The Concept of Global Health - Essay Example

Is the concept of ‘global health’ useful as a way of conceptualizing contemporary health issues in world politics? By Date Table of Contents Introduction 3 The Concept of Global Health and Contemporary Health Issues 4 Contemporary Health Issues 4 Global Health 6 Theories of International Relations and Applicability to Global Health 7 Orthodox International Relations Theory and the Concept of Global Health 8 Social Constructivism Theory of International Relations and the Concept of Global Health 11 The Concept of Global Health in Conceptualizing Contemporary Health Issues from the Perspective of Social Constructivism 14 Conclusion 17 Bibliography 19 Introduction Global health is conceptualized broadly to include, social, physical and mental ‘well-being’ among populations within the collective global community (Fidler, 2010, p. 3). Although national health institutions and policies usually deal with health issues, globalization has rendered national policies wholly inadequate as health issues in one state can filter over into another state through the movement of goods, people and animals across borders (Fidler, 1997). Thus diseases such as AIDS, SARS, Ebola, H1N1, hantavirus, avian flu as well as health threats posed by anthrax, environmental damages, crime, human trafficking and terrorism, all come to mind when the term global health is used (Yoube, 2005). Governments and inter-governmental organizations have implemented global health policies and statements indicating that global health has emerged as an important foreign policy issue especially in relation to both national and international security (Labonte and Gagnon, 2010). It would therefore appear that the concept of global health is a useful way of conceptualizing contemporary health issues in world politics. However, Ruger (2008) argues that states have viewed contemporary global health issues as a threat to national security only insofar as it relates to the threat of biochemical weapons. Thus global health initiatives can be ramed in terms of orthodox international relations theory (Ruger, 2008). In this regard, global health is irrelevant as state rivalries take center stage. On the other hand, McInnes and Lee (2013) argue that applying a social constructivist analysis, the concept of global health is useful for conceptualizing contemporary health issues as these issues intricately tie the state to the market and forms an important part of the international political economy. It has also been argued that social constructivism more adequately reflects how states and international organizations view global health. From this perspective global health issues are viewed as intricately tied to other state interests that go beyond the potential of biochemical weapons (Forman, Cole, Ooms, and Zwarenstein, 2012). This research study analyses both sides of the argument. In particular this research study analyses whether or not the international relations theory of realism or social constructivism more adequately explain the concept of global health and as such whether or not these concepts of global health are useful for conceptualizing contemporary health issues. This paper is therefore divided into three main parts. The first part of this paper explores the concept of global health and the conceptualization of contemporary health issues. The second part of this paper discusses and analyses orthodox and constructivist theories of international relations. The final part of this paper discusses how the concept of global health is useful for conceptualizing contemporary health issues from the perspective of the social constructivism theory of international relations. The Concept of Global Health and Contemporary Health Issues Contemporary Health Issues Health may be effected by national health policies in that the welfare state provides free access to health services and in non-welfare states, health is not provided freely and the health risks are therefore greater where larger populations in non-welfare states are low income. Regardless, contemporary health issues affect all populations and this is so regardless of whether health issues are contagious or non-contagious. In this regard, non-contagious health issues are capable of effecting whole populations anywhere. For example, the problem of sedentary lifestyles in contemporary living has created a growing global population with health risks associated with obesity. The problem of obesity is also related to an increase in processed foods with high fat, sugar and salt contents. Transportation technologies, an increase in office jobs and information technologies have all contributed to sedentary lifestyles that have contributed significantly to obesity (Smith, El-Anis, & Farrands, 2011). In the meantime, the problem of infant mortality has also led to concerted efforts to reduce infant mortality. This has led to longer life with the result that the incidents of poor health increases (Smith, et al., 2011). In other words larger populations, particularly of the old are especially vulnerable to contagious diseases. Alongside traditional diseases such as flus, a number of new contagious diseases have been introduced into society. These diseases include AIDS, SARS, H1N1, and many more that have the potential to reach epidemic proportions (Wilson and Mabhala, 2009). These contagious diseases are no longer thought of in terms of localized health issues. Globalization together with advances in modern technologies have increased travel and thus contagious diseases are now more mobile than ever before. Thus states are now forced to consider health policies on the basis of both national and international risks. For instance, in 2009 Tunisia placed travel constraints on citizens travelling to Saudi Arabia’s holy city for fear that the H1N1 virus would be contracted there and spread in Tunisia (Smith, et al., 2011). The World Health Organization (WHO) compiles statistics on contemporary health issues with global dimensions. The health issues include traditional illnesses