In the past year, policy makers, academics, national security professionals and even the media have taken a hard look at the potential impact of nontraditional health threats to security. Direct attacks, in the form of smallpox or influenza release, to the indirect effect between infectious diseases and state capacity highlight the possible intersection of health and security. Yet there has been great reluctance on the part of the health community, the relief community, the humanitarian assistance community, and even the security community to define health as a national security issue. In an effort to examine the relationship between health and security and to better identify their role as a nontraditional threat to security, the Woodrow Wilson International Center for Scholars hosted its sixth meeting of its working group "Preventing the Next Wave of Conflict: Understanding Non-Traditional Threats to Global Security."

Anita Sharma, the Deputy Director of the Wilson Center's Conflict Prevention Project, and Carla Koppell, moderated a discussion that addressed health as a non-traditional threat. To lead the discussion, Michael Moodie of the Chemical and Biological Arms Control Institute offered his perspectives about the topic from macro, micro, and microbial points of view. Aiding him in exploring the issue was a host of experts, to include representatives from the health, security, military, and humanitarian communities.

The speaker, Mr. Michael Moodie, is co-founder and President of the Chemical and Biological Arms Control Institute (CBACI), a nonprofit research organization established to promote the goals of arms control and nonproliferation with a special, but not exclusive focus on the elimination of chemical and biological weapons. In government, Mr. Moodie was the Assistant Director for Multilateral Affairs of the U.S. Arms Control and Disarmament Agency (ACDA) from March 1990 until January 1993. From 1983 to 1987, Mr. Moodie served as Special Assistant to the Ambassador and Assistant for Special Projects at the U.S. Mission to NATO.

Mr. Moodie started by stating that "Health and security have a long relationship. Diseases have had decisive impact in some conflicts, whether that is the Aztec situation, the invasion of Canada by the United States, or a rebellion in Haiti that ultimately led to Napoleon deciding to engage in the Louisiana Purchase with the United States. All had health dimensions as important aspects of their outcome." But looking at those connections does not necessary answer the question of whether health is a national security issue, Mr. Moodie stated. "That has been a question of significant debate. There has been great reluctance on the part of the health community, the relief community, the humanitarian assistance community and on the part of the security community, to define health as a national security issue. Rather than getting into the kind of debate that debilitated the focus on environment's relationship with security – the issue of the 1980's – we basically said that there are enough intersections in early 20th Century and after the Cold War where health and security come together and interact with one another in such a way that it is worth looking at, because it might yield some policies for the health community, the humanitarian assistance community, and for the national security community." Moodie continued, saying, "There are enough of these intersections that warrant an examination, to see what it might be able to tell us about where we are going in the future."

Mr. Moodie also stated that health is not a stand-alone issue, and that the problems that it contributes to are a result of health factors' interaction with a number of other factors. Whether they are population dynamics (both growth and movement of population), migration, urbanization, or globalization – all of those factors interact with health to create a non-traditional threat. "These interesting correlations highlight the fact that more research needs to be done to understand the relationship between health and these kinds of transitions," Mr. Moody acknowledged.

Exploring the relationship between health and security, Mr. Moodie examined the intersection of health and security at three levels, "what we call the macro level, the micro level, and the microbial level." Addressing the macro level, Mr. Moodie said that this relates specifically to the impact of health on political instability and potential conflict. The primary concern at this macro level is that infectious diseases in states with fragile political systems places strains on the social order as well as other dynamics, producing political instability which may ultimately erupt in violence and conflict. Likewise, the relationship between infectious diseases and threats to economic stability can create volatile social and political situations, producing heightened marginalization and resentment among populations, leading to a loss of government legitimacy. This stress on governmental structures can further undermine the armed forces, which obviously has an important security implication. "An over simplified description what we are talking about here is a negative synergy between health problems, population dynamics, environmental degradation, weak governmental structures and long-standing grievances. This negative synergy creates a downward spiral dynamic between infectious diseases and what Andrews calls 'state capacity' such that disease reduces the ability of the state to respond to challenges," Mr. Moodie said. This lowered state capacity results in increasing levels of not only disease but also potential violence.

