The Health of Nations: Infectious Disease, Environmental Change, and Their Effects on National Security and Development (review)

In this book, Price-Smith advances the argument that the prevalence of infectious diseases has a direct impact on state capacity. As such new pathogens as HIV and Ebola emerge, and such old diseases as tuberculosis and Malaria reemerge in more virulent forms, outbreaks are likely to have a devastating impact on the capacity of states. Citing historians such as McNeill, Price-Smith argues that this relationship between health and state capacity has always existed, but he suggests that the current increasing rate of global environmental degradation will have a dramatically negative effect on the health of nations in the near future, speeding up and enhancing the nature of crises. ¹ As a result, he posits a declining ability on the part of states to address the different problems, resulting in growing global insecurity and conflict. He concludes with the policy recommendation that Western governments should devote more attention and resources to the fight against these scourges out of their national self-interest.

The book's great strength is the wealth of anecdotal evidence adduced on behalf of this thesis. In particular, several chapters paint a devastating portrait of the economic and social effects of diseases on low-income economies. Much of this material has already emerged in bits and pieces elsewhere, but Price-Smith's presentation has the merit of being both relatively comprehensive and highly accessible to the non-specialist.

The work is not as strong about causal mechanisms. Its main explanatory instrument is a series of dubious national bivariate regressions between problematical proxies for disease and state capacity. The author moves incautiously from correlation to causality on too many occasions, making grand claims about the impact of health on state capacity, as if many other causal mechanisms were not also at work. Finally, the link between health and national security is asserted rather than demonstrated in the book's final chapters. The thesis that the security interests of Western countries, such as the United States, should lead them to assist countries in African that are ravaged by HIV/AIDS is an immensely attractive one, since our hard-headed publics do not appear swayed by humanitarian reasons alone. It is unfortunate that this book fails to make the empirical case for such an interest.