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HEALTH DIPLOMACY AS A RESOURCEFUL FORM OF INTERNATIONAL COMMUNICATION
© Dvornyicsenko Natalia
International administration Expert (MA), Doctorandus of Doctoral School of Legal Sciences, Pazmany Péter Catholic University in Budapest, Hungary
There's nothing more important than our good health — that's our principal capital asset.
Arlen Specter
In the study is considered the notion of human right to health, the applicable main regulation in this area, together with the essence and purpose of health diplomacy. The author also touched upon some specifics of activity of international organizations in the sphere of global health, exemplified by the activity of the World Health Organization and the Food and Agricultural Organization of the United Nations.
The purpose of the study: The present work aims to demonstrate the mission and potential of health diplomacy in addressing actual global issues both at national and international levels.
Key words: Global health diplomacy, international public health, foreign policy, the system of international relations, international communication, human rights, right to health, international organizations, United Nations, World Health Organization, Food Agricultural Organization, food safety and security, governmental and non-governmental actors, international conferences, globalization, interdependence, institutionalization, interstate dialogue.
Materials and methods: The theoretical basis of the synopsis was based on works related to international organizations, international communication, and modern diplomacy, publications of contemporary authors on health diplomacy, reference books, laws and regulations, as well as the use of official websites. The scientific method of data collection and processing was applied during the study.
Introduction
The current situation of progressing interdependence of states, together with their universal aspires and general strategy requires joint actions in addressing the common problematic issues, such as protection of human rights, reducing poverty, saving the nature, improving the health condition of the population and other crucial matters.
Back in history, health was not really included into the scope of interest of foreign policy and respectively, traditional diplomacy. Health has been characterized as low politics, being associated rather with science and humanitarian matters, therefore standing far from the traditionally high politics of foreign policy.
The issue of global risks to health came to the scope of international problems to solve only in the 19th century. Due to the wide spread of infectious deseases, posing growing threat to human security, an urgent need emerged for the cooperation of nations in this regard, along with the development of an effective relevant international policy, positioning health among the prominent global issues. Gradually, the domain of international health diplomacy advanced into global health diplomacy, enriching the circle of actors, which include the civil and the private-public sector by now. The responsibility for the situation in healthcare lies not on state actors and high diplomacy solely, but on all members of society.
Unquestionably, we are all responsible for the condition of our personal health, nevertheless, there are external factors we have little or no control over, such as our environment - the state of ecology, work conditions, level of public medical care or housing, which are mostly regulated by the society and municipal structures, so governments bear an obligation to protect the health of their citizens, either.
Due to the increasing health issues under the circumstances of globalization, the participants of the health sector are required to make additional efforts to be helpful and reach their goals, hence, diplomatic activities and a larger amount of high level communication are needed, more than ever before. Here comes to the fore health diplomacy, given that it can contribute into the fostering of political and economic cooperation. The classical foreign policy of a state consists of political, military, economic, cultural, scientific and other strategic aspects, which factors shape relations with other states. Health diplomacy at the present time is one of the official spheres of foreign policy, being an area of public diplomacy, used by various governments to revise the foreign resources.
Results and discussion
Everyone has «the right ... to the enjoyment of the highest attainable standard of physical and mental health», as stated in Article 12 of the International Covenant on Economic, Social and Cultural Rights. The human right to health is universally recognized as fundamental to wealth. The World Health Organization of the United Nations (WHO) defines the notion of «health» in the Preamble to the Constitution of the World Health Organization (adopted by the International Health Conference in New York on 19-22 June, 1946), as «a state of complete physical, mental and social well-being and not merely the absence of diseases or infirmity» [1]. According to Article 25 of the Universal Declaration of Human Rights «Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services... ». Subsequently, the right to health is guaranteed by international human right treaties and declarations, and the main relevant documents are:
- The Universal Declaration of Human Rights [2].
- The International Covenant on Economic, Social and Cultural Rights [3].
- Convention on the Rights of the Child [4].
- International Convention on the Elimination of All Forms of Racial Discrimination [5].
- Convention on the Elimination of All Forms of Discrimination Against Women [6].
- Comprehensive and Integral Convention on Protection and Promotion of the Rights and Dignity of Persons with Disabilities [7].
- Regulations of national Constitutions.
