Effect Measure

Small minds thinking tiny department

When it comes to controversial reports, one that said it would be good to include combatting widespead disease as an element in foreign policy would hardly seem to qualify. And ordinary person might be forgiven for thinking that was already something that was considered. You’d think. But then you’d think a lot of things that wouldn’t be true, for example, that if you were going to start a major war you’d have thought it through pretty carefully. Back to global health:

The draft report itself, in language linking public health problems with violence and other social ills, says “we cannot overstate . . . that problems in remote parts of the globe can no longer be ignored. Diseases that Americans once read about as affecting people in regions . . . most of us would never visit are now capable of reaching us directly. The hunger, disease, and death resulting from poor food and nutrition create social and political instability . . . and that instability may spread to other nations as people migrate to survive.”

In 65 pages, the report charts trends in infectious and chronic disease; reviews efforts to curb AIDS, tuberculosis and malaria; calls for the careful monitoring of public health to safeguard against bioterrorism; and explains the importance of proper nutrition, childhood immunizations and clean air and water, among other topics. Its underlying message is that disease and suffering do not respect political boundaries in an era of globalization and mass population movements.


A few of the issues it focuses on, such as AIDS treatment and research, have been public health priorities for the Bush administration. But others — including ratifying the international tobacco treaty and making global health an element of U.S. foreign policy — are more politically sensitive. The report calls on the administration to consider spending more money on global health improvement, for instance. And it warns that “the environmental conditions that poison our water and contaminate our air are not contained within national boundaries. . . . The use of pesticides is also of concern to health officials, scientists and government leaders around the world.” (Washington Post)

Not exactly far out thinking. More like, Duh . . . But apparently too far out for those in the Bush administration who aren’t used to thinking about health as an important element in foreign policy. People like William Steiger, chief of the Office of Global Health Affairs in the Department of Health and Human Services. We’ve run into Mr. Steiger before, once as far back as December 2004 in the early days of this blog (and more recently, here), first on the occasion of the resignation of his boss, Secretary of Health and Human Services Tommy Thompson. We were discussing the widespread criticism of the US for injecting politics into international health:

Thompson asked WHO to refer invitations of scientists to international meetings first to DHHS. (WHO refused, saying it would compromise the integrity of international scientific deliberations). Thompson’s reason?


The request to WHO came from Thompson’s Special Assistant, William Steiger who came with Thompson from Wisconsin. Steiger is the son of a contressman and, oh, by the way, I almost forgot, the godson of former President GHW Bush. A PhD in Latin American history with no prior health experience, Steiger was appointed to DHHS’s Office of Global Health Affairs, one of Thompson’s centralizing managerial “reforms” (“one HHS”), which Steiger characterized in Science> magazine as a “major expansion” of HHS’s international activities. Yes, expansion into political meddling: “I see an increasing and pervasive squeezing of academic freedom by bureaucratic control,” is how Gerald Keusch, former Director of NIH’s Fogarty International Center put it. Steiger quickly got a reputation for “throwing [U.S.] power and authority around” in International Health matters. (Effect Measure, December 6, 2004)

The report, which has not been released, was one in a series of internal battles the former Surgeon General, Richard Carmona, had with political operatives inside the Bush administration who insisted all reports be crafted so as only to cast a favorable light on the President. Carmona is now detailing the nature and extent of those battles. Too bad he didn’t do it earlier.

For its part the Bush administration, through Steiger, is claiming the report was held up because it was substandard:

Steiger did not return a phone call seeking his comment. But he said in a written statement released by an HHS spokesman Friday that the report contained information that was “often inaccurate or out-of-date and it lacked analysis and focus.”

Steiger confirmed that he sharply disagreed with Carmona on the issue of how much the report should promote Bush administration policies. “A document meant to educate the American public about health as a global challenge and urge them to action should at least let Americans know what their generosity is already doing in helping to solve those challenges,” Steiger said in the statement.

Steiger said that “political considerations” did not delay the report; “sloppy work, poor analysis, and lack of scientific rigor did.” Asked about the report’s handling, an HHS spokeswoman said Friday that it is still “under development.”


Richard Walling, a former career official in the HHS global health office who oversaw the draft, said Steiger was the official who blocked its release. “Steiger always had his political hat on,” he said. “I don’t think public health was what his vision was. As far as the international office was concerned, it was a political office of the secretary. . . . What he was looking for, and in general what he was always looking for, was, ‘How do we promote the policies and the programs of the administration?’ This report didn’t focus on that.”(WaPo)

Science and politics overlap, but they aren’t the same. This is a perfect example of how the Bush administration can’t tell them apart. Steiger is awaiting confirmation as our next ambassador to Mozambique. It would be a delicious irony if his behavior as head of Global Health prevented him from getting a job where promoting the Bush administration’s policies was actually appropriate, even when they are wrong.

But irony died early in this administration. RIP.


  1. #1 another
    July 31, 2007

    Yup. That’s our friends in the GOP:

    Ideology over reality. Party ahead of country. Every time.

  2. #2 suzyf
    July 31, 2007

    Here’s a link to the report, if anyone is interested.
    Hardly revolutionary stuff to anyone who knows much about global health…

  3. #3 M. Randolph Kruger
    July 31, 2007

    Is that science Revere kind of like when Clinton declassified nuclear weapon technology under the guise of “space technology” with Mr. Brown as the DOC head? When the cap was about to blow off on that political/science debaucle and immediately after the money was in the bank for the Clinton-Gore campaign, Mr. Brown who was to testify on the following Monday conveniently turned up dead in Croatia.

    Lots of science in this particular link.


  4. #4 another
    August 1, 2007


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