Public Health Engagement Aff Notes



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Economy EXT

U.S. aid solves

US aid to China on public health helps economy


Hickey '14 (Christopher Hickey, Ph.D. Countr Director for the People's Republic of China, "China's Healthcare Sector, Drug Safety, and the U.S.-China Trade in Medical Products", U.S. Food and Drug Administration, www.fda.gov/NewsEvents/Testimony/ucm391480.htm, CL)

FDA is addressing the challenges outlined above in several different ways. We currently have 13 staff in China, posted in Beijing, Shanghai, and Guangzhou. This includes eight U.S. civil servants and five Chinese staff. Using funding Congress provided in 2013, FDA is currently working to increase to 27 the number of U.S. officers it posts in China. The mission of FDA’s China Office is to strengthen the safety, quality, and effectiveness of FDA-regulated products produced in China for export to the United States. FDA’s China Office works to fulfill this mission through: Collaborating, capacity-building, and confidence-building with Chinese regulatory counterparts at central, provincial, and municipal levels; Conducting outreach to regulated Chinese firms that wish to export their products to the United States to enhance understanding of—and compliance with— FDA requirements; Monitoring and reporting on conditions, trends, and events that could affect the safety and effectiveness of FDA-regulated products exported to the United States; Conducting inspections at facilities that manufacture FDA-regulated goods; and Working closely with other key government and non-government stakeholders who work to strengthen the safety of FDA-regulated products manufactured in China. In addition to other budget requests that focus on imports from China, the Agency’s FY 2015 budget has requested $10 million in funding specifically for continuing the China Initiative. These new resources will strengthen the protection of American patients in the following ways: Strengthening FDA’s inspectional and analytical capabilities by adding nine drug inspectors to FDA’s China Office. The United States and China were able to address problems associated with visas for these staff during the visit of Vice President Biden to Beijing in December 2013, and FDA anticipates posting these new staff in country in Fiscal Years 2014 and 2015. This will allow more rapid access to Chinese facilities and will help to increase the number of FDA inspectors who have in-depth knowledge and expertise about current challenges that Chinese industry faces.

Broadening the range of inspections FDA performs in China. In addition to inspecting Chinese facilities that manufacture food and medical products for export to the United States, FDA will increase the number of sites it inspects that conduct clinical trials pursuant to investigational new drug (IND) applications, and will also perform follow-up inspections to ensure that firms continue to produce and manufacture food and medical products under safe conditions. Increasing opportunities for engagement with Chinese regulatory counterparts. Direct observation of FDA inspections can bolster Chinese regulators’ understanding of FDA’s requirements and processes and strengthen China’s inspectional capacity. Enhancing Chinese regulators’ knowledge of U.S. safety standards through participation in workshops and seminars, such as the International Conference on Harmonisation and the International Pharmaceutical Regulators Forum. These opportunities help facilitate dialogue and encourage scientific exchange on the critical role inspections play in improving the safety and quality of food and medical products. Strengthening FDA’s ability to use informatics tools, such as trend analysis, predictive modeling, and geospatial mapping. These tools will help to sharpen FDA’s understanding of potential public-health risks. Increased use of data will help FDA strengthen its systems in several key areas, including the implementation of science-based, harmonized standards. The ultimate goal is to detect and address risks through preventive, risk-based approaches before those risks result in harm to U.S. consumers.

Soft Power EXT

Decline Now

U.S. soft power has been continuously declining since 2001


Shuja '07 (Sharif Shuja, lecturer and coordinator of Issues in Contemporary Asia subjects at Victoria University, "Has the US forgotten the importance of soft power?", Newsweekly, October 27, newsweekly.com.au/article.php?id=3206, CL)

As the world's sole superpower with unrivalled economic and military dominance, the United States must make critical choices about the forms of power it employs to achieve its foreign policy objectives. In contrast to hard power that rests on coercion and is derived from military and economic might, soft power rests, not on coercion, but on the ability of a nation to co-opt others to follow its will through the attractiveness of its culture, values, ideas and institutions. When a state can persuade and influence others to aspire to share such values, it can lead by example and foster cooperation. Joseph Nye first coined the term "soft power" in a 1990 essay, Bound to Lead: The Changing Nature of American Power, and further developed the concept in a 2004 book, Soft Power: The Means to Success in World Politics. Up until 2000, American soft power was strong. The attractiveness of its society and institutions was conveyed by economic power, the domination of US businesses, American television, film and music, soaring immigration and the international appeal of its democratic culture and institutions. During that period, US foreign policy involved the use of both hard power and soft power.



