While health has always been a part of international relations, the author of this paper argues that it is only in recent years that it has attracted much attention and started the move from an issue of ‘low-politics’ to one of ‘high-politics.’ While the strategies of most governments point to the increasing central role health plays in national strategy, health is still not yet an issue at the heart of government policy. However, research and thinking by groups such as the Chatham House Centre on Global Health and Foreign Policy and the FIOCRUZ Centre for Global Health and International Co-operation can help it became an increasingly important part of it, the author argues. Given increased globalisation and ‘convergence of interest’, there will likely be much more interaction in the future between ministries of health and other ministries, as well as increased priority given to health in foreign policy strategies. The author notes that a call was made in 2009 to the United States (US) President to highlight health as a pillar of US foreign policy, and he predicts that the United States will put more resources into developing a formal foreign relations-based health strategy.
Values, Policies and Rights
Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy Issue, in the form of global health diplomacy, which informs foreign policy decision-making in the advancement of international co-operation in health. In this paper, the authors review the arguments for health in foreign policy that inform global health diplomacy. These are organised 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 conceptualised. 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.
In this article, Horace Campbell charts Africa’s exploitative history of ‘aid’ and the struggle to establish a new global system rooted in dignity, equality and genuine social justice. Throughout Africa, Asia and Latin America the author argues that international capitalism has plundered the resources of the planet. Today, ‘international plunderers’ work with local African allies and sometimes their governments in extracting resources. The author argues that some African leaders have been compromised by their “development partners” and have remained silent in the face of intensified exploitation of Africa. The continued plunder of resources by oil companies and others has grown in this period, and observers have pointed to the constant interconnections between wars, violence and economics. Similarly, as Africans move into the twenty-first century there is increased interest in the genetic resources and fresh water of Africa, especially the water resources of the Congo River and its tributaries. Thus far there is not enough work on how this century will impact the lives of Africans.
"I believe that we are at a turning point for public health - and that our choices are stark: either we reorient and strengthen public health within both modern and developing societies and institute a resilient system of global governance for health or we will face dire consequences in terms of human, social, and economic development. At present, it is the poorest countries that are paying the price for this negligence - but we have mounting signals that a new health divide is in the making as a large global underclass spreads out around the globe and defies the old definitions of vulnerable groups."
Following the recognition that morbidity and mortality due to malaria had dramatically increased in the last three decades, in 2002 the government of Zambia reviewed its efforts to prevent and treat malaria. Convincing evidence of the failing efficacy of chloroquine resulted in the initiation of a process that eventually led to the development and implementation of a new national drug policy based on artemisinin-based combination therapy (ACT). All published and unpublished documented evidence dealing with the antimalarial drug policy change was reviewed. These data were supplemented by the authors observations of the policy change process. Study results suggest that drug policy changes are not without difficulties and demand a sustained international financing strategy for them to succeed. The Zambian experience demonstrates the need for a harmonized national consensus among many stakeholders and a political commitment to ensure that new policies are translated into practice quickly.
With increasing adoption of universal health coverage (UHC), the health for all agenda is resurgent globally. This commentary discusses the origin of the health for all agenda in the 1970s and the influence of global politico-economic forces in shaping that agenda and its demise. The author proposes that it has resurged in the form of UHC in the twenty-first century, but also discusses UHC’s focus on finances and the increasing role of market economy in health care, and the need to regulate the market based provision of healthcare, and incorporate more of the people and community centred ethos of the PHC of 40 years ago.
In this interview with Adrienne Germain, President Emerita of the International Women’s Health Coalition, she talks about her experiences promoting women’s health in developing countries. She argues that there are many reasons why there is widespread resistance to integrating HIV and reproductive health services, including disease control models that emphasise risk, not vulnerability; competition for scarce resources; narrow disciplinary training that encourage health professionals to work separately rather than collaborate across subjects and services; and gender bias. She pointed out that research shows that women’s health has definitely suffered from the separation of HIV information and services from other components of sexual and reproductive health care. For example, in sub-Saharan Africa, most HIV services fail to provide contraceptives, safe abortion, treatment and referral following sexual coercion or violence, or human papillomavirus (HPV) screening to women living with HIV. She also noted that political commitment has improved, but most politicians act only in their own interests or when they are pressed to do so. In most countries, women and children don’t have a strong political voice, although in some they have gained considerable ground over the last decade or so. We must invest in both local and international advocates whose main task today is to persuade those with power and resources to transform their rhetoric into action.
Primary health care (PHC), codified at the historic 1978 Alma Ata Conference, was advocated as the means to achieve health for all by the year 2000. The principles of PHC included universal access and equitable coverage; comprehensive care emphasising disease prevention and health promotion; community and individual participation in health policy, planning, and provision; intersectoral action on health determinants; and appropriate technology and cost-effective use of available resources. These principles were to inform health-care provision at all levels of the health system and the programmatic elements of PHC that focused primarily on maternal and child health, communicable diseases, and local social and environmental issues. PHC emphasised community participation through a network of workers at all levels who would be trained both “socially and technically”. UHC is concerned with improved access to quality health services and protection from financial risks associated with health care. However, UHC, unlike PHC, is silent on social determinants of health and community participation.
This paper provides a theoretical and political critique of how the concept of resilience has been applied to places. It is based upon three main points. First, the ecological concept of resilience is conservative when applied to social relations. Second, resilience is externally defined by state agencies and expert knowledge. Third, a concern with the resilience of places is misplaced in terms of spatial scale, since the processes which shape resilience operate primarily at the scale of capitalist social relations. The authors argue that resilience is fundamentally about how best to maintain the functioning of an existing system in the face of externally derived disturbance. Both the ontological nature of ‘the system’ and its normative desirability escape critical scrutiny. As a result, the existence of social divisions and inequalities tends to be glossed over when
resilience thinking is extended to society. Ecological models of resilience are thus argued to be fundamentally
anti-political, viewing adaptation to change in terms of decentralized actors, systems and relationships and failing to accommodate the critical role of the state and politics. In place of resilience, the authors offer the concept of resourcefulness as an alternative approach for community groups to foster.
The chief of malaria for the World Health Organization has complained that the growing dominance of malaria research by the Bill and Melinda Gates Foundation risks stifling a diversity of views among scientists and wiping out the world health agency’s policy-making function. In a memorandum, the malaria chief, Dr. Arata Kochi, complained to his boss, Dr. Margaret Chan, the director general of the W.H.O., that the foundation’s money, while crucial, could have “far-reaching, largely unintended consequences.”