Framing health and foreign policy: lessons for global health diplomacy

Abstract

Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized 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 conceptualized. 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.

Politics, Power, Poverty and Global Health: Systems and Frames

“…47 It is surprising that a social constructivist approach, based on a combination of ideational considerations and material conditions, yields such a restricted range of frames as they describe. This shortcoming can be attributed to the fact that such frames, like those proposed by others, 48,49 have been developed only from the perspective of the dominant belief system within a social world where the privileged minority lives with high consumption patterns in what has been called a 'market civilization' ideology. 42 Such a belief system, presumed to be universal, underplays the pathophysiology and effects of the exploitation and discrimination associated with the materially impoverished lives of billions of people, and ignores the varied alternative belief systems within which other ideational biases could arise.…”

A internacionalização da saúde: elementos contextuais e marcos institucionais da cooperação brasileira

“…Assim, ao defender seus princípios, a reforma da saúde, no Brasil, Ao Ministério da Saúde, haveria a possibilidade de divulgar a proposta doutrinária e organizacional de seu sistema de saúde, tendo em vista o reconhecimento internacional da experiên-cia brasileira como uma política social modelar. Essa percepção se alinhava às orientações mais recentes da política externa brasileira, que conferia especial atenção à formação de blocos de aliança, nos marcos da Cooperação Sul-Sul, em particular com os países africanos de língua oficial portuguesa; com os países vizinhos latino-americanos; e com países da iniciativa IBAS (Índia-Brasil-África do Sul) (5 …”

Aid Effectiveness in the Health Sector

“…Differences in funding are also observed amongst the goods and services that are funded; for instance, more funding is allocated to the procurement of drugs than to human resources or infrastructure (Juliet et al 2009). Analysis of OECD Creditor Reporting System data shows the prominence of HIV funding, but also recent increases in broader health systems priorities: (Labonte and Gagnon 2010); for instance, to control infectious diseases that pose a threat to donors' national security (Shiffman 2006a;Shiffman et al 2002). In addition, there is some evidence that priorities are set to serve the interest of donor countries' foreign policy and trade agenda (Feldbaum and Michaud 2010).…”