Human Security and Health

The parable of a lost sheep is one of the most famous stories in the Scripture. A man who has one hundred sheep will leave the ninety nine in the hills and go in search of the stray, if one of them goes astray. It is not the will of the heavenly Father that one of these is lost. A good shepherd always goes to find a stray sheep by leaving a flock behind.

Ever since the emerging of modern states in the course of recent centuries, leaders of nations have been giving their priorities to state security. It is true that in the past security threats always emanated from outside of boundaries. In recent years many dangers have not come from outside boundaries. Poverty, environmental degradation, suffering from infectious diseases, transnational organized crime and terrorism are a few examples. Today a new consensus on security is really needed and we should pay more attention to a stray sheep by convincing political leaders that the small interest of a stray sheep is a core value and deserves to be given careful attention. The concept of human security is a viable framework to bring human-centered approach to the values of political leaders by making the interests of individuals a priority for governance and politics.

1. What is Human Security?

Since the end of the Cold War, the structure of international relations has changed in a drastic manner. Rapid waves of globalization coupled with economic liberalization and the progress of information technology are shaking the fabrics of the traditional approach of sovereign nations. This process accelerates the degree of interdependency of the world, having brought not only benefits to people, but troubles by widening the gap between the rich and the poor nationally and internationally.

Today, as many as 1.1 billion people are forced to live on less than one dollar a day. The unprecedented moves of people, goods, money and information sometime work to accelerate transnational problems. Trafficking in persons, arms smuggling and the spread of infectious diseases are only a few examples. Furthermore, the end of the Cold War, contrary to the hope we had at that time, has brought numerous civil conflicts whose root causes lie in religious, ethnic and economic contexts, coupled with refugees and internally displaced persons. Each of these challenges has a complex inter-linkage to one other.

In 1945, when the United Nations was created the security of a state such as the protection of boundaries and people of a state was the main concerns of those who built this system. Ever since the world order has been shaped, based upon this traditional concept. One of the main justifications for the military governments of Latin American countries in the 1960s was the concept of national security. Many innocent people were imprisoned and sometimes executed in the name of National security. Japan believes that to overcome new and direct threats, the traditional concept of state security alone is no longer sufficient.

Each human being is equal in having his or her own potential and should be respected as a human person regardless of nationality, race, gender and other identities. The basic concept of human security is a call for a paradigm shift of security from staying on the narrow state security ideas to expanding its focus to include people's perspective. Mrs. Sadako Ogata and Prof. Amartya Sen, together with other ten prominent members, submitted a report on the issue of human security to the Secretary General of the United Nations, Kofi Anan, in May 2003 and the report defines human security as protecting the vital core of all human lives in ways that enhance human freedoms and human fulfillment and calls for a strategy of protection and empowerment to secure people's lives, livelihoods and dignity.

Others sometimes wonder what the difference between a humanitarian response and human security is. I say that a humanitarian response is a concept of helping and rescuing people in enormously difficult situations, but stops there. It has sometimes paternalistic connotations. Human security is to make individuals stand on their own and the initiatives of individuals are essentially important.

2. Health and Human Security

Fr. Akio Nemoto, a Franciscan priest, who has spent many years in a hospice in South Africa looking after HIV/AIDS patients, once told me a story of a patient. A mother who knew she was dying with HIV/AIDS wrote a letter to her beloved 3 year-old daughter. The letter had the condition that her daughter could read it when she became 16 years old, mature enough to understand the meaning of the letter in which her mother explained how she was affected by HIV/AIDS through her husband's adultery, how much she loved her daughter and she really wanted to see her daughter's first boyfriend. The story tells us that for all people health is always the primary concern and they are ready to sacrifice everything in order to get proper health care.

In spite of the fact that health is a core value of human beings the reality is far from it. In many developing countries, political leaders pay more attention to traditional state security and expenses on health care and education are the first targets to cut when a government has to economize its expenditure since many political leaders see these areas as not essential and thus expendable. We have seen many examples in various developing countries where many problems associated with non-provision of a good health-care system are more to do with a lack of political will and poor management than shortages of resources. The main challenge here is how to convince government leaders that health care should be given prior attention.

Mely Caballerlo-Anthony, Assistant Professor of Nanyang Technological University, is right in saying that "to generate political will and commitment, the stake holders in government must be convinced of the merits of human security. More importantly, they need to be convinced that health is a priority for governance and politics. The most obvious strategy, then, is to establish the clear linkage between human security and the values that appeal to power holders."

In order to achieve that goal, there must be a system in which human security is well embedded. Civil society should be included in a process of formulating health policies; unless political leaders have great awareness about the importance of health care, their popularity will not be sustained. The parallel existence of the poor willing to lose everything in order to save their lives and the lack of political will to pay due attention to the issue of medical care should be redressed.

3. Japan's Initiatives to Make the Concept of Human Security Operative

I believe that unless the concept of human security is put into action, the concept loses its validity and reference. With this conviction Japan takes a lead in translating the idea of human security into operation. This is also based upon Japan's own experiences. Former Prime Minister Ryutaro Hashimoto in his speech in South Africa in 1999 explained this background as follows: "As of today the Japanese people enjoy the longest average longevity of over 80 years in the world; however, it is only 50 years ago that the average life of Japanese people was only 50 years. There are three elements for this success. First, people have full access to advanced health care. Second, the provision of a safe water system leads to the drastic reduction of communicable diseases. The provision of safe water constitutes a fundamental condition for health. Third, eradication of parasites. I would like to point out that Japanese success is based upon the combination of a health system and a well advanced education system."

