On Health Funding and Security

While reading a blog post over at Aetiology today which discussed Laurie Garrett, I was struck by a seeming contradiction in the discourse of global public health.

The realignment of global public health towards 'targeted' aide programs which Garrett spoke about, and which Aetiology blogs about, isn't new. It's symptomatic of a shift in attention from the Western world - in part as a result of the awareness raising and work done by Garrett herself.

Basically, developed states have woken up to the fact that they are vulnerable to certain diseases, and that chronic pandemics, like HIV, threaten not just their citizen's health but also their national security. This is because instability caused by demographic shifts and economic decay in the heavily affected countries of sub-Saharan Africa is supposed to result in more regional conflict, state-failure and 'terrorist-breeding grounds' (tm) . Foreign-policy analysts - especially US ones - don't like uncertainty (it screws up there 'models'); so the .

Garrett has spoken about the threat to national security before (PDF Ahoy!) - and she does an excellent job of unpacking the various ways in which HIV threatens the stability of states, and the welfare of whole peoples (whether they be infected or not). That said, I'm not sure whether she has fully worked through the implications for global health governance that 'securitisation' brings.

Essentially, the 'health as national security' debate has distorted the funding allocations towards the WHO. While the renewed focus on health, brought about by its securitisation, has resulted in a lot of money being spent (see PEPFAR) the money no longer flows towards capacity building in the area of public health infrastructure. The large allocations of money by Western states have been for things like GOARN - which is targeted at disease outbreaks which threaten developed states - rather than broad based programs which target basic problems like maternal health infrastructure and sanitation. These basic problems contribute the largest slice of the burden of disease in the developing world.

Garrett (as reported over at SB) bemoans the new targeted funding models, and is clearly aware of the dangers of securitising health (as seen by her report above), but she hasn't seemed to have linked the two together. My feeling is that link should be explored explicitly: to what extent is the securitisation of health driving the reallocation of health aide towards 'key diseases' rather than to broad public health infrastructure? Should we even be talking about health in security terms?