b1248_Chapter-01.qxd 11/11/2011 b1248 6:53 AM Page 1 Negotiating and Navigating Global Health FA 1 Introduction: The Art and Practice of Conducting Global Health Negotiations in the 21st Century Ilona Kickbuschi and Ellen Rosskamii Diplomacy is the art and practice of conducting negotiations. It is a specific method for reaching compromise and consensus, as well as a system of organisation within which states — and increasingly non-state actors — pursue their interests. Diplomacy is an essentially political activity oriented towards achieving a specific outcome. States set the goals for negotiation in their foreign policies, and — as globalisation proceeds to deepen — both the private sector and civil society organisations have “foreign policies” of their own. Because of the many actors on the global stage observers increasingly comment on the need for new forms of global dialogue and decision-making that move beyond the traditional state-centred bilateral and multilateral diplomatic concepts and practices that have been the focus of 19th and 20th century diplomacy. i Professor Dr. h.c. Ilona Kickbusch is the Director of the Global Health Programme at the Graduate Institute for International and Development Studies, Geneva. ii Professor Dr. Ellen Rosskam is Senior Advisor and Consultant to the Global Health Programme, Graduate Institute for International and Development Studies, Geneva, and Professor at Webster University, Geneva. 1 b1248_Chapter-01.qxd FA 2 11/11/2011 b1248 6:53 AM Page 2 Negotiating and Navigating Global Health I. Kickbusch and E. Rosskam A range of features characterise 21st century diplomacy: • • • • • • • It needs to function within a multi-polar world and within a multilevel and multi-dimensional global governance structure, which increasingly includes the regional level. It is no longer conducted only by professional diplomats; diplomats today need to interact with many different actors, not only with other diplomats as they did in the past. It is characterised by polylateral layers of diplomatic interaction and relationships and is challenged to manage not only the relations between states (bi- and multi-lateral) but also the relations between states and other actors. It manages these relationships in various diplomatic venues and with a wide range of instruments. It is increasingly engaged in public diplomacy vis à vis an informed public and many actors at home and in the host country. It is involved with and contributes to a whole host of issues which are on the international agenda and which require global coordination, such as security, health, the environment, global finance, climate change, and the like. It needs to consider a much closer interface between domestic and international policies and cooperate with other national ministries.1–7 But even as one considers these features one still has not captured the full essence of the transition: the very goals of foreign policy are changing. Foreign policy is no longer only about the “relation with external entities”8 it is about achieving security, creating economic wealth, supporting development in low income countries, and protecting human dignity” both at home and abroad.9 As a consequence, diplomats now have a double responsibility: to represent the interests of a country as well as the interests of the global community.10 This “double responsibility” implies recognition that increasingly global public goods need to be negotiated, managed, and ensured. It also means that regimes in the area of trade and economic development need to be complemented by agreements in areas of social development and on critical global trans-boundary issues, such as the environment and health. This complementarity of the national and the global interest has been expressed for example by b1248_Chapter-01.qxd 11/11/2011 b1248 6:53 AM Page 3 Negotiating and Navigating Global Health FA Introduction 3 President Lula de Silva of Brazil in his 2003 inauguration speech: “an international order guided by values is the one which offers the broadest possibilities not just for promoting the national interests … but also for systemic stability itself.”11 This means that the dynamics between health and foreign policy have changed fundamentally in the 21st century. As health becomes politically more relevant — in both domestic and foreign policy — it becomes a feature of the foreign policy of states and enters the realm of diplomacy. In two consecutive years, UN General Assembly Resolutions entitled “Global Health and Foreign Policy” recognize their “close relationship […] and their interdependence.”12,13 Health diplomacy as a profoundly political process is conducted at many different levels of governance; it includes various types of diplomacy ranging from the bilateral, to the multilateral, and polylateral, and it moves in different geo-political directions: North-South, South-North, South-South. The relationship can be illustrated by a continuum with two endpoints — one endpoint in which (A) foreign policy neglects or even hinders health, and the other where (D) foreign policy serves health as presented by the Oslo Declaration on health and foreign policy.14 Along the continuum we can define a number of different