Plagues of People

On Health Funding and Security

2008-03-13T19:18:00.005+10:00

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?

On PCR

2008-03-10T22:16:00.006+10:00

This makes me giggle; and all people of quality should giggle too:

On RIPE goodies

2008-03-09T20:52:00.005+10:00

Stefan Elbe, who has previously had some fascinating stuff to say regarding the intersection between global health and IR theory, has written a review article on three recent books detailing the emergence of three different diseases. Published in last month's Review of International Political Economy (or the oddly acronym'd RIPE), the article delves through the supposition that the emergence of new diseases is primarily a function of economic globalisation.

The books* focus on SARS, avian flu and AIDS respectively - but each adopts a perspective which is decidedly geared towards economic explanations for disease emergence, epidemiology and geographic distribution. Some of these explanations are obvious, like the expansion of global air travel being a deciding factor in the panic over SARS; while others seem to be drawing the bow a fair distance. One of these involves an almost No Logo-esque expose of evil multinational poultry organisations, used in an attempt to indict the whole global capitalist system. The prose used here is, in parts, ridiculously lurid:

...mutant influenza of nightmarish virulence – evolved and now entrenched in ecological niches created by global agrocapitalism – is searching for a new gene or two that will enable it travel at pandemic velocity through a densely urbanized and mostly poor humanity. (Davis, 2005:8)

All of this will no doubt be familiar to epidemiologists and public health practitioners for whom the "social determinants of disease" have been a research topic of high priority for a decade or more. Tony McMichael's academic work in this area immediately comes to mind, as does Paul Farmer's activism.

Of course, the recognition that health is largely based on social and economic factors engenders, dare I say it, a role for political observers and analysts. In a global system of states it isn't a simple matter of applying a technical solution to our biological problems - it requires some degree of cooperation between states. That kind of cooperation is difficult to obtain, and a number of strategies are being floated as the best way to get government's to cooperate together (mostly involving 'securitisation' of the problem).

Elbe suggests that these strategies are working and are leading to a new global 'noso-politics' (thank Michel Foucault for that brilliant piece of linguistic barbarism). Essentially, Elbe argues that the new International Health Regulations's and the concurrent strengthening of the WHO's role in global disease surveillance and response is indicative of a new consensus - one where government's are beginning to recognise the need to secure the health of everyone in order to secure the health of their own citizens.

Me, embittered cynic that I am...I'm not so sure.

* '"The books" being:

Thomas Abraham (2005) Twenty-First Century Plague: The Story of SARS, Baltimore: The Johns Hopkins University Press
Mike Davis (2005) The Monster at Our Door: The Global Threat of Avian Flu, New York and London: The New Press
Eileen Stillwaggon (2006) AIDS and the Ecology of Poverty, Oxford: Oxford University Press

On securitisation in non-democratic contexts - Part The First

2008-03-08T15:17:00.006+10:00

If, as a politician, you really want to get something done quickly you have three options:

throw money at the problem (if you have it),
convince others through reasoned argument and persuasive langauge (if you have the time), or
call it a security issue to shut everyone up and get a large slice of the treasury in the process

Traditionally, it was seen as poor form and 'just not English cricket' to push the security button unless the issue involved guns, bombs or communists. However, the popularity of option three is gaining in today's post-911 environment/age of terror/. African refugees and economic migrants have been caught in a tightening of 'Fortress Europe', and the ostensibly humanitarian US President's Emergency Plan for AIDS Relief (PEPFAR) was justified largely on security grounds (PDF Ahoy!).

The academic, and very ugly, term for the process of choosing and then enacting this final option is: 'securitisation'. Securitisation theory, a product of the Copenhagen School, delves into the way that issues become 'securitised' and has been a rich vein of research for many a tweed-bearer for almost a decade. The, largely European, contingent of scholars has focused primarily on the emergence of 'new' security threats: such as illegal immigration, terrorism and pandemic diseases.

