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The People’s Republic of China and Taiwan are on aggressive terms with each other. Taiwan is separated from China and it is governed independently. The nationalism government took over the administration of China and it contested its power on the mainland. The political leaders in China have adopted a different view point on China and Taiwan relations. Cross-strait tensions have been developed between China and Taiwan since the elections of 2016. (Maizland, 2021) China is not ready to accept Taiwan as separated from them completely. And for this purpose, China even rejected Taiwan’s place in the United Nations. Their conflict could be used by other countries for their benefit. Beijing even took some aggressive actions against Taiwan through its fighter jets. It attacked near the island. China also faced failure of a lot of plans. It tried to destroy Taiwan’s tourism sector but all in vain. The United States of America is taking complete advantage of the conflict between China and Taiwan which could result in War Confrontation between China and United states of America. China, the largest country of Asia is currently the rising power of the world. It has developed diplomatic relations with a lot 177 countries of the world and this is the most common reason of its progress and development. Since 2019, China has had the most diplomatic missions of any country in the world. Its one of the superpowers in the world and there is a clear prediction of China leading all over the world rather than America. Though it has Diplomatic relations with other countries but has cross-strait tensions with the Republic of China commonly known as Taiwan. No super power could tolerate its part being separated from them and it will make every possible attempt to gain its part back either hook or by crook. The relationship between China and Taiwan is complex due to the political status of Taiwan. China considers Taiwan as a break-away province. ROC came into being in the yar 1912 in China. During that time, Taiwan was being ruled by Japan. It was a colonial rule which was a result of 1985 Treaty of Shimonoseki. (Taiwan.gov.tw, 2021) Taiwan is an island commonly known as the Republic of China (ROC). Taiwan has its own democratically elected government and it’s a home of twenty-three million people. The people disagree with the Chinese government as they call Taiwan as a breakaway province. Also, the Chinese government sees Taiwan as part of China again in the future. But the people of Taiwan consider themselves as an independent nation whether or not independence is officially declared. China wants the reunification of China and Taiwan for the progress and development of the country. For that purpose, it gave the formula of ‘One Country Two System’ under which Taiwan would be given separate significance but Taiwan rejected the offer. (BBC news , 2021). But Taiwan relaxed the rules on China on visits. In 1991, Taiwan proclaimed the War on the People’s Republic of China on the mainland to be over. China conducted a political session in 2004. China got the benefit to use ‘unfair means’ against Taiwan through the law if Taiwan tried to take its roots out of China. In 2016, Taiwan's current president Tsai Ing-wen was elected. She is leading the Democratic Progressive Party (DPP). It’s definitely tilted towards the independence of China. United States of America is the superpower of the world. No Leading power could the other in competition. Seeing China as the rising power America is using every possible means to see the downfall of China. On January, 1979 the United States of America and the People’s Republic of China established diplomatic relations with each other. At that time, US tried to develop unofficial relations with the Republic of China as well. United States of America intentionally did that after seeing the complex terms of China and Taiwan. China also objected on the United States of America on recognizing Taiwan as separate island. China objected on US having the diplomatic relations with the both People’s Republic of China and the Republic of China. Having relations with Taiwan would mean that the United States of America believe that there are ‘Two China’ and not just ‘One China’. China believes on the “One-China Principle”. (Maizland, 2021) It has been observed that Taiwan has become the most dangerous flashpoint in US-China relations. Taiwan is in the center of two superpowers of the world. And US will definitely use it against China. Secret diplomacy could be the best word used for China and Taiwan so far. The relations between United States of America and Taiwan have remained unofficial. US is involved in helping Taiwan improving their military. It was to make them strong against China. Both US and China are now locked in a Security Dilemma. (BBC news, 2021) In response to the unofficial relations of US and Taiwan, China will increase its military reinforcement. China still doubts the relations of US and Taiwan. There is a big question mark on United States of America in defending Taiwan against China. The defense question is still unanswered.

The China-Russia relationship has become an increasingly robust, pragmatic strategic partnership since 2014, in part because the United States is pursuing policies that have driven the two countries closer together. Presidents Vladimir Putin and Xi Jinping are both authoritarian leaders whose primary preoccupation is regime survival and who are allergic to Western criticisms of their domestic systems and the repressive policies of their respective governments. China and Russia are revisionist powers in as much as they share a commitment to creating a “post-West” global order which takes their interests into account and is conducive to authoritarian rule.

Since Russia’s 2014 seizure and annexation of Crimea from Ukraine and the West’s subsequent attempts to isolate Russia, Putin has increasingly turned to China, which has enabled Russia to surmount the isolation and flourish on the world stage. Sino-Russian economic and energy ties are expanding. China is economically more important to Russia than vice versa and is Russia’s number one trading partner and the second-largest purchaser of Russian military hardware. The new Power of Siberia gas pipeline will increase their energy interdependence. Sino-Russian cooperation in the military and high-tech fields is also growing. Their joint military exercises and air patrols, as well as joint work on artificial intelligence and biotechnology pose challenges to the United States.

For as long as policymakers and scholars of international relations have sought to understand the actions of actors on the global stage, they have also debated the intentions of governments and the role those intentions play in statecraft. In a new article in the Journal of Chinese Political Science, Center Fellow Oriana Skylar Mastro proposes a new research agenda for deciphering Chinese intentions. She argues that the current treatment of intentions in international relations is not granular enough to allow for a nuanced understanding of what China wants, how it plans to achieve it, and what the implications will be for the United States and the U.S.-led world order.

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By contrast, Chinese revisionism has taken on a global profile, preferring the use of economic and diplomatic means. As the world’s second economic power, China has the economic and financial resources to challenge the supremacy of the United States on the global level. After the fall of the Berlin Wall, despite China’s territorial claims in the East and South Chinese Seas, Beijing implemented a regional ‘good neighbourhood’ policy with most of its South-east Asian neighbours that reflected a traditional Westphalian view of non-intervention, a priority given to national sovereignty and regime security, and a commitment to joint development through trade and investments. At the global level, China pursued economic integration into the Western-led world economy (see its membership in the World Trade Organization) to accomplish its peaceful rise and development policy (2003-13), based on the expansion of its production worldwide and the conquest of market shares (Buzan Citation2010).

Objectives

Countries that want to pursue their national interests sometimes need to cooperate with other countries. In this case, China is cooperating with Australia on the FTA. In line with the framework presented above, this case will be analysed using Coplin's foreign policy theory, which includes four determinants. These determinants are domestic policy, foreign policy behaviour, economic-military factors and international circumstances. Based on these determinants, it can be seen how the role of the international environment and power states can influence the formation of foreign policy. This paper uses China's main perspectives. First, the political domestic, where the dynamics of China's political situation and conditions play an important role in the foreign policy making process. China is a country that adheres to the communist system. All political affairs are related to communist principles. All political issues go directly to the Communist Party of China for discussion. However, in terms of the economy, China is more free. This is evidenced by an open economic policy, including the existence of free trade agreements (FTAs). China has experienced a number of internal political dynamics, such as the 1911 Revolution, the Cultural Revolution and so on. As an area of civilisation in the past, China contributed ideas and philosophies of life through Confucianism as the teachings of Confucius. The initial process of ChAFTA talks began in 2005. That was the year Hu Jintao became president of China. In Hu Jintao's domestic era, Hu promised massive political reform. Hu Jintao set up a group to study constitutional reform. This effort was also intended to discipline the government from corruption. In fact, Hu Jintao's leadership was questioned even more than that of his predecessors. The focus of Hu's administration was not only on the economy, but also on integrating environmental and social factors into the decision-making process. Hu recognised that development in China was still uneven. Hu called for more support for the poor, including a special budget for education and health. Before Hu became leader, China had been led by Jiang Zemin, so Hu simply continued Jiang Zemin's policy implementation programme. China's political stability was shaken in 2008 by the Tibetan riots. The riots were fuelled by separatism. Tibetans were originally celebrating Tibetan Awakening Day, but instead there were street-filling demonstrations by monks. The event was thought to have been initiated by the Dalai Lama, which was immediately denied and deemed untrue. As China is a communist country, it is not easy to establish cooperation agreements. There is a tendency to think of a military approach when things do not go according to plan. But in this case, China is looking at economic needs, so this FTA is important for economic sustainability and investment. Despite being a communist country, China is not closed when it comes to economic progress. The relevant parties are the Minister of Commerce, the President, the Ambassador and so on. Decision-making is interdependent, taking into account the direction of the Chinese Communist Party. Second, foreign policy behaviour. This is because a change in China's economic policy towards openness automatically opens up opportunities for China to compete globally. In the previous explanation, it was stated that power politics is divided into several parts. This is the case with China, Politik dan Pemerintahan China [7] which is one of the great powers. This position makes China a partner to be reckoned with in terms of its capabilities. Similarly, the great powers do not hesitate to make their own decisions and compete directly for military access. International and global policies involving great powers can affect other countries. On the economic front, China's economy grew by 9.9% in 2005. Domestic investment increased and export growth contributed to GDP ($2,262 billion) in 2005, bringing GDP per capita to $1,700 (DIckie, 2006). It is estimated that the Chinese economy has overtaken that of France and the UK. In 2015, however, China's economy slowed, growing only 6.9% from 7.3% the previous year. In its response to international issues, China is a revisionist country because it is supported by the East Asian region, which is not free from competition. The region is full of mutual suspicion, which makes it difficult for the region to form common integration in the form of institutions such as ASEAN and the European Union. In terms of engagement style, China tends to be aggressive. Especially when it comes to responding to the impact of US policies.

