“Health is Global” the United Kingdom’s (UK) Global Health strategy was launched in September 2008 because, in today’s globalised and inter-dependant world, health has become a global issue.1 A recently launched outcomes framework focuses on three areas: global health security; international development; and trade for better health.2 Global health security centres on the belief that “while a healthy population is fundamental to prosperity, security and stability … poor health does more than damage the economic and political viability of any one country – it is a threat to the economic and political interests of all countries.”1
Evidence of the possible benefits
Following the tragic events of 11 September 2001, one of the main global health security concerns is terrorism3 as it is thought that threats of terrorism are “rooted in instability, poverty and inequalities, including health inequality.”4 Communicable disease is another major global health security concern as emerging infections like SARS and swine flu clearly demonstrated that disease in one country is a threat to others. Moreover, established pandemics like HIV/AIDS are decimating countries’ economically active population, affecting all public services and the governance capacity of the country. Lack of basic services could foster instability, poverty and inequalities creating an environment in which terrorism, illegal activities and conflict can flourish resulting in failed states.
Historical analyses have provided some evidence in support of this theory with state failures being associated, among other things, with economic failure and high infant mortality rates.5 Therefore supporting LMICs to develop their economies and improve the health status of their populations could reduce the risk of states failing and the attendant concerns about them being breeding grounds for terrorism and infectious disease.
Evidence of the possible risks
The risks with the global health security agenda are that global health comes to be seen solely in security terms, is used to pursue donors’ own narrow political and security objectives and issues that represent clearer security threats to the UK are wrongly prioritised above other issues. An Oxfam briefing paper stated that “some donors’ military and security interests have skewed global aid spending; and … have too often led to uncoordinated, unsustainable, expensive and even dangerous aid projects. Skewed aid policies and practices threaten to undermine a decade of government donors’ international commitments to effective, needs-focussed international aid.”6
Furthermore, framing the debate in terms of security opens up the possibility of a greater role for the military.6 In Iraq and Afghanistan, occupying forces are involved with rebuilding and providing health services as part of peacekeeping efforts. This can confuse local populations and may lead to an erosion of the key concept of impartiality if assistance is conditional on cooperation or is used to buy information.
For some the framing of the need to support LMICs solely in terms of the benefit to the UK is an anathema. They feel that that the gross inequalities existing in health in the world today are unjust and that we are morally obliged to act to address this; no further rationale is needed.
Implications for health and wellbeing
This summary has set out some of the theory as to why a security approach to health may or may not be a good idea. However, in terms of empirical evidence as to the effectiveness of this policy this is currently minimal with little prospect of changing given the high level nature of interventions and the difficulties associated with relating these to specific health or development outcomes.
Author: Jennifer Hall, Public Health Speciality Registrar
UK area affected: UK-wide
Global Health Security Initiative http://www.ghsi.ca/english/index.asp
Chatham House Centre on Global Health Security http://www.chathamhouse.org.uk/research/global_health/
Collier, P (2008) The Bottom Billion: Why the poorest countries are failing and what can be done about it. Oxford University Press
Sachs, J (2005) The End of Poverty: How we can make it happen in our lifetime. Penguin Group.
1. HM Government. Health is Global: UK Global Health Strategy 2008-2013. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_088702 Last accessed 9th April 2011
2. HM Government. Health is Global – an outcomes framework for global health 2011-15. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_125605 Last accessed 9th April 2011
3. Global Health Security Initiative – background. Available at http://www.ghsi.ca/english/background.asp Last accessed 9th April 2011
4. HM Government. Health Is Global: Proposals for a UK Government-wide Strategy. A report from the UK’s Chief Medical Adviser Sir Liam Donaldson. Available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_072696.pdf Last accessed 9th April 2011
5. State Failure Task Force Report: Phase III Findings. Available at http://globalpolicy.gmu.edu/pitf/SFTF%20Phase%20III%20Report%20Final.pdf Last accessed 9th April 2011
6. Oxfam. Briefing Paper 135 “Whose Aid is it Anyway? Politicising aid in conflicts and crises. Available at http://www.oxfam.org/sites/www.oxfam.org/files/bp145-whose-aid-anyway-100211-en_0.pdf Last accessed 9th April 2011