From viral globalism to global health

In a remarkable April 27th New York Times column entitled 'Globalism Goes Viral' David Brooks argues that the big lesson for planetary public health from the swine flu outbreak is that decentralized local responses are what we need for the 21st century. "Subsidiarity," he concludes, "works best."  What is so remarkable about this conclusion is not so much the way it invokes a fairly normalized neoliberal nostrum about bureaucratic best practice: viz. shift any role for active government - apart from enforcing market rules - downwards to the lowest, most easily marginalized and/or disciplined scale possible.  Indeed, it would have been very surprising  to see a 'big-government-is-bad' standard bearer suddenly detour from the usual 'globalist' vision (the vision of allowing different countries and cities to compete with each other in a race to the bottom of competitive deregulation disguised as policy innovation).  However, what is remarkable about this column by Brooks is that, before reaching the 'salvation through subsidiarity' denoument, he first comes so close to advocating a very different sort of global policy-making position. 

Reflecting on the obviously global scope of the swine flu outbreak, he begins his article by highlighting the ways in which it evidences the interdependencies of globalization.  The threats, he says, "grow out of the quickening pace of globalization and are magnified by it. Instant global communication and rapid international travel can sometime lead to universal, systemic shocks.  A bank meltdown or a virus will not stay isolated."  Yet having hereby effectively echoed the very same comparisons and conclusions made by the WHO's Margaret Chan in her speech in Istanbul on the very same day, and having also therefore led his readers to think that he was about to recommend beefing up the the WHO as an antidote to nationalistic trade restrictions and other sorts of border-building defensive responses to the crisis, Brooks suddenly and dramatically veers back towards the neoliberal development dictat that decentralization is best.  A global public health body would just be too cumbersome and slow-moving, you see, dragged down by bureaucratic red tape and internal disagreements.  And so we get to the salvation through subsidiarity appeal at the close, itself, for US readers at least, little more than a rehash of traditional conservative talking points about states' rights.

The parallel with states' rights discourse, though, can at least serve as a wake-up call to the sorts of double standards and denials of rights often involved in advocating for decentralization.  One does not have to be a legal or historical expert on the Dred Scott decision to understand the problems.  And again, the example of today's global flu outbreak is illustrative.  As Lawrence Gostin has explained in the Washington Post, exceptionalist American appeals to federalism have actually been one of the stumbling blocks frustrating efforts to make the WHO's new international health regulations globally enforceable. This, combined with chronic underfunding for public health surveillance and preparedness both globally and nationally (which is itself frequently justified using rhetorics of big bad government waste), hardly speaks well of decentralized innovation in public health planning.  Moreover, we also surely need to consider how appeals to decentralization may also serve to cover up basic global inequalities.  They distract from asking questions about whether poorer countries and communities will be able to access adequate supplies of anti-viral medicines; are they just experimenting with less?  Will they be more vulnerable to contagion in the first place because of cramped living conditions and underfunded public health infrastructures?  Indeed, will there be any public health official even around in these impoverished areas to begin the process of decentralized experimentation proposed by Brooks?  

These sorts of questions lead in turn to still larger ones about the prospects of global health security in the context of today's globe-trotting infectious diseases.  Alan Ingram, a British health geographer, has argued in this respect that swine flu shows how we need a complete paradigm-shift in the way in which global health security is imagined and made possible.  As such, his intervention offers the perfect antidote to Brooks. But where does his call for a recognition of health inequalities amidst interdependencies lead us in terms of planetary pandemic preparedness and response? Might the WHO's Social Determinants of Health report itself offer a basis for thinking through global health security with these sensitivities?  And, given how close he himself came to repeating the much more enlightened arguments of the WHO director-general on April 27th, how might David Brooks respond to these emergent visions of global health?