Monthly Archives: October 2015

What are Russia’s grand designs in Central Asia?

Dr David Lewis, Senior Lecturer in Politics,  looks at Russia’s military presence in Syria, and why they might have grand plans for involvement in Central Asia.

This post first appeared in The Conversation

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While international attention has focused on Russian military operations in Ukraine and Syria, Moscow has also been involved in a flurry of diplomatic and security initiatives to address the growing instability in northern Afghanistan.

But its moves to bolster regional security are more than just a response to local security concerns. Russia has a broader strategy that could leave it as the dominant security actor across much of Eurasia.

Even before the shock of the Taliban occupation of Kunduz in late September, Russian officials were concerned about the fragile security situation in northern Afghanistan, including the rise of Islamic State in northern Afghanistan and its potential spread to Central Asia and thence to Russia’s large Muslim community. As if to emphasise the domestic threat, on October 12 Russian police announced that they had uncovered a terrorist plot in Moscow apparently involving a group of Central Asian militants.

Insecurity in Afghanistan may pose a potential security threat for Moscow, but it is being seized upon as a major geopolitical opportunity. Against a backdrop of failed Western policies across much of Russia’s southern flank, Moscow is moving quickly to fill a security vacuum in the region. It is strengthening existing alliances to consolidate its hold over former Soviet republics in Central Asia and reshaping the security dynamics of the region around its own favoured security groupings – the Collective Security Treaty Organisation (CSTO) and the Shanghai Cooperation Organisation (SCO).

The first step has been a series of meeting with Central Asian leaders, all on the front line in case of renewed Afghan insecurity. A meeting between Russian president Vladimir Putin and Emomali Rakhmon, the president of Tajikistan, led to promises of more attack helicopters to bolster the existing Russian military based in the country, which has become the hub of a well-developed defence system against cross-border infiltration.

Crisis and opportunity

Putin also took time out of his birthday celebrations in Sochi to meet Almazbek Atambayev, the president of Kyrgyzstan, a country that has become the linchpin of Russia’s security strategy in the region. Until 2014 Kyrgyzstan hosted a US airbase, but as I explored in a recent paper, Russia has been remarkably successful in ousting the Americans and turning Kyrgyzstan into a dependable ally in the region.

If Tajikistan and Kyrgyzstan are relatively relaxed about an enhanced Russian military presence, the Uzbek president, Islam Karimov, is instinctively allergic to talk of renewed Russian influence and pulled out of the Russian-led CSTO in 2012.

Now the northern Afghan crisis offers an opportunity to bring Uzbekistan back into Moscow’s embrace. A delegation from the Russian MOD, led by deputy minister Anatoly Antonov, has recently paid the country its first high-level visit since 2007.

Show of strength: Russia has recently beefed up air defences on the Tajik border with Afghanistan.
Reuters/Maxim Shemetov

There was no coverage of the Russian visit in Uzbekistan’s heavily censored press. Instead, the newpapers led on a summit with neighbouring Turkmen president, Gurmanguly Berdymukhamedov. The two presidents both have serious security concerns about Afghanistan, but both want to manage them without Russian assistance. Both states have appalling human rights records, limiting the potential for Western aid, and it may be hard to refuse Russian offers of help if unrest grows along their borders with Afghanistan.

Friends reunited

Afghan officials have also been in Moscow, seeking assistance. Vice-president and Uzbek warlord, Abdul Rashid Dostum, has sought to revive old ties during a recent visit, also paying a side visit to the influential Chechen strongman Ramzan Kadyrov, to share experiences of “fighting terrorism”. If the Afghan situation worsens significantly, Dostum offers the potential for Moscow to build up a further band of loyal forces in the north of Afghanistan, in an effective re-run of its Taliban-era support for the Northern Alliance.

Other Afghan government officials attended a conference of SCO members and observers on Afghanistan in Moscow. The chief of Russia’s general staff, first deputy defence minister, Valery Gerasimov, took time out to give a speech that highlighted the failure of US policy in the Middle East, leaving little doubt that Moscow now sees Afghanistan through the same geopolitical prism as it frames Syria. Russian intelligence officials regularly claim that IS is part of a broader US plot to destabilise Central Asia and Russia from the south.

Still, there is no appetite for Russia to get involved in Afghanistan in the way it has in Syria. There are still bitter memories of the humiliating Soviet withdrawal from Afghanistan. But an anti-IS stance in the region provides Russia with the opportunity to consolidate its presence in Central Asia and become the centre of new alliances in the region – with SCO partners such as China, and with Iran – and to sponsor anti-Taliban and anti-IS forces in northern Afghanistan.

More intriguingly, some Russian officials see Moscow’s new strategic initiatives in Syria and Afghanistan as a chance to carve out a significant role in a wider region. State Duma speaker, Sergei Naryshkin, has been talking of a “Greater Eurasia”, linking Russia not only to former Soviet republics, but more widely to a range of allies in Syria, Iran, India and China.

This may be just another of Russia’s historical spatial fantasies for now, but in a rapidly changing international environment, Moscow will try to use its dominance in Central Asia as a first step towards shaping a new regional security order.

