By Yuju Park
The region, Southeast Asia, is commonly referred to as a still relatively developing region, with the exception of highly developed cities like Singapore or Kuala Lumpur. Southeast Asia includes countries such as Cambodia, Indonesia, Thailand, and Vietnam, all countries that are not considered “developed” or as industrialized. Southeast Asia is actually a region where many Western countries build factories and employ its people for cheap labor. Again, with the exception of the metropolitan cities like Singapore, Jakarta, and Kuala Lumpur, the majority of Southeast Asia struggles with many crucial health problems and outbreaks. Such health influenzas and problems caught the attention of many Western and other developed countries in regards to providing foreign aid specifically for healthcare.
As mentioned in “Southeast Asia: an Emerging Focus for Global Health,” by Acuin et al., Southeast Asia has presented significant health challenges, which has included several strains of multi-drug resistant microbes, and thus several emerging and re-emerging infections that sometimes cross national boundaries. Because of globalization, diseases are no longer limited to one geographic area, and they is a very high likelihood that a disease in one area can cross the borders of another country and spread there. It is not therefore not a surprise that many developed and typically Western countries are invested in finding the cause of many of the diseases that seem to originate from Southeast Asia. Health services funded by foreign direct investment and the export of health workers, particularly in the Phillipines and Indonesia. With the help of foreign aid, healthcare systems have thus been developing in various ways throughout Southeast Asia. The response of individual Southeast Asian countries to the development of a more advanced global healthcare system has not been uniform and not all reactions have been positive. Moreover, the lack of standardization of healthcare development within Southeast Asia has led to a lack of regional health cooperation, which halts the advancement of health for all of the region’s people. Because healthcare in Southeast Asia has largely developed with the aid of developed, typically Western countries, how health care is delivered and how foreign funds are allotted have stimulated much debates – particularly about how global health care should be governed.
In “Overcoming Constraints of State Sovereignty: Global Health Governance in Asia,” Stevenson and Cooper state that because of how globalization affects the whole world, there is now such a need for global governance, which includes healthcare. Steven and Cooper argue that the global facilitation of capital, ideas, and more have introduced entities such as pollutants and pathogens around the world, which has blurred the line between domestic and foreign responsibility. This has also partly led to the loss of control by states over their domestic spheres and the uncoupling of territorialism. The introduction of pollutants and pathogens has undoubtedly led to health crises, and again, as Stevenson and Cooper state, “because global governance no longer exists as the exclusive domain of states, it is assumed here that states are no longer the sole actors modifying the norms that shape global health governance.” This mode of thinking is more aligned with a post-Westphalian model that couples the globalization process with global governance, whereas the old Westphalian model was based on the premise that states are the ultimate and legitimate controllers of their areas and people.
In Southeast Asia, there has been much debate as to how much control states and foreign actors should have in governing healthcare in Southeast Asian countries. Indonesia has been a highly publicized example of how the state has been rejecting global collective action on healthcare issues within the country itself. The World Health Organization (WHO) routinely collects physical virus samples from new infections from countries around the world through its Global Influence Surveillance Network. The network at the WHO does this for the international surveillance of samples used to facilitate vaccine production worldwide. Indonesia has struggled with avian influenzas and has experienced the highest number of AI human infections, yet in 2007, the Indonesian government began to withhold its physical virus samples from WHO, arguing that it was their sovereign right to safeguard their genetic materials and that foreign governments and large pharmaceutical companies were primarily using their virus samples to manufacture a product that Indonesia would not be able to derive profit or protection from. Indonesia even asked for WHO to return previous samples and also went as far as to threaten to close the U.S. naval research unit in Jakarta. Indonesia was thus highly criticized by other countries worldwide for challenging this post-Westphalian ideal that states must work with other states to safeguard public health in today’s globalized world. Moreover, many countries also worried that Indonesia would set a dangerous precedent for other countries. In response, WHO has attempted to mitigate this problematic issue by soliciting promises from the world’s largest pharmaceutical companies that they will not exploit international viral repositories for commercial gain.
Meanwhile, while Indonesia has refused to comply with the World Health Organization, Burma has been highlighted to completely ignore global health norms and ideals of collectively working together by rejecting and interfering with foreign health care aid that comes into the country. Burma has struggled with an HIV epidemic and it is estimated that 3.5% of all reproductive age adults are infected with HIV (Stevenson and Cooper). In addition, Burma experiences the highest number of annual deaths attributed to Malaria. But instead of allowing foreign help to aid in helping protecting such sick and vulnerable populations, Burma’s military regime has become known for fostering an environment that is known to be the disease reservoir that fuels the most infectious diseases within Southeast Asia. The Burmese regime states that states should invest in and commit to public health only domestically. While foreign organizations have tried to intervene in Burma, its regime has become notorious for interfering with them even though they are apolitical, non-state foreign organizations. The regime’s interference has been so severe that large, international programs such as the Global Fund have decided to discontinue their services in Burma because of how government implementation made implementation of the programs nearly impossible.
In the past, healthcare was thought to be a less politically sensitive factor in comparison to other aspects of development. However, with the influx of foreign donors investing money to developing countries, even healthcare has become political, and how it should be governed and managed has become a hotly debated topic. Globalization has indeed changed how health care is not just one country’s problem – it can potentially become the world’s problem because of how rampant travel across borders has become. Acuin et al., as well as Stevenson and Cooper, thus emphasize that there needs to be more regional cooperation among Southeast Asian countries in order to share health resources and collaborate in taking joint action. Countries like Burma and Indonesia have been examples of how its population suffers when health care becomes isolated with only domestic control, and its health care isolation also impedes global advancement of its diseases and health issues.
Acuin, Jose, Rebecca Firestone, Thein Thein Htay, Geok Lin Khor, Hasbullah Thabrany, Vonthanak Saphonn, and Suwit Wibulpolprasert. “Southeast Asia: An Emerging Focus for Global Health.” The Lancet 377.9765 (2011): 534-35. Web.
Stevenson, Michael A., and Andrew F. Cooper. “Overcoming Constraints of State Sovereignty: Global Health Governance in Asia.” Third World Quarterly 30.7 (2009): 1379-394. Web.
Pallas, Sarah Wood, Thi Hai Oanh Khuat, Quang Duong Le, and Jennifer Prah Ruger. “The Changing Donor Landscape of Health Sector Aid to Vietnam: A qualitative Case Study.” Social Science & Medicine 132 (2015): 165-72. Web.