Health, security and foreign policy

Review of International Studies

Volumn 32, Issue 1, 2006, Pages 5-23

  McInnes, Colin ^a   Lee, Kelley ^a  

^a NONE

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EID: 33644588013     PISSN: 02602105     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0260210506006905     Document Type: Review

References (131)

1. Arguably a third important area where public health has impacted upon the international agenda has been tobacco control, not least the successful conclusion of the Framework Convention on Tobacco Control (FCTC). Tobacco-related diseases remain the single greatest cause of preventable deaths in the world. Tobacco sales have earned the industry record profits since the 1990s as companies have shifted their attention to the developing world, facilitated by trade liberalisation. The World Health Organisation under Gro Harlem Brundtland campaigned for comprehensive tobacco control measures worldwide, supported by the FCTC. Although the WHO presents this as a successful partnership between the public health and foreign policy communities, as Jeff Collin points out, this smacks somewhat of hagiography. The reality is that the public health community, particularly WHO, initiated and led this international effort. Working with the foreign policy community on tobacco control proved an uphill task at times. Working with them on infectious disease and bio-terror proved much easier. Jeff Collin, Tobacco Control', unpublished paper for The Nuffield Trust.
2. The beginnings of sustained international cooperation on health were the International Sanitary Conferences held during the nineteenth century. These originated in concerns over the risk to European states from the transmission of acute and epidemic infectious diseases from outside the continent. Given the potential of such diseases to spread rapidly across national borders and cause high rates of morbidity and mortality, as well as disrupt burgeoning trade routes, international cooperation was pursued to mitigate the risks involved. Institutions such as the Organisation International d'Hygiene Publique (OIHP) were therefore created to build surveillance and reporting systems to support such cooperation.
3. For example, the Millennium Development Goals agreed in 2000 set three out of eight goals, eight of the 18 targets and 18 of the 48 indicators as related directly to health; the UN Security Council session of January 2000 was devoted to the threat in Africa from HIV/AIDS; UN Security Council Resolution 1308 of July 2000 addressed the need to combat the spread of HIV/AIDS during peacekeeping operations; United Nations Special Session on HIV/AIDS held in June 2001 declared the disease a security issue; World Health Assembly Resolution 54.14 adopted in May 2001 on ' Global health security; epidemic alert and response' focused on revision of the International Health Regulations; the G8 Summit held in Genoa in July 2001 agreed the creation of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria; and WHO's adoption of the first international health treaty, the Framework Convention on Tobacco Control, in May 2003. The driving force behind this shift originated largely within the public health sector, motivated by a desire to secure greater political attention to global public health needs. Key players included WHO Director-General Gro Harlem Brundtland, President of the US Institute of Medicine Ken Shine, former World Bank economist Jeffrey Sachs, and former US Ambassador to the UN and President of the Global Business Coalition on HIV/AIDS, Richard Holbrooke. The target was both the foreign and security policy communities. From the perspective of public health advocates, differences between the two communities have so far not been deeply explored, and the two are broadly (though not always) seen in the same light. For the purposes of analysing public health engagement with these policy communities, this lack of distinction is taken as given.
4. See for example George W. Bush, 'President speaks on fighting global and domestic HIV/AIDS', 31 January 2003, available at; 〈http://www.state. gov〉, accessed on 16 January 2004;
5. Paula J. Dobriansky, 'The fight against HIV/AIDS' and 'The emerging security threat of HIV/AIDS: Russia' both available at: 〈http://www.state. gov〉, accessed on 16 January 2004;
6. Colin L. Powell, 'Presentation at HIV/AIDS plenary, September 22, 2003', available at: 〈http://www.state.gov〉, accessed on 16 January 2004. In addition, US President Clinton issued a Presidential Decision Directive in 1996 calling for a more focused US policy on infectious diseases; the US House International Relations Committee passed the Global Access to HIV/AIDS Prevention, Awareness, Education and Treatment Act in June 2001 authorising large increases for international programmes; and US Office of National AIDS Policy shifted its focus from domestic to international efforts in 2001.
