Research Programme on Global Health Diplomacy

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Research Programme on Global Health Diplomacy

• Richard Smith and Kelley Lee
• Department of Global Health and Development

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BACKGROUND

• As part of the Bellagio Dialogues of 2009
  establishing GHD.net, a series of six papers were
  commissioned which concerned the scope of GHD and
  the associated research agenda that may be
  developed, synthesized in
• Smith RD, Fidler D, Lee K (2009). Global Health
  Diplomacy Research. Trade, Foreign Policy,
  Diplomacy and Health Draft Working Paper Series,
  World Health Organization

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GHD.Net research mission

• GHD.Net shall engage in and disseminate research
  on all facets of GHD in order to deepen
  understanding about the problems addressed, the
  players involved, and the processes utilized.
• GHD.Net shall facilitate research on issues and
  challenges facing developing and least-developed
  countries.
• GHD.Nets research activities will help identify
  the characteristics of health as a foreign policy
  and diplomatic issue and provide input for policy
  debates on how to improve the protection and
  promotion of health through foreign policy and
  diplomatic means

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SCOPE OF RESEARCH

• research agenda needed to understand four facets
  of GHD
• the topics to which GHD is applied
• the actors involved in GHD
• the process of GHD
• the outcome of GHD

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KEY SYNTHESIS PAPER RECOMMENDATION

• support production of review papers
• specific issues in GHD highlighted by meetings
• reviews of diplomatic theory and how this might
  apply to health
• research methodology
• case-studies concerning a specific issue, focused
  on low- and middle-income countries, or regional
  context
• contribute to a special issue of a high profile
  journal

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PROJECT OVERVIEW

• 12-month project as initial stage of longer-term
  research programme
• outputs will be
• 6 case-study papers, 1-2 conceptual papers, 1 (or
  more) research proposal(s) for 3-5 years
• presented at two half-day conferences in UK
  (today!) and Asia (Singapore next week)
• possible special issue of a journal and/or a book
  based on the case studies and associated work

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PROJECT OBJECTIVES

• further the development of the conceptual and
  methodological basis of the term GHD
• conduct selected case studies which illuminate
  four specific facets of GHD as described above
• strengthen capacity to conduct research on GHD
  and, through collaborations, establish a wider
  collaborative research network within GHD.Net
• develop follow-on research proposal(s) for
  supporting the research stream of GHD.net to
  undertake further research, and in other regions

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CASE STUDIES

• 6 case studies, as identified through the GHD.Net
  Bellagio dialogue meetings in 2009, as key areas
  for exploration
• focus on Asia
• worlds largest and most populous continent
• fast-paced integration in the global economy
• emergence as key actor in international GH
• build on established links of LSHTM in Asia
• optimize comparative analysis across case studies
• maximize capacity building and networking efforts

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METHODOLOGY

• similar broad methodology specific variation
• systematic literature reviews (peerreviewed,
  grey literature etc)
• semi-structured in-depth interviews with key
  informants at domestic and international level
• recorded and transcribed
• review of official negotiating documents as
  available
• review by LSHTM research ethics committee

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CASE STUDIES

• ASEANs role in global health diplomacy
• Adam Kamradt-Scott
• Lessons from building Thailands capacity in GHD
• Suriwan Thaiprayoon
• Emerging role of China in health aid to Africa
• Yiding Jiang
• Chronic diseases and marketing to children in
  India
• Rachel Irwin
• Role of GHD in Taiwans bid to be observer in WHO
• Jonathan Herington
• Role of GHD in Indonesian virus sharing issue
• Rachel Irwin

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ASEANS ROLE IN GHD

• ASEANs primary focus is regional security ties
  and economic integration
• engaged to some extent in efforts to improve
  regional health since 1970s
• increased interest in health-related activities
  post-2003 (SARS)
• food security and safety, healthy lifestyles,
  easing trade and travel restrictions for TIHS
• mostly focused on communicable disease control
• reflects more conventional security concerns
  (maintain social and economic functioning) as
  much as health

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ASEANS ROLE IN GHD

• domestic political considerations and lack of
  trust impact on regional cooperation resulting in
  silo-style, nationally-focussed activities
• key strengths of ASEAN w.r.t GHD
• discussion forum, from high-level politicians to
  technical bureaucrats
• bridges HIC and LMIC otherwise divided between
  two WHO regional offices (WPRO and SEARO)
• challenges
• lack of trust
• lack of technical expertise (within the
  Secretariat) and capacity too many targets and
  objectives

