Background

Methods

Results

Conclusions

Background: Global health diplomacy (GHD) has the potential to advance foreign policy objectives, but how GHD impacts outcomes remains unclear. Interestingly, Brazil has started to play a larger role in foreign policy via South-South cooperation (SSC), and these activities correspond to the current thinking on GHD modalities. This dissertation will focus on Brazil’s SSC activities to understand the impacts of GHD.

Objective: The primary objectives of this dissertation are: to refine the taxonomy of GHD, and to develop a framework that can be used to measure how GHD can impact trade (e.g. trade balance) and health outcomes (e.g. antiretroviral [ARV] coverage).

Methods: Paper 1: We reviewed GHD, SSC and Brazil health cooperation using peer-reviewed journal articles, government documents, white papers, and non-governmental reports (2001- 2015) to refine the taxonomy of GHD and align GHD and SSC activities. Paper 2: We evaluated the impact of GHD on trade balance by comparing available data from Countries of Africa with Portuguese as their Official Language (PALOPs) and select non-PALOPs using non-parametric methods. Paper 3: We evaluated the impact of GHD on ARV coverage by comparing available data from PALOPs and select non-PALOPs using non-parametric methods, similar to Paper 2.

Results: Paper 1 refines the definition of GHD and determines how Brazil’s SSC represents an expansion of GHD activities. Paper 2 identified that Brazil’s SSC with PALOP countries is associated with higher trade balance than with select non-PALOP countries. Paper 3 found that although Brazil’s SSC had an impact on trade balance, it did not translate into higher ARV coverage in the PALOP countries, compared to select non-PALOP countries.

Conclusion: This dissertation defined how Brazil’s SSC is a form of GHD. These investigations also determined that Brazil’s GHD activities have led to a greater trade balance among PALOP countries but has not led to greater ARV coverage, despite this health metric being a stated goal among PALOP countries. Overall, this dissertation aligns GHD and SSC activities and goals, thus expanding the taxonomy of GHD activities and strengthens the empirical methodology that can be used to evaluate impacts of GHD.

This paper examines the historical experience of tobacco control in the last five decades and shares important lessons of public health interventions to inform current and future tobacco control programs in other countries. The paper is divided into four parts. The first part gives an overview of the political economy, principal influences and interventions in tobacco control in the United States. It stresses the importance of information shocks and the role played by grassroots organizations. The current situation of tobacco control in the United States is further discussed in the second part, with emphasis on the economic case that led to litigation, as well as the response of the industry and the States. The third part focuses on the present efforts of multilaterals like the World Bank, technical UN agencies such as the World Health Organization, in the context of the new global governance structure: the Framework Convention on Tobacco Control (FCTC). The last section discusses lessons learned and provides recommendations for comprehensive tobacco control programs.

The paper suggests five major policy drivers that constitute components of a comprehensive tobacco control program: – science to inform policy, information strategies to educate consumers, advocacy to stimulate interventions, legal actions to develop regulations, and international collaboration through the FCTC. The paper concludes that while government has the responsibility for funding and implementing these activities; these can be most effective when supported by civil society.

Introduction: Global health diplomacy is important in mitigating disaster severity through collaboration. Complex health emergencies resulting from rapid onset disasters frequently rely on international stakeholders to alleviate suffering of an affected population. The United States Government possesses a unique medical capability to provide humanitarian assistance within Department of Defense (DoD that conducts proactive healthcare-capacity building Maritime Humanitarian Civic Assistance (mHCA) missions. Linking HCA proactive healthcare-capacity building activities to efficiencies in reactive disaster responses is a desired outcome for the DoD.

Methods: Through examination of peer-reviewed and “grey” literature yielded (a) the manner in which HCA missions are referenced, as health-related activities or a strategic security tool; (b) identified mHCA missions process outcomes through structured web searches; and (c) the author professional affiliations referencing mHCA missions. A comparative case study of DoD military medical resources during complex disaster responses was undertaken. Disaster-affected nations where mHCAs had been conducted during 2006-2013 were systematically selected utilizing disaster risk trend and disaster tracking databases to define the unit of analysis; and (b) conduct thematic analysis of key stakeholders’ post-disaster reports documenting foreign militaries’ medical resources impact on disaster responses and associations with mHCAs.

