Diplomacy is the art and practice of conducting international relations. There can be different instruments in conducting diplomacy, and the recent usage of the term ‘health diplomacy’ has encompassed not only international agreements on health but also efforts to promote the role of global health in foreign policy, as well as the use of health interventions to support foreign-policy objectives.

International policy

The origins of modern health diplomacy can be traced to 1851, when the first International Sanitary Conference was held to discuss cooperation on cholera, plague, and yellow fever. The 2003 SARS outbreak, the 2009 influenza A pandemic, the recent global outbreaks of Ebola and Zika, among others, have shown us how quickly infections can spread in the inter-connected world, affecting lives—most importantly—and also travel and trade among interdependent economies. The sudden spread of these new diseases has gained international attention and now nations are integrating health into their foreign policy strategies.

The World Bank estimates that the annual global cost of moderately severe to severe outbreaks of diseases is roughly $570 billion or 0.7 percent of global income. One of the diseases which has gained more attention and international resources is HIV/AIDS. 

As we know, the world is now in the phase of implementing Sustainable Development Goals (SDG). There are 17 goals with 169 targets that all UN member states have agreed to try to achieve by 2030. Health has a central place in SDG three: “Ensure healthy lives and promote well-being for all at all ages.” Addressing global health in SDG three is not only related to the issue of health but is linked to achieving the rest of the SDGs.

The Global Health and Foreign Policy Initiative was launched by the Oslo Ministerial Declaration in 2007, headed by the foreign ministers of seven countries. 

Starting in 2008, Global Health and Foreign Policy has been a regular item on the UN General Assembly agenda. Every year, a resolution on Global Health and Foreign Policy gets adopted. Likewise, the resolution, which focuses on health employment and economic growth, was adopted by the UN on December 2016. A report which informs the discussions and responds to the annual resolution is prepared by the WHO Director-General. The reports and resolutions consistently explore different areas of collaboration between health and foreign policy, provide recommendations, and contribute to better understanding of the importance of health in international policy and developmental discussions. 

A high-level meeting on anti-microbial resistance was held at the United Nations General Assembly in New York in September 2016. Global leaders gathered to discuss the important roles and responsibilities of governments, as well as other relevant stakeholders in responding to the challenges of antimicrobial resistance, which is one of the growing threats to health. Before this, HIV, non-communicable diseases, and Ebola were discussed in the General Assembly. The UN has also decided to hold a high-level meeting in 2018 on the fight against tuberculosis.

Disasters and conflicts

Natural disasters and armed conflicts have led to huge increases in mortality and morbidity. And in recent times, as the frequency of conflict and disasters has gone up, the health of millions of people has been affected. Ongoing violent conflict, as well as natural disasters, can cause mass population displacements and expose people, especially children, to unhealthy physical and psychological environments. We can take the example of our own country Nepal, where thousands of people suffered health problems in the aftermath of the earthquake. Outbreaks of diseases like diarrhea, 

respiratory illness etc resulted in health emergencies. Mental health is another serious problem. But the magnitude of mental health problems might not show due to the stigma associated with them, which stops many from discussing their issues.

Health interventions are being used in complex and contradictory ways in conflict situations. The public health community has sought to implement “health as a bridge to peace”, claiming that health interventions in “post-conflict societies can be specifically designed in such a way as to simultaneously have a positive effect upon the health of the population and contribute to the creation of a stable and lasting peace.”

Benefitting the people

Health diplomacy requires a delicate combination of technical expertise, legal knowledge, and diplomatic skills to be used effectively. Health expertise of the diplomatic corps is one very helpful tool that can be used. 

Both groups’ (in the case of bilateral relations between countries) skills and strengths will be necessary to realise the promises of health diplomacy, from maintaining the momentum for cross-border cooperation on public health surveillance and response to achieving the vision of using global health to improve international relations-and vice versa. For example, health diplomacy can be used to ease Nepal’s relations with its neighbors and minimise the public health impact. 

Also, our responses to global health crises need to include specific mechanisms to ensure the particular needs of women and girls, children, the elderly, persons with disabilities, and other vulnerable groups.

While foreign-policy interests are likely to continue to determine state engagement on global health issues, a country like Nepal should focus more on how our people can benefit from the nation’s involvement in ‘health diplomacy’, which can act as a very important tool for both bilateral and multilateral functioning.

Mainali is First Secretary at the Permanent Mission of Nepal to the UN