The Nineteenth Century Colonial Fingerprints on Public Health Diplomacy: A Postcolonial View
Dr Obijiofor Aginam
Assistant Professor of Law, Carleton University,
This is a refereedarticle published on: 30 April 2003
Citation: Aginam, O, ‘The Nineteenth Century Colonial Fingerprints on Public Health Diplomacy: A Postcolonial View’, 2003 (1) Law, Social Justice & Global Development Journal
This article explores the legacy, which the colonial origins of 19th century public health multilateral initiatives bequeathed to present day public health diplomacy, and how this legacy exacerbates South-North health divide. The colonial origins of public health diplomacy is traceable to the European-led International Sanitary Conferences, which were catalysed by the outbreaks and cross-border spread of deadly cholera epidemics from the 1830s. Besides the efforts of European states to harmonise quarantine, share epidemiological information on disease surveillance, and create a multilateral health institution, this article argues that there was as well a conscious effort to insulate Europe from the exotic diseases of ‘barbarians’ - widely thought to be endemic in the ‘uncivilised world’. This latter phenomenon, with its roots in the Age of Columbus, has its visible fingerprints in contemporary public health diplomacy in the forms of hegemony and systematic exclusion. Well over 3.3 billion people in the world are banished to the penitentiary of health insecurity. Global health governance continuously oscillates between Uppendra Baxi’s ‘Global Neighbourhood’ and ‘Universal Otherhood’, a disguised and conscious approval of the 15th century civilised-barbarian construct. The New Globalism, which has immersed all of humanity in a single microbial sea, is a catalyst that compels us to reconfigure the structures of global health governance based on enlightened self-interest.
Keywords: Globalisation of Public Health, Colonialism, South-North Health Divide, International Sanitary Conferences, Age of Columbus, the New World, the Old World, Quarantine, Cordon Sanitaire, Hegemony, Systematic Exclusion, New Globalism, Global Governance, Multilateralism, Cholera
Earlier versions of this paper were presented at the International Law Weekend (ILW) 2001 of the American branch of the International Law Association, New York, and the Postcolonial Law Conference (Pocols), Manning Park, British Columbia, Canada, 2 –6 June 2002. I should like to thank Ralph Wilde of the Trinity College, Cambridge University who chaired the panel on ‘The Limits of International Law’ at the New York meeting and invited me to explore the colonial legacy and global public health as a panellist. I should also like to thank Professors W Wes Pue, University of British Columbia, and Obiora Chinedu Okafor, Osgoode Hall Law School, York University, for inviting me to the Manning Park conference, Professors Ivan L. Head, OC, QC, Stephan Salzberg, and Karin Mickelson for their critical comments on the first draft of this article, which was written during my doctoral studies at the University of British Columbia. I am personally responsible for all shortcomings in this article.
‘Thus, the 11th International Sanitary Conference in 53 years had as its essential purpose the protection of Europe against the importation of exotic diseases …’
– Norman Howard-Jones - ‘…central elements of 19th century international law are reproduced in current approaches to international law and relations.’
– Antony Anghie - ‘….bacteria and viruses travel almost as fast as money. With globalisation, a single microbial sea washes all of humankind …’
– Gro Harlem Brundtland -
1. Microbacterial Unification of the World
Public health, especially the transnational spread of infectious and certain non-communicable diseases, has long emerged as a global issue within the policy and intellectual edifice of global governance. While Norman Howard-Jones (1995, p 85) and Antony Anghie (1999, p 8) in the quotes above, capture the colonial setting in which the 19th century public health diplomacy evolved, Gro-Harlem Brundtland (2001, p 1) captures the challenge posed to humanity’s health by the phenomenon of globalisation in today’s world. In a litany of seminal works, lawyers, epidemiologists and political scientists have explored the dynamic linkage of public health and global interdependence as the ‘globalisation of public health’ – the obsolescence of the erstwhile traditional distinction between national and international public health risks (see Yach and Bettcher, 1998a; Yach and Bettcher, 1998b; Walt, 1998; Fidler, 1997; Lee and Dodgeson, 2000). The multiple dynamics of public health in an interdependent world face a dual-pronged challenge of effectively placing public health within the agenda of global governance, and the more complex task of delivering the dividends of health security evenly across vulnerable societies in a sharply divided world.
