Public Health Engagement Aff Notes



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Pandemic control is an emphasized focus in diplomatic engagement


CGHD ND (Center for Health and Diplomacy, where high level political figures, health care workers and leaders in both the public and private sector can share and communicate their ideas, www.cghd.org/index.php/global-health-partnerships-and-solutions/public-private-partnerships/101-global-health-diplomacy-in-the-21st-century-private-sector-engagement-at-johnson-johnson)

Over the past two decades, the importance of global health, as an emphasis for diplomatic engagement, has grown. The 1994 United Nations Human Development Report heralded the potential to advance human security with "first, safety from such chronic threats of hunger, disease and repression." In 1996, following the first ever UN General Assembly focusing on a health issue, the Joint United Nations Programme on HIV/AIDS (UNAIDS) was launched to strengthen the way in which the world was responding to AIDS. And, just recently the second time the UN General Assembly convened on a health issue was in 2011 when a high level meeting on NCDs led to targets to address the global threat. We have also seen global health diplomatic activities in such areas as the Framework Convention on Tobacco Control, response to pandemics, and in other post conflict environments. Numerous countries have embraced health diplomacy. In Oslo in 2007, Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand made a joint Declaration in which they declared global health to be a "pressing foreign policy issue of our time", and committed to making health a "defining lens" for shaping foreign policy. Just last month, in December 2012, the US announced an Office of Global Health Diplomacy with a mandate to influence global stakeholders, align donor investments with country resources, and oversight, maintenance, and improvement of country-focused technical support that expands capacity for global health priorities.



While much of this evolved in the traditional circles of diplomacy — namely state actors — as the world's largest diversified health company, we believe that an approach to address the global health challenges requires private sector engagement. Our commitment to advance global health success was amongst the first global companies to include global health diplomacy as a strategic imperative in our Government Affairs and Policy department, a role which I have led since 2008. In 2010, I testified before a US Congressional Committee on Achieving the United Nations Millennium Development Goals: Progress through Partnerships and presaged the role that effective private sector engagement can offer: “We believe our efforts in global health diplomacy drive new ways of thinking that can help shape stronger, more sustainable approaches to benefit mothers and fathers around the world.” We have been engaged in a number of global health diplomacy activities, pledging one of the first private sector commitments to theMDGs that included contributions from our pharmaceutical sector increasing access for HIV and TB medications. There are three examples that provide a glimpse into the promise of the novel global health approaches in this multipolar world.

Health has empirically been a major area of collaboration in diplomatic engagement


KFF '12 (KFF, policy briefs on U.S. global health policy, "RAISING THE PROFILE OF DIPLOMACY IN THE U.S. GLOBAL HEALTH RESPONSE: A BACKGROUNDER ON GLOBAL HEALTH DIPLOMACY", Kaiser Family Foundation, September, https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8360.pdf)

The U.S. government recently announced its intention to create a new “Office of Global Health Diplomacy” at the State Department (S/GHD), elevating, at least structurally, the role of diplomacy in U.S. global health efforts. As stated in the announcement, the creation of the office is a recognition of “the critical role of health diplomacy to increase political will and resource commitments around global health among partner countries and increase external coordination among donors and stakeholders.”1 It also appears to be part of the “next phase” of the Global Health Initiative (GHI)* , the Administration’s effort to create a global health strategy for the U.S. government, with the S/GHD office “champion[ing] the priorities and policies of the GHI in the diplomatic arena.”1 While the S/GHD will be a new office, it joins a much longer history of diplomatic engagement on international health issues by the U.S. and others. To help understand this broader context and history, this article provides an overview of global health diplomacy as a concept, including how it has been defined and used, as well as the history of diplomatic engagement on health, both globally and by the U.S., more specifically. Even as there remain a number of questions about the new S/GHD office, including exactly how it will operationalize the principles of the GHI in diplomacy, now is an opportune time to examine and assess the state of understanding in the emerging field of global health diplomacy.

U.S. policies have linked health and diplomacy together over time


KFF '12 (KFF, policy briefs on U.S. global health policy, "RAISING THE PROFILE OF DIPLOMACY IN THE U.S. GLOBAL HEALTH RESPONSE: A BACKGROUNDER ON GLOBAL HEALTH DIPLOMACY", Kaiser Family Foundation, September, https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8360.pdf)

More recently, growing concern about the political and social impacts of HIV/AIDS and emerging infectious diseases such as SARS and pandemic influenza have led policymakers to place greater attention on health in the context of foreign policy and diplomatic activity. In response to the growing political attention, a new United Nations agency (UNAIDS) was created in 1996 to serve a center for multilateral policy negotiations on addressing HIV, and in 2000 the UN Security Council declared HIV/AIDS a global security threat, the first time any disease had been singled out in this way. International alarm about the spread of H5N1 avian influenza and the potential for an influenza pandemic led UN Secretary General create a new UN System Influenza Coordinator office in 2005 to help multilateral coordination.



