Wednesday, October 26, 2005

Follow-up on 'Strange Bedfellows' post


Tommy Thompson was the Secretary of Health and Human Services from February 2001 to January 2005, and is currently Chair of the Deloitte Center for Health Solutions in Washington, D.C. Someone working at Deloitte -- after reading the October 19th post on this blog -- sent the editor a link to an op-ed piece by Thompson recently published in the Boston Globe. There Thompson passionately and explicitly states the connections he sees between US national security and the improvement of health in the developing world. The more investment there is in the health care of developing countries, Thompson suggests, the safer from threats (i.e. terrorism) Americans and American interests will be. He even has a catchy concept for this alliance of foreign policy and foreign health development: ‘medical diplomacy.’

Medical diplomacy must be made a significantly larger part of our foreign and defense policy, as we clean up from costly and deadly wars in Afghanistan and Iraq. America has the best chance to win the war on terror and defeat the terrorists by enhancing our medical and humanitarian assistance to vulnerable countries. By delivering hope we will deliver freedom.

If Tommy Thompson (ex-Secretary HHS) and Andrew Natsios (current Administrator of USAID) are anything to go by, the concept of ‘medical diplomacy ‘ is all the rage in certain Washington circles. It is, at the very least, a clever attempt to siphon some of the obscenely large ‘anti-terrorism’ budget into foreign assistance coffers.

Still, bioethicists have the obligation to examine the assumptions of the medical diplomacy approach. For example, is terrorism rooted in poor health circumstances such that improving global health will necessarily undercut global terrorism? Are these defensible causal claims? On what evidence are they based?

There are possible counterexamples to the fundamental claims of medical diplomacy. The majority of the 9-11 hijackers came from Saudi Arabia, a country which made considerable investments in its own health care system (US$16.4 billion in the years 1985 to 1990). The recent London bombings were perpetrated by men who were born and/or raised in Britain, whose health system is comparable to the US and other developed nations. And conversely: some very poor nations with weak health care systems (such as Swaziland) are hardly havens for terrorists. Is it possible that the roots of terrorism are political, rather than medical in nature, and that they may have to do with the ‘less compassionate’ face of US foreign policy over the years?

Perhaps one should not look a gift horse in the mouth, and be glad investments are made in impoverished health systems, no matter what the underlying motives are. Lives can be saved by questionable intentions too. But if the assumptions behind ‘medical diplomacy’ turn out to be false, if hearts and minds are not necessarily won by new hospitals and antibiotics, then expect the global health cash flow to dry up quickly – along with talk of ‘loving your neighbor’.

3 Comments:

Blogger John Burgess said...

While Saudi Arabia has indeed made huge investments in its health and medical systems, those investments have not been evenly distributed.

The 15 Saudi hijackers, for instance, came from the Asir region, in the southwest of the country. That region has notoriously been on the short end of the development stick--as has the Eastern Province.

Health care is generally excellent in urban areas of Saudi Arabia. It is of lesser quality and quantity in rural areas.

12:13 PM  
Blogger Stuart Rennie said...

Thanks for your remarks hatcher.

You are right to point out regional differences in Saudi Arabia. But even taking into account such differences, if you look at the overall country figures, I am still inclined to think that the poor health care/terrorism connection is still thin. Take for instance the figures from the 2004 Human Development Report on Saudi Arabia:

Population with sustainable access to an improved water source (%), 2000: 95%
Population with sustainable access to affordable essential drugs (%), 1999 95-100%
One-year-olds fully immunized against tuberculosis 2001: 94%
One-year-olds fully immunized against measles 2001: 94%
Oral rehydration therapy use rate, 1994-2000 .. n/a
Contraceptive prevalence rate (%), 1995-2001: 32%
Births attended by skilled health personnel, 1995-2001: 91
Physicians (per 100,000 people), 1990-2002: 153
Public health expenditure (as % of GDP), 2000: 3.5%
Private health expenditure (as % of GDP), 2000: 1.0%
Health expenditure per capita (PPP US$), 2000: $641

I agree that the health care in rural areas is of lesser quality than in urban ones, but I think that the case of Saudi Arabia is not a very strong one in support of the 'medical diplomacy' view stated by Tommy Thompson in the post.

9:29 PM  
Blogger melloman said...

Hello Stuart Rennie, Editor, I was surfing blogs and paused at your title Follow-up on 'Strange Bedfellows' post. Thats what really caught my eye. I am promoting a horse health related website and need to find more information to offer some of my internet friends. Not exactly what I was looking for but you have givin me some good ideas about what could be done with my horse health related site that I will book mark and come back to hopefully get some more education from your site, you have some good stuff maybe you could visit my website and let me know what you think in my contact page. Just click on the link horse health. Thank you and I wish you well .

2:29 PM  

Post a Comment

<< Home