relationships between health and foreign policy, two of which are of particular importance: (B) health as an instrument of foreign policy, and (C) health as an integral part of foreign policy.15 This continuum is presented visually in Fig. 1 below. At the multilateral level health diplomacy relates in particular to points C and D. Global Health Diplomacy — that part of health diplomacy which Fig. 1. The continuum of the relationship between health and foreign policy. Adapted from Kickbusch I. (2011) 21st Century Global Health Diplomacy. b1248_Chapter-01.qxd FA 4 11/11/2011 b1248 6:53 AM Page 4 Negotiating and Navigating Global Health I. Kickbusch and E. Rosskam deals with the negotiation processes that shape and manage the global policy environment for health — can be considered as a method for reaching compromise and consensus particularly within the context of international organisations. It relates in particular to health issues that cross national boundaries, are global in nature, and require global agreements to address them both in health and non-health forums. Because of their political relevance these negotiations at the global level are conducted not only between public health experts representing health ministries of nation states but also include representatives from foreign policy, security policy, development and trade, as well philanthropists, civil society, and private players. Global health diplomacy brings together the disciplines of public health, international affairs, management, law, and economics. New skills are needed to negotiate global regimes, international agreements and treaties, and to maintain relations with a wide range of actors. A number of factors distinguish 21st century global health diplomacy: (1) the nature of the subject matter: health is a trans-boundary concern for all nations, it requires collective action, (2) the role of science and scientists: the response to the spread of disease is heavily dependent on understanding the causes and as such the productive interface between diplomats and health experts is critical to successful health negotiations, (3) the complexity of the negotiations: the interface between diplomacy and science, the multi-level, multi-factor, and multi-actor negotiations and the repercussions for trade and commerce, power relations, and values make for complicated negotiations, (4) the unique equity issues involved: equity is a driving force of the global health agenda since its inception, but has gained force with the adoption of the Millennium Development Goals. A range of global health strategies deal with equity issues in specific ways, such as differential pricing for vaccines and other essential drugs, (5) innovative features and approaches: throughout its history in each institutional phase health diplomacy has been highly innovative in developing methods, instruments, and organisational forms. An additional critical feature of health diplomacy is that international health negotiations have had an institutionalised mechanism at their b1248_Chapter-01.qxd 11/11/2011 b1248 6:53 AM Page 5 Negotiating and Navigating Global Health FA Introduction 5 disposal for over 100 years ever since a permanent international agency for health was in put in place in 1907 — today this is the World Health Organization, which was founded in 1948.16 The intent of this book is to present a wide variety of perspectives and experiences that illustrate the defining features and characteristics of 21st century health diplomacy. They are presented in case studies contributed by a range of lead negotiators, health diplomats, Ambassadors, NGOs, technical experts, private sector, international organisations, academicians, and donors reflecting the polylateral nature of the field. The range of topics covered provides a snapshot of the diversity of levels and issues: such as negotiations in multi-lateral institutions, negotiations at national level, negotiations on specific diseases, negotiations on treaties and conventions, and multi-lateral negotiations in individual countries on issues such as health sector reform and governance. The authors describe with as much objectivity as possible different types of enabling environments that facilitated successful negotiations, ways in which political space was captured, created, and used at a particular moment in time, types of leadership needed for successful negotiating outcomes, challenges and opportunities presented by the involvement of different actors holding differing degrees of power, creative and standard negotiating tools used, the role of and for policy, and analyses of why some negotiations were unsuccessful. Detailing different positions taken by individual countries and non state actors during multiple rounds of negotiations, the authors describe in detail various angles, perspectives, and postures adopted by the various players in the respective negotiations. This is the first book to present case studies about how the different negotiations took place and it is precisely this angle that makes the book pioneering, providing learning tools for today’s broad group of “new health diplomats” in the landscape of this ever-shifting, complex technical and political arena. The