Strategic RationaleGuidance for GHE James Reeves MD CAPT MC USN Disclaimer The views expressed in this presentation are those of the author and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences Department of Defense or the US Gove ID: 677468
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Slide1
Fundamentals of Global Health Engagement CourseStrategic Rationale/Guidance for GHE
James Reeves M.D.
CAPT MC USNSlide2
Disclaimer
The views expressed in this presentation are those of the author and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, Department of Defense, or the U.S. Government.Slide3
Learning Objectives
To identify/understand the linkage between Health and Security.
To identify/understand the strategic rationale for GHE.
To identify/understand the definitions of and strategic guidance for GHE.
To use the strategic rationale and guidance to shape the planning and conduct of GHE activities.
Strategic Rationale/Guidance for GHESlide4
Global Health and SecurityA Rationale
forGlobal Health EngagementSlide5
Defining the terms.
Global Health
Global Health Security
Global Health
and
Security
Strategic Rationale/Guidance for GHESlide6
Health
Security
?
Cause-Effect?
Links?
Strategic Rationale/Guidance for GHESlide7
Strategic Rationale/Guidance for GHE
https://navy.libraryreserve.com/10/50/en/ContentDetails.htm?id=BEBD4580-3F3C-4848-B805-111CC49671CDSlide8
Conflict/Instability/Lack of Security =>Physical trauma
Mental trauma
Erosion of health systems and services
Erosion of complementary systems/services => adverse health impact
Shelter, water, sanitation, food…
Health and
Security
Strategic Rationale/Guidance for GHESlide9
Maslow’s Hierarchy(Human Security)
Strategic Rationale/Guidance for GHESlide10
Health and
Security: WHO/PAHO
“
Human Security
and Public Health
are deeply intertwined.
Conditions of insecurity … lead to health deterioration and diminish people’s capacity to achieve …
and the effects of poor health undermine security
….
human security is also a precondition for peace, state security, development and sustainability”
Strategic Rationale/Guidance for GHESlide11
Health and Security
National Security
Homeland Defense – health aspects
Terrorism
Biothreats
Strategic Rationale/Guidance for GHESlide12
Global Health Security Agenda
International Health Security Agenda established by coalition of states, including the United States, that is seeking to proactively disrupt and prevent the potential for future pandemic
epidemics
Whole-of-government strategy for addressing global health threats to national security
Prevent
Detect
Respond
Health and
Security
https://
openflights.org/demo/openflights-routedb-2048.png
Strategic Rationale/Guidance for GHESlide13
Health and Security
Global Security
Increasing recognition of nexus of global health and security
Narrow focus = biosecurity, pandemics,
etc
…
Broader focus = reciprocal relationship between health and security in
general
UN Security Council recognizes AIDS as threat to international security (2000) – 1st-ever health related
resolution
Global Health as a Bridge to Peace/Security (WHO, CSIS
)
Experience from Iraq and Afghanistan demonstrates close linkage of health and
security/stability
Strategic Rationale/Guidance for GHESlide14
Health and
Security
Global Security
President Bush’s State of the Union Address, January 2003
:
“
HIV/AIDS
is a tragedy for millions of men, women and children, and
a
threat
to stability
of entire countries and of regions of our world.
Our
nations
have the ability and, therefore, the duty to confront this grave
public
health crisis.”
Led to President’s Emergency Plan for AIDS Relief (PEPFAR)DoD HIV/AIDS Prevention Program (DHAPP)
Strategic Rationale/Guidance for GHESlide15
Health and Security
National Security
U.S. National Security Strategy (
2010
)
“…promoting the dignity of all men and women through our support for
global health
, food security, and cooperative responses to humanitarian crises.” (p. 5)
“The United States has a moral and strategic interest in promoting
global health
.” (p. 39)
“The
threat of contagious disease
transcends political boundaries, and the ability to
prevent
, quickly
detect
and
contain
outbreaks with pandemic potential has never been so important.” (p. 48)
Strategic Rationale/Guidance for GHESlide16
Health and Security
National Security
U.S. National Security Strategy (
2015
)
“The spread of infectious diseases constitute a growing risk. ..most countries have not yet achieved international core competencies for health security. We will accelerate our work with partners through the
Global Health Security Agenda
in pursuit of a world that is safer and more secure from infectious disease.” (p. 13-14)
“American leadership has proven essential to bringing to bear the international community to contain recent crises while building public health capacity to prevent future ones.” (p 27)
Strategic Rationale/Guidance for GHESlide17
Health and Security
Global Security => Bio-threats = Global Threats
Asia
-
SARS, H1N1, H7N9
Middle East
-
MERS
CoV
West Africa
-
Ebola
South America -
Zika
Caribbean and beyond - Chikungunya
Global – HIV/AIDS, Multi-Drug Resistant TB, Artemisinin Resistant Malaria, Anti-microbial
resistance
Strategic Rationale/Guidance for GHESlide18
Health and Security
Bio-Threats/Pandemics
Avian Influenza/HIV/AIDS/Emerging infections (DoD focus areas)
Counterinsurgency
Essential services - gov’t legitimacy
OIF/Iraq
OEF/Afghanistan
Competitors:
Hezbollah/Hamas/Sadr/Castro
Taliban
Strategic Rationale/Guidance for GHESlide19
State Failure Task Force (SAIC) => Infant Mortality Rate =
one of the four most predictive variables for State Failure
Health and
Security?
