Recent shifts in Australia’s military operating environment such as the drawdown of operations in the Middle East, escalation of grey zone activities, and increased likelihood of conflict with a peer adversary have led to a renewed focus on near-region engagement. In the 2020 Defence Strategic Update, building engagement with Pacific Island nations is a crucial component of national strategy[1], while the Department of Foreign Affairs and Trade (DFAT) supports regional partnerships through assistance with economic recovery, stability and health security[2]. Global health is therefore explicit in Australia’s foreign policy aims; however, the contribution of the Australian Defence Force (ADF) to these initiatives is limited in scope and constrained by doctrine. I propose that deployment of our military healthcare assets to near-region nations for global health engagement can promote greater capability in our partners and build resiliency in the military healthcare system.
Organisation of Australian global health initiatives
Global health engagement involves collaborating with partner nations to provide healthcare assistance and can promote our interests by improving regional stability, building influence, maintaining the operational readiness of healthcare personnel, and supporting the right to health[3]. Australia’s global health engagement falls under DFAT, which is responsible for the disbursement of funding and coordination of the government response to humanitarian needs. In support of DFAT, the ADF has been extensively involved in humanitarian assistance and disaster relief (HADR), where its logistical expertise and ability to quickly mobilise have been critical. Recent HADR operations have included the provision of supplies and engineering support to Fiji following Tropical Cyclone Yasa, deliveries of supplies to Beirut following the August 2020 explosion, and the delivery of medical supplies to India, Nepal and Sri Lanka during the COVID-19 pandemic. While ADF support has included the delivery of material, logistics, engineering and construction, we have not provided healthcare to people in recipient countries. Doctrinally, constraints are placed on the use of military assets to support humanitarian operations due to perceived risks around conflating military and humanitarian action[4]. ADF healthcare providers have not been substantially involved in the past decade, with this function served primarily by Australian Medical Assistance Teams (AUSMAT) consisting of civilian professionals mobilised during humanitarian disasters. In contrast, HADR operations conducted in the Pacific between 1998 and 2007 involved ADF healthcare providers as the primary effort[4].
The Australian Defence Force healthcare capability
All three services in the ADF possess an expeditionary healthcare capability, with the ability to deploy a Role 2 health facility for the Air Force and Role 2 Enhanced for the Army and Navy. The purpose of the health element is solely force health protection; however, concerns have been raised about the readiness of health personnel to effectively provide clinical care in the event of a high-intensity conflict[5]. Due to the relatively sheltered recent history of the ADF, with operations primarily involving asymmetrical low-intensity conflict, military clinicians have limited exposure to the demands of operational service. While reservist clinicians typically maintain a skillset in their civilian roles, the applicability of this to their deployed role varies; for full time military personnel, access to training and clinical placements have been insufficient to alleviate concerns regarding skill fade. Furthermore, challenges in retaining healthcare personnel in the permanent forces is an ongoing threat to capability, particularly for medical officers. Anecdotally, retention may be impacted by this perceived lack of opportunity to maintain a robust clinical skillset.
Global health engagement in the Pacific: a mutually beneficial arrangement?
From a practical standpoint, ADF healthcare personnel are well suited to conducting global health engagement activities in Pacific Island nations. As military members, they are conditioned to act as directed under conditions of stress, under resource constraints and in austere environments. Leaders are trained to conduct a thorough appreciation of the situation and identify the best course of action to achieve the commander’s intent using the assets available. Some Defence personnel share lived experiences or identify with Pacific Island communities, a commonality that may expedite the relationship building process. The ADF's logistics capability is unmatched in Australia and can support sustained operations; in contrast, AUSMAT only has the capacity to respond to the emergency phase of a disaster.
From an operational readiness perspective, deployment to the tropics is a scenario that is perpetually anticipated and often trained for, suggesting that a global health deployment to a developing near-region country would be of significant training value. This would provide greater exposure for medical and environmental health personnel to demands around hygiene, sanitation and disease control. The nature of the global health intervention carried out would be negotiated in collaboration with the host nation[6]; however, this would likely afford clinicians opportunities to develop their skillsets around population health, project management, logistics and cultural competence, as well as provision of clinical care. Furthermore, positive operational experiences are likely to be intrinsically motivating and professionally gratifying to the personnel involved, supporting morale and potentially assisting with the retention of skilled
The strategic implications of increased health cooperation may include stronger alliances with partner nations, increased military interoperability, greater regional influence, and improvement to Australia’s global reputation. Crucially, significant ADF engagement in Pacific Island nations are already taking place, including the provision of military assets and training, joint exercises and community visits conducted as part of non-military engagement activities[6]. This indicates a robust appetite for military cooperation and suggests that structural and diplomatic frameworks should exist for the expansion of activities into the global health space should this become possible.
Leveraging our allies’ expertise
Development of the ADF’s global health engagement capability could be supported by, and itself support, Australia’s partnership with the US, which remains a key stakeholder in the Pacific[1]. The US military has played an instrumental role in shaping the field of global health engagement, with a long history of its use as a tool of statecraft, to bolster the readiness of its forces, and to promote global
Conclusion
Current doctrine limits the scope of Australian military clinicians to conduct global health engagement in partner nations. However, I propose that this limitation is outmoded and potentially detrimental to national interests in our current strategic environment, particularly as we align more strongly with the US which maintains extensive global health programs. Effective global health engagement by the ADF has the potential to accelerate the relationship building process with Pacific Island nations, improve health security in our region, and enhance our operational readiness.
