GHD2E #1-2020:Exploring Global Health Diplomacy, Development & Engagement Global Health Diplomacy, Development & Engagement Thought Leadership Series

Preface: Welcome to the inaugural GHD2E article! The purpose of the Global Health Diplomacy, Development and Engagement (GHD2E) Thought Leadership Series is to share thoughts and ideas on challenges and scenarios, sustainable development, systems-level issues regarding global health, and required leadership (all disciplines) competencies of GHD2E. A definitional framework is provided below followed by the concept of GHD2E.

1.     Global Health (GH): Global health combines the concepts of international health, public health, and healthcare delivery to derive a more inclusive definition of global health. Global health is collaborative trans-national set of actions used for promoting better health for all in a variety of scenarios (e.g. peace, war, conflict, emerging threats, humanitarian, etc.). The definition emphasizes the critical need for rapid collaboration and action across and within national boundaries for mutual support, defense, and sustainable development. GH applies to all specialties and disciplines. 

2.     Global Health Diplomacy (GHD): Global health diplomacy brings together the disciplines of public health, healthcare delivery, international affairs, management, and education, transportation, communication, housing law and economics with mutual interests—social determinants of health (SDOH). The focus is understanding and negotiations to shape and drive global health policy, sustainable development, and strategic initiatives.  The relationship between health, foreign policy, military, and economic or trade with mutual interests is at the cutting edge of global health diplomacy.

3.     Global Health Diplomacy and Engagement (GHD2E): GHDE combines diplomacy with development (infrastructure, processes, policies, and programs) to drive meaningful engagement on vision, goals, objectives, plans, and program implementation between leaders for mutual benefit. GHDE is a form of international relations where health system capabilities (i.e., capable, non-capable, gaps) are used to encourage positive relations, exchange specific benefits, or solve problems between nations in an interdependent (not dependent) manner. 

4.     Global Health Systems Thinking Leadership (GHSTL): Global health systems thinking is based on the interdependencies and relations of systems (i.e., parts of the SDOH) where stakeholders and the interactions between current and future systems (i.e., health and non-health) are considered. Health systems thinking is key to understanding and solving health problems in a holistic manner not just each part in isolation. Systems thinking provides the principles, approaches, and methods to rethink our basic assumptions about health, and unite to create the future that we want.

Introduction

The purpose of the paper is to illustrate how understanding globalization, defining and applying the principles of Global Health Diplomacy (GHD), and supporting the National Security Strategy (NSS) leads to prosperity, health security, and pride for the nation and why health leaders need to get involved.

Health issues have always been global and interdependent. Today, globalization is more opportunistic or threatening. It is not surprising that academics and practitioners have become interested in ways to develop a successful global business.1 With internet-based business, cross-border agreements (e.g., pharmaceuticals), and ease of international travel (e.g., medical tourism), firms including health organizations with only domestic operations will be more rare. For example, 69% of US primary care physicians used electronic medical records (EMRs) in 2012 while EMR use in the UK, Switzerland, Germany, and Australia is at 13%, 16%, 21%, and 25% respectively.2 Globally engaging in international business also requires diplomacy. Globalization and diplomacy apply to health leaders too. As such, global health diplomacy (GHD) is required.

To be effective, health leaders must not only comprehend the impact of globalization; they must apply principles of GHD for positive effect at local, regional, and national levels. When the US responded to the earthquakes in Haiti, the supply of information, health professionals, and funds began at the local level. These actions opened up national diplomatic doors and demonstrated our benevolence, especially to adversaries.

Understanding Globalization’s Impact

The global economy and global health are two-way traveling companions. Actions in security, trade, conflict and crisis, environment, and human rights have a strong bearing on whether the US can achieve national economic and global health security.3 The globalization and translation of biomedical research to cost-effective health interventions demand attention to being ethically, politically, and culturally sensitive.4 Today, more US health leaders are engaging in economic and health system development, medical tourism, and partnering with worldwide and local health organizations for mutual benefit. More US medicines are being produced in China and India, and more medical procedures are being acquired through international medical tourism. Increased immigration and open borders offer more opportunities for individuals seeking employment in the US. This situation also presents health leaders with a challenge to deliver culturally sensitive health services or support. Sharing research contributes to prosperity and security.

