As record-breaking snowstorms blanketed Washington, D.C. this winter, I took advantage of the citywide freeze to read Cleo Paskal’s new book, Global Warring: How Environmental, Economic, and Political Crises Will Redraw the World Map. In it, Paskal makes a compelling case for why the West should care about the geopolitical shifts—already underway—that will be exacerbated by climate change.

Paskal eloquently explains the science behind climate change in layman’s terms, breaking down incredibly complex issues and drawing connections across seemingly disparate challenges, such as rising food prices, degrading energy infrastructure, and growing water scarcity. She is a skilled storyteller, using memorable vignettes (and at times even humor) to effectively illustrate these climate-related complexities.

“The Canadian government should refrain from advancing the failed right-wing ideologies previously imposed by the George W. Bush administration in the United States, which made humanitarian assistance conditional upon a ‘global gag rule’ that required all non-governmental organizations receiving federal funding to refrain from promoting medically-sound family planning,” said the Canadian Liberal Party about the country’s Conservative government in a Parliamentary motion last week.

Though Prime Minister Stephen Harper had pledged to include a voluntary family planning initiative in Canada’s foreign aid plan at last year’s G8 meeting in Italy, the Conservative government recently said that the initiative will not be part of its G8 plan at the upcoming meeting in Canada this June.

This move has surprised both Canadians and Americans. U.S. President Obama overturned the Mexico City policy last year, and has fully supported the inclusion of family planning methods as part of foreign aid.

Harper’s government has maintained that maternal and child health services, such as vaccinations and nutrition, will be a priority, but various components of family planning, including birth control and abortion, will not be included in the Canadian initiative.

The Tories, as along with three Liberal MPs, voted down the Liberal motion 138-144, which requested clarification of Harper’s maternal health initiative and pushed for the inclusion of the full range of family planning options. The Tories focused solely on what they called “anti-American rhetoric” in the motion, which drew attention away from the divisive issue of abortion.

The issue has got caught up in domestic Canadian politics, with opposition Liberals trying to equate the Conservatives with the George W. Bush administration and the Conservatives trying to avoid discussion of intra-party debates on the contentious issue of abortion.

Now it seems likely like that Harper will go to the G8 summit in Ontario with a foreign aid plan for maternal health that makes no reference to issues of contraception. According to Canada’s International Co-operation Minister Bev Oda, “saving lives” of women and children is a higher priority than family planning.

But most international maternal health advocates don’t agree. “Maternal mortality rates are high among women who do not have access to family planning services. Contraception can reduce the number of unplanned pregnancies,” said Calyn Ostrowski, program associate for the Wilson Center’s Global Health Initiative. “For example, at a recent event on our Maternal Health series, Harriet Birugni of the Population Council in Kenya described how integrating reproductive health services such as family planning can reduce maternal mortality rates, particularly for poor young women who have the least access to contraception.”

In response to Canada’s announcement, U.S. Secretary of State Hilary Clinton said that the United States will be promoting global health funding, including access to contraception and abortion, at the G8. “You cannot have maternal health without reproductive health,” she said during a news conference with other G8 ministers. Britain has also agreed with this position, which has led Canadian Liberal Party Leader Michael Ignatieff to say that Canada’s G8 position goes against the international consensus.

Laura Pedro is the program assistant for the Canada Institute, and a graduate of the University of Vermont.

Photo.: Prime Minister Stephen Harper, courtesy Flickr user Kashmera

“It’s not every day you find an issue where effective diplomacy and development will allow you to save millions of lives, feed the hungry, empower women, advance our national security interests, protect the environment, and demonstrate to billions of people that the United States cares. Water is that issue,” declared Secretary of State Hillary Clinton at a World Water Day event hosted by the National Geographic Society and Water Advocates.

Alongside speeches by representatives from government and the non-profit sector, Secretary Clinton repeatedly emphasized America’s support for water issues. “As we face this challenge, one thing that will endure is the United States’ commitment to water issues,” she asserted. “We’re in this for the long haul.” Beyond simply highlighting the importance of the issue, Secretary Clinton also affirmed commitment to new programmatic, cross-cutting initiatives that will target water as a keystone for development and peace.

ECSP Director Geoff Dabelko, who attended the event, noted that Secretary Clinton’s speech ran counter to the much publicized notion that water scarcity is an unavoidable catalyst for conflict.

She came down squarely on the side of inclusion by identifying water as both a ‘human security’ and ‘national security’ issue. At the same time, she did not fall prey to the common pitfall of arm-waving about water wars. She flagged conflict and stability concerns, but also raised solutions through meeting needs associated with water and development. She went out of her way to emphasize water’s potential for peace and confidence-building, reflecting a commitment to capturing opportunities rather than merely identifying threats.