7. See State Department, United States Strategic Plan for International Affairs, first revision (Washington, DC: Department of State, 1999), pp. 9 and 41.
8. Strategic Plan Fiscal Years 2004-2009: Security, Democracy, Prosperity (Washington, DC: US Department of State and US Agency for International Development, 2004), p. 76.
9. Foreign and Commonwealth Office, UK International Priorities: A Strategy for the FCO, Cmnd 6052 (London: HMSO, 2003), p. 13.
10. Department for International Development, Eliminating World Poverty: Making Globalisation Work for the Poor (London: HMSO, 2000), pp. 21 and 34.
11. Department of Foreign Affairs and Trade [Australia], Advancing the National Interest: Australia's Foreign and Trade White Paper available at: 〈http://www/dfat.gov.au/ani〉, accessed on 20 January 2004.
12. Alexander Downer, 'Why Health Matters in Foreign Policy', available at: 〈http://www.foreignminister.gov.au/speeches/2003〉, accessed on 16 January 2004.
13. Roy J. Romanow, Building on Values: The Future of Health Care in Canada, Final Report of Commission on the Future of Health Care in Canada (the Romanow Commission). Available at 〈http://www.healthcarecommissoin.ca〉, accessed on 20 January 2004.
14. Department of Foreign Affairs and International Trade [Canada], A Dialogue on Foreign Policy and A Dialogue on Foreign Policy: Report to Canadians, both available at: 〈http://www.foreign-policy-dialogue.ca〉, accessed on 20 January 2004.
15. For a fuller discussion on health and foreign policy see Colin McInnes, 'Background paper: health and foreign policy', available at 〈http://www. nuffieldtrust.org.uk/global_health/pubs.php〉, accessed on 13 May 2004.
16. See for example the comments of President George W. Bush in signing the Public Health Security and Bioterrorism Response Act, that ' Protecting our citizens against bioterrorism is an urgent duty of ... American governments. We must develop the learning, the technology and the health care delivery systems that will allow us to respond to attacks with state of the art medical care throughout our entire country.' Transcript: Bush signs bioterror bill', Office of the Press Secretary, The White House, 12 June 2002, available at 〈http://japan.usembassy.gov/e/p/tp-se1440.html〉, accessed on 13 May 2004.
17. See also Elizabeth Prescott, 'SARS: A Warning', Survival, 45:3 (2003) pp. 207-26.
18. UNAIDS, Global Summary of the AIDS Epidemic, December 2004, p. 1, available at 〈http://www.unaids.org/wad2004/report_pdf.html〉, accessed on 12 May 2005. Due to the social stigma of HIV/AIDS infection in many societies, as well as weaknesses in capacity to collect health information, data on morbidity and mortality remain estimates, although UNAIDS believes that the accuracy of its estimates is improving.
19. See UNAIDS, AIDS Epidemic Update: December 2003, p. 1, at 〈http://www.unaids.org〉, accessed on 13 May 2004.
20. The full text of Resolution 1308 is available at 〈http://www. reliefweb.int〉.
21. See also Security Council Press Release SC/7068, 'Examining implications of HIV/AIDS for UN peacekeeping operations', 28 June 2001, available at 〈http://www.un.org/News/Press/docs/2001/sc7086.doc.htm〉, accessed on 13 May 2004. The Security Council session was followed by a special session of the General Assembly on HIV/AIDS in 2001.
22. See for example International Crisis Group, HIV/AIDS as a Security Issue, June 2001, available at: 〈http://www.crisisweb.org〉, accessed on 2 February 2002;
23. Stefan Elbe, 'HIV/AIDS and the Changing Landscape of War in Africa', International Security, 27:2 (2002), pp. 159-77
24. and Strategic Implications of HIV/AIDS, Adeplhi Paper 357 (Oxford: IISS/OUP, 2003);
25. R. Ostergard, 'Politics in the Hot Zone: AIDS and National Security in Africa', Third World Quarterly, 23:2 (2002), p. 342;
26. P. Chalk, 'Infectious Disease and the Threat to National Security', Jane's Intelligence Review, September 2001, pp. 48-50. Much of this literature, however, fails to distinguish between HIV infection and AIDS. Soldiers infected by HIV may not see their health (and therefore operational efficiency) affected for a number of years. Indeed AIDS may not appear until they have left the armed forces. Although this may raise issues over the treatment of those infected (especially the cost and the opportunity cost in terms of military budgets), the operational consequences may not be as severe as initially feared.
