Centre for Health Systems Research, Global Health Program, National Institute of Public Health, Mexico City, Mexico.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
Global Health. 2021 Dec 2;17(1):137. doi: 10.1186/s12992-021-00789-y.
Global health diplomacy (GHD) focuses on the actions taken by diverse stakeholders from different nations -governments, multilateral agents, and civil society- to phenomena that can affect population health and its determinants beyond national borders. Although the literature on conceptual advancements of GHD exists, empirical studies about how health becomes an issue of relevance for foreign policy are scarce. We present an analysis of the entry processes of health into the foreign policy and diplomatic domains in Mexico from the perspective of key informants of three different sectors.
A purposive sample of high-rank representatives of three sectors involved in GHD was designed: Two from Health Sector (HS), four from Foreign Affairs Sector (FAS), and three from Non-governmental organizations (NGOs). Nine semi-structured interviews were conducted exploring the topics of: (1) Health concerns entering diplomatic and foreign policy; (2) Processes that allow actors to influence foreign policy and negotiation and; (3) Impact of multilateral negotiations on decision-making at the national level.
Our analysis suggests that GHD in Mexico is hierarchically driven by the FAS and health concerns only enter foreign policy when they are relevant to national priorities (such as trade or security). HS possesses a lesser degree of influence in GHD, serving as an instance of consultation for the FAS when deciding on health-related issues at global meetings (i.e., World Health Assembly). NGOs resort to lobbying, advocacy, networking, and coalition-working practices with other sectors (academy, think-tanks) to prevent harmful impacts on local health from multilateral decisions and as a mean to compensate its power asymmetry for influencing GHD processes in relation to the government.
GHD in Mexico occurs in a context of asymmetric power relationships where government actors have the strongest influence. However, NGOs' experience in raising awareness of health risks needs to be weighted by government decision-makers. This situation calls for capacity building on intersectoral communication and coordination to create formal mechanisms of GHD practices, including the professionalization and training on GHD among government agencies.
全球卫生外交（GHD）侧重于来自不同国家的不同利益相关者（政府、多边机构和民间社会）采取的行动，以应对可能影响国界以外人口健康及其决定因素的现象。尽管有关于 GHD 概念进展的文献，但关于健康如何成为外交政策相关问题的实证研究却很少。我们从三个不同部门的主要知情人的角度分析了卫生进入墨西哥外交政策和外交领域的进入过程。
我们设计了一个有目的的样本，包括三个参与 GHD 的部门的高级代表：两个来自卫生部门（HS），四个来自外交事务部门（FAS），三个来自非政府组织（NGO）。进行了九次半结构化访谈，探讨了以下主题：（1）进入外交和外交政策的健康问题；（2）使行为体能够影响外交政策和谈判的过程；（3）多边谈判对国家层面决策的影响。
我们的分析表明，墨西哥的 GHD 是由 FAS 主导的，并且只有当健康问题与国家优先事项（如贸易或安全）相关时，才会进入外交政策。HS 在 GHD 中影响力较小，在全球会议上就与健康相关的问题做出决定时，HS 充当 FAS 的咨询部门（例如，世界卫生大会）。非政府组织采取游说、宣传、网络和与其他部门（学术界、智囊团）合作的做法，以防止多边决策对当地卫生造成的有害影响，并作为一种补偿其在影响与政府有关的 GHD 进程方面的权力不对称的手段。
墨西哥的 GHD 发生在权力关系不对称的背景下，政府行为体具有最强的影响力。然而，政府决策者需要权衡非政府组织在提高对健康风险的认识方面的经验。这种情况需要在部门间沟通和协调方面进行能力建设，以创建 GHD 实践的正式机制，包括政府机构的 GHD 专业化和培训。
