The Many Faces Of Global Health Security
It should come as no surprise that the concept of ‘global health security’, or GHS, means many different things to many different people. In fact, an April post here on HSP’s blog looked at just a few of the various and wide-ranging responses given when a group of young scholars is asked what exactly ‘health security’ means. Definitional uncertainty has been a hallmark of global health security since the phrase found (ir)regular usage starting in the early 2000s. Perhaps nowhere has its amorphous character been made as clear as in a paper published last year in the Lancet, where a broad collection of experts reflected on the meaning of ‘global health security’ after Ebola. Led by ex-WHO executive David Heymann, the paper brought together specialists that argued the idea spanned the gamut of global health topics: human security; food security; communicable and non-communicable disease management; human rights issues; pharmaceutical development; migration; disasters; universal health coverage—the list goes on. There is no doubt all of these represent critical issues in global health today, but after such an exhaustive reading, it seems more apt to ask: what isn’t global health security?
Some might argue that this promiscuity in meaning is a detriment, revealing disarray in the concept and the sectors that work with it. If it means everything, it means nothing—threatening to drown in a diluted pool of debate, becoming what one political scientist once called an “empty signifier”. Others might argue otherwise, pointing out that the amorphous character of the concept is primarily what gives it potency and endurance; bringing new ideas, actors, technologies, and organizations to the table in an opportunity not only to contribute to an existing platform, but to altogether re-define it through their participation. These openings, it might be argued, stoke the fires of debate and discussion about what kind of activities make up GHS, how it might be measured, and ultimately what kinds of indicators and outputs matter. As one official described it to me, this is the ‘double-edged’ sword of health security: there’s room for everyone at the table, but hardly anyone knows exactly what to do once they leave the boardroom.
In reality, I think most stakeholders fall somewhere in the middle of this debate—hoping for some clarity from the issue while celebrating its breadth and ability to include a diversity of global health initiatives in both the private and public sectors. In this way, GHS works as what sociologist-of-science Dr. Susan Leigh Star once called a ‘boundary object’—arrangements and ideas that “allow different groups to work together without consensus”. These boundary objects provide various expert communities both interpretive flexibility and a common language of deliberation. In this context, it means the Chinese government can promote private-public partnerships in drug development at the same time that Senegal sets up an Emergency Operations Center, and both are nominally seen as contributing to ‘global health security’. As a boundary object, GHS juxtaposes and links up heterogeneous or disparate programs across scale and professional communities. It allows groups to ‘smuggle in’ their interests, but it also anchors these groups to common goals—turning ideas, standards, or norms (like the International Health Regulations) into capacities, infrastructures, or ‘actions’. Whether expounding criticism for the imprecision of the concept, or celebrating its ability to solicit contributions from sectors normally left outside the negotiating table, many recognize ‘global health security’ as something to work “toward and with”, to again use Dr. Star’s words.
Therefore, rather than adopt the language of “empty signifier,” which carries quite a negative connotation, I prefer to think of the phrase ‘global health security’ functioning more like what anthropologist Claude Lévi-Strauss once called “floating signifiers”—phrases or symbols that are not anchored or fixed to single objects or ideas. Suggesting that GHS ‘floats’ around does not imply that it hovers untethered to the world, as an abstract concept debated in the halls of the WHO or the United Nations, but inconsequential to the rest of those working in global health.[1] Instead, it has challenged countries to think seriously about health systems preparedness as a multilateral commitment; policymakers to elaborate new targets, indicators, and programs; and organizations to invest time and resources into devising new products and projects. It introduces new possibilities, such as novel concepts (like ‘shared sovereignty’, an idea invoked by the WHO’s Ebola Interim Assessment Panel in their July 2015 report) and innovative technologies, but also brings about its own set of problems and challenges.
Reflecting on shortfalls in country compliance rates to the revised International Health Regulations, the lingering frustrations with the bungled responses to Ebola, and the stagnant attention to ongoing outbreaks (Zika and Yellow Fever come to mind), it might be argued that ‘global health security’ should take on new meaning. Certainly, it can and should mean many things to a variety of individuals and groups, but its success as a diplomatic and political platform relies on its ability to orient resources and attention to shared visions, problems, and goals. Finding a delicate balance between these ‘global’ problems and the specific country-wide, regional, or municipal challenges facing health ministries and departments will be a continued test.[2]
Perhaps in our readings of GHS and its many meanings, we should give up on the idea that global health security fits into a box that, when opened, will contain neatly assembled pieces of a jigsaw puzzle. Puzzles are notoriously difficult to keep together, with pieces always going missing under the couch cushion, or mingling in other puzzle boxes. The task of deciphering a bigger, coherent picture of GHS is not only Sisyphean, but misguided. For this reason, I think there is benefit in shifting the emphasis of our questions from asking: ‘What is GHS’ to ‘How does it work?’ Turning attention to the processes, procedures, and practices in this domain also helps us leave room for new possibilities—where we might find ourselves able to instead ask: ‘how might global health security work differently?’ This task of critical questioning requires charting a fluid topography of GHS; new terrains of problems, challenges, and proposed solutions that change the way we think about the world and global public health’s role in its safeguarding. It is for this reason that attention should remain not only on the emergent diseases and on the threats they pose, but on emergent institutions, partnerships, policies, and potentials that make up the changing landscape of global health security today.
[1] For anyone left unconvinced that ‘health security’ functions as more than merely an issue of “framing”, please read anthropologist Alex Nading’s 2015 piece on the drug brincidofovir during the Ebola crisis: http://limn.it/ebola-chimeras-and-unexpected-speculation/
[2] Such translations of GHS deserve more careful analysis than simply adopting a lens that views specific “local” issues as confronting general “global” ideas. Part of the argument here is that the very terms of a ‘global’ idea like GHS are contested, reshaped, and remade everywhere one looks.
Written by Raad Fadaak
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