Security is said to be a controversial concept and is often defined with political overtones and it is seen that the political leaders opt to define security in whatever suits their motives. After the Cold war where there were changes in various spheres and the concept of security was also changed and it was beginning to be defined in terms of ‘non-military challenges.
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Moreover, the issue of encountering and fulfilling the ‘basic needs and aspirations of the African people is also of central concern when it comes to the discussion of human security and health in Africa. Despite the new concern granted in favor of the African people the country has been ignored owing to the ‘traditional imperatives of state interests, power, military force, and geopolitical instability and the notion of security has not achieved the interpretation of humanity and developmental features.
This paper seeks to use the broadening and deepening of security parameters as defined by discourses on human security to demonstrate the impact of child and maternal health of Sub-Saharan Africans on human security as it has direct implications in terms of quantity and quality. This paper will lay the groundwork for discussing health, examining the definition of human security and how health in Sub-Saharan Africa is a human security issue. Moreover, the role of the communities, governments, and the developing world is analyzed. The researcher employs field research for the provision of the context for human security in Africa.
How the human security is related to health in Sub-Saharan Africa?
What are the factors that weaken the relationship?
The research makes use of secondary sources to explore the impact of child and maternal health of the Sub-Saharan Africans on human security. The secondary sources include books, journal articles, etc. Moreover, the researcher uses the field research done on Ethiopia to interpret the relationship between health and human security in Africa clear.
Aim and objective of Human Security
Human security aims to help people against threats or illnesses. As soon as the Sub-Saharan African countries gained independence they engaged in multifarious conflicts which also asserted profound impact on ‘maternal and child health’ and the ratio of demise as a consequence of ‘malnutrition’ has increased to a perilous extent. Although one of the African leaders, Kwame Nkrumah, ushered, in 1954, for his aim to make the Gold Coast a paradise once they obtain independence but he, along with the others narrowed the notion of paradise to take the legal matters of the country in one’s hands only while he ignored the health perspective. The most important of all tasks, that of building a ‘prosperous society’ was utterly ignored.
The shift of interest towards Health Care as Human Security
By the end of the European World Wars, the focus of Human security had evolved in the West as the protection of refugees, reconstruction after the conflicts, and identity rights were the focus of individual security needs. The period after World War Two also demanded a shift in discourse, as the state proved unable to provide physical and psychological protection from security threats. The Cold War era, although dominated by national security policy, still had room for humanistic focus; for instance, states Buzan (1983), which included the three pillars of identity, institutions, and population to sustain a sovereign state.
Buzan (1983), in his discussion of nations, states, and nation-states, further explored the role of individual identity (identities) in state creation and maintenance. According to Buzan (1983), individual security is a societal concern with four types of societal threats, physical, economic, rights, and position/status, all of which are not mutually exclusive. By 1989, Tuchman Mathews had expanded on Buzan’s list of threats to human security and included overpopulation, patterns of land tenure, the environment, and reproductive health as well.
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The 1994 Human Development Report was the first to approach the subject in a formalized way by presenting the freedom from fear, freedom from want agenda. The report goes further in defining seven aspects of HS, the third one being health security.
Already an influence on setting the tone for global security discourse, the United Nations Development Program’s 1994 Human Development Report is generally recognized as the watershed moment for the international recognition of human security as a priority. The Report is all-encompassing and integrative, in that it includes an urging for the protection of seven elements of HS — economic, food, health, environmental, personal, community, and political security. Later attempts to narrow the concept of human security have run into problems with value judgments, cultural relativity, and exclusion, as will be outlined here in a later section.
Since 1994, a pivotal year in terms of human security as a result of the UNDP Report mentioned earlier and the Rwandan Genocide, the relationship between states and individuals in terms of human security has come under greater international scrutiny, with a focus on development, peacebuilding, policy, and military-strategic approaches. The concept of human security today thus represents a major shift in the way government, organizations, academics, and individuals think about human security, as it places greater legal emphasis on the welfare of ordinary people.
Political theorist, Roland Paris, has defined human security as a category of security studies research, reserved for studies of nonmilitary threats to the protection of people and entities, community.
Arguing that there is a lack of evidence to support the theory of a paradigm shift in security studies towards human security, Paris has compartmentalized ever-existing issues to better navigate the complexities of analyzing security threats.
This contrasts with the widening discourse, led by Buzan and the Copenhagen school, which includes individuals and communities as potential subjects of threats. A Constructivist understanding is one that further involves nonstate actors as responders to security threats rather than just victims.