Very few, if any, international scholars explore the legacy, which the colonial origins of 19th century infectious disease diplomacy bequeathed to present-day public health diplomacy, and how this legacy exacerbates South-North health divide in the relations of nations and peoples in a supposedly postcolonial world. Medical historians have inundated postcolonial scholarship with incisive accounts of the inseparability of disease and colonialism in the Age of Columbus, as evidenced by the decimation of American Native Indian populations by imported European diseases (measles, mumps, scarlet fever, smallpox), and how the New World ‘returned the favour’, arguably with syphilis (Watts, 1997; Hays 1998; McNeil, 1976; Porter, 1999). While extant literature is replete with infallible historical evidence of the ‘transnationalisation’ of disease in the 19th century colonial project, the colonial origins of public health diplomacy in this important epoch in history and its implications for present-day multilateral public health initiatives remain largely recondite in legal scholarship.
This article explores the colonial origins of public health diplomacy in the 19th century ‘Euro-centric’ International Sanitary Conferences 1851-1897. The international sanitary conferences, according to a preponderance of opinion, were motivated by the mortality burdens of cholera epidemics that spread across Europe from the 1830s, and the need, inter alia, to harmonise inconsistent national quarantine regulations, share epidemiological information, and establish a multilateral health organisation with a mandate on disease surveillance. This article explores an often neglected question: whether European nation-states, through the multilateral health governance structures created by the 19th century international sanitary conferences, also sought to erect a ‘defence wall’ to insulate Europe from exotic diseases, especially diseases of ‘barbarians’ thought to be endemic in the ‘primitive-uncivilised’ world.
The European-led public health diplomacy in the 19th century raises one important question: how international were the 19th century international sanitary conferences? Because European nation-states, through the international sanitary conferences, sought to create normative and institutional public health governance structures, the more critical set of questions emerge. What legacy did the 19th century colonial origins and structures of infectious disease diplomacy bequeath to contemporary multilateral global health governance in a contemporary ‘postcolonial’ world? Has this legacy propelled the emergence, cross-border spread, and uneven distribution of global burdens of disease in ways that disguise and perpetuate the continued entrenchment of the ‘civilised-uncivilised’ construct in the relations of nations and peoples? To what extent have the colonial fingerprints of 19th century public health diplomacy aided or impeded multilateral health governance in the emergent paradoxical milieu of a ‘global neighbourhood’ in a ‘divided world’?
2. The Age of Columbus and its Microbial Legacy
The end of the 15th century, precisely the year 1492, presented humanity with an illusion of ‘discovery’, a history based on the ‘discovery’ of the New World by the Old World (Nussbaum, 1954; Rubin, 1992; Kennedy, 1986; Anghie, 1996). Columbus, argued an eminent international legal historian, ‘did not ‘discover’ America in any scientific sense. Human beings as an animal species had appeared possibly independently in Africa, Asia and Europe, probably about 2-3 million years ago. Human remains in the American land mass have been difficult to date earlier than about 15,000 BC … and current orthodoxy traces ‘native Americans’ to a small migration of hunters from northeast Asia about that time’ (Rubin, 1992, p 9). The difficult question, nonetheless, was how to rationalise the relations of Spaniards and American Indians given the prevailing view among European jurists that the lands found by Columbus contained resources (including human resources) that were politically and militarily weaker than their European ‘visitors’1. Apart from the complex and unique legal questions that arose concerning the legal status of ‘the Indians lately discovered’, the Columbian era together with its civilised-uncivilised construct left a microbial legacy in the interaction between Spaniards and American Indians. This legacy comes within the rubric of what medical historians have explored variously as the ‘microbial unification of the world’ (Berlinguer, 1999, p 18), ‘Columbian exchange’ (Crosby, 1972) or ‘ecological imperialism’ (Crosby, 1986).
