Germs, Norms and Power: Global Health’s Political Revolution

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Law, Social Justice & Global Development
(An Electronic Law Journal)

Germs, Norms and Power: Global Health’s Political Revolution

David P Fidler

Professor of Law and Ira C Batman Faculty Fellow,

School of Law

University of Indiana, USA and

Senior Faculty Fellow,

Center for the Law and the Public’s Health,

Georgetown and John Hopkins Universities, USA.

This is a refereed article published on: 4 June 2004

Citation: Fidler, D P, ‘Law and the Commodification of Health Care in Tanzania’, 2004 (1) Law, Social Justice & Global Development Journal (LGD).


Global health has undergone a political revolution in the last fifteen years. From a neglected area of international politics, public health has emerged prominently on the agendas of many policy areas in international relations, including national security, international trade, economic development, globalization, human rights, and global governance. This political revolution has occurred because of crises posed by infectious diseases (germs), ferment in thinking about policy responses to these crises (norms), and the need to engage material resources and capabilities to contain and mitigate the pathogenic threat (power). This article examines each aspect of global health’s political revolution to understand how germs, norms, and power converge in a manner that illuminates not only the global struggle to protect health but also 21st century international politics. The analysis of the growing infectious disease threat examines both the threat of biological weapons and emerging and re-emerging infectious diseases. The exploration of the ferment in norms probes three different conceptual frameworks that have emerged to structure responses to pathogenic threats. The consideration of the role of power focuses on the impact on global health’s political revolution of the preponderance of US power in today’s international system. The article also examines dilemmas that appear in the germs, norms, and power elements of the political revolution that call into question the meaning and sustainability of global health’s new-found importance in foreign policy and international relations. Global health’s political revolution remains enigmatic and incomplete, meaning that both danger and opportunity await this area of world politics.

Keywords: Bioterrorism, Foreign Policy, Global Health Global Health Governance, Global Public Goods for Health, Globalization, Governance, Infectious Diseases, National Security, Norms, Power, Public Health, Right to Health, Weapons of Mass Destruction, Westphalian, Post-Westphalian, World Health Organisation

1. Introduction

Dramatic change marks the history of health as an issue in international relations. Health’s emergence as a foreign policy concern in the mid-19th century, when European nations began to confront cooperatively the cholera menace, represents one such dramatic transition in how health was conceptualised and approached internationally. Subsequent treaties and international health organisations also transformed health as a foreign policy concern. Technological developments, especially antibiotics and vaccines, also produced change for public health globally.

These examples of changes in international health reveal and obscure. They reveal that health has long been a foreign policy issue. Given this history, ‘health as foreign policy’ is not a novel idea. The examples obscure that health has historically been relegated to the foreign policy fringe of technical assistance and humanitarianism. The lack of interest in health by those studying foreign policy and international relations compounded the neglect (Lee, K and Zwi, A, 2003, p 13; Kickbusch, I, 2003, p 192). Given this situation, ‘health as foreign policy’ was not an important diplomatic activity.

Dramatic change has, however, again visited health as an issue in international relations. In the past decade, health emerged from obscurity and neglect to affect many foreign and international policy agendas. Health now features prominently in debates concerning national and homeland security, international trade, economic development, globalisation, human rights, and global governance. The attention health has received in the past ten years in national and international politics is unprecedented. Kickbusch (2003, pp 192-93) captured this change:

The protection of health is no longer seen as primarily a humanitarian and technical issue relegated to a specialised UN agency, but more fully considered in relation to the economic, political, and security consequences for the complex post-Cold War system of interdependence. This has led to new policy and funding initiatives at many levels of governance and a new political space within which global health action is conducted.
Health as a global issue has undergone a political revolution in the last decade. Health’s emergence into the ‘high politics’ of international relations is a complicated and controversial development. Global health’s political revolution means that traditional approaches to, and attitudes about, public health have been ripped from their moorings and set afloat on a volatile sea. This article examines global health’s political revolution by analyzing its components and how they relate to each other in an attempt to understand the meaning of this revolution for global health’s future.
Revolutions constitute radical changes within existing political systems, and they typically involve three elements: (1) a crisis with the status quo; (2) a challenge from normative ideas different from those operative in the existing system; and (3) the application of material power to install the new ideas as the basis for future action. The article explores each of these elements in connection with global health’s transformation as an issue in international relations.
The crisis comes from threats posed by infectious diseases (germs). The mounting microbial menace has stimulated ferment among policy responses that seek to supercede existing strategies and alter how state and non-state actors address pathogenic threats (norms). The competing ideas require material resources and capabilities to contain and mitigate the microbial challenge to health (power).
How germs, norms, and power converge shapes the nature of global health’s political revolution. I argue that the political revolution remains enigmatic, and the enigma raises questions about the revolution’s impact and sustainability. Global health’s political revolution serves as a window on the future of not only the protection of health but also 21st century world politics.

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