Friday, August 24, 2012

Health Security and Bad Governance

Sometimes it helps to read the end of a news story first.

An article by Adam Nossiter published yesterday in the New York Times ("Cholera Epidemic Envelops Coastal Slums in West Africa") concludes with an observation from Jane Bevan, a sanitation specialist working with UNICEF in West Africa: "We know governments have the money for other things. I'm afraid sanitation is never given the priority it deserves."

The article describes a serious cholera outbreak centered in the slums of Freetown, Sierra Leone and Conakry, Guinea. Sierra Leone reports over 11,600 cases of cholera since January with 1,000 new cases each month. According to Doctors Without Borders, 250 to 300 people have died in Freetown and Conakry since February.

Cholera is a highly contagious disease caused primarily by exposure to the feces of an infected person. It causes vomiting and diarrhea leading to dehydration and electrolyte imbalances that, if not treated with rehydration therapy, may be fatal.

Heavy rains, which have caused flooding in shanty towns where sanitary toilets are rare, must be listed among the immediate causes of this outbreak. The existence of the shanty towns in Freeport and Conakry, however, owes much to a decade of civil war in Sierra Leone that drove many people from the countryside to the cities and to over fifty years of dictatorship in Guinea with similar effects on the distribution of population there. But if Jane Bevan is correct, these causes of the cholera outbreak could have been averted--or at least significantly mitigated--if the governments of Sierra Leone and Guinea had allocated resources in a way that took the health of their people into account. And this is something that Article 25 of the Universal Declaration of Human Rights seems to require. (See also Article 12 of the International Covenant on Economic, Social and Cultural Rights.)

The primary responsibility of government--anywhere--is to ensure the security of its citizens. This responsibility is commonly, but improperly, framed in terms of national security with a focus on external military threats. But the most serious threats affecting people all over the world--that is, the threats most likely to kill or threaten the well-being of people, even in a state like Sierra Leone that has recently emerged from conflict--are not generally military threats. Disease, poverty, environmental degradation, climate change, political repression, and a host of other "soft" threats are what people must face more often than the "hard" threat of war. It is important, consequently, for governments (even in the developed world) to shift their focus from national security to human security.