A recent issue of the New England Journal of Medicine carried a report proposing an “International Health Service Corps” (IHSC) as a vehicle for improving global health. “To break the cycle of poverty and disease,” argued the authors of the report, “we believe that the United States should create the equivalent of a Marshall Plan for health — a program that would train and fund both local providers and U.S. health care professionals to work, teach, learn, and enhance the health care workforce and infrastructure in low-income countries.” Through the IHSC, “health care workers would engage in medical-service and capacity-building partnerships overseas in exchange for health related graduate school scholarships and forgiveness of student loans.”
My hat goes off to the report’s three authors, Drs. Paul Farmer, Vanessa Bradford Kerry, and Sara Auld. Health provision remains an undervalued yet powerful aspect of international relations, and the creation of an IHSC would give current and future generations of US health workers the chance to ply their skills overseas for the betterment of all. Farmer, Kerry and Auld, however, overlook a major point. On more than three continents, US men and women are doing exactly the type of work suggested in the New England Journal of Medicine. They are on the ground in underserved areas training health care workers, repairing equipment, and strengthening the capacity of foreign governments to provide health care to their citizens. These men and women work 16+ hour days for months on end. Yet few global health researchers and practitioners are familiar with their work. Why? Because the people I’m talking about wear uniforms.
Every year the US Army, Navy, Air Force, Marines, Coast Guard and Public Health Corps conduct numerous humanitarian assistance and disaster relief operations around the world. Only a small portion of these operations attracts media attention; the majority take place out of the public eye. Last month the US Navy hospital ship, USNS Mercy, completed a six-nation training and assistance mission in Southeast Asia. The Mercy’s team, comprising personnel from all branches of the military and ten NGOs, treated over 100,000 patients and performed 859 surgeries, in addition to other construction and training projects. In Central America, the amphibious ship USS Iwo Jima is currently anchored off the Panamanian Coast, providing medical care and medical capacity building as part of a five-nation humanitarian assistance and disaster relief mission. Simply put, America’s uniformed services are the best-kept secret in global health.
Some contend these operations politicize health. They do – they’re part and parcel of US foreign policy – and that’s not necessarily a bad thing. The inclusion of medical assistance in the US foreign policy tool box can help build new relationships and strengthen old ones. Don’t believe me? How about the proposers of the IHSC? Because they claim the same thing in the first two sentences of their article. “At first glance,” they write, “medicine may seem unrelated to foreign policy, but in reality it is an unappreciated partner of diplomacy. In many parts of the world, poverty, inequity based on ethnicity or sex, shoddy public infrastructure, and environmental degradation have resulted in poor health as well as political and social instability.”
Ask any military or civilian personnel on a US medical assistance operation (and I have) why it’s important for America to repair medical equipment in Nicaragua or train medics in the Democratic Republic of the Congo, and you’ll get almost the exact same answer every time. Helping states provide health care to their populations can increase regional stability, build valuable diplomatic relationships between the US and foreign governments, and play an important role in that elusive old game: winning hearts and minds. By helping others in this way, Americans help themselves.
So is the IHSC a good idea? Absolutely. If it ever needs researchers I’ll be the first to sign up. We need to ensure, however, that the IHSC doesn’t simply reinvent the wheel. The US already has a proto-IHSC in the often-overlooked international health operations of its military and other uniformed services.