Alan Ingram

The New Geopolitics of Disease: Between Global Health and Global Security

This article describes the emergence of a new geopolitics of disease following the end of the Cold War and offers a framework for thinking about it. Three main questions are asked. First, why is disease now a geopolitical issue? Second, how has this new geopolitics emerged? And third, what are the implications of the emergence of disease as a geopolitical issue for the meaning and practice of global health? It is argued that disease is now seen as a geopolitical issue in terms of four main dimensions: destabilisation, sovereignty, the instrumentalisation of health, and geopolitical economy. Second, this new geopolitics has emerged in the context of larger debates about globalisation, development and security, and has emanated primarily from Northern institutions. Third, drawing on critical approaches to security, it is suggested that while the securitisation of health offers certain benefits, it also carries risks. The article identifies a number of critical tensions in the new geopolitics of disease as a way of negotiating these risks and anchoring the concept of global health security in a larger vision of health in an era of globalisation.

Alexander Dugin: geopolitics and neo-fascism in post-Soviet Russia

Abstract In this paper I aim to contribute to critical geopolitics through a discussion of the work of the radical right wing Russian geopolitician Alexander Dugin, focusing on his textbook The Fundamentals of Geopolitics: the geopolitical future of Russia. Dugin’s career and work are contextualized in terms of developments in Russian politics and the general shift towards Eurasianism in Russian foreign policy thinking in the last decade, and three main lines of inquiry are pursued. First, Dugin’s concept of geopolitics and his geopolitical strategy, conveyed both in text and maps (or cartogrammes), are related to debates about geopolitics, power and knowledge. I argue that Dugin’s geopolitics reproduce the worst excesses of the geopolitical and imperialist gaze, and I compare and contrast his proposals with aspects of current Russian foreign policy. Secondly, the relations between his work and questions of neo-fascism are explored. Here I argue that, despite the historically conflictual relationships between geopolitics and fascism, Dugin can in certain ways be considered a neo-fascist as well as a geopolitician. Thirdly, the relationship between rationalism and mysticism (or geopolitics and sacral geography) in Dugin’s writings, which I argue is connected in part with a reliance on environmental determinism and occultism, is highlighted at several points. Countless people…will hate the new world order, be rendered unhappy by the frustration of their passions and ambitions through its advent and will die protesting against it. H. G. Wells (1940, p. 170) . In complex post-modern times…geopolitical visions and visionaries seem to thrive. Gearoid O Tuathail (1998, p. 2) .

Critical Interventions in Global Health: Governmentality, Risk, and Assemblage

The rise of the term global health reflects a concern with rethinking the meaning of health in the context of globalization. As a field of practice, however, global health renders problems, populations, and spaces visible and amenable to intervention in differentiated ways. Whereas some problems are considered to be global, others are not. Some are considered to be matters of global security, whereas others lack this designation and remain in the realm of health or development. Attention is drawn to individual global health problems, even as their broader structural dimensions are often obscured. We suggest that a critical geographical approach to global health therefore entails reflexivity about the processes by which problems are constituted and addressed as issues of global health and identify three analytical approaches that offer complementary insights into them: governmentality, risk, and assemblage. We conclude by outlining some further issues for critically reflexive geographies of global health.

Bridging health and foreign policy: the role of health impact assessments

Health impact assessment (HIA) is an important tool for exploring the intersection between health and foreign policy, offering a useful analytical approach to increase positive health impacts and minimize negative impacts. Numerous subject areas have brought health and foreign policy together. Yet further opportunities exist for HIA to address a broader range of health impacts that otherwise may not be seen as relevant to foreign policy. HIA may also improve the quality of scientific evidence available to policy-makers. The Framework Convention on Tobacco Control offers lessons for the strategic use of HIA. However, HIA alone is limited in influencing these decision-making processes, notably when issues diverge from other core concerns such as economics and security. In such cases, HIA is an important tool to be used alongside the mobilization of key constituencies and public support.

Domopolitics and disease: HIV/AIDS, immigration, and asylum in the UK

Geographers and others have become increasingly interested in the intersections between globalization, disease, and security, particularly in relation to ‘short-wave’ public health threats such as SARS and pandemic influenza, but ‘long-wave’ epidemics such as HIV/AIDS are also often said to raise questions of security. While a literature is emerging to analyze the politics of security in relation to global HIV/AIDS relief, in this paper I argue that it is also important analytically and politically to connect and contrast this with the ways that HIV/AIDS is politicized as a security issue in relation to immigration and asylum within Western states themselves. Drawing on literatures in governmentality, biopolitics, and security, I examine the politics of HIV/AIDS, immigration, and asylum in the UK from 1997 to 2007 with particular reference to the reactionary press coverage that influenced policy formation and judicial rulings in this period. Following the work of William Walters, I trace the emergence of a ‘domopolitical’ rationality in press reporting around HIV/AIDS in terms of a number of imaginative geographies, and suggest that these imaginative geographies are both biopolitical in a classical sense and connected with the colonial dimensions of the present. The circulation of these imaginative geographies through policy and legal developments, the dilemmas they have raised, and resistance to them from medical, civil society, and parliamentary groups are then outlined. Reflecting on the disjuncture in approaches to HIV/AIDS between the global and national spheres, I argue that while the association of HIV/AIDS and security is enhancing life chances for many it is also reducing them for people caught in the wrong place at the wrong time.

