Health, security and foreign policy

Over the past decade, health has become an increasingly important international issue and one which has engaged the attention of the foreign and security policy community. This article examines the emerging relationship between foreign and security policy, and global public health. It argues that the agenda has been dominated by two issues – the spread of selected infectious diseases (including HIV/AIDS) and bio-terror. It argues that this is a narrow framing of the agenda which could be broadened to include a wider range of issues. We offer two examples: health and internal instability, including the role of health in failing states and in post-conflict reconstruction; and illicit activities. We also argue that the relationship between global public health, and foreign and security policy has prioritised the concerns of the latter over the former – how selected health issues may create risks for (inter)national security or economic growth. Moreover the interests of the West are prominent on this agenda, focusing (largely though not exclusively) on how health risks in the developing world might impact upon the West. It is less concerned with the promotion of global public health. Health has risen markedly on the international agenda over the past decade. Key to this increased prominence have been two issues: the emergence and spread of infectious diseases such as HIV/AIDS, SARS and new drug-resistant strains of TB; and the risk from biological weapons, especially bio-terrorism.1 There is of course nothing new about health as an international issue: infectious diseases have never recognised state boundaries and systems of international cooperation attempting to * This article draws on discussions held at meetings in Australia, Canada, the UK and the US at which the authors were participant observers. These include a Conference on Health as a Foreign Policy Issue held at Ditchley Park, England in March 2002; Symposium on Global Health and Foreign Affairs held by The Nuffield Trust in London in March 2003; a Trilateral Meeting on Global Health and Security hosted by RAND in Washington in April 2003; UK-Australia Seminar on Health and Foreign Policy hosted by the Commonwealth Government of Australia in Canberra in September 2003; Workshop on Rapid Assessment of the Economic Impact of Public Health Emergencies of International Concern held at the University of Toronto in January 2004; and Meeting on HIV/AIDS and Other Infectious Diseases, Project on the G20 Architecture in 2020, Costa Rica, 12–13 November 2004. We are grateful to participants at these meetings although the authors remain wholly responsible for the material in this article. Research for this article was made possible from funding from The Nuffield Trust and The Nuffield Health and Social Services Fund. We would like to thank John Wyn Owen and Alan Ingram for their support and assistance in this work. 1 Arguably a third important area where public health has impacted upon the international agenda has been tobacco control, not least the successful conclusion of the Framework Convention on Tobacco Control (FCTC). Tobacco-related diseases remain the single greatest cause of preventable deaths in the world. Tobacco sales have earned the industry record profits since the 1990s as companies have shifted their attention to the developing world, facilitated by trade liberalisation. The World Health Organisation under Gro Harlem Brundtland campaigned for comprehensive tobacco control measures worldwide, supported by the FCTC. Although the WHO presents this as