Health as a Human Security Priority for the 21st Century
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.
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