Department of Epidemiology and Community Medicine, Canada Research Chair, Globalization and Health Equity, Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, Ontario, K1N 6N5, Canada.
Global Health. 2010 Aug 22;6:14. doi: 10.1186/1744-8603-6-14.
Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.
近年来，全球卫生筹资大幅增加，表明卫生已成为外交政策的一个重要议题。一些国家政府发表了关于全球卫生问题的具体外交政策声明，并创造了一个新术语，即全球卫生外交，用以描述国家和非国家行为体为使卫生问题在外交决策中更受重视而进行互动的过程。这些国家和行为体在这方面的能力对于推动卫生领域的国际合作至关重要。本文回顾了为全球卫生外交提供信息的卫生外交政策论据。这些论据分为六个政策框架：安全、发展、全球公共产品、贸易、人权和伦理/道德推理。这些框架中的每一个都对将卫生作为外交政策问题的概念化产生影响。这些政策框架内和框架之间的不同论据虽然相互重叠，但也可能相互矛盾。这就提出了一个重要问题，即哪些论据在实际的国家决策中占主导地位。通过对与每个政策框架相关的政策或政策相关文件和学术文献进行分析，并对政策实践进行一些评估，回答了这个问题。该分析的参考点是改善全球卫生公平的明确目标。这一目标在国家公共卫生话语和决策中越来越受到关注，并且通过千年发展目标和其他多边报告和宣言，正在进入全球卫生政策讨论。初步调查结果支持传统国际关系理论，即大多数国家即使将卫生作为外交政策目标，也仍然主要根据国家安全和经济物质利益的“高级政治”做出决策。发展、人权和道德伦理方面的全球卫生援助论据是外交政策的传统“低级政治”，虽然在话语中存在，但似乎并未主导实践。虽然将卫生作为外交政策目标的政治势头依然强劲，但这一目标的框架仍然是一个有争议的问题。本文提供的分析可能有助于从事全球卫生外交工作或努力使全球治理在一系列部门利益中更加关注卫生公平影响的人。