Controversial: However, since September 11, 2001, US soft power has declined sharply due to the controversial policies of the current Bush Administration, which has relied excessively on coercive diplomacy and military power and a unilateralist approach. It has also neglected public diplomacy and cultural exchange programs, and failed to promote the attractiveness of American society to the rest of the world. Since 2001, US foreign policy, especially in the Iraq War, has become increasingly unpopular, strengthening anti-American sentiment and seeing a further decline of American soft power. It is argued that both hard and soft power are important in US foreign policy and in the fight against terrorism. However, America's neglect of soft power is undermining its ability to persuade and influence others. In comparison, the soft power capabilities of others such as the European Community and China have grown. Soft power has always been an important element of leadership. For example, the Cold War was won with a strategy of containment that used soft power along with hard power. However, in the global information age, we are seeing an increase in the importance of soft power. Communications technology is shrinking the world and creating ideal conditions for projecting soft power through the control of information. Polls taken around the world show strong evidence of America's declining popularity. A 2005 poll by the Lowy Institute reported that just over half of Australians polled had a positive view of the US, but, paradoxically, that around the same number saw the foreign policies of the US as a potential threat - equivalent to the same number of Australians who worried about the threat of Islamic fundamentalism. Polls taken in other nations suggest similar anti-American sentiment. A poll by the Pew Charitable Trust reported that the attractiveness of the US decreased significantly between 2001 and 2003 in 19 of 27 countries sampled. Gallup International polls report that, for the majority of people in 29 countries, US policies have had a negative impact on their opinion of the US. It is argued that the Bush Administration has neglected its soft power capabilities. The US State Department's public diplomacy initiatives, such as educational and cultural exchange programs, help to project the more non-commercial aspects of American values and culture, and influence public opinion overseas. These were once a linchpin of American foreign policy. Similarly, US government overseas broadcasting that is open, unbiased and informative helps to improve American credibility. However, funding has been slashed, and the efforts of the current administration to boost State Department's public diplomacy and international broadcasting have been limited. Arguably, there is currently no coherent public diplomacy strategy to communicate American values and mould public opinion worldwide. According to Joseph Nye, the US spends billions of dollars on defence and only one-quarter of one per cent of this on public diplomacy. One element of American society that tends to decrease its attractiveness abroad is its lack of knowledge and interest in the rest of the world. America's soft power capabilities are built on the style and substance of its foreign policy. J. Kurlantzeck, in an article in Current History (December 2005) said: "The Clinton Administration did not always use its political leverage to promote multilateral institutions, but it at least openly praised multilateralism while trying to publicly soothe fears of American unilateralism. The Bush Administration does not even offer such praise or reassurance." Events such as the abuse of prisoners in Abu Ghraib and Guantanamo Bay have undermined the attractiveness of American values, since that is based in part on international perceptions of the US as a humane and law-abiding nation. America's declining soft power capabilities mean it is losing its persuasive power. In its attempt to persuade North Korea to give up its weapons of mass destruction, the US has had to let China play a major role. While the US continues to rely on hard power, other nations have successfully used soft power to improve their global position. Polls taken in 2005 report that a large majority of nations believe Europe and China play more positive roles in the world than does America.

China: As its economy has rapidly grown over the last decade, China has sought to develop its soft power capabilities. It has sought to influence other countries using regional aid, public diplomacy, interaction with multilateral institutions and the embracing of free trade. Its appeal threatens to outstrip that of the United States and cast it as the primary regional power, presenting a potential danger to US influence and interests in the region. Some proponents of hard power argue that the US is so strong that it can do as it wishes without approval. According to former US Secretary of Defence Donald Rumsfeld, "The world's only superpower does not need permanent allies; the issues should determine the coalitions, not vice versa." I believe both hard and soft power are important in US foreign policy - the right balance of hard coercive power and soft co-optive power.