such as tuberculosis, cholera, malaria, HIV/AIDS, child health, environmental health, road safety, maternal and reproductive health and health funding. WHO’s statistics also include non-traditional health risks which are especially contemporary and include substance abuse, domestic violence, urban health and tobacco control (World Health Organization, 2014). Contemporary health issues now include an expanded list of communicable and non-communicable diseases and illnesses. Although communicable health risks may be specific to one state, increased mobility indicate that national policies are no longer focused entirely on the prevention and treatment at the national level, but also on international dimensions of particular health issues. The focus on international dimensions of health issues is not confined to communicable diseases. The international dimensions of non-communicable health risks are just as important. For example, if substance abuse is problematic in state A, citizens travelling to state A from state B are also at risk of abusing substances while in state A. Global Health Global health is conceptualized as not merely the threat of contagious disease or ‘disease-causing agents’, but also the ‘conditions that contribute to poor health outcomes’ or more specifically, the ‘social determinants of health’ (Fidler, 2013, p. 692). The concept of global health is captured by an increase in international and national ‘political processes that shape’ a state’s ‘foreign policies’ reflecting more profound ‘concerns about a larger range of intensifying health issues’ (Fidler, 2013, p. 692). States have been compelled to confront health threats to national security, economic growth, development and human rights. States have negotiated agreements and agendas for governing health issues globally during the 21st century (Fidler, 2013). Globalization and its corresponding market economy has eliminated single markets under national government control. Problems, including health problems are no longer singularly applicable to one state and neither are solutions to these problems. Thus states are compelled to ‘adopt legislative and administrative solutions inspired by criteria and interests’ that are not specific to its own territory (Attina, 2003, p. 4). In regulating health, the environment, the economy and so on, international organizations establish rules, intergovernmental organizations establish agreements and conduct international conferences and the laws of some states are standardized by other states as a means of formulating national laws and policies (Attina, 2003). In other words, health, as well as other factors that link countries have become enshrined in international norms, indicating that global health is conceptualized as a problem effecting all states and requiring state cooperation for solutions. The concept of global health has been shaped by a comprehensive and unprecedented ‘change in political and institutional responses’ with a focus on crises such as AIDS, malaria and tuberculosis (Forman, et al., 2012, p. 2). States, non-state actors, and intergovernmental organizations such as WHO and the EU have established funding programmes designed to bring health services to low income countries effected by diseases. It is popularly believed that low income and social disparities present primary vulnerabilities for health risks (Forman, et al., 2012). Social disparities are indicated by WHO’s (2014) compilation of statistics on health issues impacting women, especially in low income countries. Global health is therefore conceptualized as a physical and mental health issues that transcend borders either directly or indirectly. These trans-border risks force governments to rethink foreign policies with a view to addressing health issues in terms of prevention and for establishing goals for improving equitable access to health care for everyone globally. Theories of International Relations and Applicability to Global Health According to Klienman (2010), the concept of global health is more of a problem as opposed to a ‘discipline’ (p. 1518). As a result, global health is bereft of theoretical analysis and thus has not developed into an ‘intellectually robust field’ (Klienman, 2010, p. 1518). However, trends indicating the linkage between contemporary health issues and foreign policy have made it possible to analyse the concept of global health by reference to international relation theory (Feldbaum, Lee, and MiChaud, 2010). This is because there is significant evidence of developmental assistance with respect to contemporary health issues in recent decades. For instance, development assistance relative to health has increased from $5.6 billion in 1990 to $21.8 billion in 2007. This development assistance is channeled through 40 bilateral systems, 26 agencies associated with the US, 20 regional and global organizations, and 90 individual state systems (Feldbaum, et al., 2010). It is therefore possible to apply international relations theory to the concept of global health and seek explanations for why states and international organizations include contemporary health issues in foreign policies and whether or not the concept of global health is useful for conceptualizing contemporary health issues. Orthodox International Relations Theory and the Concept of Global Health Orthodox international relations theory is caught between a debate between liberals and realists. Although divided on key issues in regards to what drives state behaivour in global politics, liberalists and realists share some concepts (Thomas and Wilkins, 2004). Regardless, the debate between liberalists and realists is referred to as the ‘neo neo’ debate (Thomas and Wilkins, 2004, p. 247). Both agree that international relations and politics are centred on inter-state relations in an anarchic system. In this anarchic system with no centralized governance, states are forced to stockpile power as a means of achieving security. For realists in the neo neo debate, power is multifaceted, but is primarily achieved through military