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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" dir="ltr" lang="en-US"> <head profile="http://gmpg.org/xfn/11"><script type="text/javascript" src="https://web-static.archive.org/_static/js/bundle-playback.js?v=7YQSqjSh" charset="utf-8"></script> <script type="text/javascript" src="https://web-static.archive.org/_static/js/wombat.js?v=txqj7nKC" charset="utf-8"></script> <script>window.RufflePlayer=window.RufflePlayer||{};window.RufflePlayer.config={"autoplay":"on","unmuteOverlay":"hidden"};</script> <script type="text/javascript" src="https://web-static.archive.org/_static/js/ruffle/ruffle.js"></script> <script type="text/javascript"> __wm.init("https://web.archive.org/web"); __wm.wombat("http://globalhealth.sais-jhu.edu:80/category/harley-feldbaum/","20090904060143","https://web.archive.org/","web","https://web-static.archive.org/_static/", "1252044103"); </script> <link rel="stylesheet" type="text/css" href="https://web-static.archive.org/_static/css/banner-styles.css?v=p7PEIJWi" /> <link rel="stylesheet" type="text/css" href="https://web-static.archive.org/_static/css/iconochive.css?v=3PDvdIFv" />  <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"/> <title>Global Health and Foreign Policy Blog » Harley Feldbaum</title> <meta name="generator" content="WordPress 2.6.1"/>  <link rel="stylesheet" href="https://web.archive.org/web/20090904060143cs_/http://globalhealth.sais-jhu.edu/wp-content/themes/sais/style.css" type="text/css" media="screen"/> <link rel="alternate" type="application/rss+xml" title="Global Health and Foreign Policy Blog RSS Feed" href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/feed/"/> <link rel="pingback" href="http://globalhealth.sais-jhu.edu/xmlrpc.php"/> <link rel="EditURI" type="application/rsd+xml" title="RSD" href="http://globalhealth.sais-jhu.edu/xmlrpc.php?rsd"/> <link rel="wlwmanifest" type="application/wlwmanifest+xml" href="http://globalhealth.sais-jhu.edu/wp-includes/wlwmanifest.xml"/> <meta name="generator" content="WordPress 2.6.1"/> </head> <body>    <div id="wrapper"> <div class="header"> <div class="header-text"> <h1><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/">Global Health and Foreign Policy Blog</a></h1> <h2>Blogging on the overlap between principle and power.</h2> </div> </div> <table width="752" border="0" cellspacing="0" cellpadding="0" id="wrapper_table"> <tr> <td width="500" align="left" valign="top"> <div id="content"> <div class="post" id="post-"> <div class="dateheader">December 2, 2008</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2008/12/?y%/update-on-pharmaceuticals-and-war/" rel="bookmark" title="Permanent Link to Update on pharmaceuticals and war">Update on pharmaceuticals and war</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 5:39 pm</em></div> <div class="post_body"> <p>Sad to have this relevant update to the pharmaceuticals and war post, but the terrorists behind the recent Mumbai attacks were found to be using cocaine, LSD, steroids and possibly other stimulants during the fighting. “This explains why they managed to battle the commandos for over 50 hours with no food or sleep.” Full story from the Telegraph is <a href="https://web.archive.org/web/20090904060143/http://www.telegraph.co.uk/news/worldnews/asia/india/3540964/Mumbai-attacks-Terrorists-took-cocaine-to-stay-awake-during-assault.html" target="_blank">here</a>. Thanks to Chris Albon from <a href="https://web.archive.org/web/20090904060143/http://warandhealth.com/" target="_blank">warandhealth.com</a> for the tip.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2008/12/?y%/update-on-pharmaceuticals-and-war/#respond" title="Comment on Update on pharmaceuticals and war">Comments (0)</a> </div> </div> <div class="dateheader">June 24, 2008</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2008/06/?y%/pharmaceuticals-and-war/" rel="bookmark" title="Permanent Link to Pharmaceuticals and War">Pharmaceuticals and War</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 10:53 am</em></div> <div class="post_body"> <p>This is a rather light <a href="https://web.archive.org/web/20090904060143/http://www.time.com/time/nation/article/0,8599,1811858,00.html" target="_blank">treatment</a> of the subject in Time Magazine, covering