I’ve argued previously that every health care issue confronting us today has underlying global aspects. And while the health care services we receive appear to be local, each drug, patient record, and operating room is the culmination of a complicated international exchange we need to better understand. I also asked the question of whether a U.S. global health care aid policy could help in repairing the U.S.’s image in the world as part of a new ’soft power’ strategy. Comments to those posts have generally tended to agree with the sentiment as expressed by Jeff O’Conner:

“Until the United States acknowledges and competently implements some degree of regulation over the whole of the healthcase sector, it not only has no business trying to influence the healthcare systems of other nations, it has no competency even if invited to do so.”

or as Scott MacStravic writes:

“The problem is that our “lead” in healthcare seems to be mainly in our proven ability to spend far more per capita than any other nation on earth, while getting far less return on our investment in terms of the health of our population.”

So let’s string this discussion out a bit more since there are important issues involved.

First, we may be able to agree on the judgment, that the U.S. image around the world is at an all time low. Considerable attempts by the Bush Administration to use a public relations approach as a way “rebrand” America have failed.

Back in 2004, the RAND Corporation issued a report saying the key factor in public diplomacy is not what the U.S. government says but rather what it does.

“Misunderstanding of American values is not the principal source of anti-Americanism,” the report concluded. Many foreigners understand us just fine; they simply don’t like what they see. It’s “some U.S. policies [that] have been, are, and will continue to be major sources of anti-Americanism.”

And this low point may be historic. As Michael Vlahos laments, “in broad terms, we have squandered the World War II canon. We have lost its mythic authority. We are at the historical end of its protective embrace. We are on our own now.” We have also lost, according to Vlahos, the “war of ideas”, and we have become the “wreckers of our very own identity.”

But — and this is a very important but according to Vlahos — the destruction of this image and the accompanying narrative of American dominance in the world, has created a space for a new canon to emerge. And what will fill that new space is now ours to consider.

So we come to health care with the question as to its place in repairing America’s foreign relations. Some aspects of American health care have undeniably been injured by the our diminished image in the world. For example, the U.S.’s recent and unprecedented contribution to the worldwide prevention of HIV infection has been tainted by the focus on abstinence education. And our general openness to critique, such as the recent and well publicized Commonwealth Fund study, has laid bare some of our more difficult challenges and, admittedly, our abject failures as well.

But what of it? I would argue that the world still is out there; that our major issues in health care still remain global in scope; that the contribution of American health care to the health of the world is still eagerly awaited by many countries; and that our denial of these facts reflects either the indifference to our moral obligations to others, or a self-absorption so total that we cannot see, or do not appreciate, the comparative advantages we enjoy everyday in health care compared to the rest of the world.

What the world needs now from American health care is not a withdrawal but a more powerful engagement especially with developing countries, and multi-national health organizations; an engagement that reflects the best in both public diplomacy and health policy that we have to offer. Whether we like it or not, we are still burdened with living in this world and it still remains our job to make it work.