Ambassador Jimmy Kolker is the Assistant Secretary for Global Affairs at the U.S. Department of Health and Human Services. The Office of Global Affairs, in the Office of the Secretary, leads the Department’s efforts to better the health and well-being of Americans and of the world’s population through global strategies and partnerships and working with other U.S. government agencies in the coordination of global health policy. Now the Department’s senior health diplomat, Jimmy previously served as the Principal Deputy Assistant Secretary of the office (2011-2014).
Prior to joining HHS, Jimmy was Chief of the HIV and AIDS Section at UNICEF’s New York headquarters (2007-2011). He had a 30-year diplomatic career with the U.S. State Department where he served as Deputy Global AIDS Coordinator in the Office of the U.S. Global AIDS Coordinator (2005-2007) and U.S. Ambassador to Uganda (2002-2005) and to Burkina Faso (1999-2002). He was Deputy Chief of Mission at U.S. embassies in Denmark and Botswana and won awards for political reporting at earlier posts in the UK, Sweden, Zimbabwe, and Mozambique.
Ambassador Kolker sat with Ambassador Stuart Holliday at Meridian House for this Diplomatic Courier exclusive interview.
***
[Stuart Holliday:] Let me begin by asking you about your career. You have had a fascinating career in two different parts of the government. Could you describe to us a little bit about what the global affairs function is at the U.S. Department of Health and Human Services (HHS)?
[Jimmy Kolker:] The intersection between health and diplomacy is something I discovered unexpectedly. I was Ambassador to Uganda when PEPFAR (President’s Emergency Plan for AIDS Relief) first started. Although I didn’t have an academic background in public health or AIDS programs, PEPFAR had a decentralized decision-making process in which the country team and the ambassador were responsible for picking partners, for setting goals, and for assigning priorities. So, through no merit or virtue of mine, I became head of the largest AIDS program in the world. We were able to triple our targets during those first couple years of PEPFAR. It changed my life. I realized that evidence-based treatment and energetic U.S. leadership helped tens of thousands of people in Uganda stay alive. So when I left Uganda, I became number three in the PEPFAR program here in Washington and then went on to UNICEF for four years to work on AIDS. Now I am in the Department of Health and Human Services (HHS) working specifically on the U.S. Government’s global health work. The Office of Global Affairs (OGA) sits within the Office of the HHS Secretary and promotes the health and well-being of Americans and of the world’s population by advancing HHS’s global strategies and partnerships and working with USG agencies in the coordination of global health policy.
[SH:] Health used to just be thought of as a development issue, but because of the success of PEPFAR, it’s had an impact on how millions of people in Africa see the United States. Did you see that happening when you were there?
[JK:] No question; it changed how people saw America. AIDS in those years was something that affected everyone in Uganda. Suddenly, because of U.S. leadership, life-saving treatment, that they knew was available in developed countries, became available in Uganda and other African countries. Everyone in Uganda knew that the PEPFAR program was making a big difference, and that the U.S. was behind it.
[SH:] A lot of people have an impression of an ambassador’s role as somebody who either writes cables or goes to events. I would imagine that in advancing a massive health initiative like PEPFAR, you would have to engage multiple stakeholders in different sectors in the government and private sector and really build a coalition?
[JK:] Absolutely, and that’s what I think diplomats are good at. There are a lot of dedicated and heroic groups that have been trying to bring attention to HIV and AIDS for a long time. But I think the diplomatic skills of how you build coalitions, how you put our priorities onto somebody else’s agenda, and how you deal with civil society and put things in context are critical. You need to know what’s going on in the country beyond HIV and beyond health to know how to leverage for results. You need to be analytical about it and I think that diplomats are able to do that effectively.
[SH:] Typically when you are a bilateral ambassador, you are focused on that country, but health issues do not recognize borders. How do we ensure, when we are working on a particular country like Uganda, that we are taking advantage of the best approaches and coordinating across borders?
