Over the past ten years, it has become commonplace to hear about the ascent of global health on the international agenda. This is not without precedent; health has increasingly found itself discussed in venues that are traditionally reserved for the high politics of security and economy. For some, the reason behind this ascent can be explained by a series of external shocks that have spurred the international community into action [1]. The dramatic impact of HIV/AIDS in sub-Sarharan Africa, for instance, led to a disease being discussed in the United Nations Security Council (UNSC) for the first time in 2000, resulting in resolution 1308 [2]. The 2003 onset of Severe Acute Respiratory Syndrome and its impact on the global economy similarly propelled revisions to the International Health Regulations that were completed in 2005 [3].

As we inch closer to 2014 however, much work remains to be done, and there are signs that political momentum behind global health is fading (e.x. the recent funding crisis at the Global Fund). Indeed, despite the political and financial commitments that have been made over the past twenty years, diplomatic efforts on health do not seem to carry the same weight that they once held, just a few years ago. Consider, for instance, the 2011 High-level meeting on non-communicable diseases (NCDs) at the General Assembly. Certainly, this meeting drew a spotlight on NCDs and fostered awareness of their growing burden in developing countries, but it did little in terms of shoring up concrete financial support to address this ever-growing problem.

Thus, it might be asked why the momentum generated around global health has started to sputter? Although no single answer can adequately address this question, it seems that the High-level meeting fell victim to an unsightly yet persistent feature of global health politics; specifically, the underlying realpolitik of the field. For all the talk of financial austerity and its implications for the funding of global health initiatives – to which there is merit – I would venture that more concrete outcomes would have been achieved at the High-level meeting had the direct implications of NCDs to national self-interests (especially security and economy) been better made. For instance, it is worth recalling that the UNSC resolution on HIV/AIDS was specifically concerned with the security implications of HIV/AIDS in sub-Saharan Africa [2]. And, with almost fifteen years of hindsight, it is worth noting that China – amongst the other four permanent members of the UNSC – has become increasingly more invested in this region of the world. Put differently, UNSC action on HIV/AIDS appears increasingly more connected to national self-interests in sub-Saharan Africa.

From this perspective, the ascent of health on the international agenda has not reflected its emergence as an issue of high-politics, but rather its perception as an important variable in achieving foreign policy objectives. This is not to accuse the members of international society of failing to meet moral standards, or to imply that the motivations behind global health work undermine their ends – one would be hard-pressed to denounce the massive scale-up of donor aid to combat HIV/AIDS following the UNSC resolution. Rather, it is to raise the question of how we can sustain and foster comprehensive and long-term engagement on international health without having to ‘securitize’ it. Indeed, if the society of states continues to engage in health on the basis of health’s relationship to high politics only, then the governance of global health will remain an ad hoc process that focuses on the rise and fall of so-called health security threats. What is needed is an approach that attends to global health challenges for global health’s own sake. How this is achieved, however, sadly remains open to debate.

[1] Cooper, A., Kirton, J., and Schrecker, T. Governing Global Health: Challenge, Response, Innovation. Burlington: Ashgate, 2007.

[2] Security Council resolution 1308 on the responsibility of the Security Council in the maintenance of international peace and security: HIV/AIDS and international peacekeeping operations. New York: United Nations Security Council, 17 July 2007.

[3] International Health Regulations (2005): Second Edition. Geneva, World Health Organizations, 2005.

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