Swine Flu and Harley Feldbaum's report on US Global Health and National Security Policy

I am plugging away through the recently posted reports on the CSIS Global Health Policy Center page (see link on right hand bar). The first one up (picked because I am a long-time fan of the author and because of it's attractive slimness) by Harley Feldbaum, Associate Director of the Johns Hopkins SAIS Global Health and Foreign Policy Initiative, is a report on the U.S. policies addressing global health threats. Take the swine flu as a perfect example of what could be considered a "national security" threat.

Harley's report is really interesting though covers a tremendous amount of ground in a very brief period. His basic premise is:

1. That U.S. policymaking is complicated by dependence on health conditions in other countries, and a lack of understanding both domestically and abroad about health issues and their implications;

2. That the U.S. response to infectious disease/bioterrorism has over emphasized defensive medical countermeasures and treatment and under-invested in prevention, strengthening of public health systems and surveillance;

3. That improvements would be an increase in focus on global surveillance and response, attention to the WHO's International Health Regulations, and "putting a high priority on meeting the health needs of developing countries".

Wow. I am especially stunned by the final sentence. What Harley means is not really what the sentence says plucked out of the report like I have done here. Put in context, the essence of the argument is that instead of focusing on specific diseases which threaten the U.S., we would do better to examine the health needs of other countries and identify common ground. In the end making other countries more able to detect and deter disease will only help us. He uses Indonesia as an example--the Indonesian government will no longer participate in the WHO program for bird flu arguing that the U.S.'s program of developing drugs from virus samples donated by poor nations, which then are made available only to wealthy western nations is inequitable.

In theory I'd like to agree that we should place a high priority on meeting the health needs of developing countries. But I'm not sure I do.

For example, at the recent CSIS launch of their commission, there was discussion about chronic disease being one of the biggest looming health threats. Should we focus on assisting other countries with chronic diseases? If not, why not? Should we focus on tropical diseases that are not endemic to the U.S.? Why not? As Harley's report says: "Other major global health problems that do not directly threaten the U.S. population or strategic interests, including negelected tropical diseases, weak health systems, and maternal health, do not share the political spotlight and thus have received little attention or funding." (pg. 11) But, why is that bad? Or, why is that good? It's my tax money, after all. I can make arguments both ways on this sentence.

I think my issue here is that the report is too brief and covers a vast amount of territory. While it's attractive to make uncomplicated arguments, and I admittedly picked his report because it was thin, I am aware of the sweeping language and all the dangers that can attend such language.

The report is really well worth a read, and it touches on the most pressing contemporary problems relating to biosecurity. These are THE problems of today, elegantly presented.

Health is a Security Issue.

The Center for Strategic and International Studies is one of the leading, if not The Leading, think tanks delving in to the health-diplomacy areas. They are initiating a Commission on Smart Global Health Policy which is focused on pushing the USG toward a global health strategy. Here's the announcement: http://www.csis.org/component/option,com_csis_events/task,view/id,2004/.

Intersecting with this, the Obama administration has initiated an interagency policy coordination committee on global health. The first order of business, apparently, is an inventory of which agency is doing what. There is discussion around D.C. about the focus of the US government's energies--on single diseases--and whether there are more appropriate strategies. The Institute of Medicine chimed in on this matter here:http://www.nap.edu/catalog.php?record_id=12506 in it's report to the Obama administration called "The U.S. Commitment to Global Health: Recommendations for the New Administration". The report calls on the President to "highlight health as a pillar of U.S. foreign policy," claiming "It is crucial for the reputation of the United States that the nation live up to its humanitarian responsibilities, despite current pressures on the U.S. economy, and assist low-income countries in safeguarding the health of their poorest members." OK, while this sounds really nice, it seems to be written in complete denial of the 48 million Americans who have no health care. Balancing the priorities of internal and external politics is key to national security. And it's no longer an either-or world. Internal IS external.

The health of our nation has strategic implications. For example, one of the biggest problems facing the Army Reserve component (which means the National Guard and the Army Reserve) is health. The U.S. Army has policies against deploying unhealthy service members. For example, if a service member seems to have a cavity that will become problematic within a year, that service member is considered non-deployable until the tooth is fixed. Because most Americans don't take care of their teeth, guess what the biggest health problem affecting deployments of Army Reserve component is? Right. Dental problems. While not an insignificant problem, I also want to caution that this is not a huge deterrent right now, but more of a useful example. If we don't have healthy Americans to serve in our Armed Forces we have a national security problem. And, so the discourse should be: how much should we spend on making our nation healthy vice making foreign populations healthy? Because first we need to be healthy to work and pay our taxes, defend our nation, promulgate foreign policy.

Where I'm going with this is that reports like the IOM's that place moral and policy imperative on creating healthy international communities should also recognize that we also need a healthy nation. The challenge is not calling for more attention to yet another cause. But calling for a balanced and integrated approach for attending to both a healthy nation as well as a healthy international community. It's easy to pick out a single disease or a couple of causes du jour. It's absolutely not easy to articulate the importance of health to national security internally and externally with a cogent explanation for action. But that, in fact, is what is needed.