“During my career, my viewpoint changed significantly in the understanding and definition of what security really is,” said retired Admiral William J. Fallon at the Center for Strategic and International Studies (CSIS) on November 2. “My current appreciation of it is that it’s much more fundamental, much more personal, much more at the individual human level than I had thought in earlier years.”

Fallon spoke at the launch of a new CSIS report, Global Health as a Bridge to Security, which collects essays from a notable collection of current and former U.S. military and foreign policy leaders describing the connections between global health and humanitarian efforts and national security.

Creating Stability Through Health

“I think from a national security perspective, when the infrastructure is unable to provide health or protect the health of a population, it becomes unstable,” said fellow contributor and former Rear Admiral, Thomas R. Cullison of the Center for Naval Analysis.

Fallon made a similar point in the report, writing that “it is now widely accepted that nations with healthy populations are more likely to be productive, prosperous, and peaceful…conversely, poor health indicators are usually a sign that something is not right in a society.”

While poor health can be an indicator or a cause of societal or governmental problems, contributors also pointed out the positive potential of health interventions to increase stability and change public opinion.

The late Dr. S. Ward Casscells wrote about his efforts as the assistant secretary of defense for health affairs and an army reservist in Iraq. “[One] issue we were thinking a lot about was how you could use health care to win hearts and minds,” he wrote, commenting that “health assistance speaks to people.”

For example, health and humanitarian efforts had a tremendous impact in Indonesia following the 2004 tsunami. At the time, Fallon wrote, Indonesia was combating an insurgency in the hardest-hit province. But instead of continuing to press the rebels, the president “directed the military to focus on helping the recovery effort.”  The rebel fighters also halted attacks and came to an agreement with the government within a few months. Fallon attributed the ceasefire in part to the goodwill following the focus on the needs of the people of Aceh.

Building Bridges

“When you are involved in peace processes and trying to bring warring parties together…health is often a ‘soft’ issue that can be used to draw people together and seek consensus,” wrote former Ambassador and current USAID Deputy Administrator Donald Steinberg.

He wrote about his experience in South Africa collaborating with the apartheid government and the African National Congress on HIV/AIDS, and in Angola unifying the government and opposition forces over a polio vaccination campaign following the civil war.

Cullison touched on his experience returning to Vietnam in the early 2000s to collaborate over health issues, especially HIV/AIDS, after having served in the Vietnam War. “Working with our former enemies on a topic that was of concern to both countries was, I think, very helpful in developing a relationship,” he wrote. “Health could be a building block, a common issue for discussion among military people that was non-threatening to either side.”

Disease Doesn’t Respect Borders

Another avenue for cooperation between the national security and health communities is communicable diseases.

“We obviously understand that because diseases don’t respect borders a global approach to public health is required,” said former U.S. Ambassador to South Africa Jendayi E. Frazer.

Seasonal influenza and bird flu are two cases in point. About 40,000 Americans die every year from seasonal flu, wrote former U.S. Ambassador Cameron Hume, who served in Algeria, South Africa, and Indonesia.

Southeast Asia has long been considered “ground zero” of most influenza strains because of its large population (30 percent of the world’s population), dense urban centers which facilitate the spread of disease, and a tropical climate which does not limit the disease to a single season per year. Consequently it’s also the best place for scientists around the world to collect samples to build vaccines. But during the height of the 2007 bird flu scare, the Indonesian government refused to share virus samples with other countries, Hume said, fearing that if a vaccine were developed to the more dangerous strain, they would not receive doses until after wealthy countries purchased them.

“This dispute raised a fundamental point about the difference between looking at an issue in terms of global health and looking at it through a national security lens,” said Lange.

In other cases, addressing a global pandemic has to be balanced against respecting a nation’s sovereignty. Hume, for example, described his experience working with former South African President Thabo Mbeki from 2001 to 2004, who at the time was not receptive to discussing HIV/AIDS. Hume said that despite Mbeki’s reluctance, he would mention the epidemic as often as he could to make clear that the “subject that was always on the mind of the United States.”

Advantages and Limitations to the Military

The military also has a role to play in quick response to natural disasters. As shown during the 2004 Indian Ocean tsunami, the 2010 earthquake in Haiti, and the 2010 floods in Pakistan, even in remote regions with limited infrastructure, the U.S. military is often among the first responders. Assets like the Air Force and Navy’s air lift capabilities and the Navy’s two hospital ships, the USNS Mercy and the USNS Comfort, can bring state-of-the-art technology where it is desperately needed.

But though the military’s organization and operational speed are invaluable during first response, they are not a long-term solution. “Any health engagement that the military is likely to do will likely to be episodic,” said Cullison. “We can’t go someplace and stay there for a period of time.”

Instead, he suggested, the military should engage with organizations already on the ground and look to support their mission, not disrupt it. Fallon also urged for greater cooperation between agencies, and called for an “overall strategy for tackling global health issues.”

“Our health assets are one of our core strengths as a nation,” he wrote. “We should actively seek new opportunities to use them in the pursuit of our security interests, to build friendships, and to improve the health of people around the world.”

Sources: The Guardian, Time, UNICEF, U.S. Army, U.S. Department of Defense.

Video Credit: “Global Health as a Bridge to Security” and event video, courtesy of CSIS.