Security and Global Health
Elbe, Stefan
Polity Press, Cambridge
2010
9780745643748 (pb)
The book engages with one of the most polemical debates of the recent times on intertwining of global health governance with political security of nation states. This issue has become pertinent in the post 2001 World Trade Organisation bombing wherein international aid regimes are shifting their focus to countries which pose greater threat to the 'developed world' politically. The author engages with the debate 'medicalisation of security' versus 'securitisation of health'. The author utilises the notion of Foucauldian governmentality to explicate the contemporary debates on security theoretically to the debates on medicalisation of health. That is, health services are structured beyond the 'doctor and patient' relationship and are related to a broad set of knowledge practices which shapes health care as a powerful social institution to control and govern human behaviour.
Historically, the increasing intertwining of health and security is related to the biological warfare unleashed by the Greeks and Roman on their enemies by placing dead animals into reservoirs of drinking water. The contemporary threat comes from the non-state actors especially terrorist groups who can potent damage to nation states through biological warfare. Health governance globally has already entered its 'post-securitisation' phase, implying that public health can be improved by framing and approaching problems through security-related tactics and strategies (p. 41). Health threats are included in the human security framework as it poses a visible threat to human well-being and can cause pre mature death. HIV/AIDS was the first infectious disease to be singled out in the twenty-first century as representing more than just an important international public health or development problem. It was viewed as a threat to national security through the weakening of the military, and in the worst-case scenarios might even cause some states to collapse. It also marked the advent corporate style governance of public health problems through 'risks management' practices and professionals. Organisations such as the Global Fund work largely on the basis of 'performance based funding'. The author concludes that the presence of international agencies has improved the outreach of antiretroviral medicines to many low and middle income countries. However, interventions take a little note of underlying risk factors which underpin the epidemic HIV. Within developed nations 'health security' is related to various non-communicable 'life style' afflictions such as smoking, obesity and alcoholism which are now ubiquitously described in the policy settings and the public media as an overarching 'social crisis' and an impending 'time bomb'.
The debates presented in the book are pertinent as borders are not only defined physically but rather geopolitically and economically this is a result of globalisation, internet revolution and growing affluence of the several developing economies. Health risks are increasing conceptualised in terms of security as borders are increasingly being diluted due to 'migration' across inter and intra national borders. Therefore, growing concerns of spread of diseases is not only 'local' but easily assume global proportions.
Keerty Nakray
Queens University Belfast
