Health care workers, police officers, and members of the military share the goal of keeping people safe. All too often, though, they are working at cross purposes, set on a collision course with fatal consequences for the populations caught in the middle.
As we and 17 others write in the Lancet Special Series on Security and Health, it is time to explore how all countries can prosper from partnerships that bridge health and security silos based on this shared vision: engagement of security forces, including police and the military, in public health is synergistic and beneficial.
Take the 2014 Ebola outbreak in West Africa and Brazil’s 2015 Zika outbreak. Both are examples of how military resources, expertise, and their rapid-response capabilities were mobilized to help rein in disease outbreaks that posed significant threats.
The recent outbreak of Ebola in the Democratic Republic of Congo has further highlighted the importance of cooperation between health workers and security forces, with DRC soldiers and local police being deployed alongside United Nations peacekeeping forces to protect health workers engaged at treatment and vaccination sites from attack by rebel militias.
The fight against HIV/AIDS reveals the human and financial cost of disengagement between the health sector and security forces. Placing some 20 million people living with HIV on antiretroviral medications in less than two decades has been an extraordinary public health achievement, transforming what was once a death sentence for many into a chronically manageable disease. However, some 16 million people still do not have access to treatment.
There are, of course, many reasons for that, but one of them is the inability of health workers to gain access to the vulnerable and marginalized groups most affected by the epidemic —injecting drug users, sex workers, men who have sex with men, and people who are incarcerated. In many developing countries, that lack of access is due almost exclusively to repressive government laws and police brutality or military violence.
Security forces tend to have substantial resources, power, expertise, and the ability to act quickly — all things that the health care sector would ideally possess as well. These assets should be employed to improve health, not undermine it. We need the security and health sectors to talk to each other, train together, and work together in a systematic way, something that will require investment in partnerships and reform.
This call for closer, systematic cooperation is likely to be controversial given that security forces in many regions have been responsible for targeting civilians and health infrastructure, violating human rights, and harassing marginalized groups such as refugees. Although cooperation may not always be possible, or even or desirable in some cases, overall we can do a whole lot better.
In some countries, police already play roles in public health, roles that are often unrecognized by either public health workers or the police. From road safety to responding to mental health and drug issues, police are often front-line public health actors. The success and longevity of safe injection rooms in cities like Vancouver, Canada; Sydney; and Barcelona, Spain, are to a large degree due to the partnerships with the local police.
The opioid epidemic in North America has generated a debate around providing naloxone to reverse overdoses. One can see a clear role here for police officers, who are often the first responders. Similarly, the current debate in the U.K. over checking illicit party drugs like ecstasy tablets for contaminants at music festivals to avoid overdoses is beginning to gain traction primarily because a growing number of local police leaders have become vocal that this kind of pill testing is a preferable public health option, as it has become in cities like Barcelona and Amsterdam. The emerging response to knife violence in London is another example of treating violence as a public health issue in partnership with police.
There is still massive room for improvement. Police are not recognized or praised for their public health role, and public health practitioners are not taught about the important roles they play. Historically, this misunderstands the police mission — dealing with crime makes up less than 20 per cent of the work of the modern police agency.
The world cannot afford the human and financial cost of continued disengagement between police, armed forces, and the health sector — we need to consider when and how militaries can contribute and plan accordingly. Currently health workers and security forces are often thrown together yet are flying blind because there is no global framework or investment to facilitate their engagement.
Rather than worrying about a security sector takeover of health, we need to engage and help govern and define how and where and when militaries and police can and do provide support for an enabling environment for public and global health. To that end it is vital that we make a case for investment in the kind of partnerships that going forward make it possible for both the security and health sectors to train their personnel with the skills and understanding to operationally engage with each other in pursuit of better global and public health outcomes.
Nicholas Thomson is co-director of the Security and Health Executive Leadership Institute at the University of Melbourne School of Population and Global Health and a research fellow at the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health. Lt. Gen. Louis Lillywhite, a former surgeon-general of the United Kingdom armed forces, is currently based at Chatham House in London. Auke van Dijk is a senior strategist with the police of the Netherlands based in Amsterdam.