Health diplomacy

WHAT is health diplomacy?

Health diplomacy refers to the multi-level and multi-actor negotiation processes that influence and govern the global policy environment for health. It is the applied practice of foreign affairs to further global health goals that require international cooperation and collective action. Health diplomacy pertains specifically to health issues that transcend national boundaries given the substantial effects they can have on international security, stability and socioeconomic development. Overall, the practice of health diplomacy aims to facilitate engagement in diplomatic efforts by uniting the fields of public health, international affairs, management, law, and economics to promote and protect global health.

Health Diplomacy encompasses a variety of activities such as:  

•  Multilateral engagement: Participation in international organizations, such as the World Health Organization (WHO), the World Trade Organization (WTO), and the United Nations (UN), in order to collaborate on global health policies, exchange information, share best practices, and coordinate responses to health challenges.
• Negotiation and cooperation: countries collaborate to negotiate health-related agreements, treaties, and conventions, such as the World Health Organization’s International Health Regulations, which provide a framework for preventing, detecting, and responding to public health emergencies.
• Health aid and assistance: countries provide financial, technical, and humanitarian assistance to support the health systems of other countries, especially in contexts with limited resources. This may include the provision of vaccines and medical supplies, the training of healthcare professionals, and the support of infrastructure development.
• Health security and emergency response: health diplomacy is essential for administering and responding to public health emergencies, such as disease outbreaks and pandemics. It includes surveillance, information sharing, joint research, and coordinated response efforts.
• Health promotion and advocacy: Countries use diplomacy to advocate for specific health issues, raise awareness, and mobilize political support for global health priorities like immunization campaigns, tobacco control, and confronting the social determinants of health.

WHY is health diplomacy relevant?

Health diplomacy is relevant for several reasons:

• Global Health Challenges: In an interconnected world, health issues such as pandemics, antimicrobial resistance and the impact of climate change on health threatens the global population as a whole. Health diplomacy highlights the importance of collaborative efforts to achieve health security and equity thus promotes international cooperation and coordination to prevent, detect and respond to global health threats.
• International Security: Health threats, such as pandemics or biological attacks, have significant transnational political and security implications. Disease outbreaks can disrupt economies, strain healthcare systems, creating social and political unrest. Health diplomacy plays a crucial role towards preventing conflict and promoting stability throughout these crises by fostering collaboration on surveillance, information sharing and joint response efforts.
• Sustainable development: A vital aspect of sustainable development is health. Health diplomacy focuses on expanding access to high-quality healthcare, confronting health disparities, and bolstering health systems. By engaging in health diplomacy, countries can collaborate to attain the United Nations’ health-related Sustainable Development Goals (SDGs).
• Global Health Governance: Countries can influence the development of global health policies, regulations, and frameworks through diplomatic negotiations and collaborations. This facilitates the establishment of norms, standards, and guidelines for addressing global health challenges and ensures a coordinated global response.
• Socioeconomic Development: Health is closely linked to socioeconomic development whereby countries with healthier populations tend to experience greater economic growth and stability. Health diplomacy seeks to facilitate trade in health-related products and services, foster research collaborations, and guarantee access to essential pharmaceuticals. Furthermore, the practice of health diplomacy may generate investment within health systems which can contribute to poverty reduction, social cohesion, and sustainable development.
• Alleviating Health Inequities: The practice of health diplomacy focuses on promoting health equity by addressing the social determinants of health, advocating for fair and equitable access to healthcare resources and supporting efforts to attain universal healthcare coverage.

HOW is health diplomacy performed?

Health diplomacy is performed through various strategies and approaches that involve diplomatic engagement at national, regional, and global levels. Key ways in which health diplomacy is practiced include:

• Health Advocacy: Health diplomats can help mobilize political support for and raise awareness on specific global health issues. When in engaging in public diplomacy, health diplomats convey the significance of health within the context of larger political and economic objectives with which promoted international cooperation and generates a more coordinated global response.
• Bilateral and Multilateral Diplomacy: Health diplomacy is performed both bilaterally and multilaterally. Bilateral engagements consist of diplomatic efforts such as establishing partnerships and collaborating on healthcare infrastructure development. Health diplomacy also takes place within multilateral organizations such as World Health Organization (WHO), United Nations (UN), World Trade Organization (WTO), with health diplomats attending summits and conferences that aim to develop international agreements, guidelines, and resolutions that address global health challenges.
• Health Aid and Assistance: countries may engage in health diplomacy by supporting the health systems of other nations with financial, technical, or humanitarian assistance. The provision of medical supplies, medicines, healthcare training and expertise can help countries build their capacity whilst strengthening diplomatic relations and promoting a collective approach to solving global health challenges.

