303 - Global Health Diplomacy

Objectives

• Global Health Diplomacy
• IR Theory & Global Health
• Rationalist, Liberal & Critical
• History of Global Health Governance
• Phases & Approaches

Global Health Diplomacy

"In the past it was enough for a nation to look after itself. Today it is no longer sufficient."

- Robert Cooper, EU Diplomat

Challenges recognized:

• Original IHRs (1903): limited to reporting of cholera, plague and yellow fever
• Developed countries believe infectious disease health problems to be solved
• Malaria eradication fails
• Previous "top-heavy" & vertical models were failing
• Need for a societal / horizontal approach
• New advocates within WHO and from NGOs arise

Primary Health Care (PHC)

"Declaration of Alma-Ata"

• Taken in 1978 in Russia
• Health for All by 2000
• health as a human right
• recognizes economic inequality as cause of poor health
• advocates a horizontal approach to healthcare
• addresses root causes

Overarching Themes

• Appropriate technology
• Avoiding medical elitism
• Health as a tool for development

Selective Primary Healthcare (SPHC)

“Health and Population in Development” (1979)

• Led by UNICEF, World Bank & Rockefeller Foundation
• Introduce low-cost, efficient methods for preventing disease
• Meant to be quantifiable, provide fast results

Why reform?

• budgetary issues
• health justice movements
• failures: SARs, H1N1, Ebola

Critical Approaches to Global Health

Defined: a form of violence wherein some social structure or social institution may harm people by preventing them from meeting their basic needs

Systemic Problems:

• Racism
• Sexism
• Gender Inequality
• Slavery
• Colonialism
• Neoliberal Globalization

From Sanitation Conferences to Global Health Policy

Global Public Health Diplomacy

4 Stages of Contemporary Health Governance

GOBI-FFF

G - Growth monitoring

O - Oral Rehydration Therapy

B - Breastfeeding

I - Immunizations

"Organizational Study on the Methods of Promoting Development of Basic Health Care Services"

F - Family Planning

F - Female Literacy

F - Food Supplementation

Getting the Difference....

IR 303 - Shannon Gibson, PhD

"Health for All by the Year 2000"

WTO & TRIPS

1. Technical Matters (1948-1970s)

• vertical, narrow
• political

2. Humanitarianism (1970s-1980s)

• health equity

3. Neoliberalism (late 80s-mid 90s)

• market logic, privitization
• budget issues

4. Institutionalism (late 90s-today)

• reform
• public-private partnerships

The State of Contemporary

Health Governance

Linking International Relations with Health

"Realist / Statist"

"Rationalist / Globalist"

Globalist

• assumptions
• telling of history
• motivations
• solutions

• Polycentric
• Distributed / Competing
• Challenged by politics
• Challenged by economics
• No longer disease-oriented

Statist

Structural Violence

How do "GPH" Issues alter Traditional Diplomacy?

Critiques

Paul Farmer

Early Health Governance: 1851 - 1897

• increase in agreements on "soft issues"
• also elevates "soft issues" as they now have ramifications for state security
• from "international" to "global health" - also highlights its multi-sectoral nature
• is a more technical world - how to balance science with foreign policy interests?
• health diplomacy has institutionally

"the pathways of infection correspond to the system of human communication"

Minimal PHC Provisions

Statism

• "Securitization" skews priorities
• Leads to conflict
• Ignores necessity for cooperation

Globalism

• Very broad
• Not empirically proven
• Naive

1. Education about diseases and their control

2. Promotion of food and proper nutrition

3. Safe water and basic sanitation

4. Maternal & child care

5. Immunization against major IDs

6. Prevention/control of local endemic diseases

7. Treatment of common disease/injury

8. Provision of essential drugs

• First International Health Conference = 1851
• First Global Health Convention = 1892
• Challenges
• State self-interest (Britain)
• Lack of knowledge (Contagionists vs. Anticontagionists)
• Trade tended to trump health
• Legacy = played a major role in creation of WHO in 1948