7. Veterinary Global Health Engagement

Welcome to the Veterinary Global Health Engagement Module. Meet the SMEs for this module:

COL Nicole Chevalier is currently the strategic capability developer for veterinary Global Health Engagement. She has deployed to Iraq and Afghanistan, and has experience in conducting GHE activities in the military working dog (MWD) health care competency area. She is a veterinarian with a Masters in Public Health and a diplomate of the American College of Veterinary Preventive Medicine.

Dr. Kristina McElroycurrently works for the Defense Health Agency Veterinary Service Branch and is has oversight of global veterinary operations to include GHE and Defense Support to Civil Authorities (DSCA). She has deployed to Afghanistan and Africa, and has experience conducting GHE activities in the agriculture and livestock and veterinary public health competency areas. She is a Lieutenant Colonel in the Reserve Veterinary Corps, and is a veterinarian with a Masters in Public Health and a diplomate of the American College of Veterinary Preventive Medicine.

Dr. Paul Hollier serves as Assistant Professor of Veterinary Preventive Medicine at the Uniformed Services University. He has deployed to Africa, and has experience conducting GHE activities in the agriculture and livestock competency area. He is a LTC in the Veterinary Corps Reserves and is a veterinarian with a master’s in public health, a master’s in public administration and is a diplomate of the American College of Veterinary Preventive Medicine.

LTC Rick Tucker is currently the Command Veterinarian for US Army Special Operations Command. He served as battalion and brigade veterinarian for Civil Affairs in previous assignments. He has deployed to multiple countries within Asia and Africa in support of Global Health Engagement (GHE), and has supported coordination of GHE activities in Europe and South America. He has a Masters in Preventive Veterinary Medicine and a Masters in International Agriculture Development and spent several years in private practice as a large animal veterinarian before joining the Army. He is a diplomate of the American College of Veterinary Preventive Medicine.

Learning Objectives:

1. Explain how veterinary GHE activities contribute to DOD and theater goals.
2. Describe the competency areas in which Army veterinarians provide GHE activities.
3. Summarize the impact of livestock in rural areas on human security, and be able to recognize opportunities for veterinary GHE activities.
4. Know where to locate an Army veterinarian to assist in planning and conducting veterinary GHE activities.

Lecture:

Before watching the first lecture, make sure you have read the Kelly article from the Required Readings section. After watching this video, you should be able to:

• Know where to locate an Army veterinarian to assist you with GHE planning and execution
• Explain how GHE activities contribute to DOD and theater goals

Veterinary GHE as a Human Network Analysis Tool

Human Network Analysis (HNA) is a broad concept built of many components. It includes identifying distinct populations and personalities within a society as well as identifying their interconnection amongst civilian populations and the government along with their interests and concerns. HNA supports “influence operations” that require understanding a population, its geographic space, and how that population relates to the physical and digital world. As the military increasingly employs social and economic spheres of influence to minimize emphasis on kinetic operations, HNA becomes more critical. Many marginalized populations, who can be exploited or employed by non-state actors, participate extensively in agriculture and livestock livelihoods. Therefore, veterinary GHE activities that focus on agriculture and livestock livelihoods are a critical component of HNA.

Veterinary GHE, when employed in HNA, supports influence operations by gaining an understanding of the population relying on agriculture and livestock for their livelihoods, the geographic space those herders, butchers, farmers operate in, and the markets that supply and rely on them. These are all factors that feed into the analysis of the human network. Influence operations help prepare the operational environment (including the civilian population) 1. to resist aggression by foreign actors as part of irregular warfare, and 2. for special operations to leverage human networks when they operate in deep fires areas of Large Scale Combat Operations (LSCO)/Multi-Domain Operations (MDO). When properly planned, the knowledge gained from veterinary GHE strategies primarily employed to support HNA can offer secondary solutions to some of the planning problems in LSCO/MDO such as Class VIII logistics, CASEVAC, and even access to food/water and shelter for small teams operating far forward.

Civil Affairs personnel, which includes veterinarians, interact with foreign populations, the security forces of other nations, indigenous governments, and societal groups in order to better understand the information important to civil society. Because Civil Affairs personnel work and deploy in small teams, they use HNA concepts to ensure effectiveness and efficiency when planning their operations. Veterinary-related value chains that are important to civil societies, such as food security, livelihoods reliant on agriculture, animal infectious disease, and logistics permeate these communities and can all be mapped using HNA. Civil Affairs personnel are highly trained, but they are not experts in veterinary medicine or agriculture, and it is critical that their veterinarian is available to help identify risks and plan GHE events to address them.

