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ABSTRACT
In recent years the framings of global health security have shifted while the structures governing global health have largely remained the same. One feature of the emerging re-ordering is the unresolved allocation of accountability between state and non-state actors. This brings to critical challenges to global health security to the fore. The first is that the consensus on the seeming shift from state to human security framing with regard to the global human right to health (security) risks losing its salience. Second, this conceptual challenge is mirrored on the operational level: if states and non-state actors do not assume responsibility for health security, who or what can guarantee health security? In order to address global health security against the backdrop of these twenty-first Century challenges, this article proceeds in three parts. First, it analyses the shortcomings of the current state-based World Health Organization (WHO) definition of health security. Second, taking into account the rising pressures posed to global health security and the inadequacy both of state-based and of ad hoc non-state responses, it proposes a new framing. Third, the article offers initial insights into the operational application of beyond state responses to (health) security challenges.
Acknowledgements
Special thanks to Sharifah Sekalala and the anonymous reviewers for comments on a previous draft of this article.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1 ‘The International Covenant on Economic, Social and Cultural Rights’ (ICESCR) Article 12 states that the right to health requires states to recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, meaning that states have the obligation to respect, protect, and fulfil the right to health’’ Recognition, however, it not the same as realisation.
2 ‘Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life’.
3 Pertaining to HIV/AIDS and peace-keeping in Africa.
4 Pertaining to the Ebola outbreak in West Africa.
5 Pertaining to starvation and the denial of humanitarian aid as a tactic of war.
6 As noted above, the right to health at the individual and health security at the population levels are not always treated as one and the same. This distinction is noted here, but is not analysed further.
7 See also UNSC 1308 (2000) on HIV and AIDS response, as well as UNSC 2177 (2014) on Ebola response.
8 The literature generally refers to global public goods as ‘goods that are non-excludable and non-rival in consumption.’ While this standard has been applied to health, as per the right to health (WHO, Citation1948), and even to security as in physical security (arguably also a part of the human security paradigm) it has not been developed and applied to health security as such.
9 As far away as Zimbabwe.
10 Discussions with Franklyn Lisk, other participants at the dissemination workshop, EL-CSID, 19–20 February, University of Warwick.
11 Kay Govender during the workshop ‘Strategizing Health and Human Security’, University of Potsdam, 3 April 2018. Convened by author.
12 Interviews with the German Chamber of Commerce and Industry revealed that ‘never again’ would private industry mount a health response such as that against HIV and AIDS, Johannesburg, April 2017.
13 Discussions with Kay Govender, Berlin, May 2018.
14 This is the case, for example, within the European Union: citizen nationals, and permanent residents, residing in one county but working in another are eligible to acquire an E106 form from the country where they work and pay taxes, and apply these payments to access healthcare in their country of residence. This assumes, however, that the paperwork is processed: this failed to be the case for the author.
15 The article will not do into detail on biological, chemical or nuclear threats to health security. While once seen as key risks to state security, their sub-state proliferation makes them potential social destabilizers and therefore a vulnerability and threat to population health security.
16 Interviews with Columbian diplomat, 2018.
17 See regional protocols.
18 Conversations with P. Khunwuthikorn, Thai diplomat specialising in health diplomacy.
19 China and Thailand are doing this, and reaping the benefits of healthier populations – including, in Thailand’s case, migrant populations. Discussions with Thai diplomat, 2018.
20 A range of the latest previously unknown pathogens to plague human health security, among them, HIV, Ebola, Zika, have all been of zoonotic origin.