While globalization has generated economic opportunity abroad, it requires more protection of the health and the safety of Americans in the US. For example, the adverse effects of globalization, such as terrorism and infectious diseases, have added increased complexities for today's healthcare delivery system. Due to the nature of a globalizing economy, volume of travel, trade, and human interactions infectious disease exists anywhere in the world and can travel anywhere.4 Toronto suffered through a horrible epidemic of a disease brought by an unsuspecting elderly lady, who attended a wedding in Hong Kong, contracted SARS and then brought it back. Diseases such as West Nile Virus, malaria, and tuberculosis have come our way either by accident or on purpose. For example, the deadly Ebola virus killed 14 people in western Uganda in July. Speculation caused many people to flee their homes. It is not inconceivable; an infected person could have gotten a plane and fled to the US.5 

Further, GHD minded health leaders must understand how the effects of deteriorating health conditions create political risks in countries of strategic importance. For example, poor public health increases the likelihood of political instability, disenfranchises persons with inadequate social capital, limits economic growth, and exacerbates the human damage caused by social and economic dislocation.6 Therefore, health leadership must understand how public health, medical, academic, and health industry institutions should play a role in advancing stability in an increasingly fragile world. Investing or not investing in international health development ultimately diverts resources from the US economy. By embracing globalization and developing a GHD mindset, health leaders will be in a better position to capitalize, respond, contribute to the effects of globalization.

Global Health Diplomacy (GHD) Defined and Applicability

To start, GHD is a constructive engagement for mutual benefit. GHD is a form of international relations where health system capabilities are used to encourage positive relations, exchange specific benefits, or solve problems between nations.7 GHD can be traced to the International Sanitary Conference in 1851. Attendees argued that disease dissemination does not respect borders. Acting alone will not reduce the risk of pandemics. Therefore, nations had to work together for mutual health security and economics.8

 Former Secretary of Health and Human Services, Tommy Thompson, defined it as “To give people hope…while serving the interests of the United States,9” and later as “The winning of hearts and minds of people…by exporting medical care, expertise and personnel to help those who need it most.”10 The US Department of State categorized GHD as a subset of diplomatic efforts at the individual, regional, and national levels. It is defined as "reaching out across the world in the spirit of friendship, partnership, and respect to form partnerships resulting in a better life in meaningful ways. Americans reach out because of our belief in freedom and human rights, and, by doing so, we undermine ideological support for terrorism and nurture common interests.11  Former President Bush's definition is more explicit, "Nations with free, healthy people will be sources of stability, not breeding grounds for hate and terror. By helping others, we help ourselves.”12

Applying GHD Supports US National Security Strategy (NSS)

Many think GHD is responding to a humanitarian crisis. While true, it is more. Health leaders at the local level serving diverse populations and employees, develop culturally aware health services and programs, and work with international organizations to build partnership and capacity are applying the principles in GHD in the context of a globalized world. GHD should be considered a way of seeking mutual interests of benevolence, economic value, and health security. At the regional and national levels, GHD is the orchestration of actions to enhance US influence and security by providing care, building capacity, and strengthening health infrastructure.13 To illustrate other forms of GHD, the following examples of how other nations, adversaries, and the US are applying GHD. Each highlights a strategic (versus purely humanitarian) capability in support of the NSS to influence opinions. The more health leaders apply GHD to develop or provide resources for local and international health development, the stronger our nation becomes, ultimately leading to increased prosperity and security. For example, this was evident in our response to the earthquakes in Haiti when coordination with government organizations deployed national response capabilities both within the US government and with international partners for positive effect.6 Many US based health organizations opened their doors for those in need or sent health professionals to help. Health leaders who align, integrate, and provide resource support the US NSS. Many today see it as a calling and call to action.

 The US NSS identifies the task of building the infrastructure of democracy by building partnership and partnership capacities with other governments.14 As a US example, military and civilian organizations provided support to the December 2004 tsunami and the October 2005 Pakistan earthquake. This support was intended to enhance the legitimacy of the government and minimize instability by augmenting the medical support of the local and international non-governmental organizations (NGOs) capabilities.15 As an ‘other nation’ example, Taiwan deliberately leverages its domestic medical capabilities and sends civilian medical teams to other nations with which it is or hopes to be allied.16 Hezbollah, long considered an adversary, has a positive image among Lebanese Shia in part because of its ability to provide social services such as medical care and hospitals, which the Lebanese government is not providing.17