• Partnerships and Alliances: The practice of health diplomacy involves a multi-stakeholder approach to solving global health issues by encouraging the formation of alliances and partnerships between governments, international organizations, non-governmental organizations (NGOs), and other stakeholders. Public-private partnerships are essential towards leveraging expertise, resources, and innovative solutions to address global health challenges and promote health equity.
• Research and Data Sharing: health diplomacy entails collaborations in research and data sharing among nations to enhance comprehension and response to global health issues. Data sharing promotes increased accuracy of surveillance and encourages evidence-based decision making which is crucial to the establishment of effective health-related policies and agreements.

WHO are the actors in health diplomacy?

Health diplomacy involves multiple actors operating at various levels in order to shape and implement health-related policies and interventions. Some key actors in health diplomacy include:

• International Organizations: Operating in the multilateral context, international organizations such as the World Health Organization (WHO), the United Nations (UN), the World Trade Organization as well as regional bodies like the European Union (EU) play a crucial role in health diplomacy. The provide platforms for collaboration, facilitate the coordination of global health initiatives and provide leadership as they develop guidelines and set the global health agendas.
• Governments: National governments are central actors in health diplomacy as they dictate the allocation of resources, develop health-related policies and engage in multilateral discussions to address global health challenges. Furthermore, subsidiaries such as ministries of health and departments of foreign affairs often work together to formulate and advance health diplomacy objectives.
• Diplomatic Corps: Health diplomats represent their countries’ interests in international conferences, forums and meetings thus play a vital role in negotiating health agreements, enhancing diplomatic relations between nations, and advocating for health-related issues.
• Non-Governmental Organizations (NGOs): NGOs play multifaceted roles in health diplomacy including publicizing the diplomatic process surrounding health-related policies, advocating for specific health issues, injecting ideas and knowledge into dialogue and implementing health programs on the ground. They often work in partnership with governments and international organizations to address global health challenges, particularly in areas with limited resources.
• Private Sector: The private sector, which includes businesses, multinational corporations, private foundations and more facilitate the practice of health diplomacy through partnerships, investments and innovation. Actors in the private sector can provide direct funding and investments towards the implementation of global health initiatives as well as use their influence to raise awareness and advocate for health issues.
• Academia and Research Institutions: academic institutions and research organizations contribute to health diplomacy in various ways, notably through research and data collection, communication and dissemination of information and policy development and analysis. In addition, NGOs often act as hubs, bringing together an array of stakeholders for discussion and collaboration on health issues and facilitating partnerships between the public and private sector.
• Civil Society Organizations (CSOs): CSOs contribute to health diplomacy in several ways. They are often at the forefront of advocacy, raising awareness on specific health issued that tend to be underserviced. They offer a unique ‘grassroots’ perspective that can inform and shape health policies to be more effective and inclusive. They also play a role in monitoring health initiatives and progress to ensure transparency and accountability in the health sector.

WHEN has health diplomacy evolved? 

Health diplomacy has developed over time, adapting to shifting global health challenges and alternating international relations dynamics. Some of the key periods and specific events that have influenced the evolution of health diplomacy include:

• Early 20^th Century: The early 20^th century marked the beginning of organized international cooperation in health and effectively paved the way for modern health diplomacy. One of the most significant developments throughout this era was the establishment of the Pan American Health Organization (PAHO) in 1902 which bolstered cooperation on common health issues among the countries of the Americas.
• Post-World War II: the formation of the United Nations (UN) and its specialized health agency the World Health Organization (WHO) marked the recognition of health as an international concern. The WHO played a central role to the evolution of health diplomacy following its broad mandate which includes setting global health standards and policies, coordinating international health efforts, promoting health equity, and serving as a platform for diplomatic dialogue on health matters.
• HIV/AIDS Pandemic: the international response to the HIV/AIDS pandemic in the 1980s and 1990s highlighted the need for health diplomacy to address a significant health crisis. Multilateral initiatives, such as the establishment of the Global Fund to Fight AIDS have demonstrated the significance of collaborative strategies and resource mobilization.
• The Rise of Global Health Governance: In the late 20^th century, the emergence of issues such as the HIV/AIDS pandemic, Severe Acute Respiratory Syndrome (SARS) outbreak and the Ebola Outbreak emphasized the need for enhanced global health governance. The SARS outbreak in 2002-2003 highlighted the global interconnectedness of health and demonstrated the necessity for international cooperation and collaboration in disease surveillance and knowledge sharing in order to contain and manage infectious disease outbreaks. The Ebola outbreak in West Africa in 2014-2016 showcased the critical role of health diplomacy in coordination rapid global response to health emergencies.
• COVID-19 Pandemic: The recent COVID-19 pandemic underscored existing disparities in global health specifically in terms of healthcare capacity and vaccine distribution. As a result, discussions on health equity are now at the forefront of health diplomacy emphasizing the need for universal healthcare coverage and equitable access to health resources. Furthermore, the pandemic necessitated unprecedented levels of global collaboration which exposed the many weaknesses of existing health diplomacy mechanisms.  

