Public Health Engagement Aff Notes

U.S. policies have linked health and diplomacy together over time

More recently, growing concern about the political and social impacts of HIV/AIDS and emerging infectious diseases such as SARS and pandemic influenza have led policymakers to place greater attention on health in the context of foreign policy and diplomatic activity. In response to the growing political attention, a new United Nations agency (UNAIDS) was created in 1996 to serve a center for multilateral policy negotiations on addressing HIV, and in 2000 the UN Security Council declared HIV/AIDS a global security threat, the first time any disease had been singled out in this way. International alarm about the spread of H5N1 avian influenza and the potential for an influenza pandemic led UN Secretary General create a new UN System Influenza Coordinator office in 2005 to help multilateral coordination.

The U.S., too, has a long history of engagement in diplomacy on health issues. Early U.S. efforts stemmed as much from economic interests as public health ones, as the government sought to promote international trade and travel while also protecting shipping ports and other borders from external disease threats brought on by increased mobility. The U.S. participated in the International Sanitary Convention negotiations in the 19th Century (its first active participation coming in 1866, at the 3rd Convention)33, promoted the founding of PAHO and the creation of the WHO, and is an active a participant in the annual WHA meetings and related negotiations. Beyond the multilateral dimension, there is also a long history of U.S. bilateral diplomacy on health issues. For example, as early as 1929, the United States and Canada entered into a bilateral treaty requiring quarantine inspection of each country’s ships when entering adjacent waters, to prevent the spread of disease between the two countries.34 Even before the creation of a formal U.S. foreign health assistance apparatus, the U.S. government was already involved in negotiating and overseeing the disbursement of international health support to developing countries in the name of furthering U.S. interests; this assistance had reached approximately $40 million in 1954.35 At the time of the creation of USAID in 1961, President Kennedy clearly argued that by reaching out to other countries with assistance in health and other areas, the U.S. was furthering its interests and supporting important foreign policy goals. Foreign assistance, Kennedy said in remarks to Congress that year, could help prevent the “collapse of existing political and social structures” in developing countries that would “invite the advance of totalitarianism into every weak and unstable area,” endangering U.S. security and prosperity.3

U.S. public health policies are inherently diplomatic engagement in practice in both means and ends

KFF '12 (KFF, policy briefs on U.S. global health policy, "RAISING THE PROFILE OF DIPLOMACY IN THE U.S. GLOBAL HEALTH RESPONSE: A BACKGROUNDER ON GLOBAL HEALTH DIPLOMACY", Kaiser Family Foundation, September, https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8360.pdf)

U.S. support for international health programs grew dramatically after 2000, through newly created international assistance programs such as the multilateral Global Fund to Fight AIDS, Tuberculosis, and Malaria, which the U.S. helped to establish in 2002, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), created in 2003, along with a new Office of the Global AIDS Coordinator located within the State Department to oversee U.S. global AIDS efforts, and the U.S. President’s Malaria Initiative, launched in 2005. Such efforts channeled significantly increased financial assistance into global health, described by policymakers as important not only because they addressed pressing humanitarian needs abroad, but also because they served U.S. national interests and foreign policy objectives in a variety of ways (see Box 2, next page).44 Diplomatic engagement is an important component of putting programs into practice, because they involve negotiation with recipient country governments, other donors, and additional partners. PEPFAR, in fact, engages in a formal process of negotiating annual Country Operational Plans45 and five-year Partnership Frameworks with country recipients of assistance.

The U.S. has also engaged in global health diplomacy in response to crises or specific health-related issues. For example, U.S. diplomats played an important role in the international effort mounted in response to the cessation of polio vaccination in Northern Nigeria in 2003, a situation which placed the global campaign to eradicate polio in jeopardy.48 Likewise, U.S. representatives were involved in the diplomatic effort to reach an agreement with Indonesia regarding that country’s refusal to share samples of H5N1 influenza starting in 2006.49 Current U.S. guidance and strategy documents continue to emphasize the benefits of global health engagement and global health diplomacy. The latest National Security Strategy declares the U.S. has a “moral and strategic interest” in advancing global health. In the first ever “Quadrennial Diplomacy and Development Review” (QDDR, released in 2010), the State Department provided a blueprint for “elevating American ‘civilian power’ to better advance U.S. national interests, focusing on the role of both diplomats and development experts. Health is identified as one area that bridges both diplomacy and development. As stated in the QDDR, “we invest in global health to strengthen fragile and failing states, to promote social and economic progress, to protect America’s security, as tools of public diplomacy, and as an expression of our compassion.” A key actor identified in the QDDR for carrying out development and diplomacy is the U.S. Ambassador in country.

