DOD'S ROLE IN GLOBAL HEALTH

FROM: U.S. DEPARTMENT OF DEFENSE

DOD Plays Supporting Role in U.S. Global Health Efforts
By Cheryl Pellerin
American Forces Press Service

WASHINGTON, May 16, 2013 - The Defense Department supports U.S. global health activities because such efforts as preventing and containing lethal outbreaks align with DOD's mission to help ensure geopolitical stability and security, a senior defense official said here today.

Kathleen H. Hicks, principal deputy undersecretary of defense for policy, discussed DOD's role in global health here before an audience at the Henry J. Kaiser Family Foundation, a private health-policy analysis and research organization.

"DOD performs an important role in supporting the U.S. interagency response to human-made and natural disasters. ... In such situations, our military draws upon its incredible logistical capabilities -- providing air and sea transport for medicines, equipment and personnel," Hicks said.

DOD also serves the public health mission by maintaining an international network of laboratories and technologies, therapies and medical expertise, she added, all of which can be used in support of public-health efforts in the United States and abroad.

In its support of global public health activities, Hicks said, DOD must recognize the roles of federal agencies such as the State Department and the U.S. Agency for International Development, and recognize the importance of helping partner countries take the lead in protecting the health of their own people.

"We at DOD need templates to understand how to best engage with our fellow government agencies and our foreign partners in the complex and vital work of protecting public health in actual and potential crisis situations," Hicks noted.

Four years ago, Hicks and two colleagues published an analysis of DOD's global health engagement activities. It addressed DOD's role in global health, including the effect of the department's health activities on national and regional security, the principal deputy undersecretary said.

"That paper's recommendations included creating a strategy for global health engagement [and] a health-security cooperation plan to guide our efforts to build the public health and medical capacity of partner militaries," she said.

Above all, Hicks added, "our analysis underscored the importance of ensuring that we do a better job of synchronizing our efforts, not only with our fellow government agencies but also among our own commands and components worldwide."

Since the study was published, she said, there have been improvements in DOD coordination with the State Department and USAID, coordination within DOD, and incorporating humanitarian and global health scenarios in military exercises.

Over the past year, Hicks added, the department has made significant strides in establishing measures of effectiveness for its global-health-related activities.

"Already in 2013," she added, "there have been at least two noteworthy examples of how we used global-health engagement to help partner nations address an urgent health need."

The first occurred after a January nightclub fire in Santa Maria, Brazil, that killed 241 people, the principal deputy undersecretary said.

Brazil's Ministry of Health put out an urgent request to the U.S. government for medicine kits that could treat victims suffering from cyanide toxicity due to inhaling fumes from burning acoustic foam.

After determining that no other agency could respond in time to help, she said, U.S. Southern Command coordinated transport of the medication from St. Louis to Brazil via Miami by working with Miami-Dade aviation officials, the Transportation Security Administration and American Airlines, which flew the medicine to Brazil free of charge.

"This was a great example of public and private collaboration," Hicks said, "exactly the kind of collaboration we are likely to need as we continue to respond to urgent crises of all kinds."

In April, another health emergency occurred after a measles outbreak in Georgia. Responding to a request from that nation's Health Ministry to the U.S. Embassy in Tbilisi, the Defense Department funded 75,000 emergency vaccinations. UNICEF handled the procurement and the Georgian National Center for Disease Control distributed the vaccine, she said.

"While we need to continue to work with our partners to hone our responses to such crises, we also need to plan for future challenges," Hicks said, adding that an excellent example is an upcoming event sponsored by the Association of Southeast Asian Nations, or ASEAN.

The Humanitarian Assistance and Disaster Relief/Military Medicine Field Training Exercise will take place in June in Brunei and include 18 countries from Southeast Asia and elsewhere, including the United States.

It also will include an exchange of U.S. and Chinese medical officers, she noted. Hicks said three U.S. officers will spend the exercise aboard a Chinese ship, and three Chinese medical officers will be assigned to a U.S. medical treatment facility, "[working] together in advancing a global good: the health of the world's citizens."

To counter diseases and other threats to public health, Hicks said, the United States teams with countries worldwide.

The Defense HIV/AIDS Prevention Program, for example, is a military-to-military health-engagement program with a direct effect on security, she said.

Over the past four years, Hicks added, in collaboration with the Naval Medical Center San Diego and partner universities, the program has trained providers in 50 militaries around the world and helped strengthen HIV-prevention programs in the trainees' home countries.

Last summer the program hosted a major international military HIV/AIDS conference, bringing together military representatives from 75 countries, along with many government agencies and international organizations, she said.
The focus on infectious diseases has been a hallmark of DOD international public-health efforts over the past decade, Hicks said, but the department should consider expanding its efforts to include health concerns like malnutrition and disrupted access to clean water.

"The expertise and responsibility for dealing with these conditions obviously falls well outside the Department of Defense," she said. "However, we at the Pentagon do have a legitimate interest in the degree to which these conditions impair the security and stability of key countries."

Hicks said a 2008 National Intelligence Council study found that while noninfectious conditions may not present direct threats to U.S. interests, they can have wide-ranging effects on global health.

According to the study, she said, the United States should expand the focus of its global health program to include noncommunicable diseases, neglected tropical diseases, malnutrition and maternal and child health and mortality.

"Shifting DOD's global health engagement activities more in favor of building the public health capacity of partner nations' militaries, and toward synchronizing our efforts with the State Department and its health diplomacy and USAID's health development efforts," Hicks added, "would create a synergy beneficial to global health and potentially beneficial to global and national security."