International Health Cooperation Research Articles

Brazil’s conception of South-South “structural cooperation” in health

At the dawn of the new millennium, not only have poor countries’ health needs not diminished, but they seem to have worsened due to a complex interplay among many factors that result in huge inequities within and between countries. This critical situation calls international development cooperation into question once again and prompts new thinking. In this process, South-South cooperation has steadily gained importance. At the start of the 21st century, international – particularly South-South – cooperation has come to occupy a strategic place in Brazilian foreign policy, and health is a priority item on this agenda. This paper examines the Brazilian conception of horizontal “structural cooperation in health”. It presents a brief historical review of international development cooperation and health cooperation, explores the concept of “structural cooperation in health”, and discusses the Brazilian proposal formulated over the past decade and its implementation to date. This Brazilian approach centers on the concept of “capacity building for development”, but innovates in two respects: by integrating human resource development with organisational and institutional development and by breaking with the traditional passive transfer of knowledge and technology. It is still early to evaluate its impact, but this cooperation has been implemented on the basis of five interrelated strategic, political and technical considerations: (a) priority for horizontal cooperation; (b) focus on developing health capabilities; (c) coordinated initiatives in the regional context; (d) strong involvement of health ministers in building strategic and political consensus; and (e) encouraging partnership between ministries of health and foreign relations.

Framing health and foreign policy: lessons for global health diplomacy

Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.

Pursuing Health as Foreign Policy: The Case of China

Despite the growing political and academic interest in health as a foreign policy issue, much of the emerging scholarship has focused on the conceptual overview of the field or particular aspects of the health-foreign policy linkage (e.g., humanitarian action). Little in-depth analysis has been conducted on how major powers engage health as a foreign policy issue. This article attempts to fill that void by examining the dynamics of the health-foreign policy nexus in China. After an overview of the Maoist health diplomacy, it discusses the elevation of health issues in the hierarchy of foreign policy objectives in China's reform era. Next, the article analyzes China's SARS diplomacy, which further demonstrates the changing landscape of health and foreign policy in China. Then I analyze the defining features and dilemmas of China's health-foreign policy interaction. While the emergence of health as an important foreign policy issue in China facilitates the fulfillment of its foreign policy goals and makes important contributions to international health cooperation, I conclude that the tensions and dilemmas inherent in the health-foreign policy mix in China pose risks and challenges to global health governance.

Fifty years of the Korean Society for Parasitology.

In 1959, the Korean Society for Parasitology was founded by clinical scientists, specialists of public health, and 5 core parasitologists with experience in American science and medicine. The Society this year celebrates its 50th anniversary. Due to public health importance at the time of foundation, medical parasitology was the main stream for next 3 decades. Domestic problems of niche parasitic diseases, unlisted in 6 tropical diseases of major importance, had been studied by own efforts. To cope with the demand of parasite control, evaluation system for control activity was built up. Control activity against soil-transmitted nematodes, conducted for almost 3 decades, was evaluated as a success. Evaluation of praziquantel efficacy for clonorchiasis, paragonimiasis, and neurocysticercosis, population dynamics of Ascaris lumbricoides infection in a situation of continuous reinfections, diagnostic modalities of antibody tests combined with brain imaging developed for helminthiasis of the central nervous system and researches on intestinal trematodes were achievements in the first 30 years. During the recent 2 decades, science researches, such as cell and molecular biology of parasites and immunology of parasitic infections have been studied especially on parasitic allergens and proteolytic and anti-oxidant enzymes. Experiences of international cooperation for world health have been accumulated and would be expanded in the future.

Public/Private Partnerships in the Public Health Sector

AbstractThis article reviews and analyses the growing phenomenon of public-private partnerships in the field of international public health cooperation (PPPs). This trend has been led by the changing political dynamics surrounding international health issues as well as by the perception of the inadequacy of market mechanisms and the inability of existing international institutions for tackling pressing health problems in developing countries. The article analyses in particular the remarkable developments in international health governance that PPPs have ushered in as well as the role played and the challenges faced by the World Health Organization.

Strengthening international health co-operation in Africa through theregional economic communities

The Regional Economic Communities (RECs) are the pillars of the African Union (AU), and have been recognized by the AU as the key vehicles for economic integration and cooperation in Africa. The 2003 Session of the AU Conference of African Ministers of Health (CAMH) considered and adopted, inter alia, recommendations on a proposal to establish Health and Social Affairs Desks within the RECs. The 2003 Maputo Session of the Assembly of AU Heads of State and Government duly endorsed the Report of the Ministers and their recommendations. This paper represents an attempt to assess the extent to which the 2003 decision of CAMH has been implemented. It also argues that regional integration and cooperation should not be geared solely towards economic, trade or political purposes (but to the social sector as well), and proposes a set of criteria as useful starting points for determining which social (i.e. health) activities can be undertaken at the regional and sub-regional levels. Finally, it also proposes various programmatic options to be considered in strengthening the roles of the RECs in regional integration and cooperation in the social sector (in the context of NEPAD), as Health Desks are established within the RECs. African Journal of Health Sciences Vol. 14 (3-4) 2007: pp. 104-113