27. WHO, Severe Acute Respiratory Syndrome (SARS): Report by the Secretariat, EB113/33, 27 November 2003 (Geneva: WHO, 2003), p.1.
28. For details of the geographic spread of cases see WHO, Summary of Probable SARS Cases with Onset of Illness 2002 to 31 July 2003, 31 December 2003, available at 〈http://www.who.int/csr/sars/country/table2004_04_21/en/ 〉, accessed on 13 May 2004.
29. See also Kelley Lee, 'Decision making in the face of public health emergencies of international concern' in R. Smith and N. Drager, Rapid Assessment of the Economic Impact of Public Health Emergencies of International Concern: The Case of SARS (Geneva: WHO, in press); and Prescott, pp. 211-3.
30. G. F. Zhou and G. Y. Van, 'Severe Acute Respiratory Syndrome Epidemic in Asia', Emerging Infectious Diseases, 9:12 (2003).
31. For example Downer, 'Why Health Matters in Foreign Policy'.
32. National Intelligence Council, SARS: Down But Still a Threat, Intelligence Community Assessment ICA 2003-09 (Washington, DC: National Intelligence Council, 2003).
33. Reports from the Commission and details of its work can be found at its homepage: 〈http://www.cmhealth.org/cmh_papers&reports.htm〉.
34. See, for example, Peter Spiro, The Legal Challenges SARS Poses', available at 〈http://www.cnn.com/2003/LAW/04/29/findlaw.analysis.spiro. sars/), accessed on 14 May 2004. Concerns over the spread of SARS from Toronto led the United States' Centers for Disease Control and Prevention (CDC) to issue health alerts to travellers, including those from Toronto. CDC,
35. 'Update: Severe Acute Respiratory Syndrome - United States, 2003', available at: 〈http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5217a4.htm〉, accessed on 13 May 2004.
36. US National Intelligence Council, The Global Infectious Disease Threat and Its Implications for the United States, National Intelligence Estimate NIE99-17D (2000), available at: 〈http://www.cia.gov/cia/publications/nie/ report/nie99-17dhtml〉, accessed 5 August 2002.
37. Quoted in J. Gow, The HIV/AIDS Epidemic in Africa: Implications for US Policy', Health Affairs. 21:3 (2002), p. 57.
38. Quoted in J. Lobe, 'Spread of AIDS Seen as a Security Threat', Third World Network, available at: 〈http://www.twnside.org.sg/title/threat. htm〉, accessed 5 August 2002.
39. World Health Assembly Resolution 54.14, Global Health Security: Epidemic Alert and Response (Geneva: WHO, 2001).
40. H. Brand et al., An Evaluation of the Arrangements for Managing an Epidemiological Emergency Involving More than One EU Member State (Bielefeld: LOGD, 2000).
41. The report remains unpublished by the UK Department of Health. The UK Conservative Party announced plans to control immigration to prevent the spread of HIV and TB in the run-up to the 2005 General Election. See BBC News, Tories plan migrant health checks', 〈http://news.bbc.co.uk/1/hi/uk_politics/ 4265461.stm〉, accessed on 15 May 2005;
42. and politics.co.uk, 'Conservatives would turn away immigrants with TB', 〈http://www.politics.co.uk/election-2005/conservatives-would-turn-away- immigrants-with-tb-$13008625.htm), accessed on 15 May 2005.
43. Jeff Collin and Kelley Lee, Globalisation and Public Health: A Review and Assessment of Public Health Measures in the UK Concerned with Transborder Health Risks (London: The Nuffield Trust, 2002).
44. J. Gerard Power and Theresa Byrd, US-Mexico Border Health: Issues for Regional and Migrant Populations (London: Sage, 1998).