the seemingly increasing numbers of US Army soldiers who are prescribed antidepressants to “calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan,” fight PTSD and keep needed soldiers on the front lines. There is a long history of the use of drugs during warfare, from antidepressants in current wars, to amphetamines in Somalia (Khat), Vietnam and WWII, to alcohol from time immemorial. I heard chilling first-hand stories of Serb soldiers drunk on schlivovitz from Bosnian refugees after the war. I’m surprised Time didn’t dig a little deeper and describe the current use of amphetamines or “<a href="https://web.archive.org/web/20090904060143/http://www.stripes.com/article.asp?section=104&article=12710&archive=true" target="_blank">go pills</a>,” antidepressants and sleep aids “<a href="https://web.archive.org/web/20090904060143/http://www.stripes.com/article.asp?section=104&article=18001&archive=true" target="_blank">no go pills</a>” to improve Air Force pilot performance during long missions. And not just the US Air Force, most countries “<a href="https://web.archive.org/web/20090904060143/http://blog.wired.com/defense/2008/02/israel-mulls-vi.html" target="_blank">drug their pilots, to keep ‘em alert.</a>” A touchy political subject? Sure. An old issue that might deserve a well-researched and reasoned debate in a news magazine? I guess that’s pushing it.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2008/06/?y%/pharmaceuticals-and-war/#respond" title="Comment on Pharmaceuticals and War">Comments (0)</a> </div> </div> <div class="dateheader">March 4, 2008</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2008/03/?y%/interrogating-zimbabwes-declining-hiv-prevalence/" rel="bookmark" title="Permanent Link to Interrogating Zimbabwe’s declining HIV prevalence">Interrogating Zimbabwe’s declining HIV prevalence</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 5:57 pm</em></div> <div class="post_body"> <p>The Washington Post had a pretty good <a href="https://web.archive.org/web/20090904060143/http://www.washingtonpost.com/wp-dyn/content/story/2008/02/20/ST2008022000118.html" target="_blank">review</a> of PEPFAR last week. Unfortunately, it concluded with the misleading point that Zimbabwe has seen the largest declines in HIV prevalence in Southern Africa, while its PEPFAR-funded neighbors “lag behind.” SAIS International Health Policy student Ilaria Regondi sets the record straight in this <a href="https://web.archive.org/web/20090904060143/http://www.washingtonpost.com/wp-dyn/content/article/2008/02/29/AR2008022903244.html" target="_blank">letter</a> to the Washington Post, reprinted below. The Post called her letter “Zimbabwe’s Lethal HIV Solution,” but I think her original title, “Is State Failure an Antidote to AIDS?” gets the point across better.</p> <p>“Regarding the Feb. 20 article “African AIDS Crisis Outlives $15 Billion Bush Initiative”: According to the article, “economic collapse has coincided with fundamental social change” to decrease the rate of HIV infection in Zimbabwe.</p> <p>Nevertheless, it is rising mortality — resulting from hardship and poverty — that has been instrumental in effecting change. As mortality rates increase, the pool of infected people and the risk of new infections shrink, and — statistically speaking — this decreases HIV rates.</p> <p>Death, then, acts as a powerful incentive for behavioral change, but it can hardly be prescribed as the ideal antidote to AIDS. While the health benefits of embracing monogamy are obvious, the cause of this shift (poverty) should also be a cause for widespread concern.</p> <p>Skyrocketing unemployment and social disruption have also played a part, at once reducing mobility and increasing migration. While the former lessens the risk of infection, the latter inflates other countries’ HIV rates while letting Zimbabwe benefit.</p> <p>When a country with 150,000 percent inflation and a despotic ruler flaunts achievements that no one else can claim, perhaps a little more caution is in order.”</p> <p>Ilaria Regondi</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2008/03/?y%/interrogating-zimbabwes-declining-hiv-prevalence/#comments" title="Comment on Interrogating Zimbabwe’s declining HIV prevalence">Comments (1)</a> </div> </div> <div class="dateheader">November 7, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/11/?y%/what-does-health-mean-to-the-department-of-defense/" rel="bookmark" title="Permanent Link to What does health mean to the Department of Defense?">What does health mean to the Department of Defense?