Global Health Concepts, and Engagements: Significant Enhancer for U.S. Security and International Diplomacy

By Aizen J. Marrogi and Edwin Burkett

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Colonel Aizen J. Marrogi, USAR, MD, is a Command Surgeon with the 352nd Civil Affairs Unit at Fort Meade, Maryland, and Faculty Member at the Uniformed Services University (USU) in Bethesda, Maryland. Colonel Edwin Burkett, USAF, MD, MBA, FAAP, is the Director of the Global Health Division and Assistant Professor in the Department of Preventive Medicine and Biometrics at USU. He is also a Family Physician, Flight Surgeon, and Air Force International Health Specialist.

Jan. 1, 2016 — The United States and its global allies face a multitude of challenges to peace and stability. Civil wars in Syria, Yemen, Ukraine, and parts of Africa compound sectarian disorder in the aftermath of U.S. operations and subsequent withdrawal from Iraq and Afghanistan. Moreover, decades-old Israeli-Palestinian conflict, political unrest in Egypt and Turkey, and Iran’s attempts to dominate the region—countered by pushback from Saudi Arabia and Gulf allies—contribute to geopolitical turmoil. Compounding matters are the emergence of Daesh (the Islamic State of Iraq and the Levant) and other extreme theocratic groups and the uprooting of more than 9 million human beings, causing a complex humanitarian catastrophe rarely witnessed in modern times. Against these overwhelming difficulties, Muslims, Arabs, and the rest of the world expect and anticipate U.S. forward engagement to help resolve many of these threats.

Over the last 200 years, the United States has engaged in foreign conflicts against state and nonstate actors, with successful outcomes against the former (Spanish- and Mexican-American wars, World War I, World War II, and the Gulf wars) and guarded withdrawals when facing the latter (pirates of Tripoli, Red Russians, and Vietnam). Where the United States has failed to achieve full military and political victory has been against nonstate actors and groups with strong ideological convictions and motivations (current engagements with Daesh and the Taliban appear to follow these lines). The challenge for U.S. leaders is how to win asymmetric kinetic wars against a motivated enemy who either intimidates or has the sympathy of the local population. In accordance with stability and counterinsurgency principles, efforts to win must be directed at the population as the center of gravity.

Medical team members provide emergency room support as part of New Horizons Honduras 2015 training exercise, improving joint training readiness of U.S. and partner nation civil engineers, medical professionals, and support personnel through humanitarian assistance activities, August 7, 2015 (U.S. Air Force/David J. Murphy)

Medical team members provide emergency room support as part of New Horizons Honduras 2015 training exercise, improving joint training readiness of U.S. and partner nation civil engineers, medical professionals, and support personnel through humanitarian assistance activities, August 7, 2015 (U.S. Air Force/David J. Murphy)

The health system of a nation includes essential services that can positively influence a population if harnessed and sustained by the legitimate host nation authority. Additionally, the health system is a development engine that has a cyclical relationship with intellectual, innovative, and economic growth. As part of a comprehensive approach to security and stability, attention to the health sector can be a significant enabler of success in these complex operational environments.

The United States has capabilities, resources, and a historical desire to use health in building strong partnerships through engaging the health sector of foreign countries. Appropriate policy, doctrine, and authority for Department of Defense (DOD) health engagement are currently being refined, and validation of outcomes is being pursued. Our intention in the following articles on Global Health Engagement is not only to highlight military and diplomatic applications, but also to discuss the challenges of leadership preparation, understanding health systems, and ethical and humanitarian complexities. The U.S. military health system is rightfully focused and adequately prepared to meet its primary mission of care for deployed forces as well as forces and families at home. However, we are just beginning to improve capabilities for Global Health Engagement in the joint operating environment.

The target audiences for this conversation are military and Federal strategic decisionmakers who impact the development, organization, and employment of DOD health assets. Such leaders, in addition to health leaders, must grasp the great potential for the correct employment of health in support of regional and global interests. Since these leaders also serve as the integrators between and across agencies, a common basis of knowledge in health will be invaluable in moving toward improved outcomes and strategic effects.

Joint Force Quarterly shall publish additional articles in the series in the future. Therefore, we have organized the series into four major categories and have purposely asked contributors from different U.S. agencies and nonmedical disciplines to author pieces from their strategic viewpoints. Category one should help the reader understand the basics of global health and appreciate the significance of health capabilities as strategic assets for diplomacy and security. The second category focuses on how operational DOD health efforts can open doors and build partnerships through security assistance, security cooperation, and shaping and stability applications. The third category highlights specific regional issues or examples of health engagement and activities by various agencies with a goal of illustrating the depth of health engagement that the United States is involved in around the world. The final category includes forward-looking articles intended to stimulate the reader to contemplate policy, doctrine, training, and employment needs that will optimize the future application of DOD health engagement.

The first three articles published in this issue aim to set the basis for Global Health Engagement, discuss its place within the humanitarian community, the local cultural context, and look at aspects of health where DOD can harness capabilities for positive impacts. The first article by Gerald V. Quinnan, Jr., provides a background for global health and overview of the progress of DOD Global Health Engagement. Next, Paul A. Gaist and Ramey L. Wilson discuss the interaction among nongovernmental organizations, the larger humanitarian community, and military forces. Agreed rules of cooperation among actors operating in the same complex environment are crucial.

The last article explores specific skill sets about disaster relief (Thomas R. Cullison, Charles W. Beadling, and Elizabeth Erickson). These capabilities can be applicable on a sustainable basis in different types of operations, including humanitarian relief for displaced populations. The article on disaster relief also touches on the agreements that govern such efforts, such as the Oslo Guidelines.

The U.S. Government as well as other state and nonstate actors, friendly and competitor, have all attempted to employ health in some fashion for both altruistic reasons and for political outcomes. This series of articles is an effort to explore some of the multiple aspects of this arena for future positive outcomes. JFQ