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HUMAN SECURITY AND HEALTH IN AFRICA
Melissa Jennings
WS 509
Dr. Hassan-Yari
Winter Semester 2010
2
Human Security and Health in Africa
Introduction
After the Cold War, not only did the context of security change, the concept of security
was also changed as it was beginning to be defined in terms of ‘non-military
challenges’1
. It is often asked as why health is not considered a part of human security.
The answer to the question is difficult to find but various factors contribute to this
exclusion. The question of the distribution of health is a puzzling one. In addition the
question of who is responsible for setting the security agenda also arises.
Moreover the issue of encountering and fulfilling the ‘basic needs and aspirations’ of the
African people are also of a central concern when it comes to the discussion of human
security and health in Africa2
. Despite the new concern granted in favour of the African
people the continent has been ignored owing largely to the ‘traditional imperatives of
state interests, power, military force and geopolitical instability,’ thus the notion of
security has not achieved the interpretation of humanity and developmental features3
.
Until poor health directly affects the quality or quantity of life in developed countries it is
unlikely that health will become a practical human security priority.
Research Objective
This paper seeks to use the broadening and deepening of security parameters as
defined by discourses on human security to demonstrate the impact of child and
1
Poku, Nana K, Neil Renwick, and Joao Gomes Porto. "Human security and development in Africa." International
Affairs, 2007: 1155-1170,p.1155.
2
Ibid., p.1155
3
Ibid., p.1155
3
maternal health of Sub-Saharan Africans on human security as it has direct implications
in terms of quantity and quality of life. This paper will lay a ground work for discussing
health, examining the definition of human security and how health in Sub-Saharan
Africa is a human security issue. Moreover, the role of the communities, governments
and the developing world is analyzed.
Research Questions
• How is human security is related to health in Sub-Saharan Africa?
• What are the factors that weaken the relationship?
Research Methodology
The research makes the use of secondary sources to explore the impact of child and
maternal health of the Sub-Saharan Africans on human security. The secondary
sources include books, journal articles, etc. Moreover the researcher uses field research
done on Ethiopia in order to make the interpretation of the relationship between health
and human security in Africa clear.
Research Analysis
Shift of interest towards Health Care as Human Security
By the end of the European World Wars, the focus of Human security had evolved in
the West as the protection of refugees, reconstruction after the conflicts and identity
rights were the focus of individual security needs. The period after World War Two also
demanded a shift in discourse, as the state proved unable to provide physical and
4
psychological protection from security threats4
. The Cold War era, although dominated
by national security policy, still had room for humanistic focus; for instance, states
Buzan (1983), which included the three pillars of identity, institutions and population in
order to sustain a sovereign state5
.
Buzan (1983), in his discussion of nations, states and nation-states, further explored the
role of individual identity (identities) in state creation and maintenance6
. According to
Buzan (1983), individual security is a societal concern with four types of societal threats,
physical, economic, rights, and position/status, all of which are not mutually exclusive7
.
By 1989, Tuchman Mathews had expanded on Buzan’s list of threats to human security
and included overpopulation, patterns of land tenure, the environment and reproductive
health as well8
.
The 1994 Human Development Report was the first to approach the subject in a
formalized way by presenting the freedom from fear, freedom from want agenda. The
report goes further in defining seven aspects of HS, the third one being health security9
.
Already an influence on setting the tone for global security discourse, the United
Nations Development Program’s 1994 Human Development Report is generally
recognized as the watershed moment for the international recognition of human security
as a priority. The Report is all-encompassing and integrative, in that it includes an
urging for the protection of seven elements of HS — economic, food, health,
4
MacFarlane, Neil S, and Yuen Foong Khong. Human security and the UN: a critical history. Indiana University
Press, 2006.
5
Buzan, Barry. People, states, and fear: the national security problem in international relations. Wheatsheaf
Books, 1983.
6
as in 10
7
As in 10
8
Mathews, Jessica Tuchman. "Redefining Security." Foreign Affairs, 1989.
9
United Nations Development Programmed, Human Development Report, 1994 (New York: Oxford University
Press, 1994), p. 24.
5
environmental, personal, community and political security.10
Later attempts to narrow
the concept of human security have run into problems with value judgments, cultural
relatively and exclusion, as will be outlined here in a later section.
Since 1994, a pivotal year in terms in of human security as a result of the UNDP Report
mentioned earlier and the Rwandan Genocide, the relationship between states and
individuals in terms of human security has come under greater international scrutiny,
with a focus on development, peace building, policy and military-strategic approaches.
The concept of human security today thus represents a major shift in the way
government, organizations, academics and individuals think about human security, as it
places greater legal emphasis on the welfare of ordinary people.
Political theorist, Roland Paris, has defined human security as a category of security
studies research, reserved for studies of non military threats to the protection of people
and entities, community11
. Arguing that there is a lack of evidence to support the theory
of a paradigm shift in security studies towards human security, Paris has
compartmentalized ever existing issues to better navigate the complexities of analyzing
security threats.
This contrasts with the widening discourse, led by Buzan and the Copenhagen school,
which includes individuals and communities as potential subjects of threats.12
A
Constructivist understanding is one that further involves non state actors as responders
to security threats rather than just victims13
.
10
UNDP. UN Human Development Report. (New York: Oxford University Press, 1994).
11
Paris, Roland. "Human Security: Paradigm Shift or Hot Air?" International Security, 2007: 87-102.
12
Frerks, Georg, and Berma Klein Goldewijk. Human security and international insecurity. Wageningen Academic
Publishers, 2007.