Pandemics are for the most part disease outbreaks that become widespread as a result of the spread of human-tohuman infection. Beyond the debilitating, sometimes fatal, consequences for those directly affected, pandemics have a range of negative social, economic and political consequences. These tend to be greater where the pandemic is a novel pathogen, has a high mortality and/or hospitalization rate and is easily spread. According to Lee Jong-wook, former Director-General of the World Health Organization (WHO), pandemics do not respect international borders. Therefore, they have the potential to weaken many societies, political systems and economies simultaneously. The association of pandemics with national security threat grew to prominence in the1990s. In 1995, the World Health Assembly (WHA) agreed to revise the International Health Regulations (IHR), the only international legal framework governing how WHO and its member States should respond to infectious disease outbreaks, on the grounds that revision was needed to take “effective account of the threat posed by the international spread of new and re-emerging diseases”. In 2005, the IHR revisions were adopted as WHA Resolution 58.3. Article 2 announced that the scope and purpose of the instrument was “to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks”. Since its entry into force in 2007, signatory States have been working, individually and collectively, to meet their core capacity requirements under the new framework. The focus of IHR is on the prevention and containment of public health emergencies of international concern. Member States committed themselves to building core capacities in the areas of national legislation, policy and financing, coordination and National Focal Point (NFP) communications, surveillance, response, preparedness, risk communication, and human resources and laboratories. It was widely presumed that not all member States would achieve these eight capacities by the 1 July 2012 deadline, but those that could not would identify areas in which they needed assistance in order to achieve these capacities. The political logic behind the attachment of health to security within the IHR framework would underline their importance and help sustain the political will needed to achieve the core capacities. The global threat posed by pandemics required a global approach to security as the rapid transmission of disease in a globalized world means that capacity failures in any member State could place any other state or society in peril. By 2013, 110 member States out of 195 signatories requested an additional two-year extension to build the capacities. This unexpectedly large number could be interpreted in one of two ways. First, that member States are not taking their commitment seriously and that the use of security language in the health field is no more than rhetoric. Second, that most states face immense challenges when it comes to building core capacities, especially when domestic health systems are fragmented, inadequately funded and understaffed. At this stage, indications point to the latter rather than former explanation. Multiple extensions were built into the IHR framework in recognition of the fact that the revised framework demanded much more of member States in terms of pandemic prevention and containment. The evident difficulties in these 110 States are largely rooted in more general health system deficiencies and do not reflect political objections to the IHR or the sense of shared responsibility for the prevention of pandemics. This is reflected in the fact that it is those capacities most associated with the general performance of health systems that have proven most resistant to strengthening. According to the latest figures, nearly two thirds of the States’ parties that reported their IHR implementation progress performed best in surveillance (with a global average score of 81 per cent), response (78 per cent), and zoonotic events (80 per cent), while performance was much lower in relation to human resources (with a global averNATIONAL SECURITY AND PANDEMICS Sara E. Davies Senior Research Fellow, Human Protections, Asia Institute and Centre of Governance and Public Policy, Griffith University, Australia Journal of Humanitarian Medicine - Vol. XIII - N° 3 - July-September 2013 33 age of 53 per cent), chemical events (51 per cent) and radiological events (53 per cent). Some 194 member States have appointed NFPs. Assessments of NFP functionality have revealed that they “recognize the value of engaging with government sectors outside the health ministry, [but] they lack the convening power needed to establish solid and reliable linkages”. In other words, the NFP’s recognition of the need to engage with others may outstrip the political process. At this stage, it may be safely said that the implementation lag does not reflect a lack of commitment to IHR but lies in deeper issues surrounding state capacity and political processes. In these circumstances, viewing pandemics as a security issue has encouraged a deepening of commitment to international cooperation and pandemic preparedness, but some of the associated structural changes will take more time. One response to the capacity challenge has been the promotion of a more targeted approach to implementation. In 2013, Margaret Chan, Director-General of WHO argued: “The aim [of IHR core capacities] is not only to achieve the widest possible population coverage. It is also to ensure that there are no significant gaps at the national level, as these have the potential to threaten the health security of all countries in the world”. There are two interrelated concepts in her statement: the responsibility of states to protect as many of their citizens as possible and their responsibility to health security between states. The relationship between individual, national and international security is related to the introduction of concepts such as “human security” and “sovereignty as responsibility” in the post-cold war era, which tied the capacity of the state to secure its population to that state’s domestic and international legitimacy. Based on a realist understanding of the world, one prominent criticism of this approach was that, as rational self-interested entities, states would only commit resources to human security when they derived some direct benefit from it. Directed at the IHR framework, this critique suggests that the framework is primarily aimed at protecting states, particularly developed states, from the economic and other ills of pandemics and not, in fact, at promoting human security. Expecting core capacities for pandemic prevention to be prioritized in states where, for example, health-care coverage is far from universal has raised the question: who really benefits from the securitization of health? This question is legitimate but neglects the discussion that has flowed from the health security movement since the 1990s. Today, debates concerning what should follow the Millennium Development Goals (MDGs) are primarily focused on the promotion of universal health care as a core goal. In 2007, the Oslo Ministerial Declaration by the Ministers of Foreign Affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand suggested 10 implementation priorities which included the marriage of health security with health equality: “a global partnership for overcoming both structural and economic barriers to development and health is fundamental for reaching the MDGs and reducing vulnerabilities to neglected and emerging infectious diseases” (emphasis added). This Declaration inspired the adoption of a General Assembly resolution on Global Health and Foreign Policy. In December 2012, the General Assembly reinforced the link between security and universality in calling for member States to “recognize the links between the promotion of universal health coverage and other foreign policy issues, such as the social dimension of globalization, cohesion and stability, inclusive and equitable growth and sustainable development and sustainability of national financing mechanisms, and the importance of universal coverage in national health systems”. This approach clearly refutes realist cynicism and shows an emerging consensus that health security rests on universal and equitable health systems upon which sustained implementation of the IHR core capacities depend. A key priority then is to ensure that access to and distribution of core capacities is equitable within and across societies and that the progress of IHR does not inadvertently weaken other aspects of the health system. In South and East Asia, for example, things have progressed amid a number of competing priorities and political interests. The region sits on key trading routes, has already proven to be a hot spot for novel infectious diseases (Severe Acute Respiratory Syndrome (SARS), Dengue Haemorrhagic Fever, severe complications from Enterovirus and influenza strains such as H5N1 and H7N9), has multiple states in political transition, civil unrest, dormant and active armed conflicts, and has a number of states recovering from armed conflict. There is also sharp diversity of wealth, health coverage and health governance. Since 2004, in the aftermath of SARS, member States to WHO South-East Asia Regional Office (SEARO) and Western Pacific Regional Office (WPRO) began meeting to develop a collective strategy for addressing emerging infectious disease outbreaks. The resulted Asia Pacific Strategy for Emerging Diseases (APSED) framework was adopted in 2005. APSED aimed to assist member States with the implementation of the revised IHR and to develop a series of implementation goals and shared experiences that would reflect regional concerns and realities outside the confines of the IHR. APSED, in its second phase of implementation in 2010-2015, still works according to the principle of tailoring the IHR core capacity requirements to the priorities and capacities of SEARO and WPRO member States. WHO SEARO and WPRO staff, along with the Association of Southeast Asian Nations (ASEAN), have worked together in efforts to share dialogue and highlight progress across the eight IHR capacities. From its inception, the APSED framework has been couched in strong Journal of Humanitarian Medicine - Vol. XIII - N° 3 - July-September 2013 34 security rhetoric, one that the ASEAN secretariat has readily adopted to promote regional cooperation. However, with this ready adoption of a national security lens have come concerns that the overall approach conceals deep structural shortfalls when it comes to IHR compliance in the region. It is sometimes charged that security rhetoric allows the region to appear engaged while doing little to ensure that domestic health and political systems are reformed to meet the commitments made to IHR. These programmes rely on self-reporting and hold workshops that engage like-minded health responders, while there is no forum to openly address problems where progress is seriously lagging. In responding to these concerns, while it cannot be said that all member States are effectively achieving their core capacity targets, the region has exhibited a willingness to recognize the challenges it faces. Most notably, nearly every SEARO and WPRO member State has reported on progress towards IHR implementation, a rate of reporting significantly above any of the other WHO Regional Offices. When novel outbreaks occur, this emerging shared knowledge of where capacity and capacity gaps exist is a significant advantage, as the region’s rapid and largely effective response to H7N9 demonstrates. Indeed, WPRO and SEARO have made the most progress in narrowing the time difference between outbreak alert and formal confirmation. This is no small achievement. There are three key concepts about the relationship between pandemics and security. First, associating health policy commitments with security can elevate the level of priority given to an issue and deliver results. While 110 member States will not meet their IHR core capacities by 2014, the majority of these States are working towards an implementation path with the WHO Director-General. Few other areas of global governance can boast similar levels of commitment and compliance; fewer still where core national capacities and structures are concerned. Second, health security has not distorted policy by drawing attention away from the health crises that affect most of the world’s population. In fact, heightened global and national interest in pandemic prevention and response has helped to elevate the goal of universal healthcare coverage. It is now widely recognized that effective prevention and response to a pandemic requires national health systems that are accessible and equitable. Universal health-care coverage is not the only answer in strengthening health systems but many states, such as China, perceive it as a core part of their effective response to disease outbreak events. Third, IHR compliance needs to be understood through a regional lens and supported by global institutions. Regional mechanisms allow a more tailored approach that recognizes the contexts in which states operate and establishes frameworks consistent with regional norms. This all helps to build the necessary trust and confidence. However, regions and individual states cannot do this on their own and WHO has a major role to play in assisting its regional offices and cooperating with its member States. The wider United Nations system, especially bodies such as the Peacebuilding Commission and agencies such as the United Nations Development Programme and United Nations Children’s Fund, have a supporting role to play in helping states build the technical capacities needed to deliver the IHRs. While the marriage of security and health has helped build the necessary global political will to implement the IHRs, the institutional, technical and political challenges in achieving this goal cannot be overstated.

