Competitive co‐operation

Abstract

The security and foreign policy communities have increasingly addressed global health problems as threats to national security. Global health is a humanitarian endeavour that seeks to improve the world's health including the most vulnerable peoples, while national security works to protect the interests of people within a given state. The major statements of security policy by the United States and United Kingdom link the self-protective interests of national security with the humanitarian objectives of global health. While there is potential to expand global health activities through partnership with the security and foreign policy communities, treating global health issues as national security threats may focus attention disproportionately on countries or diseases which pose security threats to wealthy nations, rather than on the greatest threats to global health. The global health community should carefully scrutinise areas where global health and national security interests overlap.     

Disaster preparedness--formalizing a comparative advantage for the Department of Defense in U.S. global health and foreign policy

Disaster preparedness is a comparative advantage of the Department of Defense (DoD) in the global health arena. It is in line with the domestic interest of sustaining foreign natural disaster assistance and the foreign policy interest of maintaining national security. The DoD humanitarian assistance policy guidance published in 2009 states Disaster Preparedness should be considered as a key priority in humanitarian assistance engagement. Unfortunately, a whole of government disaster preparedness program framework does not exist to facilitate effective and efficient implementation. Leveraging the United Nations Hyogo Framework for Action agreed upon by 168 nations to take action and reduce disaster risk by 2015, the DoD could synchronize disaster preparedness efforts with other interagency and international partners. Increased civilian-military cooperation in disaster risk reduction supports the whole of government approach to work in a more coherent manner in pursuit of shared foreign policy goals. It also maximizes the ability to deliver critical national capacity in the health sector and beyond. Disaster preparedness is an essential element of U.S. global health and foreign policy, and the DoD must be a critical partner in a whole of government approach.     

The securitization of health in the context of the war on terror. National security and global health: the conflict of imperatives

In this article, I want to show that the securitization of health issues in the name of national interests led to the militarization of health care in the context of the war against terrorism. However, the connection between health and security also gave way to the emergence of the notion of human security, thus, converging with the human right to health approach and the cosmopolitan discourse on global health. These two perspectives on the relation between health and security lead to conflicting imperatives in the current state of counter-terrorism operations. I argue that when the securitization of health concerns in the name of national security conflicts with the provision of health care in the name of universal human rights, the higher moral end must trump the prudential one. Moreover, it is a duty to promote the human right to health when liberal democracies in foreign policies directly violate this moral ideal in the name of national security.     

The science of human security

During the 1990s medical studies using public health methodologies about injury and death due to weapons in conflict began to appear in the medical literature. The 1990s was also the period when the concept of human security was materialising in the development and humanitarian communities. Nowadays it is common for global organisations, governmental and non-governmental agencies, and academics to conduct scientific studies of human security. Many such studies gather evidence about human insecurity and these in turn lead to policy recommendations pertaining to improving human security. The data-to-policy process applies in this domain. In this article we propose that conceptual developments in human security and methods which generate scientific evidence of human security or insecurity have combined to create a new science: the science of human security. We describe key problems inherent in this new multidisciplinary science, some unique methodological challenges and new scientific opportunities.     

Effect of security threats on primary care access in Logar province, Afghanistan

Security threats are a major concern for access to health care in many war-torn communities; however, there is little quantified data on actual access to care in rural communities during war. Kinderberg International e.V. provided primary care in rural Logar province, Afghanistan, for these three years in eight districts until they were integrated into the new health care structure led by the Ministry of Health in early 2005. We examined the number of patients visiting our clinic before and during the security threats related to the parliamentary election and subsequent national assembly in 2004. The number of patients declined in remote clinics while the number increased in central locations. This finding has an important practical implication: the monitoring of access to care should include remote clinics, otherwise it may potentially underestimate compromised access to health care due to security threats.     

Bio-terrorism, human security and public health: can international law bring them together in an age of globalization?