13
As in 17
6
Paris’ cells do not offer categories for complex emergencies or the interdependence of
threats, nor does it explain the role of various actors. Regardless of whether or not
academia or policy-makers in the West have decided that there has been a paradigm
shift towards individual security in the developing world this is moot point. Security
issues for the majority of the world’s population are indeed more inclusive than survival
of inter-state warfare or avoiding super-power conflict; they include power, vulnerability,
accessibility and disconnection in an increasingly globalized world. From the Realist
perspective, Human Security based in the UNDP’s freedom from fear, freedom from
want agenda has been determined as too broad to be considered for policy.
It is my aspiration, says Kofi Annan (the former Secretary General of the United
Nations), that health will finally be seen not as a blessing to be wished for but as a
human right to be fought for14
. The altruism of Annan’s statement, as quoted by Ganguli
(2008), is evident from the fact that health is so important an aspect of human life but it
has been ignored by policy makers and public speakers whenever they talk discuss
security.
Aim and objective of Human Security in Africa
Making a link between health and human security requires some indirect associations
as well as illuminating some often overlooked relationships between cause and effect in
time of war and peace. Some researchers are of the view that if a life is lost
precociously then it is an enormous insecurity to the human beings. One aim of human
security has been to arm people against health threats or illnesses15
. As soon as the
Sub-Saharan African countries gained independence they engaged in multifarious
14
Ganguli, Mary. "Health, human rights, and the Golden Rule." Indian Journal of Medical Ethics, 2008: 8
15
Michael, Sarah. "The Role of NGOs in Human Security." Commission on Human Security, 2002: 1-30, p.1.
7
conflicts which also asserted a profound impact on ‘maternal and child health’ and the
ratio of demise as a consequence of ‘malnutrition’ has increased to a perilous extent16
.
Although one of the first African leaders, Kwame Nkrumah, celebrated in 1954 for his
aim to make the Gold Coast a paradise once independence was gained but he, along
with many others narrowed the notion of paradise in order to focus on military security
while he ignored issues around the health perspective17
. The most important of all tasks,
that of building a ‘prosperous society’ was utterly ignored18
.
Threats to Health Care & Public Health Emergencies
These include emerging new diseases that include SARS, Avian Influenza etc.
Moreover, as well as emergencies that require responses on a humanitarian basis.
These emergencies could result from changes in climate conditions such as
degradation of environmental setup or potential threats to an entire population which
requires swift responses by health bodies. In response to those health issues that could
have potential impact on the people, overall society and economy, international health
security plays a most important role. ICESCR, International Covenant on Economic,
Social and Cultural Rights, by the General Assembly of the UN, in 1996, is aimed to
make human rights accessible and feasible for all individuals, including rights to primary
health care resources and facilities.
There has been a lack of statistics to manifest the meticulous details regarding the
number of deaths as a result of malnutrition; moreover the absence of adequate system
16
O'Hare, Bernadette, and David Southhall. "First do no harm: the impact of recent armed conflict on maternal and
child health in Sub-Saharan Africa." Journal of the Royal Society of Medicine, 2007: 564–570.
17
As in 2,p.1156
18
As in 2,p.1156
8
for ‘registration’ of the birth and death further aggravates the problem19
. In addition
‘internally displaced persons’ in Sub-Saharan Africa are prone to the threats of abuse
and violence20
. As an example, O'Hare and Southhall (2007) report on the increase in
‘maternal mortality’ during conflict in Congo and also the increase in ‘child mortality
rate’ among displaced persons which makes the condition grave21
. O'Hare and
Southhall (2007) segregate death rates into ‘direct conflict deaths’ and ‘indirect conflict
deaths’22
. Where the first category includes demise as a consequence of bloodshed, the
second category includes demise as a result of illness and starvation. There are many
aspects of health that directly affect human security which include food and nutrition,
water and sanitation, disease, child and maternal/ sexual and reproductive health.
These aspects pose threats to security and insert direct impact on quantity of life.
The Most affected Group
The most ‘vulnerable group’, say MacFarlane and Foong Khong (2006), include
children, ‘women in war’ and ‘displaced persons’ whose protection is of utmost
importance23
. As women, particularly pregnant women, and children are more prone to
the threats of malnutrition therefore ‘maternal malnutrition’ has become an important
element in ‘morbidity and mortality’ in African women and 20 % of these pregnant
women have a ‘low BMI as a result of chronic hunger’24
. The insuficient access to food,
multifarious diseases and infections as well as ‘suboptimal infant feeding practices’ all
19
As in 6
20
As in 6
21
As in 6
22
As in 6
23
As in 9,p.202
24
Lartey, Anna. "Maternal and Child Nutrition in Sub-Saharan Africa: Challenges and Interventions." Proceedings
of the Nutrition Society, 2008: 105-108, p.105.
9
contribute to increased rate of deaths of children25
. Moreover, various environmental
and economical factors also pose problems for children and women in the regions of
Sub-Saharan Africa26
. The threat of HIV infection is also enormous due to disease
transmission when the HIV infected mothers breast-feed their children making them
prone to the infection as well27
.
While it is accepted that mothers are the pillars of any sustainable community
development initiative, women and particularly mothers receive very little in terms of
support and recognition for their role in communities and the problem becomes acute
when it comes to the context of Sub-Saharan Africa. With their many capabilities
women and mothers raise children, produce and sell food, work in the formal and
informal sector, participate in politics and micro-enterprise among other things. Child
soldiers, human trafficking, rape as tool of war, preventable births and deaths, gender
based violence are all major problems concerning mothers in Africa.
“A woman in sub-Saharan Africa has a 1 in 16 chance of dying in pregnancy or
childbirth, compared to a 1 in 4,000 risk in a developing country”28
. Children born in
developing countries, of which all Sub-Saharan countries are, are over 13 times more
likely to die under the age of 5 than children born in developed countries29
. Women and
children in impoverished areas of sub-Saharan Africa are at heightened risk due to the
patriarchal system at local social level. Any threats that men and boys face in
pastoralists/rural environment along with environment with dense population, urban or
25
As in 25, p.105.