Albeit, the interaction between humanity and disease, as MacNeill (1976) has postulated, is as old as human history, the Plague of Athens (430 BC) and European Bubonic Plague (14 century) were locus classicus of earlier accounts of transboundary spread of disease. The age of Columbus, marked first by the emergence of diseases of the Old World in the New World, and vice versa, opened a new vista in the globalisation of diseases. According to Porter (1999, p 46), the meeting of far-flung peoples with no previous contact had major consequences for epidemic infections. Europeans devastated Amerindian populations by bringing them into contact with the common diseases of the Old World: smallpox, measles, mumps, chickenpox, scarlet fever. The vulnerability of native populations in the New World provided an opportunity for pandemics of these diseases to decimate Caribbean Indians and visit populations in Peru and urbanised societies in Mexico with a heavy mortality and morbidity burdens. The year 1492 was a turning point in history; the globalisation of diseases, which according to Belinguer (1999, p 18), meant the ‘spreading of the same clinical entities all over the world … the transition from the separation of peoples and diseases to mutual interchange and communication’.
The microbial unification of the world, which started with the Columbian voyages was almost concluded when the Amerindian populations died in massive numbers as a result of imported diseases, and Europeans began to replace their lost labour power with slaves from West Africa. West African slaves brought falciparum malaria to the Americas, and the water casks on the slave ships brought the mosquito that carried yellow fever (Porter, 1999, pp 46 – 47).This triangular disease exchange propelled the transnationalisation of diseases between the Old and New Worlds, reshaped the contours of colonialism and made disease a visible component of the entire colonial architecture. Hays (1998), a medical historian, rightly observed that ‘since the 16thth century, the world has shrunk, with greater opportunities for the rapid movement of microbes to new populations’.
3. Insulating Europe from Exotic Disease: The Realpolitik of Nineteenth Century Public Health Diplomacy
The 19th century is a near-perfect locus for the study of colonial fingerprints on a web of ‘inter-state’, ‘inter-nation’ or ‘inter-society’ relations. The civilised-uncivilised construct invented in the Age of Columbus was now firmly entrenched in the vocabulary of international law. Applying this vocabulary to the expanding colonial project in the 19th century, the law of nations was confronted with the difficult questions of how to rationalise the European partition of Africa, and the conquest of parts of Asia and the Pacific. As well, positivism deposed natural law as the dominant analytical tool by lawyers in the colonial project (Anghie, 1999). The international community in the 19th century, according to Malanczuk (1997, p 13), had virtually become a European one on the basis of either conquest or domination; the international legal system became an exclusive European club to which non-European nations would only be admitted if they proved that they were civilised (see also Bedjaoui, M, 1979). Relating this peculiar context of the 19th century to a web of ‘inter-nation’ relations, especially the transnational infectious disease menace, the realpolitik of the colonial origins of public health diplomacy provides an impetus for deconstructing the entire agenda of the international sanitary conferences.
