World Health Organization
منظمة الصحة العالمية
Organisation mondiale de la Santé

An initiative to leverage health diplomacy and leadership to urgently address threats to healthcare in the Eastern Mediterranean Region

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Editorial

Hanan Balkhy 1

1Regional Director, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Keywords: health diplomacy, health system, leadership, global health, Eastern Mediterranean

Citation: Balkhy H. An initiative to leverage health diplomacy and leadership to urgently address threats to healthcare in the Eastern Mediterranean Region. East Mediterr Health J. 2024;31(3):157–159. https://doi.org/10.26719/2025.31.3.157.

Copyright © Authors 2025; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

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a Leadership is about giving a sense of direction and needed energy to move ahead.

b Diplomacy is the art, science and means by which nations, groups or individuals conduct their affairs, in ways to safeguard their interests and promote their political, economic, cultural or scientific relations, while maintaining peaceful relationships. https:// www.cyber-diplomacy-toolbox.com/Diplomacy.html#:~:text=Diplomacy%20is%20the%20art%2C%20the,relations%2C%20while%20 maintaining%20peaceful%20relationships.

c EMR consists of 22 countries and territories expanding from Morocco in the west to Pakistan in the east. It is home to more than 730 million people, with 1 in 7 individuals as of January 2025 (one-third of those globally) being in need of acute humanitarian assistance – due to conflicts (in Afghanistan, Libya, the occupied Palestinian territory, Sudan, Syria and Yemen) and/or natural disasters, e.g. floods in Pakistan, Libya and Morocco; droughts in Djibouti and Somalia; and earthquakes (latest in Morocco and Syria).

When I became the Regional Director for the WHO Regional Office for the Eastern Mediterranean in February 2024, I took on the immense dual responsibility of ensuring that the people of this region attain the highest standard of physical, mental and social wellbeing, while also amplifying the voices of the region in global health debates. From day one, my team and I began crafting an ambitious Regional Strategic Operational Plan 2025–2028, featuring 3 flagship initiatives (1,2), while engaging political and public health leaders at national, regional and global levels.

Successfully achieving the health goals while positioning health in the political sphere requires strong leadership a and diplomacy b. This editorial highlights the importance of global health diplomacy and leadership in advancing health priorities in the Eastern Mediterranean Region (EMR). It introduces a new programme designed to equip policymakers with the skills to navigate health diplomacy effectively.

The need for leadership and diplomacy in EMR

EMR comprises 22 countries and territories c with vast geopolitical and socioeconomic diversity. Several of the countries are in conflict or facing economic and diplomatic sanctions (3). The region hosts more than 58% of refugees and more than 40% of internally displaced persons globally (4). Almost two-thirds of the population lacks full coverage of essential health services, and 1 in 8 people face financial hardship due to out-of-pocket healthcare costs (5). Disease outbreaks have been increasing―from 31 outbreaks in 2021 to 80 in 2024―as many countries experience demographic and epidemiologic transitions (6), including ageing populations, increasing burden of noncommunicable diseases and polio endemicity. A lack of political will to translate health-related commitments into action has hindered progress, indicating the need for leadership capacity-building in healthcare.

However, there is also progress. Many countries are prioritizing health in their constitutions and political agendas. The high- and middle-income countries are transforming their health systems towards more equity, efficiency and sustainability. Examples include Saudi Arabia’s Health Sector Transformation Programme 2030, Egypt’s Universal Health Insurance programme, and the expansion of primary health care in the Islamic Republic of Iran (7–9). Several of the fragile and conflict-affected countries are on the path to recovery from long-term conflicts, leveraging the humanitarian-development-peace nexus. EMR countries are also increasingly participating in regional and global fora that aim to advance global health priorities. Effective participation in these discussions requires diplomatic competencies.

Public health: a political imperative

Public health is no longer just a specialty, it is deeply intertwined with geopolitics and diplomacy. It increasingly involves diverse stakeholders, where politics and science converge. High-level meetings of the United Nations General Assembly (UNGA) in the last two decades have addressed a wide spectrum of health priorities―from infectious diseases (HIV/AIDS in 2001) to health security (health emergency preparedness and response in 2023), to major development imperatives (UHC in 2023) (3). Decisions at UNGA highlight the responsibility of the health sector in positioning health as part of a country’s foreign policy (10). There is also a growing recognition of the need to address the social determinants of health through “Health in All Policies”, as well as the vital role of partnerships with civil society and the for-profit sector (11,12).

Global health diplomacy and leadership in EMR

WHO has a longstanding tradition of building leadership capacities in public health for mid-level managers, with a focus on the health sector (15). As health becomes increasingly complex, a distinct set of leadership competencies is required for leaders, to ensure progress on the global, regional and national health goals. That is why I am launching a Global Health Diplomacy and Leadership (GHD&L) programme for policymakers in health and related sectors. The programme addresses issues that transcend national boundaries and require collective action (13,14). It aims to enhance the diplomatic and leadership skills of high-level representatives of EMR Member States, so that they can have a greater influence on the global health agenda and better advocate for regional and national priorities. It also seeks to build competencies in the implementation of national priorities that require multisectoral action, and in leveraging the interface between domestic and foreign policy in relation to health priorities. Participants will learn how to harness diplomacy for the improvement of health domestically and globally.

