Public health’s evolving role promoting U.S. military interests

The seal of the U.S. Department of Defense, representing seven branches of the U.S. military.
The seal of the U.S. Department of Defense, representing seven branches of the U.S. military.

The U.S. Department of Defense (DoD) remains one of the most sophisticated media production machines on the planet. Its ubiquitous advertising filters into every aspect of our lives, from public schools to product placement in the lucrative gaming industry to traditional online ads.

In 2007 alone, according to a Rand Corp. study, the total recruiting budget for the Army, Navy, Air Force, and Marine Corps exceeded $3.2 billion. Rand Corp. analysts also deemed those investments as successful as measured by recruitment, even during two ongoing wars in Afghanistan and Iraq.

Events with military personnel always feature sophisticated press and social media coverage. One of the more nuanced and I think effective messages I have seen from the DoD is how the military is not just about defense, but about a more deeply and morally resonant “good.” The U.S. Navy’s very slick videos call the branch a “a global force for good,” and show Navy SEALs in action carrying that message.

This clip from a U.S. Navy recruiting video shows a successful branding effort by the U.S. Department of Defense to promote its global activities as a moral good, including special ops efforts by U.S. special forces
This clip from a U.S. Navy recruiting video shows a successful branding effort by the U.S. Department of Defense to promote its global activities as a moral good, including special ops efforts by U.S. special forces.

Helping to prop up that messaging is the country’s long-standing integration of public health services into the DoD and overall military readiness. The military is successfully integrating public health activities, and it is branding these as part of its global efforts, including on the new battlefield in Africa.

Through contracting opportunities that support these efforts, many U.S. based firms who specialize in development and traditional public health activities are actively supporting these initiatives, in order to monetize their own business models.

Chasing contracts serving two masters: public health and defense

I recently stumbled on a job posted on the American Public Health Association (APHA) LinkedIn page by a company called the QED Group, LLC. The position was similar to ones I see posted on their job site now, for work on a “monitoring and evaluation” project in Africa.

This is one of many government-contracting agencies that chase hundreds of millions of contracts with U.S. government agencies and the major public health funders like the Bill and Melinda Gates Foundation.

In this case, the company was specifically targeting those in the public health community, who are entering the field or currently have positions with backgrounds in public health, economics, science, and health. The 15-year-old company itself actually began as a so-called 8(a) contractor, which means it could win no-bid and lucrative government contracts that are now the center of an ongoing and intense controversy over government waste. (These companies were created by the late Alaska Sen. Ted Stevens, who created the provision to steer billions in government contracting to Alaska Native owned firms that partner with companies like Halliburton and the Blackwater overseas and in the United States.)

QED Project in NorthAfrica
The company QED Group showcases its recent work evaluating anti-terrorism-related efforts in North Africa.

Today, QED Group, LLC claims “it is full-service international consulting firm committed to solving complex global challenges through innovative solutions” by providing clients “with best-value services so they increase their efficiency, learning capacity, and accountability to the public in an ever more complex and interconnected world.” It lists standard international development and public health contract areas of health, economic growth, and democracy and governance.

QED Group is not the only multi-purpose public health and development agency chasing military and global health contracts in Africa.  Another health contracting company called PPD boasts of its “long history of supporting the National Institutes of Health, the nation’s foremost medical research agency,” and that it was “awarded a large contract by the U.S. Army.” It claims its is also a “preferred provider to a consortium of 14 global health Product Development Partners (PDPs), funded in part by the Bill & Melinda Gates Foundation.”

As a public health professional, QED Group looks like a great company to join. However, if one scratches deeper, one learns that this company also uses its public health competencies with the U.S. military, which is spearheaded in Africa by U.S. Africa Command, or AFRICOM.  This raises larger questions of the conflicting ethics of both promoting human health and public health and also serving the U.S. Department of Defense, whose primary mission is to “deter war and to protect the security of our country.”

AFRICOM’s emerging role flexing U.S. power in Africa

AFRICOM’s demonstration of “hard power” is well-documented through its use of lethal firepower in Africa. AFRICOM is reportedly building a drone base in Niger and is expanding an already busy airfield at a Horn of Africa base in the tiny coastal nation of Djibouti. On Oct. 29, 2013, a U.S. drone strike took out an explosives expert with the al-Qaida-linked al-Shabaab terrorist group in Somalia, which had led a deadly assault at a Kenyan shopping center earlier that month.

