Health and Communicable Disease— Protecting Life in the Global Commons 425bin Laden would only make sense if Al Qaeda had killed and maimed more human
beings worldwide than polio had, but the reverse is true.
For liberals, world health pres ents great opportunities along with real threats.
Because liberal theory’s basic unit of analy sis is the state as a member of a community
of states, concerns about acute threats of plague are no more or less impor tant than
chronic threats or preventive action. Liberals are more likely to focus on international
responsibility for dealing with health issues and to be willing to utilize all groups pos
si ble, including local, substate, state, international, and nongovernmental organ izations,
when appropriate.
Perhaps no issue clarifies these disparate approaches to world health as a transna
tional issue more than the 2011 announcement that a Dutch scientist in Malta had
successfully modified a strain of the H5N1 virus so that it could infect humans. The
team that modified the virus wanted to publish its findings. But publication was stalled
by a demand from the U.S. National Science Advisory Board for Biosecurity. The board
worried that publishing the information would make it easier for a bioterrorist to cre
ate a lethal bioweapon. Virologists (an epistemic community) were appalled: publica
tion of the information would make it much easier to stop an H5N1 pandemic in its
tracks because researchers would be able to study the virus and how to treat it. In this
situation, who is right?
Even among radicals, impor tant differences remain. Marxists, for example, might
argue that challenges to world health stem from capitalism’s tendency to concentrate
wealth and the power of multinational corporations. By forcing many of the earth’s
peoples into poverty, and compromising the health care infrastructure of states in the
developing world, the eventual emergence of a lethal pandemic that slays the owners
of the means of production along with workers is yet another way that cap i tal ists “dig
their own graves.”
Constructivists would focus our attention on key features of how we think we know
what world health means, and how that meaning came to be established. For example,
as noted earlier, the resources a state may be able to extract from its citizens to engage
health as an issue may depend on whether, in a given state, threat rhe toric is a more
successful framing than cooperation and prevention rhe toric. For some feminist inter
national relations theorists, the argument might be that women and men understand
the world differently: women may think of world health in terms of long term preven
tion and health care infrastructure, and men may think of world health in terms of
short term responses to acute threats. The fact that most epistemic communities and
states’ bureaucracies are staffed by males means that world health issues are too often
addressed as reactions to periodic health crises. More women in positions of authority,
or a more humanistic (as opposed to masculinist) perspective, might therefore be needed
before world health outcomes improve.