By Sarah Kornblet, Julie E. Fischer and Rebecca Katz – Around the world,
global health increasingly has become a part of foreign policy agendas and is
included in national security, trade, and diplomacy discussions. The SARS
outbreak of 2003 and the 2009 H1N1 influenza A pandemic show how quickly
emerging infections can spread, costing lives as well as curtailing travel and
trade among interdependent economies. One nation’s health status and risks can
affect not only its own prospects and those of its neighbors, but also those of
the entire world.
integrating health into their foreign policy strategies in today’s era of
globalization, and are looking to global
health diplomacy as a way to accomplish a variety of goals beyond typical health
concerns. The increasing number of health actors on the ground, including
wealthy donors, has resulted in an outpouring of health assistance in the last
decade. These actors have also led to a variety of new assistance mechanisms,
including public-private partnerships and global health initiatives. In short,
the increase in players has changed the way things happen. Discussions that
previously would have taken place between high-level diplomats are now taking
place in a variety of different arenas.
For example, this month, Bill Gates, a private citizen whose
organization funds global health activities on par with some governments
(dispersing more than US$ 17 billion overseas between 2002 and 2006), will meet
with national and state officials in Nigeria to discuss polio eradication. This
meeting between a private citizen and health officials overseas is a good
example of the changing face of health diplomacy.
What exactly is global
health diplomacy? This term has many different meanings. It’s used for activities
ranging from formal negotiations, to an array of partnerships and interactions
between governmental and nongovernmental actors. In a recent article published in the Milbank Quarterly, “Defining Health
Diplomacy: Changing Demands in the Era of Globalization” we describe these
activities as falling into three different categories of interaction around
international public health issues:
- Core diplomacy – Bilateral and multilateral negotiations between and
among nations to resolve disputes and enact formal agreements. This definition includes international
negotiations that fall under the auspices of multilateral institutions such as
the World Health Organization (WHO).
- Multi-stakeholder diplomacy – Refers to international negotiations and
exchanges in which various state, non-state, and multilateral actors work
together to address common issues, not necessarily intended to lead to binding
agreements. This includes partnerships between government agencies (e.g.,
ministries of health and the US Centers for Disease Control and Prevention
(CDC)), public-private partnerships (e.g., Roll Back Malaria or the Global
Fund), and activities of organized non-state entities (e.g., WHO and the World
- Informal diplomacy – Interactions between public health actors working
around the world and their counterparts in the field, including host country officials
representatives of multilateral and nongovernmental organizations, private
enterprise, and the public. This category has sprung up because of the
increasing number of government employees, NGO and private companies,
humanitarian workers and researchers, all working in the same space.
Why does this matter?
Today, countries and
their representatives (which no longer equates only to foreign service
officers, but all working in the field) do not interact solely through
traditional diplomatic channels, and the influence of independent actors on
foreign policy is substantial. There are various events that illustrate how the
outcomes of core diplomacy, multi-stakeholder diplomacy, and informal diplomacy
can converge to quicken-and potentially resolve-health crises with
international implications. One such example is the continual campaign for
polio eradication. Polio remains endemic in only four countries: Nigeria, India,
Afghanistan, and Pakistan.
Each of these countries has complex challenges. Eradication in these nations is
not just about science or money, but will require various types of diplomatic
efforts to overcome unique barriers, in order to realize what actually is a
global health objective.
In 2003, the people of
in northern Nigeria
began refusing WHO-supported polio vaccination based on rumors that the
campaign represented a Western conspiracy to sterilize Muslims. These rumors
gained momentum among communities sensitized by the “war on terror.” Here was a
local health problem that threatened to spill across borders (and, in fact, did
result in polio outbreaks all over the region), and was further exacerbated by
national and international politics. Traditional diplomatic tools, such as
state-to-state negotiations, were not sufficient to resolve what boiled down to
a community problem.
The US State
Department sought assistance from US leaders and other experts that had been
working in the region, including the CDC and the US Agency for International
Development. Officials from WHO, other UN agencies, the Organization of the
Islamic Conference, and the US government engaged in unusually intense
diplomatic efforts with Nigerian authorities to resolve the issue, utilizing
expertise from those not normally involved in such actions (i.e., CDC).
Ultimately, the negotiations proved successful and helped
lead to the resumption of vaccinations.
Polio eradication in Nigeria
has remained elusive, and today, the Gates Foundation is continuing the
campaign and negotiating with state actors in hopes of finally exterminating
the disease – a clear instance of
informal health diplomacy.
No longer is it
practical for global health diplomacy to remain an esoteric pursuit for a few
specialists. The expanding demands on global health diplomacy require a
delicate combination of technical expertise and diplomatic skills, which have
not been cultivated systematically among either foreign service or global
health professionals. Despite widespread calls for more effective country-level
coordination by health actors, formal mechanisms of communication are often
fragmented by disease, sector, or bureaucratic silos. The deepening links between health and foreign
policy require both communities to reexamine the skills, comprehension, and
resources necessary to achieve their mutual objectives. Both groups’ skills and
strengths will be necessary to realize the promises of health diplomacy.
Click here to read the full
article in the Milbank Quarterly.
Photo Credit: The Gates Foundation, http://www.gatesfoundation.org/photogalleries/Pages/default.aspx#gallery=/about/Pages/timeline-gallery.aspxℑ=7&pager=1&filter