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Health: Defense, Diplomacy and Development

Saturday, December 27, 2008

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!!
Posted by Gail Fisher at 11:43 AM No comments:
Labels: The Defense Development Diplomacy triad

Friday, December 26, 2008

"Can Washington Get Development Right?" another DoD smackdown?

More food for my (f)ire about the political maneuverings here in DC between the Dept of State, and USAID.

Foreign Affairs has an interesting piece by J. Brian Atwood, M. Peter McPherson and Andrew Natsios called "Can Washington Get Development Right?" in the November/December 2008 edition (http://www.foreignaffairs.org/20081001faessay87609/j-brian-atwood-m-peter-mcpherson-andrew-natsios/arrested-development.html). In it, the authors make a couple of strange statements:

...democracy-promotion programs and the Defense Department's aid programs around the world should largely return to civilian control, with the relevant authority and resources assigned to the new USAID. (pg 131)
DoD's aid programs? What aid programs, I wonder? Perhaps they are referring to DOD's mil-mil programs? Or how about the Overseas Humanitarian Disaster and Civic Assistance program? The OHDACA program is very small. Not even worth mentioning in an article about reforms that USAID needs published in Foreign Affairs.

Another odd statement:

Of course there will be areas of overlapping jurisdiction between the defense, diplomatic, and development institutions. One example is the provision of security assistance in countries recovering from conflict; in these difficult environments, the State Department's diplomatic mission is crucial and the Defense Department is needed for training and logistics. The key is who controls the money for noncombat activities. This authority belongs with the diplomatic mission. (p 132)

Huh? The Defense Department is needed for training and logistics, and not economic capacity building or providing security itself (vice "providing security assistance" used by the authors)? I wonder if the article was edited so dramatically that a portion of this paragraph was edited? It is so unbelievably simplistic that...well, it's unbelievable. The discussion of "combat" versus "noncombat" is difficult in post-conflict reconstruction settings. Bureaucracies must work hand in hand in this setting. The authors' maybe make a mistake in their brevity: trying to line up responsibilities in the manner suggested is simply not realistic. When military personnel are setting up clinics to treat local nationals, that is neither logistics nor training. Nor is it "combat" per se. So, how would these type of missions fall in the minds of Messrs. Atwood, McPherson and Natsios? I have a quibble with important people making simplistic little statements like this in important journals like Foreign Affairs.

The reason for my dismay is the same as in an earlier post. I think the "roles and responsibilities" question is being played too hard during this change-of-administration period to make the case for the Dept of State and USAID. It's time for serious thinkers to tell both the American public as well as the administration (both incoming and outgoing) that all agencies within the government have to work together. Roles and responsibilities are never going to be delineated in advance for all contexts. Nonetheless, the Dept of State and USAID must be enhanced in human and fiscal resources so they can work with other agencies, like the DoD. It's not "us" against "them". DoD is not hoarding all kinds of aid money, since it doesn't perceive itself to be an aid agency. DoD fights wars, first and foremost, and it also does stability, security, transition and reconstruction operations, just like always. Strong partners will make DoD's efforts more likely to end in success. I cannot say it more eloquently than Secretary Gates, writing in the current Foreign Affairs issue (http://www.foreignaffairs.org/20090101faessay88103-p0/robert-m-gates/a-balanced-strategy.html):

What is dubbed the war on terror is, in grim reality, a prolonged, worldwide irregular campaign -- a struggle between the forces of violent extremism and those of moderation. Direct military force will continue to play a role in the long-term effort against terrorists and other extremists. But over the long term, the United States cannot kill or capture its way to victory. Where possible, what the military calls kinetic operations should be subordinated to measures aimed at promoting better governance, economic programs that spur development, and efforts to address the grievances among the discontented, from whom the terrorists recruit. It will take the patient accumulation of quiet successes over a long time to discredit and defeat extremist movements and their ideologies.


Gates' whole article is worth a read. And, on that note, there is an interesting editorial in today's Washington Post about USAID. The thrust of the editorial is that USAID personnel in Afghanistan are rendered ineffective by their inability to leave the security of their compounds.
Posted by Gail Fisher at 12:16 PM No comments:
Labels: The Defense Development Diplomacy triad

Wednesday, December 24, 2008

Senator Hilary Clinton and the State Department

Senator Hilary Clinton has been making news about how she plans to shape up the Department of State. According to reports in the New York Times (http://www.nytimes.com/2008/12/23/us/politics/23diplo.html?_r=1&hp), she plans to seek more money for the diplomatic corps. The military, according to the report, is delighted :

For years, some Pentagon officials have complained that jobs like the economic reconstruction in Afghanistan and Iraq have been added to the military’s burden when they could have been handled by a robust Foreign Service.

