Health as a Human Security Priority for the 21st Century

Introduction

In this paper, I would like to consider equitable global health and development as

a human security challenge for the 21st century. The presentation is based on

the deliberations, findings, and recommendations of the Commission on Human

Security -- of which I was a member. The Commission, co-chaired by Sadako

Ogata and Amartya Sen, issued its final report Human Security Now in mid-

2003.i Through research conducted in support of the Commission’s report, we

were able to publish two edited volumes and an entire issue of a journal on

frontier challenges in human security.ii Of these research publications, the

volume most germane to this paper is entitled: Global Health Challenges for

Human Security.iii

Perhaps the most important breakthrough of the Commission’s work was to

adopt a comprehensive approach. Thus, threats to human security were

broadened beyond those traditionally considered in the realm of military security

or nation state security. The definition adopted by the Commission included any

threat that challenged the security of an individual or people or population.

So too did the Commission extend the range of actor groups responsible for

human security. Rather than simply rely on the nation state, human security calls

upon action by all sectors of society – government, business, and civil society.

While all sectors are called upon to join in generating human security, it is

recognized that the obligation to provide security among individual actors varies.

The obligations are imperfect, not absolute.

Security-Health Linkages

Health and human security are tightly linked. Good health is “instrinsic” to human

security, since human survival and good health are at the core of “security.”

Health is also “instrumental” to human security because good health enables the

full range of human functioning. Health permits human choice, freedom, and

development.

But health and human security are not entirely synonymous! While closely

related, these twin concepts are not identical. Figure 1 shows our hypothesized

linkages among health and human security. Human security is the “vital core” of

human security which may be defined as consisting of human survival,

livelihoods, and dignity. Poor health – illness, injury, disability, and death – are

critical threats to human security. And of many health problems, those

considered most germane to human security are health crisis during conflict and

humanitarian emergencies, infectious diseases, and the health problems of

poverty and inequity.

Throughout the past century, specific health achievements have been

knowledge-based and socially-driven. Knowledge not only enables us to develop

new technologies like drugs and vaccines but also basic education enables

people to shape their behavior for producing their own health. In adopting a

human security approach to health, the Commission advocated for access to

information and knowledge, especially steering intellectual property regimes to

be consistent with human security objectives. Social organizations drive the

implementation of knowledge in health care systems through preventive,

promotive, and curative actions. The Commission, therefore, recommended that

public health systems should be established to prevent and treat priority diseases

that are commonly shared. Communities everywhere, irrespective of economic

status, should have access to primary health care. And a global system for

health security should be steadily constructed to advance the health of all.

Ultimately, global health is indivisible and interdependent.

Commission Deliberations

In making these health and human security recommendations, the Commission

deliberated on many issues and controversies. Amongst them were the breadth

of the conceptual definition of health and human security, the politics of

“securitization” of health in security priorities, and alternative areas of

concentration that may be relevant to this Track’s recommendations in health

and human security.

Track Recommendations?

In considering this Track’s recommendations on health and human security,

which health problems should be prioritized, which down-graded? Not all health

problems carry the same political acceptability or salience. I believe there are

three tiers of health problems that face increasing difficulty in political

acceptance. The first are health process so tightly linked to military security that

they are easily accepted by the security community; the second are health

processes that are being increasingly accepted; and the third are the most

difficult, yet most important, health conditions deserving of human security

prioritization. Let me address these in this paper’s closing.

As poor people get sick and die in great numbers, should the tragedies be

considered humanitarian, developmental, or security? Many view this suffering

and death as a humanitarian or even a moral failure, but not a security threat.

Others view these health burdens as a development failure. But, they are also

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huge human security failures. It makes very little difference to a mother if she

loses her child to an infection that was preventable versus a stray bullet during

conflict. Why then do we classify one type of loss as security-linked and the

other as not so?

There is growing evidence of the interdependence among different insecurities.

We know that an ill child suffering from health insecurities also learns poorly and

thus is deprived of the security of knowledge. Just as war may set back

socioeconomic development, so too poverty may heighten political differences

and tensions. While not a direct cause of violence, poverty can provide a fertile

breeding ground for sympathizers and foot soldiers. In the end, poverty and its

attendant insecurities in health, education, livelihood, and the full dimensions of

deprivation is the greatest human security threat. Equitable health and

development, therefore, should constitute a central goal of human security.