Make World Health
the New Marshall Plan
| By Robert E. Hunter, C. Ross Anthony, and Nicole Lurie |
Robert Hunter is former U.S. ambassador to NATO and a senior adviser at RAND. Ross Anthony is associate director of the Center for Domestic and International Health Security at RAND. Nicole Lurie, the center's associate director for public health, is a physician at RAND and Paul O'Neill Alcoa Professor of Policy Analysis.
Today presents a historically unmatched opportunity for the United States and other advanced nations to take the lead in sharing their capabilities in health and health care with millions of people around the world, especially in poorer countries. Such a vision can become an inspiration of the age—comparable to the vision that created the Marshall Plan for Europe at a time not only of great need but also of great determination to make a fundamental difference in people's lives and in the world's future.
For this idea to take hold, though, something else must happen: an awareness that promoting health abroad is not just a matter of "doing good" or of advancing moral purposes about the future of humanity. Rather, promoting health abroad is also a critical aspect of foreign policy and, indeed, of national security—both for now and for the future.
To shape a world congenial to the United States, the American people must put behind them any antiquated illusions of retreating from world affairs and become truly internationalist. This fact was obvious to most, though not all, Americans prior to Sept. 11. Now, the perception should be inescapable. Along with the rest of the world, the United States has entered a new era. Isolation and insulation are gone forever.
For the United States, the challenge today is to turn its unprecedented, incipient power and position in the postcold war world into lasting purpose and influence by building institutions, attitudes, and relationships that will work for us over the decades ahead because they also work for and benefit others. For America's friends and allies in Europe, helping to turn such a vision into reality will be a critical test of whether the European Union can fulfill its own promise as a major actor in shaping the world of the 21st century. Other U.S. partners in Asia—such as Australia, Japan, and South Korea—are also increasingly concerned with developments in the outside world that relate to health issues.
In this swiftly globalizing world, health issues have risen in significance and must now be integrated into the broad structure of national security. The United States may have the world's most powerful military forces, but they will not suffice if the country can be attacked by bioterrorists or if drug-resistant diseases, crossing borders with migrants and travelers, cannot be contained. The United States may have the world's most powerful economy, but that will not suffice if income disparities continue to widen, health deteriorates, and hopelessness spreads—eroding stability within countries, reducing their ability to play a positive role in the world, and fueling support for terrorism.
How Health Changes the World
Better health care is a vital seed of global security. Better health care leads to better-nourished mothers and children, thus lowering infant and child mortality rates. The lower mortality rates, in turn, will ultimately reduce fertility, limit population growth, and raise per capita income. Rising incomes will further improve health status, as individuals are better fed, housed, and educated—and as countries and individuals invest more in public and curative health. Better health, stable population growth, higher incomes, and more education will produce societies that are more likely to be democratic, peaceful, socially tolerant, and valued partners in the world community. These developments would certainly enhance our security and that of other countries.
 AP/WIDE WORLD PHOTOS/B.K. BANGASH Caught in the crossfire: Amina Bibi, an Afghan refugee mother, holds her malnourished child in Islamabad, Pakistan, at the departure point for Afghanistan on June 19. Bibi was looking for medical help for her child before embarking on the long journey back home. |
In contrast, deteriorating health and a dearth of health care in much of the world cripple our own country as well as others. The cross-border spread of disease poses increasing dangers to public health at home as people travel more freely around the globe. In broader terms, poor health hinders the ability of governments to deal effectively with other national challenges, such as education, crime, ethnic tensions, economic development, and political stability. In Afghanistan and large parts of the Middle East, health and health care are woefully inadequate. This predicament stalls economic development, fuels misery and alienation, impedes governance, and helps to breed violence and terrorism.
But now is the moment of opportunity. The United States and the countries of the European Union together represent the largest repository of resources, skills, talents, potential leadership, and international interest in dealing with health as a matter of foreign policy and national security. These countries hold a historically unmatched capacity—in terms of their economic development, sophisticated health systems, medical knowledge, advanced drugs, and other therapies—to make positive contributions to poorer countries facing temporary or chronic health challenges.
For the United States in particular, such an initiative would help offset perceptions of America as a "hegemon," by demonstrating to the world that the United States is taking the lead, with its European partners, to address basic human needs that are no respecters of nationality, geography, doctrine, creed, or ideology. At issue is whether the need will be recognized, the leadership developed, effective means of delivery devised, and the resources mobilized.
First Patient: Pakistan
Pakistan is an excellent example of how we could use health as a foreign policy tool. The foreign policy stakes in Pakistan are extremely high. It has become a key ally in the fight against terrorism in Afghanistan and beyond. It is hard to conceive of long-term success in Afghanistan without the active support of Pakistan. The country is a nuclear power in confrontation with India, another nuclear power. Pakistan is also a poor country with tremendous health needs and few resources to meet them. For these reasons, U.S. foreign policy seeks to promote a stable Pakistani society—economically, politically, and socially—and to strengthen its ability to deal with extremism and the seedbeds of terrorism.
 AP/WIDE WORLD PHOTOS/P. ANIL KUMAR Not the most advanced treatment: An asthma patient is administered traditional medicine inside a live fish at a clinic in Hyderabad, India, on June 8. The medicine is given out only once a year on an auspicious day determined by astrological calculations. Nearly 700,000 patients were expected to receive the treatment this year. |
Health is a critical tool for achieving these goals. Health-based efforts in Pakistan could involve health education programs, provision of clean water and sanitation systems, and concurrent initiatives to build cultural bridges, reduce regional risks, and spur economic and military cooperation with the West. Specific efforts could include the following:
Many other interventions are possible. What is important is to set the correct criteria, namely: Are the health interventions likely to fulfill Western foreign policy objectives while at the same time fulfilling the basic human needs of the Pakistani people? Designing health policies in ways that increase human and group freedom can lead to lasting change abroad consistent with our foreign policy objectives.
Since the terrorist attacks, America's first task has been to defend the nation and to end the scourge of international terrorism. The American people are doing what they have always done at times of crisis: They are acting decisively to defend their vital interests and fundamental, democratic values. But at times of crisis, the American people have also done much more: They have seized the moment to create a vision of something far better for the future, even if it cannot be realized at once.
Making health and health care a centerpiece of U.S. foreign policy would call on the best that America has to offer. Treating health as foreign policy is the positive vision of a better world that should complement the defensive actions that we must now take against terrorism. Compared to health, no other area today offers the United States a greater chance to pursue a purposeful vision of the future, to exercise leadership, and to promote our core values and interests. If we are wise—and rarely has wisdom been more called for—promoting health and health care will play a steadily increasing role in our foreign policy.