</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 5:05 pm</em></div> <div class="post_body"> <p>For militaries, health has always meant the preservation of the health of armed forces. This is with good reason. Throughout history disease has decimated militaries, altered or cancelled military operations, and (particularly before the 1930’s) caused more deaths in wartime than combat. <a href="https://web.archive.org/web/20090904060143/http://www.amazon.ca/Rats-Lice-History-Hans-Zinsser/dp/1412806720/ref=sr_1_6/701-0428724-3160316?ie=UTF8&s=books&qid=1194468081&sr=1-6" target="_blank">Zinnser</a> writing in the 1930s went so far as to argue that “Soldiers have rarely won wars. They more often mop up after the barrage of epidemics.” So it is not surprising that a huge part of the Department of Defense’s (DoD) interest in health is in maintaining the health of its forces and their dependents during peacetime, predicting and preventing illness during deployment, and in combat care during war. (For a recent high tech example, see the <a href="https://web.archive.org/web/20090904060143/http://www.darpa.mil/dso/thrusts/bio/mainhuman/predhealth/index.htm" target="_blank">Defense Advanced Research Projects Agency’s</a> research into predicting illness in U.S. forces <em>before symptoms are apparent</em>. The rational is of course to minimize or even eliminate the impact of disease on U.S. military operations.)</p> <p>DoD is also interested in the health of foreign militaries. You might think this would be because DoD wants to know if a threatening military may be weakened by disease, but more often it is to ensure that foreign militaries do not collapse due to HIV/AIDS. Since 2001, the <a href="https://web.archive.org/web/20090904060143/http://www.nhrc.navy.mil/programs/dhapp/index.html" target="_blank">Department of Defense HIV/AIDS Prevention Program</a> (DHAPP) has been training foreign militaries, starting in Sub-Saharan Africa but now in 70 countries, to prevent, treat and cope with the impact of HIV/AIDS. DHAPP does this to 1) prevent HIV/AIDS from causing instability in foreign militaries that could lead to state instability and calls for U.S. military or humanitarian intervention; 2) ensure that foreign militaries can continue to contribute troops to peacekeeping operations and therefore eliminate the need for U.S. participation in peacekeeping; 3) build relationships through cooperation on HIV/AIDS that enables greater cooperation with the U.S. in the long war on terrorism. These programs are in DoD’s enlightened self-interest to pursue.</p> <p>DoD’s third interest in health is in using health as a tool to pursue U.S. strategic goals. The rationale for this is competitive. The example I hear repeatedly is the case of Hezbollah running hospitals, and providing public health and social services, then going on to win significant representation in Lebanese elections. The Cuban training and exporting of medical personnel across Latin America since 1960 is another often cited example. As one Air Force Colonel at DoD says; “the competition uses health diplomacy.”</p> <p>Unfortunately, DoD’s efforts to use health diplomacy seem neither as well targeted as Hezbollah’s nor as long-term as Cuba’s. One example is the recent 4 month, 12 nation <a href="https://web.archive.org/web/20090904060143/http://www.miamiherald.com/multimedia/news/usnscomfort/index.html" target="_blank">USS Comfort</a> mission to Latin America to counter Castro’s long-standing health diplomacy program. Supporters argue that the Comfort is on a “<a href="https://web.archive.org/web/20090904060143/http://www.miamiherald.com/multimedia/news/usnscomfort/index.html" target="_blank">voyage of healing</a>” that will win hearts and minds across the region. Detractors point out that the Comfort screens patients because they only treat problems they can fix within their 72 hour docking time, that the supertanker-based ship can only dock at 30% of the world’s ports, and that there is no telling when or if the Comfort will ever return. This hardly demonstrates a long-term commitment to health and development, and will likely only win a few hearts and minds for the $18 million dollar cost.