Over the past several decades, there has been marked progress in the alleviation of poverty and suffering. Life expectancy has risen worldwide, child survival has almost doubled, and the global community has turned the tide of deadly diseases. Yet, at the same time, the spread of urbanization, the speed of global travel and the movement of goods, increased consumption of animal protein, and climate change have facilitated the emergence and rapid spread of infectious diseases, such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome coronavirus (MERSCoV), pandemic influenza, Ebola virus, and Zika virus (Burkle, 2017). Additionally, drought, famine, war, and country conflicts have led to international humanitarian and refugee crises, creating unstable conditions in which radical ideologies and diseases can thrive (WEF, 2017). Historically, the United States has made major investments in global platforms and initiatives that have largely enabled containment of threats such as infectious diseases before they reach the United States and promoted global security, stability, and prosperity. Examples of such investments include human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) treatment, infectious disease surveillance and response, vaccine development, and maternal and child health improvement. These investments have also benefited U.S. businesses both in terms of enabling a growing base of healthy, prosperous customers, as well as ensuring the safety of U.S. multinational operations around the world, and facilitated the continued leadership of the United States in research and development in biomedical sciences and technologies (Daschle and Frist, 2015; Lima et al., 2013; Wagner et al., 2015). 23 24 GLOBAL HEALTH AND THE FUTURE ROLE OF THE UNITED STATES However, competing priorities and demands on government funding create an imperative for the United States to examine the economic benefits of investments in global health for the economy, national security, innovation, and global standing. Shifts in global economies and privatesector engagement are changing the nature of these investments (Sturchio and Goel, 2012). In the past decade, many countries that have historically received foreign aid have begun experiencing economic growth and rising middle classes. This growth has allowed traditional aid recipient countries to expand their tax base. In fact, through taxation and mobilization of domestic resources, the funds collected between 2000 and 2014 in subSaharan Africa rose from $100 billion to $461 billion (Runde and Savoy, 2016). The growth of many multinational businesses has also forced business executives to adopt a more global perspective regarding long-term planning, workforce development, and safety. As a country plans for both its own future and that of the world, a prudent step is to assess current investments and adapt them to reflect these global changes. Although great progress has been achieved toward the completion of the Millennium Development Goals (MDGs)1 since their launch in 2000, there are still unfinished agendas. The transition in 2016 to the multidisciplinary Sustainable Development Goals (SDGs) illustrates the continued commitment to end poverty, save the planet, and ensure prosperity for all. There is a chance to save the lives of millions of children and adults by investing in global health over the next 20 years (Jamison et al., 2013). Furthermore, investing in health has benefits beyond saving lives and is considered to have made the largest contribution to sustainable development (Jamison et al., 2016). According to the Lancet Commission on Investing in Health, achieving a grand convergence in global health by 20352—reducing infectious disease, maternal, and child deaths down to universally low levels within a generation—is estimated to produce benefits that would exceed the costs 1 The Millennium Development Goals are “The world’s time-bound and quantified targets for addressing extreme poverty in its many dimensions-income poverty, hunger, disease, lack of adequate shelter, and exclusion-while promoting gender equality, education, and environmental sustainability. They are also basic human rights-the rights of each person on the planet to health, education, shelter, and security” (Millennium Project, 2006). 2 Achieving convergence would require significant increases in health spending in low- and lower-middle-income countries—$30 billion in low-income countries and $61 billion in lowermiddle-income countries in 2035. Expected economic growth, together with other sources of revenue, such as taxes on tobacco and removal of subsidies on fossil fuels, will enable lowincome countries to finance most of this agenda on their own, while middle-income countries will easily be able to leverage resources domestically (Summers and Jamison, 2013). INVESTING IN GLOBAL HEALTH FOR AMERICA 25 of investment between 9 and 20 times for low- and lower-middle-income countries, respectively3 (Jamison et al., 2013; Yamey et al., 2016). This chapter identifies the benefits of global health investment for the United States, discusses the current spending of the United States on global health programs, and explores opportunities for future investment based on trends affecting health such as globalization, the SDG agenda, and privatesector involvement. WHY GLOBAL HEALTH FUNDING PROTECTS U.S. INTERESTS There will likely always be a demand for U.S. support when it comes to disaster relief and humanitarian efforts because the U.S. response system excels at logistics and operations. But disaster response must be complemented by investment in programs and countries during steady state times—acknowledging the public health mantra of “An ounce of prevention is worth a pound of cure.” Money spent on improvements to infrastructure, workforce training, and response systems—both in the United States and abroad—protects Americans from threats such as emerging infectious diseases or bioterror attacks. Such investments help to build everyday resilience so communities are prepared for all types of disasters, whether they take the form of a bus crash, an active shooter event, or an Ebola outbreak. Similarly, investing in the development of countries around the world through partnerships and capacity building can help foster stable economies with sufficient opportunities for their citizens, discouraging them from feeling forced to flee their country. Stable countries with growing middle class populations are more likely to become trading partners and to purchase U.S. goods; 11 of the top 15 U.S. trading partners are former recipients of U.S. foreign assistance programs (InterAction, 2011). Moreover, beyond just trading partners, the shared burden of noncommunicable diseases (NCDs) around the world is a strong justification for health and scientific partnerships that can lead to shared solutions to common problems. Many aid-recipient countries suffer from similar health burdens to those in the United States, such as hypertension, cancer, poor maternal health, or depression. The reasons for U.S. investment in global health are numerous, but with so many competing priorities, limited resources dictate prioritization. However, providing foreign assistance through overseas development aid (ODA), and acting in the best interest of the United States can often be 3 This estimate was found using a full income approach, where income growth plus the value of life years gained in that period results in a change in a country’s full income over a time period. This accounts for the omission of reduced mortality risk in typical gross domestic product (GDP) measures to give a more complete picture (Summers and Jamison, 2013). 26 GLOBAL HEALTH AND THE FUTURE ROLE OF THE UNITED STATES accomplished simultaneously. The recent change in administration in the U.S. political system is a chance to pause and take a more holistic view of each of the elements of current global health investments as part of an interconnected system. In this process, it is critical to consider the longerterm consequences that will arise from near-term decisions on the future of investments in global health. EXISTING U.S. GLOBAL HEALTH SPENDING U.S. funding for global health grew from $1.7 billion in 2000 to $8.47 billion in 2009 (Salaam-Blyther, 2013), increasing on an average of 19.53 percent per year. The 2009 Institute of Medicine (IOM) report U.S. Commitment to Global Health called for an increase in the budget for global health programs, urging the U.S. government to invest $15 bil lion annually in global health by 2012, of which $13 billion should be directed toward the MDGs and $2 billion toward NCDs and injuries. Unfortunately, the timing of the Great Recession of 2008 likely impacted this call for action, and while funding did increase slightly, annual U.S. global health funding continued to hover around $10 billion from 2009 to 2015 (Valentine et al., 2016), with approximately $6.5 billion dedicated to global HIV/AIDS efforts (KFF, 2012).4 Compared to prior years, annual growth in global health spending has only been 1.6 percent between 2010 and 2016 (IHME, 2017). ­ The most recent budget request from President Obama for FY2017 included $10.3 billion in total funding for global health programs (Valentine et al., 2016). According to Valentine and colleagues, within the international affairs budget, most of the global health funding ($8.6 billion) in the FY2017 request is provided through the global health programs (GHP) account at the U.S. Agency for International Development (USAID) and the U.S. Department of State, including funding for The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative. For a full breakdown of the GHP account, which does not include global health money spent by the U.S. Department of Health and Human Services (HHS) or the U.S. Department of Defense, see Figure 2-1. In its analysis of the global health budget, the Kaiser Family Foundation noted that Congress has approved higher funding levels for global health than those in the President’s budget request for each of the past 4 fiscal years. However, whether that trend will continue is unclear. 4 Appropriated U.S. funding for global health between 2009 and 2016 fluctuated: $8.46 billion in 2009, $9.016 billion in 2010, $8.86 billion in 2011 (Salaam-Blyther, 2013), $9.8 billion in 2012, $9.6 billion in 2013, $10.2 billion in 2014, $10.2 billion in 2015, and 10.2 billion in 2016 (Valentine et al., 2016). INVESTING IN GLOBAL HEALTH FOR AMERICA 27 FIGURE 2-1 Global health programs (GHP) account, by program FY2017 (in USD millions). NOTE: FPRH = family planning and reproductive health, HIV/AIDS = human im munodeficiency virus/acquired immunodeficiency syndrome, MCH = maternal and child health, NTD = neglected tropical disease, TB = tuberculosis. SOURCE: Valentine, A., A. Wexler, and J. Kates. The U.S. global health budget: Analysis of the fiscal year 2017 budget request. (The Henry J. Kaiser Family Foundation, March 22, 2016) (http://kff.org/global-health-policy/issue-brief/theu-s-global-health-budget-analysis-of-the-fiscal-year-2017-budget-request [accessed January 26, 2017]). ­ Table 2-1 illustrates global health spending by U.S. government agencies in the four focus areas of this report: emerging infectious diseases; HIV/AIDS, tuberculosis (TB), and malaria; maternal and child health; and cardiovascular disease (CVD) and cancers. Perceptions of U.S. Global Health Spending The American public approves of the United States taking a leading or major role in solving international problems, as revealed by a 2016 Kaiser Family Foundation survey of Americans on the United States’s role in global 28 GLOBAL HEALTH AND THE FUTURE ROLE OF THE UNITED STATES TABLE 2-1 U.S. Global Health Budgeted Spending on Priority Areas in 2016 (in $ millions) Emerging Infectious Diseases HIV/AIDS, TB, and Malaria Maternal and Child Health* Cardiovascular Disease and Agency Cancer TOTAL U.S. Department $4,320.00 $165.00 $4,485.00 of State CDC $601.50 $128.40 $219.00 ** $948.90 FDA $129.50 — $129.50 U.S. Department $712.20 $13.30 — $725.50 of Defense NIH $1,848.00 $602.10 — $23.01 $2,450.10 BARDA $522.00 — — — $522.00 Total $3,863.20 $6,089.80 $1,805.00 $23.01*** $11,758.00 USAID $50.00 $1,026.00 $1,421.00 ** $2,497.00 NOTE: BARDA = Biomedical Advanced Research and Development Authority; CDC = U.S. Centers for Disease Control and Prevention; FDA = U.S. Food and Drug Administration; HIV/AIDS = human immunodeficiency virus/acquired immunodeficiency syndrome; NIH = National Institutes of Health; TB = tuberculosis; USAID = U.S. Agency for International Development. * Budget estimates for Maternal and Child Health incorporates program areas of “Maternal and Child Health,” “Nutrition,” “Family Planning,” and “Vulnerable Children.” ** Cardiovascular disease (CVD) funding within USAID is folded into broader health systems strengthening projects, so itemized expenditures could not be identified. For CVD programs within CDC, philanthropic funding is used. *** CVD and cancer funding from the NIH are identified as global grants provided by the National Heart, Lung, and Blood Institute and the National Cancer Institute. SOURCES: Boddie et al., 2015; KFF, 2016; NIH, 2017. health (Hamel et al., 2016). Striking though, is that half of Americans think the United States is spending too much on foreign aid, until they learn that foreign aid spending is just 1 percent of the budget (Hamel et al., 2016). Global health spending, specifically, was only about 0.26 percent5 of the budget in 2016. On average, survey participants estimated foreign aid spending at 31 percent of the budget (Hamel et al., 2016). After being informed of true foreign aid expenditures, “7 in 10 Americans believe that the current level of U.S. foreign spending on health is too little or about right” (Hamel et al., 2016). While the United States contributes greatly 5 Global health spending as a percent of the budget was calculated by using 2016 enacted global health funding ($10.2 billion) from Valentine et al. (2016) and total spending ($3.9 trillion) from the Congressional Budget Office (CBO, 2017). INVESTING IN GLOBAL HEALTH FOR AMERICA 29 FIGURE 2-2 Net overseas development aid in 2015 as a percentage of gross national income (GNI). NOTE: DAC = Development Assistance Committee; GNI = gross national income; ODA = overseas development aid; UN = United Nations. SOURCE: https://www.oecd.org/dac/stats/ODA-2015-complete-data-tables.pdf (accessed January 12, 2017). to global aid, other donor countries are just as critical to ensuring robust development assistance in health across the globe. In fact, the United States actually contributes a lower percentage of its gross national income (GNI)6 than other high-income countries, with ODA at only 0.17 percent of GNI for the United States—below the levels of other high-income countries such as Germany, Sweden, or the United Kingdom, and well below the United Nations target of 0.7 (see Figure 2-2). Additionally, 75 percent of Americans surveyed think the United States should give money to multilateral health organizations, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance (Gavi); the United Nations; and the World Health Organization (WHO), to improve health in other countries. These findings indicate that there is broad recognition of the advantages of leveraging the different strengths of these organizations to complement the United States’ strength as a bilateral donor (Hamel et al., 2016). As the role of foreign assistance in global health 6 Gross national income is the sum of a country’s gross domestic product plus net income received from overseas (OECD, 2016). 