Bio-terrorism, the use of a microorganism with the deliberate intent of causing infection, before and since the anthrax attacks in the United States in October 2001, has emerged as a real medical and public health threat. The link between bio-terrorism, human security and public health raises complex questions on the normative trajectories of international law, the mandates of international organizations, and global health governance. In May 2001, the World Health Assembly of the World Health Organization (WHO) passed a resolution entitled "Global Health Security: Epidemic Alert and Response" which inter alia, urged WHO member states to participate actively in the verification and validation of surveillance data and information concerning health emergencies of international concern. This article explores the links between bio-terrorism, human security and public health, and investigates the effectiveness of international legal mechanisms that link them in an age of globalization of public health. The article explores the interaction of WHO's 'soft-law' approaches to global health security, and the 'moribund' negotiations of the verification and monitoring protocol to the Biological Weapons Convention 1972. Can international law link bio-terrorism, public health and human security? Does the WHO collaborate with other international organizations within and outside the United Nations system to develop effective legal and governance approaches to bio-terrorism and global health security? The article concludes that the globalization of public health threats like bio-terrorism requires globalized legal approaches.     

我国生物安全学科建设与能力发展

总体上生物安全是指全球化时代国家有效应对与生物相关的内外各种损害性、破坏性因素的影响和威胁,维护和保障国家利益、安全和国民健康的状态和能力。在学科上,生物安全学是研究各种生物风险因素发生发展机制与危害评估、防御能力建设与应对措施,促进生命科学与生物技术和平发展与应用,维护和保障国家利益和国民健康的科学。生物安全的核心内容是生物安全能力,特别是对生物风险的认识和应对生物风险的能力。     

The International Atomic Energy Agency’s Activities in Radiation Medicine and Cancer: Promoting Global Health Through Diplomacy

Global health has been an issue of seemingly low political importance in comparison with issues that have direct bearing on countries’ national security. Recently, health has experienced a “political revolution” or a rise in political importance. Today, we face substantial global health challenges, from the spread of infectious disease, gaps in basic maternal and child health care, to the globalization of cancer. A recent estimate states that the “overall lifetime risk of developing cancer (both sexes) is expected to rise from more than one in three to one in two by 2015.” These issues pose significant threats to international health security. To successfully combat these grave challenges, the international community must embrace and engage in global health diplomacy, defined by scholars Thomas Novotny and Vicanne Adams as a political activity aimed at improving global health, while at the same time maintaining and strengthening international relations. The IAEA (International Atomic Energy Agency) is an international organization with a unique mandate to “accelerate and enlarge the contribution of atomic energy to peace, health, and prosperity throughout the world.” This article discusses global health diplomacy, reviews the IAEA’s program activities in human health by focusing on radiation medicine and cancer, and the peaceful applications of atomic energy within the context of global health diplomacy.     

Overview of overseas humanitarian, disaster, and civic aid programs

The U.S. Department of Defense (DoD) conducts humanitarian assistance missions under the Overseas Humanitarian Disaster and Civic Aid program for the statutory purposes of training military personnel, serving the political interests of the host nation and United States, and providing humanitarian relief to foreign civilians. These purposes are undertaken via the humanitarian assistance (HA), humanitarian and civic assistance, and excess property donation programs. DoD conducts over 200 such projects annually at a direct cost of approximately 27 million dollars in fiscal year 2001. Although varying by year and command, as many as one-half of these projects involve aspects of health care. These range from short-term patient care to donation of medical supplies and equipment excess to the needs of the DoD. Despite the considerable resources invested and importance of international actions, there is presently no formal evaluation system for these HA projects. Current administrative staffing of these programs by military personnel is often by individuals with many other duties and responsibilities. As a result, humanitarian projects are often inadequately coordinated with nongovernmental organizations, private volunteer organizations, or host-nation officials. Nonmedical military personnel sometimes plan health-related projects with little or no coordination with medical experts, military or civilian. After action reports (AARs) on these humanitarian projects are often subjective, lack quantitative details, and are devoid of measures of effectiveness. AARs are sometimes inconsistently completed, and there is no central repository of information for analysis of lessons learned. (The approximate 100 AARs used in the conduct of these studies are available for official use in the Learning Resources Center, Uniformed Services University of Health Sciences.) Feedback from past humanitarian projects is rare and with few exceptions; DoD-centric projects of a similar design are often repeated. Critical reviews to determine whether other kinds of projects might be more effective are rarely conducted. Recommendations for improving the effectiveness of DoD HA under Overseas Humanitarian Disaster and Civic Aid programs include: ensuring adequate staffing to meet the complex, dynamic nature of humanitarian missions and measuring the effectiveness of each project in mandatory, standardized AARs. For medical HA projects, application of public health strategies would compliment the patient care approach of the majority of medical projects to date. This offers possibilities for enhancing host nation infrastructure, allowing improvements beyond the short period of most military humanitarian projects.     