[JK:] Even in countries where political relations and other mutual problems haven’t brought governments together, health can be a great meeting ground. Contagious diseases and viruses are obvious transnational threats, but in our response, we find additional areas in which countries can cooperate. How are we going to create the incentives to keep doctors in rural areas for underserved populations? How can a health system designed for controlling infectious disease better screen for cancer and heart disease and other non-communicable disease risks? These are huge opportunities for cooperation between countries and for learning from each other, and America can be the beneficiary as well as a technical partner in finding these answers with other countries.
[SH:] Could you talk about why HHS was created and its principal purpose?
[JK:] HHS is the United States Government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. HHS always had people that supported the Secretary of Health and Human Services in his or her travel overseas and World Health Organization governance. We realized we weren’t taking advantage of the tremendous capacity and expertise within HHS on all sorts of diseases, health systems organization, and health human resource management to meet opportunities and challenges abroad. PEPFAR opened our eyes on how much the U.S. experience could be translated into effective work overseas. Although the Office of Global Affairs was set up before, PEPFAR started putting a lot of money into CDC and other organizations for work directly abroad. Our small office works daily with CDC, NIH, FDA, the other HHS divisions and with health attachés, and other officers in our embassies overseas to meet domestic needs as well as use our expertise to work with partners around the world.
[SH:] What are some of the tools that you bring to the problems you are trying to solve?
[JK:] I think the main added-value that our office brings is to give international perspective to what HHS is doing and what we could do. The Centers for Disease Control and Prevention certainly is the world’s leader in responding to outbreaks, and in helping states in the U.S. to deal with public health problems, and that surveillance, communication and response are as valuable overseas as they are here. So, our partnership really could advance local public health in some countries. Ensuring the implementers of our programs and the health officials in those countries are aware of the latest scientific developments and are using them in their daily practices is also very important. The Food and Drug Administration can’t just protect the American people by going to grocery stores here in the United States because much of the food we eat comes from abroad. The work overseas is an essential part of what they do. On the other end of the spectrum, how do we as a government under the Affordable Care Act and through Medicare and Medicaid deal with very expensive drugs, end of life care, and the experimental methods of dealing with non-communicable diseases? Every country in the world is facing these same questions, so really focusing on the perspective of how could we partner with middle-income countries like Brazil, Colombia, South Africa, China, and India to deal with some of these problems of cost, quality and access; and applying the lessons we have learnt to countries rich and poor are important.
[SH:] That’s interesting, the talk about partnering with the middle-income countries who also have a stake in these regions.
[JK:] I think the era of donor countries and recipient countries has kind of reached the end of its shelf life. Many countries want a technical partnership with the United States, especially middle-income countries, and the BRICS have led the way on this. We see this as a sweet spot for the Department of Health and Human Services. We have the kind of experts who can raise their game. They have their critical mass of important scientists, researchers, medical professionals, and service providers, but what they need is to be sure that they’re giving state-of-the-art care, are aware of the latest developments, and have exchange with their counterparts. I don’t think it’s an exaggeration to say that the U.S. is the first choice for medical and research exchanges and expertise in every country in the world.
[SH:] You mentioned the word “exchange”. It seems to me that you’re trying to create a scenario where people can exchange ideas and best practices. How do you all advance those kinds of programs at HHS?
[JK:] Well, the multilateral system is a good basis for that, because the World Health Organization, the Global Fund, UNAIDS, and all of the areas that we work in have technical partnerships, expert groups, advisory groups, and a normative function, which help us put best practices in place for our country, and for those countries that might not have very well-developed systems. We are also trying to work with embassies in Washington, many of whom have health attachés, to identify for them the people they need to go to when their experts are looking for partnerships with the United States. At the same time, we are working with our embassies overseas and foreign governments. We tell them, “Here are some things we know are a problem in this country, and we have some expertise that can help address that, but we want to work with your experts.” By giving their experts the kind of network that our own specialists would use for solving these problems in the United States, we think that everybody is better off. So there is a sense of learning, as well as reporting on health conditions, and we know how to identify the early warnings of public health problems. All of this is an exciting kind of 21st century expeditionary diplomacy.