One blog critical of the United States’ foreign policy, Law in Action, reports that the AFRICOM is involved in the A to Z of Africa.  “They’re involved in Algeria and Angola, Benin and Botswana, Burkina Faso and Burundi, Cameroon and the Cape Verde Islands. And that’s just the ABCs of the situation. Skip to the end of the alphabet and the story remains the same: Senegal and the Seychelles, Togo and Tunisia, Uganda and Zambia. From north to south, east to west, the Horn of Africa to the Sahel, the heart of the continent to the islands off its coasts, the U.S. military is at work.”

U.S. efforts in Africa require health, public health, and development experts. As it turns out the company, QED Group,  won a USAID contract examining U.S. efforts promoting “counter-extremism” programs in the Sahel. That study evaluated work using AFRICOM-commissioned surveys, all designed to promote U.S. national security interests in the unstable area.

The area is deeply divided between Christians and Moslems. It is also home to one of the largest al-Qaida based insurgencies known as al-Qaida in the Islamic Maghreb, which has similar violent aspirations as the ultra-violent Boko Haram Islamic militant movement of violence-wracked northern Nigeria. Al-Qaida in the Islamic Maghreb military seized control of Northern Mali in 2012, which ended when U.S.-supported French military forces invaded the country and routed the Islamic extremists in January 2013.

Public health’s historic role with U.S. defense and national security

“Hard power” and “soft power” are tightly intertwined in U.S. overseas efforts, where health and public health personnel support U.S. interests. This is true in Afghanistan and is certainly true in North Africa. This particular QED-led program used the traditional public health method of a program evaluation of an antiterrorism program to see if a USAID program was changing views in Mali, Niger and Chad—all extremely poor countries that are at the heart of a larger struggle between Islamists and the West.

That research methods used in public health–and which I have used to focus on health equity issues in Seattle–can be used equally well by U.S. development agencies to advance a national security agenda is not itself surprising.

However, faculty certainly did not make that case where I studied public health (the University of Washington School of Public Health). I think courses should be offered on public health’s role in national defense and international security activities, because it is nearly inevitable public health work will overlap with some form of security interests for many public health professionals, whether they want to accept this or not.

U.S. Public Health Service Corps members proudly serve their country and wear its uniforms.
U.S. Public Health Service Commissioned Corps members proudly serve their country and wear its uniforms. This photo published on the corps’ web site demonstrates that pride.

Public health in the United States began as a part of the U.S. armed services, as far back as the late 1700s. It was formalized with the military title of U.S. Surgeon General in 1870. To this day those who enter the U.S. Public Health Service Commissioned Corps wear military uniforms and hold military ranks.

A good friend of mine who spent two decades in the Indian Health Service, one of seven branches in the corps, retired a colonel, or “full bird.” He always experienced bemusement when much larger and far tougher service personnel had to salute him when he showed his ID as he entered Alaska’s Joint Base Elmendorf Fort Richardson looking often like a fashion-challenged bum in his minivan (he frequently had to see patients on base, and was doing his job well).

The U.S. Public Health Corps' web site shows the different uniforms worn by their members.
The U.S. Public Health Service Commission Corps’ web site shows the different uniforms worn by its members.

The U.S. Army’s Public Health Command was launched in WWII, and it remains active today. One of its largest centers is Madigan Army Medical Center at Joint Base Lewis McChord, in Pierce County, Washington. Public Health activities are central to the success of the U.S. Armed Services, who promote population-based measures and recommendations outlined by HealthyPeople 2020 to have a healthy fighting force.

AFRICOM charts likely path for the future integration of public health and defense

Africom photo
This screen snapshot of an AFRICOM media file highlights the public health and health related efforts AFRICOM personnel undertake in the region, where military efforts are also underway to suppress and disrupt Islamic extremist groups.

Today, the U.S. military continues to use the “soft power” of international public health to advance its geopolitical interests in North Africa.  In April 2013, for example, AFRICOM hosted an international malaria partnership conference in Accra, Ghana, with malaria experts and senior medical personnel from eight West African nations to share best practices to address the major public health posed by malaria.

At last count, the disease took an estimated 660,000 lives annually,  mostly among African children.