30 GLOBAL HEALTH AND THE FUTURE ROLE OF THE UNITED STATES continues to shift in the coming years, it will be essential to consider the importance of other national governments and global players as partners in providing development and health aid, and the potential of synergized efforts toward shared global goals. A CHANGING WORLD: EFFECTS OF GLOBALIZATION In 2013, Julio Frenk and Suerie Moon argued that “globalization has intensified cross-border health threats, leading to a situation of health interdependence—the notion that no nation or organization is able to address singlehandedly the health threats it faces but instead must rely to some degree on others to mount an effective response” (Frenk and Moon, 2013, p. 936). In 2017, this societal interconnectedness, stemming largely from travel and trade, is fully apparent and shows no signs of reversal. Globalization and trade have cut poverty and global inequality, and have narrowed the gap between emerging economies and those of wealthy countries (WEF, 2017). Yet, the numerous advancements owed to globalization paradoxically pose threats to the security, well-being, and economic viability of all countries. For example, most of the food Americans eat each day comes from other parts of the world, making food defense and the prevention of foodborne illnesses a primary concern for the U.S. Food and Drug Administration. Many American businesses and their supply chains now depend on workers in foreign countries. Consequently, disease outbreaks, disasters, and poor health can diminish workforce capacity and harm business. Furthermore, industrialization often has negative effects on the environment, with mortality risk from air pollution in some locations being comparable to that of obesity (Pope et al., 2002). However, discussed in more detail in the section below, globalization also presents many opportunities for health, stemming in part from the increase in global communication and access to goods, as well as from the broader cross-disciplinary agendas that have emerged from a diverse network of global discussions. Leveraging Globalization for Improved Global Health Despite the increase in risks of food security, air pollution, and infectious disease outbreaks, globalization has driven innovation for the health and business sectors. Increased international trade leads to global competition, which improves the quality of products and enhances the focus on the customers, creating markets in previously inaccessible places. Similarly, sharing data and study results across countries and regions, aided by advancements in digital technology, can accelerate the elimination and eradication of global diseases and contribute to new solutions and health improvements. In November 2016, a Chinese group became the first to in­ INVESTING IN GLOBAL HEALTH FOR AMERICA 31 ject a person with cells that contained edited genes using the groundbreaking CRISPR-Cas9 technique (Cyranoski, 2016). This novel technology has the potential to revolutionize the treatment of different types of cancers, and competition between countries is expected to further fuel progress, similar to the race to the moon. The United States is likely to benefit from such innovations that address pressing health challenges, beyond the race to master gene editing. Average body mass index and rates of homicide and child and maternal mortality are higher in the United States than in any other high-income country (Kontis et al., 2017). Moreover, life expectancy for Americans is projected to stagnate in coming years. There are opportunities to learn from other countries in order to reverse these trends; global health actors often solve problems in resource-constrained environments, so the solutions are locally appropriate and fiscally sustainable. The concept of “frugal innovation” has recently been embraced by many business leaders as they expand globally, and see resource constraints as an opportunity instead of a liability, resulting in attempts to embed frugality into the company’s fundamental structure (Radjou and Prabhu, 2014). This new way of thinking could provide many opportunities for applying global health lessons to challenges faced in the United States. For example, the mobile phone–based service m-Pesa has solved the problem of limited bank account access to help Kenyans make payments through mobile phones (CBS News, 2015), which has seen extraordinary use and success since its creation. The concept has recently been specifically applied in a health context through a new program called M-Tiba that helps customers set aside money for health care needs, similar to how a health savings account works (PharmAccess Foundation, 2015). This could be adapted to certain health payment contexts in the United States to make health care payments more user-friendly. On a broader scale, the organization Global to Local, founded in 2010 in King County, Washington, identifies strategies that have been proven effective in other countries and applies them to some of King County’s most diverse, underserved populations (Global to Local, 2013). Additionally, the Robert Wood Johnson Foundation created a grant program in 2015 that funds organizations to gather evidence from other countries to improve community participation and decision making in local health systems, and then bring and adapt these findings to United States (RWJF, 2015). Globalization presents the United States with many opportunities to be at the forefront of global health, with an eye for bidirectional information flow and lessons learned. Sustainable Development Goals Improvements in health outcomes cannot be achieved by the health sector alone. This is one of the key lessons learned through the past decade 32 GLOBAL HEALTH AND THE FUTURE ROLE OF THE UNITED STATES of global health efforts and progress, including the recent outbreaks of Ebola and Zika. Health is the common denominator woven through sectors such as energy, transportation, and agriculture, and only through a multidisciplinary “health in all policies” approach can there be sustainable progress toward global health goals. Reflecting the interdependence of sectors and the implications for future development, the SDGs were put forward on January 1, 2016, to supersede the MDGs ending in 2015 as a nonbinding international agreement to harmonize the three interconnected elements of economic growth, social inclusion, and environmental protection needed to promote sustainable development (UN, 2016). While the SDGs built on the MDGs created in 2000, this new era of international cooperation shifts the vision and goals beyond those simply focused on health, and toward improving the environment, energy, economic growth, and social justice. With 17 goals and 169 targets, the Sustainable Development Agenda is too large for any one entity to successfully address and requires a multisectoral effort. To ensure success, government bodies, along with financial institutions, capital markets, and private companies, will need to be engaged in bringing the Sustainable Development Agenda to fruition. Blending funds from donor organizations, governments, and private debt and equity offers the best chance for achieving these lofty and critical development goals (Nathan, 2017). Moreover, disruptive innovation and new methods of engagement and investment will be necessary to deliver on the development agenda. But a framework for operations is lacking; although the global economy is predicted to grow to almost $100 trillion by 2021, the delivery system of goods and services is outdated and it is coming up short both in terms of protecting the planet and protecting positive social outcomes for those in need (Kharas and McArthur, 2017). Considering these factors, and the positive and negative health effects of increasing globalization, the United States must base its efforts on multidisciplinary collaboration and implementation to continue to be a leader in global health for the next decade. LOOKING TO THE FUTURE: HOW TO BETTER INVEST U.S. FUNDS The United States has an opportunity to think more creatively about the methods and mechanisms used to finance global health efforts, particularly as greater emphasis is placed on leveraging funding from other governments and increasing engagement of private financing. A number of approaches can be considered for optimizing limited U.S. government resources to achieve the global health goals, thereby ensuring a safe homeland and a strong trade network. In 2014, the Organisation for Economic Co-operation and Development (OECD) Development Assistance Com­ INVESTING IN GLOBAL HEALTH FOR AMERICA 33 mittee reported that 17 percent of U.S. foreign aid was provided through multilateral institutions, while 83 percent was provided bilaterally (Nelson, 2015). While this trend is similar to the global allocation of resources, some donor governments conversely prefer multilateral channels. For example Sweden directed an average of 60 percent of its development assistance for health toward multilateral channels between 2010 and 2015 (Yamey et al., 2016). Congress will continually be faced with the question of whether to provide aid bilaterally or multilaterally, and although each option has its advantages and disadvantages, the global transitions under way should inform this decision. Bilateral aid gives donors more control over how their money is spent, and it allows donor countries to align development assistance with broader strategic foreign policy objectives. Conversely, multilateral channels can sometimes achieve more impact—especially in areas where problems cannot be solved by any one country alone—because of their broad reach and networks. Additionally, the methods and sources of funding for global health projects have begun to shift with the growth of middle-income countries and a burgeoning middle class, allowing greater capacity to mobilize domestic resources. Finally, the growing involvement of the private sector in health and development can be a sustainable prospect for partnership and investing in global health, which offers governments a chance to do more with current spending. Global Public Goods Although traditional development assistance for health (DAH) has been successful in the last several decades, in part because of large flows of philanthropic dollars, there is no room for complacency. Owing to the increasingly globalized nature of health threats, economic growth in aidrecipient countries, and the growing need of a value-for-money approach, many argue that the allocation of DAH should shift more toward support of global goods and less toward support of local- or country-specific functions. In fact, the Center for Global Development’s (CGD’s) White House and the World Report for 2016 stated that in the present changing landscape, government revenues—as well as remittances and foreign direct investment in countries—far exceed foreign aid in all but the poorest countries (Birdsall and Leo, 2015) (see Figure 2-3). Instead of supporting countries or their programs directly, donor governments can support efficient and effective multilateral organizations, which can shift their role to catalyze new ideas, crowd-in investment,7 and promote global public goods. 7 Crowding-in is an economic principle in which private investment increases as debtfinanced government spending increases. This is caused by government spending boosting the demand for goods, which in turn increases private demand for new output sources. USD Billions 400 350 300 250 200 150 100 50 0 Total US Assistance Domestic Revenues 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 34 GLOBAL HEALTH AND THE FUTURE ROLE OF THE UNITED STATES FIGURE 2-3 Domestic revenues and U.S. aid to sub-Saharan Africa. NOTES: Aid is defined as development assistance and other official flows reported to the Organisation for Economic Co-operation and Development’s Development Assistance Committee. World Bank aid figures include both concessional and nonconcessional commitments by the International Development Association and the International Bank for Reconstruction and Development. USD = U.S. dollars. SOURCES: Birdsall and Leo, 2015, and Center for Global Development (CGD), using data from the International Monetary Fund and the Development Assistance Committee of the Organisation for Economic Co-operation and Development. Providing aid through multilateral channels allows for pooling resources, increasing purchasing power, dividing the burden, and cost sharing by donors, as well as greater coordination and aid effectiveness at the country level (Nelson, 2015). Similarly, the World Bank and other multilateral development banks (MDBs) have typically only participated in global health in an ad hoc fashion, through provision of emergency financing during various crises in recent years. Yet, they are also uniquely positioned to meet current demands for global public goods, and through a shift in purpose, MDBs could expand their missions to encompass leadership on these issues that require a global shareholder base to respond collectively (Birdsall and Morris, 2016). In fact, a high-level panel on the future of multilateral development banking recommended that the World Bank promote global public goods critical to development as its major priority. This would be achieved through the creation of a new fund with a separate governance structure set up to disburse $10 billion annually in grant resources toward programs that cannot be easily structured as country operations (Birdsall and Morris, 2016). Thus, there are important roles for different actors, and through an overarching examination, donor countries, recipient governments, regional INVESTING IN GLOBAL HEALTH FOR AMERICA 35 MDBs, and the World Bank can identify strengths and weaknesses of different approaches. In addition to directing funding toward multilateral channels, donor governments can help countries increase domestic financing, or domestic resource mobilization (DRM). These methodological considerations will be important to examine as the next administration reviews the current U.S. commitment toward unfished agendas such as communicable diseases including HIV/AIDS, TB, and malaria, and long-term investments in maternal and child health. Domestic Resource Mobilization Recent growth projections from the International Monetary Fund show an increase of 3.5 percent globally in 2017, slightly lower than previous estimates but still showing a recovery trend worldwide. Emerging market and developing economies are estimated to be slightly higher, with 4.6 percent growth in 2017 (IMF, 2016). This gross domestic product (GDP) growth is expected to continue in coming years, which will provide further support for greater DRM. Coupled with the use of sound fiscal policies, GDP growth will result in a large portion of countries graduating from DAH and beginning to fund health needs through their own domestic resources (Bhatt et al., 2015). Moreover, with the conclusion of the MDGs and creation of the SDGs in 2016, the focus is now broadening from reducing infectious disease and child mortality to the more challenging, cross-disciplinary goals of strengthening health systems and collaboration across sectors. With these trends in mind, many donors are working to support recipient governments as they transition health programs from DAH to DRM. This also reflects a shift toward even greater country ownership of their own health priorities and programs, which will inevitably translate into long-term benefits for citizens of recipient countries as they tailor the programs to their specific needs. However, many low-income and fragile-state countries will still depend on traditional sources of humanitarian aid and development assistance to support their health programs, and continued support of these programs will be critical to ensure their progress is not lost. While this transition to DRM occurs, more DAH can be directed toward the global functions and public goods of global health. Multilateral institutions, such as the Global Fund and Gavi, are well positioned to deliver great return on investment. Directing more money toward these institutions pools global resources and leverages economies of scale that can be much more responsive to global health needs. Low- and middle-income countries (LMICs) may also stand to benefit from increased fund allocation to multilateral institutions, because such countries cannot independently produce the global public goods that those institutions can, such as research 36 GLOBAL HEALTH AND THE FUTURE ROLE OF THE UNITED STATES and development, knowledge sharing, market shaping, and management of cross-border externalities (Schäferhoff et al., 2015). Importantly, pursuing these elements of global public goods will be advantageous to all countries. Leveraging the Private Sector In addition to increasing levels of DRM with partner countries, the private sector will be a critical partner in this next stage of global health and development. An article from the 2017 World Economic Forum annual meeting argued that advancing the cross-sectoral SDGs is a business imperative and transformational change should be undertaken from an ecosystem perspective, explaining “the longevity of companies the world over is predicated on the increased access and usage of financial services by those at the bottom of the pyramid” (Nathan, 2017). The U.S. government has begun to do this in a more strategic manner, through partnerships in other sectors such as Power Africa or Feed the Future within USAID. For example, Power Africa aims to crowd-in private energy partners in LMICs and, since its inception in 2013, now has more than 130 companies involved with a projected investment of approximately $40 billion. However, through this partnership and private-sector–focused model, it has kept direct costs to the agency to only $76 million for FY2016.8 Chapter 8 discusses financing models in more detail, but to emphasize the importance, the committee asks the reader to truly consider throughout the report, how to maximize public, private, and social sector dollars to spur economic growth and build stronger communities globally (Nathan, 2017). THE UNITED STATES AS A GLOBAL CITIZEN As many common global health challenges have coalesced over the past decade, including the growing burden of NCDs and potentially pandemic infectious disease outbreaks, several international agreements have been put into effect, committing political efforts and support toward improving health and life for all. As a long-time leader within the global community, the United States is a signatory on these agreements, such as the International Health Regulations (2005), the SDGs, and the Sendai Framework for Disaster Risk Reduction. Whether constituted as global action plans, frameworks, goals, or regulations, these agreements further emphasize the need and motivation for the global community to come together to advance the health and well-being of each nation’s citizens. It should be the continued duty of the United States to both follow and support these global, forward-looking, collaborative efforts.