Strategic Rationale/Guidance for GHESlide20
Strategic GuidanceFor
Global Health EngagementSlide21
National Security Strategy (NSS)
Advance Our Rebalance to Asia and the Pacific
Strengthen Our Enduring Alliance with Europe
Seek Stability and Peace in the Middle East and North Africa
Invest in Africa’s Future
Deepen Economic and Security Cooperation in the Americas
Latest version dated Feb 2015
Provides guidance for national security interests and objectives for a
whole of government approach
Strategic Rationale/Guidance for GHESlide22
“As an exemplar of a modern and responsive public health system, we will accelerate our work with partners through the Global Health Security Agenda in pursuit of a world that is safer and more secure from infectious disease. We will save lives by strengthening regulatory frameworks for food safety and developing a global system to
prevent
avoidable epidemics,
detect and report disease outbreaks in real time, and respond more rapidly and effectively.” (NSS 2015, p.14)
Strategic Rationale/Guidance for GHESlide23
US GovernmentThe Three D’s
Global
Health
Diplomacy
(Department of State)
Development
(US Agency for
International Development)
Defense
(Department of Defense)
Strategic Rationale/Guidance for GHESlide24
Overview of Policy and Guidance Hierarchy
US Global Health
Diplomacy
Developm
e
nt
Defense
DoD GHE
CCMD Activity Support
GHE Policies and Standards
Threat Reduction Coordination
CCMD
Strategic Health Engagement
COCOM Objectives
JF 2020 Gaps
GEF Requirements
Component/SPP Tactical Health Engagement
Mil-Mil
Disaster
Prep/
Resp
Mil-
Civ
Strategic Rationale/Guidance for GHESlide25
Defining the Challenges
Where does the guidance come from?
Strategic Rationale/Guidance for GHESlide26
National Defense Strategy (NDS)Released
by the Secretary of Defense (SECDEF)
Defend the Homeland
Win the Long War
Promote SecurityDeter Conflict
Win our Nation’s Wars
Latest version dated June 2008
Strategic Rationale/Guidance for GHESlide27
National Military Strategy (NMS)Released
by the Chairman, Joint
Chiefs of Staff
Deter, Deny, Defeat State Adversaries
Disrupt, Degrade and Defeat Violent Extremism
Strengthen Our Global Network of Allies and Partners
Latest version dated June 2015
Strategic Rationale/Guidance for GHESlide28
Released in January 2012Provides an update to NSS 2010 Strategic guidance to assist DoD in determining future requirements
Rebalance towards the Asia-Pacific regionStresses forward presence, engagement, and support to partner nations
Sustaining US Global Leadership:
Priorities for 21
st
Century
Defense
Written
by the President with input from Office of the Secretary of
Defense
Strategic Rationale/Guidance for GHESlide29
Additional Guidance…
Guidance for the Employment of the Force (GEF)
Directs combatant commanders to create campaign plans to achieve theater and strategic end states and provides:
Prioritized contingency planning scenarios and end states
Security cooperation priorities
Joint Strategic Capabilities Plan (JSCP)
Translates strategic policy end states from the GEF into military campaign and contingency plan guidance for combatant commanders
Provides general, regional, and functional planning guidance
Strategic Rationale/Guidance for GHESlide30
Summary of National & Line GuidanceFrom
the President’s National Security Strategy
(NSS)
, the
SecDef develops the National Defense Strategy (NDS) and the Chairman, Joint Chiefs of Staff develops the National Military Strategy
(NMS)
.
The Joint Staff provides more detailed guidance in the Global Employment of the Force
(GEF)
and
the Joint Strategic Capabilities Plan
(JSCP)
.