Caribbean Public Health Laboratory Surveillance Project: a Department of Defense-sponsored humanitarian mission

This report describes a Department of Defense humanitarian assistance project to develop and build a regional computer-assisted laboratory-based electronic disease surveillance system in the Caribbean basin. From 1997 through 2000, the project donated 146 computer systems and trained more than 250 personnel from 14 ministries of health to operate this system. This humanitarian mission provided the region with a sustainable and locally maintained and operated surveillance system having a broad and long-term impact on public health. It has improved data gathering, analysis, and reporting at the local, national, and regional level. Benefits to the region include the dissemination through the Internet of increasingly timely and accurate information on the incidence and prevalence of endemic, epidemic, and newly emerging diseases. This serves the Caribbean residents, travelers, and U.S. national interests. The project is a model for cooperative Department of Defense capacity building and training programs in support of partner countries and international public health agencies.     

Opportunities for scientists to influence policy: When does radiation metrology matter in development of national policy?

Accurate measurements of radiation and radioactivity rarely rise to the level of national policy. The things that matter most to ordinary citizens do not normally include questions of science and technology. Citizens are more often concerned with issues close to home relating to commerce, health, safety, security and the environment. When questions of confidence in measurements arise, they are first directed to the ministry that has responsibilities in that area. When the required uncertainty in field measurements challenges the capability of the regulatory authorities, the National Metrology Institute may be asked to develop transfer standards to enhance the capabilities of the ministry with the mission lead. In this paper, we will consider eight instances over the past nine decades in which questions in radiation and radionuclide metrology in the US did rise to the level that they influenced decisions on national policy. These eight examples share some common threads. Radioactivity and ionizing radiation are useful tools in many disciplines, but can often represent potential or perceived threats to health and public safety. When unforeseen applications of radiation arise, or when environmental radioactivity from natural and man-made sources presents a possible health hazard, the radiation metrologists may be called upon to provide the technical underpinning for policy development.     

美军与FDA的特需药品协调政策解析及其对我军的启示

特需药品是军队执行军事行动以及其他国家安全行动中实施医学保障的重要物质基础之一,历来受到各个国家军队的重视.美军在长期的特需药品管理中,取得了许多宝贵的经验.本文通过整合分析美军与美国食品药物管理局(FDA)的特需药品协调政策,总结其取得的经验,发现其中存在的问题,并对我军与中国国家食品药品监督管理局(SFDA)的特需药品协调政策提出建议.     

Operation Aftershock: the U.S. military disaster response to the Yogyakarta earthquake May through June 2006

The U.S. military has recently been involved in many humanitarian assistance and disaster response missions around the world. This newfound role is in response to the U.S. government's desire to use "medical diplomacy" rather than "military might" to shape its relationship with foreign governments. With each of these humanitarian assistance and disaster response missions, the U.S. military has learned how to more rapidly insert desperately needed services and skill sets into disaster-struck communities, how to arrange for in-country services (translation services, transportation, etc.) that cannot be readily brought in, and how to work closely with foreign governments and nongovernmental organizations to determine their needs and expectations without the U.S. military appearing as if it were trying to establish a permanent presence.     

Human security: expanding the scope of public health

Human security is an evolving principle for organizing humanitarian endeavours in the tradition of public health. It places the welfare of people at the core of programmes and policies and is community oriented and preventive. It recognizes the mutual vulnerability of all people and the growing global interdependence that marks the current era. Health is a crucial domain of human security, providing a context within which to build partnerships across disciplines, sectors and agencies. These principles have been demonstrated in field programmes in which healthcare delivery featuring multi-sectoral co-operation across conflict lines has been used to enhance human security. Such programmes can be a model for collaborative action and can create the sustainable community infrastructure that is essential for human security.     

