Health diplomacy often involves developing infrastructure important to health and the social determinants of health. The infrastructure can include building tangible assets, such as hospitals and roads. Health cooperation can also transfer intangible capabilities through, for example, training programs and collaborative scientific research. States use different foreign policy approaches for infrastructure development, from bilateral initiatives to grand plans, such as the U.S. Marshall Plan after World War II and China’s Belt and Road Initiative today.
New thinking about infrastructure and novel ways of infrastructure development for an urbanizing planet are gaining attention. This series of articles examines how transnational city networks are becoming more important in global health diplomacy. Such networks are developing ways to integrate the One Health strategy into urban infrastructure. The series also explores how infrastructures that function within, and that connect cities, can evolve by learning how natural ecosystems create and sustain resilience in complex, living communities.
What Is Infrastructure?
The concept of infrastructure emerged in late nineteenth-century railroad engineering to distinguish material foundations, such as soil and rocks, from the superstructure built on top of such foundations, including tracks and stations. States had the responsibility for overseeing infrastructure, and private industry took the lead in building superstructure.
Until the late 1970s, experts described the mixture of such governmental and private-sector activities as public works. The emergence of the neoliberal order in the 1980s coincided with the so-called infrastructure turn—the idea that governments could privatize infrastructure and its development to generate public revenue and private income.
Infrastructure undergirds societies by providing the basic frameworks for connected economic, natural, and social systems
Today, the distinction between infrastructure and superstructure has disappeared, and infrastructure is now used to describe the building of socially and economically beneficial capabilities. In addition, the idea of infrastructure has evolved to encompass physical assets, social systems, knowledge creation and transfer, and natural ecosystems.
The expansion of what infrastructure means has triggered disagreements between those who argue that infrastructure is built and those who take a more holistic approach. Even so, the consensus is that infrastructure undergirds societies by providing the basic frameworks for connected economic, natural, and social systems.
On the one hand, today’s understanding of infrastructure makes sense. Built, social, and natural systems have been around since time immemorial. European rail services echo the Roman road network. The manufacturing capabilities and supply chains of biopharmaceutical conglomerates harken back to systems of growing, harvesting, and distributing rice and fish that developed over millennia in Asia. On the other hand, the elasticity of the concept suggests that infrastructure is everywhere and everything, which some experts argue is a stifling and befuddling idea.
The contemporary notion of infrastructure applies at the global level. Built, social, and natural systems undergird human interactions in a globalized and ecologically interconnected world. In international society, countries use diplomacy to manage how different kinds of infrastructure connect and interact. In that sense, the built and social systems that support diplomacy are an infrastructure for global politics.
Definitional and conceptual debates about infrastructure underscore that how built, social, and natural systems connect is a defining global issue for the twenty-first century. The world faces many problems over the rest of the century, including climate change and networked warfare, but cutting across those and other challenges are the connections between infrastructure systems and the management of those interactions.
The Urban Century
Arguably, cities are the largest and most important infrastructure projects in human history. Urban settlements are now the dominant form of social organization. As of 2014, more people live in cities than any other environment, making the twenty-first century the urban century.
Cities concentrate all kinds of interconnected built and social infrastructures that promote local and global mobility, communications, knowledge creation and sharing, and service delivery managed by networks and levels of governments, businesses, markets, and nongovernmental organizations. How those urban interconnections—and their governance—shape human health has become a pressing global challenge.
The functioning and growth of cities also affect natural systems, the disruption of which can damage how built and social infrastructure function, especially concerning health outcomes. Urbanization plays a role in the rapid changes in biodiversity around the world, the emergence and cross-border spread of infectious diseases, the proliferation of transnational pollutants, and global warming. Those and other problems raise questions about how built and social infrastructures undermine the integrity of the planet’s natural systems and the health and well-being of its inhabitants.
Infrastructure and Geopolitics
A powerful indicator of infrastructure’s importance in the urban century is how prominent infrastructure development has become in the foreign policies and diplomatic activities of countries in a geopolitical world. China’s global Belt and Road Initiative (BRI) was the first in a cascade of competing efforts to gain power and influence through initiatives designed to build infrastructure in low- or middle-income countries.
China’s strategic intent with the BRI is clear—to secure access to resources around the world to sustain Chinese economic and political power. Infrastructure projects under the BRI include, for example, the development of extractive industries; construction of road, rail, air, and ocean transport capacities; and the creation of security systems and land- and space-based communication capabilities.