In January 2006, flying birds were the major concern for the chief of the checkpoint at Zakho, a small town located at the Turkey-Iraq border.1 Having served throughout history as a major market and a significant node in the circulation of goods, the town was now being recast as an important fortress in the unveiling global battle against a different form of circulation, that of the H5N1 virus. The virus was a particular form of Highly Pathogenic Avian Influenza (HPAI), which, the officials declared, could claim the lives of thousands of humans and non-human alike. The H5N1 virus—more commonly known as the avian influenza—was one of the recent examples in the series of “emerging infectious diseases” that the World Health Organization designated in its 2007 Report as a primary threat facing the global community in the 21st century.2 Zakho carried crucial strategic importance in this battle because it was the first time the flu was diagnosed outside the boundaries of East Asia. As stated by a United Nations Food and Agricultural Organization official, the failure of security measures at the border of Turkey would mean “a constant reservoir of the disease would lie at the edge of Europe.”3 Fear of penetration by foreign bodies such as illegal immigrants was supplemented by the fear of contagion by unruly flying birds at the borders of Fortress Europe. Invoking memories of the 1918 pandemic, the international community was called to arms; the United Nations searched for recruits for “an international culling task force” that would provide “a reliably robust, incorruptible public service to go around killing chickens.”4 The global call to cull translated into a full-scale mobilization in Turkey and the neighboring countries. With dizzying speed, millions of chickens were culled over the course of a few weeks regardless of their being infected or not. The number of animals killed to render life more resilient reached 2.5 million between 2006 and 2008.5 For many, the death of the birds meant a loss of food and income in a country where 28 percent of the rural population (33 percent of the country) raised poultry for self-sufficiency purposes.6 According to a 2009 report prepared for the Turkish State Planning Institution, the bird flu crisis would act as the main contributing factor to the end of poultry production in family-owned farms,

