An Application of Strategic Health Diplomacy in Latin America and the Caribbean: The U.S. Southern Command
Feb 03 2016
BY RICHARD MENGER MD, ANIL NANDA MD MPH, AND WILLIAM FRIST MD
Feb. 3, 2016 | Kennedy School Review
Strategic Health Diplomacy (SHD) recognizes that targeted global health initiatives can be an important foreign policy tool for the United States. Healthier populations are productive, safe, and less vulnerable to instability. By addressing global health in Latin America and the Caribbean (LAC), the United States can save lives and improve its national strategic interests.
The United States Southern Command (USSOUTHCOM) has always taken a leadership role in becoming a “partner in international health” in the LAC region. SHD can broaden this concept by forming a tripod of health initiatives that rests on short-term military disaster relief, long-term humanitarian assistance, and integrative healthcare education.
Delivery of targeted global healthcare is directly in line with President Obama’s 2015 National Security Strategy; “The United States is safer and stronger when fewer people face destitution, when our trading partners are flourishing, and when societies are freer,” the president proposed.
This model has proven very successful in Africa. The President’s Emergency Plan for AIDS Relief (PEPFAR) launched in 2003, when President Bush delivered $15 billion to counter HIV/AIDS, tuberculosis, and malaria in vulnerable countries. Since then, 7.7 million people have received HIV/AIDS retroviral treatment. The program is credited with saving 1.1 million lives and reducing the HIV/AIDS death rate by 10 percent.
Under PEPFAR, healthier societies have also become safer societies. Since 2004, violent activity and political instability has decreased 40 percent in PEPFAR countries. Similar non-PEPFAR countries have only seen a 3 percent decrease over the same time period. Healthier people can also contribute to their economy. Life expectancy, education, and income also increased in PEPFAR countries during the same time period.
PEPFAR illustrated that SHD can foster support and goodwill for the United States. The twelve countries in Sub-Saharan Africa receiving PEPFAR assistance had an average 68 percent approval rating of the United States. Across the same time period, the global average was 46 percent.
The same results could be seen in Latin America.
Avoidable mortality in LAC still totals over one million deaths annually. One of USSOUTHCOM’s first responses to this tragedy was via the hospital ship USNS Comfort.
The USNS Comfort is a floating hospital that provides meaningful relief during times of crisis or need within Latin America and the Caribbean. It boasts more than 12 operating theatres, 80 intensive care beds, and 1000 hospital beds. In 2011, Operation Continuing Promise treated more than 100,000 patients and performed over 1,100 surgeries in 11 countries.
The value of this particular disaster relief and humanitarian assistance model is that it is extremely visible and quantifiable. The limitation is that it is extremely specific and temporally limited. Previous deployment of Navy hospital ships showed a significant improvement in the opinion of the United States during deployment. However, after six months, public opinion returned to pre-disaster levels.
Strategic Health Diplomacy and an on-the-ground long-term plan like PEPFAR is the logical extension for a more longstanding improvement in public health for the region.
In LAC, significant variation exists in public health capacity. LAC is the world’s most unequal region. Poor, rural, and indigenous populations suffer a growing health outcomes disparity. This allows for greater manipulation of one vulnerable group against another, a vulnerability that is currently being exploited by drug-related violence.
The World Health Organization proposes strengthening public health capacity in LAC through the following elements: Public Health Workforce, Public Health Information Systems, Public Health Technologies, Institutional and Organizational Capacity, and Financial Resources.
SHD can target the public health workforce effectively and measurably with humanitarian aid. The LAC public health workforce is severely undermanned and represents a “global health workforce crisis.” There are not enough properly trained professionals to administer and deliver healthcare.
In LAC, training and development of a public health workforce has been largely ignored. The volatile sub-region of Central America showed its highest public health deficit in human resources training and development. Emigration has left a 35 percent nursing vacancy at Caribbean hospitals. Specialty doctors outnumber community healthcare providers. The United States can help bridge this gap.
The long-term humanitarian aid of Strategic Health Diplomacy can save lives, begin to reduce inequity, and look to foster regional healthcare leadership in regions of strategic importance. Furthermore, educating, coordinating, and empowering regional leaders in the application of public health and the delivery of primary healthcare is vital to a healthy society, but it must be done with attention to sustainability and training.