The right to health consists of some further components: the right to appropriate healthcare, affordable to people, also provision of preventive and rehabilitative health services; right to adequate supply of food, water and nutrition; right to maternal and child health; right to acceptable housing; right to a healthy environment and healthy working conditions; right to access to health-related information (e. g. scientific findings); right to participation in decision-making in the health sector. The adequate healthcare must be provided for all humans, on an equitable basis, when needed.
Public health is defined by the WHO as all organized measures intended to promote health, prevent deseases and prolong life of people. Public health focuses on entire populations, not on individuals and some diseases, in this manner it is associated with the total system. There are three major groups of public health actions:
- assessment and monitoring of health communities at risk to identify health problems and priorities;
- framing of public policies created to resolve the identified problems and priorotoes, both at local and national levels;
- safeguarding that the whole population has access to appropriate and cost-effective healthcare that entails health promotion and disease prevention services [8].
Speaking of health diplomacy, the term has developed from «medical diplomacy», introduced in 1978 by Peter Bourne, special assistant to the president for health issues during the Carter administration, who believed that health and medicine together, as an instrument for improving international relations had not been entirely explored and such humanitarian issues could link diplomatic barriers. The notion developed throughout the recent decades and gradually transformed into «global health diplomacy», having not only one single meaning, but some aspects of interactions in the domain of international public health topics, as listed below:
- «core diplomacy, formal negotiations between and among nations;
- multistakeholder diplomacy, negotiations between or among nations and other actors, not necessarily intended to lead to binding agreements; and informal diplomacy, interactions between international public health actors and their counterparts in the field, including host country officials, nongovernmental organizations, private-sector companies, and the public» [9, p. 8-9].
It is important to pay attention to the fact that the concept of global health diplomacy has considerable normative and practical features, in this fashion it is vital to differentiate this discipline from global health politics and global health governance [10, p. 506].
Concerning the effectiveness of international communication, practice shows that it is not enough to speak foreign languages, but it is vital, among others, to be familiar with the legal framework that governs the relationship between the subjects of international communication, binding on all participants of the system of international connections. The practice of international relations appears as a special form of political regulation of cross-cultural links between different countries, in the process of which special bodies and associations could be established, being engaged in a purposeful and broad policy of interaction of states in various fields [11, p. 122-123].
The objective changes on the international scene, together with the principle of «multi-polar world» that has been gradually embodied into the practice of international relations, require coordination of actions of the whole international community. There are special international forums, intended for such purposes, namely to bring together foreign policy actors, operating temporarily or permanently in a form of international organizations.
To have a better understanding of the functioning of international organizations, let us have a closer look at their structure and purpose. A representative international inter-governmental or public organization is an association of states, established on the basis of an international treaty, in accordance with the norms of international law for specific purposes, having a system of permanent bodies. One of the main features of international inter-governmental organizations is that they possess legal personality, which allows them to enjoy certain immunities and privileges. Such organizations could be categorized by the following attributes:
1. Legal nature.
2. Circle of participants.
3. Order entry.
4. Competency [12, p. 31-32].
International organizations, being subjects of international law are viewed by some jurists as «special breed». They classically fall into three, not always homogeneous, main groups:
I. Public inter-governmental organizations, composed of states and represented by governments:
- open international organizations - universal, that is their membership is open to all states,
- closed international organizations - accepts members from certain regions or countries.
II. Private international organizations - the NGOs.
III. International public corporations - the IPCs.
International organizations might be established not by states only, also by non-State entities - in this case being founded not by treaties, but by other instruments, as resolutions and declarations.
International organizations, possessing legal personality, are able to express powers, among others, by bringing international claims in their own right, concluding treaties, bearing full responsibility for breach of international obligations, taking decisions regarding their sphere of operations. (Besides implied powers, international organizations own inherent powers, not always easy to determine since they are not normally set up in the treaties). What is more, international organizations entitled with diplomatic privileges and immunities, which are governed by headquarters agreements with the relevant government. The embassies and permanent representations to international organizations refer simultaneously to the protocol office of these organizations and to the Ministry of Foreign Affairs of the sending state. The privileges and immunities of international organizations come from three sources:
- Treaties.
- Customary international law.
- Bilateral agreements between organizations and states.
The immunities of such type form the next four circles:
- jurisdictional immunity;
- inviolability of premises;
- freedom of communication;
- immunity related to financial matters.