WHERE is health diplomacy performed?

As a multidisciplinary field, health diplomacy is performed in various contexts including:

• Multilateral organizations and conferences: Institutions such as the World Health Organization (WHO), the United Nations (UN) and the World Bank serve as platforms for diplomatic engagement. Conferences and forums hosted by these organizations provide opportunities for health diplomats to discuss and negotiate global health polices and facilitate coordination on global health matters.
• International Health Partnerships and Initiatives: International health partnerships and alliances such as the Global Fund to Fight AIDS, Gavi, the Vaccine Alliance, or the Global Polio Eradication Initiative enable the practice of health diplomacy by bringing together the relevant stakeholders to coordinate efforts, combine resources and implement health interventions.
• Disaster Management and Humanitarian Response: Health diplomacy also takes place in the context of humanitarian assistance and disaster management situations. Coordination between countries, international organizations, and humanitarian actors is crucial for effectively addressing health needs, providing medical aid, and coordinating relief efforts in crisis-affected regions. Countries collaborate via platforms such as the WHO’s Emergency Committee, which assists with knowledge sharing, mobilization of resources and supporting the affected nations.
• Bilateral Diplomacy: Health diplomacy is frequently conducted through bilateral meetings and negotiations between two nations. Diplomatic missions and embassies facilitate dialogue and coordination on specific health-related issues based on mutual interest, ongoing collaborations, or emerging health threats.

• Academic and Research Institutions: Health diplomacy occurs within academic and research institutions as universities and research centers engage is cross-border collaborations to share scientific knowledge and address global health challenges. Scholars and researchers contribute to health diplomacy by generating evidence-based recommendations and providing expertise that informs prioritization of health issues.

• Philanthropic and Non-governmental Initiatives: Philanthropic endeavors and non-governmental initiatives promote health diplomacy by providing financing, forming alliances, advocating for causes, implementing programs, assisting with research, enhancing capacities of nations to deal with health issues. They play a crucial role in addressing global health challenges, fostering innovation, influencing policy, and facilitating the implementation of health programs and interventions.

Resources for health diplomacy

1. UN Documents

UN General Assembly [UNGA] (2008) Global Health and Foreign Policy (A/Res/63/33). Available at
http://www.un.org/en/ga/63/resolutions.shtml [accessed 03 August 2015].

UN General Assembly [UNGA] (2009) Global Health and Foreign Policy (A/Res/64/108). Available at
http://www.un.org/en/ga/64/resolutions.shtml [accessed 03 August 2015].

UN General Assembly [UNGA] (2010) Global Health and Foreign Policy  (A/Res/65/95). Available at
http://www.un.org/en/ga/65/resolutions.shtml [accessed 03 August 2015].

UN General Assembly [UNGA] (2011) Global Health and Foreign Policy  (A/Res/66/115). Available at
http://www.un.org/Depts/dhl/resguide/r66.shtml [accessed 03 August 2015].

UN General Assembly [UNGA] (2012) Global Health and Foreign Policy (A/Res/67/81). Available at
http://www.un.org/en/ga/67/resolutions.shtml [accessed 03 August 2015].

UN General Assembly [UNGA] (2013) Global Health and Foreign Policy (A/Res/68/98). Available at
http://www.un.org/en/ga/68/resolutions.shtml [accessed 03 August 2015].

World Health Organization [WHO] (1948) Constitution of the World Health Organization. Available at
http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf [accessed 03 August 2015].

World Health Organization [WHO] (1948) Rules of Procedure of the World Health Assembly. Available at
http://www.who.int/gb/bd/PDF/bd47/EN/rules-of-procedure-en.pdf  [accessed 03 August 2015].

World Health Organization [WHO] (2014) Twelfth general Programme of Work. Not merely the absence of disease. Available at
http://apps.who.int/iris/bitstream/10665/112792/1/GPW_2014-2019_eng.pdf [accessed 03 August 2015].

World Health Organization [WHO] (2014) Report of the Taskforce on the roles and the functions of the three levels of WHO. Available at
http://www.who.int/about/who_reform/task_force_report_three_levels_who_2013.pdf [accessed 03 August 2015].

