Program of Global Health, School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago de Chile, Avenida Independencia 939, Independencia, Santiago, Región Metropolitana, Chile.
Globalization and Health Equity Research Unit, School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
Global Health. 2018 Nov 16;14(1):108. doi: 10.1186/s12992-018-0428-8.
Global health diplomacy (GHD) has become an important field of investigation due to health concerns increasingly entering the foreign policy domain. Much of the existing academic writing focuses on North-South cooperation in global health, and emphasizes the role of security and economic interests by Northern countries as drivers of GHD. Chile presents a favourable environment for an expanded involvement in future GHD activities. However, there is little knowledge about what has been driving Chile's integration of health into foreign policy, and little effort to appropriate knowledge from international relations theories to better theoretically grasp the emergence of GHD.
To fill this knowledge gap, we conducted a narrative literature review of the driving forces behind Chile's integration of health into foreign policy. Drawing on a popular analytical framework used in international relations scholarship, we identified driving forces of the integration of health into Chile foreign policy at three levels of analysis.
At the international/global level of analysis, the main driving forces were related to national security concerns and compliance with regulations of international organizations. At the regional level, GHD was driven by a commitment to regional solidarity through mutually beneficial cooperation in response to neoliberal reforms; health coordination in emergencies; and protection of indigenous peoples. Finally, at the domestic level, drivers identified include economic interests of various productive sectors and how health regulations might impact those; the high degree of social inequity which impacts on access to healthcare; and management of natural disasters.
Health actions in the context of international relations in Chile are still mainly motivated by more traditional foreign policy interests rather than by a desire to satisfy health needs per se. This seems to conform with findings of existing GHD scholarship that emphasize the importance of security and economic interests as driving forces of GHD, and how health is often appropriated instrumentally within foreign policy settings to achieve other goals. But the review also reveals that in the context of South-South cooperation (and regional health diplomacy), solidarity and normative considerations can be important driving forces as well. Finally, the review demonstrates that there has been an evolution from chiefly domestically focused health policies (e.g. maternal and child nutrition treatment) towards internationally inspired integrated policies (e.g. maternal and child nutrition promotion aligned with international guidelines).
由于健康问题日益成为外交政策的重要领域，全球卫生外交（GHD）已成为一个重要的研究领域。现有的学术著作大多集中在全球卫生的南北合作上，强调北方国家的安全和经济利益是推动 GHD 的驱动力。智利为未来更广泛地参与全球卫生外交活动提供了有利的环境。然而，人们对推动智利将卫生纳入外交政策的因素知之甚少，也很少努力从国际关系理论中获取知识，以便更好地从理论上把握全球卫生外交的出现。
为了填补这一知识空白，我们对推动智利将卫生纳入外交政策的因素进行了叙述性文献综述。我们借鉴国际关系学术研究中常用的一个分析框架，在三个分析层面上确定了推动智利将卫生纳入外交政策的因素。
在国际/全球层面的分析中，主要的推动因素与国家安全问题和遵守国际组织的规定有关。在区域层面，全球卫生外交是通过互利合作应对新自由主义改革、紧急情况下的卫生协调以及保护土著人民来推动区域团结的承诺所驱动的。最后，在国内层面，确定的驱动因素包括各生产部门的经济利益以及卫生法规可能对这些部门的影响；影响获得医疗保健的高度社会不平等；以及对自然灾害的管理。
智利国际关系背景下的卫生行动主要还是受到更传统的外交政策利益的驱动，而不是满足卫生需求本身的愿望。这似乎符合现有的全球卫生外交研究的发现，即强调安全和经济利益是全球卫生外交的重要驱动力，以及卫生在外交政策背景下如何常常被工具化来实现其他目标。但该综述还表明，在南南合作（和区域卫生外交）的背景下，团结和规范考虑也可能是重要的驱动因素。最后，该综述表明，已经从主要关注国内的卫生政策（例如母婴营养治疗）向受国际启发的综合政策（例如符合国际准则的母婴营养促进政策）演变。
