Year : 2017 | Volume
: 61 | Issue : 2 | Page : 134--136
The rise of global health diplomacy: An interdisciplinary concept linking health and international relations
Vijay Kumar Chattu
Lecturer- Public Health, Faculty of Medical Sciences & Visiting Senior Research Fellow, Institute of International Relations, The University of the West Indies, St. Augustine, Caribbean, Trinidad and Tobago
Vijay Kumar Chattu
Faculty of Medical Sciences, Institute of International Relations, The University of the West Indies
Trinidad and Tobago
Global health diplomacy (GHD) is relatively a very new field that has yet to be clearly defined and developed though there are various definitions given by different experts from foreign policy, global health, diplomacy, international relations, governance, and law. With the intensification of globalization and increasing gaps between countries, new and reemerging health threats such as HIV/AIDS, tuberculosis, influenza, severe acute respiratory syndrome, Ebola, and Zika and a gradual rethinking on security concepts framed a new political context. The health problems addressed diplomatically have also become diverse ranging from neglected tropical diseases, infectious diseases, sale of unsafe, counterfeit drugs to brain drain crisis. We see that global health has become more diverse as the actors widened and also the interests appealing not only to the traditional humanitarian ideals associated with health but also to the principles grounded in national and global security. Recently, we are witnessing the increased priority given to the GHD because the issue of health is discussed by various actors outside the WHO to shape the global policy for health determinants. In fact, the area of health has become the part of UN Summit Diplomacy involving the G8, G20, BRICS, and the EU. The recent WHO Pandemic Influenza Framework, UN High Level Framework on Prevention and Control of Noncommunicable Diseases, and the WHO Framework Convention on Tobacco Control are some of the examples of long-term negotiation processes for agreements that took place.
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Chattu VK. The rise of global health diplomacy: An interdisciplinary concept linking health and international relations.Indian J Public Health 2017;61:134-136
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Chattu VK. The rise of global health diplomacy: An interdisciplinary concept linking health and international relations. Indian J Public Health [serial online] 2017 [cited 2022 Jun 29 ];61:134-136
Available from: https://www.ijph.in/text.asp?2017/61/2/134/207417
Global health diplomacy (GHD) is relatively a very new field that has yet to be clearly defined and developed though there are various definitions given by different experts from foreign policy, global health, diplomacy, international relations, governance, and law. GHD is a paradigm and in terms of international relations theory is still early in its coining. Since there is limited literature available specific to GHD, to provide a deep insight and background on this new field, the other cross-cutting and contributing fields such as foreign policy, diplomacy, international relations, global health, disaster relief, human security, and development have also been referenced. Health has gained unprecedented importance in the recent years, and the concept has changed to global health which is different from public health and international health. In contrast to public health, international health involves bilateral foreign aid and humanitarian assistance between countries where a developing or underdeveloped nation benefits from the disease control activities and medical missionary work contributed by developed nations. The focus of international health involves the study of the differences and commonalities between countries in terms of their health practices, policies, and systems according to the Global Health Education Consortium. According to the definition given by Kickbusch and Lister, global health “refers to those health issues which transcend national boundaries and governments and call for actions on the global forces that determine the health of people.”
Historical Perspectives of Health Diplomacy
Diplomacy is a field of study and practice that involves the multitude of processes and negotiations conducted between various groups to achieve some degree of mutual gain without any degree of conflict. Conventionally, diplomacy involved only professionally trained diplomats from foreign ministries or ministry of external affairs to negotiate matters related to economy, trade, and national security by creating memorialized agreements. However, due to the rise in complexity of international trade and governance, there is greater representation by other stakeholders and diplomacy is undertaken by wide range of actors such as political diplomats, advisors, envoys, and officials from domestic ministries, international organizations, and nongovernmental organizations.
Health diplomacy is a relatively a new field of study and practice which lacks a concrete definition though numerous disciplines and areas such as foreign policy, national interests, trade interests, health security, disaster relief, and human rights contribute to the concept.
The current global health environment builds on 160 years of heritage aiming to establish structures to promote health and fight diseases across national borders. The Alma-Ata Declaration and Primary Healthcare for All (1978–2000) declared and reaffirmed health as a fundamental right, bringing forward the importance of primary healthcare to achieve an acceptable level of health for all people and emphasizing the role of government in providing health for all at national level. It recognized and emphasized the need for urgent action by all the governments, nonstate actors and the influence of various social and economic players beyond the health sector. Recently, from 2000 onward, with the intensification of globalization and increasing gaps between countries, new and reemerging health threats such as HIV/AIDS, tuberculosis (TB), influenza, severe acute respiratory syndrome, Ebola, and Zika and a gradual rethinking on security concepts framed a new political context. During this phase, the financial and private sectors took more important role in international health, for example, World Bank, Bill and Melinda Gates Foundation, and public–private partnerships such as Global Alliance for Vaccines and Immunization Alliance emerged. Moreover, this period also witnessed the adoption of millennium development goals highlighting the important health issues on the UN's Agenda. Global health is seen as a shared global challenge, since in this interconnected world, the infectious diseases can spread across continents in a matter of hours and days and the lifestyle factors spread by media can influence global population very soon and knowledge can be shared instantly. The rise of health diplomacy reflects the new global health environment. The post 2015 agenda of sustainable development goals further emphasizes the need for cross-sector engagement to work together in this interconnected and multipolar world.
