Foreign Policy and Health Security
Safeguarding the health of the public is usually a domestic concern. However, with the onset of globalization, public health is increasingly recognized as important for foreign policy and, conversely, foreign policy is seen as an important mechanism for protecting public health. Governments at all income levels are increasingly prepared to cooperate to prevent the emergence and spread of infectious disease and provide public health security, defined as the provision and maintenance of measures aimed at preserving and protecting the health of the population. (Public health security is also defined as the policy areas in which national security and public health concerns overlap). There is an inevitable linkage between public health security and bioterrorism, but foreign policy is also concerned with broader dimensions of cross-border health risks including, for example, the transmission of anti-microbial resistant organisms, as well as health risks associated with noncommunicable diseases, environmental degradation and conflict.
Foreign policy structures usually include or relate closely to overseas aid-giving mechanisms, and a number of health issues inform foreign policy, including:
- Protecting citizens' health at home and abroad.
- Furthering humanitarian efforts through development cooperation.
- Capturing the diplomatic benefits: because health is a common concern, action to tackle health risks can ease tensions and support cooperation between countries.
- Capturing economic benefits - because improvements in global health levels affect potential markets and contribute to global prosperity, which benefits the “home” nation.
- Enhancing security - because slow economic growth and poor health are seen as contributors to conflict and international terrorism.
- Treaties and international agreements with health at their centre.
At times, concern about outbreaks of disease may be sufficiently strong to allow national antagonisms to be set aside in the interests of disease control. During the outbreak of Marburg haemorrhagic fever in 1998, for example, an international investigative team was permitted to enter a contested part of the Democratic Republic of the Congo. Similarly, an international guinea-worm eradication team sponsored by the Carter Centre received safe passage in southern Sudan in 1995, owing to a specially negotiated ceasefire between the government of Sudan and rebel forces. Efforts to eradicate polio have involved “days of tranquillity”: temporary ceasefires to allow immunization teams to reach children in conflict areas. As a result of these efforts, 8.7 million children in the Democratic Republic of the Congo, 4.4 million in Afghanistan, and 3 million in Angola were immunized in 1999.
The concept of human security (the right and ability of individuals, communities and societies to have the security of a livelihood free from “fear and want”) has also become increasingly important in foreign policy. This expanded definition of “security” includes military threats, but also threats to the environment, to health and to economic stability. The spread of infectious disease can be considered a security threat, along with the drugs trade, the increasing availability of small arms and other manifestations of globalization. This broader definition focuses on threats to individuals rather than to the state and sees protecting the safety and well-being of citizens as a central security concern for governments. Ideas about human security are changing to further incorporate health. The entry points identified including communicable diseases, violence and poverty.
An example of how the expanded definitions are gaining acceptance is that, in 2000, the UN Security Council adopted its first resolution on health, asking countries to wage a “peaceful war” against HIV/AIDS. The disease is seen as a destabilizing factor, because it damages economic, social, political, military and educational infrastructures, and contributes to increased conflict within and between countries and societies.
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