The microbial unification of the world through the European conquest of the Americas and the transatlantic slave trade opened a new chapter in microbe-humanity interaction. Across the world, disease pathogens criss-crossed geo-political boundaries and travelled long distances with ease. Driven by the desire to protect their populations, most of the ‘civilised’ world introduced and enforced strict quarantine regulations. Before the first international sanitary conference in 1851, medical historians identified three major ‘protectionist/isolationist’ reactions to disease by the civilised world. The first was the predominant view that disease was a punishment from the gods that could only be cured by prayers and sacrifices. The second was the isolation of a healthy society from an unhealthy one through the practice of cordon sanitaire to prevent either an importation or exportation of disease. The third was the practice of quarantine, which enabled governments to isolate goods or persons coming from places suspected of suffering an outbreak of disease to protect the community from disease importation (see Goodman, 1997, pp 27 – 29; Fidler, 1999, p 26). Goodman (1997, p 29) observed that between the 14th and 19th centuries, nearly all ‘civilised’ countries of the world adopted some form of quarantine control. This consisted of imposing an arbitrary period of isolation on the ships, crew, passengers and goods arriving from foreign ports believed to be reservoirs of major epidemic diseases, especially plague, yellow fever, and later cholera. To what extent were these extreme isolationist-protectionist policies effective in controlling the transboundary spread of disease? Two epidemics of cholera across Europe (1830 and 1847) demystified the myth that quarantine, cordon sanitaire or other pre-existing domestic protectionist policy provided any effective defence against microbial forces. The solution was therefore beyond the capacity of any one European or ‘civilised’ state; states must respond to epidemics multilaterally in a diplomatic forum.
A second factor that motivated the international sanitary conferences (public health diplomacy) was the boom associated with the Industrial Revolution. Post-Industrial Revolution Europe witnessed an exponential rise in trade, travel and maritime commerce. The development of the steamship (about 1810), the railway (1830), and the construction of the Suez Canal (1869) boosted trade and maritime commerce. To facilitate transboundary movement of goods and services, trade-hurting national quarantine regulations of various states must be harmonised in a multilateral forum. According to Siddiqi (1995, p 14):
‘…the spread of cholera involved the quarantining of shipping at different ports for months at a time. The new ease of travel and trade also transformed hitherto foreign epidemic diseases such as cholera into European scourges. One early response of European states to limit the spread of cholera involved the quarantining of shipping at different ports for months at a time. Arbitrary and unequal quarantine regulations at various ports inevitably created great burdens on the international trade of … maritime nations such as Britain and France, whose fear of economic collapse overwhelmed their dread of imported disease and led them to support … international action to relieve shipping from the burdensome shackles of quarantine regulations’.
The interlocking factors of the cholera epidemics of 1830 and 1847, and the need to multilaterally harmonise inconsistent national quarantine regulations driven by the imperatives of trade and shipping catalysed public health diplomacy in the 19th century. At the initiative of France, 11 European states2 and Turkey were represented at the first International Sanitary Conference, which opened in Paris on 23 July 1851. From 1851 to the end of the century, 10 international sanitary conferences were convened,3 and eight sanitary conventions were negotiated on the cross-border spread, and surveillance of cholera, plague, and yellow fever in Europe.
What then were the real objectives of the international sanitary conferences and conventions? As already stated, while the harmonisation of quarantine, standardisation of surveillance, and the creation of an international health organisation have featured in literature as the major motivating factors, the desire to protect Europe from the diseases of the New World, although mentioned by some medical historians, is severely marginalised in the hierarchy of motivating factors. Howard-Jones (1950) observed that the international sanitary conferences were not motivated by ‘a wish for the general betterment of the health of the world, but the desire to protect certain favoured (especially European) nations from contamination by their less-favoured (especially Eastern fellows). Cholera presents an intriguing illustration of the European desire to keep exotic diseases far from reaching European territorial boundaries. For centuries, as Goodman observed, cholera although terrible in its rapidity and high morbidity, was considered a disease largely confined to Central Asia and particularly to Bengal. But between 1828 and 1831, it was reported to have passed out of India and spread rapidly to the whole of Europe and to the USA (Goodman, 1977, p 27). From Punjab, Afghanistan and Persia,