</p> <p>Another example is the use of medical civil-assistance programs (MEDCAPs) in Iraq, which are essentially temporary health clinics set up to treat as many patients as possible in a few hours before closing down. Supporters argue that a few hours of world class medical care can help win support of local populations, gather intelligence, and reward communities for cooperation with the U.S. Describing MEDCAPs as “<a href="https://web.archive.org/web/20090904060143/http://usacac.leavenworth.army.mil/CAC/milreview/English/SepOct07/bakerengseptoct07.pdf" target="_blank">tailgate medicine</a>,” Major Jay Baker argues that MEDCAPs actually undermine local health systems while failing to build Iraqi health capacity. In the end he argues, they weaken the ability of the Iraqi government to provide health services and therefore undermine U.S. strategic goals. It seems that DoD still has a lot to learn about basic global health principles such as sustainability, building capacity, and low-tech interventions that save the most lives including clean water and maternal healthcare.</p> <p>A final uncomfortable note for those in global health is provided by David Kilcullen, currently advising General Petraeus in Iraq, in his fascinating <a href="https://web.archive.org/web/20090904060143/http://www.d-n-i.net/fcs/pdf/kilcullen_28_articles.pdf" target="_blank"><em>Twenty-Eight Articles</em></a> of conducting counterinsurgency. Those in global health who hope to use health as a bridge between fighting populations to create peace, take note: “There is no such thing as impartial humanitarian assistance or civil affairs in counterinsurgency. Every time you help someone, you hurt someone else - not least the insurgents.”</p> </div> <div class="post_footer"> <div class="comments_etc"> <span>Comments Off</span> </div> </div> <div class="dateheader">October 3, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/10/?y%/moving-left-of-boom/" rel="bookmark" title="Permanent Link to Moving Left of Boom">Moving Left of Boom</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 3:38 pm</em></div> <div class="post_body"> <p class="MsoNormal">More national security and science than global health and foreign policy, but Rick Atkinson’s four-part “<a href="https://web.archive.org/web/20090904060143/http://www.washingtonpost.com/wp-srv/world/specials/leftofboom/index.html">Left of Boom</a>” series in the Washington Post is a sobering look at the military’s attempts to use science to innovate away the devastating problem of IEDs (improvised explosive devices) in <st1:place w:st="on"><st1:country-region w:st="on">Iraq</st1:country-region></st1:place>.<span> </span>IEDs have proven to be a low-tech and deadly way to attack <st1:country-region w:st="on">U.S.</st1:country-region> troops as they travel the roadways of <st1:country-region w:st="on"><st1:place w:st="on">Iraq</st1:place></st1:country-region>.<span> </span><st1:place w:st="on"><st1:country-region w:st="on">U.S.</st1:country-region></st1:place> countermeasures have proliferated, only to see insurgent bomb-makers quickly innovate new approaches using widely available commercial products such as key fobs and radio controlled cars.<span> </span>The Pentagon’s broken procurement process plays a role in the story, as do inane and impractical projects like harnessed bomb sniffing bees ($2 million invested in those bees until Brig. Gen. Joseph L. Votel asked “How does, say, 1st Platoon manage their bees?”)<span> </span></p> <p class="MsoNormal">Just as interesting is what the articles say about the nature of this war and why high-tech solutions to the IED problem may only be half-measures.<span> </span>Retired General <a href="https://web.archive.org/web/20090904060143/https://www.jieddo.dod.mil/JIEDDOLEADERSHIP/LEADDIR.ASPX" target="_blank">Montgomery C. Meigs</a> who directs the Pentagon’s <a href="https://web.archive.org/web/20090904060143/https://www.jieddo.dod.mil/" target="_blank">Joint IED Defeat Organization</a>, provides a key observation:</p> <p class="MsoNormal"><em>“The IED is the enemy’s artillery system. It’s simply a way of putting chemical and kinetic energy on top of our soldiers and Marines, or underneath them…<span> </span>What’s different is the trajectory. Three 152mm rounds underneath a tank, which will blow a hole in it, are artillery rounds. But they didn’t come through three-dimensional space in a parabolic trajectory. They came through a social trajectory and a social network in the community.”