4 Ideas for Smart Global Health

What do you get when you ask 25 leaders to come up with a 15-year strategic plan for the U.S. on global health?

New ideas for bureaucracy! Well, that plus a number of other thought-provoking recommendations. The Center for Strategic and International Studies (CSIS) asked a broad set of leaders for their best ideas on "smart" U.S. global health policy. Chaired by Retired Navy Admiral William J. Fallon and Helene Gayle, President and CEO of CARE (also a contributor to Change.org), CSIS's Commission released its final report yesterday.

Here are four points from it to consider:

1. Global health is smart power. "Smart power" is the Goldilocks of contemporary thinking on American power -- not too hard, not too soft. Just the right balance of strength and charm. This report positions global health as a key component of American charm and power. As its authors write, Americans understand that "promoting global health advances our basic humanitarian values in saving and enhancing lives." What's more, backing global health also helps in "bolstering U.S. national security and building constructive new partnerships."

Good for us and good for them, or so thinking goes. But not everyone agrees. Bill Easterly gives the "3D approach" -- the idea that development, defense, and diplomacy go hand-in-hand -- the grand prize for "worst in aid." To him and other critics, such an approach can skew spending decisions toward countries of strategic and military importance. Just see this pie chart, which wins a grand prize of a different sort.

2. Global health is a matter of national security. In a gross understatement, the report's authors admit that discussions about improved government coordination and efficiency "rarely excite or inspire the media or the public." But while their discussion of organizational reform isn't "exciting" or "inspiring" -- not by the terms' conventional meanings, anyway -- it's still informative. And if implemented, their recommendations will result in a bold shift in the U.S. approach to global health.

Based on my reading of the report, I've modified the Commission's graphic on the U.S. government's global health architecture (which the Commission modified from this Kaiser Family Foundation report) to show the new proposed organization (oddly, the report does not do this). While the authors note that they are not recommending a new government entity "per se," they do want to see a revamped structure that centralizes power and decision-making within the National Security Council.

That's right, not USAID. Not Health and Human Services. Not the CDC or the State Department. The NSC. In their vision, a deputy advisor at the NSC would lead a new "global health management team" that would translate goals into action. This deputy would also oversee a new "Interagency Council for Global Health" that would promote coordination and collaboration across government agencies.

3. The U.S. should double down on programs that target women and children. The Commission calls for doubling U.S. spending on women and children, asserting that $2 billion per year "will catalyze inspiring results." I suspect it would. This solid recommendation will be tweeted by many global health watchers.

What is most interesting about this announcement, however, is that the Commission proclaims that "direct U.S. investments are best focused on a few core countries in Africa and South Asia where there is clear need." True as this may be, it will be interesting to watch the tension between need-based and "smart" funding priorities unfold.

4. The demand for global health training on college campuses has exploded in recent years. But are tomorrow's global health leaders "smart"? Probably not. It is unlikely that freshman global health majors or recent MPH graduates would list a desire to promote U.S. diplomacy or defense interests as a core reason they want to train community health workers or spend hours in a lab researching cures for neglected topical diseases. The topic of American power -- soft, hard or smart -- is probably not featured prominently (if at all) in most global public health curricula. If the U.S. approach to global health is to be coordinated through the National Security Council and used more explicitly as a tool for promoting American interests and security, doing so might be a smart idea.

This report is a must-read for global health students and practitioners -- and anyone interested in the future of the U.S. approach to global health.

Photo Credit: DVIDSHUB