Cuba's International Cooperation in Health: An Overview

In the first years after Cuba's 1959 revolution, the island's new government provided international medical assistance to countries affected by natural disasters or armed conflicts. Step by step, a more structural complementary program for international collaboration was put in place. The relief operations after Hurricane Mitch, which struck Central America in 1998, were pivotal. From November 1998 onward, the "Integrated Health Program" was the cornerstone of Cuba's international cooperation. The intense cooperation with Hugo Chávez's Venezuela became another cornerstone. Complementary to the health programs abroad, Cuba also set up international programs at home, benefiting tens of thousands of foreign patients and disaster victims. In a parallel program, medical training is offered to international students in the Latin American Medical School in Cuba and, increasingly, also in their home countries. The importance and impact of these initiatives, however, cannot and should not be analyzed solely in public health terms.

Una red para promover sistemas de salud basados en la atención primaria de salud en la Región de las Américas

To identify the relational components of an international network of organizations that provide technical and financial assistance to promote the development of health systems based on primary health care in the countries of the Region of the Americas; to analyze the linkages that would allow the collaborating partners of the Pan American Health Organization (PAHO) to work together on health issues; and to determine the basic theoretical elements that can help to develop action strategies that support advocacy efforts by a network. This was a qualitative and quantitative cross-sectional study based on identifying key informants and on analyzing social networks. Ethnographic and relational information from 46 international organizations was collected through a self-administered semistructured questionnaire. From 46 international health cooperation organizations, 29 decision makers from 29 organizations participated (63.0% response rate). The structure and the strength of the network was evaluated in terms of density, closeness, clustering, and centralization. The statistical analysis was done using computer programs that included UCINET, Pajek, and Microsoft Access. We found a structurally centralized theoretical network, whose nodes were clustered into four central subgroups linked by a shared vision. The leadership, influence, and political interests reflected the formal and technical-cooperation linkages, the formal support for health systems based on primary health care, and the flow of resources being more often technical ones than financial ones. The interorganizational relational components and the social-action ties that were identified could help in the development and consolidation of a thematic network for advocacy and for the management of technical and financial assistance that supports primary health care in the Americas. The linkages for joint action that were identified could advance international cooperation in developing health systems based on primary health care, once PAHO formulates clear implementation strategies and takes a leadership position in mobilizing financial resources and in creating informal and interpersonal linkages for action.

Application of Health Promotion Strategy to International Health Cooperation of Japan

Application of Health Promotion Strategy to International Health Cooperation of Japan

Parceiro relutante: as relações do Canadá com a Organização Pan-Americana da Saúde (OPAS)

Despite a strong commitment to multilateralism and international health cooperation in the post World War II era, Canada refrained form joining the Pan American Health Organization - PAHO until 1971. Drawing on letters and memos sent between Canadian diplomats and government representatives, this paper explores official Canadian accounts of the factors that delayed Canada's membership in PAHO. These factors include the initial lack of official relations between Canada and Latin America, US hegemony in the region, and budgetary constraints. Canada's cautious position regarding PAHO is also placed within the context of Canada's overall foreign policy to the region, emphasizing the parallels between Canada's reluctant association with PAHO and the evolution of Canada's engagement with the region as a whole.

Letters to the Editor

Department of International, Community Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan This work was supported by a Grant for International Health Cooperation Research (16C-4) from the Ministry of Health, Labour and Welfare.

Strategic Planning of International Health Cooperation

Strategic Planning of International Health Cooperation

What sort of international cooperation in health 2055?

In a paper comparing the challenges to international health in 1950 and 20001 one of the shifts I lamented was a loss of optimism. In 1950 there were high expectations for global cooperation through the United Nations, whereas in 2000 the UN was troubled, with global policy and cooperation dominated by the G8 nations.2 The UN's main health agency, the World Health Organization (WHO), designated to ‘direct and coordinate international health work’, was increasingly criticized and challenged by other players such as UNAIDS, the Global Fund to Fight AIDS, TB and Malaria, and the Bill and Melinda Gates Foundation, all of which arrived on the health scene only in the past decade. So what will international cooperation in health look like in 2055?

Priority Strategies for Sustainable Fight Against HIV/AIDS in Low-Income Countries

Response to HIV/AIDS epidemic in resource-constrained countries is still woefully disappointing. This paper highlights some priorities shared at recent Florence World Conference (Florence, Italy: January 21st-24th, 2004) on how to overcome the obstacles still delaying sustainable fight against HIV/AIDS in developing world areas. Messages reported here result from selection made by the authors among challenging topics by more than one hundred speakers and have been chosen because of their value as most practical ways to secure prevention, treatment and care and achieve self-managing in fighting epidemic in income-limited settings. Building for success means to set up combined strategies--actively involving people living with HIV/AIDS (PLWHA) and grounded on coordination, coalition and partnership among all players--to prevent HIV transmission at mother-to-child, young and adult levels and to improve availability and access to laboratory testing and monitoring as well as to essential drugs for HIV/AIDS and related diseases. Building for success also means to provide women with reliable and affordable vaginal microbicides and to look for control of co-infections such as viral hepatitis, intestinal and sexually transmitted diseases as well as tuberculosis and malaria. Among the measures taken into account, the need for education and training is emphasised because its value may be even more important than funding in some countries. Priorities suggested in this paper reinforce each other underscoring the bidirectional value and synergy of the treatment and prevention strategies together with the need for keeping prevention in people giving successful antiretroviral treatment. In the Author's opinion, the current HIV/AIDS scenario may be reversed if the priorities taken into account will entirely be applied through adaptation to the different cultural backgrounds and social settings, and based on achievement of government's political will and accountability as well as on properly coordinated technical, financial and human support from international health cooperation.

