The Role of Health in a Security-Obsessed World

Global Health Challenges for Human Security, edited by Lincoln Chen, Jennifer Leaning, and Vasant Narasimhan. (Boston: Harvard University Press, 2003). 338 pages. $29.95.

While globalization has driven economic prosperity in many countries over the last few decades, it has also created multiple new security vulnerabilities, including a substantial threat to global health. The relationship between health and security is explored in detail in Global Health Challenges for Human Security, an edited volume of fifteen essays commissioned by Harvard University's Global Equity Initiative. The essays highlight the security implications of recent health threats, including bio-terrorism, emerging infectious diseases like SARS, and the regional devastation caused by HIV/AIDS in sub-Saharan Africa.

While they may appear to be unlikely bedfellows, the union between health and security is not without historical precedent. A quick review of the history of global health policy reveals that international health concerns arose primarily from security interests. As Simon Szreter points out in his essay on the history of health and human security, the birth of the entire field of tropical medicine was spearheaded by nineteenth century military physicians concerned with the protection of imperialist troops against foreign diseases.¹ Universal health care came as an afterthought, when a few enlightened specialists realized that the health of the world's elite depended on the health of its poor and disenfranchised. These observations are even more relevant in today's global landscape, where economic stability is based on the global exchange of goods, services, technologies and human beings. In a world where nearly 2 million people daily fly internationally, local health problems can rapidly escalate into global ones, as the recent SARS outbreak in China demonstrated.²

Health threats defy the political boundaries that have historically defined national security pursuits. In order to adequately address the increasingly complex security challenges presented by health risks, security must acquire a broader meaning beyond the defense of national borders. To this end, the concept of "human security" was first advanced in the 1990s as an alternative to the narrowly defined, traditional notion of national security. Human security is rooted in the idea that the insecurities experienced by all people, including the world's marginalized poor, are universally threatening in an increasingly interconnected world.

The first five essays in this volume address the theoretical basis of this notion of human security and its contemporary applications. These are followed by a series of essays analyzing health threats, violence and poverty and their links to human security. Lincoln Chen's opening analysis expertly lays out the advantages of a human security approach. Chen also acknowledges the concept's weaknesses, conceding that human security is often too broad to inspire concrete action. Indeed, the definition put forth by the United Nations Commission on Human Security lacks conceptual clarity:

The objective of human security is to safeguard the vital core of human lives from critical pervasive threats while promoting long-term human flourishing.³

Not surprisingly, skeptics point out that policymakers are unlikely to respond to such ambiguous thinking.

Lately, however, decision makers have started paying attention to the more specific ways in which global health trends impact both national and human security interests. The use of anthrax after the events of September 11, 2001, quickly heightened the profile of bio-terrorism and infectious disease threats in the security community. These threats are detailed in the second cluster of essays in this volume, entitled "Global Epidemics." In an essay that delves headlong into the microbial world, David L. Heymann, Executive Director of the World Health Organization's Communicable Diseases Program, warns that new, highly lethal infectious diseases like Ebola and Hantavirus are emerging at a startling rate of one per year.⁴ Multiplying, mutating, and increasingly drug-resistant microbes are driving these emerging threats, notes Heymann. And yet, the diseases that still kill the most people worldwide are not new to humans. Despite enormous technological advances made over...