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LESSONS FROM BUILDING THAILANDS CAPACITY IN GHD

• GHD requires stronger capacity at national level
  for
• health agencies to interact with the wider
  diplomatic community (often focused on trade and
  security)
• diplomatic organisations to understand and
  incorporate health concerns within wider remit
• Thai experience of TRIPS-plus negotiations with
  USA in 1990s led to MoPH forging greater
  engagement in the trade negotiation processes to
  address health concerns

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LESSONS FROM BUILDING THAILANDS CAPACITY IN GHD

• build capacity in strategic, systematic and
  formalised manner
• INNE Model Individual (International Health
  (IH) Scholar Program), Node (IHPP, Trade and
  Health Programme, etc), Network, Enabling
  environment
• mechanisms of collaboration among agencies should
  be institutionalised rather than ad hoc
• institutional mechanisms establish formal
  relationships, interagency cooperation via
  inter-agency committees, National Health Assembly
  (new multi-stakeholder forum)
• informal network and personal connection also
  essential within and between countries

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EMERGING ROLE OF CHINA IN HEALTH AID TO AFRICA

• expansion of aid programme to Africa since 1994
• natural resource-backed concessional loans to
  fund infrastructure built by Chinese construction
  firms (heavily tied aid)
• China Africa Policy (2006)
• long history of health diplomacy to Africa since
  1960s to build solidarity with developing world
• 20,000 medical staff treating 250 million
  patients by 2009
• construction of health infrastructure
• Chinese youth volunteers to Africa since 2007
• Chinese Navy medical ship launched in 2010 (500
  beds, 8 operating theatres)

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EMERGING ROLE OF CHINA IN HEALTH AID TO AFRICA

• early recognition of importance of soft power
  in foreign policy ( bottom up, solidarity with
  local people)
• opportunity for China as developing country to
  create new modalities of aid
• complex aid bureaucracy locates health aid as
  tool of foreign policy
• risks of scaling up African presence
• heavy emphasis on bilateral over multilateral
  channels adds to existing aid coordination
  problems
• founding principles of non-conditionality and
  self-reliance at risk if health diplomacy too
  closely tied to economic policies

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CHRONIC DISEASES AND MARKETING TO CHILDREN IN
INDIA

• agreements reached at international level (via
  GHD) need to be implemented at national level
• 63rd WHA (2010) adopted Set of Recommendations
  on the Marketing of Food and Non-alcoholic
  Beverages to Children
• member states to create policies to reduce
  marketing of fatty, sugary, salty foods to
  children
• appears as successful GHD (health interests
  over trade).. but is it?
• What happens at national level after negotiations
  conclude?

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CHRONIC DISEASES AND MARKETING TO CHILDREN IN
INDIA

• global versus national context
• obesity not main problem (2 children overweight,
  43 underweight) focus of problem among urban
  wealthy
• cultural factors make recommendations
  irrelevant as reflects Western view of
  problem and how to address
• role of non-government sector unappreciated
• India Pledge with companies vulunteering to
  market appropriately
• lack of coordination
• 6 government agencies deal with food and children
• NCD recently put agenda but lack of experience
  and resources
• global health diplomacy trumped by national
  health diplomacy

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ROLE OF GHD IN TAIWANS BID TO BE OBSERVER AT WHA

• Peoples Republic of China occupying UN seat
  since 1972
• Taiwan efforts to greater access to WHO since
  1970s
• KMT concerted efforts to gain observer status
  from 1997
• punctuated by SARS outbreak and IHR revision
  negotiations
• Taiwan health authorities attend 2009 WHA (as
  Chinese Taipei) for first time since 1971
• example of health diplomacy overcoming foreign
  policy goals?
• was it business as usual or a new form of
  diplomacy?

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ROLE OF GHD IN TAIWANS BID TO BE OBSERVER IN WHO

• international health actors and fora played role
  in applying political pressure
• health officials able to move more freely
• health became focus of political concern (SARS,
  IHR)
• BUT health arguments remain subordinate to
  traditional diplomatic concerns
• observer not member, and name of Chinese Taipei
  as compromise
• observer status renewable annually (subject to
  foreign policy decision)
• closely enabled by state of, and dependent
  on,Beijing-Taipei relations
• need to acknowledge role and limitations of GHD,
  and ensure engagement with traditional diplomatic
  practice to remove blocks to global health
  initiatives