Paris’ cells do not offer any categories for complex emergencies or the interdependence of threats, nor does it explain the role of various actors. Regardless of whether or not academia or policy-makers in the West have decided that there has been a paradigm shift towards individual security in the developing world, this is a moot point. Security issues for the majority of the world’s population are indeed more inclusive than the survival of inter-state warfare or avoiding super-power conflict; they include power, vulnerability, accessibility, and disconnection in an increasingly globalized world. From the Realist perspective, Human Security based on the UNDP’s freedom from fear, freedom from want agenda has been determined as too broad to be considered for policy.
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It is my aspiration, says Kofi Annan (the former Secretary General of the United Nations), that health will finally be seen not as a blessing to be wished for but as a human right to be fought for. The altruism of Annan’s statement, as quoted by Ganguli (2008), is evident from the fact that health is so important an aspect of human life but it has been ignored by policymakers and public speakers whenever they talk about human security.
Health and Human Security
Linking health and human security requires some indirect associations as well as illuminating some often-overlooked relationships between cause and effect in times of war and peace. Some of the researchers are of the view that if a life is lost precociously then it is enormous insecurity to the human beings.
Mothers in the Human Security Debate
It is a datum that mothers are the pillars of any sustainable community development initiative, however, women and particularly mothers receive very little in terms of support and recognition for their role in communities and the problem gets acute when it comes to the context of Sub-Saharan Africa. With their many capabilities, women and mothers raise children, produce and sell food, work in the formal and informal sector, participate in politics and micro-enterprise among other things. Child soldiers, human trafficking, rape as a tool of war, preventable births and deaths, gender-based violence are the major problems in Africa. While food security is absent from the scene which is a threatening issue altogether.
Public Health Emergencies
These include emerging new diseases that include SARS, Avian Influenza, etc. Moreover, there could be emergencies that affect require responses on a humanitarian basis. These emergencies could result from changes in the climate conditions such as degradation of environmental setup or potential threats to the entire population and which requires swift responses by health bodies. In response to those health issues that could have a potential impact on the people and overall society and economy, International Health Security plays a foremost important role. ICESCR, International Covenant on Economic, Social and Cultural Rights, by the General Assembly of the UN, in 1996, is aimed to make human rights accessible and feasible to all individuals.
Threats to the Health Care
There has been a lack of statistics to manifest the meticulous details regarding the number of deaths as a result of malnutrition; moreover, the absence of an adequate system for ‘registration’ of the birth and demise further aggravates the problem. In addition ‘internally displaced persons in Sub-Saharan Africa are prone to the threats of abuse and violence. O’Hare and Southhall (2007) report of the increase in ‘maternal mortality during a conflict in Congo and also that the increase in ‘child mortality rate’ among the displaced persons makes the condition grave.
Causes of Demise
O’Hare and Southhall (2007) segregate the demise into ‘direct conflict deaths’ and ‘indirect conflict deaths’. Where the first category includes demise as a consequence of bloodshed, the second category includes demise as a result of illness and starvation. There are many aspects of health that directly affect human security which include food and nutrition, water and sanitation, disease, child and maternal/ sexual and reproductive health. These aspects pose threats to security and insert a direct impact on the quantity of life.
The Most affected Group
The ‘vulnerable group’, say MacFarlane and Foong Khong (2006), include children, ‘women in war’, and ‘displaced persons’ whose protection is of utmost importance. As women, particularly pregnant women, and children are more prone to the threats of malnutrition, therefore, ‘maternal malnutrition’ has become an important element in ‘morbidity and mortality in African women and 20 % of these pregnant women have a ‘low BMI as a result of chronic hunger.
The insufficient access to food, multifarious diseases, and infections as well as ‘suboptimal infant feeding practices are said to have increased the rate of deaths of the children. Moreover, various environmental and economical factors also pose problems for the children and women in the regions of Sub-Saharan Africa. The threat of HIV infection is also enormous as when HIV-infected mothers feed their children they are prone to the infection as well.
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Boutayeb (2009) discusses the impact of HIV on the development of African countries as it is not only a threat in terms of the health care sphere but to all the spheres of life and poses a serious threat to human security in Africa.
Women and Children in Africa
“A woman in sub-Saharan Africa has a 1 in 16 chance of dying in pregnancy or childbirth, compared to a 1 in 4,000 risks in a developing country”. Children born in developing countries, of which all Sub-Saharan countries are, are over 13 times more likely to die under the age of 5 than children born in developed countries. Women and children in impoverished areas of sub-Saharan Africa are at heightened risk due to the patriarchal system at the local society level. Any threats that men and boys face in pastoralists/rural environments along with environments with dense populations, urban or rural settings are compounded by their denied access to nutrition, maternal/pre/post-natal health, and opportunities including literacy and education shape their health indicators and consequently their human security.
