Security and Global Health: Towards the Medicalization of Insecurity

Every era, it is said, has its defining malady. What will be ours? Will it be a new human pandemic caused by an animal-borne infectious disease, such as swine flu? Will it be a lethal microbe like anthrax deliberately released by terrorists bent on causing mass civilian casualties? Or will it be one of our new ‘lifestyle' diseases - the epidemics of smoking, obesity and excessive alcohol consumption that threaten to engulf modern societies? Perhaps our era will even be remembered for its tragic neglect of certain health issues - endemic diseases such as malaria, tuberculosis and HIV/AIDS that continue to ravage millions in developing countries.

In this book Stefan Elbe shows that in the new millennium international politics is no longer characterized by its preoccupation with a single disease, but precisely by its need to urgently confront what is now an epidemic of epidemics. Over the past decade a whole host of diverse global health issues have raised the highest levels of political concern, provoking governments and international institutions to tackle such health threats through the prism of security - be it national security, biosecurity, or human security. This convergence between health issues and security concerns has also produced the new notion of health security, which has already begun to shape the way international health policy is formulated.

The intersection of the worlds of health and security is beginning to change our very ideas of what security means and how it is achieved. At the outset of the twenty-first century, practising security increasingly demands that citizens become patients, that states resemble huge hospitals, and that security itself becomes a technology of medical control. It is this transformation of security, Elbe argues in an innovative and engaging re-conceptualization of the health-security nexus, that marks nothing short of the medicalization of security.

Bound up with the human cost of HIV/AIDS is the critical issue of its impact on national and international security, yet attempts to assess the pandemic’s complex risk fail to recognize the political dangers of construing the disease as a security threat. The securitization of HIV/AIDS not only affects the discussion of the disease in international policy debates, but also transforms the very nature and function of security within global politics.  

In his analysis of the security implications of HIV/AIDS, Stefan Elbe addresses three concerns: the empirical evidence that justifies framing HIV/AIDS as a security issue, the meaning of the term “security” when used in relation to the disease, and the political consequences of responding to the AIDS pandemic in the language of security. His book exposes the dangers that accompany efforts to manage the global spread of HIV/AIDS through the policy frameworks of national security, human security, and risk management. 

Beyond developing strategies for mitigating these dangers, Elbe’s research reveals that, in construing the AIDS pandemic as a threat, policymakers and international institutions also implicitly seek to integrate current security practices within a particular rationalization of political rule. Elbe identifies this transformation as the “governmentalization” of security and, by drawing on the recently translated work of Michel Foucault, develops a framework for analyzing its key elements and consequences.

This Adelphi Paper argues that the AIDS pandemic is not only a health and development issue, but also a strategic one. Drawing on examples from Africa and Asia, it explores the impact of HIV/ AIDS on the armed forces and state stability of the worst affected countries, and anticipates the future implications this is likely to have for international security. It concludes by outlining how the security sector can make an important contribution to wider international efforts to reduce the spread of the illness.

Europe: A Nietzschean Perspective

Advances in European Politics. London: Routledge, 2003.

Available Here. Reviewed by Tracy Strong, and John Scott Gray. Also engaged with by Christan Emden.

There has been a deliberate, but as yet unsuccessful, attempt by scholars and policy makers to articulate a more meaningful idea of Europe, which would enhance the legitimacy of the European Union and provide the basis for a European identity. Using a detailed analysis of the writings of Nietzsche, Elbe seeks to address this problem and argues that Nietzsche's thinking about Europe can significantly illuminate our understanding of the European idea. He demonstrates how Nietzsche's critique of nationalism and the notion of the 'good European' can assist contemporary scholars in the quest for a vision of Europe and a definition of what it means to be a European citizen.