Global Health

Does foreign aid work? I've mentioned that question previously, but there's new disturbing data recently published in The Lancet, a prestigious medical journal. Here's the AP account of one recent study:

Trying to show health campaigns actually saved lives is "a very difficult scientific dilemma," said Tim Evans, a senior World Health Organization official who worked on one of the papers.

In one paper, WHO researchers examined the impact of various global health initiatives during the last 20 years.

They found some benefits, like increased diagnosis of tuberculosis cases and higher vaccination rates. But they also concluded some U.N. programs hurt health care in Africa by disrupting basic services and leading some countries to slash their health spending.

The other study discussed in the AP story about the journal articles notes that health aid dollars do not necessarily match need. It would appear as if many political factors influence aid decisions:

[University of Washington researcher Chris] Murray and colleagues also found AIDS gets at least 23 cents of every health dollar going to poor countries. Globally, AIDS causes fewer than 4 percent of deaths.

"Funds in global health tend to go to whichever lobby group shouts the loudest, with AIDS being a case in point," said Philip Stevens of International Policy Network, a London think tank.

Somewhat cynically, Philip Stevens of International Policy Network (a British think tank) points out the mixed motives of the aid community:

"The public health community has convinced the public the only way to improve poor health in developing countries is by throwing a ton of money at it," Stevens said. "It is perhaps not coincidental that thousands of highly paid jobs and careers are also dependent on it."

It's fairly disheartening.


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Hillary Rodham Clinton in Foreign Affairs

The November/December issue of Foreign Affairs includes an essay by Hillary Rodham Clinton outlining her foreign policy priorities.

Most of the paper reads like generic Democratic boilerplate -- emphasizing international institutions, multilateralism, soft power, etc. Clinton offers plans to address portions of the "human security" agenda -- money to fight AIDS, programs to fund education in Africa, environmental initiatives, and so on. There's not a lot of detail, but I think it sends a signal to long-time allies that her presidency would more closely align with a European security agenda.

This hawkish part of the "war on terror" section, however, sounds like it could have been written by one of George W. Bush's speechwriters:

Iran poses a long-term strategic challenge to the United States, our NATO allies, and Israel. It is the country that most practices state-sponsored terrorism, and it uses its surrogates to supply explosives that kill U.S. troops in Iraq.... Iran has enhanced its nuclear-enrichment capabilities, armed Iraqi Shiite militias, funneled arms to Hezbollah, and subsidized Hamas, even as the government continues to hurt its own citizens by mismanaging the economy and increasing political and social repression.

As a result, we have lost precious time. Iran must conform to its nonproliferation obligations and must not be permitted to build or acquire nuclear weapons. If Iran does not comply with its own commitments and the will of the international community, all options must remain on the table.

The sentence I cut criticizes the Bush administration for its decision to "ignore bad behavior rather than challenge it."

Granted, she calls for negotiations and says that various incentives may be offered, but she doesn't really say what happens next if the US and Iran cannot strike a deal.

She says nothing about deterrence. Clinton uncritically accepts the administration's narrative about Iranian assistance to Iraqi insurgents. She does not point out that Hamas and Hezbollah do not post significant threats to the US homeland. Needless to say, like most other US politicians, she ignores the fact that these groups are seen as much more than "freedom fighters" throughout the Middle East because of their broad social base and support for a Palestinian homeland.

I guess this is why she voted for Joe Lieberman's amendment that designated Iran’s Islamic Revolutionary Guard Corps as a terrorist organization. Barack Obama voted no and many of the Democrats running for President have tried to use this issue to separate themselves from Clinton.

John Edwards is certainly not the only member of his party who fears that this was exactly the kind of vote that would allow President Bush to launch war on Iran without further authorization.


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