prowess and can be obtained via ‘alliances’ or through a ‘state’s own military forces’ (Thomas and Wilkins, 2004, p. 247). Thus, in the realist concept of international relations, states are perpetually engaged in power struggles which may not be ‘permanently transformed through co-operation’ (Thomas and Wilkins, 2004, p. 247). Although liberalists typically agree with realist assumptions of anarchy and state power struggles, liberalists assume that states are compelled to compete with one another and other actors such as economic and international organizations. As a result, the international ordering has emerged as a more complicated system rendering military power more controversial. Rather states are compelled to purse security via cooperation with other states (Thomas and Wilkins, 2004). Ruger (2008) argues that historically, global health has been conceptualized through foreign policies in ways that are consistent with orthodox international relations theory. In particular states have demonstrated that health issues are significant for promoting and protecting ‘self-interests’ (Ruger, 2008, p. 429). Thus orthodox international relations theory takes a Westphalian view of world politics and this was observed in China’s response to the SARS epidemic which originated in China (Ricci, 2009). China sought to deny its existence in China and refused to cooperate with WHO leading the global challenge against the spread of SARS (Ricci, 2009). Thus, China certainly pursued self-interest in relation to the contemporary health issue of SARS. Since realism argues that state self-interest is focused on national security and survival, China’s behaviour in relation to the concept of global health can be understood by reference to the international relations theory of realism. Realism assumes that states behave a specific way as a means to protect national security and to survive in relation to other states that are seen as threats to survival and security (Fidler and Costin, 2008). It can therefore be argued, that as an emerging economy and a rising world power, China viewed the SARS epidemic as a means of lowering international perspectives of China’s rise to power. Thus its failure to cooperate with the international community in containing the SARS epidemic can be seen as a means of survival and protecting national security. China’s power is obtained through international perspectives of China. However, since, realism argues that power is primarily obtained through material acclaims, particularly military materialism, the theory of realism is not an appropriate tool for analyzing whether or not the concept of global health is useful for conceptualizing contemporary health issues. Neoliberal institutionalism differs from realism in that the latter assumes that states act and focus on ‘relative gains’ while neoliberal institutionalism assumes that states are focused on ‘absolute gains’ (Powell, 1991, p. 1303). According to neoliberalism, a state chooses to cooperate with other states for self-interest and it does not matter if other states gain or lose. All that matters is that the state gains (Powell, 1991). In other words, neoliberalists argue that states cooperate with other states purely for self-gain. Thus according to Ricci (2009), neoliberalists would accept the need for cooperation and coordination with respect to a contemporary health issue through an international institution such as WHO. According to neoliberal institutionalism, cooperation between states in global health crises is necessary because failure to cooperate could lead to significant losses. International institutions such as WHO are more qualified for monitoring and identifying threats to human health (Ricci, 2009). Neoliberal institutionalism, like neorealism is inadequate for articulating whether or not the concept of global health is useful for conceptualizing contemporary health issues in world politics. As Chekel (1998) notes, neoliberalism and neorealism are not concerned with the ‘content and sources of state interest and social fabric of world politics’ (p. 324). In this regard, both neoliberalism and neorealism assume that states cooperate with other states in contemporary health issues as a means of obtaining or maintaining material power. However, states actually cooperate with one another in relation to contemporary health issues in ways that reflect ‘shared interests and values’ (Ricci, 2009, p. 11). Since the concept of global health is manifested by cooperation between states, often mediated by international institutions such as WHO, regional organizations such as the EU and so on, it is obvious that states are focused on pooling resources to realize shared values and interests in dealing with contemporary health issues. Neoliberalism and neorealism, assumes otherwise. In particular, neoliberalism and neorealism argue that states cooperate with other states and international organizations and institutions in pursuit of material gains and are concerned with self-interests. Therefore, like neorealism, neoliberalism is not conducive to analyzing the concept of global health as a term of reference useful for conceptualizing contemporary health issues in world politics. Social Constructivism Theory of International Relations and the Concept of Global Health The United Nations Development Programme (1994) redefines the concept of human security in a way that highlights the concept of global health which in terms points to its utility in conceptualizing contemporary health issues in world politics. According to the United Nations Development Programme (1994) there are seven critical issues underlying human security in contemporary world affairs: personal, economic, environmental, community, food security and health. Within the international ordering of politics and cooperation between states, the state’s interest no longer sits at the centre. Therefore, in determining whether or not the concept of global health is useful for conceptualizing contemporary health issues in world politics, it is necessary to look beyond traditional/orthodox