The people most affected by health security are those that lack access to treatment and prevention tools including various vulnerable groups such as the rural and urban poor. Due to their constant mobility, occupying life on the periphery of society and often mistrust people from outside the community, pastoralists in sub-Saharan Africa have very limited access to health education, medical supplies/medicine, and medical facilities. Paired with this, governments and NGOs have very little interest in treating and supporting pastoralist health as the geographical regions they occupy are on the margins of society, sometimes in dangerous/conflict prone/cross-border areas and they have very little political influence.
Urbanization in Sub-Saharan Africa
A result of urbanization in Sub-Saharan Africa has also given rise to the level of poverty in the region and many governmental and non-governmental organizations have attempted to lay considerable emphasis on the issue of addressing the increase in poverty.
According to a cautious reckon, reports Hanson (2007), over ‘one-third’ of the Sub-Saharan African population is inhabited in the urban areas and the increase would not stop in the coming years. Moreover, Hanson (2007) states the statistics by the ‘UN population Fund’s State of World Population’ that the seventy percent population of Sub-Saharan Africa inhabits ‘under slum conditions’ which tends to ‘spur’ the prospect of economic prosperity. Various factors that contribute to the increase in urbanization and migration from the rural areas are an important one along with the ‘reclassification of rural areas as urban’.
Problems accompanied with Urbanization
The urban areas are at a particularly high risk of mortality due to poor health. While the problem is aggravated by the fact that the NGOs and other organizations would focus on the development of the rural areas owing to the reason that the ‘urban groups’ are in a position to influence governmental policies due to their access, unlike rural areas, thus the urban areas become the victim of ‘urban bias’ and are backed further.
Bias against Urban Areas
Although much attention is paid to these communities by governments and NGOs because of their proximity, political influence, and highly publicized needs, the explosive rate of urban migration, lack of infrastructure, and declining or stagnate human resource capacity render any gains marginal. The refugees and internally displaced persons face the challenges that are also there for both rural and urban dwellers of the slum areas. Life in overcrowded dwellings where survival is at stake and which is not permanent is a difficult task for the people. The basic facilities of life which include employment and education are also important for survival.
The Global Burden of Disease project undertaken by the World Health Organization attempts to quantify the risks to health based on premature mortality due to several major causes, disaggregated by age, sex, region to continue tracking these results in the future as well. The utility of this endeavor for Human Security lies in its ability to highlight threats, weaknesses, and trends in who is most at risk in terms of quantity of life indicators. Not surprisingly an enormous number of all deaths including communicable, non-communicable, and death due to the injury occurred in developing regions with the highest rate of death falling squarely in sub-Saharan Africa.
It is not a surprising fact that the ‘infant and child mortality rate’ in sub-Saharan Africa is still highest in the world but the immensity of the problem must be gauged from the fact that the data to identify the relevant causes of demise is not only inadequate but is of ‘questionable quality. The life expectancy in the region is extremely low and various diseases, including HIV, serve to exert a horrendous impact on the rate of life expectancy.
Responsibilities of the community
If the responsibilities of various sectors are assessed it must be concluded that the role of communities in the wake of human security and health in Africa is the most significant among all. Educating communities on safe birthing methods, infant care, and traditional harmful practices can only be done effectively by community members themselves.
The role of AMREF
The instance of the African Medical and Research Foundation (AMREF) is important to discuss when it comes to the role of community as the foundation aims for the provision of health in Africa as a possible feat in various African countries. Moreover, the foundation encourages research in the area of health care along with making the communities as strong so that they would be able to aid in improving health care systems.
Although it is easy for donor countries to set agendas that incorporated broad definitions of human security, the next step of acting on these words has been problematic. The role to be played by the governmental and non-governmental organizations and the national and international community is of utmost importance regarding the health and human security in Sub-Saharan Africa.
Role of the International community
The role of the international community in the provision of support to maintain human security and health in Africa is said to be ‘critical’. The United Nations has attempted to provide human security along with ‘national’, ‘societal’ and ‘environmental’ in Africa. The ‘human security role, notes Moller (2005), of the UN include the protection of the human beings against the ‘malign consequence, es’ of poverty which victimizes innocent children and women and more particularly ‘child soldiers and rape victims.
In 2007 on the eve of World Health Day, the theme of the event was ushered to be health security with its aim to draw the attention of the various organizations and institutions towards the significance and urgency to invest in the projects of health to make the future safer. The World Health Organization is responsible for ‘worldwide guidance in the field of public health’.