At the event, Navy Capt. (Dr.) David K. Weiss, command surgeon for AFRICOM, said: “We are excited about partnering with the eight African nations who are participating. We’ll share best practices about how to treat malaria, which adversely impacts all of our forces in West Africa. This is a great opportunity for all of us, and I truly believe that we are stronger together as partners.”

I have reported on this blog before how AFRICOM and the United States will increasingly use global health as a bridge to advance the U.S. agenda in Africa. And global health and public health professionals will remain front and center in those activities, outside of the far messier and controversial use of drone strikes.

It is likely this soft and hard power mission will continue for years to come. Subcontractors like QED Group will likely continue chasing contracts with USAID related to terror threats. Global health experts will meet in another African capital to discuss major diseases afflicting African nations at AFRICOM-hosted events. And drones will continue flying lethal missions over lawless areas like Somalia and the Sahel, launching missiles at suspected terrorist targets.

Secret military tests in St. Louis and other communities violated the Nuremberg Code, according to researcher

As a former St. Louis area resident, I first thought my friend was pulling a prank when he shared a story on Sept. 29, which was picked up by the Daily Mail tabloid in the United Kingdom and alleged my old home city was intentionally contaminated by U.S. military researchers during the Cold war. I nearly deleted the email suspecting it was spam.

Professor Lisa Martino-Taylor

It turns out it was not a prank story in the Onion. During the last week of September 2012, St. Louis’ major broadcast news stations (KMOX and KSDK) broke a news story on recently completed research of government documents that showed U.S. military researchers conducted human subjects testing, in violation of the Nuremberg Code, on poor and minority residents in St. Louis during the 1950s and 1960s. The bombshell that was dropped by St. Louis Community College-Meramec sociology professor Lisa Martino-Taylor, in her PhD thesis, was that  U.S. Army’s researchers sprayed an aerosol on human subjects that allegedly was laced with a fluorescent additive, a possible radiological compound, produced by U.S. Radium Corp. The company had been linked to the deaths of workers at a watch factory decades before.

The issue of the U.S. government testing on unwilling and non-consenting persons for military and medical research during the Cold War has long been established, both in St. Louis, and also in the Inner Mountain West and in Washington State. At the Hanford Nuclear Reservation, in southeastern Washington, radioactive iodine (I-131) was intentionally emitted in 1949 ( the Green Run test) to measure the impacts of exposure on human health as part of the U.S. Air Force’s efforts to better understand and track Soviet weapons testing. For its part, St. Louis was one of 33 U.S. and Canadian cities and rural areas intentionally exposed to the spray that was dispersed from airplanes, rooftops, and vehicles. A subsequent National Research Council committee, in 1997, claimed these tests did not expose residents to chemical levels considered harmful. However, promised follow-up studies may not have been conducted. Residents in St. Louis were quoted in press reports claiming planes dropped a white powder that fell on people below, which residents did not view as potentially harmful.

Photograph published in Martino-Taylor’s thesis on the U.S. Army’s aerosol spraying activities in St. Louis and other areas.

According to Martino-Taylor, thousands upon thousands of St. Louis residents likely inhaled the zinc cadmium sulfide spray. In St. Louis, where tests were conducted in 1953-54 and 1963-64 by the U.S. Army Chemical Corps, Martino-Taylor said, ”The powder was milled to a very, very fine particulate level.  This stuff travelled for up to 40 miles.  So really all of the city of St. Louis was ultimately inundated by the stuff.”  The Daily Mail reported one of the compounds sprayed unknowingly on St. Louis residents was FP2266 (radium 226), which according to the U.S. Army was made by U.S. Radium Corp. The compound was the same one that was linked to the death and of former U.S. Radium Corp. workers.

According to press coverage, the U.S. Army has admitted that it added a fluorescent substance to the “harmless” compound, but the issue of whether the additive was radioactive remains classified.

The story was immediately picked up by a number of blogs, which repeated the allegations and news coverage. Almost immediately, Missouri’s two U.S. senators, Claire McCaskill (D) and Roy Blunt (R), wrote to Army Secretary John McHugh demanding answers and to ask if follow-up studies promised in 1997 by the National Research Council were ever completed.  The full text of McCaskill’s letter and press release can be found here.

