At the end of 2008, the National Intelligence Council released report ICA 2008-10D, titled “Strategic Implications of Global Health“. The report expanded on the 2000 National Intelligence Estimate on the threats from infectious diseases to the United States by including a wider variety of global health issues, including malnutrition and maternal mortality.
Below is a summary of the report’s key findings (regarding threats). I have italicized points directly relevant to stability and armed conflict.
Reconstruction and Stabilization:
- Inability of the central government of Afghanistan to provide health-care and other services has helped to undermine its credibility while boosting support for a resurgent and increasingly sophisticated Taliban.
- A degraded health sector, shortages of medical personnel, and infections stemming from deficient sanitary conditions and lack of clean drinking water in Iraq have undermined the credibility of the central government.
- In both countries poor reproductive health among girls and women is a major impediment to advancing female education and workforce participation, both of which are important to enhancing prospects for economic growth.
- Russia has the overall worst health indicators of any industrialized country, and poor health undercuts efforts to diversify economic activity away from oil into more skill-intensive and value-added sectors. Poor health of Russian children and young people combined with falling birthrates also threatens Russian military readiness.
- China’s high incidence of chronic disease—stemming in great part from heavy tobacco use —threatens to slow Chinese economic growth by incapacitating workers and incurring heavy health-care costs. The health effects of industrial pollution are an increasing source of discontent in China, while the recent outcry over contaminated baby formula seemed to weaken government credibility regarding the ability of the government to ensure public health and safety.
- India suffers from rampant malnutrition and anemia that cross all socio-economic classes, putting the majority of Indian children at high risk for impaired physical and cognitive disabilities.
Adversarial States and Nonstate Actors:
- Malnutrition-related cognitive disabilities among North Korean children and young people likely will impact future economic growth in that country regardless of when Pyongyang opens to the outside world or reunifies with the South. Nationwide malnutrition has compelled Pyongyang to lower minimum height and weight requirements for military service, and an estimated 17 to 29 percent of potential North Korean military conscripts between 2009 and 2013 will have cognitive deficiencies disqualifying them for service.
- Venezuela and Cuba have been particularly adept at parlaying provision of charitable medical services to nationals of other countries into support in international forums such as the United Nations.
- Hezbollah’s provision of health and social services in Lebanon over the past 20 years has helped to legitimize the organization as a political force in that country, while HAMAS’s delivery of similar services was a factor in its winning of legislative elections in the Palestinian territories.
Overall, the report is spot on. Global health is not the exclusive realm of aid workers and Irish musicians. Rather, the health of other countries has significant tactical, operational, strategic, and grand strategic implications for the United States. Rising global interdependence only increases the importance of global health and the need to incorporate health into foreign policy. Beyond its contents, the report is indicative of Washinton’s increased interest in the implications of health in international politics and conflict.
Christopher R. Albon is a political science Ph.D. specializing in armed conflict, public health, human security, and health diplomacy.