Global health diplomacy in Mexico: insights from key actors in the field

German Guerra,Ronald Labonté,Arne Ruckert,Nelly Salgado De Snyder,Emanuel Orozco,Paulina Jiménez

doi:10.1186/s12992-021-00789-y

Abstract

BackgroundGlobal 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.MethodsA 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.ResultsOur 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.ConclusionsGHD 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.

Highlights

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
Among the main premises and core assumptions derived from these theoretical frameworks are: GHD as “niche diplomacy”; health entering the foreign policy sphere through securitization and as part of competition within the bureaucracy; [16] a relationship of subordination of health to security interests; multisectoral engagement and multilateralism as key factors for agenda setting and prioritizing within GHD processes; [17] and the conceptualization of actors as stakeholders “who have an interest in the issue under consideration, who are affected by the issue, or who – because of their position – have or could have an active or passive influence on the decisionmaking process.“[18]
Health concerns entering diplomatic and foreign policy Health Sector (HS) The most relevant GHD experience for the Mexican HS is found in its leadership to promote bi-national health within the CSF1, where health priority setting for

Summary

Introduction

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. [8] Other GHD issues in Mexico besides immigration are trade affecting food policy and reproductive rights, [9, 10] but relatively little is known about how health issues enter foreign policy agendas in the first place. To address this knowledge gap, we examine how and why health matters are endorsed and integrated into foreign policy from the perspective of representatives of three major sectors in Mexico: Health, Foreign Affairs, and Non-Governmental Organizations. We identify some barriers to effective GHD in Mexico and provide recommendations for overcoming them when health diplomacy has garnered a renewed focus amidst the COVID-19 pandemic

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Conclusion