45. Australia, Department of Immigration and Multicultural and Indigenous Affairs, The Health Requirement', Fact Sheet, Canberra, 2004. At the Japan/ASEAN Summit held in November 2001, the Japan-ASEAN Information and Human Network for Infectious Disease Control was formed.
46. Richard Coker and K. Lambregts van Weezenbeek, 'Mandatory Screening and Treatment of Immigrants for Latent Tuberculosis in the USA: Just Resistant?' The Lancet, 1 November 2001, pp. 270-6.
47. A crucial report setting this agenda came from the Board on International Health of the US Institute of Medicine. See Institute of Medicine, America's Vital Interest in Global Health: Protecting Our People, Enhancing our Economy and Advancing our National Interests (Washington, DC: National Academy Press, 1997).
48. See also for example Jennifer Bower and Peter Chalk, The Global Threat of New and Reemerging Infectious Diseases: Reconciling US National Security and Public Health Policy (Santa Monica, CA: RAND, 2003), pp. 61-74. Although the major theme is that disease may spread to the United States and elsewhere in the West, an important sub-theme is of concern that the economic burden of disease elsewhere may harm economic growth globally, thus affecting Western economies.
49. See also A.M. Kimball and K. Taneda, 'Emerging Infections and Global Trade: A New Method for Gauging Impact', paper presented at Workshop on the Rapid Assessment of the Economic Impacts of Public Health Emergencies of International Concern, University of Toronto, January 2004.
50. WHO, Facts and Figures: Water, Sanitation and Hygiene Links to Health', Geneva, 2004. Available at 〈http://www.who.int/water_sanitation_health/ publications/factsfigures04/en/print.html〉 (accessed 31 March 2005).
51. C. Murray and A. Lopez, Global Burden of Disease (Cambridge, MA: Harvard University Press, 1994),
52. and 'Progress and Directions in Refining the Global Burden of Disease Approach: A Response to Williams' Discussion Paper' (Geneva: WHO, 2000).
53. Institute of Medicine, Ending Neglect: The Elimination of Tuberculosis in the United States (Washington, DC: Division of Health Promotion and Disease Prevention, 2004).
54. Coker and van Weezenbeek, 'Mandatory Screening and Treatment of Immigrants'.
55. In his 2003 evidence to Congress, for example, the Director of the CIA referred to this as a matter of 'grave concern'. See CIA, 'DCI's Worldwide Threat Briefing: The Worldwide Threat in 2003: Evolving Dangers in a Complex World', 11 February 2003, p. 4, available at: 〈http://www.cia.gov/ public_affairs/speeches/2003/dci_speech_02112003.html〉, accessed on 14 May 2004.
56. See also The White House, 'Biodefense for the 21st century', 30 April 2004, available at: 〈http://www.whitehouse.gov/homeland/20040430. html〉, accessed on 14 May 2004. The link between public health and bio-terrorism in the US is apparent, for example, in the 2002 Public Health Security and Bioterrorism Preparedness and Response Act and in the work of the CDC.
57. See CDC Terrorism and Preparedness and Response Strategy, version March 2004, available at: 〈http://www.bt.cdc.gov/planning/tprstrategy/index. asp〉, accessed on 14 May 2004.
58. The so-called Bioterrorism Act is available at: 〈http://www.fda.gov/ oc/bioterrorism/PL107-188.pdf〉.
59. On the problem of Russian biological weapons 'leakage', see Jonathan Tucker, 'Biological Weapons Proliferation from Russia: How Great a Threat', paper presented at the 7th Carnegie International Non-Proliferation Conference, 11-12 January 1999, Washington DC, available at 〈http://www.ceip.org/ programs/npp/tucker.htm〉, accessed on 2 February 2004.
60. See also G. Christopher, T. Cieslak, J. Pavlin and E. Eitzen, 'Biological Warfare: A Historical Perspective', Journal of the American Medical Association (hereafter JAMA), 278:5 (1997), pp. 412-17.
