In this article, the author briefly examines various definitions of ‘global health diplomacy’ (GHD), reviews possible fundamental principles and discusses unresolved challenges. He argues that fundamental principles of GHD should include: ethical participation and decision making; human rights concerns and enforcements; rule of law and clear process for settling disputes; social determinants of health and how to mitigate their impact; shared bilateral and international interests and priorities; centrality of target populations and sensitivities to local customs, religions and social mores; research as part of efforts to expand the frontiers of the field; training and field experience for all practitioners; an understanding of political, policy making, advocacy and implementation issues in global health; globalisation and international trade issues; integration and mainstreaming of policies and programmes in the relationship between global health, bilateral diplomacy and multilateral development; and public/private/civil society partnerships and alliances. He identifies five challenges for GHD. The first challenge is to further develop the field of GHD as a discipline. The second challenge is how to harmonise the divergent orientation of public health experts, trained diplomats and development experts. Thirdly, stakeholders must ensure that global health diplomacy retains a significant focus on the needs of target populations around the world. Finally, stakeholders must find strategies to maintain the current non-partisan support of policy makers on global health issues over the long term.
Governance and participation in health
The author of this article argues that the emerging global health diplomacy movement points to the need for core capacities in the public health and diplomatic arenas. Among these are an understanding of international relations among public health professionals and greater recognition by diplomats of the population health outcomes of foreign policy. More specifically, the author notes that their training should include perspectives on globalisation, social determinants of health and cultural competence, macro-economics and political negotiation. Communities and citizens are often not considered in the formal policy arena but play an important role in meeting foreign policy goals and in cultivating trust and friendship across national borders, particularly in times of crisis and emergency. Future foreign policy and global health efforts need to ensure dialogue with affected communities and be more intentional in engaging and citizens groups in defining needs and goals. While it is likely that health security will remain a prominent rationale for developed countries to invest in global health initiatives, a the author concludes that more coherent approach to foreign policy and health diplomacy could result in better alignment between the health security goals of developed countries and health equity and development goals of developing countries, while at the same time recognising and channelling the growing financial and technical contributions of private citizens, companies and organisations.
In this interview, Lilian Celiberti of Feminist Dialogues reports that the World Social Forum (WSF), held in Dakar, Senegal from 6–11 February 2011, was an opportunity for a variety of activists and other civil society stakeholders to take part in discussions across varying perspectives and experiences. She highlights the strong and active participation of African women and youth, and the barriers of poor logistics and translation. She comments that the Declaration of the Women's Organisations was heavily focused on international conventions and UN-Resolutions, despite multiple tensions and conflicts amongst African groups and regions. She recognises that although interpersonal exchanges enable the deepening of debates, ‘colonisation continues in the divisions that we experience in different parts of the world’, and questions remain unanswered about how to develop collective thinking and solidarity in social movements.
In this assessment of the World Social Forum (WSF), which took place in Dakar, Senegal, from 6–11 February 2011, the author highlights an important trend in global activism: activists arrived already well prepared and networked among them and with local partners and with a key concern about further strengthening regional and global alliances on shared issues. Those convergences, at the heart of WSF’s mission, proved exceedingly successful, beyond activists’ expectations even, and for some seem to indicate a clear trend towards consolidation of struggles at the global level. The convergence of the Assembly of Social Movements, a regular event at the forums since the first edition, saw the participation of thousands of activists from all around the world. The success of the assemblies moved in the direction of addressing some of the long standing concerns of some WSF organisers and critics, namely the fragmentation of the programme and the atomisation of the different strands of global activism with the perceived outcome of weakening the resistance against neoliberalism and reducing the impact of imaginations and practices aimed at building a new, more equitable world.
Innovation in biomedicine is a global enterprise in which 'Rising Power' states (emerging states) figure prominently, and which undoubtedly will re-shape health systems and health economies globally, the authors of this paper argue. Against this background, they present an overview of a range of approaches that have potential for advancing understanding of governance of global life science and biomedical innovation, with special reference to the 'Rising Powers'. The authors’ analysis indicates significant convergences and complementarities between the approaches discussed, concluding that the role of the national state itself has become relatively neglected in much of the relevant literature. They call for a new approach that enables innovation and governance to be seen as 'co-producing' each other in a multi-level, global ecology of innovation, taking account of the particular, differing characteristics of different emerging scientific fields and technologies.
