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’.