Chronic, non-communicable diseases such as cardiovascular disease, cancer, diabetes, asthma, and chronic respiratory disease are responsible for two-thirds of deaths worldwide each year. This staggering death toll of chronic diseases is almost as underappreciated as their security consequences. To promote international peace and security, the U.S. should combat chronic disease at home and abroad through a strategy of prevention in which civilian agencies and the military play instrumental roles.
The Security Consequences of Chronic Disease
Although not often viewed through this lens, chronic disease threatens our security as much as widely-acknowledged non-traditional security threats—demographic shifts, drug trafficking, trade policy, and infectious diseases such as Swine Flu, SARS, and HIV/AIDS, to name a few. The “health [of individuals, and by extension, the state] is itself a power, a fundamental capacity for the development or maintenance of all other capacities,” and health demands the absence of both communicable and non-communicable illness. The fact that the interdependencies and causations between health and human security are not well understood does not make health any less central to the evolving concept of human security.
...chronic disease threatens our security as much as widely-acknowledged non-traditional security threats...
In more tangible terms, the economic cost of disease has security implications, as chronic diseases consume resources that might otherwise be used to bolster defense and security apparatuses. The global economic burden of chronic disease amounts to hundreds of billions of dollars each year, including the direct medical costs associated with chronic illnesses, and the cost in terms of the depleted quality and quantity of labor units.
Framing a Strategy for Combating Chronic Disease
A strategy for addressing the security concern of chronic disease around the world has three critical elements. First, the U.S. should focus on preventive, not reactive, medicine to address chronic disease in diplomatically or strategically important countries. The old adage, “an ounce of prevention is worth a pound of cure,” applies when dealing with chronic illness, as preventive medicine is both cheaper and more effective than reactionary care. The U.S. should focus on motivating positive changes to diet and lifestyle; screening for cancer; and testing for blood glucose, blood pressure, and cholesterol (among other preventive strategies), instead of nursing mature chronic illnesses.
Second, the U.S. should encourage civilian-to-military and military-to-military collaboration on a national and international scale. In addition to decreasing chronic disease, an important goal of this strategy is to build trust between civilians and soldiers around the world fighting against a common threat. Growing strong international relationships requires time and disciplined effort, not just speeches by politicians or the military airdropping medical products and devices.
Third, efforts to prevent chronic disease must be tailored to each country, as each nation has unique problems, social perceptions of disease, and control methods. An effective plan would be less like the Washington Consensus with a uniform blanket solution and more akin to the Beijing Consensus with elements customized to local conditions. For example, type 2 diabetes might demand a lot of attention in the U.S., but lung cancer might demand more attention in developing countries where smoking is still on the rise. The best platform for a prevention program in the U.S. might be public schools, but the best vehicle for a similar program in Africa might be community-level religious organizations that hold more clout.
Obstacles to a Chronic Disease Strategy
Money—often the biggest obstacle to U.S. government programs—should not be a significant limiting factor to this proposed strategy. A full range of chronic disease prevention methods are “very cheap on any scale,” according to the World Health Organization. Rather, obstacles to this idea include buy-in from the international community, the lengthy time horizon for planning and implementation by the U.S. government, and the military’s potential reluctance to accept a role in a strategy that does not require tactics or expertise traditionally linked to combat.
Ideally, this strategy requires buy-in from the U.S. military and civilian agencies, the militaries and agencies within targeted countries, and other major powers like China and the United Kingdom. A strategy like this requires as many bodies involved as possible, since one of the main benefits is to improve international relations through working together toward preventing chronic disease. Generating international commitment should be straightforward, theoretically, since chronic diseases pose objective economic and security threats for all nations, and most states have demonstrated a willingness to exercise soft power in addition to hard power.
The long time horizon of this strategy presents a larger obstacle, as budgetary regulations, changes in presidential administration, and the focus of elections on contemporary issues make it difficult for the U.S. to focus on long-term efforts like the one proposed. In the past, these constraints created a default policy of crises reaction instead of forward-looking crises prevention.
Finally, militaries in the U.S. and abroad may be hesitant to accept a strategy focused on preventing chronic disease that does not require weapons or expertise traditionally associated with the military. In fact, Captain B. H. Liddell Hart warned of this obstacle in a lecture to the U.S. Naval War College in 1952. Hart argued that peace is the object of war, and he distinguished between war’s political objective and the military objective which are “different but not separate,” as the military objective must be nested within the political objective. Hart warned that “as most of the thinking about war has been done by men of the military profession, there has been a very natural tendency to lose sight of the basic national object, and identify it with the military aim. In consequence…policy has too often been governed by the military aim—and this has been regarded as an end in itself, instead of merely a means to the end.”
Small, bottom-up initiatives that promote peace through preventing chronic disease are already underway. For instance, after retiring as the Commander of U.S. Army, South in 1992, Major General Burn Loeffke, also known as “The Peace General,” became a physician’s assistant and committed his post-military life to sharing the untapped benefits of preventive medicine around the world in an effort to reduce conflict. After three and a half combat tours in Southeast Asia and a Purple Heart, General Loeffke hates war as much as anyone, and he has lived the past 25 years of his life according to the belief that the best way to prevent war is through the language of medicine.
The challenge is to inspire a large scale, top-down initiative by the U.S. government to match more grassroots initiatives. Will the U.S. allow traditional policy constraints to continue limiting strategic alternatives? The security consequences of chronic disease are only getting worse—over the next decade, deaths from chronic disease are projected to increase by 17%. What are we waiting for?
Regina Parker graduated from the United States Military Academy at West Point with a double-major in Mechanical Engineering and American Politics. She is in China pursuing a master’s degree in economics supported by a Schwarzman Scholarship before she enrolls at Harvard Medical School in the fall of 2017. The views expressed at the author's alone and do not represent the official position of the U.S. Army, the Department of Defense, or the U.S. Government.
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Header Image: Col. Mitch Meyers, Preventive Medicine Officer, gives a class on the proper techniques for brushing, flossing and rinsing during a dental civic action program mission in Ali Sabieh, Djibouti, Feb. 10, 2016. The DENTCAP, funded by U.S. Africa Command’s humanitarian civil assistance program, spent two days providing dental care and education to the Ali Sabieh residents. (Dan Cook | USAF Photo)