OK, you try to figure out a single Discussion Table for this post.

We have discussion threads dealing with various things including short- and long-term changes in the size of the military, counterterrorism, and universal health care. We have not tended to have threads that unify, compare, and contrast these and other related issues. Let this be a starting point for examining the grand strategy of the nation in providing military and nonmilitary means to implement policy.

This post sprang from a response to tlees regarding the wisdom of a military of a given size, and the potential both for deterrence and misadventure. The exchange reminded me that individual policies often get discussed in too narrow a context.

While most of us can cite Clausewitz's definition of war as the continuation of national politics (the original word; I think policy is more accurate) through military means, reasonable planners consider direct, overt military action only one part of the continuation of national policy. Grand strategy is a more useful concept that certainly includes military action, but also includes the coordinated extension of national policy through means including diplomacy, information operations (official statements, psychological warfare, and [sometimes appropriate] secrecy), economic measures, clandestine and covert operations, law enforcement, foreign aid and training, and other measures. I shall return to the role of the military as part of grand strategy.

A nonconventional perspective from epidemiology

Some of my professional work deals with the medical discipline of epidemiology, which is broader than many nonspecialists realize. While infectious disease epidemiology is indeed one of my specific interests, infectious disease is only a subset of public health epidemiology. The broader discipline deals with all causes of mortality (death) and morbidity (nonfatal disease and injury) in the population.

In epidemiology, "eradication" has a specialized meaning: the complete disappearance of a source of mortality or morbidity. The great example of eradication is the disappearance of smallpox in the wild, an effort that took several centuries and, above all, depended on the availability of a vaccine -- and increasingly aggressive vaccination and quarantine programs.

Eradication is rarely practical. Realistic goals tend to be reducing the incidence (first occurrence) and mitigating the virulence (actually specific to infectious disease, but a good general term for severity of a case after incidence) of things that impair health. Given that cardiovascular disease, motor vehicle accidents, diabetes, and even suicide create considerably more mortality and morbidity than terrorism, justifying every expenditure with respect to its relevance to the Global War on Terror makes nice sound bites but not necessarily rational policy.

In developed countries, a reasonable goal may be to convert a virulent disease that quickly kills or disables to something manageable on a long-term basis. While we haven't eradicated HIV and there's no indication that we can even eradicate all infection in a single person, the median survival after HIV seroconversion, when last I looked, is 24 years. Especially in postmenopausal women, the strides in breast cancer treatment are such that for many patients, they can be told confidently they will likely die of another disease; "cure" is no longer an irrelevant term.

To share some personal anecdotes, my father was a cardiac cripple by his late thirties and was dead at 42. I also had early heart disease, but aggressive intervention, at the first diagnosis of hypertension, prevented more serious symptoms for around a decade. When I first had angina, again, early and aggressive treatment limited damage and had a net positive economic return. Eventually, I needed bypass surgery, which was not free of complications -- but again was done before major damage was irreversible. Subsequently, I managed to get into long-term, research-level cardiac care, and much of my cardiac function, over about ten years, changed from almost-limiting to near-athletic.

One of the features of my heart disease is a somewhat atypical presentation of what is called sick sinus syndrome. Cutting to the chase, my heart stopped for increasing periods of time, only during sleep. Implanting a pacemaker prevents any danger, as long as the battery life (typically 8-10 years). At such time as the battery runs out, either I need a replacement, or can reasonably expect to go to sleep one night and never awaken. Just from a personal standpoint, that puts access to healthcare at a very much higher priority than protection against missiles from rogue states that don't have any that can hit the US. On a more macro level, when Homeland Security budgets put terror, with bluntly limited potential damage, on a higher priority than response capabilities for major natural disasters and industrial accidents, there is a disconnect between expenditures and expected return on expenditures.

Grand strategy and deterrrence

Earlier, I brought up military capability as one part of grand strategy. Let's examine not just the questionable "surge" for Iraq, something that simply may not be possible given the time needed to generate new troops, and the role of the US military in national strategy. It may be that we need reallocation of some military budgets, possibly selective increases in force size, but always with a long-term view.

The first requirement for a military is deterrence, and then assisting the grand strategy of the nation in providing military and nonmilitary means to implement policy. Carefully constructed military training and assistance, with due regard for human rights, can be a short-of-war alternative to developing real bonds with foreign decisionmakers. The ability to reach leaders can sometimes avoid escalation. Some seem to think of deterrence as a Cold War concept, but it goes back at least to Sun Tzu, circa 400 BC:

Sun Tzu said: In the practical art of war, the best thing of all is to take the enemy's country whole and intact; to shatter and destroy it is not so good. So, too, it is better to recapture an army entire than to destroy it, to capture a regiment, a detachment or a company entire than to destroy them.