Health Diplomacy Key

Cooperation on pandemics spillovers to other international issues—decreases the risk of miscalculation and solves first impending extinction


Erickson '07 (Dr. Andrew S. Erickson, Assistant Professor in the Strategic Research Department at the U.S. Naval War College in Newport, Rhode Island and a founding member of the department’s China Maritime Studies Institute (CMSI). His research, which focuses on East Asian defense, foreign policy, and technology issues, has been published in Comparative Strategy, Chinese Military Update, Space Policy, Journal of Strategic Studies and Naval War College Review, "Combating a Truly Collective Threat: Sino-American Military Cooperation against Avian Influenza", Global Health Governance, published January 2007, ghgj.org/Erickson%20article.pdf, CL)

Cooperation against the threat of avian influenza could build mutual confidence and generate momentum for initiatives in other areas. In addition to enhancing communication, the building of bilateral contacts could give both sides a healthy respect for each other’s capabilities, thereby reducing the chance of dangerous miscalculations. Ongoing tensions in U.S.-China relations are based in part upon differences in national interests that are likely to endure. A positive bilateral military relationship will not in and of itself resolve those tensions. But such a relationship could offer realistic first steps that might serve to outline and safeguard mutual interests and thereby provide incentives to avoid unnecessary escalation and avert serious crises as the two nations seek to realize stable if competitive coexistence. China, situated at the potential epicenter of an avian influenza outbreak, has a particularly vital role to play in infectious disease control. China’s efforts in this regard are apparently growing, and seem to be increasingly impressive. Already, according to Dr. David Nabarro, Asia as a whole has made substantial progress in preparation for an influenza pandemic.

One way to increase mutual understanding and goodwill would be for Chinese and U.S. researchers to translate unclassified Chinese documents—starting with those concerning avian influenza and related public health threats—into English and to facilitate their wider distribution among Western experts. Such dissemination could increase Western knowledge of Chinese advances in disease prevention and control, which are reportedly numerous and rapid— particularly in specific technological areas. This might help to set the stage for follow-on medical research—perhaps with an innovative combination of government and private sector funding— that could exploit the synergy between U.S. technology and analysis and Chinese ability to conduct large scale experiments and biotechnological production in a cost effective manner. Moreover, Western analysts and scholars could use knowledge of China’s disease prevention efforts and security challenges to augment their analysis and understanding of China from a broader perspective. Here it must be emphasized that a more robust and nuanced spectrum of U.S. analyses of China, such as could be facilitated by greater transparency concerning Chinese military medical progress, is in China’s own national interest. After all, like its foreign counterparts, the U.S. military is duty bound to anticipate and prepare for worst case scenarios. But more optimistic projections and positive-sum suggestions produced by other analysts who are free from such responsibilities are extremely important as well. Such analyses could further elucidate the great benefits that the U.S. and China might derive from effective cooperation in a wide range of areas. Otherwise, exclusive focus on the possibility of conflict could negatively influence U.S.- China relations by overshadowing these other vital areas.

At very least, the origins and purposes of military medical and other analyses should be made transparent where possible by their authors and kept in proper perspective by those who consume them. This can be facilitated by efforts on both sides of the Pacific, even in the absence of explicit inter-governmental cooperation. There is substantial room for improvement in both nations. American analysts would do well to understand important nuances of increasingly robust (though often still somewhat opaque) Chinese policy debates in order to differentiate between official government policy and opinionated reports from China’s ever livelier media. This effort would be greatly facilitated if more Americans would develop their often inadequate language skills—Beijing can be surprisingly transparent in Chinese. Chinese analysts, who already tend to be quite sophisticated both linguistically and in their ability to trace political debates, would do well to document their assertions with ample specific references, such as footnotes, to where they obtained their information. While slowly improving, and already achieved by some highly advanced journals such as the Chinese Academy of Social Sciences’ American Studies, the overall dearth of such citations in both Chinese scholarship and official government reports makes it extremely difficult even for foreigners fluent in Chinese to assess the quality of data being presented. This is particularly true in the exacting fields of science and medicine, where a vaccine’s efficacy must be proven in a manner that is replicable by experts around the world, not simply announced without supporting evidence.

