Office of the Director of National Intelligence – National Intelligence Council Update


















Interview of the Director of National Intelligence, Mr. Mike McConnell, by Charlie Rose on PBS 

January 8, 2009



 Dr. Thomas Fingar





Mr. Mike McConnell, Director of National Intelligence


 Director of National Intelligence J.M. McConnell on Innovation in the Intelligence Community  
Subject: Office of the Director of National Intelligence – National Intelligence Council Update
Date: Fri, 9 Jan 2009 15:24:15 -0600

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Key Judgments

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.

Rising Powers:

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

Palestinian territories.


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

middle-income countries.

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.



January 8, 2009: Strategic Implications of Global Health

January 8, 2009: Strategic Implications of Global Health – Foldout



















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