[SH:] The First Lady has taken on the challenge of obesity in the United Sates, and if you look around the world, obesity seems to spare nobody. How serious of an issue is it, and what can we do?
[JK:] It’s a serious issue, and we’re pleased that HHS has been directly involved in implementing the ‘Let’s Move’ program of the First Lady. Cardiovascular conditions, cancer, and diabetes are correlated with obesity, tobacco, alcohol, poor diet, unhealthy lifestyle, and lack of exercise, and that’s increasingly true everywhere. On the U.S.-Mexico border, for instance, addressing obesity is key to dealing with the complex health problems and through our department, we have the U.S.-Mexico Border Health Commission, which looks specifically at problems of populations in underserved areas on both sides of the border. ‘Let’s Move’ has really struck a chord internationally as well as in this country.
[SH:] What is your interaction with the diplomatic community here in Washington, and to what degree do you interact with them?
[JK:] Coming from a diplomatic background, it’s one of the things I’ve urged in my two and a half years at the Department of Health and Human Services. I think we are underusing our access to diplomats in Washington. We have health attachés from a number of embassies who are in regular contact with our office, but not enough. I’m pleased to say that we’ve tried to reach out to embassies here in Washington. For instance, in advance of the AIDS conference two summers ago that was held in Washington, we did convene ambassadors and health ministers coming to this meeting. We had great feedback from that meeting, and we were looking for other, similar opportunities.
[SH:] I wonder how many health ministers talk to their foreign ministers and use the same globally-coordinated approach that we sometimes use in this country. I bet that’s not the case in most countries.
[JK:] State Department’s establishment of the Office of Global Health Diplomacy as a kind of counterpart office to ours has been a great advantage. We now systematically brief ambassadors in DC as they’re going out to post on U.S. health activity in the countries they’re going to be representing the U.S. We have lots of opportunities for that kind of coordination, but also, just bringing health into the diplomatic dialogue and the sense of where health fits in with other issues. I think over and over again, that’s where a diplomat can really make some valuable contribution.
[SH:] Speaking of skills and attributes, let’s talk about culture for a second, in terms of health. How has understanding culture been important for us as a country in terms of applying a local policy or practice in the health sector?
[JK:] I think there are two parts to that question. One is that the behavioral factors, the social milieu in which people are living are important factors that contribute to health or lack of health. These factors are unquestionably important, and we haven’t paid enough attention to them.
[SH:] You’re talking about more cultural behavior and cultural customs?
[JK:] Right. I mean, in the HIV/AIDS world, there was a practice of wife inheritance. So if a man died, his wife would marry his brother. When AIDS was the leading cause of death, this was the worst possible thing you could do from an epidemiological standpoint. So sometimes there are specific cultural practices that have a direct bearing on health. From that point of view, culture plays a role in individual patient survival and behavior. The challenges are: how do you understand the cultural context and behavior, how best to innovate, and how best to get this change adopted by the people who are actually going to have to live with it. Culture is intimately connected with social determinants of health.
[SH:] What is the global health issue or challenge that you don’t think is getting enough attention, or that we really need to pay more attention to?
[JK:] There are a lot of issues and challenges, and they’re in different stages. I think that it would be a shame to have an interview like this without mentioning polio, because we set a goal to eradicate polio by the year 2000 and didn’t meet it; it’s now down to just a couple hundred cases per year, but is spreading in some areas. Vaccination programs are crucial to getting across that goal line. And we are nearly there. We must not let this achievement get away again.
I think that we now realize how much lifestyle factors affect health, but attitudes and national policy aren’t yet clear. How can we, as a government and a society, encourage healthy behavior? The U.S. government clearly can’t make personal decisions to tell people what they can and can’t eat or drink. But we can create policies and programs that encourage people to adopt healthier behaviors. We need to put our best minds to work to make these choices obvious and attractive.
This article was originally published in the Diplomatic Courier's November/December 2014 print edition.
U.S. Mission Geneva photo by Eric Bridiers.