<o:p></o:p></em></p> <p class="MsoNormal">In other words the artillery shells are not being fired at vehicles by a traditional army, but are coming at <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> forces through a social network of insurgent financers, bomb-makers and low-level persons paid to place IEDs.<span> </span>Dealing with this social network is low-tech, requiring deep understanding of language, culture and insurgent social networks.<span> </span>The Pentagon’s high-tech efforts to protect troops against IEDs have had some success, but low-tech, on the ground intelligence may be the only way to stop IEDs before they explode under our troops, ie. to move left of boom.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/10/?y%/moving-left-of-boom/#respond" title="Comment on Moving Left of Boom">Comments (0)</a> </div> </div> <div class="dateheader">October 2, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/10/?y%/the-saffron-revolution/" rel="bookmark" title="Permanent Link to The Saffron Revolution">The Saffron Revolution</a></div> <div class="post_subhead"><em>Posted by hfeldbaum at 3:32 pm</em></div> <div class="post_body"> <p><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/burmese-monks.jpg" title="Burmese monks"><img src="https://web.archive.org/web/20090904060143im_/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/burmese-monks.jpg" alt="Burmese monks"/></a><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/soldiers.jpg" title="Soldiers"><img src="https://web.archive.org/web/20090904060143im_/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/soldiers.jpg" alt="Soldiers"/></a></p> <p class="MsoNormal"> </p> <p class="MsoNormal">Two photos from a friend witnessing the Saffron Revolution in <st1:place w:st="on"><st1:country-region w:st="on">Burma</st1:country-region></st1:place>.<span> </span>Good information has been difficult to come by as the junta attempts to enforce a media blackout.<span> </span>Official (and by that I mean the military junta) data reports 9 deaths, while a recent high-level defector <a href="https://web.archive.org/web/20090904060143/http://www.dailymail.co.uk/pages/live/articles/news/worldnews.html?in_article_id=484903&in_page_id=1811&ct=5" target="_blank">reports</a> thousands of deaths.<span> </span>Here is our friend’s interview with a monk about events at the Eastern Gate of Shwedagon Pagoda:</p> <p class="MsoNormal"><em>“On Thursday we were praying at the Kyethune Phaya. There were 30 of us. It was around noon. Then we heard the sound of the soldiers coming. Banging their sticks on their shields. Without warning they entered the pagoda and started to beat us with their sticks. Some had swords on the end of their guns. They beat a young monk, only 15 years old. He fell down, bleeding on the head.” The young monk ran and escaped. He learned later that some of his companions had been killed, most of them beaten and taken away in the “J” car – the black van with bars on the windows, a sight now common near the scene of any demonstration. <o:p></o:p></em></p> <p class="MsoNormal"><em>The elderly monk then went on to explain, “They (the Government) are afraid. They know this is different from ’88. The Sangha (religious authority) did not lead the strikes in ’88. They (the soldiers) are going to the monasteries at night. Pretending to be lay people. Entering the monastery, beating and taking away the monks. Even the young boys. They raided Waizayandar on Thursday. On Friday they cleaned the monastery and replaced the monks. With men who are not real monks or with monks who side with the government.” <o:p></o:p></em></p> <p class="MsoNormal"><em>“They have taken 3000 monks. They do not put them in prison. They take them to the many military camps around the country. The monks are refusing the small bowl of rice being offered to them by the soldiers. The soldiers offer it to them after 1pm to make them break their vows. No one is allowed to see them. We are worried.”