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Perspectives in Biology and Medicine 47.1 (2004) 140-145



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The Health of Nations: Infectious Disease, Environmental Change, and Their Effects on National Security and Development. Andrew T. Price-Smith. Cambridge: MIT Press, 2002. Pp. 232. $22.95.
Plagues and Politics: Infectious Disease and International Policy. Edited by Andrew T. Price-Smith. Global Issues Series. New York: Palgrave, 2001. Pp. 272. $68.

Over the last decade there has been a profound change in perceptions of the dynamic relationship between humans and disease organisms. Prior to the 1990s, many assumed that technological innovations and economic growth in the global South would eradicate most infectious diseases. More recently, however, a dramatic increase in emerging and reemerging infectious diseases (ERIDs) has led to a reassessment of the microbial threat. The threat received official recognition in April 2000, when the U.S. government officially declared HIV/AIDS a security threat, an event that followed efforts by the State and Defense Departments and the National Intelligence Council to highlight the threat of disease to American security interests. This declaration coincided with an increased journalistic and academic focus on the dangers posed by disease to sociopolitical and economic performance. The product of these efforts include books such as The Coming Plague (Garrett 1994), The Politics of Emerging and Resurgent Infectious Diseases (Whitman 2000), and Diseases of Globalization: [End Page 140] Socioeconomic Transitions and Health (McMurray and Smith 2001). Two additions to this growing literature, Andrew Price-Smith's The Health of Nations (2002) and Plagues and Politics: Infectious Disease and International Policy (2001), move the disease issue closer to the more traditional concerns of international relations scholars.

The Health of Nations is an innovative and ambitious project that examines the relationship between infectious disease and state capacity, or the ability of government to "maximize its prosperity and stability, to exert de facto and de jure control over its territory, to protect its population, and to respond to diverse crises" (24). State capacity is often viewed as an elusive concept, and Price-Smith seeks to make its analysis more concrete through the use of quantifiable indicators: per capita GNP and per capita government expenditures, among others. To explore the relationship between infectious disease and state capacity, he uses quantitative analysis as well as process-tracing techniques to analyze the ways in which ERIDs compromise economic development and national security.

The book begins with an overview of the tremendous burden generated by infectious diseases, particularly in the less industrialized world. In Sub-Saharan Africa, for example, HIV/AIDS claimed 2 million lives in 1998, compared to 200,000 lost to war; infection levels throughout the region are extremely high, ranging from 30 to 40% of the population, with some towns as high as 70% (2-4). Given the tremendous burden posed by infectious disease, Price-Smith seeks to assess its consequences for state capacity. Based upon quantitative analysis of the relationship between proxy indicators for ERIDs (infant mortality and life expectancy at birth) and indicators of state capacity (including per capita GNP, government expenditures, and secondary-school enrollment), Price-Smith concludes that "disease-induced mortality has a significant and strong long-term effect on state capacity" (75).

Having established a general relationship between infectious disease and state capacity, Price-Smith then turns to "process-tracing" the mechanisms by which disease may compromise state capacity. Through analyses of microeconomic, sectoral, and macroeconomic consequences of disease (with almost exclusive attention paid to the HIV/AIDS pandemic), he points to the deleterious effects that such epidemics have on a range of indicators of economic performance: household savings and consumption patterns, decreased productivity, contractions in the labor supply, widening economic disparities, and reduced attractiveness to foreign investors, among others. As economic capacity diminishes and human capital decreases, states have less capacity to respond to disease and to deal with instability. Price-Smith is quick to point out, however, that disease is but one variable that acts in concert with...

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