theories of international relations, as these theories are more useful for understanding traditional concepts of security. Constructivism offers a more realistic approach to the new and expanded concept of human security which also includes the concept of global health. Constructivism is derived from several schools, but have a number of common themes (Tsai, 2009). One of the main common assumptions is the social side of international relations. In this regard, Wendt (1995) the international community and inter-state relations are socially constructed. In this regard, the social aspects of international relations and inter-state relations are characterized by material factors, practices and shared knowledge (Wendt, 1995). Constructivists also assumes that norms, culture, learning and customs are likely to alter conduct and interests (Wendt, 1992). Constructivists also argue that inter-state relations create and cultivate identity and interest. Identity typically provides the baseline for interests (Mercer, 1995). Moreover, actors within the international arena and international politics operated interactively and interdependently (Tsai, 2009). It is through this interaction and interdependence that ideas, identity, values and norms are created and redefined (Finnemore, 1996). In essence, constructivism emphasizes non-material interest of states, but does not ignore material interests. At its core, states form identities, ideas and behaviour based on interactions between states. According to Wendt (1992) states form perceptions of itself and of others based on how they perceive states with whom they interact. In addition, states form ideas, values and engage in activities on the basis of how they are perceived and/or want to be perceived by other states (1992). In other words, states are not always competitive and seeking to obtain power over other states. For example, the US feels threatened by North Korea’s possession of nuclear weapons but is not bothered by Israel’s possession of nuclear weapons. As Wendt (1992) argues: States act differently toward enemies than they do towards friends because enemies are threatening and friends are not (p. 397). Therefore, while power within the international community might be relevant to a state’s behaviour, how it directs state behavior: …depends on the inter-subejective understandings and expectations, on the distribution of knowledge’ that constitute their conceptions of self and other (Wendt, 1992, p. 397). In much the same way, identities are acquired. States formulate their own expectations of themselves and operate within a framework in which they are aware of what is expected of them. In this regard, a state may be identified as a ‘sovereign’ or as ‘leader of the free world’ or as an ‘imperial power’ (Wendt, 1992, p. 398). In other words, relations between states are socially constructed and states will either want to maintain or achieve specific identities or may wish to alter their identities. Therefore, power struggles and material resources are not the only factors driving state behaviour and relationships. State identities forms the basis of interests. In promoting or abandoning an identity states will decide how to respond to a problem or how to engage with other states (Wendt, 1992). Institutions however represent collective interests and knowledge and provide a forum through which ‘actors’ socialize (Wendt, 1992, p. 398). Institutions therefore go beyond the ‘individual actors’ that participate in institutions and function on the basis of shared knowledge and interest (Wendt, 1992, p. 398). While there are competitive, self-help institutions, there are also ‘cooperative’ institutions in which ‘states identify positively with one another so that the security of each is perceives as the responsibility of all’ (Wendt, 1992, 399). Social constructivism is therefore more consistent with the concept of global health and its utility for conceptualizing health issues in world politics. States have consistently supported and relied on regional and intergovernmental institutions for identifying and monitoring contemporary health issues. There is a general impression that cooperation between states through international and regional institutions for funding health and dealing with health policies as a global problem indicates that the security of the states involved is regarded as the responsibility of all states that are including global health issues in foreign policies. The Concept of Global Health in Conceptualizing Contemporary Health Issues from the Perspective of Social Constructivism A review of orthodox and social constructivism theories of international relations reveals that constructivism is distinguished in two main ways: concepts of power and interests. From the constructivists’ perception, shared ideas form the basis of interests and ideas do not always originate from the most economically and militarily power countries. Ideas can be generated during negotiations between states with diverse economic and military power. Ideas forms the basis of partnerships and provides a forum where ideas and knowledge are shared (Adler, 1997). The constructivist concept of shared ideas and inter-subjectivity as the basis of international relations or interactions between states and the formation of identities are consistent with the concept of global health. States either cooperate directly through bilateralism or multilateralism through intergovernmental or international institutions for monitoring and strategizing how to deal with contemporary health issues. Shared ideas are not only important to constructivists, but are also important to the concept of global health. As Adler (1997) stated, constructivism assumes that ‘an evolutionary approach requires that new or changed ideas be communicated and diffused’ (p. 339). Applied to global health, it is important that ideas are shared for identifying, containing and preventing the spread of disease or for providing aid to countries where health risks are especially high. Perhaps more importantly, in order