‘It reached Moscow in 1830 and infected the whole of Europe, including England, by the end of 1831. It reached Canada and United States of America in summer of 1832. Another pandemic followed in 1847 and five others in the next fifty years. This was a new and terrifying disease to the Western world …’ (Goodman, 1977, pp 27 –28)
Looking at the sanitary conventions and regulations negotiated at each of the European-led international sanitary conferences in the 19 century, the policy of ‘disease non-importation into Europe’, remains conspicuous. Goodman (1977, p 29) noted that both the sanitary convention and regulations negotiated at the first International Sanitary Conference in 1851 were focused on quarantine measures on plague, cholera and yellow fever against any ship ‘having on board a disease reputed to be importable’. Fidler (1999, pp 28 – 35), one of the leading scholars of international law and public health diplomacy, has explored the fear of disease importation into Europe focusing specifically on the outcome of each of the 19thth century international sanitary conferences. According to Fidler (1999), the objective of protecting Europe from ‘Asiatic cholera’ dominated the European-led international conferences of 1866, 1874, 1885, 1892, 1893 and 1894 because each of these conferences was convened after another cholera scare in Europe. The four international treaties concluded between 1892 and 1897 followed the trend of protecting the populations of Europe from the diseases of the uncivilised parts of the world. While the 1892 International Sanitary Convention focused on the importation of cholera through the Suez Canal by Mecca Muslim pilgrims, the 1893 International Sanitary Convention focused broadly on policing European boundaries against cholera. While the 1894 International Sanitary Convention focused on Mecca pilgrimages and maritime traffic in the Persian Gulf, the 1897 International Sanitary Convention uniquely focused on keeping plague out of Europe (Fidler, 1999, p 30). At the 1897 international sanitary conference on plague, Britain, as the colonial overseer of India, was severely criticised by the other European states because of a spread of a serious and persistent epidemic of plague from Bombay to the north-west littoral of India. Austria-Hungary proposed the 1897 conference because it feared its Muslim subjects from the Mecca Pilgrimage might bring plague with them after being in contact with pilgrims from India (Howard-Jones, 1975, p 65).
The consolidation, in 1903, of the 19th century International Sanitary Conventions of 1892, 1893, 1894, and 1897, was still strongly embedded in the civilised world’s policy of disease non-importation. Focusing on the consolidated 1903 International Sanitary Convention, Howard-Jones (1975) noted that the 1903 International Sanitary Conference ‘had as its essential purpose the protection of Europe against the importation of the exotic diseases from the East’. Filder (1999) similarly observed that ‘of the 184 articles in the 1903 International Sanitary Convention, 131, or approximately seventy-one per cent of the treaty, deal with places (for example, Egypt and Constantinople) and events (for example, Mecca pilgrimages) located outside Europe’.
Today, the colonial architecture of the 19th century, in the view of many, has been, or at least is being demolished in a post-colonial context. In the so-called age of globalisation, marked by a phenomenal rise in the intrusive web of global interdependence, multilateral public health issues, are still solidly founded on governance mechanisms similar to the 19th century International Sanitary Conventions and Regulations. Today, states still participate actively in international/multilateral/global conferences and negotiate conventions to find solutions to transnational health threats. In all of this, the colonial origins of public health diplomacy in the 19th century, with its indelible fingerprints on polarisation of societies according to the standards of civilisation, has continued to shape and re-shape the contours of global health governance. The present South-North health divide conjures images of hegemony and/or systematic exclusion that impede effective governance of contemporary global health issues.
