Interview of the Director of National Intelligence, Mr. Mike McConnell, by Charlie Rose on PBS
January 8, 2009
Dr. Thomas Fingar
Date: Fri, 9 Jan 2009 15:24:15 -0600
You are subscribed to receive updates from the Office of the Director of National Intelligence – National Intelligence Council (NIC). This information has recently been updated, and is now available.
Highly publicized virulent infectious diseases—including HIV/AIDS, a potential influenza
pandemic, and “mystery” illnesses such as the 2003 outbreak of severe acute respiratory
syndrome (SARS)—remain the most direct health-related threats to the United States, but are not
the only health indicators with strategic significance.
Chronic, non-communicable diseases;
neglected tropical diseases; maternal and child mortality; malnutrition; sanitation and
access to clean water; and availability of basic health-care
2 also affect the US national
interest through their impacts on the economies, governments, and militaries of key
countries and regions.
• Considerable empirical and theoretical studies have demonstrated the links between the
health of a population and economic growth and development. An unhealthy labor force is
logically less capable of engaging in physical labor, but the impact of poor health on
cognitive ability is becoming particularly important as countries develop services and other
sectors dependent upon intellectual capital to generate productivity and growth. Moreover,
the issue of women’s health is especially urgent given the growing body of evidence that
female participation in education and paid labor is integral to economic development.
The ability to provide health-care and other basic services is viewed as a measure of a
’s legitimacy. Former South African president Thabo Mbeki was censured at
home and abroad for failing to provide adequate health-care for persons with HIV/AIDS;
health-care issues featured prominently in several recent elections in the Americas; and
nonstate actors such as terrorists and warlords have gained local and international stature and
even power by providing health services that governments could not.
• Widespread ill health in the youth cohort may reduce a country’s pool of healthy and capable
recruits, a phenomenon that is currently playing out in Russia and North Korea.
Deployed military forces will continue to be vulnerable to the ravages of infectious diseases,
and the capability of a government to provide adequate health protection for its troops will
significantly impact its ability to project force abroad.
Health-Related Challenges in Countries of Strategic Significance
Health factors appear to be impacting countries of strategic importance to the United States in a
number of different ways:
Reconstruction and Stabilization
Inability of the central government of Afghanistan to provide health-care and other services
has helped to undermine its credibility while boosting support for a resurgent and
increasingly sophisticated Taliban . Moreover, wide incidence of traumatic births,
malnutrition, and disease puts children there at high risk of impaired physical and cognitive
All health phenomena described in this paper are in fact inextricably connected and cannot be examined in
isolation from each other. A chart showing these linkages can be found on pp. 51-52.
3 More detailed country case studies can be found on pp. 37-49.
development, undermining their prospects of attending school, engaging in manual labor
(including agricultural production), or participating in other forms of economic activity.
• A degraded health sector, shortages of medical personnel, and infections stemming from
deficient sanitary conditions and lack of clean drinking water in
Iraq have undermined the
credibility of the central government. Widespread poor health also could complicate efforts
to diversify the Iraqi economy beyond the oil sector into more labor- and skill-intensive
• In both countries poor reproductive health among girls and women is a major impediment to
advancing female education and workforce participation, both of which are important to
enhancing prospects for economic growth.
• Russia has the overall worst health indicators of any industrialized country, and poor health
undercuts efforts to diversify economic activity away from oil into more skill-intensive and
value-added sectors. Poor health of Russian children and young people combined with
falling birthrates also threatens Russian military readiness.
• China’s high incidence of chronic disease—stemming in great part from heavy tobacco use
—threatens to slow Chinese economic growth by incapacitating workers and incurring heavy
health-care costs. The health effects of industrial pollution are an increasing source of
discontent in China, while the recent outcry over contaminated baby formula seemed to
weaken government credibility regarding the ability of the government to ensure public
health and safety.
India suffers from rampant malnutrition and anemia that cross all socio-economic classes,
putting the majority of Indian children at high risk for impaired physical and cognitive
Adversarial States and Nonstate Actors:
Malnutrition-related cognitive disabilities among North Korean children and young people
likely will impact future economic growth in that country regardless of when Pyongyang
opens to the outside world or reunifies with the South. Nationwide malnutrition has
compelled Pyongyang to lower minimum height and weight requirements for military
service, and an estimated 17 to 29 percent of potential North Korean military conscripts
between 2009 and 2013 will have cognitive deficiencies disqualifying them for service. .