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Interview: Ambassador Jimmy Kolker, HHS Assistant Secretary for Global Affairs
November 20, 2014
Ambassador Jimmy Kolker is the Assistant Secretary for Global Affairs at the U.S. Department of Health and Human Services. The Office of Global Affairs, in the Office of the Secretary, leads the Department’s efforts to better the health and well-being of Americans and of the world’s population through global strategies and partnerships and working with other U.S. government agencies in the coordination of global health policy. Now the Department’s senior health diplomat, Jimmy previously served as the Principal Deputy Assistant Secretary of the office (2011-2014).
Prior to joining HHS, Jimmy was Chief of the HIV and AIDS Section at UNICEF’s New York headquarters (2007-2011). He had a 30-year diplomatic career with the U.S. State Department where he served as Deputy Global AIDS Coordinator in the Office of the U.S. Global AIDS Coordinator (2005-2007) and U.S. Ambassador to Uganda (2002-2005) and to Burkina Faso (1999-2002). He was Deputy Chief of Mission at U.S. embassies in Denmark and Botswana and won awards for political reporting at earlier posts in the UK, Sweden, Zimbabwe, and Mozambique.
Ambassador Kolker sat with Ambassador Stuart Holliday at Meridian House for this Diplomatic Courier exclusive interview.
***
[Stuart Holliday:] Let me begin by asking you about your career. You have had a fascinating career in two different parts of the government. Could you describe to us a little bit about what the global affairs function is at the U.S. Department of Health and Human Services (HHS)?
[Jimmy Kolker:] The intersection between health and diplomacy is something I discovered unexpectedly. I was Ambassador to Uganda when PEPFAR (President’s Emergency Plan for AIDS Relief) first started. Although I didn’t have an academic background in public health or AIDS programs, PEPFAR had a decentralized decision-making process in which the country team and the ambassador were responsible for picking partners, for setting goals, and for assigning priorities. So, through no merit or virtue of mine, I became head of the largest AIDS program in the world. We were able to triple our targets during those first couple years of PEPFAR. It changed my life. I realized that evidence-based treatment and energetic U.S. leadership helped tens of thousands of people in Uganda stay alive. So when I left Uganda, I became number three in the PEPFAR program here in Washington and then went on to UNICEF for four years to work on AIDS. Now I am in the Department of Health and Human Services (HHS) working specifically on the U.S. Government’s global health work. The Office of Global Affairs (OGA) sits within the Office of the HHS Secretary and promotes the health and well-being of Americans and of the world’s population by advancing HHS’s global strategies and partnerships and working with USG agencies in the coordination of global health policy.
[SH:] Health used to just be thought of as a development issue, but because of the success of PEPFAR, it’s had an impact on how millions of people in Africa see the United States. Did you see that happening when you were there?
[JK:] No question; it changed how people saw America. AIDS in those years was something that affected everyone in Uganda. Suddenly, because of U.S. leadership, life-saving treatment, that they knew was available in developed countries, became available in Uganda and other African countries. Everyone in Uganda knew that the PEPFAR program was making a big difference, and that the U.S. was behind it.
[SH:] A lot of people have an impression of an ambassador’s role as somebody who either writes cables or goes to events. I would imagine that in advancing a massive health initiative like PEPFAR, you would have to engage multiple stakeholders in different sectors in the government and private sector and really build a coalition?
[JK:] Absolutely, and that’s what I think diplomats are good at. There are a lot of dedicated and heroic groups that have been trying to bring attention to HIV and AIDS for a long time. But I think the diplomatic skills of how you build coalitions, how you put our priorities onto somebody else’s agenda, and how you deal with civil society and put things in context are critical. You need to know what’s going on in the country beyond HIV and beyond health to know how to leverage for results. You need to be analytical about it and I think that diplomats are able to do that effectively.
[SH:] Typically when you are a bilateral ambassador, you are focused on that country, but health issues do not recognize borders. How do we ensure, when we are working on a particular country like Uganda, that we are taking advantage of the best approaches and coordinating across borders?
