Global Health Diplomacy short introduction

1. Global Health Diplomacyshort introduction Professor Dr. llona Kickbusch Director Global Health Programme

2. Globalization impacts health Health impacts globalization The 21st century dynamics Kickbusch Introduction Health Diplomacy 2008

3. Global Health Global Health refers to those health issues which transcend national boundaries and governments and call for actions on the global forces and global flows that determine the health of people. Kickbusch 2006 Kickbusch Introduction Health Diplomacy 2008

4. The growing health gap between and within countries The return of infectious diseases The chronic disease epidemic Health is a determinant of growth and productivity, wealth and quality of life Direct and indirect economic impact of disease outbreaks and lifestyle changes The global health dynamics Kickbusch Introduction Health Diplomacy 2008

5. A “cosmopolitan moment” • (Beck 2007:109) is a prism which brings into focus the need to address a problem at the global level through collective action. It can includes both a normative dimension - “We have a global responsibility” - and a dimension of Realpolitik -“The national interest can only be resolved through joint global action”. Indeed moral obligation (as well as indignation!) and “enlightened self interest” have become two strong driving forces of global health governance. Cosmopolitan moments usually open up new political spaces and allow – and sometimes oblige - new actors to join the global governance effort. Kickbusch Introduction Health Diplomacy 2008

6. 3 key dimensions of global health • Public health can no longer be pursued just at the national level – it needs strong global institution, mechanisms and funding • The health sector can no longer deal with the emerging challenges on its own – it needs multisectoral action and broad public and private partnerships at national and international level • Health can no longer be seen as a purely professional and technical endeavour – it needs the strong voice and the support of civil society and of political leaders to address the equity and human rights issues at stake. Kickbusch Introduction Health Diplomacy 2008

7. Global inequality and poverty • Health • Gender • Demography • Education • Social disparities • Information • Security • Geopolitics Kickbusch Introduction Health Diplomacy 2008

8. Global governance: Risks are transnational Local governance Global risk production is localized through the globalization of everyday life Impact? Preparedness? Response? 21st century risk society: interdependence Kickbusch Introduction Health Diplomacy 2008

9. A new global environment “(…) the interdependence produced by globalization has broken down traditional ways of conceptualizing and organizing the medical, economic, political and technological means to improve health” Nick Drager and David Fidler Foreign policy, trade and health: at cutting edge of global health diplomacy The World Health Organization Bulletin, Volume 85, number 3, March 2007, the Editorials. Kickbusch Introduction Health Diplomacy 2008

10. Global health governance: • a mechanism of collective problem solving for improved health through the interplay of different institutional forms and actors at different levels. • Like other forms of governance it is subject to reconfigurations of power – it is therefore always also a political undertaking. Kickbusch Introduction Health Diplomacy 2008

11. Health in foreign policy We are witnessing an increased role of health in global and foreign affairs, including in particular trade and security, as exemplified in the recent SARS epidemic and fears of biological terrorism; Health is now part of the G8 summits, UN General Assembly, poverty reduction strategies Kickbusch Introduction Health Diplomacy 2008

12. Oslo Declaration 2007 7 Ministers of foreign affairs propose an action plan for health in foreign policy and declare that „health impact“ must become a key lens through which to conduct foreign policy Norway France Thailand South Africa Brazil Senegal Indonesia Kickbusch Introduction Health Diplomacy 2008

13. CH: Agreement on health foreign policy objectives • Aim: better interdepartmental collaboration in sectors where the MFA does not have the lead (retreat of Swiss Federal Council 18.5.2005) • Agreements on shared objectives between FDFA and other sectoral department : First application: Health • Health Foreign Policy (HFP) was signed and submitted to the Federal Council on 9.10.2006 by the heads of the Federal Department of Home Affairs Pascal Couchepin and the head of the Federal Department of Foreign Affairs Micheline Calmy-Rey Kickbusch Introduction Health Diplomacy 2008

14. CH: Three Aspects of Health Foreign Policy (HFP) 1. Tool to improve health in Switzerland 2. Health as a pillar of development policy 3. Coherence with general foreign policy Global Health Policy Kickbusch Introduction Health Diplomacy 2008

15. How has diplomacy changed? Kickbusch Introduction Health Diplomacy 2008

16. Bi lateral diplomacy • „Old diplomacy“ • Directed primarily towards to the conduct of relations on a state to state basis via resident missions with the resident ambassador as the key actor Kickbusch Introduction Health Diplomacy 2008