The video you just watched of the first part of the project in Mauritania was a good example of US Civil Affairs personnel using their veterinary assets in applying HNA to design a veterinary GHE project. At the request of the US Embassy, the Civil Affairs veterinarian identified capacity gaps during an assessment of the animal health system in Mauritania. The Civil Affairs team joined the veterinarian to create a project based around the idea of using deworming medication in a comparison trial in order to generate demand for veterinary products in the region in order to not only improve livestock health, but to create a sustainable private veterinary infrastructure in the region. It was also an opportunity for the national veterinary laboratory to develop a veterinary auxiliary training program. Additionally, it created a training opportunity for the newly created Mauritanian Military Civil Affairs Team. You will see the continuation and conclusion of this project later in the module. This application of veterinary GHE is just one example of the critical importance of veterinary considerations in global health engagement strategies to address security challenges.

Veterinary GHE: Core Competencies, Security Impact, Partners, and Outcomes

Core competency areas for Army veterinarians involved with GHE includes activities conducted in the following areas:

• Agriculture & Livestock Livelihoods
• Food Protection
• Veterinary Public Health
• Military Working Dog Health Care

Veterinary GHE activities in any of these core competency areas can be designed as mil-mil, mil-civ, or mil-mil-civ engagements. For planners, this means veterinary activities are flexible and can be financed with a variety of different types of funding streams.

Security Impacts of GHE Activities by Core Competency Area

Let’s pause for a minute from our veterinary-specific discussion to review the different types of global human securities as defined by the United Nations Development Program (UNDP) in 1994. The UNDP's 1994 Human Development Report's definition of human security introduces the concept that security should be equated with people rather than territories, with development instead of weapons. The report argues that the scope of human security should be expanded to include concerns in seven areas:

The UN continues to use the following definitions of these securities in their reporting and assessments to this day.

Economic security – Economic security requires an assured basic income for individuals, usually from productive and remunerative work or, as a last resort, from a publicly financed safety net. In this sense, only about a quarter of the world’s people are presently economically secure. While the economic security problem may be more serious in developing countries, concern also arises in developed countries as well. Unemployment problems constitute an important factor underlying political tensions and ethnic violence.

Food security – Food security requires that all people at all times have both physical and economic access to basic food. According to the United Nations, the overall availability of food is not a problem, rather the problem often is the poor distribution of food and a lack of purchasing power. In the past, food security problems have been dealt with at both national and global levels. However, their impacts are limited. According to UN, the key is to tackle the problems relating to access to assets, work and assured income (related to economic security).

Health security – Health Security aims to guarantee a minimum protection from diseases and unhealthy lifestyles. In developing countries, the major causes of death traditionally were infectious and parasitic diseases, whereas in industrialized countries, the major killers were diseases of the circulatory system. Today, lifestyle-related chronic diseases are leading killers worldwide, with 80 percent of deaths from chronic diseases occurring in low- and middle-income countries. According to the United Nations, in both developing and industrial countries, threats to health security are usually greater for poor people in rural areas, particularly children. This is due to malnutrition and insufficient access to health services, clean water and other basic necessities.

Environmental security – Environmental security aims to protect people from the short- and long-term ravages of nature, man-made threats in nature, and deterioration of the natural environment. In developing countries, lack of access to clean water resources is one of the greatest environmental threats. In industrial countries, one of the major threats is air pollution. Global warming, caused by the emission of greenhouse gases, is another environmental security issue.

Personal security – Personal security aims to protect people from physical violence, whether from the state or external states, from violent individuals and sub-state actors, from domestic abuse, or from predatory adults. For many people, the greatest source of anxiety is crime, particularly violent crime.

• Physical security is part of the personal security domain, though is not specifically defined in the UN report. According to Joint Publication 1-02, DoD Terms and Definitions, physical security is concerned with physical measures designed to safeguard personnel.

Community security – Community security aims to protect people from the loss of traditional relationships and values and from sectarian and ethnic violence. Traditional communities, particularly minority ethnic groups are often threatened. About half of the world’s states have experienced some inter-ethnic strife. The United Nations declared 1993 the Year of Indigenous People to highlight the continuing vulnerability of the 300 million aboriginal people in 70 countries as they face a widening spiral of violence.

Political security – Political security is concerned with whether people live in a society that honors their basic human rights. According to a survey conducted by Amnesty International, political repression, systematic torture, ill treatment or disappearance was still practiced in 110 countries. Human rights violations are most frequent during periods of political unrest. Along with repressing individuals and groups, governments may try to exercise control over ideas and information.

If you are interested, the entire report can be read here.

