Research Article: Can Foreign Policy Make a Difference to Health?

Date Published: May 11, 2010

Publisher: Public Library of Science

Author(s): Sigrun Møgedal, Benedikte Louise Alveberg

Abstract: As part of the PLoS Medicine series on Global Health Diplomacy, Sigrun Møgedal and Benedikte Alveberg provide a diplomatic perspective on how foreign policy can make a difference to global health challenges.

Partial Text: In 2006 seven foreign ministers from Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand initiated a dialogue on the inter-linkages between health and foreign policy, with a focus on how health matters to foreign policy and whether foreign policy can make a difference to health. What brought the ministers together was the realization that the state of global health has a profound impact on all nations and is deeply interconnected with trade and environment, economic growth, social development, national security, human rights, and dignity. These are challenges that go beyond the scope of ministries of health, and represent areas for which WHO (as the UN specialized agency for health) must have broader political support from member countries. Based on the ministers’ analysis, the Oslo Ministerial Declaration in 2007 stated a commitment to “make impact on health a defining lens that each of the countries would use to examine key elements of foreign policy and development strategies” [1]. The ministers also decided to engage in a dialogue on how to deal with policy options from this perspective.

While the international audience has been receptive to the “health in foreign policy” agenda, it has been harder to mainstream the awareness of the “impact on health” across the key elements of foreign policy and development strategies within the ministries of foreign affairs. Such awareness is critical for building new practices, sustaining the attention of ministers, and generating the necessary momentum for their political leadership. While the core group of countries is like-minded in terms of the purpose of their mutual engagement, they are obviously different in perceptions, priorities, and preferences, which in itself represents the very potential of such an initiative. The work of the Oslo group up to the present time shows that the health impact of foreign policy decisions needs further research. It must be better understood, assessed, and accounted for, and include the challenges of competing interests across different policy areas, within a government as well as across countries and regions.

Combined, these developments demonstrate that foreign policy is becoming increasingly relevant to health and that health as a shared interest can help create alliances and build bridges in international relations. As argued by Feldbaum and Michaud in their PLoS Medicine article “Health Diplomacy and the Enduring Relevance of Foreign Policy Interests” [3], foreign policy challenges in the health domain have increasingly moved into the “high politics” arena. Health challenges to foreign policy now cover the whole spectrum of security, economic interest, development, and dignity. This complexity of arenas and policy domains illustrates the need for transparency in dealing with the challenges of policy coherence on the one side and pragmatic issue oriented solutions on the other. A health-responsive foreign policy can succeed only if the overarching aim is to maximize the positive impact on public health and health security and this impact is monitored and brought into policy dialogue and negotiations.

The close relationship between foreign policy and global health and their interdependence were recognized by all the member countries of the United Nations in the first UN General Assembly resolution on global health and foreign policy in 2008 [4]. The resolution asked the Secretary-General to recommend challenges, activities, and initiatives related to foreign policy and global health in close collaboration with the Director-General of the World Health Organization. With inputs from member country consultations, the result was a comprehensive report [5] that in many ways represents a breakthrough and makes the case for broadening the scope of foreign policy to include health. It identifies key health-related challenges that must be addressed by foreign policy makers to improve collective action to achieve global health outcomes. It also points to key foreign policy issues affecting global health and the need to improve the understanding of health implications of policies adopted in the non-health sectors. In response to the report, a second resolution [6] gave concrete and specific focus to some selected policy areas of immediate relevance to ongoing negotiations, such as pandemic influenza preparedness, access to medical products, and human resources for health.

It is increasingly clear from the ongoing work of WHO that foreign policy processes must be made to work for overcoming structural and policy-based barriers to achieving public health outcomes and global health security. The recent WHO negotiations for a global strategy and plan of action on public health, innovation, and intellectual property (WHO Public Health, Innovation and Intellectual Property Intergovernmental Working Group, WHO-PHI-IGWG), the pandemic influenza preparedness (WHO Pandemic Influenza Preparedness Intergovernmental Meeting, WHO-PIP-IGM), and the WHO process towards a global code of practice for international recruitment of health personnel together illustrate the complexity of these barriers, as is also pointed out by David Fidler in his PLoS Medicine article “Negotiating Equitable Access to Influenza Vaccines: Global Health Diplomacy and the Controversies Surrounding Avian Influenza H5N1 and Pandemic Influenza H1N1” [7].

Preventing, dealing with, and resolving conflict are well-established parts of a security and peace agenda and central to foreign policy. In a post-conflict situation, national capacity for safeguarding life and health of individuals and communities is recognized as basic to creating stability, good governance, and protection of human rights. Resilience—the ability to cope with and re-establish access to health and social services after crises, emergencies, and conflicts—depends heavily on the pre-conflict/crisis institutional capacity. It is now widely acknowledged that health indicators, such as infant mortality, are useful proxy indicators for local and national stability. Investing in capacity for protecting health and responding to health needs can therefore be understood as an investment in stability. Tensions still exist over the best ways to protect the “humanitarian space” in conflict and post-conflict situations and approaches to the transition from a humanitarian response to development under national leadership. While each situation needs to be understood in context, these are policy areas that call for more attention by all actors, including the need for a stronger evidence base and monitoring of health impacts. The 2010 review of the UN Peace-building Commission [9] may offer a concrete opportunity to apply a “health lens” to reconstruction and peace-building efforts and highlight the need for better evidence of impact, including the use of health indicators to measure and monitor progress toward peace and stability.

The 2009 report on “Global health and foreign policy: strategic opportunities and challenges” by the UN Secretary-General notes an urgent need to increase both the quantity and the quality of health information available to decision makers. If the impact on health is to be used meaningfully as a defining lens to examine key elements of foreign policy, the ability to collect the information, and incentives to act on it, are essential. This year, the review of the progress of countries and the international community to achieve the Millennium Development Goals will represent a major opportunity to examine impacts on health across policy domains, including policy coherence responding to public health objectives.

It is in the hands of member states to direct and enable WHO to undertake its normative and standard-setting functions effectively in facing the increasingly transnational nature of health threats, to be a trusted repository for knowledge and information, and to act as an effective convener of multiple players and stakeholders that can drive appropriate convergence, innovation, and effective decision making for health in a diverse landscape.