These significant challenges should not distract us from the larger issues at stake: a significant threat to humanity can and must be averted. This collective responsibility requires cooperation across national boundaries regardless of political differences. In this spirit, through translation and analysis of Chinese sources, I have endeavored to increase awareness among Western scholars, analysts, and policy makers of important Chinese developments and their potential relevance to Sino-American cooperation against avian influenza. The bottom line is that differences in other national interests should not prevent the United States and China—or, for that matter, all other nations—from recognizing their growing collective interests in combating emerging threats such as that of pandemic influenza. As a Chinese proverb cautions, “disasters know no boundaries” (shuihuo wuqing).


Health and disease cooperation is an optimal way to foster international relations and increase governmental stability --accounts for realism


Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of Conflict", published June 2011, CL)

Because states remain indispensable actors in these cases, international relations theory is a useful framework for thinking about international and transnational cooperation in public health and disease surveillance and response.34 This literature is vast. In a nutshell, though political realism in its many forms emphasizes the enduring propensity for conflict among self-interested states seeking their security in an anarchic environment, that is, one where there is no central authority to protect states from each other or to guarantee their security. Hence international cooperation is thought to be rare, fleeting, and tenuous—limited, by enforcement problems and each state's preferences for relative gains in their relationships because of their systemic vulnerability." Liberal approaches are particularly interested in identifying several ways to mitigate the conflictive tendencies of international relations, particularly through shared economic interests and norms and institutions (e.g., democracy). Liberals argue that these factors can help ameliorate the enforcement problem in anarchy and permit states to focus more on mutual gain defined in absolute rather than relative terms." More recently, constructivist approaches emphasize that nonmaterial, ideational factors, not just state interests and national and international institutions, are critical to understanding the formation of interests and the possibility of cooperation. As the name implies, for constructivists, the interests and identities of states are highly malleable and context-specific and the anarchic structure of the international system does not, in itself, dictate that conflict is the norm and cooperation the exception. Rather, the process of interaction between and among actors shapes how political actors (not just states) define themselves and their interests: "self-help and power politics do not follow logically or causally from anarchy. . . . Anarchy is what states make of it."37 Because identities and interests are not dictated by structure, a state's purely egoistic interests can be transformed under anarchy to create collective identities and interests by intentional efforts and positive interaction. Moving away from concerns about whether theory should focus primarily on interests, institutions, or ideas as the key causal variable in understanding cooperation (or the lack thereof), the theory of cooperation that emerges in chapter 3 blends elements of these and other approaches, often cast as alternatives, to demonstrate precisely the processes by which interests, institutions, and ideas (particularly about identity) can combine to shape cooperation in this, and arguably other, areas of international relations. In so doing, it demonstrates the organic interrelationship among the causal forces of cooperation and specifies the characteristics and dimensions of interests, institutions, and ideas about identity that facilitate cooperation.38 Most explanations for international cooperation in the area of public health come from practitioners, policymakers, and analysts, not international relations scholars." To account for cooperation in matters of international public health, the practitioner and analyst literature offers several contending, but largely untested, proto-hypotheses that draw from various social science approaches: An interest-based argument derived from the forces of globalization and the social nature of the problem, that the global benefits from controlling the transnational spread of disease necessitate cooperation and that "enlightened self-interest and altruism will converge in the increasingly interdependent world being shaped by the process of globalization." Infectious diseases know no physical borders and present particularly compelling superordinate problems that transcend the interests of contending parties, are shared by all of them, and require joint efforts for effective response.41 This explanation identifies the potential basis for interest-based cooperation in infectious disease surveillance and response, but fails to address how the difficulties inherent in providing an international public good such as disease control are overcome. A psychosocial, identity hypothesis that health initiatives promote an environment that emphasizes human well-being. The aim of reducing pain and disease is relatively undisputed. Health initiatives thus help overcome other, more divisive sources of identity by shifting the focus away from questions of national or ethnic security to human security, and allowing for an evocation and extension of altruism.42 How such identities are formed and reformed is not addressed, however. A domestic politics, rational choice* hypothesis that health cooperation provides an essential national public good46 (physical security) that redounds to a participating government's credit, thus enhancing state capacity and legitimacy and improving regional stability. This approach highlights the domestic, state-level, variables that might help account for cooperation. Furthermore, positive results in health can be observed and measured by epidemiological statistics on mortality and morbidity, have powerful impacts on citizens, and thus are attractive investments for governmental and nongovernmental actors.47 A negotiation and signaling hypothesis that health initiatives, as voluntary; novel, and consequential projects, are reliable signals for improving communication, reducing threats, and breaking patterns of conflict among traditional rivals or antagonists.48 For example, Thomas Novotny and Vincanne Adams maintain that "health and scientific interactions can serve as core diplomatic gestures to improve communication, reduce mutual or bilateral threats, and address health problems of mutual importance." This observation suggests that health initiatives can be a top-down strategy as part of national statecraft.