The 2030 Agenda for Sustainable Development, adopted by the United Nations General Assembly on 25 September 2015, recognizes not only that peace and security are prerequisites for achieving sustainable development, but that sustainable development provides the pathway to peaceful societies.

This new peace-centred agenda is inclusive and ambitious and could usher in a new spirit of global solidarity. With its five pillars of peace, people, planet, prosperity and partnerships, it opens a new era of development. Translating its 17 goals and 169 targets into concrete action on the ground will only be possible with the support and engagement of all major stakeholders, including Governments, civil society, business, academia, parliaments, and international organizations. As the world's largest regional security organization under Chapter VIII of the Charter of the United Nations, the Organization for Security and Co-operation in Europe (OSCE) is ready to do its part to contribute to this critical global effort.

The events of 2023 suggest that the global system has entered an intense period of structural transition that will reorder geopolitics and reshape the international business environment in fundamental ways. Russia’s war in Ukraine continues, frozen conflicts have reignited in places like Israel/Gaza and Nagorno-Karabakh, coups once again became commonplace in Africa, and tensions rose between China/the Philippines, Serbia/Kosovo, and elsewhere. These events are reshaping the environment of geopolitical risks and opportunities faced by businesses and investors.

The underlying causes of current shifts are hard to identify definitively in real time. The impacts, however, are more readily observable: a move away from U.S. unipolarity and towards multipolarity in global security; a messy battle for influence between Washington and its partners on one side and revisionist powers like China and Russia on the other; and various middle powers and non-state actors acting more boldly in-between to maximize their own interests. In this new age of uncertainty, high-impact events are set to become increasingly common, moving the world beyond an era of black swans and into one of steadily heightened risk.

Nor does technological “leadership” guarantee military advantage. Other factors determine military success, the most important being political will, leadership, and strategy. An opponent that has an advantage in these areas will be able to resist and thwart a more technologically advanced opponent (the Taliban, for example). Advanced technology in the service of flawed strategy will not change outcomes. There is an assumption that technology provides an advantage and, in a contest, where other factors are equal, technological leadership can be critical, but in most situations this technological advantage is only one factor among many in determining effectiveness. Specific quantitative measures may not actually measure what we want to assess. It may be better to ask what nations want (wealth, international influence, military power) to determine the contribution of a basket of technologies.

In general, the case of Japan illustrates that desecuritization does happen as a part of the political strategy to sustain the legitimacy of the governments. More often, the trail of desecuritization can be found whenever securitization happens, either to maintain the desired effect of securitization or to deescalate the rising tensions with other states which result from securitization. On a more abstract level, identity influences states’ decisions to securitize and desecuritize the issues in concern. The need to demarcate the “self” from the “other” to reinforce the self-identity potentially motivates states to securitize certain issues (alterity). Desecuritization follows afterwards in order to sustain the newly, or re-established self- identity of the states. However, that does not mean cooperation is not possible. States that are at conflict with each other over one issue can still desecuritize their relations by cooperating on the other issues as states carry in itself multiple identities differing from each other depending on different sectors (multiplicity). Finally, the thesis suggests that the study of securitization should not be separated from desecuritization as they are closely connected to one another. Removing one from the other would result in an incomplete study of the complex contemporary security environement. 5.2 Reflection and normative discussion Originally, CS scholars argue that “security should be seen as negative, as a failure to deal with issues as normal politics”, and because desecuritization moves the issue from the exceptional politics to “the normal haggling of politics”, desecuritization is preferably the “optimal long-range option” (Buzan et al., 1998, p. 29). Although the intention is to establish a new framework to study security, the language here shows that the three authors also engage themselves in the normative debate and indicate their preference on desecuritization over securitization. However, as consistently presented through the thesis, security is not above politics, and both securitization and desecuritization can be political strategies of the ruling elites to legitimize their power. Separating politics from security would undermine the ability to critically reflect on securitizing and desecuritizing moves and distant security from the complex environment in which security happens. Therefore, it is important to study both of them in tandem. Once the nexus between politics and security is closely evaluated, political motivations can be found in every decision to securitize or desecuritize the issue in concern as illustrated by the case study in this thesis. Based on this understanding, it is problematic to indicate desecuritization is more desirable than securitization. For instance, PM Abe’s ambition to institutionally legitimize the operation of the SDF goes against the will of the people. In this specific case, desecuritization is hardly a desirable option to Japanese people. Rather, it challenges the pacifist Constitution and the pacifist anti-war attitude embedded in the culture. Therefore, scrutiny and deliberation, and evaluation of all kinds of security discourse (securitizing and desecuritizing) are crucial to exercise the democratic power of the people.

“Public Administration and Regional Management in Russia Challenges and Prospects in a Multicultural Region” Pg 441-442 (Elena G. Popkova – Doctor of Science (Economics), the founder and president of the Institute of Scientific Communications (Russia) and Professor of Peoples' Friendship University of Russia.)  [https://link-springer-com.proxy.lib.umich.edu/book/10.1007/978-3-030-38497-5] //saginator

The second aspect means various forms of unarmed struggle, which also became widespread in the modern world. According to specialists, the world enters the age of the wars aimed not so much at direct annihilation of the adversary as at achievement of the political goals of the war without military opposition. This allowed the scholar M. Kaldor to announce“the end of wars between the states.” The studies in the sphere of security provided intellectual resources for this reequipment, providing a lot of literature that studied the dynamics of that which was called by M. Kaldor“new wars” (Kaldor 2001, p. 6). Another author, R. Caplan, states that after the end of the Cold War, the number of large con icts (28 con icts per year on average) had internal character: very often these states were not able to perform even their basic functions (Caplan 2002, p. 7). It should be noted that the notion“con ict” is now more often treated as a synonym of the notion“crisis,” with all their textual differences. Crises manifest themselves not only in the sphere of domestic or foreign political security. Crises are also natural disasters and catastrophes, caused by the anthropogenic influence, problems of humanitarian character (security of a person), etc. A potential source of conflicts is reduction of natural resources, demographic growth in the world (especially in the poorest countries), climate change, mass migration, and other phenomena of the global character. In the international political science, crisis is treated as a national or international situation which contains a threat to the basic values, interests, or goals of the actor (Tsygankov 2006, p. 7). It should be noted that the Strategy of Security of the EU, adopted in December 2003, is based on the fact that neither of new post-bipolar threats to security is purely military. The Strategy is based on the thesis that wide-scale aggression against any state of the EU is improbable. The new threats to security are ranked in the Strategy in the following way: terrorism, dissemination of mass destruction theory, regional conflicts,“state failure” (A formula for the states in which central authorities do not control the national territory due to corruption, weak institutes, etc.), and organized crime. For opposing these threats, the Strategy aims to use a complex of political, diplomatic, and military methods. The quintessence of the approach could be found in the Strategy’s provision—“Conflict prevention and threat prevention cannot start too early” (Government of the Brussels 2019; Vodenko et al. 2018; Vodenko 2019). 48 Trans-conflict Region in the Context of Theory of Securitization: The Problems. . . 449 Thus, specialists analyze the threats to international security and build global potential conflicts in the following order: Fighting international terrorism Protection of critical infrastructure Energy security Information security Demographic security and problems of migration Ecological security, global climate change; Biosecurity and ghting infection diseases Education and knowledge economy However, a large part of the work on studying security, which appeared as a result of strategic research (Baylis et al. 2007), leads to the questions regarding the future practice of security, which studies itself. For example, the initial work on securitization stated that the best policy of security was “desecuritization,” an attempt to put its larger part from the sphere of security into the sphere of normal policy (Buzan et al. 1998). The feminist work on the gender character of the state of national security also envisages that there is something wrong with the services provided by scholars in the sphere of security to the state. Mark Neocleous outlined these issues in the book“Critique of Security,” in which he supposed that security is a central logic of the state and substantiated the necessity to oppose the extravagant practices of state security (Neocleous 2008).

