Health Diplomacy: A Prescription for Peace

by Susan J. Blumenthal and Elise Schlissel

A recent poll by the Pew Foundation indicates a new trend in how Americans view the merits of military engagement. That survey of Americans' political and social values reveals that belief in the effectiveness of military power as a foreign policy tool has dropped to the lowest point in the last 20 years, with only 49 percent of those polled believing military strength is the best way to achieve peace.

This diminished confidence in military intervention as a cornerstone of international relations raises an obvious question: What other tools are available to advance U.S. interests in the world? Health diplomacy is an important and underutilized instrument in our nation's foreign policy toolbox. It can be a powerful playing field for diplomacy -- one organized around the possibility of sharing knowledge, tools and other resources to improve global health.

Just as diplomats have hammered out treaties over the centuries to build bridges between once-warring nations, public health officials and humanitarian organizations have begun sharing best practices and technology in an effort to build a new kind of bridge between countries to foster peace and development around the world.

Americans have only returned to recognizing that improving global health, in terms of preventing and treating both infectious and chronic diseases, must be a public policy priority. This is partly because infectious disease is a threat the United States thought it had left behind long ago. The triumph of public health interventions in the 20th century led the surgeon general at the time, Dr. William H. Stewart, to announce in 1967 that it was time for the United States to "close the book on infectious disease" and turn its attention to chronic diseases like cancer. Smallpox was nearly eradicated, AIDS was an undreamed of threat, and we were not thinking globally.

However, history has shown us Dr. Stewart's statement was premature -- it turned out to be a medical mirage In fact, since his declaration, more than 39 new diseases have emerged, including AIDS, Ebola, Lyme disease, West Nile encephalitis, SARS and H5N1 avian flu. A recent report by the World Health Organization (WHO) found new diseases are emerging at a "historically unprecedented" rate of one per year. In the last five years alone, WHO has documented more than 1,100 epidemics including bird flu, polio and cholera.

Today's three leading infectious diseases, HIV/AIDS, malaria and TB, together are responsible for six million deaths each year. Yet it wasn't until the terrorist attacks of September 11, 2001, followed by the anthrax attacks against our nation that many Americans realized infectious diseases remain a major threat to U.S. security.

But in the 21st century, infectious disease is not the only health concern nations must address. With the spread of tobacco use, obesity and other health-damaging behaviors, 60 percent of deaths worldwide are due to chronic illnesses including heart and lung disease, cancer, stroke and diabetes. In the United States, 7 in 10 deaths yearly are attributable to these conditions. Also, the safety of our food, water supply and the environment does not respect national borders.

Why, then, with so many deaths and such an impact on every nation's economy and national security, has such limited attention been paid to health threats diplomatically?

First, disease in the developing world is often not granted the focus it merits largely because it is viewed as a problem "over there." More than 63 percent of people infected with HIV live in Africa and 79 percent of the chronic disease burden is in the developing world. Whether "over there" is Africa, Southeast Asia or Latin America, inhabitants of the United States for far too long have seen little reason to worry. But Americans -- and the world -- have much to gain from increasing their focus on global health.

Health diplomacy is a means of self-preservation in an increasingly interconnected global community. AIDS, SARS, H5N1 avian influenza, and TB -- the list goes on and on -- are only a jet plane away from America's shores. For decades, AIDS and tuberculosis have been major threats to the health of people in the U.S. But just as diseases can cross borders easily today, so can solutions. Globalization facilitates the rapid response to health problems between rich and poor nations by quick mobilization of health professionals, medicines and supplies, and deployment of information technology for surveillance of diseases and the sharing of health information and best practices worldwide. As the recent WHO report underscores, this kind of exchange and cooperation is one of the most important routes to health security.

The tools of health diplomacy also can increase the so-called "smart power" of the United States abroad. The United States spent $571.6 billion on defense last year alone, but it spends only 0.16 percent of its gross national product on global health and development, the least of any major industrialized nation. We must devote more of our nation's resources to improving global health -- not just to repair damage caused by natural disasters and war, but to "win the hearts and minds" of people around the world by helping prevent the social and political discord that results from diseases and disasters globally.

For example, the tsunami relief efforts in Indonesia: A poll found that after the visit of two former U.S. presidents coupled with a commitment to invest significant funds in rebuilding communities, support for the United States rose from 36 percent to 60 percent virtually overnight in the world's largest Muslim country, while support for Osama bin Laden dropped from 58 percent to 28 percent. Governmental and private sector initiatives can build lifesaving bridges across nations. With 40 million people currently infected with HIV and 25 million deaths globally since the beginning of the epidemic, programs of PEPFAR, the Gates Foundation, the Global Fund to Fight AIDS, TB and Malaria, and amfAR, the Foundation for AIDS Research, can make a lifesaving difference. For example, in Asia -- one of the major frontiers of the pandemic -- amfAR is supporting cooperative HIV/AIDS research, education and service delivery programs through its continent-wide TREAT Asia network.

Were America to marshal fully its medical expertise, financial support and compassionate leadership to fight infectious and chronic diseases, just think what effect this would have on international opinion and on improving health and creating hope for people around the world.

Health diplomacy also offers a much-needed opportunity for building bridges between the governments of the world and the private sector, synergizing efforts of nongovernmental organizations (NGOs) and allowing them to work together to improve public health.

Building such links between nations can facilitate communications in other areas, increasing trust and confidence and helping improve overall relations. Countries cannot achieve political stability or flourish economically with unhealthy people and when average life expectancy is 38, as is the case in some African nations. Lasting peace is impossible where there are extreme disparities in health and wealth. That is why health can be a common currency among nations that helps to achieve a better future, reducing inequalities that lead to hopelessness, anger and despair.

The growing dissatisfaction among Americans about our over-reliance on military power internationally reminds us of the potential of the field of health diplomacy for improving global health and cooperation. And the words of President John F. Kennedy remind us why this agenda is so important: "Our most basic common link is that we all inhabit this small planet. We all breathe the same air. We all cherish our children's future. And we are all mortal."

Our common quest for good health knows no borders. Crossing countries, politics and cultures, health diplomacy recognizes the increasing interdependence of nations and our shared humanity.

*Rear Admiral Susan J. Blumenthal, M.D. (ret.) served as Assistant Surgeon General of the United States and Deputy Assistant Secretary for Health in the U.S. Department of Health and Human Services. She is Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research, and a Clinical Professor at Georgetown and Tufts University Schools of Medicine.

Elise Schlissel, a junior at Princeton University in the Woodrow Wilson School of Public and International Affairs, served as a heath policy intern a the Center for the Study of the Presidency (CSP) .