Vital Signs

Article excerpt

Health issues have a roller-coaster ride on the international agenda. Rising alarm about rampant viruses or bio-terrorism is just as rapidly overtaken by more topical pressing concerns like climate change or financial meltdown. What are the obstacles to health assuming its rightful place in global policy?

iNTEGRATING HEALTH INTO FOREIGN POLICY IS A controversial and serious political issue of the highest order. In the United States, with a new president, the fight to shape the health-foreign policy relationship has been underway during the transition. One set of high profile recommendations from the Committee on the US Commitment to Global Health sought to influence how US foreign policy should advance health in years to come. The recommendations failed, however, to mention issues that had made health more important to US foreign policy over the past decade - the threats of bioterrorism and pandemic influenza.

Nor did they refer to theWorld Health Organization's (WHO) International Health Regulations 2005 - one of the most important recent developments in the health-foreign policy area. These Regulations established a radically new approach to dealing with international public health emergencies and strengthening global health securtiy.

Instead, the recommendations emphasised the United NationsMillennium Development Goals, attempted to raise the profile of non-communicable diseases in US foreign policy, and framed health primarily as a matter of humanitarian values rather than national self-interest.

The group that made the recommendations was attempting to shift the debate towards a different vision of health as foreign policy.Whether this succeeds remains to be seen, but the effort highlighted the contested nature of the topic.

Although health has long been a foreign policy issue, it had been largely neglected. Its emergence in the past ten to fifteen years forced officials to manage a transformed relationship in real time without any experience or tried-and-tested templates. As Chatham House has recognised with the launch of its Centre on Global Health and Foreign Policy, a more rigorous understanding of the health and foreign policy relationship is needed.


This requires an understanding of how foreign policy incorporates health. Analytically, foreign policy serves specific functions:

* Ensuring national security, for example through military power;

* Protecting national economic power and well being by opening foreign markets, for instance;

* Fostering the development of strategically important countries through development assistance; and

* Supporting human dignity using humanitarian aid and human rights.

Health has risen in foreign policy prominence because health problems, especially infectious disease threats, began to affect the functions of foreign policy:

* Security. Experts have identified bioterrorism and pandemic infectious diseases, such as bird flu, as threats to national and international security.

* Economic power. The costs of global diseases, including damage from responses to such threats, like restricting trade flows, have made countries more aware of these problems as a matter of their national interest.

* Development. The impact of epidemics and pandemics on development efforts has caused a re-examination of the relationship between health and development. Policymakers have begun to situate health closer to the center of development strategies, for example its importance in the Millennium Development Goals.

* Human dignity. Crises, especially HIV/AIDS, have produced new interest in the human rights aspects of health.


In addition to recognising how health became more important to foreign policy, we need to understand certain features of health as a foreign policy problem.

Arguments for more foreign policy attention for health often emphasise how interdependent countries are. …