The World: A Brief Introduction

by Richard Haass

  The U.S. government in 2011 called for the internet to be open, interoperable, secure, and reliable. Not everyone agrees, and the internet already appears to be fragmenting, resulting in the creation of several distinct internets. (This trend is sometimes described as the “splinternet.”) Citing sovereignty, some governments, most prominently China, want to restrict what the internet can bring into their country as well as the ability of people in their country to communicate with one another. Some governments fear the internet will be used by political opponents to bring about what they view as threatening political change, while others believe certain content judged harmful (say, pornography) should be restricted. It is also becoming more common for governments to completely shut down the internet or social media websites in response to terrorism or acts of communal violence, fearing that people will use the internet to spread rumors or fan the flames. In 2019 alone, Sri Lanka, Iran, and India all shut down social media or the entire internet amid crises.

  Improving global governance will be extraordinarily difficult. There is probably no realistic way of preventing or even discouraging espionage by one government against another. In this, cyber is little different from other modes of communication, from old-fashioned mail to telephone calls, that are targets of intelligence agencies. But there are other government activities that might be ruled out of bounds, including preparing for or carrying out attacks on one another’s physical infrastructure (for instance, shutting down its power grid), interfering with one another’s politics (as Russia did during the 2016 U.S. presidential campaign), stealing intellectual property, or sabotaging an entity such as a corporation, as North Korea did to Sony Pictures.

  One question sure to emerge is whether there ought to be an exception to any potential ban on using the internet to attack another country. Some would argue that an exception should be made that allows countries to attack terrorists or countries that are seeking to develop weapons of mass destruction or advanced delivery systems. The United States and Israel appear to have carried out such cyberattacks to slow Iran’s nuclear program, and the United States reportedly carried out cyberattacks to disrupt North Korea’s nuclear and missile programs. Others might embrace such a rule in principle but violate it in practice, seeing cyberattacks as a useful tool of war, be it to deter or retaliate against an adversary that is stronger by more conventional military measures. In this sense, the cyber domain can be a weapon of the weak, because it is low cost and can cause a tremendous amount of damage to a militarily superior enemy. For instance, North Korea, which by all measures is one of the most impoverished countries in the world, also has one of the most sophisticated cyber arsenals. Depending on the targets selected and their effectiveness, cyberattacks have the potential to be as costly and consequential as those conducted with conventional arms or even weapons of mass destruction.

  Gaining widespread endorsement of such rules and exceptions might well be impossible. Calls for a “digital Geneva Convention” have gained little traction. And even if some collective agreement were possible, collective enforcement would not be. What comes to mind as a parallel are the international rules and norms as to when and how armed force should be used. Such rules can serve a purpose in shaping behavior but frequently are ignored if economic or national security interests are judged to be important.

  Beyond the lack of agreement, there is the reality that the relevant technologies are quickly evolving and will continue to do so. This makes it hard, if not impossible, for any international rule-making body to keep up. Indeed, any such effort would need to include not just governments but corporations central to the functioning of the internet. What’s more, there are a number of tensions and trade-offs when it comes to regulating cyberspace. One is between individual privacy and collective security. The internet has emerged as a principal and widely shared means for communicating. As a result, governments must determine under what circumstances law enforcement and intelligence agencies could read what is sent by one citizen to another with the presumption that it is between them and no one else. There is as well the issue of what data pertaining to individuals corporations should be allowed to collect and keep. Even between close friends and allies, such as the United States and the countries of the European Union, there is strong disagreement on these issues, with the Europeans arguing for further protections for individuals and more restrictions on technology companies. In fact, in 2018 the EU implemented the General Data Protection Regulation, which provides certain protections to individuals in the EU regarding their data and has fined U.S. companies such as Google for violating this law.

  There are alternatives to building an international consensus on how best to govern and regulate cyberspace. Even absent formal agreement, there is the possibility of influencing the behavior of governments. Deterrence is often discussed as one way to discourage certain unwanted actions, including interference in democratic elections. But it is difficult to make deterrence real, mostly because the vast majority of cyberattacks are below the threshold for responding with an armed attack or use of force. Imposing sanctions might not have the desired effect. It can thus be difficult to find a response that imposes costs but is not disproportionate and unduly risky. In addition, the source of the illegal or hostile action cannot always be determined. This makes retaliation (the threat of which is central to deterrence) often impossible to implement.

  If, however, a government can determine who was behind some action in cyberspace that it deems illegal or hostile, there is a range of potential responses. Those violating the law can be treated as criminals and punished. In the case of terrorists, a response could involve a physical attack. If a government is behind the cyberattack, either directly or by supporting some individual or group, economic sanctions, military action, and even some cyber-related response can be options.

