On 26 December 2004, an earthquake off the coast of Sumatra, Indonesia,
led to tsunamis that killed more than 220,000 people and caused widespread
damage around the Indian Ocean.
This marks one of the first times in human history that so many countries
were involved in a natural disaster, necessitating a global response.Since
the tsunami, people around the world have been watching pictures of
the total devastation. While there was immediate concern for survivors
and an effort to rescue and track down the missing, government officials
from around the world started to focus their attention on mounting the
massive relief effort everyone knew would be required.
The international effort in helping those affected became ‘‘an
interesting new kind of diplomacy, ’’according to the U.S.State
Department. ‘‘It was an intensive and immediate effort, multilateral
coordination and disaster relief, at a senior level, that in some ways
was virtual diplomacy. ’’The new diplomatic ground took advantage
of communication technologies such as teleconferencing and e-mail.
In the twenty-first century, communication technology has become a
central part in mobilizing humanitarian relief and health personnel.Yet
the goal of early warning systems traditionally have been used just
to avoid or minimize violence, deprivation, or humanitarian crises that
threaten the sustainability of human development. Now as the relief
and reconstruction operation is underway, we should not lose sight of
an opportunity to advance a new kind of health diplomacy and rebuild
a less vulnerable region where people and states are organized to respond
to future threats.An opportunity has been created to view future warning
systems, not just to prepare for short-term containment and relief strategies,
but also to design, build support for, and implement longer-term proactive
strategies and development programs that can reduce the likelihood of
future disasters. Such systems also can build capacity and integrate
information targeted to national government officials, representatives
of conflicting parties, and local nongovernmental organizations (NGOs)
while legitimizing the role of health in civil society.
In the post-9-11-01 world, however, more health and humanitarian resources
have been centered on security.For example, in 2003 the United States
spent $4.3
billion for bioterrorism preparedness, with the world ’s largest
public health agency,
the U.S.Centers for Disease Control and Prevention, spending more than
$2 billion
on bioterrorism, including more than $500 million for smallpox vaccine, a
disease eradicated in the last century.In contrast, the World Health
Organization, which
represents 191 member countries, has a total budget of less than $1 billion
annually.
The unfortunate event of the tsunami presents an opportunity to integrate
future
efforts into the global psyche:Health promotion, disease prevention, and
other
forms of public health should not be last in line in today ’s world
of limited resources.
If we share and advance an idea of health diplomacy, we can add great
promise and
potential to reframe issues of health and human development.
This idea of international health diplomacy is not new;it developed
from threats
to public health in the nineteenth century.In the middle of the nineteenth
century,
risks were associated with infectious diseases, opium and alcohol, occupational
hazards, and transboundary pollution.In 1851, European states gathered
for the
International Sanitary Conference to discuss cooperation on cholera, plague, and
yellow fever.This cooperation was an improvement, as transboundary disease
trans-
mission was traditionally dealt with through national quarantine policies.Yet
national policies failed to prevent the cholera epidemics that swept
through Europe
in the first half of the 19th century, which led to disease control becoming
a subject
of diplomatic discussion.
In the twenty-first century, the tsunami catastrophe can spark a new
inter- national cooperation beyond the evolution in international cooperation
on infectious diseases. Health diplomacy as a goal, builds on the 1994
United Nations Human Development Report to advance human security with
‘‘first, safety from such chronic threats of hunger, disease
and repression. And second, protection from sudden and hurtful disruption
in the patterns of daily life —whether in homes, in jobs or in
communities ’’(Human Development Report 2004, Cultural
Liberty in Today’s Diverse World, http://hdr.undp.org/2004/).
Recently, outgoing U.S.Secretary for Health and Human Services Tommy
Thompson suggested a similar idea with what he termed ‘‘medical
diplomacy ’’as an additional form of response to terrorism.Thompson
cited his travel to 37 countries ‘‘helping deliver medicine
for AIDS, malaria and other diseases.’’He stated, ‘‘[Medical
diplomacy ]can be hugely successful, and much less expensive, as a means
of fighting terrorism.’’He linked such an approach to the
tsunami and the American people: ‘‘The gratitude of people
for what America, with its wealth of medical talent, can bring, is overpowering.
We’re seeing it again with the tsunami relief.We should be doing
this on the scale of the Marshall Plan.’’
Health diplomacy will require a twenty-first century partnership on
a Marshall-like scale with input from many potential global citizens
who share this interest to advance health.This presents a certain challenge
to enhance global leadership, with international agencies, foundations,
multilateral banks, the private sector and a host of new players who
could be involved to advance this important agenda. Health as a shared
currency should engage country health ministers, country politicians,
country finance ministers, developed country (OECD)opinion leaders,
development banks / donor agency program managers and field staff, development
banks and donor agency leaders, NGOs, global media, national media (developed
and developing world), industry (health and consumer products), medical
and public health professionals and public health schools, and health
care professionals, among others.
Let’s hope the post–tsunami years will build upon a disaster
relief operation with a strong health diplomacy among several strong
institutions and formidable countries.Communication can make a difference
in health and human security; the tsunami is but another exigency warranting
a magnanimous response.
_____
Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal
of Health Communication: International Perspectives. He also is
Vice President, Government Affairs, Europe for Johnson & Johnson
with academic appointments at George Washington University School of
Public Health, Tufts University School of Medicine, Yale University
School of Medicine, The College of Europe, and University of Cambridge.