当前国际生物安全形势与展望

生物安全是指全球化时代国家有效应对生物及生物技术因素的影响和威胁,维护和保障自身安全与利益的状态和能力.本文通过对《禁止生物武器公约》履约、生物恐怖、传染病以及生物技术谬用、转基因生物安全等的形势分析,认为总体上,国际生物安全形势趋于负面,我国生物安全形势趋于平稳,建议国家重视生物安全的可持续发展.     

The US national isotope program: current status and strategy for future success.

Since their introduction in the 1940s, peaceful use of stable isotopes and radioisotopes in the United States has expanded continuously. Today, new isotopes for diagnostic and therapeutic uses are not being developed, critical isotopes for national security are in short supply, and demand for isotopes critical to homeland security exceeds supply. While commercial suppliers, both domestic and foreign, can only meet specific needs, the nation needs a consistent, reliable supply of radioactive and stable isotopes for research, medical, security, and space power applications. The national isotope infrastructure, defined as both facilities and trained staff at national laboratories and universities, is in danger of being lost due to chronic underfunding. With the specific recommendations given herein, the US Department of Energy may realign and refocus its Isotope Program to provide a framework for a successful National Isotope Program.     

Setting the scene: the new conflict environment and contemporary challenges for interventionists

This article examines the characteristics of contemporary conflict and humanitarian environments and looks at the reasons that underpin their evolution. It studies the role of globalization, international economies, weapons proliferation, warlords, individual security guarantees and urbanization. The role of the international community is discussed and the main responsibilities and actors are defined. Future challenges for multinational military forces are examined and an overview given of the role of non-governmental organizations (NGOs), United Nations (UN) agencies, bilateral and multilateral donors, commercial companies and host governments. Lastly, recommendations are given on how the international community can close existing gaps that impede operational effectiveness, whilst still providing integrated responses to global needs.     

The World Trade Organization: Implications for health policy

Agreements negotiated at the World Trade Organization already have important implications for health and health policy. They impact on the ability of governments to regulate trade in the interests of health; on national and international governance and public health standards; and on the future of the precautionary principle. Agreements on trade‐related aspects of intellectual property rights and trade in health services could benefit the multi‐national health care and pharmaceutical industries, and impact negatively on cost and equity.     

Developing a monitoring and evaluating capability for the U.S. Department of Defense Humanitarian Assistance Program

The Department of Defense spends more than $50 million dollars a year on humanitarian assistance (HA) projects. Although the projects are perceived as beneficial, demonstrating sustainable long-term impact is not possible. METHODS: A seven-step monitoring and evaluation (M&E) process was adapted for this study that combined different steps within a logical framework approach. RESULTS: A retrospective analysis found that M&E is not part of the HA program (HAP) process from nomination through completion and beyond. To address this M&E deficiency, a comprehensive logframe matrix composed of 5 goals, 14 objectives, 100 activities, and many indicators was created. CONCLUSIONS: Incorporating this proposed Department of Defense HAP logframe matrix into existing project nomination and After-Action Report (AAR) processes would enable HAP managers to prioritize limited resources, demonstrate sustainable program impact, and align individual HA projects with the overarching national defense strategy and overall U.S. government foreign policy.     

Legislation for Ukraine's public health: the current situation and paths to further development

The paper contains the findings of an analytical study of the current national health care legislation of Ukraine and identification of priority areas in its further development. One of the key objectives of the above study was to identify the compliance of the national healthcare legal framework with the approaches to health policy formation, which are set out in the documents of global and European regional international organizations, and to assess whether the national legislation includes that spectrum of functions that are to be covered by the health care legislation. The analysis showed that Ukraine's national healthcare legislation is rather strong and well developed. Though the national healthcare legislation is mostly in line with international approaches to the state health care policy formulation, the issue of enforcing already adopted laws and by-laws and ensuring their compliance by all legally established bodies, including state authorities and self-governments, citizens, NGOs, etc, is problematic.