  There are alternatives—or, better yet, complements—to fostering restraint. Steps can be taken to make systems less vulnerable even if not invulnerable. As is so often the case, there exists a running battle between offense and defense, between those technologies that would attack in one form or another and those that would defend. Many actions for individuals and small companies come under the rubric of cyber hygiene, such as using complicated, random sets of characters for passwords (as opposed to something like “password123”), not writing passwords down next to your keyboard, using a password manager, and enabling two-factor authentication on social media, email, and banking accounts. Encryption may be an option. A user can also make sure he or she is running the most recent software and continue to update that software. There is also a case to be made for resilience, including making critical equipment redundant, creating multiple backups of critical information, and ensuring business continuity under severely degraded conditions. Here and elsewhere, efficiency and security (along with potential risks and costs) will need to be considered and balanced. One thing is sure: governing the internet promises to be one of this century’s greatest and most important challenges, and right now those favoring establishing rules are losing out to fast-changing technologies that, unlike nuclear weapons, for example, are increasingly available to the many and not just a few.

  Global Health

  There is a persuasive case to be made that global health is considerably better now than at any other time in human history. And there is a case to be made that people and governments nevertheless should be concerned given developments in the health sphere and the gap between these challenges and the readiness of the world to meet them. In this latter sense, global health is but another example of the gulf between globalization’s challenges and the adequacy of the collective response.

  The reason all this matters stems from the obvious—we all want to live long lives in which we are able to perform mentally and physically at a high level, and for humanitarian reasons we would like others to as well—to the less than obvious, including the relationship between a society’s overall health and its economic perfo
rmance, political stability, and national security. Health-related costs and crises can turn a strong, successful society into a weak and dysfunctional one. Preventing, detecting, and responding to outbreaks in other countries can slow or prevent those outbreaks from spreading to your country. Health care is also central to the global economy because close to 10 percent of global economic output is spent on it. In the United States, spending on health is now estimated to be no less than 18 percent of its gross domestic product.

  The world’s population is approaching eight billion, eight times the population two centuries ago, four times what it was one century ago, and roughly twice as large as it was as recently as fifty years ago. A principal reason for this increase is that life expectancy has dramatically risen. The typical person in the world today can expect to reach his or her seventy-second birthday. In some of the wealthier countries, a person can expect to reach his or her eightieth birthday; Japan is a global leader, with a life expectancy of eighty-four years. Increasing numbers of people live into their nineties and even beyond. This average longevity is more than double what it was a century ago, which reflects a sharp increase in the average life span of those living in poorer or developing countries. The reasons for longer lives include better diet, enormous progress in the fields of medicine and health—in particular, both child and maternal mortality are down—and fewer large-scale wars. The average woman lives several years longer than her male counterpart. Due to the decline in under-five mortality since 2000, fifty million children’s lives were saved.

  Many factors account for this progress, including improvements in medical care ranging from prevention to diagnosis to treatment, breakthroughs in technology and drugs, education that has changed individual behavior for the better, improvements in diet and nutrition, and aid provided to low-income countries to bolster their health-care systems. The eradication or near eradication of several infectious diseases that previously ravaged populations is a case in point. Smallpox was officially eradicated as of 1980. Polio cases have decreased by more than 99 percent since 1988 and are now extremely rare. New HIV infections are down, and the number of people dying from AIDS-related causes is now around one million a year, half of what it was since the peak in 2004 and a small fraction of what would have been the case without changes in behavior and the development of drugs that allow individuals to manage the disease. Incidence of both malaria and measles has plummeted.

  Notwithstanding all these gains, the global health agenda remains full and demanding. Life expectancy in several African countries is barely above fifty years, while the average life expectancy for sub-Saharan Africa as a region is sixty years, a figure that represents a sharp improvement of twenty years over its 1960 level but one that is still relatively low. Infectious disease remains a threat, in part because globalization itself (for instance, the ease of travel) has made it much easier for diseases to spread. Urbanization and warmer temperatures have likewise created an environment conducive to outbreaks and transmission of diseases. Large refugee populations have also become vulnerable to outbreaks of diseases such as cholera and diphtheria.

  The overuse of existing antimicrobial drugs and underinvestment in new ones mean drug-resistant organisms are becoming more common and are more difficult to treat. Then there are viruses, for which there is often no means to ensure either prevention or successful treatment of the infected. In recent years, the world has experienced life-threatening outbreaks of diseases including severe acute respiratory syndrome, Middle East respiratory syndrome, Zika, and Ebola.