Combining the veterinary GHE core competencies with the UN’s types of global securities, we can describe the competency areas and identify the security areas in which veterinary GHE activities can have impact:

• Agriculture and Livestock Livelihood systems
  • Agriculture and livestock value chains are important in many developing nations, as you will learn later in this module. Analysis of and identification of gaps in these value chains will present a plethora of opportunities for GHE activities.
  • Improved economic, food, and human health security
• Food Protection systems
  • Food protection encompasses both food safety (preventing unintentional contamination of the food supply), and food defense (preventing intentional contamination of the food supply). Partner Nations may also refer to this as food hygiene practices or systems.
  • Improved human health security
• Veterinary public health
  • This area encompasses many potential areas of opportunity for GHE activities. One of the largest is zoonotic disease prevention, mitigation and control, including activities in pandemic preparedness.
  • Improved human health security
• Military (or police/border patrol, etc.) working dog health care
  • This area includes the entire spectrum of direct provision of care, from handler first aid training through provision of comprehensive veterinary Role 4 care. Think of this competency as very similar to human patient care, from buddy aid through the various roles of specialty care.
  • Improved human health and physical security

Partners for Veterinary GHE Activities

As you’ve learned from some of the earlier modules, partnering is critical to the success of any GHE activity. This is no different for Veterinary GHE. However, partners for veterinary activities can be a little different from those for traditional medical activities, and veterinary partners may change based on the project’s core competency area. So here’s a quick run-down of major partners for veterinary engagements:

• Ministry of Agriculture
  • This is where you will find veterinarians, extension workers, paravets, etc.
  • Essential partner for any agriculture or livestock activity
  • Critical partner for any veterinary engagement with civilian impact in the core competency areas of agriculture and livestock, food protection, and veterinary public health.
• Ministry of Health
  • You may find a veterinarian, but probably not.
  • Essential partner for any activity with a human health component, particularly engagements in the veterinary public health and food protection competency areas that have civilian impact.
• Partner Nation Military
  • You may find a veterinarian and/or food protection personnel.
  • Essential partner for any MIL-MIL activity in any of the core competency areas.
• Non-Governmental Organizations (NGO) & Intergovernmental Organizations (IGO)
  • The major IGO stakeholders are
    • World Organization for Animal Health (OIE): Actively supports the improvement of global animal health systems. Tracks and certifies countries free of transboundary animal diseases, which are those that are of economic importance to livestock industries.
    • World Health Organization (WHO): Has a common interest with the OIE when animal diseases pose a potential public health risk (e.g., zoonoses like avian influenza)
    • Food and Agricultural Organization of the United Nations (FAO): Recognizes that animal health plays a large role in food security
    • World Trade Organization (WTO): Has an important working relationship with the OIE to regulate global trade of animal source products (think market access and value chains)
  • Veterinary-specific NGOs
    • There are few national level veterinary-specific NGOs.
    • Veterinarians often collaborate with human health-related NGOs such as Save the Children, Mercy Corps, OxFam, etc., due to the relationship of veterinary public health (food protection, livestock livelihoods & value chains) to human health.
    • Some local, grass-roots level agricultural NGOs exist. You should be able to identify those that may be available as potential partners during your planning and pre-deployment site survey (PDSS) or other initial assessment. These types of organizations are valuable partners for sustainability, and to maximize legitimacy and positive impacts of the engagement.
• Civil Society Organizations, traditional governance structures (village councils, etc.)
• US Government Agencies
  • CDC, USDA/Animal Plant Health Inspection Service (APHIS), USDA/Foreign Agricultural Service (FAS), USAID

Outcomes

Depending on the core competency area, some of the outcomes of veterinary GHE activities are as follows:

• Strengthen animal health capacity within partner nation framework
• Augment and/or bridge gaps in agriculture, public health and animal health
• Strengthen partner nation military veterinary capacity (food protection, force health protection, MWDs)
• Enhance disaster preparedness planning
• Enable access to a denied environment by delivering direct animal health care services (Veterinary Civic Action Program, VETCAP)
• Improve animal health disease surveillance & detection by improving infrastructure & knowledge

This list is not all-inclusive. Can you think of some additional outcomes? Be prepared to discuss.

Agricultural & Livestock Livelihoods: Impact on Economic, Food & Human Health Securities

Each of the four veterinary Core Competency areas is important and contributes to DOD GHE goals. The least intuitive of these four areas and how it contributes to security goals is agriculture and livestock livelihoods, so we will discuss that topic in this section.

Randolph et al describe the importance of animal-source foods (ASF) and the critical linkages between livestock keeping, livelihoods, and their impact on nutrition and health. These linkages become more relevant when we understand seventy percent (70%) of the world’s rural poor depend on livestock for their livelihood. This dependence has evolved over time into social, cultural and behavioral practices that offer opportunities for prosperity, but also serve as threats to global health and human security. This module explores the interface between humans, animals, their shared environment, and the economy to provide the global health practitioner with an awareness-level understanding of the agricultural sector and how it impacts economic, food, and human health security.

The next video explores the importance of animals in Culture and Society.

