Health and security in foreign policy Rebecca Katz a & Daniel A Singer b

Introduction Health in foreign policy (or international) priority inherently alters its importance relative to other Historically, health has occupied the Many health challenges, particularly issues. Since resources are lower echelons of national priorities. infectious diseases, are widely recog- generally limited and new funding is Over the past decade, however, na- nized as global concerns that do not difficult to obtain, there is a great risk tional policy-makers have increasingly respect borders. As a result, countries that the prioritized disease will draw recognized the deleterious impacts that often include in their foreign policies resources away from other health pro- health crises may have on national inter- strategies on diseases that have the po- grammes. Indeed, some research suggests ests. As a result, particular health issues tential to threaten domestic interests. that the Polio Eradication Initiative has occasionally have been elevated within Public health challenges that are not provided secondary benefits to children’s national agendas, especially if they have concomitant security threats should be health, but competing studies suggest implications for foreign policy and/or given consideration as foreign policy the contrary.3 they are perceived as threats to national priorities on their own merits, without security. forcing them to be viewed through the Identifying a health issue as a for- prism of national security. Health as a national security eign policy or security issue, or both, One example of a health issue that is concern may lead to higher prioritization and addressed through foreign policy but is Promoting economic development and more attention from top policy-makers, not a security issue is poliomyelitis. The preventing political instability are core in turn, bringing greater political sup- eradication of polio requires sustained priorities for every government, and 1 port and more funding. While health financial commitments and coordinated are generally the primary motivations professionals may welcome the higher international efforts. Such coordination underlying national security policy. profile and greater resources given to has resulted from countries negotiating Research has demonstrated that acute their issues, characterizing a health issue high-level political commitments under and chronic changes in health status have as a national priority (and particularly as the auspices of the Group of Eight (G8) direct and indirect impacts on security, a security issue) may change the under- and other organizations that are not typi- and that epidemics may lead to destabi- standing of a health threat, put relatively cally seen as health institutions. Despite lization, political unrest, civil disorder greater emphasis on the views of those polio’s role as a major cause of disability or long-term deterioration of the eco- outside the health community and po- (and consequent loss of productivity), nomic viability of a country or region.4 tentially alter the approach to solving donor commitment to the Polio Eradi- Such health issues receive attention the problem. Consequently, care should cation Initiative is not rooted in a con- from senior policy-makers when they be taken in deciding which health issues cern for its economic or security impact, are possible threats to international, re- should be given priority on par with but in the belief that eradication would gional, national and individual security, national security issues and included be a major victory for public health and or potentially may affect the economic explicitly in national foreign policy. would achieve a global good. The im- welfare of a country or region. We support the assertion that petus for the international effort against The recent recognition that health “[w]hile it is clear that health issues polio is not national security concerns issues have implications for national often intersect with security issues, not but an altruistic desire to ameliorate security has resulted in part from health all health challenges represent security human morbidity and mortality. Thus, officials’ concerted efforts to educate concerns”.2 Health issues that do not it can be argued that polio eradication is policy-makers about the potential se- pose security threats should not be a foreign policy issue for countries, but curity impacts of certain disease-related contextualized as such, since doing so not a national security issue. events, whether naturally occurring may detract from overarching public Although characterizing a health is- (such as pandemic influenza) or in the health and foreign policy objectives. At sue as a foreign policy issue may provide form of intentionally released agents the same time, however, we believe that greater visibility and greater funding, (such as acts of biological warfare or efforts to address all types of health is- there is also a likelihood that pro- ).5,6 sues through foreign policy contribute grammes associated with such health In the of America, to overall improvements in diplomatic priorities may be subject to enhanced projections of the impact of human relations, which may enhance the secu- political scrutiny. Additionally, identify- immunodeficiency virus/acquired im- rity of countries. ing a particular health issue as a national munodeficiency syndrome (HIV/AIDS)

a Department of Health Policy, George Washington University, 2021 K Street, Suite 800, Washington, DC 20006, USA. Correspondence to Rebecca Katz (email: [email protected]). b Avian Influenza Action Group, US Department of State, Washington, DC, USA. Ref. No. 06-036889 (Submitted: 25 September 2006 – Final revised version received: 30 November 2006 – Accepted: 4 December 2006)

Bulletin of the World Health Organization | March 2007, 85 (3) 233 Special theme — Health and foreign policy Health and security in foreign policy Rebecca Katz & Daniel A. Singer on the workforces of many countries aspects of an issue outweigh its eco- programmes to security programmes and data on the seroprevalence of HIV nomic and security considerations, such may undermine this opportunity for among military personnel in several as with polio, policy-makers and health bridge building, to the detriment of global regions contributed to the deter- professionals must resist the temptation both foreign policy and public health mination that HIV/AIDS is a security to depict it as a security or economic concerns. issue.7 This led to that country’s creation threat, despite the increased political vis- of the President’s Emergency Plan for ibility and availability of resources that Public health diplomacy AIDS Relief, as well as motivating its this might offer. Characterizing a health support for global AIDS programmes. issue as a security threat often results in and security Likewise, the recognition of epidemio- it being addressed through programmes Cooperation and assistance targeted at logical similarities between H5N1 influ- and policies developed for law enforce- public health challenges that are put enza and the 1918 influenza pandemic, ment rather than public health. The in the context of foreign policy may combined with the economic impact of result may be that a disproportionate broaden partnerships and build diplo- the relatively small outbreak of severe emphasis is placed on assigning respon- matic relationships. In this way, the act acute respiratory syndrome (SARS) and sibility and levying sanctions to control of promoting global health enhances the the potential impact of H5N1 influenza the threat, as opposed to more tradi- security of countries. When countries on economic and national security, led tional health models that identify and work together to successfully address a to increased interest among WHO and ameliorate risk factors and behaviours global health challenge, be it a localized its Member States in preparing for the that contribute to the threat. epidemic or a potential threat to inter- next pandemic. Additionally, characterizing a health national security, the world becomes a Identifying a health issue as a secu- issue as a security concern may assign a healthier and safer place. Maximizing rity issue, as happened with HIV/AIDS stigma to any assistance that is provided. the opportunity for such partnerships and pandemic influenza, may bring Since good health is a common value requires paying close attention to the more funding, political prominence and shared among all people, international nature of public health threats and care- attention from senior policy-makers. health programmes are naturally suited fully considering whether or not they are This leads to more political support, to being used as tools of diplomacy truly security threats. O increases in resources and higher priori- among countries that do not have a tization. However, when the public health broad common agenda. Pegging health Competing interests: None declared.

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