Rousseau, Kant and health

Existing literature analysing foreign policy and health often observes that health has long been a foreign policy issue, but one of little importance in the hierarchy of foreign policy objectives. This reality does not support principles informing WHO’s establishment, such as the principle that “[t]he health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States”.¹ For most of WHO’s existence, countries did not behave in their relations with each other as if the health of all peoples was critical to national or international peace and security. Health has not been at the heart of foreign policy theory or practice, and perhaps not even at the margins.

The emergence of health as an important foreign policy issue in the last decade has revealed some consequences of the historical separation of health from foreign policy. In particular, health policy communities have not been well versed in the harsh realities of foreign policy, especially the cold calculations that officials are expected to make in constructing, protecting and promoting national interests. As explored by scholars of politics and international relations, foreign policy dynamics flow from the condition of anarchy in which countries interact. The lack of any recognized common, superior authority means that countries are ultimately responsible for their own sovereignty, security and survival. Diplomats and scholars differ on the dangers and opportunities that international politics create for countries; these differences produce diverse attitudes about the potentialities of foreign policy behaviour. Regardless of these varied perspectives, however, the anarchical nature of international relations forces countries to set political priorities in contingent, uncertain and often dangerous circumstances.

The eminent political scientist Stanley Hoffmann captured the tension in foreign policy-making when he argued that “[w]hoever studies contemporary international relations cannot but hear, behind the clash of interests and ideologies, a kind of permanent dialogue between Rousseau and Kant”.² When it came to international politics, Rousseau was a deeply pessimistic realist, who could see little more than competition, conflict and enmity in intercourse between countries. By contrast, Kant saw the potential for perpetual peace, achievable through revolutionary transformations of domestic and transnational politics. As Hoffman argued, the diplomat listens to the dialogue between Rousseau and Kant, and realizes that “he must play the game of international competition, from which he can escape only exceptionally, and at the same time he ought not to lose sight of Kant’s ideal. He ought not to give up the hope of a future world community, but he cannot act as if it already existed.”