Global Health Diplomacy

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Global Health Diplomacy

• A tide that should lift all boats
• Jaime Sepulveda
• UCSD March 11-13th, 2007

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Outline

• In search of definitions
• Historical perspectives
• Case examples
• Vertical vs. Horizontal?
• Conclusions

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Definitions

• Public Health
• International Health
• Global Health
• Health Diplomacy
• Ideal vs. Real

Global health
Public health
Health diplomacy
Intl health
International relations
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Globalization and healthHistorical Perspective

• Citizen of the World coined by Greek
  philosopher Diogenes (IV b.C.)
• Plague in Europe in XIV Century (international
  transfer of risks due to trade)
• Conquest and Colonization of America
• Seven Cholera Pandemics
• Today 3 million international travels p-d 1
  billion internet users
• Knowledge (international transfer of
  opportunities)

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Influence
PAHO
New Bilateral initiatives USA, UK, Scandinavia
WHO
U.S. bilateral initiatives
1900
1950
2000
Rockefeller Foundation
Gates Foundation
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Private foundations
Bilateral actions
Bilateral actions
Multilateral organizations
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Case Examples

• Rockefeller Foundation
• Cuba Venezuela
• PEPFAR

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Rockefeller Foundation

• Founded in 1913 to promote well being of
  mankind through IHD
• Privileged technological over social measures
• Hookworm germ of laziness
• Public Health Schools (Hopkins, Harvard, Mexico)
• RF was US Int Health arm for 30 yrs. (goodwill
  instead of gunboat diplomacy)

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Cuba and Venezuela

• Cuba has one of the best public health systems
  and impressive health indicators
• IMR 5.6 e0 77 yrs 1 MD x 159 pop
• 10,000 medical students from 27 countries
• 70 countries have Cuban doctors (30,000 just in
  Venezuela Oil for MDs interchange)
• Brilliant diplomatic tool and economic source
  (2.4 billion USD)

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PEPFAR

• The U.S. President's Emergency Plan for AIDS
  Relief (Emergency Plan/PEPFAR) is the largest
  commitment ever by any nation for an
  international health initiative dedicated to a
  single disease-- a five-year, 15 billion,
  multifaceted approach to combating the disease
  around the world.

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Emergency vs. Sustainabilitythe case of PEPFAR
Top Down
North
South
Building Up
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Two schools of thought on Health Interventions
Scandinavian
North American
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DIAGONAL APPROACH

• Vertical programs versus horizontal programs?
  false dilemma,
• A diagonal approachthat is, the proactive,
  supply-driven provision of a set of highly
  cost-effective interventions on a large scale
  that bridges health clinics and homes.

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Asymmetries in Global Health

• Rich -gt Poor
• Poor -gt Poor (South South)
• Poorer -gt Richer (Mision milagro)

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Conclusions

• Global Health International transfer of risks
  and opportunities (health interdependence)
• Health in Diplomacy means or end?
• New money from Private Foundations welcome
• Multilateralism needs another chance
• New approaches to strengthen health systems
• Health Diplomacy is an exciting and necessary
  component of Global Health