The importance of global health as an emphasis for diplomatic engagement has continued to grow. Over the past decade, proponents of global health have focused on how diplomacy and foreign policy can be used to support global health goals. For example, the current WHO Executive Director opened a unit dedicated to global health diplomacy,28 and heralded the burgeoning interest in diplomacy for health as a “new era” for global health.29 The WHO served as the forum in which countries debated and came to agreement on the Framework Convention on Tobacco Control, a global health treaty adopted by the WHA in 2003, and the negotiations leading up to the revision of the International Health Regulations, which were approved by the WHA in 2005. As a further indication of the growing international attention on the relationship between diplomacy and health, a diverse set of countries (Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand) made a joint declaration in 2007 known as the Oslo Ministerial Declaration, in which they declared global health to be a “pressing foreign policy issue of our time”, and committed to making health a “defining lens” for shaping foreign policy.30 Likewise, governments of Switzerland and the United Kingdom have declared intentions to integrate health considerations into the development of their foreign policy and diplomatic negotiations.

The U.S., too, has a long history of engagement in diplomacy on health issues. Early U.S. efforts stemmed as much from economic interests as public health ones, as the government sought to promote international trade and travel while also protecting shipping ports and other borders from external disease threats brought on by increased mobility. The U.S. participated in the International Sanitary Convention negotiations in the 19th Century (its first active participation coming in 1866, at the 3rd Convention)33, promoted the founding of PAHO and the creation of the WHO, and is an active a participant in the annual WHA meetings and related negotiations. Beyond the multilateral dimension, there is also a long history of U.S. bilateral diplomacy on health issues. For example, as early as 1929, the United States and Canada entered into a bilateral treaty requiring quarantine inspection of each country’s ships when entering adjacent waters, to prevent the spread of disease between the two countries.34 Even before the creation of a formal U.S. foreign health assistance apparatus, the U.S. government was already involved in negotiating and overseeing the disbursement of international health support to developing countries in the name of furthering U.S. interests; this assistance had reached approximately $40 million in 1954.35 At the time of the creation of USAID in 1961, President Kennedy clearly argued that by reaching out to other countries with assistance in health and other areas, the U.S. was furthering its interests and supporting important foreign policy goals. Foreign assistance, Kennedy said in remarks to Congress that year, could help prevent the “collapse of existing political and social structures” in developing countries that would “invite the advance of totalitarianism into every weak and unstable area,” endangering U.S. security and prosperity.3



While health, foreign policy, and diplomacy, therefore, have been linked over time in U.S. policy, the more contemporary and explicit use and application of “health diplomacy” as a concept and pursuit has its roots in the Carter administration. In 1978, the administration released a landmark report on the role of international health in U.S. diplomacy titled New Directions in International Health Cooperation. 37 At that time Peter Bourne, a special assistant to President Carter for health, wrote that U.S. support for international health “can be a basis for establishing dialogue and bridging diplomatic barriers”, and used the term “medical diplomacy” to describe such activities.38 The administration advocated for greater U.S. engagement in this area, highlighting the contributions they could make to furthering U.S. interests and achievement of foreign policy goals.

U.S. public health policies are inherently diplomatic engagement in practice in both means and ends


KFF '12 (KFF, policy briefs on U.S. global health policy, "RAISING THE PROFILE OF DIPLOMACY IN THE U.S. GLOBAL HEALTH RESPONSE: A BACKGROUNDER ON GLOBAL HEALTH DIPLOMACY", Kaiser Family Foundation, September, https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8360.pdf)

U.S. support for international health programs grew dramatically after 2000, through newly created international assistance programs such as the multilateral Global Fund to Fight AIDS, Tuberculosis, and Malaria, which the U.S. helped to establish in 2002, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), created in 2003, along with a new Office of the Global AIDS Coordinator located within the State Department to oversee U.S. global AIDS efforts, and the U.S. President’s Malaria Initiative, launched in 2005. Such efforts channeled significantly increased financial assistance into global health, described by policymakers as important not only because they addressed pressing humanitarian needs abroad, but also because they served U.S. national interests and foreign policy objectives in a variety of ways (see Box 2, next page).44 Diplomatic engagement is an important component of putting programs into practice, because they involve negotiation with recipient country governments, other donors, and additional partners. PEPFAR, in fact, engages in a formal process of negotiating annual Country Operational Plans45 and five-year Partnership Frameworks with country recipients of assistance.

The U.S. has also engaged in global health diplomacy in response to crises or specific health-related issues. For example, U.S. diplomats played an important role in the international effort mounted in response to the cessation of polio vaccination in Northern Nigeria in 2003, a situation which placed the global campaign to eradicate polio in jeopardy.48 Likewise, U.S. representatives were involved in the diplomatic effort to reach an agreement with Indonesia regarding that country’s refusal to share samples of H5N1 influenza starting in 2006.49 Current U.S. guidance and strategy documents continue to emphasize the benefits of global health engagement and global health diplomacy. The latest National Security Strategy declares the U.S. has a “moral and strategic interest” in advancing global health. In the first ever “Quadrennial Diplomacy and Development Review” (QDDR, released in 2010), the State Department provided a blueprint for “elevating American ‘civilian power’ to better advance U.S. national interests, focusing on the role of both diplomats and development experts. Health is identified as one area that bridges both diplomacy and development. As stated in the QDDR, “we invest in global health to strengthen fragile and failing states, to promote social and economic progress, to protect America’s security, as tools of public diplomacy, and as an expression of our compassion.” A key actor identified in the QDDR for carrying out development and diplomacy is the U.S. Ambassador in country.