26
As in 25,p.105
27
As in 25,p.106
28
UNICEF, “5. Improve Maternal Health,” Millennium Development Goals, Accessed 10 March 201:
http://www.unicef.org/mdg/maternal.html
29
United Nations Development Program, “Reduce Child Mortality,” MDG Monitor: Tracking the Millennium
Development Goals, 2007. Accessed 10 March 2010: http://www.mdgmonitor.org/goal4.cfm
10
rural settings, for women these are compounded by their denied access to nutrition,
maternal/pre/post-natal health and opportunities including literacy and education shape
their health indicators and consequently their human security.
The people most affected by health security are those that lack access to treatment and
prevention tools including various vulnerable groups such as the rural and urban poor.
Due to their constant mobility, occupying life on the periphery of society and often
mistrust of people from outside the community, pastoralists in sub-Saharan Africa have
very limited access to health education, medical supplies/medicine and medical
facilities. Paired with this, governments and NGOs have very little interest in treating
and supporting pastoralist health as the geographical regions they occupy are on the
margins of society, sometimes in dangerous/conflict prone/cross-border areas and they
have very little political influence.
Urbanization in Sub-Saharan Africa
As a result of urbanization in Sub-Saharan Africa has also given rise to the level of
poverty in the region and many governmental and non-governmental organizations
have attempted to lay considerable emphasis on the issue of addressing the increase in
poverty30
. According to a cautious reckon, reports Hanson (2007), over ‘one-third’ of
Sub-Saharan African population inhabirs the urban areas and the increase will continue
in the coming years31
. Moreover, Hanson (2007) states the statistics collected by the
‘UN population Fund’s State of World Population’ show that seventy per cent of the
population of Sub-Saharan Africa survives ‘under slum conditions’ which tends to
30
Hanson, Stephanie. "Urbanization in Sub-Saharan Africa ." Council on Foreign Relations, 2007
31
As in 32
11
hamper the prospect of economic prosperity32
. These high density, impoverished urban
areas are at a particularly high risk of mortality due to poor health. Although much
attention is paid to these communities by governments and NGOs because of their
close proximity, political influence and highly publicized needs, the explosive rate of
urban migration, lack of infrastructure and declining or stagnate human resource
capacity render any gains marginal. The refugees, migrant labourers and internally
displaced persons living in these areas face the compounded challenges that are
existing for both rural and urban dwellers of the slum areas. Life in overcrowded, non-
permanent dwellings where survival is a daily task is extremely risky when it comes to
communicable and injury related health risks.
Premature mortality
The Global Burden of Disease project undertaken by World Health Organization
attempts to quantify the risks to health based on premature mortality due to a number of
major causes, disaggregated by age, sex and region with a goal to continue tracking
these results in future as well33
. The utility of this endeavour for Human Security lies in
its ability to highlight threats, weakness and trends in who is most at risk in terms of
quantity of life indicators. Not surprisingly an enormous number of all deaths including
communicable, non-communicable and death due to injury occurred in developing
regions with the highest rate of death falling squarely on sub-Saharan Africa.
It is not a surprising fact that the ‘infant and child mortality rate’ in sub-Saharan Africa is
still highest in the world but the immensity of the problem must be gauged from the fact
32
As in 32
33
Lopez, Alan D, and Disease Control Priorities Project. Global burden of disease and risk factors. World Bank
Publications, 2006.
12
that the data to identify the relevant causes of demise is not only inadequate but is of
‘questionable quality’34
. The life expectancy in the region is extremely low and various
diseases, including HIV, serve to exert a horrendous impact on the rate of life
expectancy.
HIV threat
The major threats to Sub-Saharan regions includes making the provision of health care
possible as well as coping with the rise in deaths owing to HIV/AIDS infection. AIDS
was considered a disease in 1980s but it was accompanied by the dreadful realization
that ‘a new epidemic of unprecedented proportions was spreading throughout Sub-
Saharan Africa’35
. The population of Africa is an estimated forty million, as reported by
the World Bank and Jaminson (2006), ’28.5 million’ people were reportedly found to be
infected in Sub-Saharan Africa.36
‘Voluntary testing’, ‘counseling programmes’ and use
of ‘ARVs’ can help in the treatement of AIDS,37
and a heavy imposition of the USAID led
Abstinince, Be faithful, Condom (ABC) policy has been applied to prevent further spread
of the epidimic. Moreover the number of children orphaned as a result of the disease
has increased to a dangerous extent. Boutayeb (2009) discusses the impact of HIV on
the development of the African countries as it is not only a threat in terms of health care
sphere but to all the spheres of life and poses a serious threat to human security in
Africa.38
Threats include economical, infection as a tool of war (including the Rwandan
34
Ewbank, Douglas C, and James N Gribble. Effects of health programs on child mortality in Sub-Saharan Africa.
National Academies Press, 1993, p.1.
35
Jaminson, Tean T, and World Bank. Disease and mortality in Sub-Saharan Africa . World Bank Publications,
2006,p. 237.
36
As in 45, p.237.
37
As in 45, p.242.
38
Boutayeb, Abdesslam. "The impact of HIV/AIDS on human development in African countries." BMC Public
Health, 2009: 1471-2458.
13
genocide), education, public and private service capacity, military infection rates and so
on.
Roles & Responsibilities
If the responsibility of various sectors is assessed it must be concluded that the role of
communities in the wake of human security and health in Africa is the most significant
among all. Educating communities on safe birthing methods, infant care and traditional
harmful practices can only be done effectively by community members themselves.