The research has essentially focused upon the types of language (or as some have pointed out the types of multimedia) that governments, groups and individuals use to successfully make the argument that something they value (like their money, culture or health) is under threat from something else (be that Al Gore, migrants or iced VoVos). In order to be successful in this rhetorical game, you need; an ability to speak, to be listened to, and to have an audience which is receptive to your arguments. If you are successful in convincing your audience, then you will have put issue beyond 'normal' politics and into the rarefied expanse of security politics - where you will have carte blanche in your quest to neutralise the threat. In explaining, for example, the security rhetoric surrounding the responses to illegal immigration in the liberal, democratic and developed states of Europe - successful this have been.

However, because IR theorists are an especially pedantic bunch of individuals, there have been a number of critiques of this glittering example of a theory. One particularly salient point, especially when you travel outside the sandstone gates of European universities, is that securitisation theory only works to explain the security dynamics in democratic states (see the wonderfully named 'The Copenhagen School on Tour in Kyrgyzstan'). For despots options one and two look pretty attractive - if only because they already control the cash, and they can have dissenters sent away to rake sand rather than needing to persuade them. Why do you need to make something a security issue when you already have the power to deal with it directly? Why bother to try and convince people of something when you can just nail an official proclamation to the nearest counter-revolutionary and be done with it? In other words, why bother with option three when options one and two aren't a problem?

This is where Finnish political scientists and their illocutionary logic's come in. For those of you (which means me; since I'm the only one reading) who feel the urge for some speech act theorising - stay tuned! I'll be sharpening my dissection kit, and hopefully answering these rhetorically posed questions, in Part Le Deux.

On shiv-ing work

2008-03-07T20:11:00.004+10:00

Curiously, whenever I am at work (and I use this term advisedly), I have the strangest urge to read things I shouldn't. Not pornographic things. Nor musical things. Not even deliciously caustic things. Just things which can only be described as academic methadone.

Things like this

Or this (which I am foolishly going to discuss later)

But the question is: why?! This isn't part of what I'm paid to do, in fact it's a mile away from the dreary world of open plan desks (and the partitions which seperate them); and I wouldn't classify it as recreational reading because, in this respect, I adhere to the strict proposition that reading isn't recreational until you are either in a hammock or getting quietly drunk on a cheap cleanskin. Nonetheless, there is something strangely compulsive about the need to do a different kind of work at work. Whether that be catching up on primary results, getting into some legal theory or reading epidemiological reports from the World Health Organisation - there is a strong desire to sneak a few minutes of illicit knowledge-gathering on the boss's dime.

Potentially, this is a form of 'status anxiety' for the pretentiously academic - who are always fearful that there is some smug prick in an office nearby who is getting his learnin' on better than you are. Or worse, a PhD student somewhere who had the capacity to withstand poverty that you didn't have, and is now eagerly eating up some obscure Finnish political philosopher on their way to a Valhalla of tweed. Call it: "Keeping up with the Slavoj's".

Well, if I meet this nemesis - I'll be able to vanquish him with my new found knowledge of the 'illocutionary potential of the speech act' and will definitely impress with a CFR or two.* Until tomorrow - when it will be back to square one...

*For those of you looking to get a leg up in this game, pulling out an obscure acronym is like delivering an intellectual shuriken to the frontal lobe. Beware though, if your opponent is, or was at one time, a public servant, it is likely they will have mastered the art of acronym combat....in this case: flee the scene.

On starting shit....

2008-03-07T19:47:00.001+10:00

Well, a bold new experiment being thrust out into the ether here, no doubt to be consumed by the interwebs with the voracity it deserves. A raft of hope and optimism set adrift upon the stormy seas of criticism and overly purple prose.

....

Enough of that pablum. I intend this little slice of mass-produced 2.0 media to be a collection of my thoughts on security theory, disease and the murky linkage that exists between them. Plus a bit of my life, and my thoughts on this and that....bugger it, let's just call it an evolving mass of unfiltered crap till I get a handle on it. Pre-determined themes are for pansies....