Global Health Policy Steel Cage Match: The U.S. Surgeon General vs. the Department of Health & Human Services Office of Global Health Affairs

The Washington Post ran a story on the front page of Sunday's paper about a Bush political appointee blocking a report by then-Surgeon General Richard H. Carmona that called on Americans to help tackle global health problems. The report, entitled "Call to Action on Global Health," was blocked because it did not "promote the administration's policy accomplishments" according to the article. The political appointee in question is William R. Steiger, the director of the Department of Health and Human Services Office of Global Health Affairs. Mr. Steiger, according to the article, is a "a specialist in education and a scholar of Latin American history whose family has long ties to President Bush and Vice President Cheney" and is "without any background or expertise in medicine or public health."

The report touches on many of the issues in global health and how America could be working towards improving health worldwide. More importantly, however, is that the report examined how global health problems are linked to violence and social ills and also how these public health issues impact America's security, a topic which is a core focus of Bush administration policy. However, the administration's discomfort with some aspects of the report led to each side fighting tooth and nail over this report, with the surgeon general and medical experts fighting to have it released, while the administration, and specifically Steiger, fought to keep it under wraps claiming that "sloppy work, poor analysis, and a lack of scientfic rigor" delayed the release of the report. Steiger also said in a statement that the report addressing global challenges to health ought to "at least let Americans know what their generosity is already doing in helping to solve those challenges."

While the report addressed health topics that are a priority in the Bush administration (i.e. HIV/AIDS and malaria), it also called for more action on such issues as the international tobacco treaty and including global health as an element of US foreign policy. These latter two matters are considered quite politically sensitive, contributing to the administration's unease with the report. Furthermore, the article notes that Steiger was more concerned with making the Office a political arm rather than an office operating with a clear public health focus. According to Richard Walling, a former career official in the global health office, Steiger always operated with his "his political hat on" and that "[w]hat he was looking for, and in general what he was always looking for, was, 'How do we promote the policies and the programs of the administration?'"

Though the Bush administration has indeed provided a great deal of funding for certain global health issues, the selectivity towards certain global health issues that administration officials are displaying is of concern. As the draft of the report noted, certain diseases and the social ills that accompany them were once limited to remote parts of the world, but in the era of globalization, they can easily spread to the most developed of nations. The reasons for the blocking of the report are specious at best and it should be pointed out that improving global health could have a positive impact on the administration's goal of "securing the homeland." Furthermore, the improvement of global health abroad will result in healthier populations, healthier workforces, and most importantly, healthier economic partners for the United States. According to an Economist article from July 5th, the private sector is already taking steps to improve global health because of the costs of an unhealthy workforce. Large local and multinational firms are promoting anti-AIDS and anti-malaria programs for their workforces in Africa and Asia, for example, and other private sector efforts promote sustainability in the countries they work in. Certainly, some aspect of this approach towards improving global health must appeal to the Bush administration.

Fortunately, with the publicity this story from the Washington Post is receiving, the message of the report is getting out there. But, like almost anything in Washington, it is not without controversy.