ABSTRACT
Global health practice is becoming a key enabler within UK Defence and foreign policy. The definition of global health remains debated, though some important themes have been identified including: the multidisciplinary nature of global health, its ethical foundation and the political nature of global health. This paper contributes to the ongoing rational discourse that this important discipline deserves and recommends a framework and principles to apply to military health and care system strengthening in the Defence Engagement (Health) (DE(H)) practitioner role. DE(H) involves complex multiorganisational relationships and processes, and while practitioners should be mindful of the political nature of their role, the broad aims of preventing conflict and building stability mean DE(H) should contribute positively to global health.This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement.
ABSTRACT
Defence Engagement (DE) (Health) themes are reviewed in this paper through two historical perspectives set in very different contexts. The first-person narrative in Guerrilla Surgeon by Lindsay Rogers outlines the experience of a medical officer building capacity with Tito's Partisans behind enemy lines in Second World War Yugoslavia. This is contrasted with a more academic evaluation of strategic and medical benefits of DE (Health) delivered by the US military during the Vietnam War in Robert Wilensky's Military Medicine to Win Hearts and Minds: Aid to Civilians in the Vietnam War Both texts infer that clear objectives, supported by effective strategic communication, are required for the impact of DE (Health) to be fully realised. Wilensky, in particular, noted that the US military medical effort in Vietnam had no measurable impact on health or political goals in the conflict. Rogers' experience on a more individual level speaks to the promise of DE (Health) delivery contrasted against the lack of regional objectives and cites the loss of British influence when Soviet propaganda was more cohesive and coordinated, resulting in the shift in Partisan loyalty despite British efforts in supplying the bulk of military and medical material. While neither author offers a definitive guide on DE (Health), they offer clear examples of themes that should be considered and demonstrate the importance of evaluating activity and maintaining the historical record to provide an evidence base for future work. This is an article commissioned for the Defence Engagement special issue of BMJ Military Health.
ABSTRACT
With the emergence of SARS-CoV-2 and now monkeypox, the UK Defence Medical Services have been required to provide rapid advice in the management of patients with airborne high consequence infectious diseases (A-HCID). The Defence Public Health Network (DPHN) cadre, consisting of closely aligned uniformed and civilian public health specialists have worked at pace to provide evidence-based recommendations on the clinical management, public health response and policy for monkeypox, with military medicine and pathology clinicians (primarily infectious disease physicians and medical microbiologists). Military environments can be complicated and nuanced requiring specialist input and advice to non-specialists as well as unit commanders both in the UK and overseas. DPHN and military infection clinicians have close links with the UK National Health Service (NHS) and the UK Health Security Agency (UKHSA), allowing for a dynamic two-way relationship that encompasses patient management, public health response, research and development of both UK military and national guidelines. This is further demonstrated with the Royal Air Force (RAF) Air Transport Isolator (ATI) capability, provided by Defence to support the UK Government and UKHSA. Military infectious disease clinicians are also embedded within NHS A-HCID units. In this manuscript we provide examples of the close interdisciplinary working of the DPHN and Defence clinicians in managing military monkeypox patients, co-ordinating the public health response, advising the Command and developing monkeypox policy for Defence through cross-government partnership. We also highlight the co-operation between civilian and military medical authorities in managing the current outbreak.
