Global Health Diplomacy, ‘Smart Power’, and the New World Order

Abstract

Both the theory and practice of foreign policy and diplomacy, including systems of hard and soft power, are undergoing paradigm shifts, with an increasing number of innovative actors and strategies contributing to international relations outcomes in the ‘New World Order’. Concurrently, global health programmes continue to ascend the political spectrum in scale, scope and influence. This concatenation of circumstances has demanded a re-examination of the existing and potential effectiveness of global health programmes in the ‘smart power’ context, based on adherence to a range of design, implementation and assessment criteria, which may simultaneously optimise their humanitarian, foreign policy and diplomatic effectiveness. A synthesis of contemporary characteristics of ‘global health diplomacy’ and ‘global health as foreign policy’, grouped by common themes and generated in the context of related field experiences, are presented in the form of ‘Top Ten’ criteria lists for optimising both diplomatic and foreign policy effectiveness of global health programmes, and criteria are presented in concert with an examination of implications for programme design and delivery. Key criteria for global health programmes that are sensitised to both diplomatic and foreign policy goals include visibility, sustainability, geostrategic considerations, accountability, effectiveness and alignment with broader policy objectives. Though diplomacy is a component of foreign policy, criteria for ‘diplomatically-sensitised’ versus ‘foreign policy-sensitised’ global health programmes were not always consistent, and were occasionally in conflict, with each other. The desirability of making diplomatic and foreign policy criteria explicit, rather than implicit, in the context of global health programme design, delivery and evaluation are reflected in the identified implications for (1) international security, (2) programme evaluation, (3) funding and resource allocation decisions, (4) approval systems and (5) training. On this basis, global health programmes are shown to provide a valuable, yet underutilised, tool for diplomacy and foreign policy purposes, including their role in the pursuit of benign international influence. A corresponding alignment of resources between ‘hard’ and ‘smart’ power options is encouraged.

Keywords:

• smart power
• global health diplomacy
• foreign policy
• international relations

Acknowledgements

Mr. Eamon Agnew (Saint Andrew's College); Professor Solomon R. Benatar (University of Cape Town); Professor Ruairi Brugha (Royal College of Surgeons in Ireland); Professor Richard Coker (London School of Hygiene and Tropical Medicine); Mr. Jeremy Emmet-Booth (University College Dublin); Dr Theodore Fleischer (University of Cape Town); Dr. David Heymann (Royal Institute for International Affairs); Professor James G. Khan (University of California, San Francisco); Professor Willi McFarland (University of California, San Francisco); Professor Stephen F. Morin (University of California, San Francisco); Professor Charles Normand (Trinity College Dublin); Professor Thomas Novotny (University of California, San Diego); Dr Michael Purser (Trinity College Dublin); Professor Michael Reyes (University of California, San Francisco); Professor George Rutherford (University of California, San Francisco); Professor Starley Shade (University of California, San Francisco); Dr Gavin Yamey (University of California, San Francisco).