The instance of African Medical and Research Foundation (AMREF) is important to
discuss when it comes to the role of community as the foundation aims for the provision
of health in Africa as a possible feat in various African countries. Moreover, the
foundation encourages research in the area of health care along with making the
communities strong so that they could be able to aid in improving health care systems.
Although it is easy for donor countries to set agendas that incorporate broad definitions
of human security, the next step of acting on these words has been problematic. The
role to be played by governmental and non-governmental organizations and national
and international community is of utmost importance in regard to the health and human
security in Sub-Saharan Africa.
The role of international community in the provision of support for the purpose of
maintaining human security and health in Africa is said to be ‘critical’39
. The United
Nations has attempted to provide human security frameworks along with ‘national’,
‘societal’ and ‘environmental’ agendas in Africa40
. The ‘human security’ role, notes
Moller (2005), of the UN include the protection of the human beings against the ‘malign
39
As in 2,p.1170
40
As in 1,p.4
14
consequences’ of poverty which victimizes innocent children and women and more
particularly ‘child soldiers and rape victims41
. In 2007 on the eve of the World Health
Day the theme of the event was ‘health security’ with an aim to draw attention of the
various organizations and institutions towards the significance and urgency to invest in
the projects of health in order to make the future safer. The World Health Organization
is charged as the body responsible for world-wide guidance in the field of public health.
After the end of the Cold War nations became sensitive to threats that the world was to
face due to the health crisis making the WHO initiative possible. This sensitivity and
interest of the nations was potentially beneficial for the developing countries like those
in Sub-Saharan Africa where the threats were so dangerous. Various attempts have
been made to formulate global health policy but none have been granted the legitimacy
required to make health a human security issue.
The role of the Non Governmental Organizations is also important but they are often
caught in the middle of what ought to be done and what is being done. However, many
NGOs focus their efforts mainly in urban, easily accesible areas, largely ignoring other
vulnerable populations including the rural and pastoralist communities. Pressures
placed on NGOs from various donors, governments, emergencies and thier own internal
policies makes advocacy work in terms of security and health a low priority.
Conclusion
Human security is indivisible’, reflects Thomas (1999), therefore must be assured to
every member of the society regardless of any impediments as it is the ‘central pillar’ of
41
As in 1,p.5
15
society42
. Moreover, human security must aim to eliminate gulf between polarities
existent in the society or countries43
. By institutionalizing health as a global security
concern we are protecting the agents of sustainable development initiatives, punishing
the perpetrators of insecurity and ensuring a stable future in Africa.
The bottom line is that poor health, like war, will result in avoidable deaths within a
population. Health as a human security issue falls into the widely accepted “freedom
from fear” and also into the much debated ‘freedom from want’ categories. “The
emphasis on conventional security whilst millions die without good reason reflects the
power relations threaded throughout international relations, between rich and poor,
males and females, marginal and included, vulnerable and secure’44
. There is still an
acute need to stay on focusing health as a human security in the Sub-Saharan African
region which is encircled with multiple problems and diseases. Health must now be
considered as a state of emergency.
42
Thomas, Caroline. "Furthering the Debate on Human Security." In Globalization, human security, and the African
experience, by Caroline Thomas and Peter Wilkins, 179-184. Boulder: Lynne Rienner Publishers, 1999,p.183.
43
As in 55,p.183.
44
Roberts, David. "The Science of Human Security: A Response from Political Science." Medicine, Conflict and
Survival, 2008: 16-22.
16
Bibliography
Boutayeb, Abdesslam. "The impact of HIV/AIDS on human development in African
countries." BMC Public Health, 2009: 1471-2458.
Buzan, Barry. People, states, and fear: the national security problem in international
relations. Wheatsheaf Books, 1983.
Ewbank, Douglas C, and James N Gribble. Effects of health programs on child mortality
in Sub-Saharan Africa. National Academies Press, 1993.
Frerks, Georg, and Berma Klein Goldewijk. Human security and international insecurity.
Wageningen Academic Publishers, 2007.
Ganguli, Mary. "Health, human rights, and the Golden Rule." Indian Journal of Medical
Ethics, 2008: 8.
Hanson, Stephanie. "Urbanization in Sub-Saharan Africa ." Council on Foreign
Relations, 2007.
Jaminson, Tean T, and World Bank. Disease and mortality in Sub-Saharan Africa .
World Bank Publications, 2006.
Lartey, Anna. "Maternal and Child Nutrition in Sub-Saharan Africa: Challenges and
Interventions." Proceedings of the Nutrition Society, 2008: 105-108.
Lopez, Alan D, and Disease Control Priorities Project. Global burden of disease and
risk factors. World Bank Publications, 2006.
MacFarlane, Neil S, and Yuen Foong Khong. Human security and the UN: a critical
history. Indiana University Press, 2006.
Mathews, Jessica Tuchman. "Redefining Security." Foreign Affairs, 1989.
17
Michael, Sarah. "The Role of NGOs in Human Security." Commission on Human
Security, 2002: 1-30.
Moller, Bjorn. The United Nations: As a Security Political Actor-With a Special Focus on
Africa. Copenhagen: Danish Institute for National Studies, 2005.
O'Hare, Bernadette, and David Southhall. "First do no harm: the impact of recent armed
conflict on maternal and child health in Sub-Saharan Africa." Journal of the Royal
Society of Medicine, 2007: 564–570.
Paris, Roland. "Human Security: Paradigm Shift or Hot Air?" International Security,
2007: 87-102.
Poku, Nana K, Neil Renwick, and Joao Gomes Porto. "Human security and
development in Africa." International Affairs, 2007: 1155-1170.
Roberts, David. "The Science of Human Security: A Response from Political Science."
Medicine, Conflict and Survival, 2008: 16-22.
