Global Health Engagement (GHE): What it is, what it is not, and relevant DoD issues within the legal and physician practitioner arena

Introduction Welcome Purpose Presentation Format Participant Bios

Participants Moderator Mr. Joshua Girton, (USU OGC) Panelists Dr. Kevin Riley, (CDHAM) Dr. Shakir Jawad, (CDHAM) Lt Col Bradley Boetig, USAF MC (USU PMB) CAPT Glendon Diehl, USN MSC (USU PMB)

What is “Global Health” “The area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.” Koplan JP, Bond TC, Merson MH, et al; Consortium of Universities for Global Health Executive Board. Towards a common definition of global health. Lancet. 2009;373:1993-1995

International Medical Corps founder Dr Robert Simon teaches Afghan medics surgery by candlelight. In many developing countries, the lack of skilled health workers and training can shatter health systems that are already fragile. International Medical Corps has established 57 clinics and 10 hospitals in rural Afghanistan. Museyebo Mutaba, from the Lui river region in Zambia, fell seriously ill with malaria when heavily pregnant. A community volunteer from the Zambia Anglican Council (ZAC) insisted her family take her to hospital rather than a traditional healer, as was their intent. Museyebo and her baby now sleep beneath an insecticide-treated mosquito net provided by ZAC. Submitted by Christian Aid

What does the DoD do in Global Health? Foreign Humanitarian Assistance (FHA) Humanitarian Civic Assistance (HCA) Medical Stability Operations (MSO) Security Cooperation and Building Partner Capacity Health Diplomacy Global Health Security

“Global Health Security” 2006 National Security Strategy: “The risks [from public health challenges like pandemics that know no borders] to social order are so great that traditional public health approaches may be inadequate, necessitating new strategies and responses…. If left unaddressed, [they] can threaten national security.” 2010 National Security Strategy: “The threat of contagious disease transcends political boundaries, and the ability to prevent, quickly detect and contain outbreaks with pandemic potential has never been so important….Addressing these transnational risks requires…extensive collaboration with the global community.” Also refers to “promoting global health security” and calls for a “comprehensive global health strategy” 2015 National Security Strategy: “America is the world leader in fighting pandemics…and in improving global health security… We will accelerate our work with partners through the Global Health Security Agenda in pursuit of a world that is safer and more secure from infectious disease.”

“Global Health Security” Global Health “Diplomacy”

Global Health Diplomacy Efforts in the health domain designed to achieve diplomatic aims Efforts in the diplomatic domain designed to achieve health aims “a political change activity that meets the dual goals of improving global health while maintaining and strengthening international relations abroad, particularly in conflict areas and resource-poor environments.”

Are the DoD’s actions “humanitarian”? Dictionary definition Humanitarian Principles: Humanity Neutrality Independence Impartiality

Issue 1 Do the DoD GHE activities qualify to be classified as humanitarian endeavors? If not, on what technical elements would the DoD GHE activities be disqualified from this definition of humanitarian endeavors? Is the humanitarian endeavor label necessary or required, either internally, or externally, in order to lend credibility or authority to these DoD GHE activities?

Issue 2 How should GHE activities be used in the context of greater DoD missions? How is mission success within the GHE arena defined, measured, and publicized by the DoD? What are the ethical and legal quandaries of the potentially competing strategic objectives within that GHE mission planning process? What counsel should physicians and attorneys provide to the unit commander for consideration with regard to GHE activities at the strategic level?

Issue 3 Does the DoD currently execute GHE activities in a consistent and unified manner? If GHE activities are executed in a disparate manner, is that variation detrimental or helpful? If disparate GHE activity execution is either sub-optimal, or counterproductive, what could be done to better harmonize the GHE activities executed by the DoD? How does the disparate funding authorities of GHE activities influence the direction and ultimate effectiveness of those endeavors?

Issue 4 What are the tactical considerations for the front line DoD physicians and attorneys in these GHE activities? What are, or should be, the criteria for eligibility of medical services for local national patients? What obligation does the DoD have to local national patients in regards to post intervention observation, or follow up care? What are the potential collateral damage side effects of employing GHE activities in the first place, or incorrectly, at the tactical level?

Issue 5 What elements of beneficence, if any, are conveyed by our DoD medical providers to the local national patients receiving treatment as part of these GHE activities? Is there any legitimacy to the argument that directing DoD medical intervention in the first place potentially violates the Hippocratic oath of doing no harm? If DoD GHE activities cannot create sustainable medical solutions, would it be advisable simply not to engage at all?

Questions??? Contact information Mr. Joshua Girton, USU OGC, joshua.girton@usuhs Dr. Kevin Riley, CDHAM, kriley@cdham.org Dr. Shakir Jawad, CDHAM, sjawad@cdham.org Lt Col Bradley Boetig, MC USAF, USU PMB, bradley.boetig@usuhs.edu CAPT Glendon Diehl, USN MSC, USU PMB, glendon.diehl@usuhs.edu CDHAM, http://www.cdham.org/