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Taking it Online: Intersection of Public Health and Foreign Policy

April 6, 2020 ~ As many of us reflect on the first three months of 2020 while working from home (WFH), there is no denying how interdependent and connected our modern world really is with the rapid spread of the COVID-19 pandemic. The outbreaks in 2016 of Zika, in 2014-2015 of Ebola, in 2012 of MERS, in 2009 of H1N1 and in 2002-2004 of SARS sounded alarms across the globe even as we were all warned that it would not be a matter of if, but when the next pandemic would strike. Despite the alarms, we repeatedly ignored them, hitting the snooze button and delayed waking up to the reality that ignoring the warning signs results in real and devastating harm. In the absence of advanced and appropriate planning, more lives will needlessly be lost and livelihoods irreversibly ruined. We are just starting to realize this global health crisis’ impact and disruption, necessitating a rebalance of developing and developed economies to adjust ways of doing business; a renewed definition of national security priorities and public health threats among states and countries; a reformulation of pedagogy and practice for teachers and administrators and students on education; and not least, a re-assessment for individuals as to what constitutes essential. The impact of COVID-19 has been swift, broad and deep and our behaviors as global citizens, as communities and as individuals are forever altered. These are conceivably far more “wicked” issues than those raised during Rittel and Webber’s (1973) time as some of the most complex and challenging.


The worldwide lack of planning and preparedness in responding to this global crisis makes clear that the intersection of public health and foreign policy is an area that requires greater attention. Furthermore, to the extent possible, we should prepare not only for more pandemics, but also for more pandemics with greater frequency. How do we position ourselves to better prepare and manage these scenarios and to act with agility? As the number of COVID-19 infections and levels of anxiety grow by the day, we are finally seeing welcomed leadership in the United States and other countries and evidence in the past few weeks that they are taking this crisis seriously and acting on it. But are they the right actions and how will we know if they are the right actions? In the rush to take action and be seen as being proactive, there has traditionally been an inclination to look to money and funding as the solution for societal woes -- $2+ trillion in stimulus, as a modern example -- and an aversion to reflect, evaluate and fix existing policies and programs through periodic critical adjustments and modifications. Indeed, money and funds are undoubtedly a part of the solution.


On a viable response to these scenarios, I revisit the role of public health and foreign policy priorities through health diplomacy as a critical element of foreign policy planning. Health diplomacy as a term has been around at least 20 years and the U.S. Department of Health and Human Services (HHS) assigns Health Attachés through its Office of Global Affairs to key posts at U.S. missions abroad, so these are not new initiatives or concepts. PBS aired a March 20 interview that speaks to this link between public health and foreign policy. This piece resonates with those of us following this connection between public health and foreign policy, but it should resonate more broadly across public audiences. Interestingly, the 116th Congress introduced bills last October in both the House and the Senate chambers that call for a U.S. Global Health Commission, a U.S. Global Health Attaché Program, as well as efforts to ensure interagency policy coordination across HHS and the Departments of Agriculture, Defense, Homeland Security, State and U.S. Agency for International Development. This bill stalled, however, and legislators missed an opportunity to address interagency coordination, transparency and accountability in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. I am cautiously optimistic by this legislation that authorizes additional funding through September 30, 2021 or 2022, to “prevent, prepare for, and respond to coronavirus, domestically or internationally” across the U.S. federal government that this comes at the expense of other important policies and programs yet to be identified. Even with recent actions to stem the spread of infections and flatten the curve, there should be concurrent action taken to prioritize public health as an essential dimension of national security and foreign policy.


Experience tells us and research studies suggest that ongoing and recurring feedback, assessment and evaluation can be helpful in recommending changes and alterations as the data and evidence are collected and considered to inform policymaking. On reflection, one might ask the following questions: What role did these offices have in preventing the spread of COVID-19 and can they do better? What worked and what didn’t work? Pursuant to the CARES Act, what role might these offices have, if any, in a future health crisis or pandemic? How will these new functions be evaluated, using what criteria, how often will they be evaluated and by whom? What impact did these offices and functions have? To what extent was it due to funding constraints and to what extent was it due to human resource constraints or policy priorities? In policy and program evaluation, scholars and practitioners quite frequently encounter unintended consequences that spill over into other arenas. How will these spillover effects be captured and addressed? In public management literature, Rainey and Jung (2014) challenge us to identify levels of goal clarity for different conditions and settings. The language of diplomacy and foreign policy can benefit a great deal from goal clarity, even as we are eager to aid, relieve and secure. Kevany (2014) and Bleiker and Hutchison (2008) find that global health programs and emotions, respectively, are as yet an underutilized tool for diplomacy and foreign policy, including their role in the pursuit of international influence and perceptions. For those of us not in the frontlines, we can ask ourselves: Additionally, What role do we as private citizens can and should play?


Acting with agility is another serious matter for further consideration if we are to take seriously investment in human capital. Along with establishing policies, programs and processes, there is a need to challenge our assumptions further and address how the workforce can be more agile. HHS Secretary Alex Azar affirmed a whole of government response, but he was short on specifics. To be effective and have sustained impact, the federal government might look to advice and expertise from the whole of society, including subnational government, private sector, non-governmental organizations as well as academic institutions and research and think thanks, and even beyond to foreign entities and international organizations. These positions should not only be as appointments to leadership positions, but should also extend to mid-level and entry-level positions. This could mean shaking loose the rigid administrative silos to develop a mechanism(s) that would incentivize the movement of experts between and among these sectors to exchange perspective, knowledge and tools.


For my February blog, I introduced a logic model that illustrates how knowledge, data and evidence in the public policy domains might inform decisions on the application of a variety of foreign policy instruments to contribute to possible outcomes. With the advantage of time and reflection since, I have updated my logic model to illustrate the intersection and importance of public health and foreign policy. Again, the faded borders denote outcomes that reflect more accurately the fact that we rarely experience absolutes. Addressing wicked problems of the present and the future requires a fundamentally new approach to thinking and acting. The logic model below is an attempt to help spark further thinking and perhaps even build momentum for more immediate action.

Citations: Bleiker, R., & Hutchison, E. (2008). Fear No More: Emotions and World Politics. Review of International Studies, 34, 115–135. Kevany, S. (2014). Global Health Diplomacy, ‘Smart Power’, and the New World Order. Global Public Health, 9(7), 787-807. Rainey, H.G. and Jung, C.S. (2014) A Conceptual Framework for Analysis of Goal Ambiguity in Public Organizations. Journal of Public Administration Research and Theory 25(1): 71-99. Rittel, H. W. J., & Webber, M. M. (1973). Dilemmas in the general theory of planning. Policy Sciences, 4, 155–169.



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