Kevany Sebastian
a University of California , San Francisco , CA , USA.
Glob Public Health. 2014;9(7):787-807. doi: 10.1080/17441692.2014.921219. Epub 2014 Jun 23.
Both the theory and practice of foreign policy and diplomacy, including systems of hard and soft power, are undergoing paradigm shifts, with an increasing number of innovative actors and strategies contributing to international relations outcomes in the 'New World Order'. Concurrently, global health programmes continue to ascend the political spectrum in scale, scope and influence. This concatenation of circumstances has demanded a re-examination of the existing and potential effectiveness of global health programmes in the 'smart power' context, based on adherence to a range of design, implementation and assessment criteria, which may simultaneously optimise their humanitarian, foreign policy and diplomatic effectiveness. A synthesis of contemporary characteristics of 'global health diplomacy' and 'global health as foreign policy', grouped by common themes and generated in the context of related field experiences, are presented in the form of 'Top Ten' criteria lists for optimising both diplomatic and foreign policy effectiveness of global health programmes, and criteria are presented in concert with an examination of implications for programme design and delivery. Key criteria for global health programmes that are sensitised to both diplomatic and foreign policy goals include visibility, sustainability, geostrategic considerations, accountability, effectiveness and alignment with broader policy objectives. Though diplomacy is a component of foreign policy, criteria for 'diplomatically-sensitised' versus 'foreign policy-sensitised' global health programmes were not always consistent, and were occasionally in conflict, with each other. The desirability of making diplomatic and foreign policy criteria explicit, rather than implicit, in the context of global health programme design, delivery and evaluation are reflected in the identified implications for (1) international security, (2) programme evaluation, (3) funding and resource allocation decisions, (4) approval systems and (5) training. On this basis, global health programmes are shown to provide a valuable, yet underutilised, tool for diplomacy and foreign policy purposes, including their role in the pursuit of benign international influence. A corresponding alignment of resources between 'hard' and 'smart' power options is encouraged.
外交政策与外交的理论和实践，包括硬实力和软实力体系，都在经历范式转变，在“新世界秩序”中，越来越多的创新行为体和战略对国际关系结果产生影响。与此同时，全球卫生项目在规模、范围和影响力方面继续在政治领域占据更高地位。这种情况的交织要求重新审视全球卫生项目在“巧实力”背景下的现有和潜在效果，这基于对一系列设计、实施和评估标准的遵循，这些标准可以同时优化其人道主义、外交政策和外交效果。“全球卫生外交”和“将全球卫生作为外交政策”的当代特征综合，按共同主题分组并在相关领域经验背景下产生，以“十大”标准清单的形式呈现，以优化全球卫生项目的外交和外交政策效果，并在审视对项目设计和实施的影响的同时列出标准。对外交和外交政策目标敏感的全球卫生项目的关键标准包括可见性、可持续性、地缘战略考虑、问责制、有效性以及与更广泛政策目标的一致性。虽然外交是外交政策的一个组成部分，但“对外交敏感”与“对外交政策敏感”的全球卫生项目的标准并不总是一致的，而且偶尔会相互冲突。在全球卫生项目设计、实施和评估中明确而非隐含外交和外交政策标准的可取性体现在对（1）国际安全、（2）项目评估、（3）资金和资源分配决策、（4）审批系统以及（5）培训的影响中。在此基础上，全球卫生项目被证明是外交和外交政策目的的一种有价值但未充分利用的工具，包括其在追求良性国际影响力方面的作用。鼓励在“硬实力”和“巧实力”选项之间相应地调整资源。