In this article, the author examines the potential role of health information technology (IT) in addressing healthcare disparities among racial and ethnic minority populations. The author’s overview of health IT utilisation among healthcare providers reveals that use of health IT among racial and ethnic minorities carries significant promise and potential. Yet realising the potential will not come without surmounting several significant technical, practical and human challenges. In order to measure success or failure, he argues for ongoing surveillance and monitoring of progress at a national level. However, because of the great diversity in the types of technologies, types of users, and settings in which health IT may be employed, obtaining accurate estimates of adoption and utilisation will be a significant challenge. In addition, the development of the ‘meaningful use’ criteria and the linking of meaningful use to provider reimbursement will help, the author adds. As patients become more involved in accessing, managing, and using their health information, a need to develop ‘meaningful patient use’ criteria may arise, he predicts, which will help refine systems.
The authors of this study conducted a print media analysis in 44 countries in Africa, the Americas, Asia and the Eastern Mediterranean to find out whether and how policymakers, stakeholders, and researchers talk in the media about three topics: policy priorities in the health sector, health research evidence, and policy dialogues regarding health issues. In their literature review, the authors identified approximately five times more articles describing health research evidence compared to the number of articles describing policy priorities. Few articles describing health research evidence discussed systematic reviews (2%) or health systems research (2%), and few of the policy dialogue articles discussed researcher involvement (9%). News coverage of these concepts was highly concentrated in several countries like China and Uganda, while few articles were found for many other jurisdictions. The authors conclude that, in many countries of the countries reviewed, the print media (as captured in a global database) are largely silent about these three topics central to evidence-informed health systems. These findings suggest the need for proactive-media engagement strategies.
Developing countries have highlighted a number of concerns over the reform agenda of ‘The Future of Financing for WHO’, which was unveiled by the Director-General of the World Health Organization (WHO) at the 128th session of the organization's Executive Board held from 17-25 January. Several developing countries pointed out that health cannot be de-linked from socio-economic development, and voiced strong support for the WHO's role in development and its leadership on global health issues. There was also a call for a transparent process to discuss the reform. While the reform agenda was initially instigated by the need to ensure more predictable and sustainable financing for WHO, proposals for reform that are contained in Director-General Margaret Chan's report suggest a more far-reaching agenda that could lead to significant changes in the role of WHO on matters of public health at the global level. In depating the proposals representatives of several low and middle income countries pointed out that health cannot be de-linked from socio-economic development and WHO cannot be reduced to being a mere technical agency. They also expressed strong support for WHO's role in development and its leadership in global health issues. Civil society groups, including the People’s Health Movement cautioned that public health should not take a back seat to market-led initiatives. Mozambique, on behalf of the African group, stated that reform of the organisation should maintain WHO's leadership position in international health, adding that any debate on financial aspects deserves a wider discussion.
The African Peer Review Mechanism (APRM), a tool designed to promote good governance on the continent, is built on the belief that the continent does not lack ideas to advance its development, but that states have struggled to live up to their principles and implement their policies. The APRM rests on the fundamental belief that good governance is a precondition for taking Africa out of its spiral of conflict, underdevelopment, poverty and increasing marginalisation in a globalised world. Looking back almost a decade after the APRM was first conceived, Grappling with Governance explores how this complex process has evolved from theory to practice in a variety of contexts. In a combination of case studies and transversal analysis, multiple voices from different African civil society actors - mainly analysts, activists and journalists - examine the process from their specialised perspective. The chapters tease out what can be learned about governance in Africa from these experiences, and the extent to which the APRM has changed the way that governments and civil society groups engage. This book demonstrates that undergoing review through the APRM can be messy, haphazard and full of reversals. Like any tool, the APRM’s effectiveness depends on the suitability of its design for the task at hand, the situation in which it is used, and the skill of its user. The different authors reflect on these characteristics as users of this tool. While it is ill-advised to draw universal conclusions, this book nevertheless demonstrates that the APRM has added value, sometimes in unexpected ways.
With the current World Health Organization (WHO) Director-General’s term of office ending in June 2012, WHO members have set up a drafting group to try to reconcile divergent views on the process leading to the election. At the WHO Executive Board meeting, which ran from 17-25 January 2011, some countries were in favour of geographical rotation, citing over 60 years of no representation from their regions, while others objected that rotation should not override more important selection criteria such as expertise and experience, as it could endanger the organisation’s future. A draft resolution on the rules of procedure for the appointment of the WHO Director-General (DG) was proposed by Burundi on behalf of the member states of the African region, asking for the Executive Board to approve the principle of geographical rotation of the post of DG among the six regions of WHO, namely Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific. In this draft resolution, Burundi stressed the need for further strengthening of guarantees of transparency and equity among the six geographical regions of the WHO in the process of nominating and appointing the DG. The proposed document stirred a debate that some countries said has been on the table since 2006.