In The Social Contract, the Swiss republican political philosopher JeanJacques Rousseau explicitly linked population health, economic productivity, and effective governance:
What is the object of any political association? It is the protection and prosperity of its members. And what is the surest evidence that they are so protected and prosperous? The numbers of their population. Then do not look beyond this much debated evidence. All other things being equal, the government under which, without external aids . . . the citizens increase and multiply most is infallibly the best government. That under which the people diminishes and wastes away is the worst.2
Indeed, Rousseau recognized that implementation of the social contract effectively entailed an exchange between the sovereign and the governed wherein the latter pledged their fealty (and taxes) to the former in exchange for the protection of their lives and property: "Their very lives which they have pledged to the state, are always protected by it. . . ."3 Such duties of the state were noted by the English republican political theorist Thomas Hobbes, who argued in Leviathan that the state possessed a fundamental obligation to protect its people from predation by external agents (i.e., foreign militaries) or by internal agents (criminals).4 One might certainly extend the argument to posit that the state is also obligated to protect the people from pathogenic forms of predation. States that fail to protect their citizens from predation may be viewed as in violation of the social contract. Such failures erode governmental claims to legitimacy in the eyes of the much diminished and debilitated people. In the domain of the political, both Rousseau and Hobbes are claimed as part of the Realist tradition, yet, as Daniel Deudney and Nicholas Onuf argue, they are in fact best conceived of as belonging to an antecedent and "republican" tradition of political thought. Realpolitik and Liberalism, which originated in the nineteenth century, then are conceptualized as the analytical descendants of this earlier republican school, and facets of both of these successor paradigms may be located in that earlier theoretical progenitor.5
To provide conceptual clarity, I adopt Deudney's concise definition of a republic as "a political order marked by political freedom, popular sovereignty, and limited government."6 The republican tradition, which was certainly dominant in ancient Greek thought (Aristotle, Plato, Thucydides), was based in part on Aristotle's heralded debate between physis (nature) and nomos (convention) and the mutual influence they exerted upon each other.7 Ultimately, Aristotle held that physis provided the basis for the emergence of nomos, and thus the natural world profoundly influences the derivative world of human constructs, such as political entities.8 Aristotle was therefore the progenitor of structural-materialist thought in political philosophy. Plato concurred, and argued that physis constituted a powerful driver of political transformation. Such logic was particularly evident in his chronicling of various natural disasters (earthquakes, floods, fires) that devastated human societies and left the survivors to reconstruct (or re-invent) their modes of social and political association.9
The Hellenic republican tradition infused Western political thought and informed Machiavelli, Rousseau, Montesquieu, and Hobbes, who also held that material-contextual variables10 were of profound significance in determining the trajectory of political affairs, both domestically and internationally.11
Such material factors were often cast as forces of "nature" and regarded as representing constraints and/or opportunities for a polity.12 Montesquieu also noted the pivotal role of physis when he proclaimed that "the empire of climate is the first and most powerful of empires."13 This is certainly logical from an epidemiological perspective, insofar as the disease gradient and the aggregate burden of disease on a society increase dramatically as one moves from temperate climes into the tropics. As Deudney argues, Montesquieu's work is central to understanding the relations between physis and polis, and Montesquieu stands as a pivotal empiricist in the domain of political thought even though much of modern international relations theory ignores his work. "Montesquieu's materialist arguments," Deudney writes, "are marshaled as part of a general effort to explain the origins and differences in the mores and laws of particular societies."14
In the post-Cold War era, the rise of environmental politics, and the environment-and-security debate in particular, sought to resurrect the decisive role of physis with some partial success,15 although political science in the early twenty-first century maintains its profoundly ideational bias. In his exemplary discussion of the role of physis in republican discourse, Deudney argues that "the physical world is not completely or primarily subject to effective human control and . . . natural material-contextual realities impede or enable vital and recurring human goals. Such arguments attempt to link specific physical constraints and opportunities given by nature to alterations in the performance of very basic functional tasks universal to human groups."16 Leo Strauss echoed this axiom of the fundamental role of physis, and the Aristotelian search for "first causes," when he argued that "the discovery of nature is the work of philosophy."17
Thus, Realist theory is heir to the materialist tradition of republican theory, particularly in its application of technological change to questions of security (e.g., the development of nuclear weapons).18 Realists seek to explain politics as it is, and not as it ought to be, suggesting that there are fixed and empirically based laws that govern the political sphere. Conversely, the poverty of much "critical" or post-modern political theory emanates from its blatant omission of material-contextual factors, including demography, geography, energy, advances in technology, and the subject of this discourse, population health.19 Largely as a consequence of Weberian thought, political discourse in the late twentieth century exhibited the increasing dominance of the ideational over the material, impoverishing current debates. The extreme marginalization of material variables within the predominant political discourse is problematic, as it leads to the inaccurate assumption that human societies are no longer subject to the laws of nature (and thus completely divorced from physis). Conversely, an extension of Aristotelian logic would hold that material-contextual factors are primal and intrinsically important, and that they form the empirical basis for ideational variables such as culture, identity, and political constructs. Of course, this relationship between physis and nomos exhibits evidence of reciprocal causation, as human society (largely through technological ingenuity) has over the centuries increasingly altered nature through its actions.
