At the end of February, I had the pleasure of speaking about global health diplomacy at the Nursing Leadership in Global Health Symposium at Vanderbilt University. Nurses are one of the specialties that we support in the Frist Global Health Leaders program facilitated by Hope Through Healing Hands, a nonprofit dedicated to advancing peace by supporting health care services and education in some of the world’s most vulnerable communities. Nurses, including the men and women I met at Vanderbilt, have an enormous opportunity to affect health and global health diplomacy. Indeed, everyone in the medical profession can play a crucial role in health diplomacy.
Global Health Diplomacy And Foreign Policy
For several years now I’ve been thinking about—and speaking about—global health diplomacy. The term started appearing around 2000 and has many definitions, representing the complexity of the issue itself. Diplomacy, at the simplest level, is a tool used in negotiating foreign policy. Health diplomacy is different, though. As a physician, the overall goal of health is clear: improve quality of life by improving health and meeting overall patient goals of care. As a diplomat and policymaker, the goal is more complicated.
Foreign policy, in general, is a dance—a negotiation of shared goals and identification of conflicts between nations, always with inherent tension. For example, what we want for the government of Afghanistan may not align with their complex political and cultural ideologies.
When health is involved, the proposal is made more complicated by the U.S.’s past use of health initiatives as cover for military operations, which only fosters distrust of health workers.
However, the health that all nations theoretically want for their populations is more aligned than our political goals, and we need to take advantage of that. We need to use global health diplomacy as a tool for overall negotiations in foreign policy.
I and other leaders have long recognized that the United States must seize the mantle of using global health as a vital diplomatic instrument to strengthen confidence in America’s intent and ability to bring long-term improvements to citizen’s lives among our partners. The fight for global health can be the calling card of our nation’s character in the eyes of the world.
Federal Budget Priorities
This principle has been recognized in U.S. foreign policy for a century or more, but never more than right now. The FY2014 budget allots $9.1 billion to global health programs, which is the highest ever historical level. This encompasses PEPFAR, the President’s Emergency Plan for AIDS Relief; President Obama’s Global Health Initiative; and more.
But compared to that $9.1 billion, in 2012, the U.S. spent almost $1 trillion on Medicare and Medicaid (in federal spending and state matching). Not that the U.S. is a model of the most efficient health care spending—though we should certainly aspire to be—but the numbers re-enforce that there is plenty of opportunity for work to be done.
We must be excellent stewards of what resources we have, and judiciously use these funds at the most impactful points. This message has never been more relevant than in our personal climate of health care reform.
Of course, the federal government certainly cannot go it alone. This work needs to be shared by NGOs and other private entities. For example, Hope Through Healing Hands has partnered with the Bill and Melinda Gates Foundation to launch the Faith-Based Coalition for Health Mothers and Children Worldwide to focus specifically on maternal, newborn, and child health and family planning.
So what does this mean for nurses and other medical professionals, both at home and working abroad?
It means we need leadership to determine the best way to apply global health funds. Advocacy is not just about asking for more funding and support. Stakeholders can help guide our nation’s leaders in the allocation of funding to achieve more impact for the dollars spent.
At Vanderbilt, I challenged those in the audience to take advantage of their unique position and advocate for global health, and I think it’s a role for all of us.
Health workers are the often on the frontlines of culture. They see, feel, and touch patients; hear their stories; and share their pain. All health workers can bring their own experiences—along with relevant facts and statistics—to their representative policymakers.
I encourage you to take a trip to D.C. and visit your congressmen and women in person, if possible. As a former Majority Leader of the US Senate, I have received many of these visits; I know these stories bring realism to the issues and foster the empathy necessary to lead the crusade for funding and support.
I also know it was the stories I shared in the Oval Office with President Bush that played a critical role in moving forward the legislation that eventually became PEPFAR.
It is also these stories and facts that help us better tailor spending and policy objectives to be more impactful with our dollars. The workers on the ground see the needs and the gaps in care so they must talk about it!
As we all know, the funding is not the sole responsibility of government. Advocates should not limit their attention to elected officials. Find the NGOs that already support your specific cause and appeal to them as well for expansion or change in the areas you know it is most needed.
I am so excited about the evolution of global health diplomacy. It is not a new concept, but a growing one, one that will change the way we interface with the world as a nation, and at the same time, improve the health of the global citizenry.
Competing interests and potential conflicts threaten to sideline health diplomacy efforts, and the only way to keep making it work is to focus on the facts and keep identifying the most important needs. Funding for funding’s sake is a waste.
That’s where our experiences as health care workers are so crucial.
Our greatest role in global health diplomacy is to share our stories, and to offer guidance to lawmakers and NGOs to help them make the biggest difference with what resources they have.
Editor’s note: The topic of global health diplomacy is also addressed in an article published in the July 2012 PEPFAR-themed issue of Health Affairs.