Thomas, Caroline. "Furthering the Debate on Human Security." In Globalization, human
security, and the African experience, by Caroline Thomas and Peter Wilkins,
179-184. Boulder: Lynne Rienner Publishers, 1999.

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WS509-final paper

  • 1. HUMAN SECURITY AND HEALTH IN AFRICA Melissa Jennings WS 509 Dr. Hassan-Yari Winter Semester 2010
  • 2. 2 Human Security and Health in Africa Introduction After the Cold War, not only did the context of security change, the concept of security was also changed as it was beginning to be defined in terms of ‘non-military challenges’1 . It is often asked as why health is not considered a part of human security. The answer to the question is difficult to find but various factors contribute to this exclusion. The question of the distribution of health is a puzzling one. In addition the question of who is responsible for setting the security agenda also arises. Moreover the issue of encountering and fulfilling the ‘basic needs and aspirations’ of the African people are also of a central concern when it comes to the discussion of human security and health in Africa2 . Despite the new concern granted in favour of the African people the continent has been ignored owing largely to the ‘traditional imperatives of state interests, power, military force and geopolitical instability,’ thus the notion of security has not achieved the interpretation of humanity and developmental features3 . Until poor health directly affects the quality or quantity of life in developed countries it is unlikely that health will become a practical human security priority. Research Objective This paper seeks to use the broadening and deepening of security parameters as defined by discourses on human security to demonstrate the impact of child and 1 Poku, Nana K, Neil Renwick, and Joao Gomes Porto. "Human security and development in Africa." International Affairs, 2007: 1155-1170,p.1155. 2 Ibid., p.1155 3 Ibid., p.1155
  • 3. 3 maternal health of Sub-Saharan Africans on human security as it has direct implications in terms of quantity and quality of life. This paper will lay a ground work for discussing health, examining the definition of human security and how health in Sub-Saharan Africa is a human security issue. Moreover, the role of the communities, governments and the developing world is analyzed. Research Questions • How is human security is related to health in Sub-Saharan Africa? • What are the factors that weaken the relationship? Research Methodology The research makes the use of secondary sources to explore the impact of child and maternal health of the Sub-Saharan Africans on human security. The secondary sources include books, journal articles, etc. Moreover the researcher uses field research done on Ethiopia in order to make the interpretation of the relationship between health and human security in Africa clear. Research Analysis Shift of interest towards Health Care as Human Security By the end of the European World Wars, the focus of Human security had evolved in the West as the protection of refugees, reconstruction after the conflicts and identity rights were the focus of individual security needs. The period after World War Two also demanded a shift in discourse, as the state proved unable to provide physical and
  • 4. 4 psychological protection from security threats4 . The Cold War era, although dominated by national security policy, still had room for humanistic focus; for instance, states Buzan (1983), which included the three pillars of identity, institutions and population in order to sustain a sovereign state5 . Buzan (1983), in his discussion of nations, states and nation-states, further explored the role of individual identity (identities) in state creation and maintenance6 . According to Buzan (1983), individual security is a societal concern with four types of societal threats, physical, economic, rights, and position/status, all of which are not mutually exclusive7 . By 1989, Tuchman Mathews had expanded on Buzan’s list of threats to human security and included overpopulation, patterns of land tenure, the environment and reproductive health as well8 . The 1994 Human Development Report was the first to approach the subject in a formalized way by presenting the freedom from fear, freedom from want agenda. The report goes further in defining seven aspects of HS, the third one being health security9 . Already an influence on setting the tone for global security discourse, the United Nations Development Program’s 1994 Human Development Report is generally recognized as the watershed moment for the international recognition of human security as a priority. The Report is all-encompassing and integrative, in that it includes an urging for the protection of seven elements of HS — economic, food, health, 4 MacFarlane, Neil S, and Yuen Foong Khong. Human security and the UN: a critical history. Indiana University Press, 2006. 5 Buzan, Barry. People, states, and fear: the national security problem in international relations. Wheatsheaf Books, 1983. 6 as in 10 7 As in 10 8 Mathews, Jessica Tuchman. "Redefining Security." Foreign Affairs, 1989. 9 United Nations Development Programmed, Human Development Report, 1994 (New York: Oxford University Press, 1994), p. 24.
