https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61127-1.pdf

Technologies for global health

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61558-5.pdf

Global public health: a scorecard

Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.

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Framing health and foreign policy: lessons for global health diplomacy.

There is growing acceptance of the concept of health security. However, there are various and incompatible definitions, incomplete elaboration of the concept of health security in public health operational terms, and insufficient reconciliation of the health security concept with community-based primary health care. More important, there are major differences in understanding and use of the concept in different settings. Policymakers in industrialized countries emphasize protection of their populations especially against external threats, for example terrorism and pandemics; while health workers and policymakers in developing countries and within the United Nations system understand the term in a broader public health context. Indeed, the concept is used inconsistently within the UN agencies themselves, for example the World Health Organization's restrictive use of the term 'global health security'. Divergent understandings of 'health security' by WHO's member states, coupled with fears of hidden national security agendas, are leading to a breakdown of mechanisms for global cooperation such as the International Health Regulations. Some developing countries are beginning to doubt that internationally shared health surveillance data is used in their best interests. Resolution of these incompatible understandings is a global priority. Language: en

Health security as a public health concept: a critical analysis.

Harley Feldbaum and Joshua Michaud consider the important interplay between foreign policy and global health interests, and introduce a series on Global Health Diplomacy beginning this week in PLoS Medicine.

https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1000226&type=printable

Health Diplomacy and the Enduring Relevance of Foreign Policy Interests

Introduction "In the past"--said Robert Cooper, one of Europe's pre-eminent diplomats--"it was enough for a nation to look after itself. Today it is no longer sufficient." (1) This is particularly true in the health arena, There is an increasing range of health issues that transcend national boundaries and require action on the global forces that determine the health of people. The broad political, social and economic implications of health issues have brought more diplomats into the health arena and more public health experts into the world of diplomacy. Simple classifications of policy and politics--domestic and foreign, hard and soft, or high and low--no longer apply. (2) Diplomacy is frequently referred to as the art and practice of conducting negotiations. (3) It is usually still understood to mean the conduct of international relations through the intervention of professional diplomats from ministries of foreign affairs with regard to issues of "hard power", initially war and peace, and--as countries compete economically--economics and trade. But in recent years there has also been an increase in the number of international agreements on "soft issues", such as the environment and health; it is now recognized that some of these issues have significant "hard" ramifications on national economies. The term "global health diplomacy" aims to capture these multi-level and multi-actor negotiation processes that shape and manage the global policy environment for health. Global health diplomacy is at the coal-face of global health governance --it is where the compromises are found and the agreements are reached, in multilateral venues, new alliances and in bilateral agreements. It is a world to which outsiders find it difficult to relate, where the art of diplomacy juggles with the science of public health and concrete national interest balances with the abstract collective concern of the larger international community in the face of intensive lobbying and advocacy. No longer do diplomats just talk to other diplomats--they need to interact with the private sector, nongovernmental organizations, scientists, activists and the media, to name but a few, since all these actors are part and parcel of the negotiating process. Global health diplomacy is gaining in importance and its negotiators should be well prepared. Some countries have added a full-time health attache to their diplomatic staff in recognition of the importance and complexity of global health deliberations; others have added diplomats to the staff of international health departments. Their common challenge is to navigate a complex system in which issues in domestic and foreign policy intertwine the lines of power and constantly influence change, and where increasingly rapid decisions and skilful negotiations are required in the face of outbreaks of disease, security threats or other issues. Missions to the United Nations and international organizations--for example, in New York and Geneva--increasingly need to deal with health issues, as do the classical bilateral embassies. An important part of global health diplomacy still takes place within the World Health Organization; indeed it has recently gained new momentum through the negotiation during the past five years of the Framework Convention on Tobacco Control and the International Health Regulations. But the venue of global health diplomacy has shifted to include other spaces of negotiation and influence, and the number of organizations dealing with health has increased exponentially. At all levels we are witnessing a diversification of actors, the most illustrative development being the growth of public--private partnerships and platforms around a multitude of health issues, all clamouring for attention and funds. It is clear that the profound change underway requires new mechanisms and new skills for global health diplomacy. Yet an informal survey by the authors of staff of the international departments of health in countries that belong to the Organisation for Economic Co-operation and Development (OECD), in Latin America and of health attaches in Geneva has confirmed that many do not feel well prepared for the challenges that confront them. …

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Global health diplomacy: the need for new perspectives, strategic approaches and skills in global health