<o:p></o:p></em></p> <p class="MsoNormal"><em>“But we know. We knew what would happen. We see the situation in the country. We go around and we beg for our food. We see the rich and the poor. We see that a very few people are very rich. They are all the families and relations of the Generals. We see that the people are getting poorer. They cannot even feed themselves. We see this. We cannot ignore it.” <o:p></o:p></em></p> <p class="MsoNormal"><em>“We don’t know how long it will take. One month. One year. But too many of us have died already. We cannot go back.”<o:p></o:p></em></p> <p class="MsoNormal"><st1:country-region w:st="on"><st1:place w:st="on">Burma</st1:place></st1:country-region> has long been a terrible example of how violation of <a href="https://web.archive.org/web/20090904060143/http://www.jhsph.edu/humanrights/images/GatheringStorm_BurmaReport_2007.pdf" target="_blank">human rights contributes to worsening public health</a> (warning, large pdf file).<span> </span>The country is suffering under one of the highest rates of tuberculosis in the world, extensive malaria and HIV/AIDS, along with rising drug-resistance due to counterfeit drugs.<span> </span>Here’s hoping the Saffron Revolution succeeds for the health and political freedom of the Burmese.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/10/?y%/the-saffron-revolution/#respond" title="Comment on The Saffron Revolution">Comments (0)</a> </div> </div> <div class="dateheader">July 19, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/07/?y%/is-this-what-us-foreign-aid-looks-like/" rel="bookmark" title="Permanent Link to Is this what U.S. foreign aid looks like?">Is this what U.S. foreign aid looks like?</a></div> <div class="post_subhead"><em>Posted by Harley Feldbaum at 11:21 am</em></div> <div class="post_body"> <p><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/us-foreign-assistance.jpg" title="US Foreign Assistance"><img src="https://web.archive.org/web/20090904060143im_/http://globalhealth.sais-jhu.edu/wp-content/uploads/2007/10/us-foreign-assistance.jpg" alt="US Foreign Assistance"/></a></p> <p>This frightening image is from Lael Brainard’s “<a href="https://web.archive.org/web/20090904060143/http://www.brookings.edu/press/books/securitybyothermeans.htm" target="_blank">Security by Other Means: Foreign<br/> Assistance, Global Poverty and American Leadership</a>.” Brainard and Steve Radelet from the Center for Global Development testified at the Senate Foreign Relations Committee last week on the need to reform U.S. foreign aid. While the above picture should be sufficient to convey their main message, the testimonies are also worth reading. Both call for major reforms including the creation of one integrated agency to manage U.S. foreign aid (akin to the UK’s DFID), and a complete overhaul of the 1961 Foreign Assistance Act. Interestingly, both cite preventing and managing infectious disease epidemics as a key part of advancing U.S. national security and national values. This is a good sign that the links between global health and foreign policy are recognized and accepted, at least within Washington DC. Their testimonies, available <a href="https://web.archive.org/web/20090904060143/http://www.senate.gov/~foreign/hearings/2007/hrg070612p.html" target="_blank">here</a>, are a good overview of the problems and potential reforms to our foreign aid system.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/07/?y%/is-this-what-us-foreign-aid-looks-like/#comments" title="Comment on Is this what U.S. foreign aid looks like?">Comments (1)</a> </div> </div> <div class="dateheader">July 12, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/07/?y%/white-house-meddling-with-the-surgeon-general/" rel="bookmark" title="Permanent Link to White House meddling with the Surgeon General">White House meddling with the Surgeon General</a></div> <div class="post_subhead"><em>Posted by Harley Feldbaum at 1:55 pm</em></div> <div class="post_body"> <p><em>This just in</em>: White House interferes with public health and science. In case there is anyone reading who doubts that public health is a political activity, and I assume there are not many among our readers, this <a target="_blank" href="https://web.archive.org/web/20090904060143/http://www.washingtonpost.com/wp-dyn/content/article/2007/07/10/AR2007071001422.html">Washington Post</a> article on White House interference with the Surgeon General is required reading. And it’s not just this administration; politicizing public health is a bipartisan sport. Note that all three previous Surgeons General, under Regan, Clinton and G.W. Bush, reported political pressure to modify or stop their speaking out on important public health issues.