The Geographic Combatant Commanders develop a Theater Campaign Plan
(TCP)
which includes Theater Security Cooperation
(TSC)
activities.
Strategic Rationale/Guidance for GHESlide31
Strategic Rationale/Guidance for GHESlide32
Strategic Rationale/Guidance for GHESlide33
Military Health System – Line(s) of Effort:
“Define and develop the MHS core resources and competencies to support
Global Health Engagement
.”
Strategic Rationale/Guidance for GHESlide34
Definitions:
Stability Operations
…an
overarching term
encompassing various military activities
outside the United States
in coordination with other agencies to maintain or reestablish a
safe and secure environment, provide essential governmental services,
emergency infrastructure reconstruction, and humanitarian relief. (DODI 3000.05, Sep 09)
JP 3-07, 29 Sept 2011: defines stability operations the same
way
Medical Stability Operations
MHS activities that support achievement of stability operations
Strategic Rationale/Guidance for GHESlide35
DODI 3000.05 re Stability Operations
:
“It is DoD policy that: Stability operations are a core US military mission that DoD shall be prepared to conduct and support.
They shall be given priority comparable to combat operations
and be explicitly addressed and integrated across all DoD activities
…”
Establishes
requirement to “Ensure DoD medical personnel and capabilities are prepared to meet military and civilian health requirements in stability operations.”
Strategic Rationale/Guidance for GHESlide36
DODI 6000.16 – re Medical Stability Operations
“Medical Stability Operations (MSOs) are a core U.S. military mission that the DoD MHS shall be prepared to conduct throughout all phases of conflict and across the range of military operations, including combat and non-combat environments.”
Strategic Rationale/Guidance for GHESlide37
Policy Cable re Global Health Engagement
"Health
activities which the DoD conducts in support of the National Security Policy and Military Strategy of the United States. They are a means to partner with other nations to achieve security cooperation and build partner capacity through health-related activities and exchanges
.”
Emphasis on:
Strategic
OSD
linkages
Coordination (interagency, international, partner nation)
Capacity-building
Monitoring and evaluation/Measures of Effectiveness
Strategic Rationale/Guidance for GHESlide38
Strategic
Linkages
National
Strategy
National Security Strategy
National Defense Strategy
Guidance for the Employment of the Force
Theater Strategy
Theater Campaign Plan
Theater Security Cooperation Plan
Medical Security Cooperation Strategy
Strategic Rationale/Guidance for GHESlide39
GHE MYTHS
T
rue
or
False
?
GHE
is not a true DoD mission (illegal, no funding, no mandate).
Strategic Rationale/Guidance for GHESlide40
True
or F
alse
?
GHE is not a true DoD mission (illegal, no funding, no
mandate)
F
alse
: GHE is a real and current mission – governed by a number of existing and forthcoming policies
Strategic Rationale/Guidance for GHESlide41
GHE MYTHS
T
rue
or
False
?
GHE is not a true DoD mission (illegal, no funding, no
mandate)
False
: GHE is a real and current mission – governed by a number of existing and forthcoming
policies
GHE
is
for “Civil Affairs”.
Strategic Rationale/Guidance for GHESlide42
Strategic Rationale/Guidance for GHE
GHE MYTHS
T
rue
or
F
alse
?
GHE is not a true DoD mission (illegal, no funding, no
mandate)
False
: GHE is a real and current mission – governed by a number of existing and forthcoming
policies
GHE
is
for “Civil Affairs”.
False
: GHE is the responsibility of the Commander – the Surgeon (medical) shares this responsibility with Civil Affairs (if present
)Slide43
GHE MYTHS
True or False?
GHE is not a true DoD mission (illegal, no funding, no mandate)
False: GHE is a real and current mission – governed by a number of existing and forthcoming policies
GHE is for “Civil Affairs”.
False: GHE is the responsibility of the Commander – the Surgeon (medical) shares this responsibility with Civil Affairs (if present)
GHE is Easy (standard military medical skills, experience, and training translate readily to medical stability ops activities
)
Strategic Rationale/Guidance for GHESlide44
GHE MYTHS
True or False?
GHE is not a true DoD mission (illegal, no funding, no mandate)
False: GHE is a real and current mission – governed by a number of existing and forthcoming policies
GHE is for “Civil Affairs”.
False: GHE is the responsibility of the Commander – the Surgeon (medical) shares this responsibility with Civil Affairs (if present)
GHE is Easy (standard military medical skills, experience, and training translate readily to medical stability ops activities
)
F
alse
: Specialized skills, experience, and training are required to optimize
GHE
Strategic Rationale/Guidance for GHESlide45
QUESTIONS?