Hope Through Healing Hands, a global health nonprofit started by Senator William Frist, works to educate and equip local leaders through the Frist Global Health Leaders program. The program offers grants for health professional students, residents, and fellows to serve and train abroad in underserved communities. Their efforts bolster capacity in clinics in need of support as well as offer training to community health workers to promote sustainability.
The Pan American Health Organization gives specific recommendations for the development of vertically integrated primary care health teams in the Americas. These include healthcare providers but also community leaders. These teams are regionally targeted to meet the unique needs of diverse populations. They have distinct goals and public health core competencies.
The United States can aid in this process through education, coordination, and mechanisms of disrupting health inequity by providing clear and transparent objectives. This is tangible, has quantifiable measures, and is algorithmically reproducible. As the host nation grows, its medical and regional educational capabilities can increase exponentially.
The healthcare sector in Cuba is an excellent example of opportunities for explosive growth. Sen. Frist has made several trips to Cuba in the past year. As the United States re-establishes relations with the country for the first time since 1959, there are valuable opportunities for science and medical exchanges to further our understanding of the area’s needs and strengths and to support the health infrastructure with training and education.
Future application of SHD should focus on specific communicable and non-communicable diseases in areas with strategic value within USSOUTHCOM. The disease should be both prevalent and treatable.
Any initiative designed should identify clear goals with distinct policies that have a visible effect in a transparent and accountable fashion. These considerations should be sensitive to local contexts, rooted in building host nation capacity, and designed for long-term solutions.
Improved overall health in developing countries will increase economic opportunity, promote stability, and resist political upheaval. Military disaster relief is immediate, visible, and measurable. Humanitarian assistance through SHD will create a more long-term health imprint through education and expansion of primary health teams.
Richard Menger MD is a neurosurgery resident who currently serves as the Hale Champion Public Service Fellow and a Master in Public Administration candidate at the Harvard Kennedy School of Government. He is a lieutenant in the Navy Medical Corps (Reserve).
Anil Nanda MD MPH is the Professor and Chairman of Neurosurgery at LSU Health Sciences Center in Shreveport LA. A leader in global neurosurgery, he has authored more than 380 publications and has spoken at over 400 conferences and institutions.
William Frist MD is a nationally acclaimed heart and lung transplant surgeon and former Senate Majority Leader. He is currently co-chairs the Bipartisan Policy Center’s Health Project is the founder and Chairman of Hope Through Healing Hands.
The views expressed are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.
By Melinda Gates, co-chair of the Bill & Melinda Gates Foundation
Jan. 28, 2016 | Medium
Four years ago, I stood with an international alliance of family planning advocates to set an ambitious goal for the world. We pledged that by 2020, 120 million more women and girls would have access to the family planning services they want and need to live their healthiest, best lives.
The good news is that, thanks to our collective efforts, over the last four years, tens of millions of unintended pregnancies have been avoided.
The bad news is that if we continue at current rates, we will fall short of our goal, breaking our promise to millions of women.
The consequences of failure are huge?—?for women, for their children, for everyone. An unplanned pregnancy often means that girls are forced to drop out of school and that women can no longer work outside the home, both of which contribute to keeping families and communities trapped in cycles of poverty. Unplanned pregnancies also carry significant health risks to both women and their children.
These 120 million women and girls are counting on us to keep our promise. We need to get back on track now.
Jan 25 2016
By Michael Miller
Jan. 25, 2016 | Foreign Policy
If you weren’t paying close attention during the president’s final State of the Union speech — and perhaps even if you were — you probably missed the shout out to one of the great foreign policy success of George W. Bush. In a speech that was otherwise criticized for its sunny characterization of perilous times, it was a welcome if brief indication that, from the beginning of his first term, Barack Obama embraced what was then and still is widely viewed as George Bush’s most enduring legacy — the President’s Emergency Plan for AIDS Relief (PEPFAR) and the subsequent President’s Malaria Initiative (PMI). Here, the progress is real and the president’s optimism appropriate.
What the president surely understands is that, more than a decade on, Bush’s vision for defeating global AIDS and malaria is more than a humanitarian success story — it is a foreign policy success story that has profoundly redefined our relationship with sub-Saharan Africa. This success likely has broader implications for America’s standing in the world that are still not fully understood or appreciated. Certainly, President Obama is viewed positively in Africa, in no small part because of his African heritage, but there can be no doubt that he stands firmly on the foundation laid by President Bush.