The privileges and immunities, granted to the officials of international organizations are, indisputably, not for the personal benefit, but given to enable the organizations to effectively carry out their functions and to guarantee their international status. (The treaties of international organizations normally provide the inviolability of their premises and archives, so the headquarters area shall be inviolable, together with the property and assets of the international organization.) The immunity is not always absolute, though and it could be waved of any official in case of misuse [13, pp. 130-197].
The collective efforts of member-states of various World Organizations and also, the work of international assemblies make a significant contribution into the rulemaking process, during which international legal acts are being created and adopted, incorporating rules of international law, mainly of advisory character. On that account, the Organization of the United Nations plays an important role in the international arena, being the world's largest universal inter-governmental organization. Authors of the project of the United Nations created a mechanism that can bring together and involve into the process of communication simultaneously hundreds of thousands of people from around the world. This communicative beginning makes up the uniqueness of the diplomatic school and practice of the United Nations [14, p. 5].
The committees of the United Nations - the so-called treaty bodies, consist of independent experts and their task is to supervise the implementation of partic-
ular human rights treaties and accords. These committees administer the treaties in a number of ways, for example, by analyzing reports of related governments and civil societies on the implementation of these agreements, making comments to the government reports, and issuing general comments about the content of treaties or some specific rights [15].
With regard to the human right to health, the General Assembly of the United Nations back in 2008 in its Global Health and Foreign Policy Resolution 63/33 acknowledged «the close relationship between foreign policy and global health and their interdependence and ... that global challenges require concerted and sustained efforts by the international community» [16]. The aim is to advance the synergy between foreign policy and global health, placing health as a foreign policy issue on the international agenda, because global health is also a long-term objective with national, regional and international dimensions th\at requires sustained attention, commitment and closer international cooperation beyond emergency.
Political analysts note that during the last fifteen years we have seen health to occupy a more central place development, becoming a foreign policy issue. The United Nations have to deal with the spread of diseases that create diplomatic challenges for some countries, since this critical situation affects their communities and economies. Foreign policy actors apply soft power to reach consensus on global health strategies. Foreign ministers jointly work on ways to use diplomacy to secure better health for all peoples and to raise the profile of global public health. The international arena had enriched by a number of new actors by now with involvement of civil society, private sector and other non-state participants into shaping the health-related policy. It is a challenge, though to agree on strategies and ensure policy coherence. Speaking of issues related to healthcare, professionals stress «the urgent need for the health guardians to practice the kind of diplomacy that will drive coordinated governance beyond the health sector» and declare: «It is clear that the global health architecture needs a shakeup. It needs to be simplified and streamlined». The responsibility and management should be shared and the normative leadership would concentrate on health promotion and protection, either, with taking into account the principles of evidence and human rights. The implementation of necessary reforms in healthcare would demand skilled diplomacy, performed by both national leaders and health advocates internationally [17].
In the system of the United Nations, for example, in terms of health such objectives are pursued by the WHO. The World Health Organization is a recognized leading specialized agency for health that performs functions with regard to health policy in accordance with its mandate. The Global Health Diplomacy of the World Health Organization is an initiative with interdisciplinary approach that brings together the fields of public health, international affairs, management, law and economics, aimed at working out the optimal management in global policy environment for health. The link between health, foreign policy and trade is at the most advanced stage of global health diplomacy, with two main tasks, namely
support of the development of a more systematic and pro-active approach to identification of key current and future changes, which impacts global public health, and to build capacity among Member States to be able to take collective action and use opportunities, also mitigate the risks for health [18].
Furthermore, the Department of Ethics, Equity, Trade and Human Rights established The Unit on Trade, Foreign Policy, Diplomacy and Health (TFD). The mission of TFD is to facilitate and coordinate actions for greater policy coherence between the promotion and protection of health and other government policies, such as trade and foreign policy. The primary objectives of TFD are to support countries in application of international trade and trade agreements for health, assist in ensuring health promotion and protection in the context of foreign policy, to provide capacities for countries to negotiate in favor of collective action in addressing global health challenges. The related areas of works are, as follows:
1. Foreign Policy and Global Health: responding to cross-border risks to public health.
2. Global Health Diplomacy: forming and managing the global policy environment for health.
3. Trade and Health: assistance in effective trade and trade agreements in the health sector [19].
The WHO is the directing and coordinating authority for health within the system of the United Nations, responsible for providing leadership on global health subjects, outlining the health research plan, setting norms and standards, suggesting evidence-based policy options, providing technical support to countries, monitoring and assessing health development. Currently health is a shared responsibility task, involving equitable access to essential care and collective defense against transnational threats. The Organization is undergoing a reorganization process, to be better equipped to address the numerous, complex challenges of human health in the 21st century, because due to new and emerging public health threats, the WHO needs to be flexible enough to respond to such evolving environment [20].
