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Infectious Diseases and International Relations Theory-Discourse and Reflexivity Based on Interdisciplinary Research
Global Health Research
Emerging and Re-Emerging Infectious Diseases
Neglected Tropical Diseases
Development Assistance for Health
Millennium Development Goals
Global Health Security
Global Health Governance
International Health Regulations
Global Health Politics
Access to Medicine
Global Health Partnerships
Global Public Goods for Health
International Health Cooperation
就傳染病控制的疾病監測通報而言，本文透過愛滋病的衛生安全化作為個案分析來反思全球衛生安全這個主流概念的真正符號內涵。本文以為，現實主義所詮釋的全球衛生安全乃是指涉全球衛生的國家安全化，尤其反映西方大國的國家安全利益。現實主義與安全研究社群透過衛生安全化將某些新興傳染病賦予全球衛生安全位階成為高度政治議題，比如著名的「三大疾病」(the big three)。本文認為，全球衛生安全其實並不是現實主義所指稱的傳染病被衛生安全化，而是某些少數被西方大國所選定的新興傳染病被衛生安全化。
Assessing from the perspectives of traditional international health or emerging global health studies, infectious diseases have received considerable attention over these decades in international community. Infectious diseases are usually used to refer to a serious process of involving diseases outbreak, surveillance, notification, research and development of drugs, drugs commercialization, access to medicine and international health assistance. The research objects of this dissertation are those diseases regarding Emerging and Re-Emerging Infectious Diseases (EID) and Neglected Tropical Diseases (NTD) in particular. The author adopts four theories relating to liberalism, realism, institutionalism and cosmopolitanism in the fields of IR and IPE to analyze and examine current infectious diseases debates on diseases control, diseases cure and international health assistance. Given that previous studies had failed to consider theoretical discourses of infectious diseases, this study tries to offer a complete and cross-disciplinary theoretical discourse for infectious diseases. In regard to surveillance and notification of diseases control, this study makes an attempt at adopting HIV/AIDS as a case study to analyze the core meaning of global health security which has been constructed by realism and security scholarship. The study argues that global health security should be interpreted as national securitization of diseases so as to make some specific EID become high politics issue, such as famous the big three diseases. More importantly, global health security doesn’t mean that diseases are health securitized, but rather that some EID which great powers had decided are health securitized on the basis of great power’s power and interests. As far as the access to medicine of diseases cure is concerned, this study has argued that although liberalism can interpret the technology innovation on research and development of drugs as to provide curative effect drugs, it still failed to rationalize the debates over market failure of access to medicine on NTD caused by the gap of extremely international health resources in the world. In order to examine the access to medicine debates on NTD, this study is concerned with these perspectives on global health governance, global health public goods and global health partnerships. This study claims that even though global health partnership for NTD is regarded as a concrete business model in practice based on global health governance, it needs to avoid those democratic deficits that institutionalism fails to justify, such as accountability, transparency, and legitimacy. In matters of great power's responsibilities on international health assistance, this study claims that this controversy is essentially contested on basis of global health justice and power allocation. Great powers place emphasis on infectious diseases and global health by means of drawing attention to increasing international health assistance funding. This study argues that mainstream arguments of realism regarding international health assistance still focused on great power’s security, political and economic interests. As far as Obama's global health declaration is concerned, it not only presents political commitments for UN Millennium Development Goals, but also shows emerging foreign aid thinking based on integration between self-interest and altruism. Rested on the above depictions, this study offers some suggestions as follows: First of all, from the perspectives of institutionalism and cosmopolitanism, this study offers a new discourse about global health politics by criticizing the extant arguments of international health politics that has been illuminated by the mainstream of international relation community. On the one hand, the global health politics is suffering from dual deficits, that is, it not only presents a critical gap between EID and NTD, but it demonstrates an unsymmetrical allocation of health power and resources. On the other hand, global health politics should be characterized as both horizontal and vertical health governance between states and non-state actors. Secondly, this study finds that current diseases dilemma is caused by the double failures, that is, government failure and market failure, and these failures have generated some controversies on disease control and cure dimensions. Facing these controversies, the author is convinced that the arguments of institutionalism and cosmopolitanism will be more persuasive than other theories. For institutionalism, on the one hand, it is able to offer health institutional construction arguments beyond dichotomy between state-oriented realism and market-oriented liberalism. On the other hand, institutionalism tries to construct an emerging system of global health governance which is constituted of states, pharmaceutical industry and global civil society organizations so as to interpret and solve disease’s double failures dilemma. On the other hand, because institutionalism takes global civil society into consideration, an institutional network, in which states, pharmaceutical industry and global civil society organizations interact with each other, will be made for solving the disease’s double failures dilemma. Finally, this study finds that if we attempt to govern the disease issues simply relying on the international health institutions such as global health partnerships, it may be in futility on the one hand, and probably generate some institutional risks, such as accountability, transparency, and legitimacy on the other hand. For this reason, this study makes up for institutional deficits by adopting the perspectives of cosmopolitanism. Given that the emerging global health studies have focused on the issues of global health inequalities, the cosmopolitanism, by emphasizing normative dimensions relating to global health ethics and health justice, will play a complementary role in the global health governance system. Consequently, this study suggests that the theoretical loophole of global health inequalities that institutionalism has made might be filled by the arguments of cosmopolitanism, such as world poverty, health distributional justice, and health equality demands.
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