4. Hegemony and/or Systemic Exclusion ?
Systematic exclusion is an indicator that, centuries after 1492, the civilised-industrialised world has continued to ‘discover’ other worlds, and has done so many times over even in the 20th and 21st centuries (Head, 1991, p 10)4. This continuous (unending) discovery leads to the relegation of ethno-medical therapies prevalent in the discovered worlds to the margins of global health governance (see Aginam, 2002). Ethno-medical/pharmacological practices indigenous to the discovered worlds are dismissed from the parameters of public health governance as uncivilised/primitive barbarism unfit for integration into the corpus of multilateral health framework. Edward Said (1978), in Orientalism, describes a similar project of systematic discovery and exclusion as a style of thought based upon ontological and epistemological distinctions between the Orient and (most of the time) the Occident. In another related sense, Orientalism also means the:
‘corporate institution for dealing with the Orient, dealing with it by making statements about it, authorising views of it, describing it by teaching it, settling it, ruling over it: in short, Orientalism as a Western style for dominating, restructuring, and having authority over the Orient.’ (Said, 1978, p 2)
Power/hegemony, on the other hand, implicates 19 century public health diplomacy as the forerunner and precursor of the present South-North health divide in the web of interdependence between nations. The colonial foundation of public health diplomacy set the stage for the institutionalisation of entrenched power imbalance that perpetuates South-North health inequalities. Because of the cumulative effects of hegemony and/or the politics of exclusion in a post-colonial world order, variegated theoretical responses have emerged (Fitzpatrick and Darian-Smith, 1999, p 1)th, they all aim at deconstructing traditional orthodoxy and embedded power relations as humanity continues to be immersed in a single global microbial sea. Applied specifically to the global health context, variants of postcolonial scholarship: critical legal theory (Hutchinson, A, 1989; Kairys, D, 1998), critical race and feminist theories (Crenshaw et al, 1995) and Third World approaches to international law (TWAIL) (Mutua, M, 2000; Anghie, A, 1999, Gathii, J, 2000; Mickelson, K, 1998) offer invaluable pathways towards exploring the contemporary South-North health divide. The practice and structure of public health diplomacy, entrenched power relations between states, the politics of exclusion, and the process of continuous discovery all conspire to impede emerging global health governance mechanisms, and widen the gulf of inequalities in a postcolonial global health context.
5. South-North Health Divide in a Postcolonial World Order: Health as a ‘Global Public Bad’ ?
We live in a turbulent world. At the dawn of the 21 century, the world is polarised less by geo-political boundaries and ethno-cultural affinities, and increasing by poverty and underdevelopment. International institutions publish startling statistics year after year as evidence of accelerated rise in income and socio-economic disparitiesst. In 1990, the South Commission chaired by Dr Julius Nyerere of blessed memory, observed that if all of humanity were to be a single nation-state, the present North-South divide would have made it an ungovernable, semi-feudal entity, split by internal conflicts. A small part of it (one quarter) would be prosperous and industrialised while its bigger portion (three quarters) would be poor and underdeveloped (South Commission, 1990, p 1). Because poverty breeds disease and disease breeds underdevelopment, South-North divide in terms of socio-economic inequalities among nations has led to South-North health divide. An obvious consequence of this web of vulnerabilities is the uneven distribution of diseases between the populations of ‘industrialised-civilised’ world, and those of the ‘other worlds’ - civilising, developing, or westernising societies.
Quite recently, the World Health Organisation (WHO) used an indicator called the Disability-Adjusted Life Years (DALYs) to investigate the burdens of infectious and non-communicable diseases as well identified health risks globally. Focusing on eight regions of the world: established market economies (EME), former socialist economies of Europe (FSE), India, China, other Asia and Islands, Sub-Saharan Africa, Latin America and the Caribbean, and Middle Eastern Crescent, DALYs offered a persuasive evidence of an epidemiologically divided world with an appalling gap between the health conditions of the ‘civilised’ and the other worlds. Cumulatively, countries of the South lag behind those of the North (see Murray, CJL, and Lopez, A, 1996). In a postcolonial world, a litany of diseases, endemic in nature, confront the lives of populations in civilising societies (mainly in the global South), shorten their life expectancy and significantly impact on the quality of life they live. For example, malaria, African trypanosomiasis (sleeping sickness), dengue, onchocerciasis (river blindness), lymphatic filariasis, guinea worm, mostly endemic in Africa; and American trypanosomiasis (chagas disease), endemic in parts of South America, although placed on the agenda of mutlilateralism, deserve more attention and resources from multilateral institutions. They are largely treated as diseases of the Third World.