The fact that the president singled out malaria as worth his and Congress’ special attention in his final year is significant. Although sometimes viewed as a kid brother to the United States’ global AIDS program, it’s not an exaggeration to say that the progress against malaria in the past decade has brought us close to a true milestone of human history. When I began working on malaria at USAID in 2004, the disease killed more than a million people annually — the vast majority of them African children. Since then, deaths have been cut roughly in half, and endemic countries and donors are looking to achieve a state just short of eradication in coming years. One of mankind’s deadliest and most persistent killers is in retreat.
Jan 25 2016
By Melinda Gates, co-chair of the Bill & Melinda Gates Foundation
Jan. 25, 2016 | Devex
This week a hugely important conference on family planning is taking place in Indonesia, a conference that nearly never happened. In November, a volcano erupted in Lombok, closing the airport in Bali and postponing the original event. The family planning community rallied together to organize a new conference in just two months, reflecting a shared sense of urgency about meeting our family planning promise to women and girls.
It may not seem like it to those of us for whom deciding if and when to have children — or how many to have — involves little more than a trip to the doctor or the pharmacy. But for many women and girls there is, in the words of a young woman I met recently in Niger, no other option but to hope and pray.
You get a glimpse of just how much is at stake when you look through the eyes of two young women in Bihar, India. Sushma Devi and Manju Devi don’t only share a last name. They are also both married, mothers, in their late 20s, from poor families and rural communities. They live about 20 miles from each other — but their lives are worlds apart.
Jan 22 2016
By REBECCA BLUMENSTEIN and KHADEEJA SAFDAR
Jan. 22, 2016 | Wall Street Journal
DAVOS, Switzerland—The world may well see its last case of polio in 2016, Bill and Melinda Gates said Friday, an event that would start a countdown toward the official eradication of the highly contagious and crippling disease.
“It’s possible that the last case will be in 2016,” Mr. Gates said. “We need some good execution and a little bit of luck.”
The co-chairs of the Bill & Melinda Gates Foundation laid out their agenda for the year ahead in an interview with The Wall Street Journal on the sidelines of the World Economic Forum in Davos, Switzerland.
Polio-eradication leaders have made tremendous progress in the past few years, the couple noted. The World Health Organization said last year that Nigeria had successfully stopped transmission of polio in the country. That has left just two countries—Afghanistan and Pakistan—that still haven’t eliminated transmission of wild poliovirus, the cause of most cases of polio. If there are no more cases after 2016, polio-eradication leaders will meet their pushed-back goal of eradicating the disease in 2019. The WHO considers a disease to be eradicated if there are no cases for three years.
But ridding Pakistan of polio remains a huge challenge. At least 15 people were killed in a suicide attack on a polio-vaccination center in southwestern Pakistan earlier this month. In recent years, polio workers in Pakistan have been targeted by militants who accuse them of working as spies for the U.S. government.
By Don Melvin, CNN
Jan. 14, 2016 | CNN
The World Health Organization declared an end Thursday to the current Ebola outbreak in West Africa. But the global health organization cautioned that Liberia, Guinea and Sierra Leone remain at high risk for additional small outbreaks of the disease and must remain vigilant.
For now, the WHO said in a statement, "all known chains of transmission have been stopped in West Africa."
The organization said its job was not over. More flare-ups were expected, and strong surveillance and response systems would be critical in the months to come, it said.
Liberia was first declared free of Ebola transmission in May 2015, but the virus has been reintroduced twice since then, with the latest flare-up occurring in November. Thursday's announcement came 42 days -- two 21-day incubation cycles of the virus -- after the last confirmed patient in Liberia.
Three hardest-hit countries now have zero cases
"WHO commends Liberia's government and people on their effective response to this recent re-emergence of Ebola," said Dr. Alex Gasasira, the WHO representative in Liberia. "The rapid cessation of the flare-up is a concrete demonstration of the government's strengthened capacity to manage disease outbreaks. WHO will continue to support Liberia in its effort to prevent, detect and respond to suspected cases."
This date marks the first time since the start of the epidemic two years ago that all three of the hardest-hit countries -- Guinea, Liberia and Sierra Leone -- have reported zero cases for at least 42 days. Sierra Leone was declared free of Ebola transmission on November 7 and Guinea on December 29.
"Detecting and breaking every chain of transmission has been a monumental achievement," said Dr. Margaret Chan, WHO director-general. "So much was needed and so much was accomplished by national authorities, heroic health workers, civil society, local and international organizations and generous partners. But our work is not done and vigilance is necessary to prevent new outbreaks."