Abstract
BackgroundGlobal 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.MethodsTo 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.ResultsAt 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.ConclusionHealth 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).
Highlights
Global health diplomacy (GHD) has become an important field of investigation due to health concerns increasingly entering the foreign policy domain
We conducted a narrative literature review with the goal to identify: 1) what health concerns enter diplomatic and foreign policy discussions and negotiations in Chile; 2) how they are framed in this process; 3) what are the driving forces for their inclusion into foreign policy; and 4) how we can theoretically understand these processes by drawing on international relations (IR) theory
Public health scholars have only rarely engaged with IR theory or other relevant theoretical traditions when trying to understand GHD processes [6], with theoretical explanations tending to focus on the role of dominant states in pursuing security and economic interests, with little effort to examine the role of Southern partners in GHD
Summary
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 NorthSouth cooperation in global health, and emphasizes the role of security and economic interests by Northern countries as drivers of GHD. Global health diplomacy (GHD) has become an important field of academic investigation due to health concerns increasingly entering foreign policy considerations. Subject to many interpretive definitions, GHD is most defined as the multi-level and multi-actor negotiations that shape the global policy environment for health [1] This includes various efforts through which States, intergovernmental organizations, and nonState actors negotiate responses to global health challenges (in which improved health is the identified policy goal); and encompasses using health concepts or mechanisms in global policy negotiations to achieve other political, economic, and social objectives (in which health is a means to other foreign policy objectives such as security) [2]. Much of the existing academic work focuses on North-South cooperation in global health, and emphasizes the role of security and economic interests by (historically dominant) Northern countries as drivers of GHD. In Chile the integration of health into the foreign policy agenda is not immediately visible in official diplomatic channels (i.e. at the Ministry of Foreign Affairs [MINREL] and its network of specialized agencies), our findings reported below demonstrate that Chile has been a vital player and keen promoter of important regional and global health initiatives
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