Secretary Clinton highlighted five crucial areas that comprise the United States’ whole-of-government approach to water issues:

1. Building capacity:
Through efforts with international partners, the United States hopes to strengthen the abilities of water-stressed nations to manage vital water resources. Agencies such as the Millennium Challenge Corporation and USAID are implementing initiatives that will enhance national ministries and encourage regional management cooperatives.

2. Elevating diplomatic efforts:
A lack of coordination between the numerous UN agencies, governments, and multilateral funding organizations hinders global water progress. By bringing this work together, the United States can act as a leader, demonstrating a positive diplomatic precedent for fragile and water-stressed nations.

3. Mobilizing financial support:
Relatively small grants have achieved large impacts. Work by the United States to strengthen capital markets in the water sector shows that it is possible to earn large returns on water investments. Successful examples range from educational and awareness-building programs, to desalinization and wastewater treatment plants.

4. Harnessing the power of science and technology:
Although there is no silver technological bullet to solve the global water crisis, simple solutions, such as ceramic filters and chlorine disinfection systems, do help. Additionally, sharing government-accumulated technological knowledge can have significant impacts, as demonstrated in a recent NASA-USAID project establishing an Earth-observation monitoring and visualization system in the Himalayas.

5. Broadening the scope of global partnerships:
By encouraging partnerships and elevating water in its global partnership initiatives with NGOs, non-profits, and the private sector—all of which are increasingly engaged in water issues—the Department of State hopes to maximize the effectiveness of its efforts.

The holistic approach advocated by Secretary Clinton reflects a distinct evolution of American diplomacy within this area, which is strongly supported by the water community. “The policy directions outlined in the speech, the five streams, represent a victory for those in and outside of government who have argued for a broad, rather than narrow, view of water’s dimensions,” said Dabelko. “The diversified strategy focuses on long-term and sustainable interventions that respond to immediate needs in ways most likely to make a lasting difference.”

In her concluding remarks, Secretary Clinton sounded a positive note, noting that for all of the press and attention devoted to the dangers of the global water crisis and the possible dark and violent future, dire predictions may be avoided through a smart, coordinated approach. “I’m convinced that if we empower communities and countries to meet their own challenges, expand our diplomatic efforts, make sound investments, foster innovation, and build effective partnerships, we can make real progress together, and seize this historic opportunity.”

“Much of the conversation about the global environment, frankly, is an elite conversation,” says Ken Conca, professor of government and politics at the University of Maryland. “But at the same time there are community-level voices, there are voices of indigenous people, there are voices of the powerless, as well as the powerful…. I think it’s important to capture them and not just limit [the conversation] to the most easily accessible voices.”

Leaders from the African Union,the European Union, NATO, and the United Nations have agreed unanimously that climate change threatens international peace and security, and urged that the time for action is now.

“By one count, there are now over 140 goals and priorities for U.S. foreign assistance,” Senator John Kerry said during the nomination hearing for USAID Administrator-designate Rajiv Shah. If Shah is confirmed, his principal tasks will be moving development out from the shadow of defense and diplomacy and bringing definition to USAID’s mission.

“USAID needs to have a strong capacity to develop and place and deploy our civilian expertise in national security areas,” Shah said at his nomination hearing. USAID “has a responsibility to step up and offer very clear, visible, and understood strategic leadership,” as well as clarify “the goals and objectives of resources that are more oriented around stability goals than long-term development goals.”

Stabilizing and rebuilding state infrastructure in post-conflict settings has been increasingly recognized as critical to aiding the population and preventing renewed conflict. The United States has increasingly invested in rebuilding health systems, and in some cases assisting in the delivery of health services for the first time.

While global health concerns have recently received significant attention, as witnessed by President Obama’s Global Health Initiative, the importance of health system reconstruction to stabilization efforts remains unevenly recognized. On November 10, 2009, experts met at the Global Health Council’s Humanitarian Health Caucus to discuss investing in health services in the wake of war and the challenges of funding this investment.

“Deconstruction from violence extends beyond the time of war and often leads to severe damage of health infrastructure, decreased health workers, food shortages, and diseases…resulting in increased morbidity and mortality from causes that are not directly related to combat,” shared Leonard Rubenstein, a visiting scholar at Johns Hopkins School of Public Health. Rubenstein argued that while relieving suffering in post-conflict settings should be a sufficient reason to include health reconstruction in U.S. foreign policy, policymakers narrowly define rationales for engagement based on claims that investments increase peace and improve the image of the U.S. government.

Investing in Health Systems Builds State Legitimacy

The evidence for investing in health systems to deter future conflict is limited and this approach is dangerous, according to Rubenstein, because it distorts spending decisions and fails to consider comprehensive capacity development strategies. Additionally, the Department of Defense’s approach of “winning the hearts and minds” is too short-term and neither linked to “system-building activities that are effective and sustainable…nor consistent with advancing the health of the population,” he said.

