Iran Chat: Interview with Dr. James Miller about Health Diplomacy

Our latest Iran Chat is with Dr. James Miller, Managing Director of the Oxford International Development Group, a health research and project management consulting company in Oxford, Mississippi.   Dr. Miller began working in the area of health diplomacy in 2004 while seeking ways to improve health outcomes and access to medical care for people in the impoverished rural Mississippi Delta region.  For this, he turned to Iran’s primary health care model, which is known for its system of health houses staffed by citizen health workers who provide health education and preventative health services to their local communities.  Recognized by the World Health Organization for its success in improving medical outcomes for rural communities in Iran,  Dr. James Miller began working with the architects of this system to develop and adapt the Iranian model in ways that could address the health disparity challenges in the impoverished Delta regions.    Our conversation with Dr. Miller involves an examination of this interesting project to bring Iran's health care model to the rural Mississippi Delta region; it also covers a range of related topical issues– including the ways that humanitarian programs can improve dialogue and understanding between the US and Iran, and a broader discussion of health care, which continues to be a hot button issue in the US.  

Some highlights from our conversation:

The Background of Iran’s Preventative Health Care System: 

“In 1978 all WHO members unanimously agreed in the Alma-Ata Declaration – a seminal document in public and global health initiatives that access to basic health services was a fundamental human right. The declaration also highlighted the importance of primary care and many countries, including Iran, revised their health care system around the primary health care focus… After Alma-Ata, key health care experts in Iran including the late Dr. Shadpour, who was one of the original architects of the primary health care model in Iran, determined the most effective way forward for Iran was through the implementation of a comprehensive and integrated primary health care system with the health house serving as the main service entry point, and the results speak for themselves…. The infant mortality rate in Iran fell over 70%, with similar results in maternal mortality. Health care access in rural areas compared to those in urban areas all but eliminated health disparities, and infectious diseases were all but eliminated in rural areas."

Why Mississippi Looked to Iran for Help:

"The rural counties in the Delta are some of the most impoverished in the US and the living conditions in those counties have health indicators and economic conditions similar to those in developing countries. It’s shocking.  Overall Mississippi is the poorest state in the US and today it has 22% of its population living below the poverty line. Subsets of that [are faring even worse]: the African American poverty rate is over 34%, Native Americans over 28% and Latinos at 27.5%.  Mississippi is also the unhealthiest state, and it ranks last in national surveys by respected foundations and institutions… [Furthermore] there has been no change, no discernible improvement with time. Health problems twenty years ago are still the same as we have now.  Of special concern… and this is what got us so interested in the Iranian model: infant mortality rates in a number of Delta counties are similar to that of Algeria, Libya, and Vietnam…" "[Therefore we looked to see if] there were some places around the world that might be similar in lack of resources, using a cost effective and adaptable model that we could deploy in those counties throughout the Delta region, and deal especially with the issue that there are few doctors available to serve this particular segment of the population.  The World Bank and World Health Organization, and in researching and reviewing the results, all pointed to the Iranian system as being most effective."

Health Diplomacy: Meetings Between American and Iranian Doctors

"Doctors see things [from a perspective of] science and empirical analysis.  They want to hear new things about treatments.  From what I observed, when Iranian and American doctors got together, it was like friends getting together for a great time, talking about their work and their families and personal issues.  You couldn’t tell them apart!   My observation was they can get along famously.  There is no problem between physicians and scientists:  science is nonpolitical no one country owns science or medicine… it belongs to us all and that is something in the upper most in physicians’ and scientists’ minds; it’s universal."

Making the Case to Politicians for Engagement:

"Back in December I started a letter writing campaign to my congressmen and senators to say, 'Here’s [my experience from my work engaging with Iran] and please take this into consideration when you’re viewing the Iranians and formulating Iranian policy.  If you cut this positive channel of communication off, then we (Americans) are the losers in this, and it’s going to just lead to more tension.'  In fact, this kind of public diplomacy is the kind of communication we need to be emphasizing… The State Department isn’t involved so much anymore in trying to build Iranian relations, so we the people have to do it, and we need to communicate it with our elected representatives." "Our representatives have to consider what we know, what we have seen, what we hope.  That’s the nature of a democracy and I’m trying to do my part, and I hope others who may listen to this podcast may be willing to do their part in helping us avoid conflict."