Several weeks after 9/11, the world, once again, watched in horror as a series of anthrax-tainted packages mailed to two U.S. Democratic Senators killed five civilians. Since the deadly attacks, numerous U.S. government efforts such as the Joint FBI-CDC Criminal and Epidemiological Investigations have been established to predict and prevent incidences of bioterrorism. While the U.S. government has established protocols for the ‘weaponization’ of bio agents, there has been little consideration to use health diplomacy as a tool to prevent violent extremism.
Former Secretary of State, John Kerry, at White House Summit to Counter Violent Extremism (on usa.gov)
According to Wallin, part of being credible in U.S. public diplomacy (PD) is matching actions to words. Ironically, U.S. diplomats have previously addressed the importance of global health initiatives, but they appear to have fallen short on matching deeds to rhetoric. In 2009, Assistant Secretary of State Kerri-Ann Jones confirmed the explicit connection between global health and extremism. She revealed, “ better global health promotes stability and growth, which can deter the spread of extremism”. However, eight years have passed since that declaration, and little has been done to turn those words into practical diplomatic programs.
In our increasingly globalized world, infectious diseases ignore the Westphalia system of order: mosquitoes are not required to show their passports and American Exceptionalism is nullified. Currently, the U.S. government’s diplomatic programs do not mimic the shift in global health from this-is-your-country’s-problem to a global human security issue.
What is Global Health Diplomacy?
The Science and Diplomacy Report, “ Bridging Public Health and Foreign Affairs” loosely defines global health diplomacy (GHD) as “a political activity that meets the dual goals of improving public health infrastructures and strengthening relations among nation states”.
The definition of GHD highlights Nye’s concept of soft power diplomacy. In contrast to hard power, which is rooted in coercion and force, soft power is the ability to co-opt countries and set the agenda through attraction to shared values. A 2015 report by the International Institute for Counter-Terrorism argued that soft power initiatives are more effective at deterring terrorism than hard power ones as the programs are designed to understand the reasons behind extremism. If executed with respective cultural sensitivities in mind, GHD’s soft power approach could engage developing nations, rather than alienate them.
Centers for Disease Control and Prevention Global Health Security Campaign (usa.gov)
The Connection Between Violence and Epidemics:
One reason to explain why GHD has been overlooked is because the explicit connection between extremism and epidemics has not been extensively examined.
A recent Foreign Policy article: “ The Ebola Rape Epidemic No One’s Talking About” captures this grave oversight. Once the World Health Organization declared that the 2014 Ebola outbreak in West Africa was contained, the region saw an immediate surge in gender-based violence. Monica Onyango, professor of global health at Boston University, claims that epidemics create permissible conditions for internal hostility. She states: “you have a loss of governance; you have chaos and instability”- the state of the post-epidemic environment leaves the population vulnerable to violence.
While NGOs and other nonprofits may be constrained by funding and have to vacate the area once the epidemic is declared to be ‘contained’, GHD could have an immediate impact on diminishing the rise in violence that occurs in a post-epidemic setting.
Why the Global Health Diplomacy Framework is Different:
Georgetown University recently published one of the first explicit reports on countering violent extremism through the use of the public health model. A significant finding: the GHD Framework is different because it uses both a multi-sector and non-discriminatory approaches to counter violent extremism (CVE). Moreover, the report found that violent extremists are often drug users. Applying the public health model to CVE addresses structural social issues for violent extremism. Additionally, public health models aim to mitigate immediate risks such as rehabilitating drug users.
The Build Resistance Against Violent Extremism (BRAVE) public health model in Maryland uses both a multi-sector and non-discriminatory approach to CVE. This framework goes beyond profiling specific individuals and focuses on multiple risk factors including specialized treatment plans for drug abusers, health education, poverty, literacy, and social inclusion. Contrary to the targeted U.S. Homeland Security initiatives to CVE, BRAVE allows anyone to participate in the program regardless of their race and religious backgrounds. This inclusive approach mitigates threats that do not fit a standard profile. The Georgetown Report concludes that the BRAVE model had a “positive effect on 12 of 14 CVE-related indicators in individuals”.
Although BRAVE is only a case study, it demonstrates that there is a potential place for GHD in CVE.
Recommendations:
U.S. Global Health Diplomats exist, but they are few and far between. Dr. Deborah L. Birx, is the current U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy.
Dr. Deborah L. Birx, current U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy with Former Secretary of State, John Kerry (usa.gov).