After the end of the Cold war, nations became sensitive to the threats that the world was to face due to the health crisis. This sensitivity and interest of the nations were beneficial for the developing countries like Sub-Saharan Africa where the threat was so dangerous. The development of the ‘International Health Regulations (IHR)’, reports Sheward (2005), was an attempt to provide a ‘global public health safety and security’ and to prevent infectious diseases.
Role of NGOs
The role of the Non-Governmental Organizations is also important but they are often caught in the middle of what ought to be done and what is being done. But the NGOs focus their efforts in rural areas and the urban areas are utterly ignored for the reason that as the ‘urban groups’ have the benefit of their location so they can pressurize government for their rights and reforms but the rural areas are not in this position. But the NGOs tend to ignore the multiple problems that the urban areas face and do not fulfill their responsibility in this regard.
The major threats to the Sub-Saharan regions include making the provision of health care possible as well as to cope the rise in demise owing to HIV infection. AIDS was considered a disease in the 1980s but it was accompanied by the dreadful realization that a new epidemic of unprecedented proportions was spreading throughout Sub-Saharan Africa’. Around forty million of population, report World Bank and Jaminson (2006), is found infected in Africa among which ‘28.5 million’ are in Sub-Saharan Africa only. ‘Voluntary testing’, ‘counseling programs’ and the use of ‘ARVs’ can help in preventing AIDS.
Ethiopia: A Case Study
Ethiopia, as a state that is not currently involved in a major external or internal conflict, with a government that enjoys international support and some of the lowest health indicators in the world stands as an appropriate example to find a link between health and human security.
In Ethiopia, HIV has emanated to a perilous extent. USAID has determined that youth between the ages of 15-25 are the age group with the highest rate of infection, with girls having a 3 times greater prevalence rate than boys of the same age. ‘At the end of 1999, an estimated 3 million Ethiopians, or nearly11% of the adult population, were living with HIV/AIDS, an estimated 150,000 of those infected are children. Between 15% and 30% of adolescents attending antenatal clinics in major urban centers tested positive for HIV’. No other region in the world is as affected by HIV as is Sub-Saharan African region. According to an estimate, about 23 million populations are affected by the disease. Moreover, the number of children orphaned as a result of the disease has increased to a dangerous extent.
Field research in Ethiopia
Non Communicable disease: Malaria
Communicable diseases: HIV/AIDS and STIs according to a World Bank report on health and poverty, it is estimated that among pregnant women aged 15-24 attending urban antenatal clinics, 8.8% tested positive for syphilis”.
Water and Sanitation
Maternal Health: Early childbirth
In Addis Ababa, the average age for childbirth is 15 years; nationally, the adolescent fertility rate is estimated at 154 births per 1,000 women aged 15-19.
The Worde Health bureau does not have data for hospital births, as most mothers give birth at home with the assistance of a traditional midwife. “According to 2000 estimates, 26% of women in Ethiopia receive antenatal care from a health care provider; approximately 6% of births are attended by trained health care professionals.”
“Young girls are at a higher risk for obstetric complications, nutritional anemia, obstructed labor leading to fistulae, and postpartum hemorrhage.”
There is no data as to how many failed traditional abortions have been carried out as Word clinic staff exclusively document the complications. Nationwide, the MOH estimates that nearly 70% of women who seek medical attention for incomplete abortions are under 24 years of age and cite botched abortions as one of the leading causes of maternal mortality in Ethiopia, resulting in 55% of fatalities, 13% of which are adolescent girls.
It is often asked as to why health is not considered a part of human security. The answer to the question is difficult to find but various factors contribute in this regard. The question of the distribution of health is a puzzling one. In addition, the question also arises as to who is responsible for setting an agenda for security. Until poor health directly affects the quality or quantity of life in developed countries it is unlikely that health will become a human security issue.
Human security is indivisible’, reflects Thomas (1999), therefore must be assured to every member of the society regardless of any impediments as it is the ‘central pillar’ of society. Moreover, human security must aim to eliminate the gulf between polarities existent in the society or countries. By institutionalizing health as a global security concern we are protecting the agents of sustainable development initiatives, punishing the perpetrators of insecurity, and ensuring a stable future in Africa.
The bottom line is that poor health, like war, will result in avoidable deaths within a population. Health as human security issue falls into the widely accepted “freedom from fear” and also into the much debated ‘freedom from want’ categories. “The emphasis on conventional security whilst millions die without good reason reflects the power relations threaded throughout international relations, between rich and poor, males and females, marginal and included, vulnerable and secure’. There is still an acute need to stay on focusing health as human security in the Sub-Saharan African region which is encircled with multiple problems and diseases. Health must now be considered a state of emergency.
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