C. National Security

Extremely poor health in other parts of the world can also affect the security of the United States and its allies. Research shows a correlation between health and the effective functioning of government and civil society. The CIA, for example, finds that high infant mortality is a leading predictor of State failure, and the State Department called AIDS a national security threat. States with exceptionally unhealthy populations are often in crisis, fragmented, and governed poorly. In its most extreme form, poor health can contribute to political instability, civil unrest, mass migrations, and human rights abuses. In these States, there is greater opportunity to harbor terrorists or recruit disaffected people to join in armed struggles. Politically unstable States require heightened diplomacy, create political entanglements, and sometimes provoke military responses.

Diseases of poverty overwhelming are concentrated in sub-Saharan Africa, and it is no surprise that many of these political and military entanglements occur in that region. The rest of the world, however, has largely been insulated from the devastation wrought by these endemic diseases. The explanation for this “awful dissonance” may lie in the region’s marginal strategic importance. Sub-Saharan Africa has weak political, military, and economic power.

The same cannot be said about the burgeoning health crises emerging in pivotal countries in Eurasia, such as China, India, and Russia. These countries are in the midst of a “second wave” of HIV/AIDS, which mirrors the earlier explosion in Sub-Saharan Africa. The HIV prevalence in the Ukraine and the Russian Federation, for example, have risen twenty-fold in less than a decade. In the decades ahead, the center of the global HIV/AIDS pandemic is projected to shift from Africa to Eurasia.

The HIV/AIDS crisis in Eurasia is exacerbated by additional emerging health problems. Recall that infant mortality is a prime predictor of State instability. Russia’s official infant mortality rate (which is thought to be vastly under-reported) is 3-4 times higher than in North America and Western Europe, and similar levels are found in parts of India and China. Of children who are born alive, nearly two-thirds will be unhealthy, many suffering lifelong illness and disability. Women’s reproductive health is also poor, with nearly half of all pregnant women being malnourished and sick, many losing their babies before term.

Eurasia is a region of high strategic importance in terms of its population, economic and military prowess, and political influence. It has more than 60% of the world’s inhabitants; one of the highest combined GNPs; and at least four massive armed forces with nuclear capabilities. But due to extreme health hazards, Eurasia will suffer economic, political, and military decline. Political instability in a region with such geostrategic importance will have major international ramifications.