17. Multilateral diplomacy involves the art of building and managing coalitions before, during, and after negotiations on a particular issue across national boundaries – frequently within the context of international organizations. High level of complexity: Multi actor, multi issue, multi roles, multi values “New diplomacy”: Multilateral international diplomacy Kickbusch Introduction Health Diplomacy 2008

18. „The breaking of nations“ • 1989 end of balance of power system • In the past it was enough for a nation to look after itself - today that is no longer sufficient. • Post modern perspective: the objective of foreign policy is taken to be peace and prosperity rather than power and prestige • Robert Cooper 2006 Kickbusch Introduction Health Diplomacy 2008

19. Diplomacy today……….. • the shift from international (between states) to global (trans-boundary/ multi-actor) challenges, indeed there are some who have suggested that departments of foreign relations be renamed to fit their new purpose: global affairs; Kickbusch Introduction Health Diplomacy 2008

20. Diplomacy today………… • the importance assigned to “soft power” strategies as well as “nation building” and the role health plays within such approaches • the recognition that certain “global public goods” need to be negotiated and ensured and that regimes in the area of trade and economic development need to be complemented by other goods such as health Kickbusch Introduction Health Diplomacy 2008

21. Trans-boundary collective human security issues • Trade/mobility • Global Crime • Terrorism • Environment • Infectious disease • Intellectual property • Disaster response IHR Kickbusch Introduction Health Diplomacy 2008

22. International (health) law Pooling sovereignty and right to intervene on behalf of the health of the global community Kickbusch Introduction Health Diplomacy 2008

23. The crisis is primarily not a disease crisis, it is a crisis of governance –its key characteristic is a weakening of public policy and interstate mechanisms as a consequence of global restructuring and a fragmentation of actors and programs. New response to the global health crisis Kickbusch Introduction Health Diplomacy 2008

24. Global Health Diplomacy Health diplomacy may be defined as a political activity that meets the dual goals of improving global health while maintaining and strengthening international relations, particularly in conflict areas and resource-poor environments (Novotny, Leslie, Adams, Kickbusch 2008) Global Health Diplomacy refers to the multi-level and multi actor negotiation processes that shape and manage the global policy environment for health. (Kickbusch 2007) Kickbusch Introduction Health Diplomacy 2008

25. 3 key objectives of Global Health Diplomacy Ideally global health diplomacy results in better health security and population health outcomes for each of the countries involved (thus serving the national and the global interest) improving the relations between states and strengthening the commitment of a wide range of actors to work to improve health a common endeavour to ensure health as a human right and a global public good and delivering results that are deemed fair ( “for all” - reducing poverty, increasing equity) . Kickbusch Introduction Health Diplomacy 2008

26. The diplomatic space A major part of global health diplomacy takes place within the United Nations specialized agency for health - the World Health Organization - but the range of actors and “spaces” is expanding rapidly. This includes venues such as the World Trade Organization, the World Bank, regional organizations and new organizations such as global alliances, global funds and global forums. Kickbusch Introduction Health Diplomacy 2008

27. ….the new political space • Health and….. • Foreign policy • Security policy • Economic policy • Trade policy • Demographic Geopolitics • (Migration) • Global “interhuman” Ethics: Make poverty history Kickbusch Introduction Health Diplomacy 2008

28. The new health diplomats • Increasingly the negotiations on global health matters are not only conducted between public health experts representing health ministries of nation states but include a growing array of other national actors as well as major players in the global arena such as NGOs, the private sector, academia and foundations . Kickbusch Introduction Health Diplomacy 2008

29. Global Health Diplomacy within a fragmented POLITICAL ECOSYSTEM MSF CLINTON BONO PHA WEF World Bank 150 PPPH Kickbusch Introduction Health Diplomacy 2008

30. Forms of power • new forms of power and influence that take place in the many transnational arenas • discoursive power, decision making power, legal power and resource based power. Kickbusch Introduction Health Diplomacy 2008

31. Forms of legitimacy • universalistic structure (one country – one vote) • moral standing (Health for All), • quality of technical expertise (expert legitimacy), • ability to achieve commonly set goals (resultsbased legitimacy) • ability to act in the face of crisis • results based legitimacy - a characteristic of market multilateralism Kickbusch Introduction Health Diplomacy 2008

