University of California, San Francisco, San Francisco, CA; Centre for Global Health, Trinity College Dublin, Dublin, Ireland.
Ann Glob Health. 2015 Sep-Oct;81(5):611-7. doi: 10.1016/j.aogh.2015.12.004.
San Francisco has a distinguished history as a cosmopolitan, progressive, and international city, including extensive associations with global health. These circumstances have contributed to new, interdisciplinary scholarship in the field of global health diplomacy (GHD). In the present review, we describe the evolution and history of GHD at the practical and theoretical levels within the San Francisco medical community, trace related associations between the local and the global, and propose a range of potential opportunities for further development of this dynamic field.
We provide a historical overview of the development of the "San Francisco Model" of collaborative, community-owned HIV/AIDS treatment and care programs as pioneered under the "Ward 86" paradigm of the 1980s. We traced the expansion and evolution of this model to the national level under the Ryan White Care Act, and internationally via the President's Emergency Plan for AIDS Relief. In parallel, we describe the evolution of global health diplomacy practices, from the local to the global, including the integration of GHD principles into intervention design to ensure social, political, and cultural acceptability and sensitivity.
Global health programs, as informed by lessons learned from the San Francisco Model, are increasingly aligned with diplomatic principles and practices. This awareness has aided implementation, allowed policymakers to pursue related and progressive social and humanitarian issues in conjunction with medical responses, and elevated global health to the realm of "high politics."
In the 21st century, the integration between diplomatic, medical, and global health practices will continue under "smart global health" and GHD paradigms. These approaches will enhance intervention cost-effectiveness by addressing and optimizing, in tandem with each other, a wide range of (health and non-health) foreign policy, diplomatic, security, and economic priorities in a synergistic manner--without sacrificing health outcomes.
旧金山作为一个国际化、进步和国际城市，拥有悠久的历史，与全球卫生有着广泛的联系。这些情况促成了全球卫生外交（GHD）领域新的跨学科学术研究。在本综述中，我们描述了旧金山医学界在实践和理论层面上 GHD 的演变和历史，追溯了本地与全球之间的关联，并提出了一系列进一步发展这一充满活力的领域的潜在机会。
我们提供了 80 年代“86 病房”范式下合作式、社区所有的艾滋病毒/艾滋病治疗和护理项目的“旧金山模式”发展的历史概述。我们追溯了这一模式在《瑞安·怀特关爱法案》下扩展到国家层面，以及通过《总统艾滋病紧急救援计划》在国际上的发展。与此同时，我们描述了全球卫生外交实践从本地到全球的演变，包括将 GHD 原则纳入干预设计，以确保社会、政治和文化的可接受性和敏感性。
受旧金山模式经验教训启发的全球卫生项目越来越符合外交原则和实践。这种认识有助于实施，使政策制定者能够在采取医疗应对措施的同时，追求相关和进步的社会和人道主义问题，并将全球卫生提升到“高政治”领域。
在 21 世纪，外交、医疗和全球卫生实践将继续在“智能全球卫生”和 GHD 范式下融合。这些方法将通过协同方式同时解决和优化一系列（卫生和非卫生）外交政策、外交、安全和经济优先事项，提高干预措施的成本效益，而不会牺牲卫生成果。
