The intersection of diplomacy and public health: the role of health attachés in the United States governments global engagement Matthew Brown, MPS, Office.

The intersection of diplomacy and public health: the role of health attachés in the United States government’s global engagement

Matthew Brown, MPS, Office of Global Affairs, US Department of Health and Human ServicesCraig Shapiro, MD, MPH, Office of Global Affairs, US Department of Health and Human ServicesAlicia Livinski, MPH, MA, National Institutes of Health LibraryThomas Novotny, MD, MPH, San Diego State UniversityJimmy Kolker, Ambassador (ret.), MPA, Office of Global Affairs, US Department of Health and Human ServicesThe views expressed in this presentation are those of the authors’ and do not reflect the official policy or position of the US Department of Health and Human Services, National Institutes of Health or San Diego State University

What is global health diplomacy (GHD)?

• Global health diplomacy is a political activity that meets the dual goals of improving health while strengthening relations among nations

Adams V, Novotny TE, Leslie H. Global Health Diplomacy. Medical Anthropology. 2008/10/28 2008;27(4):315-323

USG Participants in GHD

• U.S. Department of State, Office of Global Health Diplomacy (formerly the Global Health Initiative office)

• U.S. Department of Health and Human Services (and various Staff/Operating Divisions)

• U.S. Department of Defense• U.S. Agency for International Development• Other federal agencies who work with

global health issues

GHD & HHS

• Lead US Government agency on health is the Department of Health and Human Services (HHS). – In HHS, global health matters are coordinated by

the Office of the Global Affairs (OGA)• Many HHS divisions have global health offices:

• CDC Center for Global Health• NIH Fogarty International Center; NIH/NCI Center

for Global Health• FDA International Program Office• HRSA Office of Global Health Affairs

GHD & HHS

Health Attachés are HHS employees who are posted in U.S. Embassies of countries of strategic importance to the Department and U.S. Government

Represent the HHS Secretary and advance the science and practice of global health diplomacy, supporting Ambassador’s global health agenda and U.S. foreign policy objectives abroad

1948 JAMA article first mentions a Health Attaché assigned to Embassies in Paris, Brussels and The Hague.

Sanders. First Public Health Attache Appointed. JAMA. 1948;138(10):761

Why Health Attachés (HA)?

• New Diplomacy (QDDR) – diplomacy needs to expand beyond commercial, military, and political affairs

• U.S. Ambassadors increasingly need and want technical advice and program leadership focused on health

• This function is often delivered through a combination of efforts by: – State Dept. Economic, Science, Technology and

Health Officer– CDC Country Director– USAID Health Officer– State Dept Local or Regional Medical Officer (primary

care physician for Embassy community and families)

Jones K-A. New Complexities and Approaches to Global Health Diplomacy: View from the U.S. Department of State. PLoS Med. 2010;7(5):e1000276.

Who is a Health Attaché?

“A Health Attaché is a diplomat charged with reporting on health issues of concern for the U.S. Government, coordination of U.S. health policy and supporting the multiple agencies of HHS engaged in global health.”

Brown M, Mackey TK, Liang BA. Global health diplomacy and management mechanisms of US-China public health collaborations in China: Lessons for emerging markets. J Commercial Biotech 2012; 18(4):44-50.

Health Attachés & HHS

= 5 Current Health Attachés

= 4 Previous Health Attachés

Pretoria

Brasilia

Geneva

Beijing

HanoiNew Delhi

Addis Ababa

Baghdad

Kabul

Role of Health Attachés

• Report on local health issues that impact USG global health policy

• ‘Go-to’ person for health matters for host country and U.S. Ambassador & Embassy

• Negotiate and follow-up on bilateral and multilateral agreements and treaties

• Facilitate and coordinate public health research, technical assistance & information sharing

• Develop professional contacts of value to the USG

Role of Health Attachés

• Support high level global health delegations -- meetings

• Look for opportunities where the USG has capacity to address public health issues

• Monitor and encourage adherence to international conventions

• Serve as a bridge between domestic and international health issues and actors

Career of Health Attachés

• HAs are funded by HHS• HAs have offices within the U.S. Embassy and

carry a diplomatic title• Career of HA – most drawn from HHS agencies

and serve one or more tours• Training and skills of HA – most have

advanced training in public health/medicine, extensive field and program experience, and skills in policy analysis and negotiation

• OGA is working on creating a ‘global health career track’ within the Department

Health Attachés future

• Post 2015 Millennium Development Goals• Increasing role of BRICS (Brazil, Russia,

India, China and South Africa)• Middle income countries want expanded

collaboration in health & specifically HHS• Expanding importance of Non-

Communicable Diseases (NCDs)• Health security and pandemic

preparedness

Thank you.

Questions? matthew.brown@hhs.gov