The release of the UK National Security Strategy (NSS) increases the visibility of health issues as a security concern. Pandemics have made the top tier of risks. Health care in fragile states also received a mention. But a number of health risks have fallen off the government's agenda.
With four influenza pandemics in the last century, and the outbreak of SARS as the first new pandemic threat of the 21st century, it remains a case of when, not if the next pandemic will appear. However the social and economic consequences can be varied. In light of the controversies around the severity and response to the recent H1N1 influenza pandemic, it is commendable that the UK government has maintained this focus. Actions to address low probability, high impact events such as pandemics also address a number of other risks: for example, preparations and adaptations required by health services, and diplomacy in international negotiations, will be relevant to other security risks.
Health rising up the agenda
There has been a slow, steady build up of interest in the national and international dimensions of the spread of disease in the UK. The concerns over the 2003 SARS outbreak led civil servants to consider the risks not just to the health of the UK population, but to trade and the economy. By 2008, pandemic influenza had become a cross-government priority deserving of coordination at the Cabinet Office. An international strategy was released. Then in May 2010 pandemics were confirmed at the top of the UK National Risk Register of Civil Emergencies.
The UK has a history of viewing health as a security issue. Health is Global was the Labour government strategy to address cross-sectoral risks to health that threatened wider prosperity and security. It was designed to improve long-term resilience in the UK and detailed other risks such as water, food, climate change, conflict and migration that require both domestic and international action. Such a cross-government approach to global health has been echoed in the US, China, and the EU amongst others.
In an era of austerity, there are opportunities and risks. As a result of the Spending Review, Whitehall staff are being cut. Decentralisation and efficiencies within government are welcome; however it still has a strong role in strategic direction and coordination for high-level threats. In terms of resources this need be only a few talented individuals. The efficiencies they create can mean cross-government work on health issues saves money as well as lives. The UK government can and must ensure both resilience and response.
Coordination around international issues often requires a Cabinet Office or Foreign and Commonwealth Office function. Pandemics and conflict stabilisation are such issues; however is it time for longer-term, complex threats in global health to be given the strategic oversight they require. The UK's leadership in this area can be maintained with limited and strategic resources, applied at the appropriate level.
What is missing?
The National Security Strategy states that there are many risks that have not made the current list because there are existing mitigation strategies which need to be maintained. An approach that fully understands the risks and systems in other sectors such as global health would be a welcome development.
Referring to the 1998 Defence Review, David Cameron states in the NSS that the machinery of government failed to adapt to the new circumstances - lacking both the urgency and the integration needed to cope with the new situation. The same applies to unexpected health threats. Expect the unexpected.