Human security and public health
Mirta Roses Periago
Director, Pan American Sanitary Bureau, Washington, D.C., United States of America
I am pleased to present this special issue of the Pan American Journal of Public Health/Revista Panamericana de Salud Pública, dedicated to the topic of human security within the context of public health. Human security and its relationship with health, social determinants, the Millennium Development Goals, and human rights are inseparable concepts that need to be understood in greater depth by public health researchers and practitioners as well as policymakers at all levels of government.
Human security is an emerging paradigm for understanding global vulnerabilities that has evolved over the past two decades from being a traditional notion of national security with heavy investments in military preparedness and response to focusing more on the dimensions that sustain the security of people through investing in human and community development. Today, the human security paradigm maintains that a people-centered view of security is vitally essential for national, regional, and global stability.
The concept's dimensions were first presented in the United Nations Development Program (UNDP) Human Development Report 1994 (1)considered a milestone publication in the field of human securitywhich put forth the critical proposal that ensuring "freedom from want" and "freedom from fear" for all persons is the best path to tackle the problem of global insecurity.
The UNDP devoted a chapter of the report to the need to shift the paradigm from state-centered security to people-centered security; from nuclear security to human security. The chapter on the new dimensions of human security states:
The concept of security has for too long been interpreted narrowly as security of territory from external aggression, or as protection of national interests in foreign policy, or as global security from the threat of a nuclear holocaust. It has been related more to nation-states than to people (1).
More than six decades after the end of World War II, a direct appeal is being made to overcome the fear created during the Cold War and to gear efforts toward eliminating the threats that affect daily life, with a complementary vision from three interrelated vital perspectives: (a) human development that permits people to freely choose among personal options for their own development, (b) a guarantee of the exercise and defense of human rights by governments, and (c) human security to enable people to live without constant fear or threats that frustrate both the development and the exercise of human rights.
In light of the new geopolitical realities, in 2005 the Human Security Centre of the Liu Institute for Global Issues at Canada's University of British Columbia published the Human Security Report (2), which points to the significant reduction in postCold War armed conflict. The marked reduction in inter- and intrastate warfare, both worldwide and in the Americas, over the past two decades has shifted attention to other challenges that affect people's security and enabled them to become more visible.
Prior to the groundbreaking ideas presented in these two reports, threats to the safety and security of people in generalor to women, children, ethnic groups, and other vulnerable sectors, in particularwere not sufficiently assessed as representing potential threats to the welfare of society as a whole. Poverty, the spread of diseases, environmental destruction, lack of clean drinking water access, poor maternal health, and unemployment were not contextualized on the human security agenda, since the overriding threat was perceived as existing outside national borders and basically as a distant confrontation among the global superpowers.
Concerned with this very narrow interpretation, the United Nations proposed modifying the concept of safety, from being one based on the excessive emphasis on weapons and territorial defense to a broader one incorporating equitable access to education, to work, and to health, as well as a respect for human rights, as essential components of safety. This paradigmatic shift, while not relieving governments of their obligation to guarantee national security to their respective citizenry, redirects the focus away from external threats and conflict toward the peaceful, cooperative, sustainable internal development of nations and their people.
The new paradigm of human security, as part of a larger development process, recognizes the responsibility of governments to safeguard vital human freedoms. This includes protecting the population from risks and threats that can adversely affect their aspirations and quality of life, as well as creating systems that facilitate people's access to the basic rights of survival, dignity, and decent work. In this context, the gamut of human freedoms and their interrelationship become more transparentfreedom from hunger and other basic needs, freedom in the face of fear, and freedom to act in one's own name and on one's own behalfwithin a framework that promotes the full realization of human potential. The evolution of these concepts has provided new opportunities to countries and communities everywhere to address the risks and threats to human development and to implement strategies that strengthen human security.
Human development and human security are, in fact, inseparable: whereas human development seeks to increase peoples' options, opportunities, and access to public services and goods, and emphasizes what can be achieved, human security focuses on the risks, dangers, and threats to human development, evaluates the degree of confidence that people have in public services and goods, and emphasizes what can be lost when human potential is thwarted.
Some may question the focus on human security in a postCold War global society. Yet few would deny the real threat that such phenomena as transnational organized crimedrug trafficking, human trafficking, weapons smuggling, money laundering, and interpersonal violencepose for individuals and communities alike in achieving their fullest development potential.
