Understanding global security - Peter Hough

HEALTH THREATS TO SECURITY
Greater public scrutiny of business
As with the ‘greening’ of petrochemical firms witnessed in the politics of the
environment, greater consumer awareness has prompted MNCs operating in the
developing world to improve their public image. The cynic can point to tax breaks
often open to MNCs who make charitable contributions and to the advertising
pay-offs of apparent philanthropism, but the fact remains that businesses are donating
significant sums to global public health and contributing to a global good. At the
same time, blatantly cynical activities by MNCs which undermine public health
are increasingly likely to be highlighted by pressure groups and be used to damage
their image in the eyes of ever more enlightened consumers. The backtrack of the
pharmaceutical firms and US government over the patenting of HIV drugs in Brazil
and South Africa provides a clear instance of this.
Democratization and more socially responsive
government
The logic of the Sen thesis, that famines are less likely under democratic conditions,
holds also for public health in general. Citizens empowered with the vote are unlikely
to tolerate governments negligent in securing their health. The Indian state of Kerala
has been highlighted by Sen and others as a case study of human development in the
face of economic adversity. The state government of Kerala in the 1970s introduced
a major reform package of social security provision and land redistribution in
the face of significant political protest. Despite insignificant economic growth in the
state, Keralan citizens’ lives improved remarkably over the next two decades, including
a major advance in life expectancy. Sen’s advocacy of a ‘support-led’ approach to
development does not simply equate democratic political systems with better health
since he emphasizes how countries like China and Cuba have achieved better
health for their people than wealthier, democratic states by having well-funded public
health and education systems (Dreze and Sen 1991: 221–226). Marxist/Maoist
governments often have an instinctive, ideological commitment to public health
which does not need to be prompted by society (the Keralan government was also
leftist). It is the globalization, then, of socially responsive government rather than
simply democratization that has contributed to improved standards of public health.
The globalization of the public service ethos
The injection of private money into global health programmes has brought with it
fears that policy could be transformed from the ‘Health for All’ social security
approach expounded by the WHO to a more uneven charity-style approach. Similar
fears were expressed when developed democracies began undergoing a ‘welfare
backlash’ from the mid-1970s. Then the cost of state support began to spiral due
to ageing populations and higher levels of unemployment, causing more people than
ever envisaged to fall into the welfare safety net. Countries of Western Europe and
North America responded, to varying degrees, by incorporating private solutions to
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