A tailored approach

Most public health training programmes focus on the acquisition of technical public health skills. GHD&L is designed for ministers of health and high-level health officials, ministers from related sectors (e.g. foreign affairs, economy, labour and social affairs), ambassadors to the United Nations, and health attachés. The programme will equip EMR representatives to the WHO governing bodies with the required skills to effectively position our region in discussions. It will empower EMR Member States to apply the skills they have acquired to negotiations at regional and global meetings, including those of the League of Arab States, the Gulf Cooperation Council, the World Bank, International Monetary Fund, United Nations, and the G20.

The way forward

In the post-pandemic world, investing in health is central to economic development (15). Dr Tedros Ghebreyesus, WHO Director-General, has highlighted that “the best vaccine is peace” (16). As the geopolitical context increases in complexity, EMR Member States must become strong health advocates and actors for their people. Through GHD&L, we aim to position health as a driving force for promoting and advancing peace in the EMR.

References

  1. World Health Organization. Strategic operational plan for the Eastern Mediterranean Region, 2025–2028. Cairo: WHO Regional Office for the Eastern Mediterranean, 2024. https://applications.emro.who.int/docs/Strategic-operational-plan-eng.pdf.
  2. World Health Organization. Related to expanding equitable access to medical products, investing in a resilient health work- force and accelerating public health action on substance use. Cairo: WHO Regional Office for the Eastern Mediterranean, 2024. https://www.emro.who.int/about-who/regional-director/flagship-initiatives.html.
  3. Pintor MP, Suhrcke M, Hamelmann C. The impact of economic sanctions on health and health systems in low-income and middle-income countries: a systematic review and narrative synthesis. BMJ Glob Health 2023;8(2):e010968. doi: 10.1136/bm- jgh-2022-010968.
  4. World Health Organization. Refugees and internally displaced persons in the Eastern Mediterranean Region: a health perspective. Cairo: WHO Regional Office for the Eastern Mediterranean, 2021. https://www.who.int/docs/default-source/documents/publications/refugees-and-migrants-eastern-mediterranean-region-a-perspective.pdf.
  5. World Health Organization. Universal Health Coverage Day 2024: WHO urges governments to prioritize financial protection for health. News, 12 December 2024. https://www.emro.who.int/media/news/universal-health-coverage-day-2024-governments-urged-to-prioritize-financial-protection-for-health.html.
  6. World Health Organization. Multi-country outbreak of cholera. External Situation Report No. 22, 24 January 2025. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20250110_multi-country_outbreak-of-cholera_sitrep--22.pdf?sfvrsn=568bfb6d_3&download=true.
  7. Saudipedia. Health sector transformation program. Jeddah: Saudi Arabia Ministry of Media, n.d. https://saudipedia.com/en/article/361/government-and-politics/vision-2030/health-sector-transformation-program#:~:text=The%20Health%20Sector%20Transformation%20Program%20aims%20to%20align%20with%20Saudi,%2C%20efficiency%2C%20and%20patient%20satisfaction.
  8. Sadoun A, Elsaid D, Mohamed A. Egypt’s universal health insurance system: Strategies for sustainability. Zagazig University Medical Journal, 2025; 31(1): 165-171. doi: 10.21608/zumj.2024.313585.3538.
  9. Takian A, Bakhtiari A, Tabrizi JS, Raoofi A. The Islamic Republic of Iran: a primary health care case study in the context of the COVID-19 pandemic. Geneva: World Health Organization, 2022. https://iris.who.int/bitstream/handle/10665/366316/9789240063761-eng.pdf?sequence=1.
  10. Labonté R, Gagnon ML. Framing health and foreign policy: lessons for global health diplomacy. Global Health 2010;6:14. doi: 10.1186/1744-8603-6-14.
  11. Odile Frank. High-Level Commission on Health Employment and Economic Growth. Geneva: Geneva Global Health Hub, n.d. https://g2h2.org/posts/comheeg/.
  12. World Health Organization. Commission on Social Determinants of Health in the Eastern Mediterranean Region. Build back fairer: achieving health equity in the Eastern Mediterranean Region: Report of the Commission on Social Determinants of Health in the Eastern Mediterranean Region – executive summary. Cairo: WHO Regional Office for the Eastern Mediterranean, 2021. https://applications.emro.who.int/docs/9789290224976-eng.pdf?ua=1.
  13. Kickbusch I, Liu A. Global health diplomacy—reconstructing power and governance. Lancet 2022;399(10341):2156-2166. doi: 10.1016/S0140-6736(22)00583-9.
  14. Ruckert A, Labonté R, Lencucha R, Runnels V, Gagnon M. Global health diplomacy: a critical review of the literature. Soc Sci Med. 2016 Apr;155:61-72. doi: 10.1016/j.socscimed.2016.03.004.
  15. World Health Organization. Macroeconomics and health: Investing in health for economic development. Report of the Commission on Macroeconomics and Health. Geneva: World Health Organization, 2001. https://apps.who.int/iris/bitstream/10665/42435/1/924154550X.pdf.
  16. World Health Organization. Health diplomacy. Cairo: WHO Regional Office for the Eastern Mediterranean, n.d. https://www. emro.who.int/health-topics/health-diplomacy/index.html.