61. David Fidler, 'Facing the Global Challenges Posed by Biological Weapons', Microbes and Infection, 1999:1, pp. 1059-66;
62. D. Leigh, 'Iraq Stockpiled Anthrax in Run-up to Gulf War', The Guardian, 15 October 2001. Evidence has recently emerged that the strain of anthrax found in Iraq - anthrax 14578 - may have originated in US labs. See comments by Senator Riegle, Congressional Record (Senate), 9 February 1994, available at: 〈http://www.svsu.edu/=aboles/index/iraq/ussuppliesiraqgas.htm〉, accessed on 15 May 2005.
63. For example, CIA, 'DCI's Worldwide Threat Briefing', p. 4.
64. J. Simon, 'Biological Terrorism: Preparing to Meet the Threat', JAMA, 278:5 (1997), p. 428.
65. R. L. Shapiro, C. Hatheway, J. Becher and D. L. Swerdlow, 'Botulism Surveillance and Emergency Response', JAMA, 278:5 (1997), pp. 433-5.
66. J. B. Tucker, 'National Health and Medical Services Response to Incidents of Chemical and Biological Terrorism', JAMA, 278:5 (1997), pp. 362-8.
67. D. R. Franz, P. B. Jahrling, A. M. Friedlander et al., 'Clinical Recognition and Management of Patients Exposed to Biological Warfare Agents', JAMA, 278:5 (1997), pp. 399-411. On 2 December 2002 the UK government announced its intention to inoculate a limited number of key health personnel with the smallpox vaccine in order to create strategically available emergency health personnel in the event of a biological attack.
68. See CDR Weekly, Interim Guidelines for Smallpox Response and Management published by the Department of Health, 5 December 2002, available at 〈http://www.hpa.org.uk/cdr/PDFfiles/2002/cdr4902.pdf〉, accessed on 15 May 2005.
69. G. Pearson, The Complementary Role of Environmental and Security Biological Control Regimes in the 21st Century', JAMA, 278:5 (1997), pp. 369-72.
70. WHO, 'Countries Need to Plan Effectively for "Deliberate Infections" - WHO Leader Urges Health Ministers', WHO Press Release, 24 September 2001. The Global Outbreak Alert and Response Network is a system of 72 global and regional networks of laboratories, public health experts, and internet-based information systems that continually monitor reports and rumours of disease events around the world. The system is backed by WHO and expertise from more than 250 laboratories, and is linked to the International Health Regulations.
71. See, for example, Health Canada, 'Ministerial Statement', Fourth ministerial meeting on health security and bioterrorism, Berlin, 7 November 2003. Available at 〈www.hc-sc.gc.ca/english/media/releases/2003/ ministerial_statement.htm〉.
72. Linda D. Kozaryn, 'Bush Signs Health Security, Bioterrorism Act' American Forces Press Service 13 June 2002, available at: 〈http://www.defenselink. mil/news/Jun2002/n06132002_200206133.html〉, accessed on 14 May 2004.
73. The Bioterrorism Act is available at: 〈http://www.fda.gov/oc/ bioterrorism/PL107-188.pdf〉.
74. H. C. Lane and A. Fauci, 'Bioterrorism on the Home Front: A New Challenge for American Medicine', JAMA, 286:20 (2001), pp. 2595-7.
75. J. Barbera et al., 'Large-Scale Quarantine Following Biological Terrorism in the United States', JAMA, 286: 21 (2001), pp. 2711-17.
76. These efforts are detailed on the Biological and Toxic Weapons Convention website at: 〈http://www.opbw.org/〉.
77. See also the resource page on strengthening the BWC held by the Department of Peace Studies, University of Bradford: 〈http://www.bradford. ac.uk/acad/sbtwc/〉.
78. J. Laurance, 'US on Alert for Smallpox Terror Attack', Independent on Sunday, 22 April 2001.
79. The UK Department of Health holds pre-11 September stocks for 3 million people which could be diluted to cover 15 million people. J. Meikle, 'Wanted: More Smallpox Vaccine', The Guardian, 28 October 2002.
80. K. Singh, 'War Profiteering: Anthrax, Drug Transnationals and TRIPS', paper prepared for the Asia-Europe Dialogue Project (2001), available at 〈http://www.ased.org〉.