The Human Development Report 1994 (1) groups the threats to human security into seven principal categories: economic, food, health, environmental, personal, community, and political. It further notes that:
- human security is a universal concern;
- the components of human security are interdependent; and
- human security is easier to ensure through prevention than later intervention.
Within this framework, health security, in particular, is vulnerable on a number of fronts. Daily threats include disease pandemics, deficient water and sanitation systems, natural and man-made disasters, inadequate attention to maternal and child health, unemployment, violence, and unsafe roads and transportation systems.
Poverty, as a major threat to human health, is a major component of human insecurity. The ability to fulfill one's basic needs facilitates people's power to choose among different opportunities and ensures the conditions needed for the health and well-being of the community as a whole by promoting the acquisition of knowledge and adequate preparation for life. In this sense, the various categories of human security are directly related to the determinants of health: economic security with educational and employment opportunities; food security with safe and adequate nutrition; environmental security with clean air, water, and sanitation and adequate green spaces; personal security with protection from threats such as war, ethnic tension, crime, gang violence, rape, domestic violence, child abuse, and self-inflicted harm, such as suicide and drug abuse; community security with policies that promote healthy lifestyles and strong family and social networks; and political security with the protection of human rights.
Public health is a joint action by the state and civil society to protect and improve the health of the people. It is an interdisciplinary social practice (3). To better understand the universal, interdependent, and preventative relationship public health and human security share, two questions are critical:
- How does human insecurity affect health?
- How do disease and adverse health conditions affect people's security?
Both of these questions are answered quite simply, yet eloquently, in the UNDP report:
In the final analysis, human security is a child who did not die, a disease that did not spread, a job that was not cut, an ethnic tension that did not explode in violence, a dissenter who was not silenced. Human security is not a concern with weaponsit is a concern about human life and dignity (1).
Nowhere does the interplay of health and human security issues become of more critical importance than in transnational border communities. In the U.S.Mexico border area, the 2009 influenza A(H1N1) pandemic was a jolting reminder of the human and economic costs of health emergencies. Violence and injuries are another public health and human security concern in this region. A recent analysis of homicides shows that the Region of the Americas holds one of the highest rates of homicides in the worldclose to 30 per 100 000 population, whereas in Mexico, and especially along the northern border communities, that rate is almost double this regional statistic (4). The global economic crisis has, likewise, had a dramatic impact in lower-resource border communities where instability in the job and housing markets has resulted in lost family incomes and homes, which have repercussions for health and the other dimensions of human security.
Although there have been significant advances in conceptualizing human security and its contributions to health since publication of the Human Development Report 1994, public health emergencies have brought to the forefront the urgent need for well-defined systems of global health and human security. The concept of human security goes beyond addressing the risk of disease, encompassing instead the full spectrum of the determinants of health and of the structural inequities that can be redressed only if tackled by multidisciplinary and multisectoral approaches. The high visibility of health, the emergence of new definitions of global health that reflect a globalized, yet interdependent world, and the accompanying governance challenges call for a sustained engagement in developed and developing nations. We need to ensure local, regional, and global commitment to inserting the new human security paradigm in health plans and government policies. Above all, the guiding values of equity and solidarity need to be readily recognized as the drivers of human security. Finally, when reflecting on who is accountable when addressing issues of human security, we should willingly accept that all members of society are stakeholders and have a level of accountability.
1. Programa de las Naciones Unidas para el Desarrollo. Informe sobre desarrollo humano 1994. Nueva York: Oxford University Press; 1994. Capítulo 2: Nuevas dimensiones de la seguridad humana. Disponible en: http://hdr.undp.org/es/informes/mundial/idh1994/ Acceso el 8 de junio de 2012.
2. Human Security Centre. Human security report 2005: war and peace in the 21st century. Nueva York: Oxford University Press; 2005. Disponible en: http://www.hsrgroup.org/human-security-reports/2005/text.aspx Acceso el 5 de junio de 2012.
3. Organización Panamericana de la Salud (OPS). La salud pública en las Américas: nuevos conceptos, análisis del desempeño y bases para la acción. Washington, DC: OPS; 2002.
4. Briceño-León, R. Urban violence and public health in Latin America: a sociological explanatory framework. Cad Saude Publica. 2005;21(6):1629-48.