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
What is global health diplomacy
• Global health diplomacy is a political activity that
meets the dual goals of improving health while
strengthening relations among nations
Adams V, Novotny TE, Leslie H. Global Health Diplomacy. Medical Anthropology.
2008/10/28 2008;27(4):315-323
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
• 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
Health Attachés are HHS employees who are
posted in U.S. Embassies of countries of strategic
importance to the Department and U.S.
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
1948 JAMA article first mentions a Health Attaché assigned
to Embassies in Paris, Brussels and The Hague.
Sanders. First Public Health Attache Appointed. JAMA.
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)
Jones K-A. New Complexities and Approaches to Global Health Diplomacy:
View from the U.S. Department of State. PLoS Med. 2010;7(5):e1000276.
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.”
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.
Health Attachés & HHS
New Delhi
Addis Ababa
= 5 Current Health Attachés
= 4 Previous Health Attachés
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
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
• Serve as a bridge between domestic and
international health issues and actors
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
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 NonCommunicable Diseases (NCDs)
• Health security and pandemic
Thank you.
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