If ending political violence and securing life is the dream of the modern political project (as captured by Immanuel Kant’s vision of “perpetual peace”), how is it that the spread of this political project across the globe has translated into not less but more violence, not a disinvestment from but an overwhelming investment in more efficient ways to kill life? How is it that an era of exponentially increasing objects to be secured—objects as diverse and disparate as the nation, the environment, food, health, the human and the globe—is also an era when a constant state of terror inflicted by war, hunger, poverty, displacement, and xenophobia become the defining features of global political life? Taking this paradox as the starting point for my dissertation, I argued that what is needed is to dismantle security rather than reproduce its imperial gaze. To make this argument, I investigated the implications of the construction of politics as a global security project and critically inquired into the implications of politics devoted to securing life at its most general level, in an all encompassing manner. I explored the meaning of dismantling security as untimely critique in this empire of security and discussed alternative conceptions of politics beyond politics of security. I started my analysis by diagnosing the way in which security has emerged as a global bio-political apparatus in the contemporary era—an apparatus that is charged with the task of producing and transforming life at its most general level. In Chapters 1 and 2, I mapped out the contemporary landscape of in/security and discussed the 182 way in which security becomes a sovereign demand amidst the terrorization of life globally. I highlighted the way in which the project to secure life gets articulated in temporal terms through the logic of preemption—revolving around not only the fear of what exists, but also the danger of what might be—and pointed out that the same logic animates contemporary form of capital accumulation. Chapter 4 built upon this diagnosis about preemption becoming the defining feature of politics of security and capital accumulation, where I situated contemporary manifestations of the temporal homology between them within the context of bio-political modernity. Elaborating on the way in which, in modernity, political time gets reduced to abstract unit measure, I suggested that security colonizes the future by annihilating political time as possibility and writing the future as present. It is upon this premise that I offered an interpretation of my call to dismantle security as an untimely claim on time. I carried out a parallel inquiry into the meaning of dismantling security as untimely critique by relating it to an investigation of the reproduction of the hegemony of the sign of security through the disciplinary production of knowledge on security. In Chapter 3, I engaged with the critical security studies literature and tried to show how such critiques of security end up securing security’s hegemonic hold. If critical thought on security in its current formulation transmogrifies into a form of questioning that further consolidates the disciplinary project of security, how then are we to conceptualize a form of critique that would open the space for dismantling security? This was the question that I grappled with in Chapter 5, where I formulated an understanding of critical thought as an untimely intervention—one that is historically situated, yet, not historically foreordained or determined. In contrast to a form of critical subjectivity that takes the limits of what exists as the limits to what is possible, critique in this formulation becomes an untimely intervention that resets the account of times and renders the present as the site of non-utopian possibility. It is this understanding of critique, I argued, that gives form to dismantling security as a critical project. After making these deconstructive moves on the terrain of the empire of security, in the final chapter, I turned to a discussion of what a politics beyond politics of security would entail, what ethical and political possibilities open up when insecurity is embraced as an inescapable condition. What happens when thought of politics starts at the limits of security? To answer this question, I inquired into three possible moves beyond politics of security. One of these three moves, I suggested, passes through de-centering the sovereign subject of security by exposing the Otherness constitutive of subjectivity as such. Shattering the illusion of a sovereign and secure self opens the way to formulate ethical responsibility on the premise of the radical interdependence inscribed at the heart of being. It recasts politics as a way of being in the world beyond a techno-politics of life. The second move beyond a politics of security that I discussed centered on the works of Jacques Rancière, where politics is conceptualized as the overturning of the ordered space of security by staging political subjectivities in excess of the secure and functional order. Deploying the distinction that Rancière makes between “police” (logic of consensus) and “politics” (logic of dissensus), I suggested that, on this account, a politics beyond disrupts the reduction of politics to the management of the given and the securing of the proper distribution of identities, space, and time. I elaborated the third and final move beyond politics of security by visiting Jacques Derrida’s conception of political time as aporetic and his account of the future beyond representation. Such a conception of political time inscribes anxiety that issues from the absence of secure grounds as the condition of possibility of politics. In contrast to politics of security that annihilates political time as possibility by legislating the future, I argued, Derrida’s thinking on political time allows for a form of writing the future beyond security. My investigation into alternative conceptions of political subjectivity beyond security hopes to serve as an opening that calls for further inquiry into other possibilities, other conceptions of politics that would allow approaching global political life with an idiom detoxified from security. Politics beyond politics of security can be a point of reflection in the light of many other questions that could be raised. For instance, if security reduces the body of the political community to a species body, what alternative forms of thinking about the body are available that could challenge this assertion? How would different conceptions of the body beyond biological thinking enable different forms of politics beyond bio-politics of security? Or should political thought abandon the thought of the body altogether? Does politics beyond politics of security call for a new body or a no body? Besides alternative political and ethical possibilities beyond security, another issue that calls for sustained interrogation relates to the question of violence. One of the points that I highlighted in my discussion is the extent to which thinking about violence is confined within the framework of security, which, I argued, is itself an order of violence. This prompts a series of questions, which could be fruitfully pursued. For instance, how are we to think about violence beyond security? If the subject of security is a violent subject, does it mean that abandoning security demand that we abandon the subject of violence as well? What sorts of political and ethical challenges do we face if we abandon security, but not violence? How are we to think about the relation between violence and politics on an alternative terrain to the politics of security? I certainly do not think that these are the only possible questions that could be raised. My only hope is that dismantling security opens the way to diversifying and pursuing such questions rather than being held captive by the impossible and violent promise of security.

A security dilemma is a situation where the actions taken by a state to increase its own security cause reactions from other states, which leads to a decrease rather than an increase in the state’s security. Some scholars of international relations find that the security dilemma is the most important source of conflict in international relations. They argue that in the international realm there is no legitimate monopoly of violence – i.e. there is no world government - and as a consequence each state must take care of its own security and survival. For this reason the primary goal of states is to maximize their own security. Even if states focus solely on this goal and have no intention of harming others, many of the actions taken by states to increase their own security – e.g. weapons procurement and the development of new military technologies - will decrease the security of others. Decreasing the security of others does not automatically place the state in a dilemma, but because of the anarchic structure, other states will follow suit, if one state arms. They cannot know whether the arming state will use its increased military capabilities for attack in the future. For this reason they will either choose to increase their own military capabilities in order to reestablish the balance of power, or they will launch a preemptive attack in order to prevent the arming state from upsetting the balance in the first place. If they choose the first option, the result may be a security spiral. A security spiral is an action-reaction process, where two states are tied in an armaments race with each state responding to increases in weapons procurement and defense expenditure by the other state leading them both to arm more and more heavily. This may lead to war in the long run. If they choose the last option, military conflict will be imminent. The logic of the security dilemma was first described Herbert Butterfield in 1949. The term was coined by John Hertz in 1950. Although the logic seems to fit particularly well with the security competition between the United States and the Soviet Union during the Cold War, proponents of the term do not see it as tied to a specific historic era. Rather it reflects the fundamentally tragic nature of international life: state actors strive for peace and stability, but end up in military conflict. Thus, even if all states are status quo powers wishing only peace and security, war may occur, because of the fear and insecurity following from the anarchic structure of the international system. This focus on the effect of international anarchy on the behavior of states is typical of so-called structural realism – sometimes termed neorealism – which posits that the international system is a self-help system, where states must focus on their own interests in order to maximize their chance of security and survival. In particular, the security dilemma logic is central to so-called defensive realism. Proponents of defensive realism argue that states seek to maximize their chance of security and survival by maintaining their position in the international system, not by expansion. Still, scholars working within alternative theoretical traditions have discussed how the security dilemma logic looks from their perspective and utilized their own theoretical insights to suggest how we might move beyond the security dilemma logic and create a more peaceful world. A large number of International Relations scholars have applied and developed the logic of the security dilemma. Some of the most prominent security dilemma scholars are Robert Jervis, Barry Posen and Charles Glaser. From a more critical stance, the security dilemma logic has been explored by among others Ken Booth and Nicholas Wheeler. Recent research on the security dilemma has applied the logic to most regions of the world and resulted in a proliferation of more fine-grained distinctions between different types of security dilemmas. Some scholars of international relations argue that all states face a security dilemma all of the time, but most of them agree that the intensity of security dilemmas tend to vary over time and space. The literature on international relations points to different sources of variation in the security dilemma. Security scholars such as Stephen Van Evera, argue the intensity of the security dilemma depends on the ease of conquest. If conquest is easy, states will typically face an intense security dilemma, because the risk of military defeat is raised every time a competing state adds to its military capabilities. Conversely, if conquest is difficult the security dilemma is ameliorated, because other states may add to their military capabilities without posing a direct offensive threat. If we are able to tell the difference between offensive and defensive weapons, states may even signal their benign intentions by deploying defensive weapons. Other states will know that they have acquired weapons not to attack, but to defend. Offense and defense dominance vary over time and space depending on a number of factors including geography, military technology and military doctrine. Also, regime type may affect the intensity of the security dilemma. Although democracies often go to war, they rarely go to war against other democracies. When two autocracies face each other or when a democracy and an autocracy face each other, security spirals sometimes spin out of control, because each side interprets the move by the other side as potentially threatening. But this is rarely the case when two democracies face each other. Two characteristics of modern, stable democracies explain why. First, the policy processes in liberal democracies is fairly transparent, even when viewed from outside the country. Parliamentary debates are usually open to the public – sometimes even televised – and political parties outside government, mass media and interest groups ensure that few government decisions of any importance are taken without scrutiny and public debate. Second, democracies usually have rules and regulations preventing them from rushing into war. Some policies are made extraordinarily difficult thereby binding the policy makers and signaling to the outside world that decisions cannot be taken without prior warning. Both of these characteristics of modern liberal democracies reduce uncertainty, and thereby ameliorate the security dilemma. As summed up by Charles Lipson ‘[B]ecause democracies have more accurate perceptions of each other, they are better able to cooperate, build trust and avoid war’ (Lipson 2003: 72). Other scholars argue that the security dilemma is largely irrelevant, because international conflict is not the result of status quo powers seeking to maximize security, but of revisionist powers seeking to maximize power.