Almost a decade ago, the WHO identified the South-North health divide as an inequity that should stir the conscience of the world. According to 1993 calculations, a person in one of the least developed countries has a life expectancy of 43 years. In one of the most industrialised countries, it is 78 years, a difference of more than a third of a century (WHO, 1995, p1). A flight from France to Cote d'Ivoire takes only a few hours, but in terms of life expectancy, it spans almost 29 years. A short air trip between Florida in the USA and Haiti represents a life expectancy gap of over 19 years (WHO, 1995). The South-North health divide is transforming public health into a global ‘public bad’. In dynamic but complex ways, well over 36 billion people are banished to the penitentiary of health insecurity, denied of the dividends of health as a global public good, and excluded from the protective structures of global health governance. As the status quo of exclusion continues, global governance (including global health) grapples with the paradoxical challenges of striking a balance between the emerging ‘global neighbourhood’ and ‘universal otherhood’ (Baxi, 2000, p 525)5, a disguised or conscious approval, in today’s world, of the 15 century distinction of the ‘civilised’ and ‘barbarians’.
6. Public Health as a Global Public Good in a Postcolonial World: An Extended Postscript
If health, as some scholars have recently postulated, is a global public good (Chen et al, 1999, p 384); then global health governance must confront the paradoxical puzzle a global village in a divided world (Aginam, 2000)th. Health, like other public goods, must meet two important conditions. First, its benefits must have strong qualities of ‘publicness’ as marked by non-rivalry in consumption and non-excludability. Second, its benefits must be quasi-universal in terms of countries (covering more than one group of countries), people (accruing to several, preferably all, population groups), and generations (extending to both present and future generations, or at least meeting the needs of present generations without foreclosing development options for future generations) (Kaul et al, 1999, p 2). What ought we do to redistribute the dividends of health as a public good fairly and quasi-universally across countries, populations and generations? Why should the civilised-industrialised societies look beyond their narrow self-interests to be more engaged with transnational health issues? In a semi-feudalistic world marked by socio-economic inequalities between the civilised-industrialised and civilising-developing countries, who has an obligation (moral or legal) to finance health as a global public good? And most importantly, why is this obligation necessary and/or mandatory?
It is no longer in doubt that a new form of globalism (New Globalism) has emerged. Never in history has humanity been so closely bonded together and so sharply divided at the same time. This dual-dimensional challenge, albeit intriguing and frustrating, nonetheless catalyses an articulation of immutable values in a system of global health governance. As the Commission on Global Governance noted, stability in the global neighbourhood is dependent on recognition of, and utmost respect for neighbourhood values: peace, respect for life and other human rights, lack of institutional and structural violence in the international system, justice and equity, mutual respect and caring, economic security, sustainable development, and access to basic necessities of life by the poor (Commission on Global Governance, 1995). The New Globalism, which takes cognisance of these values, has also rendered the traditional distinction between national and international health obsolete. Disease pathogens and infectious agents disrespect state sovereignty with impunity, criss-cross national boundaries with unprecedented speed, and threaten or infect populations thousands of miles away easily. History is replete with epidemics and pandemics that wiped out populations; the Plague of Athens 430 BC, Bubonic Plague in 14 century Europe, small pox, measles, scarlet fever, chicken pox, and influenza in the Americas in the 16thth and 17th centuries, and the global swine flu of 1918-1919. The spread of deadly infectious diseases has continued to be across geo-political boundaries of nation-states through the New Globalism fuelled largely by increased travel (global airline networks), tourism, trade liberalisation and foreign direct investment, forced and intentional migrations, and other emerging dynamics of globalisation.
