Global Health Security

by

Sara E. Davies, Jessica Kirk

• LAST REVIEWED: 25 August 2021
• LAST MODIFIED: 25 August 2021
• DOI: 10.1093/obo/9780199756797-0204

Introduction

Global (public) health security is defined by the World Health Organization as the activities required, both proactive and reactive, to minimize the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries. This definition is normative in that it tells us how global health security ought to be done. It does not explain how “activities” should be enacted, or what should be done to “minimize” the danger and impact of public health events across geographical regions and international boundaries. The literature below is a sample of the rich research that has tried to grapple with the how and what questions of global health security. This entry includes research from a range of disciplines, including public health, political science, law, economics, sociology, anthropology, and philosophy. It is just a small sample but there are thematic continuities across the literature that led to the selection of the sections identified below. A large part of the literature providing General Overviews, in the 1990s and 2000s, examined the evolution of the definition of “global health security” as an extension of, or distinct from, national health security. The marriage of global health and security became the subject of much debate. In particular, what events constitute Securitization, which is the second theme of literature examined below? The evolution of Biosecurity literature emerged at the same time. Securitization literature is quite different from biosecurity literature in that biosecurity literature does not engage, for the most part, with discussions about the protection of peoples (as defined under global health security). This literature has been concerned primarily with the protection of states. The consequence of two health security literatures running at different tracks of inquiry is different approaches, interests, and prioritization of global health security. This has led to the proliferation of Multidisciplinary usage of the term “global health security” from a range of theoretical and methodological perspectives. However, gaps remain practice and research. A consistently neglected area of global health security is Inequalities. Who are the “peoples” in global health security practice and research? Finally, this entry examines the events where global health security is (or is not) “applied” to health threats, which is examined in the Outbreaks section.

General Overviews

The literature has revolved largely (but not exclusively) around questions of what global health security means and does. Davies 2010 outlines this as a debate between “statist” and “globalist” perspectives, where a state-centric and disease-focused approach clashes with one more concerned with the health challenges faced by individuals. Price-Smith 2002 captures the “statist” approach neatly, offering a comprehensive argument for why states must consider health as a component of their security. Fidler 1999 focuses on the specific issue of infectious disease, suggesting that they pose such a significant threat to states that international cooperation (“microbialpolitik”) through law is vital. From a more critical perspective, King 2002 traces the evolution of this worldview and its links to colonial-era ideologies of medicine and health. Conversely, Gostin 2014 and Thomas 1989 offer powerful articulations of the globalist perspective, focusing on the inequalities global health exposes and the need for a stronger consideration of human rights and justice. While these pieces offer strong arguments toward their preferred definitions, recent contributions have questioned how global health security is actually employed in practice. Rushton 2011 disputes that there is a serious debate, suggesting that the statist approach is dominant in academic and policy definitions of “global health security.” McInnes and Roemer-Mahler 2017 returns to this question to suggest that the limitations of this approach in properly capturing the threat of disease have sparked moves away from security toward risk. Nunes 2014 also acknowledges the dominance of this national security–oriented understanding of health security, but refuses that this must remain the case. Offering an alternative understanding based on security as emancipation, Nunes argues that health security could be an incisive tool to reveal the insecurities faced by individuals. The health insecurity of individuals is often rendered invisible in comparison to state-based security considerations. Harman 2016 argues that global health governance benefits from the free labor of women in formal and informal care roles and yet renders them invisible in policy and practice.

• Davies, Sara E. 2010. Global politics of health. Cambridge, MA: Polity Press.

  A clear and accessible overview of global health politics, covering a wide range of issues from international political economy to global governance. The book exposes a central tension between “globalist” and “statist” perspectives, which correspond to questions of whose security and from what.

• Fidler, David P. 1999. International law and infectious disease. Oxford: Clarendon Press.

  An examination of the threat of infectious disease from the perspective of international law. Fidler offers the term “microbialpolitik” to capture this political perspective and examines what has been and could be done in the area of law and governance to protect states.

• Gostin, Lawrence O. 2014. Global health law. Cambridge, MA: Harvard Univ. Press.

  DOI: 10.4159/9780674369870

  By a scholar of international law and global health governance, Gostin’s book provides a rich overview of the inequalities and injustices within global health politics, as well as a call to arms to address them.

• Harman, Sophie. 2016. Ebola, gender and conspicuously invisible women in global health governance. Third World Quarterly 37.3: 524–541.

  DOI: 10.1080/01436597.2015.1108827

  This article was one of the first global health security pieces that examined the conspicuous invisibility of women and girls during the Ebola outbreak in West Africa in 2014–2015. The article is a manifesto for policy and scholarship communities to see the gendered effects of health emergencies.

• King, Nicholas B. 2002. Security, disease, commerce: Ideologies of post-colonial global health. Social Studies of Science 32.5–6: 763–789.

  DOI: 10.1177/030631270203200507

  AN examination of the rise of the “emerging disease worldview” that underpins global health security, this article compares this “post-colonial” approach to colonial-era ideologies of medicine and public health, finding crucial similarities and differences.

• McInnes, Colin, and Anne Roemer-Mahler. 2017. From security to risk: Reframing global health threats. International Affairs 93.6: 1313–1337.

  DOI: 10.1093/ia/iix187

  A recent article on the meaning and logic of “global health security,” one that proposes that a change is occurring from understanding health threats as “security” toward “risk.” As the authors argue, this has effects on governance, response, and state-level politics.

• Nunes, Joao. 2014. Questioning health security: Insecurity and domination in world politics. Review of International Studies 40.5: 939–960.

  DOI: 10.1017/S0260210514000357

  A critical piece that evaluates the concept of health security and the literature surrounding it. Refuting the idea that health security must be synonymous with national security, it proposes an alternative conceptualization based on the idea of emancipation.

• Price-Smith, Andrew. 2002. The health of nations: Infectious disease, environmental change, and their effects on national security and development. Cambridge, MA: MIT Press.

  One of the most concise and comprehensive examinations of health as a national security concern, detailing how infectious disease (and environmental change) pose threats to state stability, population health, and economic growth.

• Rushton, Simon. 2011. Global health security: Security for whom? Security from what? Political Studies 59.4: 779–796.

  DOI: 10.1111/j.1467-9248.2011.00919.x

  Addressing claims that multiple understandings of “global health security” exist, this article proposes that the academic and policy literature is actually relatively unified, with the dominant formulation being concerned with a narrow range of health issues (infectious disease, HIV/AIDS, and bioterrorism) and their potential threat to the West.

• Thomas, Caroline. 1989. On the health of international relations and the international relations of health. Review of International Studies 15.3: 273–280.

  DOI: 10.1017/S0260210500112884

  A seminal article on the need for international relations (IR) scholarship to consider the politics of global health. For Thomas, IR can provide much to the study of global health, through questions of justice, equity, and order, but health can also push IR toward a more holistic analysis of the world.