Instead, Rubenstein recommended that the United States invest in health systems after conflict because it advances state legitimacy. Although additional evidence is necessary, Rubenstein maintains that the promotion of state legitimacy enhances the perception that the government is responding to their long-term needs and encourages local ownership and accountability. Developing health systems in post-conflict settings is complex and cannot be done quickly, he noted, and thus increased financial and human resource capacities will be essential.

Coordination and Transition Funding

“We need to recognize that the U.S. is not the only funder, as there are many stakeholders involved,” argued Stephen Commins, strategy manager for fragile states at the International Medical Corps. Commins argued that there is a “desperate need to coordinate donor funding … both within and across government systems, as well as an increased need for transparent donor tracking systems.”

As countries come out of conflict and start to gain government legitimacy, they need increased support to stabilize conflict and avoid collapse. Transition funding for health systems needs to support both short and long-term efforts, maintained Commins, but unfortunately the donors driving these timelines are often driven by self-interest, not the rights of the individual living in conflict.

Without a transparent donor tracking system, it is hard to demonstrate actual monetary disbursements versus commitments, so Commins called for a system that tracks allocations and spending in real time. These are not our countries, he argued, and responding to health systems in post-conflict settings should be tailored to the country’s needs, not the donor’s. He also called for increased research that describes, over time, the costs for rebuilding and transitioning from international NGO-driven systems to self-sustained governments.

Rebuilding Health Systems in Sudan

George Kijana, health coordinator in southern Sudan for the International Rescue Committee, discussed reasons for why Sudan’s health system remains poor five years after conflict. According to Kijana, the government in Southern Sudan has not been held accountable by its donors, leading to a breakdown in infrastructure and a lower quality of health workers.

Additionally, a majority of the available health data comes from non-state actors that are not easily accessible. Kijana shared that in order for Sudan to move forward, more research and data are needed to help target long-term capacity building projects, as well as short-term interventions that address infant and maternal mortality. While progress is slow, he pointed out encouraging signs of progress, as the Ministry of Health now recognizes their weaknesses and positively engages with its development partners such as the United Nations.

Photo: Romanian Patrol administers medical treatment to Afghan communities, courtesy of Flickr user lafrancevi.

MORE

The Center for Global Development’s latest report, Start With A Girl: A New Agenda For Global Health, sheds light on the risks of ignoring the health of adolescent girls. Like other reports in the Girls Count series, it links broad social outcomes with adolescent health. “Adolescence is a critical juncture for girls. What happens to a girl’s health during adolescence determines her future–and that of her family, community, and country,” state coauthors Miriam Temin and Ruth Levine.

Between childhood and pregnancy, adolescent girls are largely ignored by the public health sector. At the same time, programs and policies aimed at youth do not necessarily meet the specific needs of girls. Understanding the social forces that shape girls’ lives is imperative to improving their health.

Like recent books by Michelle Goldberg and Nicholas Kristof, the report argues for increased investment in girls’ education to break down the social and economic barriers that prevent adolescent girls from reaching their full potential. Improving adolescent girls’ health will require addressing gender inequality, discrimination, poverty, and gender-based violence.

“For many girls in developing countries, well-being is compromised by poor education, violence, and abuse,” say Temin and Levin. “Girls must overcome a panoply of barriers, from restrictions of their movement to taboos about discussion of sexuality to lack of autonomy.” The report points to innovative government and NGO programs that have successfully changed negative social norms, such as female genital cutting and child marriage. However, the authors urge researchers to examine the cost-effectiveness and scalability of these programs.

In the last five years, the international community has become increasingly aware of the importance of youth to social and economic development. Some new programs are focused on investing in adolescent girls, such as the World Bank’s Adolescent Girls Initiative and the White House Council on Women and Girls, but significant additional investment and support is needed.

“Big changes for girls’ health require big actions by national governments supported by bilateral and multilateral donor partners, international NGOs…civil society and committed leaders in the private sector,” maintain Temin and Levin. They offer eight recommendations:
1. Implement a comprehensive health agenda for adolescent girls in at least three countries by working with countries that demonstrate national leadership on adolescent girls.
2. Eliminate marriage for girls younger than 18.
3. Place adolescent girls at the center of international and national action and investment on maternal health.
4. Focus HIV prevention on adolescent girls.
5. Make health-systems strengthening and monitoring work for girls.
6. Make secondary school completion a priority for adolescent girls.
7. Create an innovation fund for girls’ health.
8. Increase donor support for adolescent girls’ health.

“We estimate that a complete set of interventions, including health services and community and school-based efforts, would cost about $1 per day,” say the authors of Start With a Girl. There is no doubt in my mind that this small investment would indeed have a high return for the entire global community.