Global health policy has become a cornerstone in diplomatic U.S. efforts

Global Health Council ND (a United States-based non-profit networking organizing linking "several hundred health non-governmental organizations, "U.S. GLOBAL HEALTH DIPLOMACY AND THE ROLE OF AMBASSADORS", Global Health Council, globalhealth.org/event/u-s-global-health-diplomacy-role-ambassadors/)

In recent years, the U.S. government has increasingly made global health issues a key element of its diplomatic efforts – most notably in the creation of a new Office of Global Health Diplomacy at the State Department in 2013, which includes a goal of supporting U.S. Ambassadors and embassies to enhance the focus on global health as part of their diplomatic engagement. How does diplomacy intersect with global health, and how is the new focus on global health diplomacy reshaping the work of U.S. Ambassadors with partner countries? How does this new office relate to and coordinate with other parts of the U.S. government’s global health architecture and foreign policy?

Public health is an important discussion on the topic of foreign policy

Lim and Blazes '15 (Matthew Lim and David Blazes, Matthew Lim is an infectious diseases physician who has been assigned to the U.S. Department of Defense’s HIV/AIDS Prevention Program and served as a liaison officer working with the World Health Organization, David Blazes is an infectious diseases physician who has been assigned to the USNS Comfort and the Navy research laboratory in Peru and directed the U.S. Department of Defense’s Global Emerging Infections Surveillance program, , “Collateral Duty Diplomacy”, U.S. Department of Defense and Global Health Diplomacy, September 21, www.sciencediplomacy.org/article/2015/collateral-duty-diplomacy)

In a world of increasingly diverse and complex actors, political forces, and transnational issues, global health diplomacy is emerging as an important arena of international relations across societal groups, including the education, policy, research, operational, and response communities. In the past, health as a foreign policy matter was largely seen as a charitable humanitarian concern or, in the case of infectious diseases, an issue primarily of quarantine laws and border inspections. By the turn of the twenty-first century, however, improving health at national and global levels increasingly became a foreign policy goal in its own right, as well as a vehicle for other foreign policy interests. Various trends contributed to this change: the globalization of travel and trade and the correspondingly increased risk of transnational epidemics; the recognition of the importance of health as a driver of economic development; and the belief that health, as an agent of “soft power,” was a means to affect political agendas. Health as a soft power tool seemed particularly attractive and relevant in developing world settings where poor health and other fragile elements of human security might abet the growth of violent extremism. Internationally, the significance of health as a foreign policy priority was highlighted by events such as the Oslo Ministerial Declaration on health and foreign policy in 2007, signed by the ministers of foreign affairs of seven developed and developing countries, as well as real-world crises such as the 2005 Boxing Day tsunami, the 2009 H1N1 influenza pandemic, and the thirty-year global struggle against HIV/AIDS. In recent years the concept of “health security,” whether as an aspect of development, emergency preparedness, or a distinct set of emerging threats and vulnerabilities, has underscored the close linkage between improved health and improved security at local, national, regional, and global levels. In 2014 the Obama administration launched the Global Health Security Agenda, a partnership of more than forty nations committed to accelerating progress in preventing, detecting, and responding to outbreaks of infectious disease of natural, accidental, or deliberate origin.

Engagement consists of health diplomacy interactions between governments

Lim and Blazes '15 (Matthew Lim and David Blazes, Matthew Lim is an infectious diseases physician who has been assigned to the U.S. Department of Defense’s HIV/AIDS Prevention Program and served as a liaison officer working with the World Health Organization, David Blazes is an infectious diseases physician who has been assigned to the USNS Comfort and the Navy research laboratory in Peru and directed the U.S. Department of Defense’s Global Emerging Infections Surveillance program, , “Collateral Duty Diplomacy”, U.S. Department of Defense and Global Health Diplomacy, September 21, www.sciencediplomacy.org/article/2015/collateral-duty-diplomacy)

There is no single definition of “health diplomacy.” One commonly cited characterization is political action that simultaneously advances public health as well as relations between states.2 Katz et al.3 propose three levels of health diplomacy: “core” (interactions between governments); “multistakeholder” (interactions involving governments and multilateral institutions, in support generally of transnational and “polylateral” agendas); and “informal” (engagements at the technical or program level among actors in health). In this model, the DOD has no specific mandate to engage in “core” or “multistakeholder” diplomacy by representing, per se, the U.S. government. However, its extensive activities in “informal” diplomacy have ramifications across all three levels as well as engagements beyond the health arena. This accords well with the DOD’s self-identification as a “supporting, not supported” global health actor: the U.S. military’s global health engagements are not derived from the pursuit of global health as a good endeavor in its own right, but as complementary to the primary purpose of defending U.S. national interests. As such, there is not an overarching “health goal” that governs U.S. military health diplomacy efforts. Instead, each institution, program, or mission is justified with reference to a U.S. military strategy or priority beyond the health domain.

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