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

1. Matthew Brown, MPS, Office of Global Affairs, US Department of Health and Human Services Craig Shapiro, MD, MPH, Office of Global Affairs, US Department of Health and Human Services Alicia Livinski, MPH, MA, National Institutes of Health Library Thomas Novotny, MD, MPH, San Diego State University Jimmy Kolker, Ambassador (ret.), MPA, Office of Global Affairs, US Department of Health and Human Services The intersection of diplomacy and public health: the role of health attachés in the United States government’s global engagement The 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

2. 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

3. 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

4. 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

5. GHD & HHS Health Attachésare 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

6. 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

7. 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.

8. 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.

9. Health Attachés & HHS Geneva Kabul Beijing Baghdad Hanoi New Delhi Addis Ababa Brasilia Pretoria = 5 Current Health Attachés = 4 Previous Health Attachés

10. 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

11. 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

12. 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

13. 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

14. Thank you. Questions? matthew.brown@hhs.gov