Securing Health

Securing Health: Lessons from Nation-Building Missions

Seth G. Jones
Lee H. Hilborne
C. Ross Anthony
Lois M. Davis
Federico Girosi
Cheryl Benard
Rachel M. Swanger
Anita Datar Garten
Anga Timilsina
Copyright Date: 2006
Edition: 1
Published by: RAND Corporation
Pages: 388
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  • Book Info
    Securing Health
    Book Description:

    RAND researchers analyzed the health components of seven post-World War II nation-building efforts conducted after major conflicts-Germany, Japan, Somalia, Haiti, Kosovo, Afghanistan, Iraq-and found that two factors are correlated with successful health outcomes: planning and coordination, and infrastructure and resources.

    eISBN: 978-0-8330-4074-9
    Subjects: Sociology, Political Science

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-xii)
  5. Tables
    (pp. xiii-xiv)
  6. Summary
    (pp. xv-xxx)
  7. Acknowledgments
    (pp. xxxi-xxxii)
  8. Acronyms
    (pp. xxxiii-xxxvi)
  9. CHAPTER ONE Introduction
    (pp. 1-8)

    Since World War II, the United States and its allies have invested significant resources in rebuilding health in the aftermath of interstate wars and civil unrest. Most articles and books on health efforts tend to be case studies that evaluate single operations, such as Vietnam, Bosnia, Kosovo, Haiti, and East Timor.¹ This is also true in the broader social science literature on nation-building. There are several good historical accounts of U.S. and European reconstruction efforts after World War II in Germany and Japan, as well as of more recent efforts carried out after major conflicts. Over the past decade, scholars...

  10. CHAPTER TWO Germany
    (pp. 9-38)

    In the early morning hours of May 7, 1945, German General Alfred Jodl unconditionally surrendered all German forces to the allies in Reims, Germany. He was met by delegations from the United States and Great Britain, as well as representatives from France and the Soviet Union. Germany’s surrender signaled the end of World War II in Europe, allowing the allies to begin the process of postwar rebuilding.

    This chapter argues that health reconstruction efforts in the U.S. sector of Germany were largely successful. U.S. and German health authorities improved nutrition and sanitation conditions, helped decrease infectious and other types of...

    (pp. 39-82)

    The war in the Pacific ended on August 15, 1945, when the Japanese emperor broadcast a radio address calling for his subjects to “endure the unendurable.” The formal articles of surrender were signed aboard the battleship USSMissouriby representatives of the emperor and the Japanese military on September 2, 1945, with General Douglas MacArthur and Fleet Admiral Chester Nimitz present.

    The stated mission of the Public Health and Welfare section of the allied occupation of Japan was to safeguard the security and health of the occupation forces. But once begun, this mission expanded in scope and import to include...

  12. CHAPTER FOUR Somalia
    (pp. 83-116)

    In 1992, the UN intervened in Somalia in response to an escalating civil war and humanitarian emergency. It brokered a ceasefire among the warring clans and undertook a limited peacekeeping operation in April 1992. The United Nations Operation in Somalia (UNOSOM I)—a small contingent of 50 UN observers and a 500-person Pakistani security force—was dispatched to monitor the ceasefire agreement. This UN force was followed by two others: a U.S.-led Unified Task Force (UNITAF) in December 1992, and a second UN-led force (UNOSOM II) in May 1993. The UN and a number of NGOs also began efforts to...

  13. CHAPTER FIVE Haiti
    (pp. 117-148)

    On September 18, 1994, Haitian General Raul Cédras signed an agreement with the United States stating that he would step down from power in order to avoid an imminent U.S. invasion. The agreement restored to power President Jean-Bertrand Aristide, who had been ousted by a military coup three years earlier following democratic elections. As part of the 1994 agreement, the United States committed to lifting the economic sanctions that had been in place since 1991. A force of 20,000 U.S. troops arrived in Haiti on September 19 to help oversee Haiti’s transition to democracy, allowing reconstruction efforts to begin.


  14. CHAPTER SIX Kosovo
    (pp. 149-186)

    On June 9, 1999, following 77 days of NATO air strikes, NATO and the Federal Republic of Yugoslavia signed an agreement that led to the immediate withdrawal from Kosovo of the Yugoslav army and the Serbian police. The United Nations Security Council subsequently authorized a 50,000-strong NATO-led Kosovo Force (KFOR) and established the United Nations Interim Administration Mission in Kosovo (UNMIK) to oversee the civilian administration of the territory.

    The Serbs and Albanians had struggled for control over Kosovo, the southernmost province of the former Federal Republic of Yugoslavia, for years. In 1989, Yugoslav President Slobodan Milosevic revoked Kosovo’s autonomous...

  15. CHAPTER SEVEN Afghanistan
    (pp. 187-220)

    Following the September 11, 2001, terrorist attacks, the United States used a combination of special operations forces, air power, and support from indigenous allies to overthrow the Taliban regime in Afghanistan. While small-scale fighting continued, the United States and the international community began the process of reconstruction. On December 5, 2001, Afghan leaders signed the Bonn Agreement, which detailed a process for moving toward the establishment of an independent Afghan state and set forth rigorous and ambitious benchmarks that included confirmation of an interim government, draft and approval of a new constitution, and national elections.

    The post-conflict reconstruction efforts in...

    (pp. 221-274)

    On March 19, 2003, military forces led by the United States invaded Iraq to remove Saddam Hussein from power. A U.S. Disaster Assistance Response Team simultaneously deployed to the region to assess and coordinate humanitarian relief, emergency reconstruction, and civil administration efforts. After limited air strikes and ground force operations, President George W. Bush declared major combat operations over on May 1, 2003. The U.S.-led Coalition Provisional Authority (CPA) took over as the official interim governing body until June 28, 2004, when it transferred sovereignty back to Iraq.

    The reconstruction effort followed more than two decades of conflict and international...

  17. CHAPTER NINE Evaluating Health Reconstruction
    (pp. 275-302)

    How successful have past efforts to rebuild public health and health care delivery systems during nation-building operations been? What are the most important lessons for future missions? In this chapter, we answer these questions by bringing together data and lessons from the seven case studies presented in previous chapters. We definesuccessas improvements in water and sanitation conditions, infectious disease rates, mortality and morbidity rates, and food and nutrition conditions over the course of reconstruction. More broadly, we consider how success in rebuilding health affects success in other areas of nation-building, such as security, economic stabilization, and infrastructure.


  18. APPENDIX A Methodology
    (pp. 303-330)
  19. APPENDIX B Factor Analysis
    (pp. 323-330)
  20. Bibliography
    (pp. 331-352)