Pruitt-Igoe housing complex before it was dynamited and cleared.

According to an Oct. 3, 2012, AP story, aides to Sens. McCaskill and Blunt said they have received no response. At the time of the story, the U.S. Army declined to be interviewed by the AP. The AP’s story notes that St. Louis was chosen for reserach because it resembled some Russian cities. However, one of the primary areas that was chosen for testing was the Pruitt-Igoe public housing complex, which was razed in the 1970s as a failed national public housing experiment–and one of St. Louis’ legacies as a decaying city. At the time of the spraying by federal researchers, the complex had 10,000 mostly African-American and low-income residents, 70 percent of whom were 12 and younger.

Martino-Taylor’s thesis (The Manhattan-Rochester Coalition, research on the health effects of radioactive materials, and tests on vulnerable populations without consent in St. Louis, 1945—1970) is worth examining first-hand, as it describes how she was tipped to the improbable and almost unbelievable tales of two women, both sharing stories of having been unwilling human subjects to military spraying and suffering health consequences from that research. Surprisingly, she knew nothing about these then allegations. Thus began her effort to request information under the U.S. Freedom of Information Act from the federal government, often in severely redacted form. A point that much of the media continues to miss is that her research focuses on the researchers as well as their victims. Her thesis statement states her work looks at how a “large number of participants inside an organization will willingly participate in organizational acts that are harmful to others, and how large numbers of outsiders, who may or may not be victims of organizational activities, are unable to determine illegal or harmful activity by an organization.”

The leaders of the studies, which she calls the Manhattan-Rochester Coalition, were the researchers who conducted the human-subjects research on nuclear weapons as part of the country’s efforts to prepare for, and win, a possible nuclear confrontation with the U.S.S.R. During the tests in St. Louis and other areas, according to Martino-Taylor, the U.S. Army violated the 1947 Nuremberg Code, the standard set after trials of Nazi doctors and war criminals, which established that “voluntary consent of the human subject is absolutely essential” for any human-subjects testing. There was no such standard in these tests in St. Louis, Minneapolis, and elsewhere, Martino-Taylor maintains.

Medical experimentation room at the Terezin concentration camp in the Czech Republic.

During the 1940s, the Nazi regime’s corrupt and criminal medical and scientific community committed horrific crimes at dozens of concentration and extermination camps in Nazi-occupied Europe, including live vivisections, gassings, cold water immersion tests, high-pressure testing, lethal injections, and intentional murder for “scientific purposes.” I in fact visited many of the rooms and buildings where these crimes against humanity occurred during my tour of the camps in the summer of 2000, so it was especially painful for me to know that my own government, in my former home city, may have been breaking established international guidelines that were codified following the defeat of the Nazis and their murderous state. (See my photo documentary here.) According to Martino-Taylor, the initial congressional investigation of the spraying program included testimony from experts that claimed the experiment team “chose to ignore Nuremberg.”

In the United States, following the Tuskegee Institute’s syphilis experiments on African-American men, reforms were passed in 1979 through the Belmont Report, which theoretically was supposed to protect human subjects from harm in research. However, even as the media report on this sensational story of testing on humans in two countries (Canada and the United States) in the 1950s and 1960s, researchers at elite universities and laboratories continue to violate the principles first set out at Nuremberg. this year reported that “marginalized groups have frequently been coerced into studies that violate their right to consent. A recent review of the bio-ethics of human research in the U.S. offers little prospect for change.”

The story, from Jan. 22, 2012, was gloomy in its overall assessment of the failure of safeguards to prevent unethical research on humans, particularly when large corporate interests are involved. The story said the Presidential Bioethics Commission issued a report on protecting human research subjects that trumpeted the United States’s so-called “robust” protections—rules that have repeatedly permitted and legitimized breaches of informed consent. “The failure to elicit consent is not confined to the U.S. One in every three U.S. corporate medical studies is now carried out abroad, usually in places where trials can be conducted more cheaply than in the U.S. Subjects are often unaware that the treatments are experimental.”

I am pretty sure the dust from this recent controversy will settle quickly, and even in St. Louis, the community will focus more on their beloved Cardinals’ bid for another World Series title. It is likely no one involved in these unethical if not possibly illegal studies will ever be held accountable for their actions against the civilians they may have harmed.