  • 5. 5 environmental, personal, community and political security.10 Later attempts to narrow the concept of human security have run into problems with value judgments, cultural relatively and exclusion, as will be outlined here in a later section. Since 1994, a pivotal year in terms in of human security as a result of the UNDP Report mentioned earlier and the Rwandan Genocide, the relationship between states and individuals in terms of human security has come under greater international scrutiny, with a focus on development, peace building, policy and military-strategic approaches. The concept of human security today thus represents a major shift in the way government, organizations, academics and individuals think about human security, as it places greater legal emphasis on the welfare of ordinary people. Political theorist, Roland Paris, has defined human security as a category of security studies research, reserved for studies of non military threats to the protection of people and entities, community11 . Arguing that there is a lack of evidence to support the theory of a paradigm shift in security studies towards human security, Paris has compartmentalized ever existing issues to better navigate the complexities of analyzing security threats. This contrasts with the widening discourse, led by Buzan and the Copenhagen school, which includes individuals and communities as potential subjects of threats.12 A Constructivist understanding is one that further involves non state actors as responders to security threats rather than just victims13 . 10 UNDP. UN Human Development Report. (New York: Oxford University Press, 1994). 11 Paris, Roland. "Human Security: Paradigm Shift or Hot Air?" International Security, 2007: 87-102. 12 Frerks, Georg, and Berma Klein Goldewijk. Human security and international insecurity. Wageningen Academic Publishers, 2007. 13 As in 17
  • 6. 6 Paris’ cells do not offer categories for complex emergencies or the interdependence of threats, nor does it explain the role of various actors. Regardless of whether or not academia or policy-makers in the West have decided that there has been a paradigm shift towards individual security in the developing world this is moot point. Security issues for the majority of the world’s population are indeed more inclusive than survival of inter-state warfare or avoiding super-power conflict; they include power, vulnerability, accessibility and disconnection in an increasingly globalized world. From the Realist perspective, Human Security based in the UNDP’s freedom from fear, freedom from want agenda has been determined as too broad to be considered for policy. It is my aspiration, says Kofi Annan (the former Secretary General of the United Nations), that health will finally be seen not as a blessing to be wished for but as a human right to be fought for14 . The altruism of Annan’s statement, as quoted by Ganguli (2008), is evident from the fact that health is so important an aspect of human life but it has been ignored by policy makers and public speakers whenever they talk discuss security. Aim and objective of Human Security in Africa Making a link between health and human security requires some indirect associations as well as illuminating some often overlooked relationships between cause and effect in time of war and peace. Some researchers are of the view that if a life is lost precociously then it is an enormous insecurity to the human beings. One aim of human security has been to arm people against health threats or illnesses15 . As soon as the Sub-Saharan African countries gained independence they engaged in multifarious 14 Ganguli, Mary. "Health, human rights, and the Golden Rule." Indian Journal of Medical Ethics, 2008: 8 15 Michael, Sarah. "The Role of NGOs in Human Security." Commission on Human Security, 2002: 1-30, p.1.
  • 7. 7 conflicts which also asserted a profound impact on ‘maternal and child health’ and the ratio of demise as a consequence of ‘malnutrition’ has increased to a perilous extent16 . Although one of the first African leaders, Kwame Nkrumah, celebrated in 1954 for his aim to make the Gold Coast a paradise once independence was gained but he, along with many others narrowed the notion of paradise in order to focus on military security while he ignored issues around the health perspective17 . The most important of all tasks, that of building a ‘prosperous society’ was utterly ignored18 . Threats to Health Care & Public Health Emergencies These include emerging new diseases that include SARS, Avian Influenza etc. Moreover, as well as emergencies that require responses on a humanitarian basis. These emergencies could result from changes in climate conditions such as degradation of environmental setup or potential threats to an entire population which requires swift responses by health bodies. In response to those health issues that could have potential impact on the people, overall society and economy, international health security plays a most important role. ICESCR, International Covenant on Economic, Social and Cultural Rights, by the General Assembly of the UN, in 1996, is aimed to make human rights accessible and feasible for all individuals, including rights to primary health care resources and facilities. There has been a lack of statistics to manifest the meticulous details regarding the number of deaths as a result of malnutrition; moreover the absence of adequate system 16 O'Hare, Bernadette, and David Southhall. "First do no harm: the impact of recent armed conflict on maternal and child health in Sub-Saharan Africa." Journal of the Royal Society of Medicine, 2007: 564–570. 17 As in 2,p.1156 18 As in 2,p.1156
  • 8. 8 for ‘registration’ of the birth and death further aggravates the problem19 . In addition ‘internally displaced persons’ in Sub-Saharan Africa are prone to the threats of abuse and violence20 . As an example, O'Hare and Southhall (2007) report on the increase in ‘maternal mortality’ during conflict in Congo and also the increase in ‘child mortality rate’ among displaced persons which makes the condition grave21 . O'Hare and Southhall (2007) segregate death rates into ‘direct conflict deaths’ and ‘indirect conflict deaths’22 . Where the first category includes demise as a consequence of bloodshed, the second category includes demise as a result of illness and starvation. There are many aspects of health that directly affect human security which include food and nutrition, water and sanitation, disease, child and maternal/ sexual and reproductive health. These aspects pose threats to security and insert direct impact on quantity of life. The Most affected Group The most ‘vulnerable group’, say MacFarlane and Foong Khong (2006), include children, ‘women in war’ and ‘displaced persons’ whose protection is of utmost importance23 . As women, particularly pregnant women, and children are more prone to the threats of malnutrition therefore ‘maternal malnutrition’ has become an important element in ‘morbidity and mortality’ in African women and 20 % of these pregnant women have a ‘low BMI as a result of chronic hunger’24 . The insuficient access to food, multifarious diseases and infections as well as ‘suboptimal infant feeding practices’ all 19 As in 6 20 As in 6 21 As in 6 22 As in 6 23 As in 9,p.202 24 Lartey, Anna. "Maternal and Child Nutrition in Sub-Saharan Africa: Challenges and Interventions." Proceedings of the Nutrition Society, 2008: 105-108, p.105.