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ROLE OF GHDIN INDONESIAN VIRUS SHARING ISSUE

• Global Influenza Surveillance Network (GISN)
  operated for 50 years
• countries share samples of viruses which are used
  by WHO to assess which strains pose most threat
  and recommend control and vaccine production
• 2007 Indonesia ceased sharing
• equity and affordability of vaccines
• accusations of threats to global health
  security
• IGWG/OEWG negotiation resulted in framework
  passed at WHA 2011

Indonesian Minister of Health Siti Fadilah
Supari, WHA (2007)
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ROLE OF GHDIN INDONESIAN VIRUS SHARING ISSUE

• reasons and context for GH issues on agenda
• breakdown of trust between Indonesia system
• role of individuals
• Siti Fadilah Supari (health minister) accused US
  of using samples to create biological weapons
• US Ambassador to the UN (Richard Holbrooke)
  stated not-sharing as morally reprehensible
• role of domestic context
• Internal politics and wider foreign policy
• highlight gaps in current system IHR, CBD

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KEY LESSONS 1

• domestic politics matters and shape GHD
  processes
• Marketing Food to Children in India
• Role of GHD in the Indonesian Virus Sharing Issue
• Lessons from Building Thailands Capacity in GHD
• The Emerging Role of China in Aid to Africa
• Global in GHD may distract us from domestic
  interests, aspirations, and perceptions which
  shape strategies
• need to align global with local to engage
  action

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KEY LESSONS 2

• Domestic institutional capacity shapes GHD
  strategies
• Marketing Food to Children in India
• The Emerging Role of China in Aid to Africa
• The Role of GHD in the Indonesian Virus Sharing
  Issue
• Need to institutionalise aspects related to wider
  global context within MoH and wider governmental
  system

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KEY LESSONS 3

• Importance of civil societys role in
  influencing/strengthening GHD processes
• The Role of GHD in Taiwans Campaign to Become an
  Observer in the WHO
• Marketing Food to Children in India
• Lessons from Building Thailands Capacity in
  Global Health Diplomacy
• Piggy-back on other issues
• Capacity building at local level

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KEY LESSONS 4

• analysis of GHD has to be undertaken over the
  long-term as causal processes are slow moving,
  entailing gradual institutional and policy
  shifts
• The Role of GHD in Taiwans Campaign to Become an
  Observer in the WHO
• Lessons from Building Thailands Capacity in
  Global Health Diplomacy
• The Emerging Role of China in Aid to Africa
• Role of GHD in the Indonesian Virus Sharing Issue
• Marketing Food to Children in India

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KEY LESSONS 5

• Impact of political regime will influence the key
  state actors and their relative involvement
• Lessons from Building Thailands Capacity in
  Global Health Diplomacy
• The Emerging Role of China in Aid to Africa
• Health officials and other departments can
  identify synergies and help each other make their
  arguments more persuasive when engaging in
  international negotiations
• rolling alliances built for specific purpose

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RESEARCH AGENDA 1

• need to understand more about domestic drivers
  for GHD
• role of GHD in international image building
• role of institutions in development of
  international agenda and engagement in GHD
• use of domestic political science
• origins of political, bureaucratic, and civil
  societal interests and commitment to GHD
• why and how nations craft new domestic
  institutions for international trade negotiations
• How do domestic politics shape global health
  negotiations?

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RESEARCH AGENDA 2

• What factors influence an issue being deemed a
  GHD issue?
• national security
• economic/financial impact
• morbidity/mortality
• How do global health issues relate to other new
  diplomacy issue areas?

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RESEARCH AGENDA 3

• Who engages in GHD?
• To what extent is there a set of actors in GHD
  distinct from global health?
• What is the relative power and influence of
  specific actors?
• Are GHD actors in Asia different from actors in
  other regions?

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RESEARCH AGENDA 4

• Where does GHD take place?
• What is the relative importance of formal versus
  informal settings
• To what extent is GHD integrated with other
  realms of diplomacy/foreign policy and hence
  venues
• How is the shifting balance of power in world
  politics affect GHD?

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RESEARCH AGENDA 5

• How can we judge successful GHD?
• How important has GHD been in facilitating
  agreement on global health issues requiring
  collective action?
• What factors influence the success or failure of
  GHD in facilitating collective action?
• What can GHD teach us about the challenges of
  strengthening collective action in an
  increasingly global world?
• What criteria are used to establish success and
  over what time period?

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NEXT STEPS

• Submissions to secure substantial future funding
  for GHD.Net research stream
• Significant expansion of GHD.Net collaborators
  across public health and international relations
• Enhancing capacity on GHD research
• Publication of case-studies and other papers
• So...over to you!

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