Personal views: Human security: a prerequisite for health
Authors: David R Meddings
Journal: BMJ (2001)

Recent events in Kosovo will remain in the public consciousness for some time. Many people were killed or injured or experienced some catastrophic loss.


However unforgettable, human suffering was not the only dimension of this conflict. Kosovo is perhaps the most memorable instance where lack of human security for people living within a state was used to justify military intervention against that state. 


The overlap between the concepts of health and human security is substantial



Some countries contend that “human security” offers a new perspective to guide foreign policy. But what is human security, and is this concept of interest to those in the health professions?

The predominant themes emerging from definitions of human security are sustainable access to essential needs and the guarantee of certain rights. However, the definition provokes less controversy than some of the issues that arise in incorporating consideration of human security into political practice.

One issue is the relative importance of human security versus state sovereignty. State sovereignty is a core political value. It seems that the international community, or parts of it, is prepared to attach a value to the conditions of human security within states. Experience shows that these values can lie in conflict, and resolution of this may imply something as profound as large scale military intervention.

Since the values of state sovereignty and human security can lie in competition existence of the state is no guarantee of human security.

Some indications suggest that the United Nations is prepared to safeguard human security—at least when a state intentionally jeopardises the security of its citizens. The secretary general of the UN, Kofi Annan, has argued that states cannot be permitted to persecute citizens and that “massive and systematic” violations of human rights cannot be allowed to stand.

In 1995, the Commission on Global Governance argued for revising the UN charter to allow for an international response to violation of human security on humanitarian grounds.

Clearly, consideration of how respect for human security might be incorporated into political practice raises an important debate. While this debate may seem far removed from a doctor's everyday work, it is a debate that concerns the fundamental determinants of human health. For the human security debate is essentially about deciding what priority the community of states is willing to attach to the wellbeing of individuals within states.

The World Health Organization's constitution defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The notions embedded within human security—sustainable access to essential needs and respect for certain rights—are necessary but not sufficient conditions for health. The overlap between the concepts of health and human security is substantial, and emerging interest in human security reflects a willingness to integrate concern for individual health within international political discourse.

This integration will pose ethical dilemmas, and the medical community has a unique viewpoint and potentially important contribution to make to resolving these.

Human security is not a completely novel preoccupation. Since 1864, guided by the same principles, the international community has devoted considerable efforts to the development of international humanitarian law and human rights law.

While not necessarily novel, consideration might be given to why concern for human security is emerging now. The international political scene is no longer dominated by the Cold War. Withdrawal of superpower support from various regions has facilitated the revival of ethnic tensions and shown several failures of postcolonial state building processes. This has profoundly changed conditions of security for entire populations, and the international community is being forced to come to grips with this.

People in the Western world build their lives on the bedrock of a secure environment, and most probably give little thought to security. However, there is an important overlap between the concept of health—that is, how fulfilling your life may be—and human security. Indeed, Thomas Hobbes provided a particularly apt description of ill health in describing life in the absence of security: “In such condition there is no place for industry . . . no arts; no letters; no society; and which is worst of all, continual fear, and danger of violent death; and the life of man, solitary, poor, nasty, brutish, and short.”

The international community is engaging in discussion about the value of human security. The international medical community has a responsibility to help build an ethical framework to ensure the greater good.