1. The intersection of diplomacy and public health: the role of health attachés in the United States government’s global engagement
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 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
OGA provides technical advice on health policy and program issues:
Advises the Secretary in the development of policy related to global health, social welfare and family issues
Directs and coordinates international activities to ensure alignment with the Secretary’s vision, the Department’s global priorities, and overall U.S. foreign policy
Facilitates coordination and collaboration across HHS OpDivs, StaffDivs and with other USG Agencies
Works with relevant stakeholders to ensure that international policies and programs are grounded in the best possible science
OGA does not usually:
Make grants
Implement programs
Conduct research
Adams V, Novotny TE, Leslie H. Global Health Diplomacy. Medical Anthropology. 2008/10/ ;27(4):

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 Attachés are 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.
The role of Health Attachés grew out of the practice of having medical officers stationed at Embassies who not only provided medical care for diplomatic personnel stationed in a foreign country but also reported on issues of public health concern, such as outbreaks and local capacity to prevent or treat illnesses.
For the United States, Health Attachés assigned to embassies abroad are group of professionals who have supported the improvement of global health policy for decades.
HA have been instrumental in helping to launch the major global health initiatives of the last decade – negotiating with host country government, among U.S. government agencies, and with multilateral institutions
- PEPFAR
- PMI
- Global Fund for HIV/AIDS, TB and Malaria
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)
Ambassadors increasingly need and want advice and program leadership focused on health. Where there is no Health Attaché, this function is often shared through a combination of efforts by an Economic officer, Science, Technology and Health Officer, PEPFAR or GHI coordinator, CDC Country Director and/or USAID Health Officer.
OGA does receive requests for HAs to serve in other courtiers, however budget does not permit us to fill all request
OGA has appointed some HHS Country Representatives – to serve in a limited function from existing staff already deployed on the ground – OGA has appointed HHS CRs in:
Guatemala
Thailand
Vietnam
Kenya
Jones K-A. New Complexities and Approaches to Global Health Diplomacy: View from the U.S. Department of State. PLoS Med. 2010;7(5):e

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.”
A health attaché is a diplomat who collects, analyses, and acts on information concerning health in a foreign country or countries.
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 = 5 Current Health Attachés
Geneva
Kabul
Beijing
Baghdad
Hanoi
New Delhi
Addis Ababa
Previous HAs:
Ethiopia – African Union
Vietnam – Regional
Afghanistan – health system building
Iraq – health system building
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. Questions? matthew.brown@hhs.gov
Thank you.
Questions?