collection of case studies fills an important gap in both knowledge and practice by providing insight on how negotiations on global health issues have transpired, successes, challenges, failures, tools and frameworks for negotiation, mechanisms of policy coherence, ways to achieve global health objectives internationally, and b1248_Chapter-01.qxd 11/11/2011 FA 6 b1248 6:53 AM Page 6 Negotiating and Navigating Global Health I. Kickbusch and E. Rosskam how global health diplomacy used as a foreign policy tool can improve relations between nations. The case studies are told as the negotiations were experienced by individuals who participated in the various debates, dialogues, negotiations, or by experts who have studied them. They highlight the art and the practice of health diplomacy. Today more than ever diplomats and negotiators need practical and technical information on global health and how to use global health as part of foreign policy to improve relations between countries. Simultaneously, non state actors need practical information to help them in negotiating and in the use of diplomacy. In response to these needs the book is directed at representatives of ministries of health, foreign affairs, finance, and trade, staff of international organisations, and a wide range of non state actors who engage in trans-border health negotiations. It aims to increase their understanding of the dynamics as well as the art of global health diplomacy and to improve their negotiation skills. Schools of public health and international relations should also find this book highly useful for those giving more attention to this developing area. The Global Health Programme at the Graduate Institute for International and Development Studies will be using it in conducting capacity building in Global Health Diplomacy. The editors hope that this unique collection of case studies will be useful for diplomats and other actors in this field from a wide range of countries. The diverse collection of topics, regions, and contributing authors provides a rich palette to springboard debate, which is strongly encouraged. Reader reflection about how other perspectives might present the same case study is an example of what might catalyse debate, discussion, or reaction based on the angle from which the case is told, the topic, or specific content. References 1. Barston R. (2006) The Changing Nature of Diplomacy. In: Barston R. Modern Diplomacy. Pearson Longman. New York. 3rd Edition. 2. Moon S., Szlezák NA., Michaud CM., Jamison DT., Keusch GT., Clark WC., Bloom BR. The Global Health System: Lessons for a Stronger Institutional b1248_Chapter-01.qxd 11/11/2011 b1248 6:53 AM Page 7 Negotiating and Navigating Global Health FA Introduction 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 7 Framework. PLoS Med (2010) 7(1): e1000193 [doi:10.1371/journal.pmed. 1000193]. Frenk J. The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress. PLoS Med (2010) 7(1): e1000089 [doi:10.1371/journal.pmed.1000089]. Heine J. (2006) On the Manner of Practising the New Diplomacy. Centre for International Governance Innovation (CIGI) Working Paper No. 11. Sucharipa E. (2002) 21st Century Diplomacy, available at: http://campus. diplomacy.edu//lms/pool/BD%20materials/Sucharipa.htm. Accessed September 2010. Wiseman G. (2004) “Polylateralism” and New Modes of Global Dialogue. In Christer Jönsson and Richard Langhorne (eds), Diplomacy Vol. III, London: Sage, pages 36–57. Szlezák NA., Bloom BR., Jamison DT., Keusch GT., Michaud CM., Moon S., Clark WC. The Global Health System: Actors, Norms, and Expectations in Transition. PLoS Med (2010) 7(1): e1000183 [doi:10.1371/journal.pmed. 1000183]. Hudson V. (2008) The History and Evolution of Foreign Policy Analysis. In: Smith S., Hadfield A., Dunne T. Foreign Policy: Theories, Actors, Cases. New York: Oxford University Press. United Nations (2009) Global Health and Foreign Policy: Strategic Opportunities and Challenges. Note by the Secretary-General (A/64/365), United Nations General Assembly, Sixty-fourth session. Muldoon J. Jr., Sullivan E., Aviel JF., Reitano R. (eds.) (2005) Multilateral Diplomacy and the United Nations Today. Cambridge Westview Pr. 2nd ed. Parola A. (2007) A Ordem Injusta; Brasília: Fundação Alexandre de Gusmão. United Nations (2008) Resolution Adopted by the United Nations General Assembly on “Global Health and Foreign Policy” (A/Res/63/33), Sixty-third Session. United Nations (2009) Resolution Adopted by the United Nations General Assembly on “Global Health and Foreign policy” (A/Res/64/108), Sixty-forth Session. Ministers of Foreign Affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand “Oslo Ministerial Declaration — Global Health: A pressing foreign policy issue of our time”, The Lancet (2007) 369: 1373–78. b1248_Chapter-01.qxd FA 8 11/11/2011 b1248 6:53 AM Page 8 Negotiating and Navigating Global Health I. Kickbusch and E. Rosskam 15. Kickbusch I. (2011) 21st Century Global Health Diplomacy. In: Novotny T., Kickbusch I. (eds.) 21st Century Global Health Diplomacy. World Scientific Press. 16. Novotny T., Kickbusch I. (eds.) (2011) 21st Century Global Health Diplomacy. World Scientific Press.
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