81. For example, the UK Public Health Laboratory Service (PHLS), now the Health Protection Agency, issued guidelines for action in the event of an anthrax attack. UK PHLS, Anthrax: Provisional PHLS Guidelines for Action in the Event of a Deliberate Release (London: CDSC, 2001).
82. See, for example, information on measures promoted or endorsed by the US Department of Health and Human Services at 〈http://www.hhs.gov/disasters/ index.shtml#bioterrorism〉.
83. Typical of this is UK Prime Minister Tony Blair's comment on intervention in Kosovo, that 'We must act... to save the stability of the Balkan region, where we know chaos can engulf all of Europe'. Statement by the Prime Minister in the House of Commons, 23 March 1999, available at 〈http://www.fco.gov. uk/news/newstext.asp?2149〉 accessed on 20 June 1999.
84. See, in particular, Nicholas J. Wheeler, Saving Strangers: Humanitarian Intervention in International Society (Oxford: Oxford University Press, 2000).
85. The White House, National Security Strategy of the United States, p. 9. Available at 〈http://www.whitehouse.gov/nsc/nss.html〉, accessed on 16 January 2004.
86. Ministry of Defence, Delivering Security in a Changing World- Defence White Paper, Cmnd 6041-I (London: HMSO, 2003), p. 5.
87. Stefan Elbe for example has examined the impact of HIV/AIDS on stability. See his Strategic Implications of HIV/AIDS.
88. US National Intelligence Council, The Global Infectious Disease Threat.
89. See, for example, ibid, and R. Ostergard, 'Politics in the Hot Zone', p. 344.
90. See, for example, P. Chalk, 'Infectious Disease and the Threat to National Security', p. 49;
91. J. Lobe, 'Spread of AIDS Seen as a Security Threat'.
92. D. C. Esty et al., 'State Failure Task Force Report: Phase II Findings', Environmental Change and Security Project Report Issue 5 (1999), available at 〈http://ecsp-si-edu/pdf/Report5-Sect2.pdf〉, accessed 8 August 2002. Other studies of state failure exist which may similarly be used to demonstrate this link; our use of the CIA study is simply to demonstrate the potential links rather than to prioritise one set of findings over another.
93. For example, US National Intelligence Council, The Global Infectious Disease Threat.
94. US National Intelligence Council, The Global Infectious Disease Threat.
95. The National Security Strategy of the United States, pp. 21-3 and especially p. 23.
96. Department of Emergency and Humanitarian Action, Conflict and Health, Working Paper (Geneva: WHO, 2000).
97. See also WHO, 'From Health Relief to Health Reconstruction: WHO Brief for Afghan Support Group Meeting, 5-7 December 2001', available at: 〈http://www.reliefweb.int〉, accessed on 5 August 2002.
98. WHO, Peace through Health: Summary of WHO peace building experiences, principles and strategies in Bosnia and Herzegovina (WHO/EUR/PAR, November 1999).
99. WHO, 'Peacebuilding through Health', Health in Emergencies (8), available at: 〈http://www.reliefweb.int/w/Rwb.nsf/s/ CF7700C552584AE2C12569CF0065A20A〉, accessed on 5 August 2002.
100. A. Vass, 'Editorial: Peace through Health', British Medical Journal, 323, 3 November 2002, p. 1020;
101. WHO Europe, WHO/DFID Peace Through Health Programme: A Case Study Prepared by the WHO Field Team in Bosnia and Herzegovina (Copenhagen: WHO, 1998);
102. Graeme MacQueen and Joanna Santa Barbara, 'Peacebuilding through Health Initiatives', British Medical Journal, 321, 29 July 2000, pp. 293-6.
103. A. Manenti, Health as a Potential Contribution to Peace. Realities from the Field: What WHO has learned in the 1990s (Geneva: WHO, 2001), p. 1. Available at 〈http://www.who.int/disasters/hbp/developing/ HBP_WHO_learned_1990s.pdf〉, accessed 1 November 2004.