2. Hence to fight and conquer in all your battles is not supreme excellence; supreme excellence consists in breaking the enemy's resistance without fighting.

3. Thus the highest form of generalship is to balk the enemy's plans; the next best is to prevent the junction of the enemy's forces; the next in order is to attack the enemy's army in the field; and the worst policy of all is to besiege walled cities.

There is a legitimate concern that a large military, including a peacetime draft, can encourage adventurism, but I also recognize strategic concepts after Sun Tzu, again well back in history, such as Mahan's 1890-ish writings on the deterrent effect of a potent "fleet in being".

Finding a Balance

Let me broaden the scope of national security, defense, homeland security, or whatever it may be called. Just as grand strategy goes beyond military means alone, a coherent national defense strategy considers deliberate attack, but also the effects of accidents and natural disasters. It is impossible to provide sure protection against all threats deliberate or not, so there must be prioritization.

National missile defense ("star wars", NBMD) is a quite different problem than theater BMD. While the more recent TBMD systems both have passed fairly stringent operational tests, and can stabilize hot spots such as North Korean threats to Japan, NBMD is of questionable reliability and is positioned against a relatively low-priority threat from China and North Korea. At the present time, the longest-ranged North Korean missile, if it didn't blow up shortly after launch, doesn't have the range even to come into radar view of the NBMD facilities.

In contrast, there are very real vulnerabilities in critical national infrastructure, where changes in regulation and other market factors really do not provide the funding for the private sector to harden facilities. My greatest concern is the chemical industry, especially chemicals in transit. Terrorists didn't need to import chemical weapons to produce the Bhopal disaster; there are many such potential incidents, of varying risk, in the US. There's much ballyhooing of terrorist attacks on nuclear power plants, but, with some specific knowledge of both nuclear and chemical facilities, the chemical is a much, much more vulnerable target. Yes, it may cost more to reroute chemical tank cars such that they don't go through center cities.

While I haven't looked at the tracks in a year or so, there is a overpass in Washington DC, a few blocks from the Mall, and near major office buildings and transportation facilities, that was not even protected by a chain-link fence. Trains go by carrying several standard tank cars of gas, one of the least toxic of which is chlorine. Chlorine tank cars carry 55 or 90 tons; the first WWI attack at Ypres used 160 tons on a 8000-meter front. While chain-link fence is easy enough to penetrate, it can be alarmed, and, more importantly, such fence will also predetonate many handheld antitank rockets.

Another infrastructure system very vulnerable to disruption from sabotage, accident, or natural disaster is electrical power. We've already seen regional problems such as the Ohio Valley in 2003, which was caused by a combination of weather, old technology, and the unfortunately coincidental occurrence of the SLAMMER computer worm. There are reasonable estimates that hardening the national electrical grid would cost about the same as NBMD. Which is the real, as opposed to the dramatic, priority?

Now, let's return to universal health care. If you go to the open literature on the threat of covert bioterrorism, it is quite likely that the best early warning may come from privacy-protected data mining of (hopefully universal) electronic health records. Without a universal healthcare system, the records won't exist. Once such systems do exist, it is quite likely that they will lower the actual cost of healthcare (including error reduction), so, after a very real issue of initial cost, they are actually financially wise.

Going back to terrorism, I do not see it as ever being eradicated. Terrorism is a tactic available to groups of all radical ideologies, and it is too useful to them to disappear. Approaching terrorism from a public health standpoint, there is an acceptance that it will never disappear, but that its incidence can be reduced both by addressing the causes of radicalism as well as preventive measures, and limiting the impact of outbreaks by protecting infrastructure whose protection suffers from the attention given to things where politicians can be seen to be Doing Something (TM).

Simply on a basis of prioritization, there are real vulnerabilities here today, and not limited to deliberate terrorist action. Even looking pessimistically at Iranian and North Korean intention, they are years away from a capability against the United States that exceeds the weighted risk -- probability of event times the damage caused if it does -- than are many other threats, admittedly less dramatic ones. If anyone wants to argue an immediate threat from Iran, I should be delighted to do so with anyone that will include hard, cold engineering factors into a discussion that deals with the union of warheads, delivery system range, and delivery system accuracy.

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Howard

*equal opportunity offense to both extremes*

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Howard

*equal opportunity offense to both extremes*