</p> <p>Rather than issuing lamentations pleading for the political independence of public health, (see Waxman’s quote in the article,) we might try accepting that public health policies that determine whether or not people become sick and die are inherently political. Maybe then the public health community will be more successful in designing <em>political strategies</em> that build support for needle exchange programs, sex education, and other controversial interventions for which there is abundant scientific evidence but little political support.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/07/?y%/white-house-meddling-with-the-surgeon-general/#respond" title="Comment on White House meddling with the Surgeon General">Comments (0)</a> </div> </div> <div class="dateheader">July 6, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/07/?y%/india-warns-military-wives-to-beware-of-hivaids/" rel="bookmark" title="Permanent Link to India warns military wives to beware of HIV/AIDS">India warns military wives to beware of HIV/AIDS</a></div> <div class="post_subhead"><em>Posted by Harley Feldbaum at 1:11 pm</em></div> <div class="post_body"> <p>The good news about the HIV epidemic among India’s general population, most recently reported <a target="_blank" href="https://web.archive.org/web/20090904060143/http://www.nytimes.com/aponline/world/AP-India-AIDS.html">here</a>, was accompanied with bad news about the epidemic for India’s armed forces and their families. In an unusual <a target="_blank" href="https://web.archive.org/web/20090904060143/http://www.ft.com/cms/s/d43d0af0-1a14-11dc-99c5-000b5df10621.html">announcement</a>, Yogendra Singh, director general of the Armed Forces Medical Services, is urging wives of military personnel to protect themselves from HIV as the epidemic spreads among the armed forces. The government is “alarmed” at the spread of HIV in the military and Singh says “the youthful, exuberant and aggressive attitude of our troops, combined with the long separation from families and high mobility has compounded the risks faced by [wives].” One might add to this list of causes the rapid growth of brothels surrounding military bases in areas where soldiers often have higher incomes than the local population. The spread of HIV in India’s huge armed forces, (with 1.3 million active military personnel, 535,000 reserve force members, and another 1.3 million in paramilitary forces,) is occurring despite force-wide HIV screening introduced in 2006.</p> <p>A major driver of this problem is the large number of Indian troops stationed in the insurgency-plagued Northeast, where heroin trafficking and use has contributed to high HIV prevalence in the area, especially in Nagaland and Manipur. Lieutenant General Bhopinder Singh, Director General of Assam Rifles (one of the paramilitary forces involved in counterinsurgency in the Northeast) recently <a target="_blank" href="https://web.archive.org/web/20090904060143/http://www.aegis.com/NEWS/AFP/2005/AF050431.html">said</a>: “Now we find more soldiers dying to HIV-AIDS than to bullets fired by militants.” I have written <a target="_blank" href="https://web.archive.org/web/20090904060143/http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030171">here</a> about how the overlap of insurgencies, sex workers, and heroin trafficking will create black holes in India, Russia and China’s efforts to fight HIV/AIDS. India’s Northeast, China’s Xinjiang and Yunnan provinces, and Russia’s North Caucasus region (which is also seeing a <a target="_blank" href="https://web.archive.org/web/20090904060143/http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=45659">rapid rise in HIV prevalence</a>) are major internal security issues for these states, and host large numbers of government troops. These troops are at high risk for infection, and will spread the disease when they are redeployed elsewhere or demobilized. I fear these troubled regions will become drivers of the epidemic in Russia, India and China, exporting HIV, TB and narcotics to neighboring areas and undermining efforts to fight the disease in these critical states.