  At the same time, a large-scale global epidemic—a pandemic—cannot be discounted. Vaccines cannot anticipate specific strains of flu, and it is possible that a particularly virulent form could emerge one season and quickly go global. By the time the influenza virus had been identified, it likely would have spread and taken root. During the Spanish flu pandemic a century ago, it is estimated that at least fifty million people died. Literally hundreds of millions (especially the young and the old) would be at severe risk today from the outbreak of a virulent form of flu, and the global economy could suffer a major blow because travel would be interrupted, health systems overloaded, and people discouraged from going to work or anywhere where they could come into contact with people who might be contagious. In the realm of contagious diseases, little stays local for long.

  The other large emerging threat to global health stems not from infectious diseases but from noninfectious or what are termed noncommunicable diseases. NCDs include cardiovascular disease, respiratory diseases, cancers, and diabetes. In 1990, three of the top seven causes of death in the world were the result of NCDs; by 2015, the number was six in seven. NCDs are the leading cause of death globally and were responsible for thirty-eight million—or 68 percent—of the world’s fifty-six million deaths in 2012. By 2030, NCDs are projected to cause nearly five times as many deaths as communicable diseases worldwide. This shift is the result of progress realized in the fight against infectious diseases (which among other things increased life spans) but even more reflects the result of a much greater prevalence of NCDs.

  NCDs can result in part or whole from genetic disposition, for instance, cardiovascular disease. A separate cause is prolonged exposure to or interaction with a polluted environment. NCDs are often a consequence of individual behavior, be it sedentary lifestyles, poor diets, smoking, and drug and alcohol abuse. NCDs also encompass mental illnesses, including dementia and Alzheimer’s, which most affect those living lives longer than was common just decades ago.

  NCDs tend to be costly to treat. Many drugs are prohibitively expensive. NCDs also affect economies because individuals who have NCDs often must leave the workforce prematurely. The adage “an ounce of prevention is worth a pound of cure” applies here. Education and consumer information about risks associated with certain consumption and behaviors (along with the benefits of others) are one thing. Regulation and taxation can make it more difficult and expensive to smoke or drink alcohol. Workplaces and environments can be inspected and required to meet certain standards with sanctions and penalties introduced if such standards are not met. Increased access to primary health care in developing nations would also make a big difference, because people are often diagnosed too late and treatment becomes more difficult. However, there is resistance at many levels (from the personal to the political) to adopting these measures.

  PREMATURE DEATHS FROM INFECTIOUS DISEASES ARE DECLINING, WHILE DEATHS FROM NONCOMMUNICABLE DISEASES ARE RISING

  Total deaths under 70 years old, selected diseases

  Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

  Global efforts in the health realm are complicated. One reason is the sheer number of actors involved. There is the World Health Organization (WHO), but its impact is less grand than its name suggests. Established in 1948, it lacks the necessary authority, capacity, and resources to carry out its mission of fostering “the attainment by all peoples of the highest possible level of health.” Besides the WHO, there is the World Bank, a number of initiatives and nongovernmental organizations often associated with particular diseases, the Gates Foundation (which by itself is responsible for the majority of all private giving for global health) and other philanthropic undertakings, pharmaceutical companies, hospitals, doctors, nurses, and an assortment of national and local health authorities. Despite the numerous individuals and groups involved, there are few procedures to determine priorities much less coordinate efforts and ensure goals are being met.

  For example, the International Health Regulations, agreed to by many of the world’s governments in 2005, call on countries to monitor and prepare for infectious disease outbreaks. Ideally, governments would create and support organizations within their countries modeled on the Atlanta-based Centers for Disease Control and Prevention. They would also make sure that first responders and hospitals at the local level received the necessary training
, equipment, and facilities to handle outbreaks. More than a decade later, many countries, lacking expertise and resources alike, have failed to put into place such capacities.

  Making matters worse, there is no consensus on priorities. The UN’s Sustainable Development Goals, adopted in 2015, call for efforts against both infectious and noncommunicable diseases. But the overwhelming share of the resources devoted to global health continues to focus on fighting known infectious diseases such as HIV/AIDS, malaria, and tuberculosis, or on meeting the special health demands of mothers, newborns, and children. NCDs, by contrast, receive only a few cents on the dollar, even though they have emerged as a much greater cause of illness and death. In 2017, for example, twice as many premature deaths were from NCDs than from infectious diseases. This emphasis has remained in place despite the progress made against infectious diseases or in reducing maternal and infant mortality and the increasing number of older people in many societies. NCDs lack the urgency or the sense of crisis associated with infectious disease outbreaks, and thus it is more difficult to galvanize a response to them.

  These factors—a lack of consensus on priorities and policies, the absence of an organized governance framework, a shortfall in resources, the continuing threat of infectious diseases, and the emergence of an epidemic in NCDs—add up to two realities: health around the globe has improved dramatically, yet the future of global health remains uncertain and the health of any society remains vulnerable due to its interconnectedness to the health of others.