Health for health's sake, winning for God's sake: US global health diplomacy and smart power in Iraq and Afganistan

The superordinate quality of health has resulted in health assistance attracting attention for its political as well as its health benefits. This potential resonates with concepts of Global Health Diplomacy and smart power: that actions undertaken for a benevolent purpose (in this case, developing and providing health services for populations in need) may also be used to leverage political benefits. Yet the closer alignment of health assistance with political objectives has been extremely divisive, with many in the public health and humanitarian aid communities expressing disquiet. In this article we investigate this tension at the ‘sharp end’, focussing on the question of whether health assistance in conflict can indeed generate both health and strategic gains and what ethical challenges are involved in this. It examines the conflicts in Iraq and Afghanistan as specific attempts to use health interventions for wider strategic benefit.