</p> <p>The better news here is the recognition that HIV/AIDS can be a greater threat to troops than combat will push militaries to expand and improve their efforts to prevent transmission of the disease. The Assam Rifles seem to have realized this, as has the Indonesian military, which saw more of its peacekeepers in the UNTAC mission <a target="_blank" href="https://web.archive.org/web/20090904060143/http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=7475754&dopt=Abstract">dying of AIDS than combat</a>. The U.S. Navy runs an excellent military to military HIV/AIDS training <a target="_blank" href="https://web.archive.org/web/20090904060143/http://www.nhrc.navy.mil/programs/dhapp/index.html">program</a> that addresses this issue by helping foreign militaries prevent and treat HIV/AIDS in their armed forces. These military efforts should be welcomed and might help limit the spread of HIV in the troubled areas where insurgencies, drug trafficking and commercial sex overlap.</p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/07/?y%/india-warns-military-wives-to-beware-of-hivaids/#comments" title="Comment on India warns military wives to beware of HIV/AIDS">Comments (1)</a> </div> </div> <div class="dateheader">June 28, 2007</div> <div class="post_header"><a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/06/?y%/china%e2%80%99s-rising-role-in-foreign-policy-and-global-health/" rel="bookmark" title="Permanent Link to China’s rising role in foreign policy and global health">China’s rising role in foreign policy and global health</a></div> <div class="post_subhead"><em>Posted by Harley Feldbaum at 11:21 am</em></div> <div class="post_body"> <p>Richard Holbrooke, former U.S. Ambassador to the UN and CEO of the Global Business Coalition on HIV/AIDS, suggests in the <a target="_blank" href="https://web.archive.org/web/20090904060143/http://www.washingtonpost.com/wp-dyn/content/article/2007/06/27/AR2007062702228.html">Washington Post</a> that we may be seeing a change in Chinese foreign policy towards greater cooperation with the U.S. on issues of mutual concern. He cites as evidence increased Chinese diplomatic pressure on the governments of North Korea, Sudan and Burma (Myanmar) that has shown some small (but still insufficient) impact in negotiations with these states.</p> <p>The ends toward which China directs its increasing foreign policy clout will have a major impact on global affairs, but it’s not just traditional foreign policy that interests China. The Chinese Ministry of Science and Technology <a target="_blank" href="https://web.archive.org/web/20090904060143/http://news.xinhuanet.com/english/2007-06/27/content_6295537.htm">announced yesterday</a> “efforts to establish a biological security system in 20 years to fight against bio-terrorism and prevent serious epidemic diseases.” This raises big questions about the scope of this system, its linkage with other global surveillance efforts, the sharing of data on disease outbreaks, and the ends toward which the proposed Chinese biological security system is directed. While these questions play out, I think we can expect China to play an increasingly important and assertive role in global health security efforts.<u style="display: none"><br/> </u></p> <p><u style="display: none"><br/> </u> </p> </div> <div class="post_footer"> <div class="comments_etc"> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/2007/06/?y%/china%e2%80%99s-rising-role-in-foreign-policy-and-global-health/#respond" title="Comment on China’s rising role in foreign policy and global health">Comments (0)</a> </div> </div> <a href="https://web.archive.org/web/20090904060143/http://globalhealth.sais-jhu.edu/category/harley-feldbaum/page/2/">Next Page »</a> <div class="copyright_footer"> <p>Copyright © 2007, all rights reserved. The views and opinions expressed in this page are strictly those of the page author(s). 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