Global Health and the Future Role of the United States (2017) / Chapter Skim
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9 Global Health Leadership
9 Global Health Leadership
Pages 269-290
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in 2003, and the development of the Global Health Security Agenda (GHSA) in 2014, shows the continuing need for a U.S.
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efforts in global health diplomacy. This chapter opens with a review of the definitions and needs for global health governance, including the recent calls for reform of WHO following the 2014–2015 Ebola outbreak in West Africa, and newly established multilateral organizations.
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national level, WHO can no longer be the sole manager of these types of intergovernmental health challenges. Despite many criticisms, there is still a need for WHO, its strong convening power to coordinate the many new global health players, and its ability to set norms and standards in global health care (The PLOS Medicine Editors, 2007)
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. While nations must be held responsible for developing their own infrastructure to respond to emerging health threats, the commissions argued that WHO must coordinate global preparedness and hold nations accountable for its maintenance.
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Multiple assessments and commissions have called for improved funding for WHO (Gostin et al., 2016; Ebola Interim Assessment Panel, 2015) ; to ensure that countries have the capacity to implement and maintain the IHR, WHO has leveraged additional funding to help countries that need assistance.
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As multiple infectious disease outbreaks have immediately threatened global health security in the past several years, newer partnerships have been formed just since 2014, including the Coalition for Epidemic Preparedness Innovation (CEPI)
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By continuing to provide technical and financial assistance and collaborate with partners to help countries assess and improve their national health security capacities, together the world can more effectively contain outbreaks, as well as promote evidence-based plans for limiting the global spread of disease (Nuzzo and Shearer, 2017)
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Many opportunities like this still exist to protect American interests through development and soft-power diplomacy initiatives, and if the United States fails to act through the other two legs of the foreign policy stool, other countries are likely to fill this role instead. In the last few decades, China has quietly increased many of its health and development programs around the world, asserting itself as a powerful and committed leader both through bilateral programs and taking a leadership role in multilateral organizations.
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Department of State's efforts for pandemic response, and ensures that global health issues, such as emerging infectious diseases, global health security and antimicrobial resistance, are incorporated into U.S. foreign policy.
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TABLE 9-1 Bureaus and Offices in the U.S. Department of State That Explicitly Work on Global Health-Related 278 Issues Undersecretary for Economic Undersecretary of Civilian Growth, Energy, and the Undersecretary for Arms Control and Security, Democracy, and Human Undersecretary for Environment International Security Rights Political Affairs Bureau of Bureau of Bureau of Bureau of Bureau of Bureau of Regional Bureau of Economic Oceans and Arms Control, International Democracy, Population, Bureaus International and Business International Verification and Security and Human Rights, Refugees, and Organizations Affairs Environmental Compliance Nonproliferation and Labor Migration and Scientific Affairs Office of Office of Office of Office of the International International Chemical and Biological Policy Finance and Health and Biological Staff Development Biodefense Weapons Office of Cooperative Threat Reduction Office of Missile, Biological, and Chemical Nonproliferation Office of Threat Reduction SOURCES: ISAB, 2016; U.S.
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. In e mbassies that lack ESTH officers, the health portfolio is managed by economic officers.3 The neglect of global health in the Foreign Service career track system (which includes consular, economic, management, political, and public diplomacy)
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If the health programs were designed and measured for indicators beyond just health outcomes, their use and knowledge generation could be attractive to foreign policy experts and decision makers (Kevany, 2015)
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.5 Although the agreement itself was positive for health-related outcomes at the time, the ongoing relationship that was developed served as a platform for collaboration in the subsequent H5N1 and Ebola epidemics. During the H5N1 pandemic in 2005, this agreement enabled smoother sharing of information, and during the Ebola outbreak in 2014, the agreement clarified roles each country would play in the response (in which China built a treatment center in Liberia and a 60-bed hospital 4 Personal communication with Matthew Brown, NIH, January 5, 2017.
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population.9 Furthermore, due to the lack of a predictable and unified process of rotating HHS employees in and out of overseas positions, the department is unable to maintain institutional knowledge of overseas operations and is not flexible enough to meet its expanding global mandate.10 HHS has acknowledged this weakness, and in an American Journal of Tropical Medicine and Hygiene editorial, Nils Daulaire (former Assistant Secretary for OGA) stated that OGA is working to "establish a global health career track within HHS to formalize career opportunities and training for our staff working in global health, both domestically and internationally" (Daulaire, 2012)
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government has an inadequate workforce to meet its global health needs. Owing to the neglect of global health in the Foreign Service career track system and limited knowledge of health by ESTH officers, the U.S.
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Department of State as the track gets developed, and can lead to cooperation during outbreaks and global health emergencies in the future. An amendment of the Foreign Service Act by Congress to authorize HHS to use the Foreign Service Personnel System14 would also be a first step to developing a foreign service arm of HHS.
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By using the Foreign Service Personnel System, HHS can enable employees to pursue a career in global health in the short term. In the long term, this would systematically build a global health workforce -- a necessary prerequisite for HHS to develop a pool from which to draw future health attachés to support U.S.
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In the absence of a health career track in the Foreign Service, the demand for U.S. health expertise in host countries cannot be sustainably filled and those that are deployed often lack diplomacy skills.
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This new approach should include the com mitment of the U.S. Department of State to creating a global health career track and congressional action to enable the establishment of a cadre of global health experts within HHS through an amendment to the Foreign Service Act.
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2016. When health diplomacy serves foreign policy: Use of soft power to quell conflict and crises.
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2017a. Career tracks for foreign service officers.
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