The Undersecretary of Defense for Policy takes on StratComm

USD Policy has been undergoing significant reorganization lately, and it's shape and function is not exactly clear to those of us on the 'outside'. The Office of the Undersecretary of Defense for Policy is perhaps "The Source" of power within the Pentagon, and the new Undersecretary, Michele Flournoy, is trying to shape her office to be more responsive to the global context, it seems. Those of us around D.C. not within USD(P) are waiting to understand the new organization and it's new direction. The Defense News reported last week (URL:http://www.defensenews.com/story.php?i=4190904&c=AME&s=TOP ) that Flournoy was going to put together a small team to shape communications both to Congress and to other US Govt agencies. The team will replace an office within USD(P) that used to be called "Support to Public Diplomacy". Flournoy disbanded the Support to Public Diplomacy office this year, seeking a fresh start to Strategic Communications efforts after the Support to Public Diplomacy office became embroiled in an internal conflict over it's issuances. (Apparently it was issuing 'propagandistic' information that soldiers in Afghanistan refused to use about casualty rates). While this all sounds rather archaic, it's not. The goal of the team is to coordinate Strategic Communications across DoD. I would suggest they start by reading the CENTCOM reports to Congress on progress in Afghanistan and Iraq. As I've blogged before the reports are pathetic at best, and do not show off the significant efforts in either theater of war.

As the U.S. tries to shape its global presence to positively effect and stabilize the international commons, it must be cognizant of its communications. It's all part of the "Smart Power" construct.

CSIS Launches Commission on Global Health and Smart Power

I had the opportunity to attend a CSIS launch of their new Commission on Smart Global Health Policy. The idea of the Commission is to create an action plan that will seek ways to create a more strategic approach to the way the U.S. government does "health development" abroad. (Health development in its broadest sense.) (URL: http://www.csis.org/globalhealth/)

As I listened, several things occurred to me. First, that the audience questions tended to focus on the health of recipient populations, or the urgency of need in recipient populations. And therefore one of the underlying assumptions is that U.S. global health policy is intended to make people in other countries healthy. I would suggest that's only one piece of the pie. There are a couple other reasons why we do health development around the globe: 1) because it makes us, the American tax payer, feel good; 2) medicine is a way to engage with the rest of the world that is less ethically challenging than, say, dealing in arms--so it's an engagement strategy; 3) private industry (drug manufacturers) makes money from our efforts to build health systems abroad and has a hand in the development efforts. Those three reasons are just off the top of my head, and need to be articulated better, but I hope they are recognized by the Commission.

Next, there was talk about sustainability. Panelists discussed long-term solutions like creating "systems of delivery" that would endure and help communities for longer than just one intervention. Associated with this thread of discussion was discourse about sustainable funding and I link in the topic of chronic diseases. I thought this was an interesting discussion because there was little clarity (probably due to time constraints) about the taxpayer. The reason some diseases and causes are more popular than others is because Congress pays more out to defend the U.S. from diseases which appear to "threaten" the U.S. in some way. The U.S. taxpayer is not particularly interested in saving rural Chinese populations from obesity, say, whereas the taxpayer might be lots more compelled to take an interest in the next round of influenza.

Finally, the Commission includes a media person. Her focus was unclear to me--she only had a few moments to talk. She presented a view of the media that seemed to focus on their utility as an informational device for the recipient populations (cell phones, popular shows, games etc). I think that's the obvious part of the story and again, what's forgotten here is the U.S. taxpayer. It's obvious to me that the U.S. tax payer does not know what the US is doing abroad in terms of global health, and we do not have a "story line" that the media can tie in to. I think the reason we don't have a developed story line is because America hasn't developed a story and belief about it's good work. That story is what political leaders need to begin to develop in order to influence both U.S. populations as well as foreign populations. It will be a story that the media can help develop and tap in to. Until we do this, "Smart Global Health Power" will be a fractured effort.

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.

Public Diplomacy+Military Medicine=the Comfort

The intersection of public diplomacy (typically a Department of State activity aimed to influence foreign populations) and military medicine is most easily identifiable in what the Navy is calling Humanitarian and Civic Assistance missions--the Comfort, the Mercy and so on. Under the new Maritime Strategy, the Navy is tackling the problem of how to do medical interventions with a goal of fostering good relations.

The Comfort has just set sail from Norfolk, and here is the blog:http://comfort2009.blogspot.com/.

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?