Can Foreign Policy Make a Difference to Health?

In 2006 seven foreign ministers from Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand initiated a dialogue on the inter-linkages between health and foreign policy, with a focus on how health matters to foreign policy and whether foreign policy can make a difference to health. What brought the ministers together was the realization that the state of global health has a profound impact on all nations and is deeply interconnected with trade and environment, economic growth, social development, national security, human rights, and dignity. These are challenges that go beyond the scope of ministries of health, and represent areas for which WHO (as the UN specialized agency for health) must have broader political support from member countries. Based on the ministers’ analysis, the Oslo Ministerial Declaration in 2007 stated a commitment to ‘‘make impact on health a defining lens that each of the countries would use to examine key elements of foreign policy and development strategies’’ [1]. The ministers also decided to engage in a dialogue on how to deal with policy options from this perspective. The need for countries to protect themselves from cross-border exposure to health risks was not a new insight in 2006. The world had already had the experience of pandemics, bioterrorism, and other threats to global health security. (The reference to security should not be understood in terms of threats to the maintenance of peace and security enshrined in the UN Charter. So far, there is no consensus on the definition of ‘‘global health security,’’ see Oslo Ministerial Declaration 2007 [1] and World Health Report 2007 [2]). A realization was already growing that in an interdependent world no country can manage exposure to public health risks and threats on their own, since people, animals, goods, and skills travel around the world faster than ever before in human history. What was new was the commitment on the part of the ministers of foreign affairs to get engaged. Bringing together and building on perspectives and insights from four regions around the world, they agreed to make common vulnerability, shared risk, and shared responsibility the major starting points of their efforts. Collaboration across borders (rather than protection of ‘‘my borders’’) was key to this process, as was a recognition that a nation’s pursuit of pure self interest might undermine solutions that can respond to the challenges of growing interdependence. The Oslo Declaration noted that moving forward would entail a need to combine a respect for national sovereignty with the attributes of transparency, trust, accountability, and fairness. In their follow up, the approach of the seven ministers and their teams in capitals, in Geneva, and in New York, has been practical and issue oriented, geared to capturing opportunities, engaging with each other, and seeking to communicate better and differently across traditional alliances, regions, and blocs. The agenda has now been set for health in foreign policy at both national and international levels. The process itself must now prove its value over time.