U.S. Key

The United States is the expected leader of public health diplomacy engagement


Brown et al. 13 (Matthew Brown, Bryan A. Liang, Braden Hale, and Thomas Novotny, Senior Advisor at Office of Global Affairs, US Department of Health and Human Services - ‎US Department of Health and Human Services, “China's Role in Global Health Diplomacy: Designing Expanded U.S. Partnership for Health System Strengthening in Africa”, Global Health Governance, Volume 6, No. 2, CL)

Why would the U.S. government explore expanded public health collaborations with China in Africa? It is important to note that these two nations already have a shared history of public health collaboration. The United States and China have collaborated for more than two decades on infectious diseases (HIV/AIDS, influenza, and emerging infections), cancer, and other non-communicable diseases.37 These collaborations share common goals for improving the practice of public health as well as strengthening public health institutions in detecting and responding to public health problems in the United States and China. Additionally, improving medical infrastructure and health systems are shared global health objectives and stated priorities of African leaders, and such activities may also facilitate economic development and commerce among these partner nations.38-39 Despite common goals, strategic cooperation in health development activities on the continent of Africa between the United States and China remains limited. From the early 2000s, the United States has focused on single disease approaches in Africa. For example, the United States has supported a series of large global health initiatives on HIV/AIDS; in fact, the President’s Emergency Plan for AIDS Relief (PEPFAR) represents the largest amount of funding pledged by any nation to a single disease.40-41 However, PEPFAR’s single-disease approach also supported the development of public health institutions that can tackle additional public health problems that plague African nations.42 This was the objective behind the creation of the GHI in 2009, capitalizing on the infrastructure of PEPFAR to tackle other diseases of public health significance.43 For the United States, the next phase of global health investment also coordinated by the DOS includes strengthening health systems.44 Drawing upon lessons learned from U.S.-China collaborations and employing leadership of the S/GHD to explore and map potential collective action with the Chinese government presents an opportunity to amplify the public health impact of development assistance by both nations. It also provides the basis to respond to African leaders’ call for stronger coordination among donor nations. characteristic of this evolution is the critical role U. S. Ambassadors now play in allocating and directing public health resources. As the U.S. President’s representative to a foreign country, Ambassadors negotiated PEPFAR expansion and Partnership Frameworks directly with leaders of host governments. While the implementing agencies were still responsible for the funds appropriated for their programs, U.S. Ambassadors were held accountable for the overall success or failure of the PEPFAR country program. Authority to make funding recommendations rested with the Ambassador and PEPFAR performance elements were integrated into U.S. Mission Strategic Plans in each target country. This escalation and expansion of public health management accountability to the diplomatic sector was unprecedented and helped engender stronger foreign policy attention overall to global health in embassies abroad and, to some extent, in the DOS as a whole. For example, both the Global AIDS Coordinator and the deputy head of the Office of Global Health Diplomacy routinely attend the Secretary’s weekly staff meeting of all the bureau heads.