I don’t care for the name of the “security dilemma,” since it’s not very evocative of what it describes, but I wish everyone understood the basic concept. It is, as Chinese political scientist Shiping Tang explains, “one of the most important theoretical ideas in international relations.” It refers to the way that countries can take actions they perceive as defensive, but which are perceived by other countries as aggressive, and which create a spiral of hostility that can end in war. Tang describes two states, neither of which intends to threaten the other and both of whom want to live in a world of peace:

The two states, however, cannot be sure of each other’s present or future intentions. As a result, each tends to fear that the other may be or may become a predator. Because both believe that power is a means toward security, both seek to accumulate more and more power. Because even primarily defensive capability will inevitably contain some offensive capability, many of the measures adopted by one side for its own security can often threaten, or be perceived as threatening, the security of the other side even if both sides merely want to defend their security. Consequently, the other side is likely to take countermeasures against those defensive measures. The interaction of these measures and countermeasures tends to reinforce their fears and uncertainties about each other’s intentions, leading to a vicious cycle in which each accumulates more power without necessarily making itself more secure, through a self-reinforcing or positive feedback mechanism. This vicious cycle can also lead to unnecessary thus tragic conflicts—threats of war or war.

Everything, for example, has now become possible. But what human being seems most impelled to do with the power of its actions is to turn itself into a species; not merely an animal species, nor even a species of currency or consumption (which amount to the same thing), but a mere species of calculation. For only by reducing itself to an index of calculation does it seem capable of constructing that political arithmetic by which it can secure the security globalised Western thought insists upon, and which a world made increasingly unpredictable by the very way human being acts into it now seems to require. Yet, the very rage for calculability which securing security incites is precisely also what reduces human freedom, inducing either despair or the surrender of what is human to the de-humanising calculative logic of what seems to be necessary to secure security. I think, then, that Hannah Arendt was right when she saw late modern humankind caught in a dangerous world-destroying cleft between a belief that everything is possible and a willingness to surrender itself to so-called laws of necessity (calculability itself) which would make everything possible. That it was, in short, characterised by a combination of reckless omnipotence and reckless despair. But I also think that things have gone one stage further—the surrender to the necessity of realising everything that is possible—and that this found its paradigmatic expression, for example, in the deterrent security policies of the Cold War; where everything up to and including self-immolation not only became possible but actually necessary in the interests of (inter)national security. This logic persists in the metaphysical core of modern politics—the axioms of interState security relations, popularised, for example, through strategic discourse— even if the details have changed.

These estimates (rounded to one decimal point) include nuclear warhead and nuclear capable delivery systems operating costs and development where these expenditures are publically available and are based on a reasonable percentage of total military spending on nuclear weapons when more detailed budget data is not available. ICAN urges all nuclear-armed states to be transparent about nuclear weapons expenditures to allow for more accurate reporting on global nuclear expenditures and better government accountability. Due to lack of reliable and consistent information, these estimates do not include the costs to remediate the environment contaminated by nuclear weapons or to compensate victims of nuclear weapon use and testing, although these are also important markers of the added financial and human cost of nuclear weapons.1,2 A 2011 Global Zero cost estimate which added “unpaid/deferred environmental and health costs, missile defences assigned to defend against nuclear weapons, nuclear threat reduction and incident management” found that this “full” cost of global nuclear arsenals was over 50% higher than just the cost of nuclear weapons system maintenance and development.3 The methodology and sources used to calculate each country’s spending on nuclear weapons in this report is outlined in the following section.

The nuclear-armed states spent nearly three-quarters of one hundred billion dollars in 2019 on building and maintaining nuclear warheads and delivery systems. The incalculable human and environmental costs of nuclear weapons only add to this shocking figure. From 2018 to 2019, there was an estimated $7.1 billion increase in nuclear weapon spending, and these totals will only continue to rise in the next decade according to documented nuclear weapon programmed and budgets in several nuclear-armed countries.

Since the mid-2000s, Russia has raised the possibility of withdrawing from the INF Treaty. Moscow contends that the treaty unfairly prevents it from possessing weapons that its neighbors, such as China, are developing and fielding. Russia also has suggested that the proposed U.S. deployment of strategic anti-ballistic missile systems in Europe might trigger a Russian withdrawal from the accord, presumably so Moscow can deploy missiles targeting any future U.S. anti-missile sites. Still, the United States and Russia issued an Oct. 25, 2007, statement at the United Nations General Assembly reaffirming their “support” for the treaty and calling on all other states to join them in renouncing the missiles banned by the treaty.

Reports began to emerge in 2013 and 2014 that the United States had concerns about Russia's compliance with the INF Treaty. In July 2014, the U.S. State Department found Russia to be in violation of the agreement by producing and testing an illegal ground-launched cruise missile. Russia responded in August refuting the claim. Throughout 2015 and most of 2016, U.S. Defense and State Department officials had publicly expressed skepticism that the Russian cruise missiles at issue had been deployed. But an Oct. 19, 2016,  in The New York Times cited anonymous U.S. officials who were concerned that Russia was producing more missiles than needed solely for flight testing, which increased fears that Moscow was on the verge of deploying the missile. By Feb. 14, 2017, The New York Times cited U.S. officials declaring that Russia had  an operational unit of the treaty-noncompliant cruise missile now known as the SSC-8. On March 8, 2017, General Paul Selva, the vice chairman of the U.S. Joint Chiefs of Staff,  press reports that Russia had deployed a ground-launched cruise missile that “violates the spirit and intent” of the INF Treaty.

Detailed consideration of the likelihood and consequences of nuclear war is not usually explicit in developing national security strategy. Yet implicit assumptions on these questions have a strong influence on nuclear policy, and explicit generalizations of them have been invoked to justify major new directions in policy. The entire nuclear arms control enterprise—from the “hotline” memorandum of understanding through the Anti-Ballistic Missile Treaty and Strategic Arms Limitation Treaty (SALT), the Intermediate Nuclear Forces (INF) Treaty, the Strategic Arms Reduction Treaty (START), the Strategic Offensive Reductions Treaty (SORT), and the current New START Treaty—was motivated principally by fear of nuclear war. In the 1950s the dominant theoretical concern involved a disarming surprise attack, but fear of nuclear war was made all too tangible by the Cuban missile crisis of 1962 and has been reinforced throughout the Cold War by the nuclear arms race and nuclear posturing. Similarly, arguments for national missile defenses depend in no small part on the judgment that deterrence is unreliable. As expressed by President Reagan in his oft-quoted Strategic Defense Initiative speech

of 1983:5 Tonight . . . I am directing a comprehensive and intensive effort to define a long-term research and development program to begin to achieve our ultimate goal of eliminating the threat posed by strategic nuclear missiles. This could pave the way for arms control measures to eliminate the weapons themselves.We seek neither military superiority nor political advantage.Our only purpose—one all people share—is to search for ways to reduce the danger of nuclear war. [Emphasis added.]President George W. Bush invoked the inadequacy of deterrence and the consequences of nuclear use by “rogue” states and terrorists to justifypreemptive attack as a critical element of national security strategy:6 It has taken almost a decade for us to comprehend the true nature of this new threat. Given the goals of rogue states and terrorists, the United States can no longer solely rely on a reactive posture as we have in the past. [Emphasis added.] The inability to deter a potential attacker, the immediacy of today’s threats, and the magnitude of potential harm that could be caused by our adversaries’ choice of weapons, do not permit that option. We cannot let our enemies strike first.More recently, the prospect of nuclear use motivated President Obama’s call for a nuclear-free world:7 Today, the Cold War has disappeared but thousands of those weapons have not. In a strange turn of history, the threat of global nuclear war has gone down, but the risk of a nuclear attack has gone up . . . So today, I state clearly and with conviction America’s commitment to seek the peace and security of a world without nuclear weapons.Clearly, quite different policies have been motivated by the concern that deterrence might fail. However, assertions that deterrence cannot be relied on are based on intuition and limited perspectives rather than syntheses of the broadest expertise and most appropriate analytic methods that can be brought to bear.