“The Pentagon would like to turn functionality over to civilian resources, but the resources are not there,” the official said. “We’re looking to have a State Department that has what it needs.”

And apparently, some of the blame for the current problem seems to lie with former Pentagon resident, Colin Powell, Dick Cheney, and even "the intelligence agencies" :

The steps seem intended to strengthen the role of diplomacy after a long stretch, particularly under Secretary of State Colin L. Powell, in which the Pentagon, the vice president’s office and even the intelligence agencies held considerable sway over American foreign policy.
In their search for a story--" the blame," --the important point that the authors miss is that it will take more than one single agency in this complex world to solve problems. The Pentagon will most likely be involved in economic reconstruction somewhere in the world at any given point, regardless of what the Treasury or State Departments are doing because the economy in question is embroiled in some kind of armed conflict. Under NSPD-44 the Dept of State has the lead, and of course it therefore needs to have more resources, for responses to complex emergencies. But the newsworthy point here is that all agencies will work together as we go forward. The media could help shape the public and political understanding were they able to better describe this sea change.

Happy Holidays!


Posted by Gail Fisher at 7:44 AM No comments:
Labels: The Defense Development Diplomacy triad

Wednesday, December 17, 2008

"A Gentler Hegemony" the way forward for the US military?

Robert Kaplan published a provocative editorial in the Washington Post today (http://www.washingtonpost.com/wp-dyn/content/article/2008/12/16/AR2008121602480.html?nav=hcmoduletmv). He opines that the future role for the military will most certainly involve responding to humanitarian disasters like tsunamis and earthquakes with assistance. In fact he posits that international community will demand that the U.S. military be responsive:

"American military power is not going away. But instead of being in-your-face, it will lurk just over the horizon. And that will make all the difference. " He goes on to say: "As world population rises, and with vast urban areas with tottering infrastructures in the most environmentally and seismically fragile zones, the opportunities for U.S. military-led disaster relief will be legion. The American military remains a force for good, a fact that will become self-evident in the crises to come." However, "Yet American hegemony post-Iraq will be as changed as Britain's was after the Indian Mutiny. It will be a more benign and temperate version of what transpired in recent years. Henceforth, we will shape coalitions rather than act on our own." Kaplan's thoughts are framed by his view of America's decline, and here I am plucking out pieces that relate to the military.

Kaplan's linking of America's decline to the use of the military is perhaps the most provocative thought, among many other provocative thoughts, of this editorial. The military's view is that there is more than one instrument of national power. However recently it has become more than obvious that the military is the most-used, or at least the most-funded and therefore most robust instrument. Regardless of whether America's hegemony is waxing, waning or plateauing, could it be that more use of public diplomacy, the State Department and USAID will better legitimize the actions of the U.S. in the international public view?

Although Kaplan most likely hits the nail on the head that international opinion will cry out for the U.S. military to respond to humanitarian disasters, what he doesn't address is the next logical question: Is it ethically, politically and logically appropriate for the U.S. military to get in to the humanitarian response business when there are many many other more experienced players? Maybe that's actually three questions, but three inter-related questions.

Perhaps the role of the U.S. military is better abridged to fighting wars? By rushing to comply with international opinion, do we lose legitimacy with the publics that we are trying to aid? Not every public is happy to be rescued by Americans or even people in uniform. Think of people who have been living in conflict zones for their whole lives--trust in a uniform might be lower than we expect. As we should have learned in Iraq, the rest of the world does not share our world view.

Further, could it be, as some argue using what ethicists call a distributive justice argument, that by using military capabilities to rescue other peoples we are taking away from our own?

These are important questions that we need to answer, and that we most likely will begin to answer, by trial and error.
Posted by Gail Fisher at 7:49 AM No comments:

Tuesday, December 9, 2008

The role of information and health in the GWOT

I just added a fantastic blog that I follow, Mountain Runner. It's a blog about "public diplomacy", which is perhaps a mysterious term to the uninitiated. There are several discussions about the differences between, or tensions between, "public affairs", "information operations", and "public diplomacy". It seems to me, from the outside, that this debate over the proper roles and responsibilities of practitioners of each is somewhat like the false debate about the definition of terrorism. Definitions are symbols produced by their users which validate their perspectives and cause further definition of the environment. The point of bringing this up here is that information--whether it's passive or purposeful, to U.S. or outside audiences--is important. We can leave the definitions to the communities that struggle with them and focus on information communication for our purposes. While the topic of information-flow might seem tangential to the triad of health-national security-international relations that I propose to cover in this blog, it's not. Actions convey information, and lately I have been formulating a theory that a center of gravity for the GWOT might not really be "public opinion" since defining publics and their opinions during military operations is difficult. A center of gravity for the GWOT might instead (or additionally) be primary symbols. Recall the photos and TV coverage of soldiers pulling down the statute of Saddam Hussein in Baghdad. Simple example, but it conveys the point that symbols are powerful.

