Tuesday, June 16, 2009

America's Global Health Influence from the Kaiser Family Foundation

I was discussing DoD's role in global public health with colleagues yesterday. Most people asking "what is DoD's lane" in global public health are from outside the DoD, and are part of NGOs, IOs, and other USG agencies. The Kaiser Family Foundation and CSIS are addressing the US government's role, and they have some interesting information posted on their website (http://globalhealth.kff.org). They not only have a break down of the monies spent by various agencies, they also have conducted a poll of American opinions about sustaining the substantial investment that the US is making around the globe.

I am beginning to think that the question of DoD's role in global public health is the wrong question, and is really being posed by people from within organizations that have options to either engage or not engage at will. The DoD, unlike other agencies, is not actually free to decide where it will engage, strategically speaking. Of course, at the tactical or programmatic level there are always decisions being made that have some effect. For example, the much-derided 'Medcaps'--somewhere at some level is a DoD employee who decides whether a medcap will be conducting in town X versus town Y. But at the strategic level, the DoD is engaged in Afghanistan and Iraq at the pleasure of our country's politicians. Not at the behest of Secretary Gates. Adding to this perspective of limited choice about the matter is the hierarchical nature of command. All military personnel understand that when the commander (at any level) says jump, everyone jumps. So, when a maneuver commander in Iraq tells his doc to go out and arrange a clinic in the nearby town, the doctor pretty much figures out how to do just that. There's only a very limited amount of free-will in the matter.

It has begun to occur to me that the question of DoD's role, as asked by those from within agencies where people at very low levels are directing programs and making independent decisions, and from within agencies that can decide to be in, say, Iraq, is being asked from the perspective and culture of will. The answer, from a DoD perspective, is that we go where we are told and do what we are told to do in the best way we can figure out. This answer is less than satisfactory to most questioners, and they keep asking.

So, I'm coming to the conclusion that the real discussion should be held at the point of contention: the competition on the ground or in the 'humanitarian space' as it is called. The real question, it seems to me, should be how can we mitigate profound confusion and misalignment of intent? The topic that nobody wants to address is right there: intent. The institutional bias of the Department of Defense will always make the health of other populations a secondary result or interest. In other words, the DoD is actually a health-destroying war-making organization. We know how to fight conflicts. Even in counter-insurgency when the goal is to secure populations and 'win hearts and minds', the DoD's focus will be on security. That's the fundamental nature of the beast. Not making foreign populations healthy. So, how do we create some order and sense of cooperation among the various actors? I think this is the more productive question.

Saturday, June 13, 2009

The Long Silence is hereby officially broken: CNAS conference and H1N1

Haven't had a chance to blog for the past month, but I'm back. So much has gone on, it's hard to know where to start.

First, congratulations to Chris Albon for passing his oral exams, and now being ABD. Chris writes the War and Health blog.

Second, the H1N1 epidemic. Guess who exported it to Kuwait via the war in Iraq? We did, apparently. Here's a report from Reuters: (URL http://www.reuters.com/article/healthNews/idUSTRE54M1G720090524)

KUWAIT (Reuters) - Eighteen U.S. soldiers in Kuwait have H1N1 flu, the first cases in the Gulf Arab oil-exporting region, a government official said on Sunday.

"(The soldiers) were confirmed with the virus upon their arrival from their country to the military base (in Kuwait)," Ibrahim al-Abdulhadi told Reuters.

Kuwait is a logistics base for the U.S. army for neighboring Iraq, where the U.S. military said there were no known cases yet of H1N1.

What are the implications of this? Obviously there are diplomatic issues, issues relating to quarantine, sovereignty and the war. Not insignificant.


Next, I had the good fortune to attend the Center for New American Security's day-long conference on the counter-insurgency in Iraq and Afghanistan, the problems with North Korea, and a session tossed in about the security implications of natural resources. Kind of an odd mix. The session on natural resources completely bogged down and became dangerously close to sounding like a self-licking-ice-cream-cone argument. Senator Warner moderated the panel and was pleased to describe his previous legislation that demanded that DoD address resource issues in terms of security. The CNAS staffer leading the discussion, Sharon Burke, claimed that it was DoD's responsibility to both fight the nation's wars as well as mitigate potential future wars. (Oh, really? I didn't see that in the Constitution...I'll have to go look again). The panel consisted of two academics and one Navy Commander who is responding to the good Senator's legislation by addressing the security issues relating to resources for the upcoming QDR. Nobody else from DoE or EPA was present apparently. Is DoD really the answer to resource issues? While I don't think it's irrelevant for DoD to be engaged in the discussion, sticking a Navy commander up on the panel with no other USG representative potentially skews the argument. Obviously this problem would require a whole of government approach, but where was the rest of the government?

Quite in contrast to the resource discussion was a panel all about the North Korea problem. The panel consisted of CNAS staff and diplomats with nary a military member present. Really? So, DoD should focus on resources, but not North Korea? I asked about this at the really swell post-conference cocktail party and was told that CNAS had asked for a DoD rep, but the timing was short and none had been proffered. Too bad.

The lunch speaker was the Honorable Judith McHale who gave a terrible speech, reading in a soft voice from her notes, about public diplomacy. It was disappointing to me that when someone from the audience asked about the distinction between Public Diplomacy and Strategic Communications she couldn't answer the question. Oh oh. Obviously she has only been in the position for a couple of weeks, but I would have thought her staff might have briefed her up on what it is that her agency is supposed to do--public diplomacy. I've heard that staffs don't do that in the other governmental agencies.

Look to CNAS to enter the military health/military readiness arena shortly. The basic premise is that if you have a military force with PTSD and TBI and other health issues, readiness is declinated. The 'mavricky' team at CNAS (to borrow a term from the Palin SNL skits) has reached out to an officer who has been severely wounded and become an advocate for soldier's health while remaining in the military. He himself is somewhat mavricky and I look forward to seeing what comes of the effort.

I have much more to post--stay tuned. First I have to write a paper for Command and General Staff College.