Though global health has attained a prominent position on the global political agenda over the course of a generation, the inauguration of the Trump Administration in the United States threatens to challenge this international consensus.
Trump has evinced scepticism about the value of multilateralism, called for significant cuts to foreign aid, and expressed fear that foreigners would bring disease to the United States. In the face of these challenges and the need to at least maintain current levels of international commitment to global health to prevent reverses in health gains, the securitisation of health may offer a pragmatic strategy for keeping the United States engaged on global health issues.
The US has historically held a leadership role in global health. It has provided both leadership and financial backing that have helped elevate the attention paid to it. That does not necessarily mean that the United States government has always engaged with global health for selfless reasons or that its interventions have been without problems, but it has helped the global community recognise health’s importance in at least five keys ways. These five ways include: playing a major role in highlighting the connections between disease and security; playing a major role in large-scale international health programs; consistently being the world’s largest funder of development assistance for health (DAH); consistently receiving both bipartisan and broad public support; and playing important roles in mobilising responses to global health emergencies.
The Trump administration challenges the US’ leadership in global health. Upon taking office, Trump’s actions did little to allay fears. In May 2017, Trump administration released its first proposed budget. It proposed cutting funding for global health activities by $2.2 billion, or 26 percent, for fiscal year 2018. With the United States government contributing roughly one-third of DAH, these cuts would have significant ripple effects and reduce the US’ global health spending to its lowest level in at least a decade. Trump’s budget proposals went beyond reductions to specific health interventions to making far-reaching cuts to institutions and organisations that provide crucial support for global health. The National Institutes of Health (NIH) received a $5.8 billion cut, roughly 20 percent of its budget. Reducing the NIH budget reduces the number of grants available for developing treatments or vaccines for diseases like Ebola.
Trump’s initial budget blueprint in 2017 made a vague commitment to creating some sort of federal emergency response fund, which could theoretically enable a quicker response to global emergencies, but the document was vague about whether this would be new money or a reallocation of existing funds. Trump also proposed cutting the United States’ contributions to United Nations organisations, including the World Health Organization. These cuts would extend to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, reducing the United States’ contributions to this major international multilateral health funder by 17 percent. Cutting its contributions would have serious effects on the Fund’s abilities to support programs in low- and middle-income countries. The Trump Administration’s global health cuts have not only targeted infectious diseases. Three days after taking the oath of office, US President Donald Trump issued a Presidential Memorandum Regarding the Mexico City Policy. Also known as the “global gag rule,” this policy mandates that non-governmental organizations (NGOs) receiving funding form the US government cannot provide abortion services, provide abortion counselling or referrals, or advocate for liberalising abortion laws. In response, eight countries—including the Netherlands, Sweden, Denmark, Luxembourg, Finland, Canada, and Cape Verde—announced an initiative to raise funds to replace the shortfall caused by the Trump Administration’s policies. “‘The gag order’ could be so dangerous for so many women,” declared Swedish Deputy Prime Minister Isabella Lovin when unveiling the response. Critics of the Trump policy and the global gag rule more broadly, argue that this strategy is more about American domestic politics than protecting the health of women internationally, implements rules that would be ruled unconstitutional if they were introduced and threaten the efficacy of a wide range of global health initiatives.
Given these realities, the challenge becomes identifying a way to encourage the Trump Administration to engage with global health on some level. Interestingly, this is exactly where securitisation could be a useful tool for the international community. Securitising health could offer a logic that would encourage Trump to support global health. How could securitisation be used as a force for good for encouraging the Trump Administration to engage with global health? Drawing on Trump’s own rhetoric, three possible avenues exist.
First, securitisation could potentially appeal to the Trump Administration’s economic interests. Spending money upfront bolsters the global economy and reduces the likelihood that foreign governments and international organisations will need to ask for funding in emergency situations. This ties in with Trump’s recognition at the United Nations in 2017 that prosperity demands health. On another level that may appeal to Trump’s business inclinations, healthier people will be better workers. If you are sick, you will either miss work or be less productive. There is a certain crassness in appealing to the economic bottom line to motivate involvement with global health issues — and Tillerson’s departure may give this argument less weight — but this is driven by recognising the current domestic political and social context and finding a message that will resonate with key policymakers.
Second, securitisation could encourage greater investment in health systems around the world. Trump has repeatedly shown an aversion to people with infectious diseases coming to the United States. That was well-illustrated by his tweets about the one travel-related case of Ebola that appeared in the United States and the furore over quarantining health care workers who had served in West Africa regardless of whether they were exhibiting any symptoms of illness.
Third, securitisation may provide the logic for the Trump Administration to see value in using the military to provide logistical and operational support during disease outbreaks. Securitising global health would provide a more direct route for the Trump Administration to understand the role that the military could play in supporting other responders. Simultaneously, to avoid putting too much responsibility on the military’s shoulders, it would be crucial to ensure that other responders—such as CDC and WHO—have sufficient resources so that the military does not become the default global health emergency responder. Given Trump’s professed support for the military, this would provide the military with an additional mission and elevate its international status.
The Trump Administration presents perhaps the most significant challenge to the contemporary global health governance system. Trump himself has openly questioned the efficacy of foreign aid, multilateralism and the fundamental bases of global health governance into question. The international community can ill afford to reduce its vigilance on global health, but the Trump Administration seems to be calling for just that. In order to counter these messages, this article suggests that the securitisation of health may actually contain positive opportunities for the maintenance and expansion of global health governance. Securitisation may not be the ideal framing for many global health advocates, but it may be the most pragmatic and appropriate response in the current political and social context in which the United States government is operating. Securitisation may provide a rationale necessary to encourage continued political, economic and financial engagement on these issues. Securitisation may not be the right approach for all governments or in all situations, but it may prove a useful frame that will resonate with the current American presidential administration.
Dr Jeremy Youde is a Fellow and Senior Lecturer at the Australia National University’s College of Asia and the Pacific.
This article is an extract from Youde’s article in the Australian Journal of International Affairs titled “The securitization of health in the Trump era.” It is republished with permission.