The use of information to actively change opinion might be more powerful if we understood the symobology of other people. The Assistant Secretary of Defense for Health Affairs sponsored a symposium on Culture, Health and Human security last week and two of the speakers discussed cultural creation of symbols. For example, I learned that there is a relatively specific culturally-derived view of women and health in the Jewish community. It strikes me that health, being at the very bottom of Maslow's hierarchy of human needs, is also perhaps a striking symbol that we should more carefully consider.

On December 12, the USS Kearsarge and USS Boxer will return to the U.S. after a trip to Latin America and the Caribbean where the staff delivered medical and veterinarian assistance to eight nations. There will be a media event at the University of Miami. Here's where there is more information: http://www.southcom.mil/appssc/index.php. These missions are designed to "foster goodwill and demonstrate U.S. commitment and support to Latin America and the Caribbean" according to the U.S. SOUTHCOM website. However it remains to be seen if these missions, which are being conducted in partner with other U.S. government partners like Health and Human Services, NGOs like Project Hope, and which are coordinated with the involvement of the public diplomacy community, are effective or efficient at communicating goodwill. It might be more effective, and more efficient, to examine the health symbols of the countries we visited and try to understand if there is a way to positively influence those symbols. This is not to say that these missions --the Comfort and Mercy included--are bad. It's easy to speculate from the comfort of one's own computer desk chair. However these missions are expensive and are using military resources so the question is a valid, if somewhat academic, question.

Switching focus to American audiences, the U.S. public is relatively unaware of these missions, which is unfortunate since we are a nation that likes to do good. And also a nation that likes to support its military. As symbols of both the military and our best wishes for the rest of mankind, these missions most likely could communicate powerfully to the American public. The current media focus seems to be on Latin American publics instead of the American public, oddly.

Consideration of symbols of cultures, and operationalizing a plan for communicating our intentions goes together. Creating good health for people around the world seems to be benign at worst, but are we sure?
Posted by Gail Fisher at 6:37 AM No comments:
Labels: information operations, public diplomacy, strategic communications

Saturday, December 6, 2008

What's mendstate?

This blog is being created to discuss trends in the 'securitization' of 'health'. What does that mean? Well, I plan to discuss the health treatment of foreign nationals (and their health systems) by our military (and by coalition partners) as part of either a security operation, a stability operation, a transition operation or a reconstruction operation. SSTR-operations (SSTRO) is the new US military acronym for something that has been around for a long time and which has other names du jour like "nation building" or "winning hearts and minds" depending upon the context. Everyone tosses these words about as if they are synonomous, which of course they aren't. But much like trying to define "terrorism," the definition and action of 'nation building' to one person could be considered 'imperialism' to another. And that leads me to legitimization. I'm pretty certain I'll touch on ideas of 'legitimate' action --or when the world's public and the American public thinks the military and the government is acting righteously. Polls show positive response to our continued delivery of aid. Using the military to deliver humanitarian medical assistance post-conflict (as an example) might be perceived as being legitmate by some. On the other hand using the military to deliver medical humanitarian aid to 'stabilize' a country might not be perceived to be legitmate by those same few who would stop to consider. In it's bid to charm the rest of the world, how will American use its instruments of national power? And, particularly, how will global public health be affected, how will America be perceived? How effective can we be in doing our good deeds?

Foreign policy, global health and national security hang together quite naturally as do an egg white and an egg yolk. But oddly enough there is scant scholarship about the matter. Part of the problem is that although these ideas form a cogent and intuitively balanced perimeter, it is really hard to know what goes in the perimeter or when you have enough in the perimeter. Measuring traditional national security policy actions tends to be most persuasive in binary terms: either we win or they win. Foreign policy is much fuzzier since probably nobody quite wins everything, in absolute. But perhaps all sides gain a bit and hopefully lose a bit less. Global public health, which one would imagine could be defined by matters of counting (as in the number of people who are diseased), is even fuzzier. Different cultures define health differently than we do in the West. Not only that, but it's just plain hard to count much of anything in the middle of a conflict. Hence describing, measuring and furthering the practices of foreign policy, global health and national security (when taken as one), becomes darn near impossible. How do we know when we have reached an end state?