Perspectives Global health diplomacy: training across disciplines Ilona Kickbusch, a Thomas E Novotny, b Nico Drager, c Gaudenz Silberschmidt d & Santiago Alcazar e Introduction In the March 2007 issue of the Bulletin, cross-cutting issues involving health and foreign policy were examined from a broad range of perspectives: conceptual, educational, military, trade, develop- ment and humanitarian aid, national and human security, migration, analytic, environmental and human rights. David Fidler, an expert in international law, re- flected that there might in fact be a revo- lution under way in health and foreign policy, 1 though the transformation is not completely understood and still relies on governments to see health as a key function of foreign policy. Nevertheless, the changing landscape of health and foreign policy now involves so many new actors, approaches and funding opportu- nities that there is an inevitable sense of chaos accompanied by excitement about the opportunities ahead. Some governments have taken pur- poseful strides to incorporate health as a foreign policy tool. Perhaps, however, it is the other way around: foreign policy is now being driven substantially by health to protect national security, free trade and economic advancement. We offer a few examples of this changing field of health and foreign policy as background to our academic response: • The United Kingdom is attempting to establish policy coherence with the development of a central govern- mental global health strategy based on health as a human right and global public good. Rooted in the recogni- tion of globalization and its effects on health, this new effort will bring together the United Kingdom’s for- eign relations, international develop- ment, trade and investment policies that can affect global health. 2 a • Switzerland has prioritized health in foreign policy by emphasizing policy coherence through mapping global health across all government sec- tors. 3 Through the Departments of Interior (Public Health) and Foreign Affairs, an agreement on the objec- tives of international health policy was submitted to the Swiss Federal Council to assure coordinated devel- opment assistance, trade policies and national health policies that serve global health. • Brazil has demonstrated policy co- herence through its assertion of health as key to its own development and as a basis for south-to-south cooperation. In particular, Brazil’s role in asserting flexibility in the Trade-Related Aspects of Intellec- tual Property Rights (TRIPS) agree- ment to support the health concerns of sovereign nations set the stage for an integrated, rights-based approach to trade policy. Today, Brazilian dip- lomats serve key roles in health and other ministries to assure policy co- herence across the government; they have also provided leadership in key multinational health negotiations such as the Framework Convention on Tobacco Control. • The Global Health Security Initia- tive (GHSI) is an international part- nership to strengthen health pre- paredness and response globally to biological, chemical, radio-nuclear and pandemic influenza threats. Launched in November 2001 by Canada, the European Commis- sion, France, Germany, Italy, Japan, Mexico, the United Kingdom and the United States of America, WHO provides technical support to the initiative (available at: http://www. ghsi.ca/english/index.asp). • The ministers of foreign affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand established an initiative on Global Health and Foreign Policy in 2006, with an Oslo Ministerial Declaration in 2007 that recognized the need for new forms of governance to support development, equity, peace and se- curity. 4 The issue of health and foreign policy has not escaped the attention of multi- national organizations such as the Or- ganisation for Economic Co-operation and Development (OECD), the World Trade Organization (WTO) and others. 5 WHO has formed the Inter- governmental Working Group on Intel- lectual Property, Innovation and Public Health to find new ways to deal with access to health care and medicine. Director-General Margaret Chan has made it clear that health and foreign policy are inextricably linked and that the Member States are challenged to support this linkage. The interface be- tween trade and health is, in fact, on the cutting edge of health diplomacy. Health professionals need to under- stand this interaction to assure rational trade agreements, informed by health needs and supported through progres- sive foreign policy. 6 However, global health governance is a mixed bag of unclear accountability and exciting op- portunity. The infusion of large, new funding sources from philanthropy and the unprecedented attention provided by celebrities, former presidents, de- velopment economists, multinational banks and others has stimulated the Graduate Institute for International Studies, Geneva, Switzerland. University of California, San Francisco, United States of America. Correspondence to Thomas E Novotny (e-mail: novotnyt@globalhealth.ucsf.edu). c Department of Ethics, Trade, Human Rights and Law, World Health Organization, Geneva, Switzerland. d Swiss Federal Office of Public Health, Bern, Switzerland. e Ministry of Health for International Affairs, Brasilia, Brazil. doi: 10.2471/BLT.07.045856 (Submitted: 8 July 2007 – Revised version received: 24 October 2007 – Accepted: 25 October 2007 – Published online: 1 November 2007) b Bulletin of the World Health Organization | December 2007, 85 (12)

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Global health diplomacy: training across disciplines

The field of global health has reached a critical juncture, where both its visibility and the complexity of its challenges are unprecedented. The World Health Organization, as the only global health actor possessing both democratic and formal legal legitimacy, is best positioned to capitalize on this new, precarious situation in public health and respond with the governance innovation that is needed to bring the increasingly chaotic network of activities and entities affecting health outcomes under the fold of a centralized, standard-setting agency. One such proposed innovation to guide normative and strategic coordination in global health is the creation of a Committee C of the World Health Assembly that would promote consensus building and multi-stakeholder decision-making within the unique convening power of the World Health Organization.

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Gaudenz Silberschmidt

Papers

Global health diplomacy: the need for new perspectives, strategic approaches and skills in global health

Global health diplomacy: training across disciplines

Addressing Global Health Governance Challenges through a New Mechanism: The Proposal for a Committee C of the World Health Assembly

Creating a committee C of the World Health Assembly

Coordination and accountability in the World Health Assembly. Authors' reply