ABSTRACT
Certain transmissible pathogens have become increasingly securitized in the contemporary global context. Within a single decade, there have been two UN Security Council special sessions devoted to the threat of AIDS; and the global response to Severe Acute Respiratory Syndrome (SARS) and H5N1 (avian influenza) were effective and well-coordinated operations executed with military precision and urgency – and accompanied by a military discourse: the language within which particular viruses have been couched has become increasingly militarized, with ‘enemies’ to be ‘combated’ and ‘wars’ to be won. For instance, instead of ‘medical interventions to counter the HI virus’, it is common to refer to the ‘war on AIDS’ – or cancer or drugs. In the short term, this response has been effective: both SARS and H5N1 have (for now) been contained. But within this political and discursive trajectory, there is evidence of tension between
health as a human security issue, linked to a broader developmental and human rights agenda, and health as a national security issue manifested in the form of a few diseases that seem to directly threaten the industrialized world. This tension has implications for the policy responses that governments implement; for instance, a ‘national security’ response would enable much more invasive prescriptions such as shutting down airports, detaining the carriers of certain viruses and even waiving some international legislation in the name of the national interest. A developmental response to health issues implies less invasive, more human rights-centred approaches and policy prescriptions. Just over 30 years ago, member states of the World Health Organization (WHO)
adopted the Alma Ata Declaration, ‘Health for All by the Year 2000’, which called for ‘the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life’ through the implementation of a broad primary healthcare vision. The neoliberal economic and political restructuring of states through World Bank and IMF conditionalities was introduced soon after, beginning in the 1980s and, with the introduction of Structural Adjustment Programs (SAPs), vertical interventions focused on single diseases became more fashionable, while the understanding of public health became increasingly disengaged from health’s social determinants. This transformation has occurred within the context of a mostly discreet, yet influential battle between individual state sovereignty and its
concomitant prescriptions on how to respond to new epidemics on the one hand, and the multilateralization and globalization of diseases on the other. One of the ways in which this tension has manifested itself has been through appeals to the dangers that certain diseases imply for state survival, or an agenda that appeals more directly to a softer human-security approach that underlines the nefarious implications both of the erosion of the social determinants of health and of epidemic disease for individual human rights related to health. But there is also evidence of the convergence of these discourses of hard and soft security. In Alan Ingram’s words (2007: 514), ‘continuing domestic and international campaigns on development and health have offered an opportunity … to show a human face as well as an iron fist in … foreign policy’. This chapter examines how the relationship between global health and security has been
historically constructed, and looks at the effects of the securitization of certain diseases on the global architecture of health governance. The first section is a brief overview of the state of global health. The second section places ‘health security’ within the broader security polemic that has evolved over the past few decades, presenting an account of the contemporary evolution of the ‘mainstream’ securitization of emerging pandemics, drawing on the specific cases of avian influenza, SARS and AIDS. The third section focuses on the role of the UN over the years as a securitizing actor, the G8 countries and the US in particular. Finally, the consequences of the contemporary securitization of disease and emergent policy responses for global public health and the challenges shaping the future of global health in the contemporary global context are sketched.
