Health Diplomats are Experienced Negotiators.
Health diplomacy has been at the core of international action for health since countries began to cooperate on health-related matters. For over 100 years—from the first International Sanitary Conferences to the establishment of a health office of the League of Nations and finally the creation of the World Health Organization—countries have been engaged in coordinated and cooperative action, not only to counter common threats to human health but also to address the many factors that determine health. In a global world with an increasing number of health challenges, the WHO is the legitimate leader with the authority to set agendas, adopt treaties and coordinate international health work. Today health diplomacy includes not only many different actors in the global health arena, but also new mechanisms that allow the wider public to engage. It is a two-way street: health helps build relationships between countries and can act as a bridge for peace, while diplomacy can help create the alliances needed to achieve health outcomes.
Health is a human right—yet equality in access to health and universal health coverage is not always prioritised (or even considered) in international agreements. Health diplomats negotiate for health in the face of the interests of other sectors and of other global players, so that health is placed high on the political agenda. The high relevance of global health as “a pressing foreign policy issue of our time” was strongly recognised by the foreign ministers of Norway, France, Brazil, Indonesia, Senegal, South Africa and Thailand, who launched a declaration on health and foreign policy in Oslo in 2007(1). The relevance of health to the well-being, wealth and security of nations is reflected in the Post-2015 Development Agenda and the increasing interest it is gaining in deliberations at the United Nations General Assembly(2). Health is now also on the agenda of many global and regional meetings, many of which bring together heads of state and government such as the G7, BRICS, ASEAN and the European Union. And it is taken into account when business leaders meet at the World Economic Forum.
At the WHO, much health diplomacy takes place during the World Health Assembly and WHO Executive Board sessions, and in the regional committees. These meetings have been subject to significant changes over recent decades as delegations face an extensive and complicated agenda requiring intensive preparation as well as significant intersectoral consultations. Health issues are now part of wider agendas: the security agenda, driven by the fear of global pandemics; the economic agenda, which sees the health sector as a US$7-trillion global growth industry; and the social-justice agenda, which advocates health as a social value and human right.
Many sophisticated global negotiations take place at the WHO. Countries work together to agree on instruments and mechanisms to take health forward as a common goal through resolutions, joint global action plans, and international frameworks and codes, as well as legally binding instruments such as the Framework Convention on Tobacco Control and the International Health Regulations. The subject matter ranges from combating non-communicable diseases and ensuring access to safe medicines, to promoting universal health coverage and addressing health-worker migration. Technical and political issues intersect, and often the protection of sovereignty by nation-states clashes with the need for collective action, as in pandemic control.
No progress can be achieved without skilled negotiators, now often referred to as health diplomats. This was recognised by WHO member states in the Twelfth General Programme of Work, which provides the WHO’s high-level strategic vision for the period 2014–9. It acknowledges the significance of increasing capacity-building in global health and training health diplomats(3). In response, the WHO and its member states have partnered with academic institutions (such as the Global Health Programme of the Graduate Institute in Geneva) to train staff, including country representatives as well as representatives from ministries of health and of foreign affairs. A wide range of courses, books and case studies have been developed over the last decade to support global health diplomacy(4, 5).
In the European Region of the WHO, the environment and health process can be understood as the practice of modern health diplomacy. In the late 1980s, European countries initiated the first-ever collaboration to eliminate the most significant environmental threats to human health. Progress towards this goal is driven by a series of ministerial conferences, held every five years and coordinated by WHO/Europe(6). Successful health diplomacy is also exemplified by the two-year development process (2010–2) of the European health policy framework—Health 2020(7)—and cooperation with the European Union in health matters. Because the increasingly political nature of the meetings of the governing bodies creates an increasing demand for health diplomacy, a resolution titled “Health in foreign policy and development cooperation: public health is global health” at the 60th session of the WHO Regional Committee for Europe (Moscow, 2010) requested the regional director to “contribute to strengthening the capacity of diplomats and health officials in global health diplomacy”(8).
In order to respond to this request, between 2010 and 2015 WHO/Europe commissioned European executive training events (of two to five days), including countries of the South East European Health Network and the Commonwealth of Independent States, as well as interregional activities and global online courses, which also enrolled European participants. In the European region, around 300 national delegates and WHO staff have participated in health diplomacy training so far. Public-health professionals and diplomats attend these workshops together and learn from one another, especially during simulation exercises. Future plans in capacity-building for health diplomacy include a textbook with case studies tailored to Europe to strengthen the consistency of education and the extension of WHO-sponsored courses to EU member states.
The year ahead will open up enormous opportunities for health diplomacy for European countries. Three high-level international meetings share the responsibility to chart a new era of sustainable development including health:
- the International Conference on Financing for Development, in Addis Ababa in July
- the Special Summit on Sustainable Development in September (the culmination of a long process to define the Post-2015 Development Agenda)
- the 21st Conference of the Parties of the UN Climate Convention, in Paris in December.
These conferences are all connected, and coherence and reinforcement between them is critical also from the point of view of health. The 68th World Health Assembly (WHA69)—in the wake of Ebola—has put global health security firmly back on the agenda, which requires extensive negotiations not only between countries but also between many different sectors and agencies. In a way, both the WHO and health diplomacy have come back to their roots: to agree to pool sovereignty for the benefit of all. German Chancellor Angela Merkel expressed this in her statement to WHA68: “[The] WHO is the only international organisation that enjoys universal political legitimacy on global health matters”(10). Health diplomacy is at the core of the obligation to work towards the attainment by all peoples of the highest possible level of health.
1 “Oslo Ministerial Declaration—global health: a pressing foreign policy issue of our time” (2007). The Lancet. Published online 2 April 2007, DOI:10.1016/S0140-6736(07)60498-X. Available at: www.who.int/trade/events/Oslo_Ministerial_Declarat… 2 UN General Assembly Resolution (2008) 63/33. “Global health and foreign policy”. Available at: www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/… 3 WHO Twelfth General Programme of Work (2014): “Not merely the absence of disease”. Available at: apps.who.int/iris/bitstream/10665/112792/1/GPW_201… 4 Oxford Bibliographies: “Global Health Diplomacy”. www.oxfordbibliographies.com 5 Kickbusch, I. and Kökény, M. (2013): “Global health diplomacy: five years on”. Bulletin of the World Health Organization 91, pp. 159–159A. Available at: www.who.int/bulletin/volumes/91/3/13-118596/en/ 6 WHO/Europe: “Environment and health”. Available at: www.euro.who.int/en/health-topics/environment-and-… 7 WHO/Europe: “Health 2020: the European policy for health and well-being” (2012). Available at: www.euro.who.int/en/what-we-do/health-topics/healt… 8 WHO Regional Committee for Europe, 60th Session (2010): Resolution: “Health in foreign policy and development cooperation: public health is global health”. EUR/RC60/R6. Available at: www.euro.who.int/__data/assets/pdf_file/0010/12223… 9 “Address by Her Excellency Angela Merkel, the Federal Chancellor of the Federal Republic of Germany, to the Sixty-eighth World Health Assembly” (2015). Available at: apps.who.int/gb/ebwha/pdf_files/WHA68/A68_DIV5-en….