[JK:] Even in countries where political relations and other mutual problems haven’t brought governments together, health can be a great meeting ground. Contagious diseases and viruses are obvious transnational threats, but in our response, we find additional areas in which countries can cooperate. How are we going to create the incentives to keep doctors in rural areas for underserved populations? How can a health system designed for controlling infectious disease better screen for cancer and heart disease and other non-communicable disease risks? These are huge opportunities for cooperation between countries and for learning from each other, and America can be the beneficiary as well as a technical partner in finding these answers with other countries.
[SH:] Could you talk about why HHS was created and its principal purpose?
[JK:] HHS is the United States Government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. HHS always had people that supported the Secretary of Health and Human Services in his or her travel overseas and World Health Organization governance. We realized we weren’t taking advantage of the tremendous capacity and expertise within HHS on all sorts of diseases, health systems organization, and health human resource management to meet opportunities and challenges abroad. PEPFAR opened our eyes on how much the U.S. experience could be translated into effective work overseas. Although the Office of Global Affairs was set up before, PEPFAR started putting a lot of money into CDC and other organizations for work directly abroad. Our small office works daily with CDC, NIH, FDA, the other HHS divisions and with health attachés, and other officers in our embassies overseas to meet domestic needs as well as use our expertise to work with partners around the world.
[SH:] What are some of the tools that you bring to the problems you are trying to solve?
[JK:] I think the main added-value that our office brings is to give international perspective to what HHS is doing and what we could do. The Centers for Disease Control and Prevention certainly is the world’s leader in responding to outbreaks, and in helping states in the U.S. to deal with public health problems, and that surveillance, communication and response are as valuable overseas as they are here. So, our partnership really could advance local public health in some countries. Ensuring the implementers of our programs and the health officials in those countries are aware of the latest scientific developments and are using them in their daily practices is also very important. The Food and Drug Administration can’t just protect the American people by going to grocery stores here in the United States because much of the food we eat comes from abroad. The work overseas is an essential part of what they do. On the other end of the spectrum, how do we as a government under the Affordable Care Act and through Medicare and Medicaid deal with very expensive drugs, end of life care, and the experimental methods of dealing with non-communicable diseases? Every country in the world is facing these same questions, so really focusing on the perspective of how could we partner with middle-income countries like Brazil, Colombia, South Africa, China, and India to deal with some of these problems of cost, quality and access; and applying the lessons we have learnt to countries rich and poor are important.
[SH:] That’s interesting, the talk about partnering with the middle-income countries who also have a stake in these regions.
[JK:] I think the era of donor countries and recipient countries has kind of reached the end of its shelf life. Many countries want a technical partnership with the United States, especially middle-income countries, and the BRICS have led the way on this. We see this as a sweet spot for the Department of Health and Human Services. We have the kind of experts who can raise their game. They have their critical mass of important scientists, researchers, medical professionals, and service providers, but what they need is to be sure that they’re giving state-of-the-art care, are aware of the latest developments, and have exchange with their counterparts. I don’t think it’s an exaggeration to say that the U.S. is the first choice for medical and research exchanges and expertise in every country in the world.
[SH:] You mentioned the word “exchange”. It seems to me that you’re trying to create a scenario where people can exchange ideas and best practices. How do you all advance those kinds of programs at HHS?
[JK:] Well, the multilateral system is a good basis for that, because the World Health Organization, the Global Fund, UNAIDS, and all of the areas that we work in have technical partnerships, expert groups, advisory groups, and a normative function, which help us put best practices in place for our country, and for those countries that might not have very well-developed systems. We are also trying to work with embassies in Washington, many of whom have health attachés, to identify for them the people they need to go to when their experts are looking for partnerships with the United States. At the same time, we are working with our embassies overseas and foreign governments. We tell them, “Here are some things we know are a problem in this country, and we have some expertise that can help address that, but we want to work with your experts.” By giving their experts the kind of network that our own specialists would use for solving these problems in the United States, we think that everybody is better off. So there is a sense of learning, as well as reporting on health conditions, and we know how to identify the early warnings of public health problems. All of this is an exciting kind of 21st century expeditionary diplomacy.
