On October 15, 2008 the Department of China Studies at The Nixon Center hosted a roundtable discussion with U.S. Health and Human Services Secretary Mike Leavitt to discuss U.S. health diplomacy initiatives. Secretary Leavitt was joined by moderator Drew Thompson, Director of China Studies and Starr Senior Fellow at The Nixon Center, along with roundtable participants from the military, public and private sectors.

In an increasingly globalized world, the United States plays a vital role in international political, economic and social affairs. Since the 2004 Indian Ocean tsunami struck, U.S. health diplomacy efforts have intensified and expanded, supplementing U.S. support for multilateral institutions that address poverty and health issues, such as the World Bank and the United Nations. Referring to "Health Diplomacy" as America's "highest octane fuel for our soft power machine," Secretary Leavitt discussed his travels to Asia and Latin America, and the various initiatives he has overseen in his time in office.

American spending on global health care initiatives is roughly seven to nine times higher than it was less than ten years ago. In many cases, U.S. health diplomacy programs are high profile and targeted, like the President's Emergency Program for HIV/AIDS Relief (PEPFAR) or the President's Malaria Initiative. These two in particular compliment other multilateral programs, such as the Global Fund, serve to establish a global U.S. health presence, and protect American health and security interests at home and abroad.

Health diplomacy is an important component of the American arsenal against terrorism as well. By establishing the United States as a recognized global-health provider and bolstering the health-delivery systems of fragile states, America can counter efforts by terrorist organizations or other groups to undermine legitimate governments or threaten U.S. interests. In Iraq, al-Qaeda and other insurgents actively targeted the health system and medical relief efforts to challenge the legitimacy of the Iraqi government. Likewise, organizations such as Hamas and Hezbollah operate health clinics and ambulance services in order to pose as a legitimate political force in the communities where they operate. By bolstering a legitimate government's efforts to deliver public services, including health, the United States can contribute to international security.

Many U.S. medical assistance programs foster relationships and networks with regulators and laboratories in developing countries. These programs have the potential to prevent emerging infectious diseases, such as pandemic flu, from spreading around the world and overwhelming national health systems. China is an important stakeholder in the global effort to prevent infectious disease outbreaks from becoming pandemics. As a source point for Severe Acute Respiratory Syndrome (SARS) and Avian Influenza, establishing relationships between U.S. and Chinese health authorities is vital for the fast exchange of information and marshalling of resources to mitigate the impact of a future outbreak.

China quickly and effectively contained SARS, and likewise, China will come to terms with its food safety challenges. Recent crises, such as the contamination of products including toothpaste, animal feed and milk has led to an international call for unified product-safety standards, necessitating some fundamental changes. The creation of trustworthy regulatory inspection systems at the point of export is critical to ensuring the growth of trade in safe food and consumer products between China and the United States. In 2007, the United States and China signed Memorandums of Agreement to bolster cooperation to ensure effective oversight of trade in food, drugs and medical devices. Improving China's regulatory oversight, re-instilling confidence in the "Made in China" brand and protecting American consumers are mutual interests.

An outgrowth of the constructive bilateral dialogue is the agreement to open three Food and Drug Administration (FDA) offices in China. Experience from these efforts, as well technical exchanges and workshops with Chinese counterparts, can be applied to other nations as well. Building on these efforts, new offices in India, Jordan and Latin America will soon be opened. Hopefully these outposts can be expanded and become responsible for coordinating medical and health capacity building efforts in other developing nations.

These undertakings represent a new and positive phase in U.S.-China relations in which trust and cooperation trump ideological and cultural differences. This will benefit U.S. global health interests, Secretary Leavitt noted, because it will result in greater transparency and information exchange in important public health matters.

Globally, U.S. health-diplomacy efforts are undertaken by a myriad of government agencies and departments, NGOs and private companies. The next president will have the opportunity to increase the coordination of U.S. health-diplomatic efforts abroad. Since the 2004 tsunami relief effort, significant strides have been made to bolster civilian-military cooperation. One example is the Navy's humanitarian-assistance mission, which is based on the Navy's two hospital ships and several amphibious assault ships. Those vessels have provided free medical assistance at port calls in Asia and in Latin America, using civilian doctors provided by U.S. NGOs and dispensing free medicine donated by pharmaceutical corporations.

While medical missions carried out by Navy public-private partnerships are valuable and appreciated by the host countries, there is concern about what happens in a community after a vessel and its doctors departs. Recognizing that many developing nations have shortages of trained medical personnel, there is a pressing need for the creation of regional training centers. Secretary Leavitt described one such center, located in Panama, which is serving all of Central America. The center recently passed from U.S. hands into those of Central Americans, with the United States offering continued assistance, potentially serving as a model for similar centers elsewhere. Providing health training on a global level will require substantial cooperation and coordination between countries and provide a permanent visible presence for the United States.

Roundtable participants agreed that improved communications associated with health-diplomacy initiatives are necessary, including more effective branding of U.S. efforts. The military and civilian agencies and the private sector will have to make more of an effort to share in each other's successes. In many current aid efforts, numerous agency logos-which are meaningless to the aid recipient-are displayed on relief goods. These agencies need to create an "American brand" of global assistance, much like the slogan USAID prints on its relief supplies: "From the American People." Ideally, organizations should "speak as a chorus, not as a bunch of souls."

There is ample evidence that the effectiveness of disaster relief and health assistance improve public opinion. Linking these missions with effective communications and the "American brand" will increase the likelihood that U.S. interests are protected across the globe. For example, public opinion toward the United States in many Arab and Muslim countries noticeably improved following the 2004 tsunami response. In Pakistan, public opinion of the United States is generally low, with the exception of northern regions where America provided disaster relief following the earthquake in 2005.

U.S. diplomats play an important role in projecting American soft power through health programs. However, it remains an under-utilized asset, deserving greater resources and attention from different government sectors. Increased coordination and expanded efforts will help to ensure that American interests are protected globally through the application of health-diplomacy initiatives.

 

Drew Thompson is the Director of China Studies and Starr Senior Fellow at The Nixon Center. Sarah Bisceglie is an intern at The Nixon Center.