One step forward

The time is ready for international co-operation in circumpolar health to move one step forward. The emergence of cheap telecommunication and several well established research institutions that focus on various aspects of health in the Arctic have made it possible to pursue international co-operation also outside the context of the triennial congresses of circumpolar health. In a sort of grassroots movement, but also inspired by the values of the International Union for Circumpolar Health (IUCH), representatives from Canada, Denmark, Finland, Greenland, Norway, Russia and United States met in Toronto during the last week of February, 2004. While the immediate aim of the meeting was to present an overview of health research among circumpolar indigenous peoples and to discuss a pan arctic study of health transition in this population, the first steps towards a formalised institutional collaboration were taken. (Int J Circumpolar Health 2004; 63(1):4-4)

International health in a globalized development perspective.

Eleven issues highlight the relation between globalization and health:Globalization endangers health. Risks are spreading. AIDS and SARS are examples.Global alliances are emerging to protect health, especially fighting AIDS, malaria and tuberculosis.In many millennium declarations, health was declared a worldwide development goal.The international development cooperation for health is ailing everywhere despite three good reasons to make health a priority.Good health supports good politics and national security.The lack of security in health is an essential trap of poverty and increases population growth.Health has essential macroeconomic benefits. Leading economists have made this clear.Thus, health and education are true keys to social and economic development. Brains and bodies are the most essential factors of production.“Empowerment in security creates opportunities”. This new motto underlines the strategic importance of health literacy and social health insurance.International or global health is a leitmotiv of this decade of development.Globalization requires powerful ethics to gain a human face. Professional ethics and a rebellious civil society ought to be allies. Current globalization is both a threat and a positive challenge, indeed.

One step forward

The time is ready for international co-operation in circumpolar health to move one step forward. The emergence of cheap telecommunication and several well established research institutions that focus on various aspects of health in the Arctic have made it possible to pursue international co-operation also outside the context of the triennial congresses of circumpolar health. In a sort of grassroots movement, but also inspired by the values of the International Union for Circumpolar Health (IUCH), representatives from Canada, Denmark, Finland, Greenland, Norway, Russia and United States met in Toronto during the last week of February, 2004. While the immediate aim of the meeting was to present an overview of health research among circumpolar indigenous peoples and to discuss a pan arctic study of health transition in this population, the first steps towards a formalised institutional collaboration were taken.

Global governance, international health law and WHO: looking towards the future.

The evolving domain of international health law encompasses increasingly diverse and complex concerns. Commentators agree that health development in the twenty-first century is likely to expand the use of conventional international law to create a framework for coordination and cooperation among states in an increasingly interdependent world. This article examines the forces and factors behind the emerging expansion of conventional international health law as an important tool for present and future multilateral cooperation. It considers challenges to effective international health cooperation posed for intergovernmental organizations and other actors involved in lawmaking. Although full consolidation of all aspects of future international health lawmaking under the auspices of a single international organization is unworkable and undesirable, the World Health Organization (WHO) should endeavour to serve as a coordinator, catalyst and, where appropriate, platform for future health law codification. Such leadership by WHO could enhance coordination, coherence and implementation of international health law policy.

Book Review: International Co-Operation in Health

Book Review: International Co-Operation in Health

International Co-operation in Health. Martin McKee, Paul Garner and Robin Stott, eds.

International Co-operation in Health Martin McKee, Paul Garner and Robin Stott, eds Published in 2001 by Oxford University Press, Oxford, UK. ISBN 0 19 263198 5 (hardback); Price £39.50. The book International Co-operation in Health represents an important contribution to a growing but scant literature on the subject of globalization and its effects on health and health care. More specifically, the book seeks to inform and educate (public) health professionals about diverse threats to health on a global scale. These include risk factors that have traditionally been studied by epidemiologists (e.g. infectious diseases, tobacco, and diet) as well as other global phenomena that affect health but have not been traditionally studied in this context (e.g. climate change and migration). As the editors point out, current epidemiological methods that dominate public health research are insufficient to understand the relationship between globalization and health. Theoretical frameworks and methods of inquiry drawn from political science, sociology, and economics are also required. Several authors draw on these approaches to analyze select social, political, and economic forces operating at the international level and the health consequences of these global phenomena. However, not all contributors make these frameworks equally explicit. The analysis of globalization and health would also benefit from concepts and methods drawn from the study of international relations. Although not stated as such, the most common theoretical perspective held by the editors and contributors to this volume seems to be that of a pluralist state and an interdependent international system where diverse groups can compete for influence and participate in a system of global governance [1]. It is within …