At a March 2016 town hall event, army veteran Robert Kitelinger asked Trump what, in his opinion, are the top three functions of the U.S. government? Trump responded, “well, the greatest function of all, by far, is security for our nation, I would also say health care, I would also say education. I mean, there are many, many things, but I would say the top three are security, security, security.” From this answer alone, there is no denying that Trump is focused on national security. In nearly every other mention Trump has made about national security, we found a particular focus on protecting the U.S. from immigrants, whom he views as a security threat. “Thousands and thousands of people are infiltrating our country. We don’t know who they are.” Building a wall between the U.S. and Mexico, creating the strongest military the U.S. has ever had, and ending what he calls the “theft” of American jobs are talking points throughout Trump’s speeches which support his view of the U.S. as the center of the world. Even when Trump describes U.S. foreign action in countries such as Iraq, Syria, and Afghanistan, these statements are centered on American interests. Generously translated, Trump appears to take the notion that if the U.S. is strong at home, the world is a safer place. Fair enough.
Trump’s speeches are laden with the words “health” and “health care”, but only with reference to the U.S. health system (i.e. nothing on global health). “Total catastrophe” and “the big lie” are just a taste of the harsh language used to describe his view on Obamacare. For months, Trump promised a new health care plan far superior to Obamacare, yet the recent release of his plan has faced harsh criticism, with one critic claiming the plan resembles “the efforts of a foreign student trying to learn health policy as a second language.” Trump has a public, firm view on the future of U.S. public health, but his plans make no mention of U.S. involvement in health on a global scale. With reference to health security, Donald Trump has yet to combine “health” and “security” to discuss the interplay of these two overarching concepts.
Foreign policy and public diplomacy are undoubtedly critical components to U.S. national security. However, Trump’s record here is monotonous, emphasizing foreign policy only with relation to U.S. military intervention and defense in what he calls an “America First” foreign policy. Trump believes that U.S. foreign policy has been a disaster for decades, citing the Cold War as the last big win for U.S. foreign engagement. This stanch view on extreme military strength and U.S.-centric attitude have been consistent principles in Trump’s view of U.S. foreign policy for decades. In a 1990 interview with Playboy, when asked about a Trump presidency, he commented in third person saying, “he would believe very strongly in extreme military strength. He wouldn’t trust anyone. He wouldn’t trust the Russians; he wouldn’t trust our allies; he’d have a huge military arsenal, perfect it, understand it.” Although many aspects of the beliefs Trump expressed in this interview have changed over the years, such as his statement “I don’t want to be president. I’m one hundred percent sure” and his conviction that if he did run, he’d be best suited as a Democrat, Trump’s single-minded view of foreign policy has proven to withstand the tests of time.
Trump’s recent foreign policy speech on April 27th made no mention of public diplomacy, reflecting his long-withstanding policy positions that have made no reference to global health or diplomacy, let alone to the importance of scientific evidence in policymaking. How would Trump, as a leader, advocate for major health security policy actions such as international vaccine campaigns when he actively promotes the myth that vaccines cause autism on Twitter? Bottom line: Trump is a wild card when it comes to health and diplomacy.
Does this mean that a vote for Trump as president is a vote for de-emphasis on international health and diplomacy as essential national security pillars? Not necessarily. Again, being generous, Trump has no background in any of these areas or in policymaking itself; he has not had to make decisions about the nation’s health or security and thus has not yet experienced the reality or gravity of these policy issues. So far, his priorities have focused on campaign marketing over policy development, which in some ways has been wildly successful. We have hats with a play on his slogan in our office. That’s success.
Hillary Clinton
From helping to create the DOJ Violence Against Women office during her time as First Lady to leading the development of the first QDDR in 2010 while Secretary of State, few policymakers rival Hillary Clinton’s depth of experience. Her background covers an expansive repertoire of issues, including positions, policies, and actions directly linked to addressing health security issues on both a national and global scale. As First Lady, Clinton was an active supporter of USAID; then-Administrator Brian Atwood stated that Clinton “deserves more credit than anyone” for helping to secure congressional funding for USAID in the late 1990s. Clinton herself reaffirmed her long-standing support for USAID when, two days into her role as Secretary of State, she addressed USAID at their headquarters stating, “As First Lady… I was able to see the work you do, and to see the results with my own eyes, and to travel a lot of miles to support you and your predecessors in the important work of literally embodying American values…So I’m ready to roll up my sleeves and get to work with you.” During her time at State, Clinton’s focus was to strengthen collaboration between USAID and State, using the QDDR as a framework to reevaluate the priorities, organization, and resource allocation of each agency. With this track record, we can safely assume that a Hillary Clinton presidency would come with a priority for health and diplomacy policies and programs.
Throughout her career, Clinton has been active and vocal about speaking on behalf of women worldwide, pushing for equal access to health care, employment, education, and legal recourse for all. Forging truly global alliances for closing the gender gap, eradicating disease, and countering violent extremism were all top priorities during her tenure as Secretary of State. Clinton also has a track record to back her vision to better connect development investments with national security. In a 2010 speech, Clinton stated, “what we will do is leverage the expertise of our diplomats and military on behalf of development, and vice versa. The three Ds [defense, diplomacy, development] must be mutually reinforcing.” Likewise, Clinton’s current campaign website clearly articulates her priority for foreign affairs is to strengthen existing partnerships and foster new ones.
Taken together, Clinton’s history points to the likelihood that, in office, she will maintain, if not boost, the level of support and funding for global health security issues. Throughout her career, she has been forced to make tough policy decisions, often changing her position entirely. This characteristic that has drawn criticism to her current candidacy, but is a realistic occurrence for any veteran policymaker. Regardless of that, Clinton has a consistent vision for health, security, and diplomacy, backed by real experience making the sort of policy decisions that most will never face. Will she actually follow through if she gets to the Oval Office? As scientists who are driven by data over conjecture, we think she likely will. Only time will tell.
Bernie Sanders
While Sanders is likely not going to make it through a potentially contested convention, we certainly respect and feel the ‘Bern’, so we did our homework on him as well. With regard to his work toward improving global health security, Sanders leaves us with virtually nothing to reference. He has taken a clear view on domestic public health through a continued push for a single-payer, universal health care system. Aside from a few “yes” votes on foreign aid-related issues during his time in the Senate, Sanders does not have much to show for work on international health. His foreign policy remarks do not mention global health and describe diplomacy only in terms of preventing international conflict and war. As a contemporary Robin Hood looking to provide free higher education, universal health care, higher wages, and more jobs, we applaud his idealism but know there is no free lunch: the funding will need to come from somewhere. Based on our research, there will have to be cuts, and themes of global health security are nowhere to be found as a priority in Sander’s campaign. One could surmise that in order to fund his priority big-ticket items such as education and health care, resources for GHSA and other programs that address health security won’t be sustained.
Kate Consavage is a Program Associate at HSP. She holds a B.S. in Biology from Emmanuel College, and she currently attends Georgetown University in pursuit of a M.S. in Global Health.
Jason Rao, PhD is a former senior policy advisor to President Obama and current Advisory Board Chair at HSP. He teaches global health security and diplomacy at Georgetown and Cornell Universities.