32. Kickbusch 2006

33. Looking back at 150 years of health diplomacy Kickbusch Introduction Health Diplomacy 2008

34. Paris 1851 Paris 1859 Constantinople 1866 Vienna 1874 Washington 1881 Rome 1885 Venice 1892 Dresden 1893 Paris 1894 Venice 1897…….1938 International Sanitary Conferences Kickbusch Introduction Health Diplomacy 2008

35. Pan American Sanitary Bureau 1902 Kickbusch Introduction Health Diplomacy 2008

36. Religious Missions Kickbusch Introduction Health Diplomacy 2008

37. Red Cross Movement Kickbusch Introduction Health Diplomacy 2008

38. 1913 Rockefeller International Health Division: basic health research, training of personel, model health programmes (yellow fever vaccine) Foundations Kickbusch Introduction Health Diplomacy 2008

39. OIHP: Office International d‘Hygiene Publique • 1907: 23 European Countries establish the OIHP located in Paris: Bulletin • Role: collection and dissemination of new knowledge on infectious diseases: cholera,plague, yellow fever • Later widened to 60 countries and a range of other infectious and vector borne diseases……………… Kickbusch Introduction Health Diplomacy 2008

40. Basis for the „new“ diplomacy • „a completely novel form was added to the institutional repertoire of states in 1919: • The multipurpose, universal membership organization- instantiated first by the League of Nations and then by the United Nations Kickbusch Introduction Health Diplomacy 2008

41. International health studies Field assistance to countries 1921 Subdivision: „prevention and control of diseases“ Health organization of the League of Nations, later the Health Committee of the League League of Nations Kickbusch Introduction Health Diplomacy 2008

42. 1945 San Fransisco Conference agrees to establish a health organization • 1946 Constitution is adopted • 1948 Constitution comes into force • 1951 International Sanitary regulations • 1969 International health regulations • 1978 Alma Ata Kickbusch Introduction Health Diplomacy 2008

43. WHO „the coordinating authority on international health work“ • First decade: major diseases • Second decade: liberation of former colonies – health manpower development • Third decade: eradication of small pox, new issues such as family planning • Fourth decade: Primary health care WHO UNICEF Health for All – Equity – cooperation • Fifth decade: investment in health, poverty eradication • Sixth decade: common health security and health as a global public good Kickbusch Introduction Health Diplomacy 2008

44. WHO Constitution • Articles 19-23 • Enable the WHO to adopt conventions or agreements, regulations and recommendations in all public health endeavors • A highly radical approach to International Law at the time of its creation • Persuasive approach • Soft law (norms that fall between morality and binding law) • Hard law (legal obligation) Kickbusch Introduction Health Diplomacy 2008

45. The WHO Constitution describes a series of policy-making instruments available to WHO Smith 2008 Kickbusch Introduction Health Diplomacy 2008

46. The range of policy instruments in global health has expanded considerably over time Kickbusch Introduction Health Diplomacy 2008 Smith 2008

47. "The WHO FCTC negotiations have already unleashed a process that has resulted in visible differences at country level. The success of the WHO FCTC as a tool for public health will depend on the energy and political commitment that we devote to implementing it in countries in the coming years. A successful result will be global public health gains for all." Dr LEE Jong-wook. Director-General, World Health Organization 2006 Framework Convention Tobacco Control 27.05.2005 Kickbusch Introduction Health Diplomacy 2008

48. The renewed mandate given to Member States and WHO under the IHR(2005) has also increased their respective roles and responsibilities. In particular, States Parties* to the IHR(2005) are required to develop, strengthen and maintain core surveillance and response capacities to detect, assess, notify and report public health events to WHO and respond to public health risks and public health emergencies. International Health Regulations Kickbusch Introduction Health Diplomacy 2008

49. Dreifuss Commission “…to collect data and proposals from the different actors involved and produce an analysis of intellectual property rights, innovation, and public health, including the question of appropriate funding and incentive mechanisms for the creation of new medicines and other products against diseases that disproportionately affect developing countries…” The Commission on Intellectual Property Rights, Innovation and Public Health Kickbusch Introduction Health Diplomacy 2008

50. In diplomatic practice • Policy coherence: Agreements between ministries of foreign affairs and health SWI, BRAZ, National global health strategies UK • Staff exchanges: diplomats into MOH, public health experts into diplomatic missions „strengthen the bonds“ • Diplomats with health brief: MEX US border health commission • Health section in MFA: USA • New composition of delegations • Diplomatic leadership of health negotiations IHR FCTC • Action plan: Oslo Declaration of 7 MFA Kickbusch Introduction Health Diplomacy 2008