104. The National Security Strategy of the United States, especially p. 23.
105. R. Horton, 'Public Health: A Neglected Counterterrorist Measure', The Lancet, 358 (2001), pp. 1112.
106. G. MacQueen, 'Iraq: Harm Reduction through Health', The Lancet, 360 (2002), p. 1031.
107. For example, Vass, 'Editorial', p. 1020.
108. Vass, 'Editorial', p. 1020.
109. This point might be made more generally about the links between health and stability. Although there are good reasons to believe that such links might exist, the empirical evidence remains patchy.
110. A good contemporary account is A. Nicaso and L. Lamothe, Global Mafia: The New World Order of Organized Crime (Toronto: Macmillan Canada, 1995).
111. Other forms of illicit activity with health implications are arms smuggling, illegal dumping of pollutants such as toxic substances, and the unregulated collection and use of biologicals including organs and blood products.
112. Paul Stares, Global Habit: The Drug Problem in a Borderless World (Washington, DC: Brookings Institution, 1996);
113. and UN Office on Drugs and Crime, Global Drugs Report 2000 (New York: United Nations, 2001).
114. See also UN Office on Drugs and Crime, Drugs and Crime Trends in Europe and Beyond, 29 April 2004, available at: 〈http://www.unodc.org/pdf/ factsheets/unodc_factsheet_eu_29-04-2004.pdf〉,
115. Global Illicit Drug Trends 2003 available at: 〈http://www.unodc.org/ pdf/trends2003_www_E.pdf〉, both accessed on 13 April 2005.
116. Interpol, People Smuggling: Challenge and Response, Interpol Fact Sheet (2004), available at ∠www.interpol.int〉.
117. USAID, 'Women as Chattel: The Emerging Global Market in Trafficking', Gender Matters Quarterly, 1 February 1999.
118. S. Camarota, Immigration from Mexico: Assessing the Impact on the United States (Washington, DC: Center for Immigration Studies, 2001);
119. P. Stalker, Workers without Frontiers: The Impact of Globalization on International Migration (Boulder, CO: Lynne Rienner, 2000).
120. Collin and Lee, Globalisation and Public Health.
121. While the health risks arising from undocumented migration are real, the authors do not support policy proposals that target all migrants for testing, underpinned by threats of deportation or exclusion. Rather, such measures will discourage at risk populations from identifying themselves, putting the host population at further risk. See Collin and Lee, Globalisation and Public Health for a discussion of this issue.
122. F. Abrams, Tobacco firm may face inquiry over "smuggling" ', The Guardian, 17 February 2000;
123. and L. Joosens, Tobacco Smuggling, Tobacco Control Factsheets, International Union Against Cancer, 2002, available at 〈http://factsheets. globalink.org/en/smuggling.html〉.
124. P. Jha and F. Chaloupka (eds.), Tobacco Control in Developing Countries (Oxford: Oxford University Press, 2000).
125. This includes the illegal production and consumption of narcotics, the growing manufacture and distribution of counterfeit pharmaceuticals, and the poorly regulated use of legal drugs such as their sale on the black market. The latter two raise concerns about the undermining of therapeutic effectiveness of existing drugs, resulting for instance in the spread of drug-resistant infections.
126. See for example Jeff Collin, Eric LeGresley, Ross MacKenzie, Sue Lawrence and Kelley Lee, 'Complicity in Contraband: British American Tobacco and Cigarette Smuggling in Asia', Tobacco Control, 2004, 13 (Supp. II): ii 104-ii 111;
127. Joanna Busza, Sarah Castle and Aisse Diarra, Trafficking and health', British Medical Journal, 328 (2004), pp. 1369-71;
128. and Guilhem Fabre and Michel Schiray, Globalisation, Drugs and Criminalisation (Paris: UNESCO, 2002).
129. The notable exception to this is the FCTC, though as noted above this proved an uphill task for the public health community. See Collin and Lee, Globalisation and Public Health.
130. Downer, 'Why Health Matters in Foreign Policy'.
131. We attempt to address these questions in Colin McInnes and Kelley Lee, 'Health and Security', Politik 8:1 (2005), pp. 33-45.