The Conversation

David Lewis, Senior Lecturer, Politics, University of Exeter

This article was originally published on The Conversation. Read the original article.

Cornwall can be at forefront of radical UK healthcare reform.

Professor Sir John Tooke, President of the Academy of Medical Science, discusses how Cornwall could be at the forefront of healthcare reform following his Duchy Health Charity Lecture which was sponsored by the University of Exeter and Plymouth University.

The NHS, one of the greatest institutions a civilised democracy has produced, needs to evolve to be fit for purpose in a very different world from that which saw the passing of the Act in 1946.

A remarkable sense of social solidarity in the aftermath of the Second World War created the conditions for a comprehensive service available to all, regardless of ability to pay.

A recent ranking of national health systems put the UK first with the US 11th, largely reflecting the inclusion of equity and access in the ranking metrics. On some measures, such as survival rates for common cancers, UK performance is far less impressive. There is a huge gulf between life expectancy for the advantaged in our society compared to the disadvantaged, reflecting the economic and social determinants of health.

The  success of our health system has helped shift the age profile such that by 2030 there will be twice as many citizens over the age of 85 than in 2010,  increasing the burden of degenerative diseases, especially dementia, failing joints, vision and hearing. Life style changes related to diet and sedentary behaviour are resulting in a cumulative expression of diseases such as Type 2 diabetes and ischaemic heart disease.

At the same time the prospect of new, highly effective and specific treatment has never been greater, reflecting our ability to interrogate the human genetic code and vast data sets. Such promise has led to soaring public expectation. While medical therapeutic innovation holds great promise, technological advances that add only marginal incremental benefit are major cost drivers, a critical consideration in the current affordability crisis.

Despite these residual deficiencies and new challenges, society’s allegiance to the NHS and its iconic status make it hard for those in power to question fundamental precepts.  It follows that political will can only be galvanised if i) a new social compact can be struck with society that reflects the need for evolution while retaining public confidence, and ii) if clinical leaders champion the need for change, threatening in many cases their own vested interests.

A simple, relatively uncontentious purpose for a 21st Century National Health ‘System’, is the optimisation of health and wellbeing for the whole population in a manner that is accessible and affordable and tackles health inequalities. The requirements include: a service that seamlessly integrates primary and secondary care, public health and social care, organised around the needs of patients/citizens, not professions or NHS structures; a shift towards prevention; empowerment of patients and frontline health workers, and the adoption of genuine shared decision making.

Key points

To bring this about I suggest seven key proposals.

  1. The system should be organised around the needs of patients and citizens, recognising that control lies with the patients, not professionals.
  2. An holistic approach recognising that environmental factors, social factors and local economy are major determinants of health outcomes. ‘Integration’ needs to embrace that reality and dissolve divisions between primary and secondary care. Public health needs redefining for the changes of the next 20 years.
  3. Funding per head that reflects local factors such as rurality and health burden, for a comprehensive integrated system (the current commissioning arrangements add cost and risk of aggravating divisions between primary and secondary care). Contract periods need to be long enough (say 15 years) to incentivise investment in primary care, preventive medicine and the ‘new’ public health.
  4. ‘Digitalisation’ should continue apace to i) act as the ‘glue’ for integration; ii) provide the means to improve productivity of systems and processes; iii) empower patients in the co-development of their own health; and iv) provide the data to drive research, innovation and a ‘learning’ organisation culture.
  5. Academic alliances should be fostered to: i) Promote excellence, innovation and evidence-based practice; academic health science systems should oversee the faster adoption of  therapies of true benefit. ii) Provide the education and training. iii) Take advantage of the digital revolution. iv) Stimulate the local economy.
  6. The medical profession needs to recognise that many technical procedures and protocol-driven care can be delivered by trained others. Doctors should be advocates for public health as well as the patient in front of them, and recognise a role as managers of resources.
  7. A social compact should be forged that reflects a mutual commitment to a new National Health ‘System’ that involves rights and responsibilities and reflects economic reality. We should learn from less advantaged nations which are creating high-quality transformative approaches based on limited affordability.

The solutions to health care challenges are often context specific. Cornwall has 31 per cent more residents over the age of 75 than the rest of England; rurality and relatively low population density; economic challenges; and scale and cost effectiveness of specialist services for a relatively small population. But Cornwall could harness its strong regional identity, be in the vanguard, and champion radical, integrative solutions for health, social care and public health, exploiting unitary authority status.

The health system in Cornwall has long championed the importance of education and medical school alliances can be fostered to drive innovation and evaluation. The path will not be easy – specialist services will need to be realistically distributed and health care professionals adjust to new roles and ways of working. But the prize is a locally responsive sustainable health and social care service for Cornwall, fit for the 21st Century, not post-war Britain.

Professor Sir John Tooke is president of the Academy of Medical Sciences and helped create the Peninsula College of Medicine and Dentistry for the South West. He was in Cornwall this week giving the 2015 President’s Lecture for the Duchy Health Charity