Health and security in foreign policy.

Abstract

Introduction Historically, health has occupied the lower echelons of national priorities. Over the past decade, however, national policy-makers have increasingly recognized the deleterious impacts that health crises may have on national interests. As a result, particular health issues occasionally have been elevated within national agendas, especially if they have implications for foreign policy and/or they are perceived as threats to national security. Identifying a health issue as a foreign policy or security issue, or both, may lead to higher prioritization and more attention from top policy-makers, in turn, bringing greater political support and more funding. (1) While health professionals may welcome the higher profile and greater resources given to their issues, characterizing a health issue as a national priority (and particularly as a security issue) may change the understanding of a health threat, put relatively greater emphasis on the views of those outside the health community and potentially alter the approach to solving the problem. Consequently, care should be taken in deciding which health issues should be given priority on par with national security issues and included explicitly in national foreign policy. We support the assertion that [w]hile it is clear that health issues often intersect with security issues, not all health challenges represent security concerns. (2) Health issues that do not pose security threats should not be contextualized as such, since doing so may detract from overarching public health and foreign policy objectives. At the same time, however, we believe that efforts to address all types of health issues through foreign policy contribute to overall improvements in diplomatic relations, which may enhance the security of countries. Health in foreign policy Many health challenges, particularly infectious diseases, are widely recognized as global concerns that do not respect borders. As a result, countries often include in their foreign policies strategies on diseases that have the potential to threaten domestic interests. Public health challenges that are not concomitant security threats should be given consideration as foreign policy priorities on their own merits, without forcing them to be viewed through the prism of national security. One example of a health issue that is addressed through foreign policy but is not a security issue is poliomyelitis. The eradication of polio requires sustained financial commitments and coordinated international efforts. Such coordination has resulted from countries negotiating high-level political commitments under the auspices of the Group of Eight (G8) and other organizations that are not typically seen as health institutions. Despite polio's role as a major cause of disability (and consequent loss of productivity), donor commitment to the Polio Eradication Initiative is not rooted in a concern for its economic or security impact, but in the belief that eradication would be a major victory for public health and would achieve a global good. The impetus for the international effort against polio is not national security concerns but an altruistic desire to ameliorate human morbidity and mortality. Thus, it can be argued that polio eradication is a foreign policy issue for countries, but not a national security issue. Although characterizing a health issue as a foreign policy issue may provide greater visibility and greater funding, there is also a likelihood that programmes associated with such health priorities may be subject to enhanced political scrutiny. Additionally, identifying a particular health issue as a national (or international) priority inherently alters its importance relative to other public health issues. Since resources are generally limited and new funding is difficult to obtain, there is a great risk that the prioritized disease will draw resources away from other health programmes. …