  • 9. 9 contribute to increased rate of deaths of children25 . Moreover, various environmental and economical factors also pose problems for children and women in the regions of Sub-Saharan Africa26 . The threat of HIV infection is also enormous due to disease transmission when the HIV infected mothers breast-feed their children making them prone to the infection as well27 . While it is accepted that mothers are the pillars of any sustainable community development initiative, women and particularly mothers receive very little in terms of support and recognition for their role in communities and the problem becomes acute when it comes to the context of Sub-Saharan Africa. With their many capabilities women and mothers raise children, produce and sell food, work in the formal and informal sector, participate in politics and micro-enterprise among other things. Child soldiers, human trafficking, rape as tool of war, preventable births and deaths, gender based violence are all major problems concerning mothers in Africa. “A woman in sub-Saharan Africa has a 1 in 16 chance of dying in pregnancy or childbirth, compared to a 1 in 4,000 risk in a developing country”28 . Children born in developing countries, of which all Sub-Saharan countries are, are over 13 times more likely to die under the age of 5 than children born in developed countries29 . Women and children in impoverished areas of sub-Saharan Africa are at heightened risk due to the patriarchal system at local social level. Any threats that men and boys face in pastoralists/rural environment along with environment with dense population, urban or 25 As in 25, p.105. 26 As in 25,p.105 27 As in 25,p.106 28 UNICEF, “5. Improve Maternal Health,” Millennium Development Goals, Accessed 10 March 201: http://www.unicef.org/mdg/maternal.html 29 United Nations Development Program, “Reduce Child Mortality,” MDG Monitor: Tracking the Millennium Development Goals, 2007. Accessed 10 March 2010: http://www.mdgmonitor.org/goal4.cfm
  • 10. 10 rural settings, for women these are compounded by their denied access to nutrition, maternal/pre/post-natal health and opportunities including literacy and education shape their health indicators and consequently their human security. The people most affected by health security are those that lack access to treatment and prevention tools including various vulnerable groups such as the rural and urban poor. Due to their constant mobility, occupying life on the periphery of society and often mistrust of people from outside the community, pastoralists in sub-Saharan Africa have very limited access to health education, medical supplies/medicine and medical facilities. Paired with this, governments and NGOs have very little interest in treating and supporting pastoralist health as the geographical regions they occupy are on the margins of society, sometimes in dangerous/conflict prone/cross-border areas and they have very little political influence. Urbanization in Sub-Saharan Africa As a result of urbanization in Sub-Saharan Africa has also given rise to the level of poverty in the region and many governmental and non-governmental organizations have attempted to lay considerable emphasis on the issue of addressing the increase in poverty30 . According to a cautious reckon, reports Hanson (2007), over ‘one-third’ of Sub-Saharan African population inhabirs the urban areas and the increase will continue in the coming years31 . Moreover, Hanson (2007) states the statistics collected by the ‘UN population Fund’s State of World Population’ show that seventy per cent of the population of Sub-Saharan Africa survives ‘under slum conditions’ which tends to 30 Hanson, Stephanie. "Urbanization in Sub-Saharan Africa ." Council on Foreign Relations, 2007 31 As in 32
  • 11. 11 hamper the prospect of economic prosperity32 . These high density, impoverished urban areas are at a particularly high risk of mortality due to poor health. Although much attention is paid to these communities by governments and NGOs because of their close proximity, political influence and highly publicized needs, the explosive rate of urban migration, lack of infrastructure and declining or stagnate human resource capacity render any gains marginal. The refugees, migrant labourers and internally displaced persons living in these areas face the compounded challenges that are existing for both rural and urban dwellers of the slum areas. Life in overcrowded, non- permanent dwellings where survival is a daily task is extremely risky when it comes to communicable and injury related health risks. Premature mortality The Global Burden of Disease project undertaken by World Health Organization attempts to quantify the risks to health based on premature mortality due to a number of major causes, disaggregated by age, sex and region with a goal to continue tracking these results in future as well33 . The utility of this endeavour for Human Security lies in its ability to highlight threats, weakness and trends in who is most at risk in terms of quantity of life indicators. Not surprisingly an enormous number of all deaths including communicable, non-communicable and death due to injury occurred in developing regions with the highest rate of death falling squarely on sub-Saharan Africa. It is not a surprising fact that the ‘infant and child mortality rate’ in sub-Saharan Africa is still highest in the world but the immensity of the problem must be gauged from the fact 32 As in 32 33 Lopez, Alan D, and Disease Control Priorities Project. Global burden of disease and risk factors. World Bank Publications, 2006.
  • 12. 12 that the data to identify the relevant causes of demise is not only inadequate but is of ‘questionable quality’34 . The life expectancy in the region is extremely low and various diseases, including HIV, serve to exert a horrendous impact on the rate of life expectancy. HIV threat The major threats to Sub-Saharan regions includes making the provision of health care possible as well as coping with the rise in deaths owing to HIV/AIDS infection. AIDS was considered a disease in 1980s but it was accompanied by the dreadful realization that ‘a new epidemic of unprecedented proportions was spreading throughout Sub- Saharan Africa’35 . The population of Africa is an estimated forty million, as reported by the World Bank and Jaminson (2006), ’28.5 million’ people were reportedly found to be infected in Sub-Saharan Africa.36 ‘Voluntary testing’, ‘counseling programmes’ and use of ‘ARVs’ can help in the treatement of AIDS,37 and a heavy imposition of the USAID led Abstinince, Be faithful, Condom (ABC) policy has been applied to prevent further spread of the epidimic. Moreover the number of children orphaned as a result of the disease has increased to a dangerous extent. Boutayeb (2009) discusses the impact of HIV on the development of the African countries as it is not only a threat in terms of health care sphere but to all the spheres of life and poses a serious threat to human security in Africa.38 Threats include economical, infection as a tool of war (including the Rwandan 34 Ewbank, Douglas C, and James N Gribble. Effects of health programs on child mortality in Sub-Saharan Africa. National Academies Press, 1993, p.1. 35 Jaminson, Tean T, and World Bank. Disease and mortality in Sub-Saharan Africa . World Bank Publications, 2006,p. 237. 36 As in 45, p.237. 37 As in 45, p.242. 38 Boutayeb, Abdesslam. "The impact of HIV/AIDS on human development in African countries." BMC Public Health, 2009: 1471-2458.
