Global Health and International Relations
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Health is traditionally perceived as a domestic issue in politics. With the globalisation and increasing interdependence of states, health has become an important foreign policy and diplomatic concern that has implications for security, economics and international development. In recent years, the world has witnessed an increasing interaction between international relations and health due to the reasons such as involvement of intergovernmental organisations, impact of the transnational epidemics, and the problem of access to drug treatment for poor populations as part of human rights. Thus, because of its social and economic effects as well as its geopolitical and security implications, health has become a major factor in international relations. The recognition of health as an important issue in global politics requires greater policy coherence both domestically and internationally.
Global Health and International Relations by McInnes and Lee mainly argues that achieving this coherence requires better understanding of the relation between health and International Relations. It examines the topic of health from an International Relations perspective as opposed to the majority of related works on health, which have treated the issue as part of domestic politics and public policy. Thus, the authors of the book fill a gap in literature with their research by exploring not only the issue of health, but also the importance of its place in International Relations. They question whether the emergence of health onto the agenda of International Relations serves for any purpose from a social constructivist perspective (p. 24).
It is possible to divide the book into six sections based on specific thematics, with Chapter One acting as an introduction to the global health issue with a broad discussion of the topic. Chapter Two is where the authors explain the emergence of health as an agenda in International Relations. Chapter Three is an illustration of the health issue as part of foreign policy and the importance of global health diplomacy. Chapter 4 focuses on the global health from an International Political Economy perspective. Chapter Five examines the global health governance as a concept and discusses its pros and cons whereas the Sixth Chapter primarily focuses on the security dimension of the health issue in International Relations. The conclusion chapter offers a summary, comparison and evaluation of the analysis made.
McInnes and Lee question why the health as a subject could not have been incorporated into the discipline of International Relations by claiming that health has been ignored by the discipline. By taking a social constructivist stand, McInnes and Lee suggest that health was ignored because the interests of the states were not created in a way that would allow them to engage with this question (p. 30). The health issue has traditionally been left as a competence of the states that could not be interfered by the others. However, globalisation had impacted the perception of health as well and explaining the globalisation of the issue requires taking a step away from traditional rationalist theories and taking a more reflectivist position. The authors argue that the relationship between global health and International Relations is not a natural response of the states to an evolving circumstance, but the relationship itself is something that has been constructed in a particular way, resulting in an emphasis on certain issues rather than others. Thus, according to McInnes and Lee, a useful question would be “why” instead of “what” (p. 159).
The framing of the health issue can be in the form of political economy, security or foreign policy. These frameworks comprise set of values that shape the articulation of ideas, interests and institutions and even the definition of global health. Consequently, these frameworks construct the attitude of the states towards the global health and explain the relationship between health and International Relations.
Much of the book is devoted to assisting readers understand these frameworks. However, the difference between the concept of global health and international health is not defined properly. The authors refuse to use the term “international health” unlike previous works in literature, but ignore the fact that the readers may not get the difference. Relatedly, the improper identification of the “frameworks” creates a theoretical obstacle for the analysis. Why political economy, security and foreign policy are used as frameworks that construct the idea of global health is not explained thoroughly. Thus, a better analysis would be discussing whether other frameworks such as gender and development could be included for a better analysis.
Another theoretical shortcoming is the lack of discussion about the reason of focusing solely on social constructivism. What are the advantages of looking from a reflectivist perspective compared to other theories of IR? Although, the authors keep away from rationalist explanations, they still focus on the individual Western states and their behaviours on health issues.
The discussion of global health governance in the Chapter Five may not satisfy the reader as it fails to explain the place of developing and underdeveloped countries in the global governance. Furthermore, there is lack of discussion about to what extent the global governance of health can be effective and how. Thus, global governance of health is presented as the Western governance of health in the book in which neither the place of non-Western states nor its effectiveness is clear.
Despite these shortcomings, the Global Health and International Relations is a significant contribution to the literature on health and International Relations. McInnes and Lee fill a gap in the literature by presenting the issue from a social constructivist perspective. The analysis illustrates how the normative frameworks construct the issue of health in IR as well. Despite the traditional rationalist perspectives, the book shows that these frameworks construct the attitude of the states towards the health and explain the place of health in International Relations.