Her esteemed diplomatic status of Ambassador-at-Large could indicate that the State Department has an appreciation of GHD. However, from an operational perspective, the State Department offices do not always have the necessary expertise to converge global health and diplomacy: the expert epidemiologists are not always aware of the tools that are at their disposal.
In order for GHD to counter violent extremism:
- More high-ranking Global Health Diplomats are required, specifically, more joint collaboration between U.S. Security Departments and Health Departments need to be established.
- More GHD attachés are needed to coordinate the large sums of funds from the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
- In order to counter violent extremism through GHD, more coordination between the World Health Organization, nongovernmental organizations and the State Department is needed.
A priority for the new U.S. government is to deter violent extremism both at home and abroad. Before Congress approves the budget to cut the funding for the U.S. Agency for international Development’s health programs, they should reconsider these development projects as they may have the potential to thwart violent extremism.
Caveat: The views expressed in this blog are the author’s own and do not necessarily reflect those of the Institute for Public Diplomacy and Global Communication or the George Washington University.
This blog brings up a very interesting connection that most probably wouldn’t think of. I wonder, though, if the new administration will be looking at this as something to pursue, when the Obama administration didn’t really do much even after Jones’ comments. Are there any specific reasons the Obama administration didn’t act on this, and why the Trump administration is more or less likely to do so?
I completely agree! I feel strongly about the connection between poverty, clean water access, inequality, etc., and violent extremism, but I hadn’t given enough thought to global health and epidemics specifically. I see increased US efforts as providing a 2-part benefit: bolstering our global credibility as we establish ourselves as leaders in global health and stopping the empirically-proven roots of extremist recruitment before they escalate. This provides another strong argument for the improvement of general global development efforts with the policy goal of CVE.
Prior to reading this piece, I’d never thought about the ways in which epidemics and extremism are connected and found your explanation to be thought-provoking and insightful. I was also relatively unfamiliar with the Global Health Diplomacy Framework. This blog post clearly and succinctly laid out the reasons why the GHD is important, especially to countering violent extremism. Here is a Health Affairs Blog that similarly discusses PEPFAR’s far-reaching impact: http://healthaffairs.org/blog/2017/04/17/the-future-of-investment-in-pepfar-understanding-pepfars-multiple-economic-health-and-diplomatic-impacts/.
Lola, this is a very interesting topic. I definitely think the Global Public Health plays a vital role in the security of states. You mentioned gender-based violences that happened in West African countries following the Ebola outbreak. While there definitely needs to be more than one Public Health Ambassador at Large, I would be interested to hear further about strategically where their work would be seen as vital. Are the more regions than others than need this type of support?
This is a really great point and needs to be more salient in our national/global discussion of countering violent extremism; there is no doubt a correlation between disease and conflict. This article, which also addresses PEPFAR, makes a similar argument in framing U.S. intervention in health crises as almost both soft and hard power initiatives: http://healthaffairs.org/blog/2017/04/17/the-future-of-investment-in-pepfar-understanding-pepfars-multiple-economic-health-and-diplomatic-impacts/ Also “mosquitoes are not required to show their passports” – such a great line!
This is a very interesting gap that you have highlighted and one that I think the U.S. would be wise to act upon. I think that as you mentioned this is strongly correlated with the idea of soft power and can help with the prevention aspect of CVE by mitigating some of the petri dishes that cultivate extremism. Your topic also serves to amplify the ways that the proposed budget would ultimately harm U.S. interests, as there are so many ways that the State Dept. could use more resources.
I think blog addresses an important area of CVE literature and potentially presents a framework to spur investment in global public health initiatives. Becuase there is consistently more funding and attention put on CVE, the mechanism you propose can serve as both a way to improve public health and counter-CVE, a true win0win situation. I would suggest you look at Egypt as a case study, as I believe there are important facts about Egypt’s public health situation and violent extremism that would lend themselves to this approach. This report may be helpful in that analysis: http://www.nationalacademies.org/hmd/Reports/2017/countering-violent-extremism-through-public-health-practice.aspx
Lola,
Thank you for your informative article on global health diplomats and how this framework can help work as a CVE measure. One of your best recommendations, I believe, is better coordination with the World Health Organization. One of the best things they do is organize discussion and standard practices in one organization and allow for an exchange of information. Although I’m not sure if these count as public diplomacy, the journals on the WHO website are an interesting read and could be expanded to reach more people: http://www.who.int/publications/journals/en/
An interesting article you may be interested in is this article on health diplomacy in Africa (http://www.aho.afro.who.int/en/ahm/issue/15/news-and-events/health-diplomacy-intensified-improve-africa%E2%80%99s-health) in the African Health Monitor.