In 2007, when I was commander of the US Army Southern Command,
treated close to 100,000 patients
in 12 countries, performed 1,700 surgeries, issued more than 32,000 immunizations and trained 28,000 medical students and technicians.
Some people are shocked that military leaders are such strong advocates of what Harvard's Joseph Nye called "soft power," or the ability of a country to persuade without force or coercion. But I know first-hand how it enhances America's security.
Which is why I am so concerned about the Trump's administration proposed budget cuts to soft-power programs throughout the government. Under the budget proposal for 2018
, military spending amounts to about 16% of the budget, while State Department programs account for less than 1%.
Worst yet, recently the President proposed a cut of 26% for global health programs -- "the lowest level of funding since FY 2008," according to an analysis by the Kaiser Family Foundation
. Funds for AIDS alone would drop by about $860 million.
While I am not proposing a specific ratio of spending, I believe there is a symbiotic relationship between hard and soft power and that, in both cases, we need to invest in the programs that succeed.
And I'm not the only military man who thinks this way. Four years ago, Gen. James Mattis, who was about to retire from the United States Central Command, was testifying before the Armed Services Committee. Sen. Roger Wicker (R-Miss) asked him, "Have you observed that the International Development budget is helpful to us in providing national defense for our country?" The General responded
, "If you don't fund the State Department fully, then I need to buy more ammunition. ... The more that we put into the State Department's diplomacy, hopefully the less we have to put into a military budget."
Mattis is now our Secretary of Defense. I know Mattis well, and, while he and I are strong advocates of more military spending, I would assume that he's quietly pushed for more international development money as well.
And if the Trump administration needs proof that soft power carries great weight, it need look no further than the previous Republican White House. The President's Emergency Program for AIDS Relief, or PEPFAR, launched by George W. Bush and extended under Barack Obama, has been critical in the fight against AIDS in Africa. (Under Donald Trump, PEPFAR remains intact -- at least for now.)
PEPFAR began at a critical time. In the late 1990s, AIDS was sweeping across Africa, destabilizing the continent just as global terrorism was rising. In July 2000, President Bill Clinton called AIDS a "national security threat" to the United States. The next year, Secretary of State Colin Powell warned
that the disease posed "a clear and present danger to the world."
Powell was influenced by a secret CIA estimate
issued in May 2001. The report, since declassified, concluded, "AIDS could cause greater dislocation death, and illness in Africa than any combination of drought, famine or war."
The epidemic also threatened US national security. For example, "A fall in tourist revenues, mandatory testing of African students [in the US], and the possibility of visa and immigration restrictions will inflame anti-Western rhetoric and negatively affect bilateral relations." In addition, says the report
, in African countries affected by AIDS, "The mission and capabilities of both the armed forces and internal security forces will be adversely affected because of... loss of trained, experienced officers and technicians."
Two years later, PEPFAR was launched with massive bipartisan support, including from conservatives like Rep. Mike Pence, now Vice President, who understood the security benefits
right from the start. In 2015, those benefits were verified in a study co-authored by former Sens. Bill Frist (R-TN) and Tom Daschle (D-SD) for the Bipartisan Policy Center
Researchers compared two groups
of African countries -- PEPFAR partners and non-partners. They found that from 2004 to 2013, political instability fell by 40% in PEPFAR countries and just 3% in non-PEPFAR countries. Rule-of-law metrics increased 31% versus just 7%.
In 2007, as PEPFAR was taking hold, approval ratings for the US averaged about 40% in both PEPFAR and non-PEPFAR African nations. By 2011, the ratings for PEPFAR countries rose to about 80% while in non-PEPFAR countries, the rise was around 50%.
This is the context in which Congress should make budget decisions over the next few months.
I want to see more PEPFARs, not fewer. During a career in the Navy that spanned five decades, I learned that national security and global health are inextricably linked. David Smith, deputy assistant secretary of Defense for Health Readiness Policy last year emphasized
"the connection between global health and global security. ... Think of the destabilizing effects of threats like the HIV-AIDS epidemic, SARS, MERS-CoV, Ebola and Zika."
It was 36 years ago that the Centers for Disease Control and Prevention reported
the first cases of what would later become known as AIDS. We have the chance to make this terrible disease a horror of the past. Let's continue to seize the opportunity.