Results: The literature review identified 800 citations regarding mHCA missions with 126 meeting inclusion criteria. Documents identified as grey literature represented 58% of the results and focused on national security agendas while describing maritime HCAs as a strategic security tool. No mention of mHCA mission impact on host nation health status was noted. Several themes emerged: a) pre-disaster health engagements with foreign nations are not identified with improvements in disaster responses; b) the benefit of establishing a formalized international disaster response and preparedness framework integrating military resources is acknowledged; and (c) ongoing disaster management education of military personnel is needed.

Conclusion: This dissertation contributes to the understanding on the utility of military medical assets providing purposeful global health resources in disaster management. By examining the literature on proactive mHCAs and developing a comparative case study, the DoD’s strategic perspectives in disaster mitigation are better understood to inform the design of policy solutions to synergize DoD efforts in disaster-risk-reduction through healthcare-capacity building

ABSTRACT OF THE DISSERTATION

Applied Health Diplomacy: Advancing the Science, Practice, and Tradecraft of Global Health Diplomacy to Facilitate More Effective Global Health Action

by

Matthew D. Brown

Doctor of Philosophy in Public Health (Global Health)

University of California, San Diego, 2016

San Diego State University, 2016

Professor Thomas E. Novotny, Chair

Global Health Diplomacy (GHD) is a burgeoning field that bridges independent priorities in both global health and foreign affairs. Given the increasing need to mobilize the global community to respond to Public Health Emergencies of International Concern (PHEIC) such as Ebola or Zika, as well as forge new and expand existing collaborations to tackle public health challenges of mutual concern, effective and timely coordination and cooperation among actors is critical. Health Attachés are key diplomats who represent nation-states in these negotiations. Despite this diplomatic mandates, they are very few in numbers and little is published about this profession, preparation, and perspectives in field of GHD. Additionally, no institution has published a GHD core competency model to help standardize recruitment, training, and preparation of personnel changed with the practice of GHD, which can lead to confusion when trying to align actors and institutions to achieve effective global health action.

Objectives: (1) Update definitions and practice models in GHD related to the development and practice of Health Attachés; (2) Create a GHD core competency model to address gaps in training for global public health, foreign affairs, and other professionals; and (3) Present a profile of practicing Health Attachés accredited to the United States and foreign governments.

Methods: By synthesizing literature and definitions used in the field with an emphasis on practice, develop a framework for GHD and a tradecraft model for Health Attachés in the 21st Century (Chapter 2). Developed a core competency model for GHD by: (a) identifying core competency models from global public health and foreign affairs training institutions; (b) employing a priori word counts drawn from the foreign affairs literature, measure degrees of association and divergence between global public health and foreign affairs competency models; and (c) based on these comparisons, formulate an initial core competency model for GHD (Chapter 3). Utilize key informant interviews to qualitatively explore perspectives, preparation, best practices, and challenges in the field of GHD among Health Attachés accredited to the United States and foreign governments (Chapter 4).

Results: In Chapter 2, we introduce a Pyramid of Global Health Diplomacy, presenting three levels of GHD practice: core, multi-stakeholder, and informal, each with associated actors, definitions, and tools; and a Tradecraft Model of Global Health Diplomacy and Health Attachés, to map relations among stakeholders, counterparts, and institutions. In Chapter 3, we propose a Global Health Diplomacy Core Competency Model illustrating foreign affairs institutions need additional knowledge, skills, and abilities in: (a) heath communication, (b) public health analysis, and (c) public health ethics; and global public health institutions need additional knowledge, skills, and abilities in: (a) leadership, (b) foreign languages, and (c) foreign policy goals, objectives, and strategies. In Chapter 4, Health Attachés identified skills in diplomacy and negotiation, applied science, and cross cultural competency critical for success, and providing expanded communication protocols on health plans and counterparts, while on-the-job training and mentored experiences for practitioners is important for future actors in the field.

Conclusion: This dissertation provides needed advancements in the field of GHD, helping to advance the science, practice, and tradecraft of GHD. While models presented in this body of work need to be tested, evaluated, and refined with additional research, they serve as a collective practice framework for the field, to inform any profession or institutions who practices GHD. Additionally, findings may help professionalize the field of GHD, the practice of Health Attachés, and create a more effective bridge between the fields of foreign affairs and public health, by increasing cross-field competence, and fostering more effective global health action when maintaining, expanding, and initiating new global health collaborations.