GHD is translating words into action. The NSS for Public Diplomacy discusses medical diplomacy as means to communicate values far more effectively than words.18 As a US example, the Afghanistan and Iraq governments' capacity to meet healthcare needs is improving but is not sufficient. The US has employed GHD in Afghanistan since 2002 and in Iraq since 200319 by providing equipment, training, and advisors from civilian and military organizations as a means to create stability. Efforts have expanded to include medical civic-action programs and partnering with other worldwide health organizations.20 Cuba employs medical diplomacy to obtain recognition, resources, and other benefits. Cuba defined medical diplomacy as "the collaboration between countries on health matters to improve relations.” 21 Cuba has medical personnel in 70 countries, has provided no cost-flights to Cuba for free eye operations for as many as 750,000 people, and hosts nearly 10,000 foreign medical personnel for training.22 Hamas, another adversary has used health as a means to influence the population of the Gaza strip.23 Each applies GHD for mutual benefit. US health leaders can do the same.

GHD Strategies for Health Leaders

To be effective, health leaders must embrace GHD as a necessary skill and responsibility. GHD offers health leaders an opportunity to increase positive perceptions of the US, enhance the health of affected populations, and create mutual benefits for their organizations.24 Health leaders need to assure organizations are structured to support the NSS for a swift response to a crisis, create agreements, and actively engage in winning the trust and confidence of international health partners. Leveraging and integrating health services builds relationships for human growth, economic development, and cultural diversity. To begin, health leaders can employ GHD to assure cohesion with culturally aware programs, encourage volunteerism for international support, and make GHD an agenda item at annual association meetings. 

For GHD to be active at the national, regional, and local levels, close coordination to develop policy, procedures, and pre-event coordination, and training is required.25 They must integrate, exercise, and evaluate their organization’s capabilities with other components of the health and economic system to produce improved health security, partnerships, and capacity.6 This approach includes supporting the international and national goals for eliminating threatening diseases and helping develop sustainable, coordinated health system capacity among partner organizations and governments to prevent morbidity and mortality. Health leaders can establish partnerships and exchange programs with international health counterparts to provide or train a cadre of GHD and medically trained personnel. Organizations with large groups of international patients can create customized health programs, and they can invest in cultural awareness and sensitivity training to build cohesion. Contributing to improving response to natural and human-made disasters, including complex humanitarian emergencies, creates positive impressions by other nations and negates the same actions being used by our adversaries. Health leaders can ensure that local capabilities and processes are exercised and evaluated to assure the best health security. The United States has been a world leader in medical science and technology. To maintain medical preeminence, the US must align its strategic and functional planning to ensure execution at the highest level.26 Finally, flexibility must be provided to physicians, nurses, and medical specialists, including military reservists or those who are members of health-related organizations who may be called upon to respond to work under challenging environments and situations. 

Conclusion

Health issues have always been global, interdependent, and diverse. Today, they are more rapid, opportunistic, or threatening. Health leaders, academics, and practitioners must be more interested in ways to develop themselves as successful global health leaders. It must begin with comprehending the impact of global health trends applying the principles of global health diplomacy (GHD) for positive effect at local, regional, and national levels. Many see it as a calling. Employing a strategy of collaboration with diplomatic, developmental, and integrative activities will open up more prosperous, economic, and secure doors.

However, GHD begins at home. US health leaders who understand the value of GHD and opportunities will be more effective. Health leaders who can effectively see the connection with their organization and manage through this complex, changing and often ambiguous global environment are critical to the success of their organizations and the nation's health and economic security. By healing hearts and minds, we win them and more important, gain their trust and confidence. Global health leadership and GHD is a calling and call to action.

About the Author: Douglas “DrQD” Anderson, DHA, MSS, MBA, FACHE shares his 30+ years of experience, consulting, and research. He served on multiple deployments including Medical Advisor to the Afghanistan National Police Surgeon General. He is coauthor of Health Systems Thinking: A Primer Follow him on Twitter: @Doug_Anderson57 and his Strategic Health Leadership (SHELDR) E-Zine. Contact him at [email protected] for opportunities to help you and your team succeed.

Disclosure and Disclaimer:  Douglas E. Anderson has no relevant financial relationships with commercial interests to disclose. The author’s opinions are his own and do not represent an official position of any organization. Any publications, commercial products or services mentioned in his publications are for recommendations only and do not indicate an endorsement. All non-disclosure agreements (NDA) apply.

References: All references or citations will be provided upon request. Not responsible for broken or outdated links, however, report broken links to [email protected]

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