Global Leadership and Global Health: Contending Meta-narratives, Divergent Responses, Fatal Consequences

Global health problems are often framed as common challenges confronting humanity, and while political commitment and resources have recently increased, a number of faultlines run through efforts to mount collective responses. Although the United States has staked its claim to leadership in the fight against disease, its actions diverge in several key respects from much of the international community, undermining the effectiveness of global efforts. These divergences can be traced to domestic politics, and are related to three debates of significance for international relations more generally: on global governance, models of globalisation, and relationships between development and security. In this article US approaches are contrasted in each of these dimensions with those of the UK, which has been active in promoting its own vision. The prospects for overcoming current limitations are examined on two levels: the technocratic, and the ideological and political. Developments on both levels are evaluated in light of events early in the second term of the Bush administration. In conclusion, it is suggested that there are two contending meta-narratives underlying the faultlines in global health.

The Pentagon's HIV/AIDS Programmes: Governmentality, Political Economy, Security

This article brings together governmentality and political economic readings of security to offer a critical examination of the international HIV/AIDS programmes operated by the US Department of Defense, particularly as they focus on populations in Africa. Reaching groups often left out of national HIV/AIDS strategies and conducting research into HIV vaccines, US military HIV/AIDS programmes can be read as supportive of the broader global health effort to secure populations from HIV. However, a consideration of publicly available material shows that growing US commitment to addressing the problem of HIV/AIDS parallels, and in the case of military programmes intersects with, the idea of Africa as a locus of strategic resources, fragile states and potential terrorist threats. These ideas are furthermore articulated in terms of a neoliberal teleology, in which health programmes appear as part of an effort to help populations along the path to normal, healthy development, occluding the exploitative manner in which populations and regions highly affected by HIV have been incorporated into the global political economy. Such rationalities are problematic in that they obviate a more substantive grounding of health in ideas of peace or equity and thus provide a poor guide to a more healthy global order. While noting the contribution of US military programmes to the international response to HIV/AIDS, the article emphasises the importance of examining associations between HIV/AIDS, military forces and security in terms of the broader web of rationalities and relationships within which they are situated.

The International Political Economy of Global Responses to HIV/AIDS

Global responses to HIV/AIDS have shifted considerably since the mid 1990s. The development of combination anti-retroviral therapy (ART), which can extend significantly the lives of people living with HIV, was central to this. While ART rapidly became available to many of those in need within richer countries, leading to dramatic reductions in AIDS deaths, it was generally considered too expensive and too complicated for poor and middle-income countries, where around 90 per cent of people living with HIV were located. An increased focus on preventing transmission was considered to be the only viable way to address the epidemics of poor countries, leaving millions of people infected with HIV to die of AIDS.

Passports and pestilence: migration, security and contemporary border control of infectious diseases

Since the late 1990s, increasing attention has been paid to the broader societal implications of certain chronic infectious diseases, above all HIV/AIDS. In particular, connections have been drawn with ideas of international security, and these are now reflected in post-9/11 global policy discourse, as are questions of migration.1 As it affects issues of disease, this discourse is driven by a relatively small number of linked strategic concerns. The first is that in an era of increasing interconnections, diseases may spread more easily from one region to another through travel and migration. The second is that over the longer term disease may threaten economic interests. The third is that, in undermining the social, political and economic fabric and through its disproportionate effects on governance and military institutions, disease may in some places have destabilizing implications for state sovereignty and international security over the medium to long term. For many analysts, this requires that the familiar concerns of state security be complemented with the imperative of human security, or the protection of individuals and populations from threats to their well-being and existence, regardless of their citizenship, and, perhaps, location. This is challenging in a world that is still fragmented geopolitically and highly unequal economically. As a result, the discourse on globalization, disease and security that has emerged is beset by tensions, particularly in relation to questions of economic integration and migration.

Spies, vaccines and violence: Fake health campaigns and the neutrality of health

On 2 May 2011, a US Navy Seal unit conducted a raid in the Pakistani town of Abbottabad, in which Osama bin Laden and four other people were killed. Hailed as a great success by the US government, ...