A C-Change in Presidential Rhetoric: Compassion to Conscience and Common Interest

In his speech on Saturday in Accra, Ghana, President Barack Obama described the motivation for U.S. support to AIDS, malaria and other health programs in Africa:

America will support these efforts through a comprehensive, global health strategy, because in the 21st century, we are called to act by our conscience but also by our common interest, because when a child dies of a preventable disease in Accra, that diminishes us everywhere. And when disease goes unchecked in any corner of the world, we know that it can spread across oceans and continents.

Ghana was also the setting, in February 2008, for President Obama's predecessor to offer his Administration's motivation for large global health programs focused on Africa. In a pre-trip interview, then-President George Bush said his aim was to show that "the American people are a compassionate people, a decent people, who want to help moms with -- deal with malaria, and families deal with HIV/AIDS, and the need to feed the hungry.""Compassion" then. "Conscience and common interest" now.Just a switch in speechwriters, or a fundamentally different conception of why U.S. tax dollars should be used to support improvements in Africans' health?I'm no hermeneut, but I think the word choice represents a significant shift. Compassion connotes a relationship between individuals, where one is empathetic and voluntarily chooses to ease the suffering of another. Conscience implies a duty, based on knowledge of right and wrong. And common interest clearly balances the notion of a lifeboat, offered for reasons either of compassion or conscience, with an image of us all in the same boat.And yet another “c-word” has popped up in official statements about the orientation of U.S. global health programs: “comprehensive.” A fact sheet released by the State Department last week commits to a “comprehensive global health approach.” In it, the Administration strongly signals an intention to expand beyond HIV/AIDS to, greater attention to other causes of maternal and child death, reduction in unintended pregnancies and a focus on neglected (but not for long) tropical diseases.We will see whether this difference in the way the U.S. leader talks about global health translates into different actions -- or into a change in support for the President by others, including those who for nearly a decade have helped to define the not-entirely-comprehensive agenda of compassion.