Why Health is Important to US Foreign Policy

It is no longer possible to dismiss health problems in other countries as a “soft” factor in US foreign policy. These problems have come to the fore as the global transmission of disease becomes a risk for Americans and with increasing documentation of the links between health problems in other countries and American security, prosperity, and interest in economic development abroad. Nationally, Americans are at great risk from emerging and reemerging infectious diseases. Infectious diseases are resurgent globally; they spread more easily as national borders become porous under economic globalization, and they are more difficult to treat because of the alarming proliferation of drug-resistant microorganisms. In the international arena, these diseases threaten ordered existence by exacerbating political instability, disenfranchising those without social capital, and stunting economic growth. The result is to make countries more vulnerable to violence and war and to aggravate their effects. American Intervention Would Be Welcomed These challenges offer a great opportunity. In many regions of importance to the United States, its leadership is resented or resisted. Public health, however, is a unique site in foreign policy. Here US leadership in international health affairs can provide an unequivocally positive framework for pursuing what is in our interest as well as that of the world. It can be an important component of a response to the inequities of globalization. The annual cost of such a health initiative on behalf of the two billion people who now live on less than two dollars a day is estimated to be 15 dollars per recipient. By comparison, an average of $4,000 is spent annually for health care for each American. With strong leadership by the US, other donors in the public and private sectors, as well as developing countries themselves, should be able to assume a significant portion of the costs. Recommendations For reasons of narrow self-interest, enlightened self-interest, and humanitarian interests, the US government should consider health as an integral part in its foreign policy. In order to effectively address global health issues, the administration should: ▪ Create an interagency structure on global health headed by a senior government official with broad representation from a variety of departments and agencies. ▪ Work closely with Congress to identify priorities that will gain bipartisan support. ▪ Work with representatives from business and nonprofit organizations to create a strategic action plan and multiyear budget projections. ▪ Assign health attaches to US embassies and missions or make them available to work within government bureaucracies in South Africa, Nigeria, Russia, India, China, Ukraine, Mexico, and Brazil to increase attention to health issues in these critically important countries. ▪ Conduct policy research and analysis to (1) determine how health and health care affect political stability in countries of clear US interest; (2) assess health risks in countries deemed critical to US national security and determine effective interventions; (3) work with the World Health Organization to identify projects in which investments in improving and maintaining health can spur development; and (4) support research for vaccine and other health technology. Giving higher priority to international health in foreign policy is good for the United States and good for the world—an issue on which there can be widespread agreement. This article is adapted with permission from a longer report with the same name published by the Council on Foreign Relations and the Milbank Memorial Fund, which was the result of conversatio increasing understanding of the world anns and meetings initiated by the Council and the Fund beginning about two years ago. The Council on Foreign Relations, founded in 1921, is a nonpartisan membership organization, research center, and publisher (of Foreign Affairs, considered the leading journal on global issues), dedicated tod contributing ideas to US foreign policy. The Milbank Memorial Fund, founded in 1905, is an endowed national foundation dedicated to innovation in health and social policy by nonpartisan analysis, study, research, and education. Copies of the full report may be requested from the Milbank Memorial Fund, 645 Madison Ave., 15th Fl., New York, NY 10022; (212) 355-8400; e-mail:[email protected]; or accessed on the Web atwww.milbank.org