for ideas to be shared, cooperation is necessary. Institutions such as WHO or the EU provide networks for states to share ideas, although not always directly with one another. Institutions also provide a forum through which knowledge is shared and therefore forms the basis for creating and sharing ideas, norms and values. States learn what other states are doing in response to contemporary health issues. In addition, states learn why and how these responses are working or not working and therefore knowledge and ideas are exchanged and norms and policies are harmonized with a view to ensuring that a unified concept of global health is formed and implemented. By taking this approach it becomes clear that states take the position that health and safety in one state impacts health and safety elsewhere, and thus health and safety is the collective responsibility of the international community. This too is consistent with social constructivism which views security in terms of the social construction of state interactions with one another. Social constructivism permits a view of security that is more consistent with the threat to security posed by health risks within the global health paradigm. As revealed in this study, security is no longer conceptualized as external military threats from other state actors. Security has become more personalized and now includes many factors that relate to human beings in general and directs attention to citizens (United Nations Development Programme, 1994). As Davies (2010) argues, this new concept of security has broadened and deepened ‘international relations and engagements’ directing attention to a new understanding of ‘what security is, what peace looks like and how conceptions of order, power, identity and interests are constructed and changed’ (p. 13). According to Davies (2010), even some liberals will agree that safe-guarding the ‘well-being of citizens is the key indicator of successful governments’ (Davies, 2010, p. 13). In this regard, applying social constructivist theory of international relation, the concept of global health is entirely useful for conceptualizing contemporary health issues in world politics. States want to cooperate with other states, share ideas and knowledge on pertinent health issues for the purpose of protecting their populations. This is necessary for projecting the image of a ‘successful government’. It is also necessary for national security reasons when one considers that the new and expanded definition of security includes human health. The idea that states are compelled to cooperate with other states in dealing with contemporary health issues for the purpose of projecting the image of a successful government is not always true. For example China chose not to cooperate when SARS emerged as a disease that originated in China. Arguably, China chose not to cooperate with WHO for precisely the same reason that states are expected to cooperate. China too wanted to project the image of a successful government that was capable of safeguarding the well-being of its population. However, China might be seen as the exception to the rule and not the rule itself. China is an emerging economy with an unprecedented rise to economic and military power. Thus, according to social constructivism theory, China had an image or self-perception and a specific image that it wanted the remainder of the international community to have about China. The fact that a deadly virus originated in China and not only killed hundreds of Chinese and escaped to other countries killing other citizens tarnished the way that China perceived itself and how China wanted to be perceived by other states. Ordinarily, states want to cooperate with international institutions investigating and monitoring contemporary health issues as they do not want to be perceived as uninterested in safeguarding the well-being of their citizens. In other words, China made a calculated mistake in thinking that refusing to cooperate might indicate that SARS was not a problem in China contrary to common knowledge. China’s behaviour nevertheless is consistent with social constructivist assumptions that the international community is socially constructed and states interact with one another and form identities on the basis of how they perceive themselves or want to be perceived by others or how they are actually perceived by other states. Thus identity forms the basis for ideas and action. Aside from China’s behaviour during the SARS epidemic, states have cooperated to understand, identify, prevent and eliminate contemporary health issues such as AIDS, SARS, H1N1 and so on. As for health issues effecting low income countries, states and regional and international actors have also contributed to knowledge and funding to ensure that health care is available to those who are unable to afford it. In other words, global health which focuses on collective action for promoting and protecting the well-being of human beings is useful for conceptualizing contemporary health issues in world politics. According to constructivist theory of international relations, states view politics as a shared social reality. Therefore global health as a shared social institution is one way of expressing a concerted political effort to deal with contemporary health issues as an international problem or a problem that transcends borders. Conclusion Security is no longer confined to external military threats, but also includes human security on a person level and invariably includes human health. Globalization and advances in transportation technology have facilitated the interconnectivity of states so that a health issue in one state is a health issue in another state. The concept of global health is constructed around this idea so that states have taken the position that when health security is threatened in one state it is the responsibility of all states to deal with that threat to health. This is consistent with the social constructivism theory of international relations. 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