Failed States: Global Public Health's Weakest Link

Global public health requires global efforts. In some cases, such as medical R&D, progress depends on the most powerful states. In other cases, progress depends on the weakest and most fragile states—states often caught in a maelstrom of violence and anarchy. Smallpox was extinguished in Somalia in 1977, but that country has been embroiled in conflict since 1991. Smallpox eradication also coincided with a temporary lull in an ongoing civil conflict in Sudan. It is sobering to think that the greatest success of global public health might not be achievable today. Polio has resurged in a number of countries that were previously polio-free and that now rank high on the Failed States Index. Though a pandemic influenza virus could emerge anywhere, it is more likely to emerge in conflict zones. The world's handling of these challenges is typically unilateral and defensive. It needs to be more international and offensive. It needs, in particular, to focus on improving public health capability in the most dysfunctional, conflict-prone states.

These and related issues are taught in a number of courses within the International Policy program at the Johns Hopkins University School of Advanced International Studies, with the support of the Global Health and Foreign Policy Initiative, funded by the Gates Foundation. Courses such as International Health Policy focus entirely on global health in an interdependent world. Other courses address a range of global issues, showing the connections between them. Students also take courses within the Conflict Management program, where the focus is more on conflict than on public health. Teaching on both programs stresses the need for effective institutions to address these complex, interrelated challenges.