The Security Dividend: What the United States Can Obtain from Investing More in International Health Care Capacity
With their increased emphasis on soft power, both the Bush and Obama Administrations have opened up a new front in the war of ideas regarding who will have the most influence over developing countries as the world moves through the twenty-first century. Currently the political and philosophical differences between the parties of this conflict are not as starkly defined as they were in George Kennan’s historic argument for containment (i.e., there is no “Evil Empire,” and “terrorism” can be a process, act, or method, but not a state). Yet the consequences of losing this international war on poverty have been defined as no less than a tangible threat to U.S. national security interests and moral leadership. This paper narrowly focuses on one particular type of strategy in this new war—foreign aid for health—and how, by helping countries to supply and train more of their own soldiers in this type of fight (i.e., non-physician health workers and surgically trained workers) the United States can achieve the best results in terms of sustainability, cost, and regional impact.
Following the September 11, 2001 terrorist attacks, the US military expanded its global health engagement as part of broader efforts to stabilize fragile states, formally designating “medical stability operations” as use of Department of Defense (DoD) medical assets to build or sustain indigenous health sector capacity. Medical stability operations have included medical assistance missions launched by US Africa Command and in other regions, deployment of hospital ships to deliver humanitarian assistance and build capacity, and health-related efforts in Afghanistan and Iraq. The public health impact of such initiatives, and their effectiveness in promoting stability is unclear. Moreover, humanitarian actors have expressed concern about military encroachment on the “humanitarian space,” potentially endangering aid workers and populations in need, and violating core principles of humanitarian assistance. The DoD should draw on existing data to determine whether, and under what conditions, health engagement promotes stability overseas and develop a shared understanding with humanitarian actors of core principles to guide its global health engagement.