Department of Defense Global Health Engagement

link to page 1

Updated January 16, 2020
Department of Defense Global Health Engagement
Since the Spanish-American War, the Department of
These activities include in-person subject-matter exchanges,
Defense (DOD) has conducted global health engagement
embedded advisors with partner ministries of defense,
(GHE) to prevent certain infectious diseases from
augmenting partner military capabilities to support civil
threatening U.S. national security or military operations.
authorities, collaborative research efforts, live training
Early GHE in partner nations and U.S.-controlled territories
exercises, and direct medical care.
included site visits by epidemiological survey teams and
establishment of DOD research laboratories to conduct
How does DOD organize its GHE?
research and monitor emerging disease threats. As a result,
Within DOD, the Under Secretary of Defense for Policy,
DOD has played a major role in discovering and developing
through the Assistant Secretary of Defense for Special
vaccines for numerous infectious diseases, such as yellow
Operations and Low-Intensity Conflict (ASD[SO/LIC])
fever, influenza, and most recently, Ebola.
provides guidance and oversight for all GHE programs.
ASD (SO/LIC) also leads the DOD GHE Council, which
What is GHE?
coordinates GHE programs that span across DOD
DOD policy defines GHE as activities that:
components (e.g., military services, combatant commands,

defense agencies, joint staff). DOD GHE may also be
promote and enhance partner nation stability and
coordinated with, or in support of, interagency partners

(e.g., U.S. Agency for International Development,
develop military and civilian partner nation capacity;

Department of State [DOS], Department of Health and
build trust, confidence, and resilience;

Human Services [HHS], and Department of Homeland
share information and coordinate mutual activities;

Security [DHS]). Congress funds GHE through various
maintain influence to enable implementation of the
defense (e.g., operation and maintenance; research,
certain military strategy and priorities; and

development, testing, and evaluation; overseas contingency
support U.S. national security objectives.
operations) and nondefense accounts (through interagency
The policy also establishes a framework to align GHE to
one or more broad DOD objectives (see Figure 1).
Figure 1. DOD Framework for GHE

Source: CRS adapted graphic based on DOD Instruction 2000.30, “Global Health Engagement Activities (GHE),” July 12, 2017, p. 4.
Note: R&D = Research and Development.

Department of Defense Global Health Engagement
Who conducts GHE?
agency. Congress may seek to establish formal entities or
The geographic combatant commanders conduct most of
processes to facilitate interagency coordination on GHE.
the Defense department’s GHE as part of their theater
campaign plans
, with the support of other DOD
Mission Creep
components (e.g., military services, Defense Threat
While DOD uses GHE in the context of stability operations,
Reduction Agency, and the Defense Health Agency), and
such activities may be susceptible to a gradual expansion of
interagency partners, in coordination with the respective
roles or responsibilities beyond the mission’s original intent
U.S. Embassy’s country team. Typically, the military
(i.e., mission creep). For example, broader U.S. government
services are responsible for developing and training certain
efforts to support global public health initiatives–such as
personnel in GHE planning. The Center for Global Health
the Global Health Security Agenda–have incorporated
Engagement at the Uniformed Services University of
certain DOD GHE (e.g., Defense HIV-AIDS Prevention
Health Sciences also trains GHE planners and provides
Program, Malaria research programs, and biosurveillance
technical assistance for combatant commands.
partnerships). Some experts have noted that DOD’s
engagements to promote domestic or global health security
GHE and U.S. National Security
objectives directly support the National Security Strategy.
In 2005, DOD began using GHE as part of its
Other experts have said that other federal entities, such as
implementation strategy for stability operations, in
DHS, DOS, or HHS, are more appropriate to conduct these
accordance with National Security Presidential Directive 44
(Management of Interagency Efforts Concerning
Reconstruction and Stabilization
), which directed U.S.
Program Effectiveness
government agencies to plan and coordinate efforts that
Finally, Section 715 of the FY2012 National Defense
would assist certain partner nations with establishing a
Authorization Act (P.L. 112-239) directed DOD to establish
“sustainable path toward peaceful societies, democracies,
goals, processes, and tools to measure its GHE and how
and market economies.” Shortly thereafter, several other
“effective and efficient [they are] in meeting the national
U.S. national security policy documents incorporated the
security goals of the United States.” While individual DOD
promotion of global health and biological threat reduction
components and combatant commands assess the
efforts as national security priorities.
effectiveness of their respective GHE activities, DOD
policy does not establish or outline a formal, department-
These documents included various iterations of the National
wide evaluation processes.
Security Strategy, National Military Strategy, National
Biodefense Strategy, and National Health Security Strategy.
Additionally, DOD is now a component of several
Relevant Statutes
interagency global health efforts, including the Global
Chapter 16, Title 10, U.S. Code – Security Cooperation
Health Security Strategy (GHSS), the President’s
Chapter 20, Title 10, U.S. Code – Humanitarian & Other
Emergency Plan for AIDS Relief (PEPFAR), and the
President’s Malaria Initiative.
Chapter 22, Title 32, U.S. Code – Foreign Assistance
Considerations for Congress
CRS Products
Funding Complexities
CRS In Focus IF10530, Defense Primer: Military Health System,
Various defense and nondefense accounts fund DOD GHE
by Bryce H. P. Mendez
programs. Funding sources spread across numerous DOD
CRS In Focus IF10542, Defense Primer: Commanding U.S. Military
programs and federal entities often present funding
Operations, by Kathleen J. McInnis
complexities that may create competing interests or hinder
CRS In Focus IF10022, The Global Health Security Agenda and
planning efforts. Some of these complexities derive from
International Health Regulations, by Tiaji Salaam-Blyther
congressional restrictions on certain appropriations or
interagency transfers that require advanced coordination
Other Resources
and cooperation between two or more agencies.
DOD Instruction 2000.30, “Global Health Engagement (GHE)
Activities,” July 12, 2017,
Interagency Coordination
Uniformed Services University of Health Sciences, Center for
Numerous federal entities conduct GHE as part of a whole-
Global Health Engagement,
of-government effort to advance U.S. national security
priorities. To prevent duplicative efforts and optimize

resources, DOD often prioritizes the use of interagency
coordination. The interagency planning and coordination
Bryce H. P. Mendez, Analyst in Defense Health Care
process for GHE has mostly occurred on an ad-hoc basis or
through subordinate working groups of the National
Sara M. Tharakan, Analyst in Global Health and
Security Council (NSC). During the Trump Administration,
International Development
NSC staff positions responsible for coordinating U.S.
Emily K. Lane, Defense Health Policy Fellow
global health efforts have remained vacant, been reassigned
to other working groups, or been returned to a federal

Department of Defense Global Health Engagement

This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
United States Government, are not subject to copyright protection in the United States. Any CRS Report may be
reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include
copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you
wish to copy or otherwise use copyrighted material. | IF11386 · VERSION 3 · UPDATED