World Health Organization [WHO] (2015) WHO Reform: overview of reform implementation (A68/4). Available at
http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_4-en.pdf [accessed 03 August 2015].

World Health Organization [WHO] (2015) Draft Resolution: Framework of engagement with non-state actors (WHA68.9). Available at
http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R9-en.pdf [accessed 03 August 2015].

World Health Organization [WHO] (2015) Health in the post-2015 development agenda (A68/14). Available at
http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_14-en.pdf [accessed 03 August 2015].

2. Useful websites

Global Civil Society Knowledge Base

Global Health Diplomacy Network (GHD-NET)

Global Health Europe

Global Health Programme website

Global Health Strategies Initiatives (GHSi)

Sustainable Development Knowledge Platform

United Nations Development Group website

World Health Organization website

3. Other Resources

Global Health Programme (2013) Discussing a Definition of Global Health. Global Health Diplomacy Briefing. Available at

http://graduateinstitute.ch/files/live/sites/iheid/files/sites/globalhealth/ghp-new/Documents/Publications/Policy%20Briefs/Definition%20Global%20Health%202013.pdf [accessed 03 August 2015].

Global Health Programme and Rabin Martin (2014) Universal Health Coverage. An Annotated Bibliography May 2014. Geneva: Graduate Institute. Available at

http://graduateinstitute.ch/files/live/sites/iheid/files/sites/globalhealth/ghp-new/publications/UHC_Bibliography_v9_web.pdf [accessed 03 August 2015].

Kickbusch I and Behrendt T (2014) Global Health Diplomacy. Oxford Bibliographies. Available at
http://graduateinstitute.ch/home/research/centresandprogrammes/globalhealth/publications/bibliographies.html [accessed 03 August 2015].

Publications from the Global Health Programme. Available at http://graduateinstitute.ch/globalhealth-publications

4. Books

Bliss K (2013) The Changing Landscape of Global Health Diplomacy. Center for International and Strategic Studies. Available at

http://csis.org/publication/changing-landscape-global-health-diplomacy [accessed 03 August 2015].

Fairman D et al. (2012) Negotiating Public Health in a Globalized World: Global health diplomacy in action. New York: Springer. Available at
http://www.amazon.com/Negotiating-Public-Health-Globalized-World/dp/9400727798 [accessed 03 August 2015].

Gostin L (2014) Global Health Law. Cambridge: Harvard University Press. Available at
http://www.hup.harvard.edu/catalog.php?isbn=9780674728844 [accessed 03 August 2015].

Harman S (2012) Global Health Governance. Routledge Series on Global Institutions. London and New York: Routledge. Available at
http://www.routledge.com/books/details/9780415561587/ [accessed 03 August 2015].

Khanna P (2011) How to Run The World. New York: Random House. Available at
http://paragkhanna.com/how-to-run-the-world/ [accessed 03 August 2015].

Kickbusch I et al. [Eds] (2013) Global Health Diplomacy: Concepts, Issues, Actors, Instruments, Fora and Cases. New York: Springer. Available at
http://www.springer.com/public+health/book/978-1-4614-5400-7 [accessed 03 August 2015].

Kickbusch I and Rosskam E [Eds] (2011) Negotiating and Navigating Global Health: Case Studies in Global Health Diplomacy, Global Health Diplomacy Book Series Volume 2. London: World Scientific Publishers. Available at http://www.amazon.com/Negotiating-Navigating-Global-Health-Diplomacy/dp/9814368032 [accessed 03 August 2015].

Low-Beer D [Ed.] (2012) Innovative Health Partnerships – The Diplomacy of Diversity. London: World Scientific Publishers. Available at
http://www.worldscientific.com/worldscibooks/10.1142/8242 [accessed 03 August 2015].

Novotny T et al., [Eds] (2013) 21st Century Global Health Diplomacy. Global Health Diplomacy 3. Hackensack, NJ: World Scientific. Available at
http://www.worldscientific.com/worldscibooks/10.1142/8178 [accessed 03 August 2015].

Parker R and Marni S (2011). Routledge Handbook of Global Public Health. London: Routledge. Available at
http://www.amazon.com/Routledge-Handbook-Global-Public-Health/dp/0415818893 [accessed 03 August 2015].

Schrecker T [Ed] (2012) The Ashgate Research Companion to the Globalization of Health. Farnham, UK, and Burlington, VT: Ashgate. Available at
http://www.ashgate.com/isbn/9781409409243 [accessed 03 August 2015].

Youde J (2012) Global Health Governance. Cambridge, UK, and Malden, MA: Polity. Available at
http://eu.wiley.com/WileyCDA/WileyTitle/productCd-074565309X.html [accessed 03 August 2015].