Such material-contextual factors continue to operate at both the domestic (or unit) level and the international (or system) level, freeing us of the dichotomization of modern political analysis into the domestic and system levels of analysis. While such divisions may suit intellectuals who seek parsimony, they are profoundly incapable of dealing with the many trans-boundary issues that now vex human societies. For example, emergent and re-emergent pathogens (e.g., SARS and HIV) originate within states, often function as global collective action problems, and ignore the porous political boundaries of sovereign states. In the same vein, environmental collective action problems (e.g., protection of the atmospheric and oceanic commons) routinely cross the unit/system level boundary. Onuf argues that this division itself is a legacy of Weberian thought, notably its second modern phase: ". . . social thought and practice before modernity's second phase . . . made no clear distinction between social relations within and among states."20
In this analytical domain, republican theory diverges from its theoretical successors, as both Realist and Liberal theories presuppose a sharp delineation between international and domestic politics, the latter having little if any influence on conduct between polities in the former. However, the empirical reality is that many problems arising within the territory of a sovereign state may defy containment within that polity, and function as externalities that destabilize not only contiguous countries but also (in some cases) distant polities and/or the entire international system. For example, an infectious disease arising in China (e.g., SARS) may not remain contained within that polity but may proliferate throughout East Asia and North America, and may destabilize global economic relations. In similar fashion, failed states generate externalities that often affect the entire system, as did the rise of Al-Qaeda under the
Taliban in the failed state of Afghanistan. The political scientist James Rosenau echoes this skepticism toward the unit/system level dichotomi-zation, holding that "in a rapidly changing, interdependent world the separation of national and international affairs is problematic."21 Rosenau argues that this porous and nebulous domain of interaction between the domestic and international levels is best conceptualized as "the Frontier."
Another area of divergence between republican theory and orthodox late-twentieth-century Realism lies in the latter's almost exclusive focus on relations between the great powers, and the general neglect of middle powers and smaller states as "inconsequential" to the operations and mechanics of the global system. In the realm of infectious disease, however, global pathogenic threats may emanate from failed states or quasi-states, or from those polities that exhibit low endogenous capacity, with poor public health infrastructure, entrenched poverty and structural inequities, high population density, and ecological degradation.22 Thus, owing to dynamics of global interdependence, processes at work within the weakest countries on the planet may generate negative externalities that ultimately compromise the material interests, and perhaps even the national security, of the great powers. This emphasis on complex interdependence between sovereign countries, particularly in the realm of trans-national issues, is the domain of republican theory's other successor, Liberalism. Yet the notion that disease could be transferred from one society to another is ancient, finding its first manifestations in Thucy-dides' account of the Plague of Athens, which suggests that the plague was imported via trade from Africa.23
As Rousseau noted, the health and size of a given population would certainly have been regarded as indispensable to the vitality of that body politic, and to the puissance of that nation. The manifestation of pathogenic infectious disease represented (and represents) a direct threat to the population base, erodes economic productivity, often weakens the institutions of the state and its ability to provide public goods, compromises governmental legitimacy, and often led to intra-class and/or intra-ethnic conflict within the state. Thus, an exogenous agent could act to fundamentally threaten the material interests and the stability of the affected polity in question. Furthermore, republican theory is concerned with placing constraints on the development of hierarchy within the state, recognizing the potential for despotic government and violence, directed by the state against its own people. Such concerns become readily apparent in the chapters that follow as the disruptions induced by plague, cholera, HIV, and pandemic influenza often resulted in draconian violence by the state against the people in order to quell the disruption engendered by the pathogen in question.
It is not the purpose of this volume to reconstruct international relations theory. However, I should like to make a few brief observations, and I recommend a republican revision of Realist theory. Such a revision entails maintaining certain postulates of Realism, that the international system is anarchical, that this state of anarchy is primarily competitive, and that sovereign states remain the dominant actors in international politics. Moreover, Realist theory states that states seek to maximize their power in order to attain their primary goal of survival. A republican revision entails considerable modification to Realist orthodoxy. First, echoing the work of the political scientist Robert Jervis, republican Realism abandons assumptions of the Rational Actor Model, holding that foreign policy is often driven by powerful elites and factions within the state, and that these policy makers are subject to cognitive and affective limitations. Thus human nature, human limitations and their effects upon rational decision-making are brought back into Realist theory.24 Furthermore, republican theory eschews orthodox Realism's fixation upon great power politics as ethnocentric, and holds that interactions between all states (including middle and small powers) are worthy of analysis. Moreover, while states remain the central actors in international politics, republican models accept the rise of non-state actors and other challenges (environmental degradation, disease) as threats to the material interests (and security) of sovereign states. Finally, a republican revision of Realism notes that the harsh dichotomization between the system and domestic levels of analysis is analytically problematic, particularly given that diseases, environmental degradation, or radical networks within a given state may generate externalities that compromise proximate states, and perhaps affect the system in its entirety.
A central claim of the present work is that pathogens can act as stressors on societies, economies, and institutions of governance. The proliferation of infectious disease may thereby compromise state capacity, and may destabilize the institutional architecture of the state. Under certain conditions, infectious disease may therefore represent a direct and/or an indirect threat to the material interests of the state, and therefore to national security. Thus, I pursue a state-centric theory of analysis, but one that acknowledges the complex interaction between state and society
Externalities: Regional and Global
human capital financial capital
revenues bureaucracy military/police cohesion power security
Theoretical construct of possible relations.
human capital financial capital
revenues bureaucracy military/police cohesion power security
medical treatment food/materials technology
in the context of contagion. (See figure 1.1.) This conceptualization of the relations between variables—an extension of previous work (Price-Smith 2001)—includes significant revisions to the original model: society is included as an intervening variable, and it is specified that effects on the dependent variable (state capacity) can generate radiating externalities that affect entire geographic regions and possibly the global system.
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