The Foreign Service Journal, December 2004

mortality levels from such outbreaks shrink the work force, decimate the educated elites, and reduce the effectiveness of critical sectors (e.g., education, law enforcement, the military, and the civil service). This attrition of resources, both human and economic, in turn diminishes the ability of the state to provide for the fundamental needs of its people — food, housing, education and employment. However, it is the indirect, long-term effects of epi- demics that most seriously threaten state capacity and provide a breeding ground for instability and conflict. These effects include the evaporation of public confi- dence; the erosion of the cohesive family unit; the loss of accumulated knowledge and skills as tradesmen, laborers and farmers die early; and the emergence of a large orphan population that is undereducated, disaf- fected from society, and facing a vastly diminished life expectancy. All too often, the result is to turn what should be active cooperation into antagonistic con- frontation as societies turn against their leaders, result- ing in increasing incidents of civil and ethnic conflict. The resulting social upheavals can dwarf in magnitude the direct macroeconomic effects of population deci- mation. These threats do not only affect remote Third World countries. In his book The Health of Nations (MIT Press, 2002), Andrew Price-Smith observes that: “[Such a] confluence of negative trends may compro- mise the ability of transitional states (e.g., Russia and South Africa) to consolidate democratic and effective systems of governance.” Such lessons may seem obvious, and indeed, it is only recently that we have defined security so narrow- ly as to focus primarily on military power. Prior to the 1940s, security discussions routinely included econom- ic capacity, population growth rates, education levels, and public health. It was the emergence of the bipolar Cold War, with its threat of nuclear destruction, that narrowed the definition of security to military capabili- ty and projection of force. Lost in the discussion were human development and advancement — the very underpinnings of the social contract upon which the English philosopher Thomas Hobbes based his defini- tion of government more than three centuries ago. Now that the Cold War era is over, another develop- ment is forcing us to alter our perception of the issue, globalization: the pace and scope of interconnectivity between nations and peoples. Historically, health was viewed as a national public good, and efforts to address health problems were taken within sovereign states. However, this paradigm is useless, even dangerous, in an interconnected world in which capital, labor, pro- duction, and consumption move globally. Travel time between remote corners is measured in hours, not weeks, and information travels in fractions of a second, at a pace faster and a volume greater than we humans can process. Consequently, the parochial concept of “national security” has become a quaint, dated legacy of our past. Security is a multi-dimensional, interconnected global fabric — made all too apparent to Americans by the tragedy of the 9/11 attacks. Since security must now be addressed globally, so must its basic foundations — including health. It is no longer enough to concern ourselves with national health, for threats to security in any region, however remote, can have serious implica- tions for all regions. Global threats require global solu- tions, and the threat to public health is no exception to the rule. Microbial Threats, Old and New The list of infectious diseases threatening human survival changes over time, but never diminishes in number. Ancient scourges like malaria, cholera, typhus and plague (which ravaged parts of India as recently as 1994) persist, and global travel and envi- ronmental encroachment have released pathogens which provide new challenges to human survival. The migration of Lassa and Ebola hemorrhagic fevers from the Congo jungle to Europe and the United States is probably just a matter of time and opportunity. SARS traveled from remote China to Toronto in a matter of weeks in 2003, and while it has not taken as drastic a F O C U S D E C E M B E R 2 0 0 4 / F O R E I G N S E R V I C E J O U R N A L 23 Randy Cheek, a former FSI instructor, is a senior fellow and Africa analyst at the Institute for National Strategic Studies at the National Defense University. In addition to lecturing at the National War College and Industrial College of the Armed Forces at NDU, he teaches courses on health and security, and African security issues, at the Elliott School of International Studies at The George Washington University. Mr. Cheek has also published articles on HIV/AIDS and African issues in U.S. and African journals.