[SH:] The First Lady has taken on the challenge of obesity in the United Sates, and if you look around the world, obesity seems to spare nobody. How serious of an issue is it, and what can we do?
[JK:] It’s a serious issue, and we’re pleased that HHS has been directly involved in implementing the ‘Let’s Move’ program of the First Lady. Cardiovascular conditions, cancer, and diabetes are correlated with obesity, tobacco, alcohol, poor diet, unhealthy lifestyle, and lack of exercise, and that’s increasingly true everywhere. On the U.S.-Mexico border, for instance, addressing obesity is key to dealing with the complex health problems and through our department, we have the U.S.-Mexico Border Health Commission, which looks specifically at problems of populations in underserved areas on both sides of the border. ‘Let’s Move’ has really struck a chord internationally as well as in this country.
[SH:] What is your interaction with the diplomatic community here in Washington, and to what degree do you interact with them?
[JK:] Coming from a diplomatic background, it’s one of the things I’ve urged in my two and a half years at the Department of Health and Human Services. I think we are underusing our access to diplomats in Washington. We have health attachés from a number of embassies who are in regular contact with our office, but not enough. I’m pleased to say that we’ve tried to reach out to embassies here in Washington. For instance, in advance of the AIDS conference two summers ago that was held in Washington, we did convene ambassadors and health ministers coming to this meeting. We had great feedback from that meeting, and we were looking for other, similar opportunities.
[SH:] I wonder how many health ministers talk to their foreign ministers and use the same globally-coordinated approach that we sometimes use in this country. I bet that’s not the case in most countries.
[JK:] State Department’s establishment of the Office of Global Health Diplomacy as a kind of counterpart office to ours has been a great advantage. We now systematically brief ambassadors in DC as they’re going out to post on U.S. health activity in the countries they’re going to be representing the U.S. We have lots of opportunities for that kind of coordination, but also, just bringing health into the diplomatic dialogue and the sense of where health fits in with other issues. I think over and over again, that’s where a diplomat can really make some valuable contribution.
[SH:] Speaking of skills and attributes, let’s talk about culture for a second, in terms of health. How has understanding culture been important for us as a country in terms of applying a local policy or practice in the health sector?
[JK:] I think there are two parts to that question. One is that the behavioral factors, the social milieu in which people are living are important factors that contribute to health or lack of health. These factors are unquestionably important, and we haven’t paid enough attention to them.
[SH:] You’re talking about more cultural behavior and cultural customs?
[JK:] Right. I mean, in the HIV/AIDS world, there was a practice of wife inheritance. So if a man died, his wife would marry his brother. When AIDS was the leading cause of death, this was the worst possible thing you could do from an epidemiological standpoint. So sometimes there are specific cultural practices that have a direct bearing on health. From that point of view, culture plays a role in individual patient survival and behavior. The challenges are: how do you understand the cultural context and behavior, how best to innovate, and how best to get this change adopted by the people who are actually going to have to live with it. Culture is intimately connected with social determinants of health.
[SH:] What is the global health issue or challenge that you don’t think is getting enough attention, or that we really need to pay more attention to?
[JK:] There are a lot of issues and challenges, and they’re in different stages. I think that it would be a shame to have an interview like this without mentioning polio, because we set a goal to eradicate polio by the year 2000 and didn’t meet it; it’s now down to just a couple hundred cases per year, but is spreading in some areas. Vaccination programs are crucial to getting across that goal line. And we are nearly there. We must not let this achievement get away again.
I think that we now realize how much lifestyle factors affect health, but attitudes and national policy aren’t yet clear. How can we, as a government and a society, encourage healthy behavior? The U.S. government clearly can’t make personal decisions to tell people what they can and can’t eat or drink. But we can create policies and programs that encourage people to adopt healthier behaviors. We need to put our best minds to work to make these choices obvious and attractive.
This article was originally published in the Diplomatic Courier's November/December 2014 print edition.
U.S. Mission Geneva photo by Eric Bridiers.