The number of leaders is increasing, who belong to the world of politics and academia, who search the way of structuring and utilizing diplomacy to serve global health, since the globalization gradually dissolves the distinction between foreign and domestic problems. Let us remember, that one nation's health status and risks is able to affect not only its neighboring countries, but the entire world. In view of that, policymakers and practitioners now speak of «global» health and wellbeing in terms of international health programs. The global health diplomacy covers activities from formal negotiations to vast amount of partnerships between governmental and non-governmental participants. This critical situation has placed a new claim, among others, on legal instruments, requiring new legal (international) agreements, so in many countries global health is part of national security and diplomacy now. The growing demands on global health diplomacy
necessitate a refined combination of legal knowledge, technical expertise and diplomatic proficiency that have not been developed among foreign service and global health professionals. In this way, the expanding ties between foreign and health policies call for both the diplomatic and health areas to reconsider the expertise and assets to achieve their mutual targets. It must be noted, that despite of the increasing need in health diplomats, their training has not been institutionalized until now within this sub-discipline. This course of action would have been acknowledged equally by the diplomatic corps and professional health community, to create a specialization that could assist health to advance international relations and the other way around [21, pp. 503-518].
The WHO's multilingual web site, publications and other resources ensure health information to reach people who need it, in the languages they can understand. This makes access to health information both more equitable and effective. Multilingual communication bridges gaps and fosters understanding between peoples. It allows the WHO to more effectively guide public health practices, reach out to international audiences and achieve better outcomes worldwide. In this way, multilingual communication is an essential tool for improving global health. «A multilingual WHO is better equipped to communicate health messages, to produce and disseminate health information and to generate, share and use knowledge about health in an equitable manner. It is also better placed to meet today's major public health challenge: strengthening health systems in order to provide essential health care for all» [22].
In addition, the WHO's project of Global Health Diplomacy offers a training «Negotiating health in an interdependent world», on the grounds that since health becomes an ever more critical element in foreign policy, security policy, and trade agreements, new skills are needed to negotiate global regimes, international agreements and treaties, to maintain relations with a wide range of stakeholders. This course focuses on global health diplomacy concerns, discussing the key difficulties in this field and how they are addressed by different groups at different levels of governance, developing health strategies, in this way linking global health to foreign diplomacy [23].
The multistakeholder diplomacy embraces a wide range of connections of actors which earlier did not really take part in foreign affairs. An other important institution of the United Nations is FAO - the Food and Agricultural Organization [24], connected to the WHO in the domain of human health by joint work concerning food safety standards and food risks. The provision of food safety and food security to the population - which is the mission of FAO - is just essential to maintain a healthy life. FAO cooperates with governmental and non-governmental parties, together with the civil members of the society, thus contributing into the human and economic development for the benefit of the whole mankind. (There is a Diplomatic Corps accredited to FAO, granted special diplomatic exemptions.) Additionally, in our age still the hunger exists, even that the global food production could satisfy the needs of
every person on the planet. Moreover, the hidden hunger that refers to micronutrient deficiencies and affects over 2 billion people worldwide could also be result of poor quality diet. The link between food and health is obviously, direct, as the correlation of nutrition and infection or rather, undernutrition and desease [25, p. 2].
The food assistance by FAO increases global food security, being provided to those, who have suffered emergencies, such as natural disasters and crises, caused by humans. The food assistance could be arranged in diverse direct and indirect forms, the latter cover nutrition education, post-emergency rehabilitation, crisis prevention, food-related policies. The lack of food security affects human development, since it means lack of access to health care, either. The standard-setting procedure, effected by WHO, with assistance of FAO is a complex and multipart procedure where negotiations require both technical expertice and diplomatic skills, for these institutions hold talks at the governmental level, representing the welfare of unprotected and often more insecure groups of the population.