Mr. Moodie continued, saying, "This is a process that is most intense in developing countries." As a result, a pernicious pattern develops in which deteriorating levels of health, care, immunization, sanitation, education, and the total burden of disease on a society interact with poverty and ecological degradation to roll back the level of development. The country therefore looses ground in the fight for quality of life. While this is perhaps most common in the developing world, it is a pattern that is happening elsewhere, including in some countries of especially strategic significance, where conflict and instability could have profound consequences for regional and global instability. To highlight his point, Mr. Moodie mentioned the briefing paper's emphasis on HIV/AIDs, saying that it "is really the poster child for this relationship between health and security."

"But there is a second dimension also at this macro level, which has to do with the relationship between health and complex humanitarian emergencies," Mr. Moodie stated. "These kinds of emergencies are produced by four scourges: war, disease, hunger and displacement. These complex emergencies are characterized by having their roots in ethnic, tribal, religious animosities, deterioration of governmental authority with control passing to other elements in the country, mass population movements, massive dislocation of the economic system and decline in food security." Essentially what these complex humanitarian emergencies do is highlight the inability of governments to cope, Moodie said. They underline the destructive dynamic between disease, population movement and inadequate food security.

Referring to the relationship between health and security and what might be called the micro level, Mr. Moodie said that this is the level of community warfare. He defined the micro level as "aggression through control and denial of vital human needs of a civilian populace for political and military objectives." Mr. Moodie noted that there are a number of examples and a number of dimensions of health and community warfare that reflect in part a violation of the laws of war, where health care resources have become targets in conflicts. As an example, Mr. Moodie referred to Mr. Milosevic's placement of anti-aircraft guns on the top of hospitals.

"So our choice has to be between our desire to help and our desire to avoid risk; between altruism and between self-interest; between being motivated by values and motivated by interests," Mr. Moodie offered. "But to pose it this way is really to pose a false choice. It really can't be either or. Rather our challenge is to determine how we balance these competing imperatives."

Recommending responses, Mr. Moodie said that the first thing is leadership. He cautioned, however, that this leadership must be properly resourced, stating that financing is obviously a part of meeting health and security challenges. "What we are seeing with respect to AIDs and the Global Fund is an interesting new model that brings private money and public money together in a way that is designed to maximize the impact of both," Mr. Moodie said.

Another response suggests the need for a new partnership between the public and private sectors. "Different kinds of dynamics have to be created between private companies, the corporate community, the humanitarian community, the military community, and the general broader security community," Mr. Moodie offered.

Mr. Moodie remains convinced that this is an effort worth making, "Not because health problems will be the most important security challenge, but because health and security represents so well the complex problems that awaits us in the future. Health as a security issue brings together the personal, the public, the individual and the international in a world characterized by globalization and fragmentation, enormous wealth and crushing poverty, soaring human achievement and incomprehensible human brutality. By focusing on the ways that health and security interact, we may be able to achieve a better understanding about how to live in that world."

Turning to microbial health issues, Mr. Moodie stated that as a starting point, the quality of our assessments is not very good - threat assessments in particular. "Traditionally, biological threat terrorism threat assessments have been one factor analysis focusing on one of three factors," Mr. Moodie stated. The problem is that a proper assessment includes assessing the interaction of operational considerations, the fact that various targets are going to shape the outcome of any attack, and the characteristics of agents, to include genetically manipulated agents.

"So you have these for categories, each of which have a number of elements between them and it is looking at the interaction – how you mix and match those things - which shapes the threat envelope that you are really going to have to confront." All of this takes place in an environment of incredibly rapid scientific and technological change that is not only happening in the laboratory but is diffusing globally. To confront this challenge, Mr. Moodie said that he believes that it is going to take a different way of doing business, creating a new kind of environment that is characterized by different sorts of relationships between industry and government in particular.

Mr. Moodie concluded by reiterating that accepting the challenges presented by the intersection of health and security are worth are best efforts, and indeed necessitate them.