Nations have long recognized the central importance of health security to national security, and over the centuries have often implemented actions to try to ‘stop’ diseases at borders, for example through measures of quarantine. In more recent years they have begun to recognize that health security is more than a national concern – it is a global issue affecting not only countries, but also a range of national industries and international corporations. This illustrates the increasing link between domestic and foreign policy.
In recent decades, global public health approaches have focused on diseases, care, prevention and research and monitoring. In an era of globalization and geopolitical shifts, new dimensions of the links between health and security are now coming to the fore. All countries, regardless of income or level of development, face systemic risks, such as disease outbreaks, with the potential for very significant impact on health, tourism, trade, exports and international relations. Emerging infections and biological risks are not the only area of concern; other hazards, such as chemical and radiological hazards, are equally important and are increasingly covered by a range of international instruments, frameworks and agreements. For infectious diseases and food-borne diseases these include the Pandemic Influenza Preparedness Framework, the Codex Alimentarius and the International Health Regulations (2005). The anticipated adoption of the Convention on Biological Diversity will also have implications for health security.
It is crucial that diplomats in all countries understand the significance of international health agreements and the compliance with international law that follows. It is essential that nations take their commitments and the implementation of such agreements seriously to maintain both global and national health security. It is crucial that foreign policy is well informed about anticipated risks, such as the growing threat to global health security of infections, disease outbreaks and antimicrobial resistance. Foreign policy must increase its role, along with other sectors and ministries, in advocating for and engaging in an all-hazard approach to health security.
How foreign policy can contribute to health diplomacy
Central to the seminar was a panel discussion of senior diplomats on how foreign policy can contribute to health diplomacy. They agreed that there is a need for broader engagement of the countries of the Region in strengthening the interface of health and foreign policy, both within and across countries, with the support of WHO. This may mean the involvement of other ministries, in particular the ministries of finance, as well as the involvement of other stakeholders, such as the private sector and nongovernmental organizations. The goals of the process of engagement need to be clear, and transparency and accountability need to be ensured.
Experience shows that time invested in developing intersectoral cooperation can bring major benefits but it requires the building of institutions and capacity. Several key points were highlighted by the ambassadors.
Strengthening health diplomacy will depend on strong leadership and political commitment that positions health higher on both the political agenda and the development agenda. This can include heads of government who can be instrumental in taking health issues forward, helping set the agenda and strategic goals, and making political space and resources available.
Broader engagement between countries would strengthen their ability to evolve common positions and thus strengthen their responses, not only on health issues, but also on issues that impact on health, such as nutrition, food and access to medicines and technologies. It would also encourage countries to share best practices and capabilities and to pool technical and other resources and capacities, rather than looking outside the Region, which is costly and often faces obstacles.
While foreign policy has much to contribute to health diplomacy, so health itself supports many goals of foreign policy. Including health diplomacy in the training of diplomats and strengthening the dialogue between diplomats and health professionals will significantly help to strengthen health diplomacy. Such a dialogue can also help to avoid the disconnect between agreements reached in different international forums, and ensure that health impact becomes a key consideration in all negotiations.
Diplomacy should not be used to serve interests detrimental to health, nor should health be used as a political tool at the cost of the lives of people. However, health can be a bridge for peace, bringing significant benefits to crisis situations, diffusing tensions and helping to create positive environments for political dialogue. Health diplomacy can also contribute to the re-building of health systems by emphasizing the importance of universal health coverage for sustainable, equitable development.
Health diplomacy contributes to relationship building. It can help overcome obstacles and be a cross-cutting catalyst for many initiatives. It can create help develop community trust, create and coordinate response, improve access and create an atmosphere for engagement, while ensuring harmony with regional cultures.
Health diplomacy can raise awareness that health is not just a national issue but has many global and trans-boundary dimensions and can significantly contribute to global public goods and people’s welfare all around the world. It responds to the fact that many of the health challenges of the 21st century will require solutions that will be political rather than technical.