Foreign policy, global health, and bioterrorism, oh my!

In the last decade the threat of bioterrorism has increased and called upon public health officials to create response plans, as well as enhance pathogen security (Ostfield, 2009).With this growing concern it is important to look at the relationship between global health and foreign policy, as this will determine the success of responses to global pandemics. Understanding how foreign policy and global health interact, will also help to navigate the motivations, objectives, and creation of policies around bioterrorism.

Global health and foreign policy have always been linked, and there are three theories on how foreign policy uses global health: as a goal, a tool, or in a mutually promoting dynamic (Fidler, 2005). In the first perspective, the health of the global population is the intended outcome of foreign policy; so interventions come from an altruistic sense of improving global health. Policies are created and shaped around public health knowledge using best practices to stop pandemics. The second implies that foreign policy uses global health in order to make political and financial gains by developing alliances and trade agreements and ensuring an international market (Stuckler and McKee, 2008). Developed countries, under the guise of improving international health status, implement projects with ulterior goals in mind, such as financial or political gain. The final theoretical view sees public health and foreign policy as a constantly changing and mutually effecting relationship, such that the science and theory of public health help influence foreign policies, as much as are influenced by them.

National security concerns have always been a part of global health, in that there is a desire to protect the population from communicable diseases and health scares, which has more recently included bioterrorism (Stuckler and McKee, 2008). When the threat of biological warfare or contagious disease is eminent, public health becomes a greater concern for the state, and therefore receives more attention (Feldbaum, 2010). At first this appears to be the first example, global health influencing policy: there is a health crisis and response is necessary. When examined closer, it appears that this link is “dominated by the concerns of foreign and security policy, not of global public health” (McInnes, 2006, p22). Global health as national security, which is the framework used when biological threats appear, often focus on diseases in developing countries or potential terrorist groups who are inimical to the developed country. The response not only focuses on containing the disease, so that it does not spread in the developed world, but on shifting policies in the country of disease origin, and developing markets-by forcing them to by products or services from the country providing assistance.

With the H1N1 scare, developing countries were resistant to sharing viral samples for fear of bioterrorism (Sedyaningsih, E, 2008). This does not portray motivation towards the goal of global health security, but rather a nationalistic self-interest. Global health has the potential to create partnerships and form solidarity among the nations of the world. Response to health crises and threats has a tendency to put aside political discourse and focus on the well-being of the world’s population. Foreign policy that creates disparity, promotes the interest of the aid-giver, and denies mutual gain for the aid-receiver, generates mistrust and damages international relations.


Feldbaum, H. et al. Global Health and Foreign Policy. Epidemoiologic Reviews 2010 32(1): 82-92.

Fidler DP. Health as foreign policy: between principle and power. Whitehead J Diplomacy Int Relat 2005;6(2):179-194.

McInnes, C. Lee, K.  Health, security and foreign policy. Rev Int Stud 2006 32:523.

Ostfield, M. Pathogen security: the illusion of security in foreign policy and biodefense. Int. J. Risk Assessment and Management, Vol. 12, Nos.2/3/4, 2009

Sedyaningsih, E. al. Towards mutual trust, transparency and equity in virus sharing mechanism: the avian influenza case of Indonesia. Ann Acad Med Singapore 2008;37(6):482488.

Stuckler, D. and McKee, M. Five metaphors about global-health policy. The Lancet 2008  372: 95-97.


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