And that brings me to the name of the blog which is a play on words for mending, and state, and end state. What's the end state when you are mending a state? Or even mending non-state actors? Very hard to know. But really interesting to consider.
Posted by Gail Fisher at 5:06 PM No comments:
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Other links worth checking:

  • 3D Security from Eastern Mennonite University
  • Armed Forces Journal
  • CSIS Global Health Policy Center
  • Center for Global Development
  • Centre on Global Change and Health, London School of Hygiene and Tropical Medicine
  • Conflict and Health Journal
  • Conflict and Health Page, London School of Hygiene and Tropical Medicine
  • DoD H1N1 Watchboard
  • Georgetown Law Oneil Institute
  • HHS Global Health
  • Health and Fragile States Network
  • Human Security Gateway
  • Institute for Effective States
  • International Initiative for Impact Evaluation
  • Kaiser Family Foundation
  • Medical Corps International
  • Military Health System
  • National Intell Council's Global Health Report
  • Small Wars Journal
  • Team Rubicon
  • WHO Bulletin from March 2007 on health diplomacy

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My Blog List

  • War Is Boring
    Japan’s PM ‘runs’ to Trump, Ishiba aims for a meeting in November - Adnkronos International, Rome(TNS) During the phone call that lasted about five minutes, Ishiba and Trump – Kyodo reports again – did not talk about the ...
    6 months ago
  • International Political Economy Zone
    African Extractive Industries: PRC Neocolonialism - That the slow development of the African continent can be traced to Western colonialism is an archetype of this field of study: Mainly interested in extr...
    11 months ago
  • The Best Defense
    Japan Finally Got Inflation. Nobody Is Happy About It. - After 25 years of deflation, the public is mad about price rises.
    1 year ago
  • Biosecurity Blog
    - I have launched a new blog Inspiring and informative stories about public health heroes and the battles between the human race and infectious diseases
    5 years ago
  • The Will and the Wallet
    12 Greske Ferieperler - Byen har også mange små hoteller, og god og pålitelig bussforbindelse ut til strendene. Den opprinnelige fiskerlandsby ligger litt opp i skråningen, nærmes...
    5 years ago
  • Conflict Health
    Adjust contrast of a pdf free - Closer to the eye of the shooter, this is because Preview is quite literally applying a filter to each individual page of the PDF you are saving. the proce...
    7 years ago
  • Weekly Baur
    BlackBerry Mercury tidak akan diluncurkan di India, mengatakan TCT - BlackBerry – TCL komunikasi teknologi Holdings terbatas (TCT) di garis samping CES Tinjauan acara dikonfirmasi untuk gadget 360 bahwa codenamed smartphone ...
    8 years ago
  • MountainRunner
    Sign up for the new MountainRunner.us… - In the very near future, a new MountainRunner.us site will be launched. The new site has a clean and fresh look and better readability across different dev...
    10 years ago
  • Global Health Ideas
    Garcinia Cambogia Diet – Find The Best Garcinia Cambogia Extract - Health, Fitness, and Weight Loss Supplements - What’s the biggest challenge faced by many of those who are trying to lose weight? Believe it or not, it’...
    12 years ago
  • D3
    The District Stability Framework - For those of you who don't know about the District Stability Framework, it's a conflict assessment tool used to diagnose the sources of instability in a ...
    12 years ago
  • DoD HIV Aids Prevention Program
    -
  • COMOPS Journal
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  • USA and USMC Counterinsurgency Center Blog
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  • Understanding War
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      • Must-read: presentation by HHS Secretary Leavitt o...
      • "Can Washington Get Development Right?" another ...
      • Senator Hilary Clinton and the State Department
      • "A Gentler Hegemony" the way forward for the US mi...
      • The role of information and health in the GWOT
      • What's mendstate?

About Me

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Gail Fisher
Gail is a Lieutenant Colonel in the U.S. Army Reserve, holds an MA in Journalism and a Master's in Public Health and a Master's Certificate from the Naval Postgraduate School in Security, Stability and Development in Complex Operations. She'd like to eventually get a PhD. She has been following the use of U.S. military health capabilities for nation building and health diplomacy for several years and recently decided to blog about it. This blog is intended to build a resource of relevant news, documents and other online content. The views expressed here are personal and do not reflect those of any agency.
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At the U.S. Embassy in Kabul
 

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