Besides the inter-governmental organizations, international conferences also take a serious place in the system of international relations. International intergovernmental conferences are temporary official bodies of external relations for exchange of views, analysis of the international situation, and development of a coordinated stand on a particular issue, with the aim to adopt a joint statement, or giving recommendations for the resolution of the current international situation. The agreement, reached on the particular matter is put in written in relevant international legal documents, depending on the subject discussed, such as politics, economy, security, humanitarian assistance and other. Furthermore, the diplomatic international conferences are held in order to develop international agreements. The founding international conferences are held to adopting the Charter of international inter-governmental organizations. The inter-governmental organizations could be categorized by certain attributes, as well, as follows:
1. Circle of participants: universal and regional.
2. Periodicity: regular and extraordinary.
3. Status of officials participated: Heads of States (summits), Ministers of Foreign Affairs, experts and other persons.
The specific name of the conference (meeting, conference, forum, etc.) is not essential for the international community. The initiator of an international conference, for example, a state or group of states, international organizations or international official - provisionally proposes themes for the international forum, the venue and time of the event, the agenda, presiding candidacy, working languages, etc. An international conference elects its chairman, vice chairman, identifies the main speakers, together with the main or general committee, credentials committee for delegates, committees to discuss certain issues included in the agenda, drafting committee, forms the secretariat, etc. Opening and closing of an international conference takes place, usually in the form of an opening plenary session. The committee sessions are usually being held behind closed doors.
The decision-making at the international conference is performed in accordance with the voting rules, which are also accepted at the relevant international forum. An international conference adopts documents of the current character, such as references, reports, statements, appeals (for example, to the parliaments of the world), resolutions, final acts, agreements and so on, which may contain provisions of international law [26, p. 33-37]. Speaking of the domain of health, there are international conferences arranged on public global health, urban health, hetlhcare, health promoting, health and social care, health and climate, health policy statistics and other.
In concordance with the above-said, certain specialists state that in global health diplomacy the core issue is to find an institutional form needs to be found for the polyrateral diplomacy of the 21st century that has the ability to estimate the prospects for health and bring outcomes to a challenging public. «To some extent health diplomacy has gone full circle: in 106 years it has moved from a political to a technical discussion and is now back as a political negotiation. It is ... a political priority to be addressed by open public diplomacy at the highest level of the United Nations» [27, p. 24].
Scholars point out that health is a growing concern in foreing affairs also because health issues are connected to core foreign policy functions, namely support of human rights and dignity, enhancement of economic growth and development. Unfortunately, foreing policy-makers pay attention to public health mostly in times of crisis (for example, global pandemics), while there is an urgent need to establish a more sustainable relationship between foreign policy and health. The task would demand more strategic inputs from academic institutions, policy anal-ists and researchers to raise the profile of health, along with the careful management [28, p. 498].
The success of implementation of foreign policy goals depends on the right coise of actions taken and instruments applied, and the decision-making process itself includes the following four stages:
1) formulation of goals, in accordance with the interest of the relevant foreign policy actor;
2) identification of possible actions to achieve the specified goals;
3) assessment of the expected consequences, id est weighing the costs and benefits;
4) as a consequence of the first three steps, arrive to the best - the profit maximizing decision [29, p. 29].
It should be pointed out that the level of accomplishement of the chosen goal and the associates tasks should be certainly measured, and this last step would complete and finalize the whole process.
Conclusion
The role of health diplomacy is evolving in the 21st century, permitting to influence the world events, as a result of changes in interstate relations, increased
activities of public diplomacy and supranational organizations, influence of scientific and economic factors, along with the activization of private sector. The aims of health diplomacy have become more extensive, with the growing list of new goals. What is more, health diplomacy has a larger application area at present and is able to reach a broader audience, spreading its values and implementing programs.
Health diplomacy can evolve changes in social life, possessing a broad variety of possibilities, being able to develop the ways of fitting the universal principles into the local culture and adjust them to national specifics. Although, along with further studies on how states integrate global health into foreign policy, more attention is needed to the matter of personnel training in this regard - the institutionalization of an academic course, to provide highly educated public health professionals, including public health diplomats, to deal with formal and informal health diplomacy. The progressing correlation between the states needs continual dialogue, therefore, calls for the skilled diplomacy, to participate in social peace building by overcoming the cultural differences and strengthening the inter-governmental ties.
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