In order to fight poverty, "peace, security and good governance" are prerequisites. These three elements will convince each individual in society that "tomorrow can be better than today", and the most important keyword towards this end is "hope". Having "hope" in mind, people can make an investment, people can provide education, which is an investment for the future, and people can pay attention to health. People can afford to meet their partners with affection and respect which leads to gender equality. Japan believes that this process of development creates the sense of ownership among people based upon partnership between donors and recipients.

In the G-8 summit meetings of 1997 and 1998, Japan took an initiative for the network building to fight parasites in Asia and Africa, which led to a creation of the "international parasite study center" of the Mahidon University in Bangkok. In the year 2000, at the Okinawa G-8 Summit, Japanese Prime Minister Yoshiro Mori emphasized the importance of combating communicable diseases, which led to the creation of "the Global Fund to Fight HIV/AIDS, TB and Malaria." For the first time, Japan drew the attention of world leaders to the issue of these communicable diseases in concrete terms, thus narrowing the gap between the people in need and the agenda of world political leaders. In the past, policy-makers, even summit leaders, cared less about health than they did about depression, jobs and the exchange rate, but now world political leaders realize the importance of good health. Since the creation of the Global Fund in the year 2002, in the course of 3 years of operation the Global Fund has raised nearly 4 billion US dollars out of which Japan contributed 250 million US$. June 30th this year, Japanese Prime Minister Junichiro Koizumi made an announcement Japan's new commitment of half a billion US$ for the Global Fund for coming years. The Global Fund was established in a way to reflect the concept of human security. In each country, its country coordination mechanism was established in a process of discision making in which not only government officials but representatives of faith-based organizations and civil societies were represented. Although States still hold main responsibilities for providing health care to people, there is also awareness that a State's capabilities are limited and thus human security must allow non-governmental actors and international organizations to provide health care. Health is too important to be left in the hands of a few people. This theory is also applicable to the awareness of the people of rich countries. In these days, medicines for HIV/AIDS, TB and malaria are affordable for common people of industrial nations and their small savings can go a long way to saving the lives of the people of developing countries. The Global Fund makes health of people in developing countries the business of developed countries. This is also the realization of human security.

4. The Primary Health Care Project (Lusaka, Zambia)

I would like to give another concrete example of a health project based upon human security concept. The Japanese government has incorporated the principle of human security into its international development assistance policy. The Japan International Cooperation Agency (JICA), an implementation agency of Official Development Assistance of Japan, which Mrs. Sadako Ogata, former UNHCR, is heading, is also working on ways to operationalize the concept more specifically.

In George Compound, close to Lusaka, the capital of Zambia, JICA has been supporting a series of health care projects, whose activities are carried out by community volunteers. Unplanned settlements were created by rapid migration from the suburbs before urban planning could catch up. These people migrated mainly from agricultural areas as a result of economic depression. Shortages of health care and luck of infrastructure development in the areas meant that the infant mortality rate for children under five was as high as 15%. This lack of a health care system caused a mass outbreak of cholera during the rainy season coupled with a rapid increase of TB and measles. Ever since the year 1994, Japan has provided a grant to build a water system. But what is more important is the starting of a community-based model of primary healthcare projects since 1997. Reducing the infant mortality rate and improving health and sanitation conditions are carried out by two main activities: a growth monitoring program by health center staff and trained volunteers from the community-based health workers. A health expert said that there has been a growing awareness in the community of the importance of health and of improving the situation in their own living areas. The success of these activities and the completion of water facilities has led to a significant reduction in the number of deaths from cholera, from seventy per 10,000 lives before the project began (1994) to one per 10,000 lives (2000). Significant improvement of health of children is also evident. The community also set up a small fund for maintenance of public toilets and the expenses of volunteers. This project illustrates that a system can be made where people in the community can be self-reliant and critical links can be sustained between the community and the government. We see here a good example of making health care everybody's business.

5. The Trust Fund for Human Security

In 1999 Japan took another initiative to translate the concept into action. It established the Trust Fund for Human Security in the United Nations and by February 2005 Japan had contributed approximately 256 million US$ to the Fund. Applying the approaches of "protection" and "empowerment" in the action, the Fund, focusing in on each individual, supports projects to protect people and empower people to enhance their resilience.

The Fund finances projects to be carried out by organizations of the United Nations system and in partnership with non-UN actors to advance the operational impact of the human security concept. Japan welcomes the participation of the "Good Samaritan Foundation" as a partner of UNICEF, WHO or any other UN organizations to carry out projects. Projects shall be selected according to the following parameters:

The budget estimate of one project is approximately one million dollars in a year in ordinary cases, though explicit upper or lower limits are not defined. Budgetary requirements should be calculated based upon the feasibility and needs of each project. The budget can be greater when they are of a comprehensive or regional nature or multiyear projects.

6. Conclusion

The concept of human security has been already put into practice. In these difficult times of crises and uncertainties, Japan believes human securities offer hope. Hope is a key for the development of people who are under severe conditions. This is a concept that a small interest of one stray sheep will not be sacrificed in the name of state security but rather that one sheep's care is all sheep business. Partnership, protection and empowerment are key words for human security and Japan hopes that this new security concept will be widely accepted to meet new challenges.

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H.E. SHIGEKI SUMI

Currently Ambassador of Japan to the International Organizations in Vienna,
Former Deputy Director-General Global Issues Department
Ministry of Foreign Affairs of Japan,
Former Board member of the Global Fund to fight HIV/AIDS, TB and Malaria.

Bibliography

• Human Security Now, Commission on Human Security, New York 2003
• Overview of Health and Human Security Case Studies, Mely Caballero-Anthony 2002
• Communicable Diseases and Japanese Foreign Policy, Kaoru Ishikawa 2004
• Project: Human security, JICA FRONTER 2005, 6

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