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Research Questions

  1. How does GHE support theater plans?
  2. What type of GHE activities are being conducted?
  3. What are the primary funding sources used to support GHE activities?
  4. What challenges do current GHE funding mechanisms pose?

The combined challenges that the U.S. Department of Defense (DoD) faces in addressing the coronavirus disease 2019 (COVID-19) pandemic and preparing for a potential conflict with a near-peer adversary have made the need to protect the health and safety of U.S. forces more acute. Global health engagement (GHE) provides an important mechanism to work with allies and partners to develop their medical capacity and medical support capabilities and improve U.S. interoperability with allies and partners to help ensure U.S. force protection and medical readiness. Although the defense community has a broad remit to engage in global health activities with partner nations for the purpose of improving the health and safety of U.S. warfighters, it has not integrated GHE into combatant command operational or security cooperation planning, nor has it provided consistent funding for these activities.

In this report, the authors identify the evolving GHE priorities of five of the six geographic combatant commands (GCCs) and the challenges they face supporting combatant command objectives with current sources of funding. They reviewed the relevant GHE instructions and policies and engaged in discussion with more than 75 DoD policy and service leaders and members of the medical community in five GCCs and their service components, as well as members of the policy, legal, and financial communities across DoD. Based on these discussions and a series of follow-up group discussions, they propose several courses of action for providing more-targeted resources to conduct GHE activities in support of GCC objectives.

Key Findings

  • GHE priorities vary across the GCCs.
  • In the U.S European Command and U.S. Central Command, GHE efforts focus on expanding regional expeditionary medical capacity and trauma care support for current and potential operations.
  • In the U.S. Southern Command and U.S. Africa Command, GHE efforts relate to (1) increasing partner capacity to respond to infectious diseases and public health needs and (2) developing medical support capabilities for humanitarian assistance and peacekeeping missions.
  • In the U.S. Indo-Pacific Command, GHE activities are focused both on enhancing public health and support for humanitarian disasters and increasingly on developing regional military medical capabilities in support of potential contingency operations.
  • Despite differences in regional priorities, GCCs are increasingly focused on achieving U.S. force protection and medical readiness objectives.
  • GHE funding is not prioritized to build partner-nation medical capacity or develop the interoperable medical capabilities necessary to meet future combatant command requirements for medical support.


  • GHE should focus on enhancing U.S. force health protection and medical readiness as a means of achieving GCC objectives. Specifically, GHE should become more closely integrated into GCC operational planning by identifying the demand for medical support and focusing GHE activities on building partner-nation capacity and capabilities to meet these demands.
  • To accomplish this, the GCC strategic planners and surgeons general should clarify the medical readiness and force protection requirements for their operational plans and identify how GHE can help meet these requirements. Furthermore, the GCCs, in coordination with the Joint Staff and Deputy Assistant Secretary of Defense for Global Partnerships (DASD/GP) should develop regionally specific GHE plans based on operational requirements.
  • DASD/GP should consider ways to incorporate GHE into its security cooperation evaluation and learning agenda. This would draw greater attention and resources for the assessment, monitoring, and evaluation of medical- and health-related security cooperation activities on a regional and country basis.
  • DASD/GP should continue to leverage existing security cooperation mechanisms to support GHE, even while it pursues dedicated GHE funding to increase partner-nation capacity and capabilities to ensure the health and safety of U.S. forces.

This research was sponsored by the Office of the Assistant Secretary of Defense for Health Affairs and conducted within the Personnel, Readiness, and Health Program of the RAND National Security Research Division (NSRD).

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