Key Trends in Global Health Diplomacy
Looking at the players, problems, processes, and principles that make up GHD, we can identify the quantity, diversity, velocity, and instability issues in each of these aspects. In the current era, there are increased number of diverse players with much more involvement of NGOs and civil society actors which influence the global health. From the problems side, we have increased number of concerns ranging from traditional communicable disease threats, increasing epidemic of noncommunicable diseases (NCDs), neglected tropical diseases, deteriorating social determinants of health such as poverty, education, climate change, and gender issues. Players address these problems through various processes by the increased use of “public–private partnerships.” In the processes, there are a lot of new normative concepts, ideas, and rules resulting in the creation of new global health governance and growing influence of health in the areas of foreign policy.
The diversity of actors has increased enormously ranging from great powers to failing states. The traditional international health organizations such as Rockefeller Foundation are joined by various foundations, small and big NGOs, celebrities, and entrepreneurs in advancing global health causes. Moreover, the health problems addressed diplomatically have also become diverse ranging from neglected tropical diseases, infectious diseases, sale of unsafe, counterfeit drugs  to brain drain crisis. We see that global health has become more diverse as the actors widened and also the interests appealing not only to the traditional humanitarian ideals associated with health but also to the principles grounded in national and global security.
The health problems and issues of different kinds have taken on urgency which was never experienced before in the long history of international health activities. The speed of events and its impact on players, problems, and processes also affects how diplomatic activities reflect normative concepts and international legal rules. The increased quantity, diversity, and velocity as explained above contribute to the fourth common factor – instability. Health problems also exhibit instability through changing patterns of microbial resistance, climate change, environmental degradation, poverty alleviation, and sustainability of healthcare systems. There are increased tensions over securitization of global health problems  (Antimicrobial Resistance, increasing multi-drug resistant TB, recent Ebola epidemic, Zika epidemic  and norms such as human right to health). In the same way, the diplomatic processes are also unstable with the new initiatives frequently appearing. GHD involves number of disciplines ranging from public health, law, international affairs, management, and economics which aim to shape the policy environment for health through proper negotiations. GHD intersects the areas of health, foreign policy, and trade. According to Hotez, GHD can even promote peace and security and highlights the correlation between the under-five child mortality (because of infectious diseases) and engagement in war as he argues that addressing the child mortality through vaccination programs could decrease the chances of conflict.
The Rise of Global Health Diplomacy
Recently, we are witnessing the increased priority given to the GHD because of many reasons. First, the issue of health itself has become a priority issue which is discussed by various actors outside the WHO to shape the global policy for health determinants. In fact, the area of health has become the part of UN Summit Diplomacy involving the G8, G20, BRICS, and the EU. Since the threat of communicable diseases or NCDs is addressed by all the stakeholders at global level, the ministries of health work to promote the health of its own citizens along with the global community. Second, the foreign ministries are becoming more involved with the health domain as it is used for soft power, developing security policies, trade agreements since it touches the issues of national development and economic interests. Third, the emergence of new public–private partnerships, alliances, and various regional cooperations between low- and middle-income countries has challenged the need for health diplomacy. The recently WHO Pandemic Influenza Framework, UN High Level Framework on Prevention and Control of NCDs, and the WHO Framework Convention on Tobacco Control, including health in the UN Framework Convention on Climate Change, are some of the examples of long-term negotiation processes for both the binding/nonbinding agreements that took place. There are various legal instruments for GHD such as binding and nonbinding, hard and soft international law to make the GHD more effective. The hard law instruments have greater state engagements and have more structured implementation mechanisms such as WHO constitution, Framework Conventions as mentioned above and regulations such as International Health Regulations 2005 and Protocols. The recent Zika epidemic also has alerted the international scenario which has affected the travel, trade, tourism, and business in the South American and the Caribbean countries, and in this case, the WHO has declared it as Public Health Emergency of International Concern on February 1, 2016. This Zika being public health emergency and health security issue has already spread to more than 46 countries including the USA. GHD holds a great promise to address the needs of global health security through its binding or nonbinding instruments enforced by the global governance institutions.
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Conflicts of interest
There are no conflicts of interest.
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