424 CHAPTER ElEvEn ■ TransnaTional issues
21 percent and the effects will probably continue, even if the crisis is abated. Clearly, the
economic development gap and the quality of individual lives cannot change without
improvements in health conditions. That is why the Millennium Development Goals
related to improving health (reducing child mortality and improving maternal health)
and the new Sustainable Development Goals have even a broader conception of healthy
lives (with goals related to nutrition, mortality, tobacco, and alcohol). The fact that
during the 1980s the World Bank became the largest multilateral financier of health
programs in developing countries confirms the health- development connection. The
Bank uses a sector approach, funding programs to increase the capacity of national and
local health facilities, facilities that were lacking in many African states. Without a doubt,
health is a transnational issue affecting politics, economics, society, and individuals.
a theoretical take
Health is an example of a quin tes sen tial functionalist issue. (See Chapter 7.) Virtually
every one agrees that prevention of disease is critical and good health is desired by
all. This consensus extends to the belief that we should rely on technical experts and
highly trained medical personnel to prevent the spread of infectious disease. Given
these two functionalist criteria, it is not surprising that one of the first historical areas
of international cooperation was health, as states sought to harmonize quarantine
practices and address the spread of communicable diseases such as the plague. This was
the narrow purpose of the First International Sanitary Conference of Paris in 1851. But
interstate cooperation to manage communicable disease has dramatically expanded
since that time. On this issue, realists, liberals, radicals, and constructivists can all find
common ground.
Differences remain, however. Because most realists focus on states and define secu-
rity narrowly (as physical security), realists tend to reduce a broad array of global health
issues to such goals as responding to outbreaks of communicable disease or preparing
against the possibility of the deliberate use of bioweapons by state or nonstate actors.
Once conceptualized as a threat, relevant questions tend to get reduced to the capacity
of the state to defend itself against the threat of infectious disease or a biological weap-
ons attack. The result is a paradox in two re spects. First, because it privileges states as
in de pen dent po liti cal actors, threat rhe toric tends to attract considerable orga nizational
and financial resources. Yet the likelihood that any single state, however power ful, can
succeed in mitigating the “threat” is low. Not all transnational issues demand a multi-
lateral response, but health care is one of them. Second, the privileging of short- term,
direct threats like terrorism over longer- term indirect threats like a compromised global
health- care infrastructure can lead to seemingly irrational policies. Jeopardizing the
polio immunization program in Pakistan and Af ghan i stan by using it to locate Osama