The discovery of air traffic has led to an unprecedented surge in global travel. In 1993, it was estimated that 500 million people crossed international borders on board aircraft. Toady, this number has reached 1.4 billion persons (Fidleer, 1997, p 771). With New Globalism, the opportunities for travel to spread disease transnationally have increased astronomically. Ebola haemorrhagic fever, lassa fever, hanta-virus, West Nile virus, HIV/AIDS, and strains of drug-resistant tuberculosis have continued to emerge and re-emerge with vicious propensity within ‘civilised-industrialised’ and ‘civilising-developing’ societies. The dynamics of New Globalism have immersed all of humanity in a single germ pool, and there is no health sanctuary in an interdependent world. There is infallible evidence that, in the modern world, ‘bacteria and viruses travel almost as fast as money. With globalization, a single microbial sea washes all of humankind’ (Brundtland, 2001). For contemporary global health governance to shed off vicissitudes of 19th century colonial fingerprints, public health has to bring ‘the world toward a single community in which the health of each one member rises or falls with the health of all others’ (Garrett, L, 2000, p 585). Because most of the world’s health threats endanger us all, enlightened self-interest places global health squarely within the humane multilateral governance. Malaria, dengue, chagas, tuberculosis, American and African trypanosomiasis, and a host of other microbial forces may be endemic in ‘civilising’ countries, and may indeed have a heavy mortality and morbidity burdens in those societies, but they are no longer the exclusive problems of the Third World. They endanger us all. The ‘vital interests’ on the civilised-industrialised countries will best be served if they engage in promoting global health, especially by remedying conditions that are endemic in the ‘civilising-developing’ world6. Ideally, the postcolonial world order, in a public health context, as Nobel Laureate Joshua Ledeberg noted, ‘is just one village. Our tolerance of disease in any place in the world is at our own peril’.
1Endnotes Rubin (1992) and Anghie (1996) provide very insightful analysis of this interaction between Europeans and Native Indians.
2 The states included the Italian City States then known as the four Papal States: Sardinia, Tuscany, and the Two Sicilies. Others were Austria, Great Britain, Greece, Portugal, Russia, Spain, and France – the convenor and host. The criterion for excluding Turkey from Europe is not known. All the leading text writers on the subject adopt the formulation ‘eleven European states and Turkey’. I adopt the same formulation as used by the text writers.
3 Paris 1851 and 1859, Constantinople 1866, Vienna 1874, Washington 1881, Rome 1885, Venice 1892, Dresden 1893, Paris 1894, and Venice 1897.
4 Head (1991, p 10) argues that ‘the North has discovered the South many times, and has given the South a variety of names sometimes in error. Curiosity, greed, fear, evangelic fervour, the zeal to civilise: the motivation for contact has ranged from the loftiest to the most base. The North assumed that modernisation is desirable, and has thus interpreted Northern dominance as earned. Records of the odysseys of discovery were written by or about the adventurers, by those discovered’.
th See Fitzpatrick and Darian-Smith (1999, p 1), arguing that postcolonial concerns maintain an intense engagement with many mmatters of current intellectual significance – the centrality of law in questions of alterity, identity, community and globalism, and rascism’s new protean forms.
st See, for example, the successive human development reports by the United Nations Development Programme (UNDP) 1997 – 2002; the successive World Development Reports by the World Bank, and the successive World Health Reports by the World Health Organisation.
5 I borrowed the juxtaposition of the expressions ‘Global Neighborhood’ and ‘Universal Otherhood’ from Baxi, Upendra (2000) ‘Global Neighborhood and the ‘Universal Otherhood’: Notes on the Report of the Commission on Global Governance’ Alternatives, p 525.
th For my discussion of the paradoxical complexity of a global village and a divided world in the health context, see Aginam, Obijiofor (2000) ‘Global Village, Divided World: South-North Gap and Global Health Challenges at Century’s Dawn’. Indiana Journal of Global Legal Studies 7, p 603.
6 Brundtland (2001) put it succinctly: ‘enlightened self-interest compels both industrialised country governments and private corporations to do what it takes to drastically reduce the current burden of disease in the developing world. To do so will be good for economic growth, be good for health and be good for the environment. Not only for the three billion people who have yet to benefit from the technological and economic revolution in the past 50 years – but for us all … Better health provides people with an opportunity – both as a good in its own rights, and as a means, which can enable many of the world’s poorest to emerge from poverty. Better health is a duty in the sense that we cannot ignore or condone growing inequity’.
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