Now, we will learn a little more about livestock livelihoods and their impact on human and economic health security. It may seem natural for us to talk about human health in a global health focused course, but we can’t neglect the importance of economic health either; families and communities that are economically healthy are more stable and less likely to rely on illegal activities to provide a livelihood for their survival, and they are less susceptible to the influences or recruitment from non-state actors. GHE activities that target agriculture and livestock and food protection impact human and economic health, and improve food security, which can strengthen partner capacity while helping the US achieve its security goals.

After watching these videos, you should be able to:

1. Describe the importance of livestock to the rural poor in developing nations.

2. Summarize the impact of livestock in rural areas on human security, and have an awareness of how to recognize opportunities for veterinary GHE activities.

3. Explain how veterinary GHE activities contribute to DOD and theater goals through improving economic, food, and human health securities.

Using the mighty chicken as an example, let’s learn a little more about this interconnectedness with the economic health and human health securities.

This figure above is from Melinda Gates, and demonstrates how chickens can improve the livelihoods of women. This is a great illustration of how livestock can support livelihoods by providing food, as well as extra income, which can be used for school fees, health care, and basic necessities to create a more resilient household. Often times people chose to sell their animal products rather than consume them, or they might use eggs to produce more chickens rather than for consumption. Women in agriculture and the livestock sector are very important. While we don’t have time to cover gender issues more specifically, it’s worth mentioning that often women can’t own land, but they can own livestock, especially chickens and small ruminants such as sheep and goats. Additionally, when looking for potential partners for GHE activities, there are often special programs (and funding sources) for activities targeting women and children.

Summary: Animal Health Impacts Economic and Human Health Security

The figure below is an excellent summary of the two main mechanisms through which animal diseases can negatively impact human security. Diseased or otherwise unhealthy animals pose risks to human health and the economy, both of which ultimately affect human wellbeing and security. Poor hygiene and limited refrigeration can also restrict market access and prevent smallholders from being able to get traction in any kind of animal-source food export market. Smallholders still dominate production in many countries such as East Africa, India, Vietnam, and the Philippines. With the unprecedented demand for animal-source foods in developing countries, engagements that target animal health and improve food hygiene and food safety practices in rural areas can have great benefit. Many of the countries in which the DOD has strategic interests afford excellent opportunities for Global Health Engagement activities focused on livestock systems.

Now, before watching the video please read the Providence et al. reading from the Required Readings section.

Veterinary GHE Examples and a Few Words on the VETCAP

To conclude the veterinary module, we’ll compare and contrast two different veterinary GHE activities. The first two engagements you will see are the continuation and conclusion of the activity in Mauritania that you watched earlier. The third video with the goats is an activity that is an example of the traditional Veterinary Civic Action Program, or VETCAP. The VETCAP is the legacy model of a veterinary engagement, and LTC Paul Hollier will spend some time discussing why this legacy model is outdated and potentially counterproductive. After that, Dr. McElroy returns to compare and contrast the two types of veterinary engagements: Mauritania vs. the Morocco VETCAP. To conclude, Dr. McElroy discusses how VETCAPs can still be employed in a more productive, sustainable manner. We’ll compare this with the Mauritania example and end by discussing how the VETCAP can be planned and conducted in a more productive manner.

Module Summary

Hopefully, we’ve convinced you that the primary reason to conduct GHE activities is for security: to assist in achieving Theater Campaign Plan objectives.

In the majority of countries where the DOD has strategic interests, animal health greatly impacts human security. Theater campaign plan objectives, as well as human & animal health, livelihoods, and economies in these countries can benefit from engagements incorporating the veterinary core competencies, whether those are agriculture/livestock, food protection, veterinary public health, or military working dog healthcare.

When strategically employed and properly targeted, veterinary GHE activities can improve animal and human health, strengthen livelihoods, and build partner capacity while meeting DOD and U.S. Government goals.

Please contact the course facilitators in the future if you have questions about planning, shaping, or utilization of a veterinary global health engagement activity. We welcome all questions and inquiries.

Veterinary GHE Contacts

• COL Nicole Chevalier (nicole.a.chevalier.mil@mail.mil)
• Dr. Kristina McElroy (kristina.m.mcelroy2.civ@mail.mil)
• LTC Rick Tucker (thomas.tucker@socom.mil)

Supplemental Materials:

1. Nurturing Development with Animal-Source Foods, USAID, 2017
2. Food Safety in Developing Countries: Research Gaps and Opportunities USAID, 2017

After You Watch/Read/Engage:

1. Visit the Sakai discussion forums.
2. Join the live VTC on Thursday.
3. Complete the Quiz before Wednesday at 2355 EST.

Looking Ahead:

1. Next week is a module on GHE as an enabling methodology for other USG and GCC priorities, especially WPS and the GHSA.
2. The comprehensive final paper assignment (2000 words) is due May 13 at 2355 hours.