• Venezuela and Cuba have been particularly adept at parlaying provision of charitable
medical services to nationals of other countries into support in international forums such as
the United Nations.
Hezbollah ’s provision of health and social services in Lebanon over the past 20 years has
helped to legitimize the organization as a political force in that country, while HAMAS’s
delivery of similar services was a factor in its winning of legislative elections in the
Health aid by the developed world is frequently targeted at infectious diseases seen as posing the
greatest humanitarian or security threats, rather than to diseases and other health problems in
developing countries that are persistent and overwhelming. HIV/AIDS, for example, garners
about 25 percent of global health aid while constituting 5 percent of the disease burden in lowand
Developed world efforts similar to the US fight against HIV/AIDS—but focused on broader
global health objectives—could simultaneously help advance economic development, foster
diplomacy, and improve overall health worldwide:
Medical Diplomacy. States such as Cuba and Venezuela garner a disproportionate amount of
international influence thanks to their provision of health services worldwide. More and
better-publicized developed world medical diplomacy efforts—for example, the US Naval
Ship Comfort’s humanitarian tour of 12
Latin American countries in 2007—could mitigate
such influence while improving the health of citizens of poor countries.
Reconstruction and Stabilization. In Afghanistan , amelioration of such major health
challenges as hepatitis B, drug addiction, high maternal and child mortality, and access to
basic health-care could bolster support for the Karzai administration and the allied
reconstruction effort, a greater degree of gender equality, and economic development.
Visible Coalition fostering of better health-care in
Iraq could have a similar impact, as well
as enabling the Iraqis to develop the human capital needed to grow and diversify their
economy. Additionally, marked health improvements in these two Muslim countries could
play a role in easing frictions between the West and the Islamic world.
• Smoothing Relations with Adversaries. Cooperation on health issues has historically kept
international lines of communication open even at times of increased tensions among
countries. Western health cooperation with
Iran and North Korea—for example, assisting
Pyongyang with the country’s heavy health burden, or encouraging Tehran to consolidate its
recent improvements in health-care—could serve as a means of “diplomacy through the back
• Fruitful Engagement with Rising Powers. International assistance with the significant
health burdens stemming from environmental degradation could provide potential
opportunities for cooperation with China, India, and Russia. In the case of China, shared
interests by it and the developed world in strengthening African capacities to fight infectious
diseases could be an additional means of cooperation.
• Easing North-South Tensions. Joint developed-developing world efforts to tackle
inadequate health-care services in
poor countries—frequently the result of South-to-North
migration of health professionals in search of better pay, emphasis in some low- and middleincome
countries on health tourism over provision of basic health-care, lack of affordable
drugs, and the resultant proliferation of harmful counterfeit medications—could be a means
of trust-building between North and South.
• Advancing Economic Development. Increased developed world attention to the top three
killers in the developing world—maternal and newborn mortality, infections of the lower
respiratory tract, and diarrheal diseases, with their disproportionate impacts on young
children—as well as highly debilitating neglected tropical diseases could simultaneously
mitigate a tremendous portion of the health burden in low-income countries and help them
out of poverty.
Significant improvements to global health are increasingly beyond the capacities of any
single actor. Multilateral organizations can be effective force-multipliers, reducing
financial and other costs to any one country. The global health infrastructure is under
strain, however, and successful execution of programs may require a fresh look at
mechanisms for delivering health aid
• The World Health Organization is currently constrained by the fact that the bulk of monies
provided by member countries are tied to the battling of single diseases. Freeing up funding
for more comprehensive programs could render the WHO a more effective partner in
fostering better global health.
The Global Fund for HIV/AIDS, TB, and Malaria, an independent public-private partnership,
has thus far been primarily focused on tackling of specific diseases, but its operating
procedures offer ideas for multilateral cooperation on other health needs. These include
fostering of multi-sector coalitions—governments, multilateral organizations,
nongovernmental organizations, and private enterprise—to implement projects; heavy
dependence upon local expertise for the running of programs; and placing a premium on
• A recent Center for Global Development study indicates that the effectiveness of initiatives is
enhanced when affected governments and populations are not merely recipients of health aid
but have a sense of ownership in the program.
ADD NEWS ON YOUR SITE FREE!!!