Global health policy has become a cornerstone in diplomatic U.S. efforts


Global Health Council ND (a United States-based non-profit networking organizing linking "several hundred health non-governmental organizations, "U.S. GLOBAL HEALTH DIPLOMACY AND THE ROLE OF AMBASSADORS", Global Health Council, globalhealth.org/event/u-s-global-health-diplomacy-role-ambassadors/)

In recent years, the U.S. government has increasingly made global health issues a key element of its diplomatic efforts – most notably in the creation of a new Office of Global Health Diplomacy at the State Department in 2013, which includes a goal of supporting U.S. Ambassadors and embassies to enhance the focus on global health as part of their diplomatic engagement. How does diplomacy intersect with global health, and how is the new focus on global health diplomacy reshaping the work of U.S. Ambassadors with partner countries? How does this new office relate to and coordinate with other parts of the U.S. government’s global health architecture and foreign policy?


Public health is an important discussion on the topic of foreign policy


Lim and Blazes '15 (Matthew Lim and David Blazes, Matthew Lim is an infectious diseases physician who has been assigned to the U.S. Department of Defense’s HIV/AIDS Prevention Program and served as a liaison officer working with the World Health Organization, David Blazes is an infectious diseases physician who has been assigned to the USNS Comfort and the Navy research laboratory in Peru and directed the U.S. Department of Defense’s Global Emerging Infections Surveillance program, , “Collateral Duty Diplomacy”, U.S. Department of Defense and Global Health Diplomacy, September 21, www.sciencediplomacy.org/article/2015/collateral-duty-diplomacy)

In a world of increasingly diverse and complex actors, political forces, and transnational issues, global health diplomacy is emerging as an important arena of international relations across societal groups, including the education, policy, research, operational, and response communities. In the past, health as a foreign policy matter was largely seen as a charitable humanitarian concern or, in the case of infectious diseases, an issue primarily of quarantine laws and border inspections. By the turn of the twenty-first century, however, improving health at national and global levels increasingly became a foreign policy goal in its own right, as well as a vehicle for other foreign policy interests. Various trends contributed to this change: the globalization of travel and trade and the correspondingly increased risk of transnational epidemics; the recognition of the importance of health as a driver of economic development; and the belief that health, as an agent of “soft power,” was a means to affect political agendas. Health as a soft power tool seemed particularly attractive and relevant in developing world settings where poor health and other fragile elements of human security might abet the growth of violent extremism. Internationally, the significance of health as a foreign policy priority was highlighted by events such as the Oslo Ministerial Declaration on health and foreign policy in 2007, signed by the ministers of foreign affairs of seven developed and developing countries, as well as real-world crises such as the 2005 Boxing Day tsunami, the 2009 H1N1 influenza pandemic, and the thirty-year global struggle against HIV/AIDS. In recent years the concept of “health security,” whether as an aspect of development, emergency preparedness, or a distinct set of emerging threats and vulnerabilities, has underscored the close linkage between improved health and improved security at local, national, regional, and global levels. In 2014 the Obama administration launched the Global Health Security Agenda, a partnership of more than forty nations committed to accelerating progress in preventing, detecting, and responding to outbreaks of infectious disease of natural, accidental, or deliberate origin.


Engagement consists of health diplomacy interactions between governments


Lim and Blazes '15 (Matthew Lim and David Blazes, Matthew Lim is an infectious diseases physician who has been assigned to the U.S. Department of Defense’s HIV/AIDS Prevention Program and served as a liaison officer working with the World Health Organization, David Blazes is an infectious diseases physician who has been assigned to the USNS Comfort and the Navy research laboratory in Peru and directed the U.S. Department of Defense’s Global Emerging Infections Surveillance program, , “Collateral Duty Diplomacy”, U.S. Department of Defense and Global Health Diplomacy, September 21, www.sciencediplomacy.org/article/2015/collateral-duty-diplomacy)

There is no single definition of “health diplomacy.” One commonly cited characterization is political action that simultaneously advances public health as well as relations between states.2 Katz et al.3 propose three levels of health diplomacy: “core” (interactions between governments); “multistakeholder” (interactions involving governments and multilateral institutions, in support generally of transnational and “polylateral” agendas); and “informal” (engagements at the technical or program level among actors in health). In this model, the DOD has no specific mandate to engage in “core” or “multistakeholder” diplomacy by representing, per se, the U.S. government. However, its extensive activities in “informal” diplomacy have ramifications across all three levels as well as engagements beyond the health arena. This accords well with the DOD’s self-identification as a “supporting, not supported” global health actor: the U.S. military’s global health engagements are not derived from the pursuit of global health as a good endeavor in its own right, but as complementary to the primary purpose of defending U.S. national interests. As such, there is not an overarching “health goal” that governs U.S. military health diplomacy efforts. Instead, each institution, program, or mission is justified with reference to a U.S. military strategy or priority beyond the health domain.

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