the federal government. (p 24)

And, as if in response to my previous blogs he makes the point that the federal agencies must work together, and that fixing one agency (e.g. USAID) is not going to cut the mustard:

This is not a trivial matter. The way our government
does not optimize the benefit of our benevolence is something
we need to change. Fixing the federal government’s siloed
approach, however, can only be done by the President. Fixing
it one department at a time won’t work. The next president
early on should implement a common branding strategy across the
government by executive order.(p26)

Wow!!