In the wake of the recent Ebola panic and the stigma surrounding health workers upon their return from infected regions, the viability and benefits of providing foreign medical assistance are increasingly cast into question. What critics of overseas medical efforts fail to realize in the midst of their paranoia however is that health diplomacy continues to be one of the most persuasive tools in a nation’s soft power arsenal.
Just as they did when John Logan was writing in the mid-1950s the world’s two mightiest economies struggle to win hearts across the developing world through health assistance. In the present day, however, the Russian grizzly has been supplanted by the Dragon. Chinese medical experts began working in African in 1953, helping the newly founded Algeria establish healthcare infrastructure. While it has offered support almost continually since that time, in recent years Beijing has expanded its medical efforts on the continent manifold. In 2010 it was noted the Chinese government documented that “51 (out of the 53) countries in Africa received aid from China.” These efforts take a variety of forms including “17,000 medical workers to 48 African countries, treating 200 million patients…30 malaria prevention and treatment centers” and a relationship between Chinese provinces and specific nations to provide medical professionals.
This assistance while much needed is not without its controversies. “China’s soft power” unlike that of many other nations “does not consist of democracy and human rights” allowing it to extend assistance to regimes other donor nations avoid. While these gestures provide “a very influential tool to pave the way for Chinese businesses to expand in one of the most potentially lucrative markets in the world” they also help to bolster a number of the world’s most tyrannical regimes. In light of China’s success and its potential repercussion, it is now more important than ever that the United States maintain its efforts lest it be “edged out of the continent politically and economically.”
The President’s Emergency Plan for AIDS Relief represents arguably the greatest exertion of America’s health diplomacy in the 21st century. By any objective measure, PEPFAR must be counted among the most successful global health policies of the modern era. The largest commitment by any country to the treatment of 1 disease the programs has yielded major impacts in it’s less than a decade of existence. By 2012, more than 5 million men, women, and children received antiretroviral treatment as a result of the program including 11 million pregnant HIV-positive women. As a direct result of this treatment, 230,000 infants were born free of HIV infection in 2012 alone. In addition to treatment, PEPFAR has funded care and support for 17 million people in 2013 including more than 5 million orphans and vulnerable children as well as HIV testing and counseling for more than 57.7 million.
While many of the problems with the Chinese programs stem from their lack of emphasis on culpability those associated with PEPFAR often emerge from overemphasizing it. The “conscience clause” allows PEPFAR funded organizations to choose those groups and individuals to whom they are “morally” comfortable providing care. This document permits the denial of services to those whose behavior, identity, religion, or other attributes may be deemed unacceptable philosophy even if such policies are in conflict with human rights and evidence-based interventions such as the promotion of condom use.
While it is obvious that neither nation’s policies are perfect, what the consideration of Chinese and United States health diplomacy make irrefutable is that “in many parts of the world where depressed and dissatisfied people grow in numbers, it is simply a matter of who gets there first.” If a nation were to attempt to spread those ideologies and dogmas it espouses it is undeniable that it must invest in “funneling the energies of the people toward goals of social betterment” or its rivals will undoubtedly do so.
