In our increasingly globalised world, health is no longer an internal issue; it needs to be examined through a host of different lenses. Governments invest a lot of money in health, ranging from richer countries such as Canada with universal healthcare provision, to India with state-provided public health to the opposite end of the spectrum in places like Angola, where there is effectively no state healthcare provision. Add to this the effect of health outcomes in countries near and far, and the issue escalates from local to global pretty quickly. Today, departments of defence, labour, and even tourism have a stake in the global health profile.
Global health diplomacy is an interdisciplinary unit combining the issues of public health, international relations and law. Even though it is a relatively new discipline, global health diplomacy is increasing in importance as governments realise that the threats to its citizens can come on a plane from anywhere in the world.
The increasing importance of global health diplomacy
In an article published in the Bulletin of the World Health Organization 2013, Ilona Kickbusch and Mihály Kökény outlined the four main elements that have increased the importance of global health diplomacy. First, the sheer importance of health in the national and economic interest, which is affected by trans-border challenges such as pandemics and climate change. The haze in Singapore, for example, which is caused by man-made forest fires in Indonesia, is a grave health concern as it brings the entire city-state to a halt. An exercise in ASEAN (Association of South East Asian Nations) diplomacy, it brings conflicting incentives to the forefront, as Indonesia would have to bear the cost of ratifying an agreement on the matter, even though the country and others around it suffer from a halt in economic activity during the worst of the haze season. 12 years after the other ASEAN members, the Indonesian government finally signed the agreement this year, agreeing to the target of a haze-free ASEAN by 2020.
Second, the number of stakeholders in the global health diplomacy field is increasing. Health diplomacy now refers to ‘both a system of organization and to communication and negotiation processes that shape the global policy environment in the sphere of health and its determinants’. Health diplomats today can be NGOs, foundations, and companies. An excellent example that comes to mind is the MenAfriVac- a meningitis vaccination produced specifically to combat strains of the disease in West Africa, with the collaboration of African governments, the WHO, PATH, the Bill and Melinda Gates Foundation, the Gavi Alliance (a vaccine alliance), Serum Institute of India, US Food and Drug administration and Britain’s National Institute for Biological Standards and Control. The collaborative project managed to vaccinate more than 100 million Africans at the end of 2013.
Third, globalization, has led to new dimensions in relationships between countries. Over the past few decades, some countries, such as the US and China have shifted from a donor-recipient relationship, to that of a partnership. Health is also seen as a source of soft power in the world, as well as an important element in foreign policy, security policy and trade agreements. So much so that then US Secretary of State Hilary Clinton established a new ambassadorial office for global health diplomacy in March 2013, effectively putting health diplomacy in the same agenda as foreign policy.
Finally, there is a need for competent and sustainable diplomacy venues, not drawn out negotiation processes in international hubs such as Geneva, New York and Brussels. Many countries cannot dedicate the resources needed for these processes, and lose out on getting their voice heard as a result.
A model for health diplomacy
PEPFAR (President’s Emergency Plan for AIDS Relief) is an example that stands out as the US’ poster child for success in health diplomacy. The programme was launched in 2004 providing more than 7.7 million people till date with anti-retroviral treatment and preventing new infections. Today, the programme reaches 65 countries.
Its importance in American health diplomacy comes from its bipartisan background, something not a lot of programmes can claim, and from studies that show a causal relationship between PEPFAR countries and global stability, lower threat to development and US national security, higher US approval ratings and higher outcome per workers.
Not without its critics, the programme has received backlash for its promotion of abstinence-until-sex education, alliances with faith based organisations and recruitment practices in the regions it operates in for offering such high salaries to locals that they are diverted from maintaining general health in the community to the PEPFAR cause. Studies that prove causal relationships between PEPFAR and global stability should be subject to greater scrutiny as they may be biased to the evidence and organisation they come from.
An outline of what would make the beginnings of a good model would be the following- clear goals and policies needed to achieve them, collaboration with local organisations to realise context, sustainable long term programmes that build capacity beyond the work of any one country/organisation, transparency and more importantly, accountability.
As more actors engage on the stage of global health- countries building leadership specifically to tackle global health strategies, companies investing in infrastructure and foundations funding specific disease related programmes, international co-operation is the key to global health outcomes, and vice versa in the years to come.
So really, this is just the beginning.
Sakshi Jain, Global Health Editor