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David Rieff takes on Hillary’s “new approach” to global health

In a blog post for The New Republic, author David Rieff calls Hillary Clinton’s approach to development naïve, contradictory, and muddled. His post is a response to Clinton’s speech, delivered last week at SAIS, about the administration’s six-year, $63 billion Global Health Initiative.

Rieff’s critique rests on three main arguments, all of which will be familiar to Aid Watch readers.

1) Insisting that development is going to be “elevated” to the level of diplomacy and defense won’t make it so. Better to follow the money and see where the real priorities lie:

The secretary was already on record as claiming that the initiative would be a “crucial component of American foreign policy and a signature element of smart power.” On its face, this seems highly unlikely. Anyone doubting this should ponder the fact that one military program, the F-35 Joint Strike Fighter—a weapons platform that no one claims is needed for the counter-insurgency operations that are currently at the core of the U.S. military’s requirements—is on course to cost $325 billion, and may well go higher….In other words, Washington is going to spend on a ‘signature element’ of its smart power less than one-fifth of what it is already committed to spending on something that even the Pentagon does not claim is a signature element of our hard power. No, money may not be everything, but ‘follow the money’ remains the best advice for understanding what the priorities of the American government really are, as she has claimed before.

2) The bureaucratic structure of the initiative verges on the absurd, fails to make any one agency responsible for success or accountable for failure, and seems almost designed for a meltdown:

[I]n either designing or at least signing off on a program which grants authority for day to day running of the program to three separate agencies (USAID, the Centers for Disease Control, and PEPFAR, the Bush-era President’s Emergency Plan for Aids Relief), each with their own institutional interests, while calling on the resources and expertise of the National Institutes of Health, the Peace Corps, not to mention the departments of Defense and of Health and Human Services (“among others,” as Secretary Clinton said, without irony, in her speech), all reporting to Deputy Secretary Lew, the administration has laid the groundwork for a bureaucratic calamity.

[We would add to this only that Jack Lew, the designated leader of this crew, is leaving his post, no word yet on his replacement, which could take months.]

3) Politicians who assert, as Clinton does here, that health aid can be used as a public diplomacy tool to win the hearts and minds of America’s reluctant allies are basing this view on too little evidence and simplistic assumptions about how aid recipients come to their perceptions of the US:

A far graver mystification is Secretary Clinton’s claim that investments in global health are an important tool of public diplomacy….

…[I]f the secretary really is suggesting that that recipients of foreign aid in very poor countries are so childlike that they view these contributions as dispositive about the nature of America’s values and intentions, then however unintentionally, she is speaking of these adults as if they were children.

But perhaps this hyper-conceited, hyper-complacent conviction of America’s good intention is so internalized in U.S. policymakers—even in one as intelligent as Secretary Clinton—that they are incapable of thinking clearly about how U.S. foreign aid, whether for emergency relief, health, or long-term development, is received by its beneficiaries.

Rieff’s whole, incendiary piece is worth reading in full.

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  1. Adam Baker wrote:

    Naïve… my main Aid Watch pet peeve is that it pretends to believe what politicians say, and then publishes these breathless critiques. What is the Secretary of State going to say? “Today we will throw more money at a problem that is far too complex for any of us to understand. To expect even incremental progress in addressing problems overseas that we can’t even address in our own nation, would be the height of folly.” Faux naïvete is more irritating than actual naïvete.

    Posted August 25, 2010 at 9:49 am | Permalink
  2. William Easterly wrote:

    Adam, I think both David Rieff and I understand the value of inspirational rhetoric as motivation. What is not acceptable is politicians pretending to act when not in fact doing so, or in fact doing the opposite, and using the promises as a substitute for constructive actions. If more observers, activists, and voters got mad about this, politicians would be less likely to get away with it.

    Posted August 25, 2010 at 2:36 pm | Permalink
  3. Jeff Barnes wrote:

    Another important criticism of GHI in the article are the bureaucratic configurations for GHI. People working in the USG health sector can tell you that the USAID-CDC sharing around PEPFAR has been fraught with coordination problems and turf battles. GHI looks to make that worse by bringing even more cooks into a crowded kitchen.

    There are enough good reasons to invest in Global Health without deluding ourselves that we are buying goodwill or improving our security. Better that Clinton say nothing than to make claims that are doomed to disappoint.

    Posted August 25, 2010 at 3:20 pm | Permalink
  4. ewaffle wrote:

    Shooting fish in a barrel is unsporting but sometimes the fish jump into the barrel right in front of you and hand you the gun–or would if they had hands.

    The reason for having a large number of government departments involved in this this fiasco in the making is to convince them to “sign on” to it–to become stakeholders and insure its success. What will occur will be bureaucratic battles over who gets to make decisions and who is in charge.

    With Jack Lew leaving and the Senate refusing to confirm anyone for anything the program may be run by an Acting Deputy Secretary which means no one will think it necessary to even pretend to listen to him.

    Posted August 25, 2010 at 8:58 pm | Permalink
  5. Alan Eastham wrote:

    What is more ridiculous is the hidden fact that NONE of the money will be spent in ANY country that does not already have a USAID mission. That was the sine qua non of PEPFAR and it continues in this far-from-“global” initiative. Further, as Rieff notes, there’ll be a positively vicious feeding frenzy as agencies struggle to grab chunks of the money for “health care systems strengthening” — in plain language, pursuing our favorite programs, no matter what the country in question might need.

    Posted August 25, 2010 at 9:17 pm | Permalink
  6. Adam Baker wrote:

    I certainly agree that we should hold the politicians’ feet to the fire when they make promises, etc., I just don’t think that analyzing these fluffy policy speeches is the way to do it. The text of the speech reads like a State of the Union address (perhaps, deep down…). Here’s a standalone paragraph: “Against tuberculosis, we intend to save 1.3 million lives by increasing access to treatment.” Rather than analyze a throwaway line written by the Assistant to the Undersecretary of the President’s Representative to the Special Commission to End Bad Things, isn’t it more meaningful to look at what the State Department actually did, and what effect it had?

    Posted August 26, 2010 at 4:12 pm | Permalink

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  1. […] Hillary’s “new approach” to Global Health David Rieff takes on the US Secretary of State’s approach to global health and development calling it naive, contradictory and muddled. […]

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    The Aid Watch blog is a project of New York University's Development Research Institute (DRI). This blog is principally written by William Easterly, author of "The Elusive Quest for Growth: Economists' Adventures and Misadventures in the Tropics" and "The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good," and Professor of Economics at NYU. It is co-written by Laura Freschi and by occasional guest bloggers. Our work is based on the idea that more aid will reach the poor the more people are watching aid.

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