  • 13. 13 genocide), education, public and private service capacity, military infection rates and so on. Roles & Responsibilities If the responsibility of various sectors is assessed it must be concluded that the role of communities in the wake of human security and health in Africa is the most significant among all. Educating communities on safe birthing methods, infant care and traditional harmful practices can only be done effectively by community members themselves. The instance of African Medical and Research Foundation (AMREF) is important to discuss when it comes to the role of community as the foundation aims for the provision of health in Africa as a possible feat in various African countries. Moreover, the foundation encourages research in the area of health care along with making the communities strong so that they could be able to aid in improving health care systems. Although it is easy for donor countries to set agendas that incorporate broad definitions of human security, the next step of acting on these words has been problematic. The role to be played by governmental and non-governmental organizations and national and international community is of utmost importance in regard to the health and human security in Sub-Saharan Africa. The role of international community in the provision of support for the purpose of maintaining human security and health in Africa is said to be ‘critical’39 . The United Nations has attempted to provide human security frameworks along with ‘national’, ‘societal’ and ‘environmental’ agendas in Africa40 . The ‘human security’ role, notes Moller (2005), of the UN include the protection of the human beings against the ‘malign 39 As in 2,p.1170 40 As in 1,p.4
  • 14. 14 consequences’ of poverty which victimizes innocent children and women and more particularly ‘child soldiers and rape victims41 . In 2007 on the eve of the World Health Day the theme of the event was ‘health security’ with an aim to draw attention of the various organizations and institutions towards the significance and urgency to invest in the projects of health in order to make the future safer. The World Health Organization is charged as the body responsible for world-wide guidance in the field of public health. After the end of the Cold War nations became sensitive to threats that the world was to face due to the health crisis making the WHO initiative possible. This sensitivity and interest of the nations was potentially beneficial for the developing countries like those in Sub-Saharan Africa where the threats were so dangerous. Various attempts have been made to formulate global health policy but none have been granted the legitimacy required to make health a human security issue. The role of the Non Governmental Organizations is also important but they are often caught in the middle of what ought to be done and what is being done. However, many NGOs focus their efforts mainly in urban, easily accesible areas, largely ignoring other vulnerable populations including the rural and pastoralist communities. Pressures placed on NGOs from various donors, governments, emergencies and thier own internal policies makes advocacy work in terms of security and health a low priority. Conclusion Human security is indivisible’, reflects Thomas (1999), therefore must be assured to every member of the society regardless of any impediments as it is the ‘central pillar’ of 41 As in 1,p.5
  • 15. 15 society42 . Moreover, human security must aim to eliminate gulf between polarities existent in the society or countries43 . By institutionalizing health as a global security concern we are protecting the agents of sustainable development initiatives, punishing the perpetrators of insecurity and ensuring a stable future in Africa. The bottom line is that poor health, like war, will result in avoidable deaths within a population. Health as a human security issue falls into the widely accepted “freedom from fear” and also into the much debated ‘freedom from want’ categories. “The emphasis on conventional security whilst millions die without good reason reflects the power relations threaded throughout international relations, between rich and poor, males and females, marginal and included, vulnerable and secure’44 . There is still an acute need to stay on focusing health as a human security in the Sub-Saharan African region which is encircled with multiple problems and diseases. Health must now be considered as a state of emergency. 42 Thomas, Caroline. "Furthering the Debate on Human Security." In Globalization, human security, and the African experience, by Caroline Thomas and Peter Wilkins, 179-184. Boulder: Lynne Rienner Publishers, 1999,p.183. 43 As in 55,p.183. 44 Roberts, David. "The Science of Human Security: A Response from Political Science." Medicine, Conflict and Survival, 2008: 16-22.
  • 16. 16 Bibliography Boutayeb, Abdesslam. "The impact of HIV/AIDS on human development in African countries." BMC Public Health, 2009: 1471-2458. Buzan, Barry. People, states, and fear: the national security problem in international relations. Wheatsheaf Books, 1983. Ewbank, Douglas C, and James N Gribble. Effects of health programs on child mortality in Sub-Saharan Africa. National Academies Press, 1993. Frerks, Georg, and Berma Klein Goldewijk. Human security and international insecurity. Wageningen Academic Publishers, 2007. Ganguli, Mary. "Health, human rights, and the Golden Rule." Indian Journal of Medical Ethics, 2008: 8. Hanson, Stephanie. "Urbanization in Sub-Saharan Africa ." Council on Foreign Relations, 2007. Jaminson, Tean T, and World Bank. Disease and mortality in Sub-Saharan Africa . World Bank Publications, 2006. Lartey, Anna. "Maternal and Child Nutrition in Sub-Saharan Africa: Challenges and Interventions." Proceedings of the Nutrition Society, 2008: 105-108. Lopez, Alan D, and Disease Control Priorities Project. Global burden of disease and risk factors. World Bank Publications, 2006. MacFarlane, Neil S, and Yuen Foong Khong. Human security and the UN: a critical history. Indiana University Press, 2006. Mathews, Jessica Tuchman. "Redefining Security." Foreign Affairs, 1989.
  • 17. 17 Michael, Sarah. "The Role of NGOs in Human Security." Commission on Human Security, 2002: 1-30. Moller, Bjorn. The United Nations: As a Security Political Actor-With a Special Focus on Africa. Copenhagen: Danish Institute for National Studies, 2005. O'Hare, Bernadette, and David Southhall. "First do no harm: the impact of recent armed conflict on maternal and child health in Sub-Saharan Africa." Journal of the Royal Society of Medicine, 2007: 564–570. Paris, Roland. "Human Security: Paradigm Shift or Hot Air?" International Security, 2007: 87-102. Poku, Nana K, Neil Renwick, and Joao Gomes Porto. "Human security and development in Africa." International Affairs, 2007: 1155-1170. Roberts, David. "The Science of Human Security: A Response from Political Science." Medicine, Conflict and Survival, 2008: 16-22. Thomas, Caroline. "Furthering the Debate on Human Security." In Globalization, human security, and the African experience, by Caroline Thomas and Peter Wilkins, 179-184. Boulder: Lynne Rienner Publishers, 1999.