Yes Spillover

Foreign aid towards public health systems strengthens U.S. credibility in negotiating other issues—spills over to long term diplomatic, economic, and security agreements


Institute of Medicine Committee ’09 (Institute of Medicine (U.S.) Committee on the U.S. Commitment to Global Health, a subpart of a branch of the National Institutes of Health, “The US Commitment to Global Health: Recommendations for the New Administration”, National Center for Biotechnology Information, http://www.ncbi.nlm.nih.gov/books/NBK32621/, CL)

Given the importance of health in building stable and prosperous communities, the committee encourages the new President to make a bold public statement that global health is an essential component of U.S. foreign policy. This could be confirmed by a major speech early in his tenure to pledge support to the United States’ successful investments in this arena and propose new means for pursuing global health objectives in a committed, cooperative, and nonpartisan manner. In a public address, the President should declare that the dominant rationale for U.S. government investments in global health is that the United States has both the responsibility as a global citizen, and an opportunity as a global leader, to contribute to improved health around the world. The U.S. government should act in the global interest, recognizing that long-term diplomatic, economic, and security benefits for the United States will follow. Priorities should be established on the basis of achieving sustained health gains most effectively, rather than on short-term strategic or tactical U.S. interests. Government efforts should focus on reducing deaths and disabilities among the most vulnerable and marginalized populations in regions with the greatest need, in countries that possess the capacity to effectively use financial and technical resources. Equally important, health resources should not be withheld from people in countries where the United States takes an unfavorable view of the governing regime. The U.S. offer of cyclone assistance to Myanmar in February 2008 was a good example of placing priority on humanitarian needs over politics. In developing sanctions at the UN and elsewhere, food, medicine, and other health necessities should not be included among the areas of denied trade or assistance.

U.S.-China cooperation creates dialogue and new areas of multilateralism in global health security


Huang ’16 (Yanzhong Huang, Senior Fellow for Global Health, Council on Foreign Relations, and professor of Diplomacy and International Relations at Seton Hall University, “China’s Healthcare Sector and U.S.-China Health Cooperation”, April 16, Council on Foreign Relations, CL)

U.S-China cooperation in addressing other health challenges



U.S.-China cooperation, of course, is not confined in R&D for new drugs, vaccines and therapies. They have cooperated in other areas of global health security. The U.S. and China were two of the first countries to respond to the Ebola outbreak in Western Africa. Unlike the United States, China has not publically framed the Ebola outbreak as an international security threat or deployed a large number of military personnel to the affected countries. Its dispatch of elite PLA units to the affected countries nevertheless suggests that it did view the outbreak as an existential security threat that required a response out of the normal political boundaries. Beijing’s willingness to implicitly securitize trans-border disease outbreaks has opened a new area for future collaboration between China and other countries (e.g., the U.S.) under the Global Health Security Agenda. Indeed, during the crisis Chinese military personnel trained a Liberian engineering company so that the latter could play an instrumental role in helping the U. S. Army to construct its treatment center in the country. Similarly, the U.S. Air Force provided large forklifts to help unload the supplies that China brought to Liberia. On June 24th, 2015, US Secretary of Health and Human Services Sylvia Mathews Burwell, Chinese Vice Premier Liu Yandong and Minister Li Bin of China’s National Health and Family Planning Commission, met to recommit to that partnership in addressing public health emergencies by renewing a Memorandum of Understanding for the next five years on cooperation to address emerging and re-emerging infectious diseases.

In addition, both governments have established partnerships over basic medical research. In 2008, National Cancer Institute (NCI) launched a research partnership with China and established NCI Office of China Cancer Programs. This is followed by the launch of US-China Program for Biomedical Research Cooperation in 2011, by NIH and National Science Foundation of China. Non-governmental organizations are also involved in establishing partnership with China. In August 2014, Massachusetts General Hospital was reported to be in early discussions with two partners to build a full-service hospital with 500 to 1,000 beds in China. Mass. General also signed a “framework agreement’’ with a Chinese hospital specializing in traditional medicine and a Chinese investment firm, allowing the three parties to exchange financial information and work on developing a definitive agreement to open a facility in an island city close to Hong Kong. In late November 2015, the U.S.-China Joint Commission on Commerce and Trade (JCCT) was held in Guangzhou, China. Secretary of Commerce Penny Pritzker and U.S. Trade Representative Michael Froman co-led a high-level U.S. government delegation to the high-level dialogue. The Chinese delegation was led by Vice Premier Wang Yang. For the first time in JCCT’s 26 years of history, the dialogue featured a one-day healthcare event attended by senior government officials and business leaders from the healthcare industry in both countries.

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