Working Papers and Abstracts
Thomas Novotny, M.D., M.P.H.
Global Health Sciences, UC San Francisco
Vincanne Adams, Ph.D.
Global Health Sciences, UC San Francisco
Health diplomacy may be defined as a political change activity
that meets the dual goals of improving global health while maintaining
and strengthening international relations abroad, particularly
in
conflict areas and resource-poor environments. Although there
are historical precedents for health diplomacy (examples are found
in
early missionary work, colonial and post-colonial health development
aid, faith-based and other non-governmental efforts, and now
the new global health philanthropies, ) the imperatives of disease
globalization,
persistent international conflicts, and new threats to human
security call for defining global health diplomacy as an academic
discipline
for our times. This paper provides a prospective overview of
the content of global health diplomacy, defines areas of interest,
and sets out
an agenda for development of knowledge, pedagogy, and service
in the field.
Nils Daulaire, M.D., M.P.H.
President and CEO, Global Health Council
David P. Fidler
Indiana University
School of Law
This conference seeks to advance understanding about “global health diplomacy,” which the organizers see as an emerging interdisciplinary field of study and practice. In line with this theme, I argue that the concept of global health diplomacy, as presented in the Working Paper distributed in advance of the conference, itself requires some governing before we can understand the political nature of this endeavor.
The task of governing global health diplomacy arises in two contexts. First, the manner in which the Working Paper conceptualizes global health diplomacy runs the risk of divorcing this concept from the realities of international politics and foreign policy. More specifically, global health diplomacy does not contain the transformative potential the Working Paper suggests it has. Second, activities under the rubric of global health diplomacy require governance given concerns about the lack of coordination of the explosion of global health activities over the past decade. Far from being a beacon of progress, current global health diplomacy may be out of control, making things worse rather than better. The potential for bringing global health diplomacy under control is, however, limited by the rational interests of States and non-State actors engaged in global health politics. In short, the politics of global health governance in the early twenty-first century challenge the potential of global health diplomacy in ways that raise questions about the promise this new interdisciplinary field offers international relations.
Laurie
Garrett, Senior
Fellow for Global Health
Council on Foreign Relations
NOTE: This is an extremely large
(71.1 MB) Powerpoint file.
Laurie Garrett, Senior Fellow for Global Health
Council on Foreign Relations
David P. Fidler
Indiana University
School of Law
The twenty-first century will witness U.S. national security and foreign policy increasingly tested by transnational events, phenomena, activities, and threats. U.S. national security and foreign policy thinking will need to adapt to this new world. Although the United States was a key architect of today’s networked anarchy, the federal government faces daunting responsibilities to increase the resiliency of the nation and the international system to multiplying transnational challenges. Global health advocates must develop arguments in support of “health diplomacy” that recognize these trends, and rigorously immerse themselves in the appropriate language and vision of U.S. security. The use of “health” as a diplomatic tool, traditionally a partisan activity finding strongest support from liberal Democrats, must be promoted within a far larger transnational threat agenda.
Dr. Delon Human
President, HEALTHDiplomats
As the field of health diplomacy represents a combination of a science and
the art of diplomatic practice, it will be important to include case studies
and practical exercises of applied health diplomacy in politicized situations.
Moreover, it is essential to enrich the curriculum with examples from outside
the Americas, particularly the European, Middle East, African and Asian settings.
More emphasis should be placed on potential contributions by health professionals,
non-governmental groups, the private sector, and fields such as health communication.
Seven potential focus areas for health diplomacy training and practice deserve
consideration and could enhance its use and effectiveness in political negotiation.
C. William Keck, M.D., M.P.H.
Hidden behind the information screen imposed by the U.S. embargo, Cuba has
developed its post-revolutionary health and education systems largely out of
the view of the United States. During almost fifty years of consistent political
will and action, Cuba has transformed itself, despite its continuing relative
poverty, from one of the less healthy and less educated countries in the world
to a country with health status and educational attainment that matches or
exceeds that of the world’s developed nations.
Decision Making for Global Health Research Funding: The View from a Former NIH Decision Maker
Gerald T. Keusch, M.D.
Associate Provost and Associate Dean for Global Health, Boston University
“At Bethesda, a great international center for research in biology and medicine
dedicated to international cooperation in the interests of the health of mankind.” With
these words, uttered more than forty years ago, Congressman John E. Fogarty
of Rhode Island laid out his vision for a more global agenda for the National
Institutes of Health, in which international biomedical research would be essential
because, as he phrased it, “disease knows no national boundaries” and “we care.” The
result, the Fogarty International Center, was far less than he imagined it
should or would be. For most of the ensuing years the vision has been limited
by fiscal penury and political prerogative, both within and without the NIH.
While many constraints remain, and probably will never be entirely removed,
there has been a shift in perspectives as global health threats have loomed
larger in the past twenty years and the consequence of narrow action has become
apparent. How science decisions are made and implemented will be explored in
the context of emerging concepts of global health diplomacy and the enlarging
list of global players.
Randall Kuhn, M.A.,
Ph.D.
Denver University
Vinh-Kim Nguyen, M.D.,
M.Sc., Ph.D.
University of Montreal
Reflections
on Public Health: Biopolitics and Health Diplomacy
Mark Nichter
University of Arizona
Clinical Trials
Offshore: On Private Sector Science and Public Health
Adriana Petryna
Department of Anthropology, University of Pennsylvania
Clinical research plays an increasingly important (though generally under-acknowledged) role in public health services provisioning in middle- and low-income countries. But the benefits deriving from such research are unevenly distributed. This talk draws on work with contract research organizations (CROs), a specialized industry focusing on subject recruitment and clinical development for the drug industry; and interviews with national regulators, public health experts, and clinical trial researchers in Poland and Brazil, two clinical trial ‘growth regions.’
In addressing the strategies of evidence-making that inform clinical trial offshoring, I consider the context-specific calculations by which experimental groups are being identified. I also address the harms and uncertainties that, despite the oversight of institutional review boards and informed consent, are being produced. Whether they work directly for the clinical trial industry as scientists and study monitors or are occasionally on its payroll as recruited investigators, my informants in the United States, Poland, and Brazil reaffirm the need for a sounder science and of stretching the capacity of clinical trials as health interventions—medical research and care go hand-in-hand. As the turf war among pharmaceutical sponsors for human subjects rages on, I show how senses of accountability are being brought to the offshored clinical trial and how its public health challenges are at least partially heeded.
Global Health Diplomacy: A Tide That Should Lift All Boats
Jaime
Sepúlveda, M.D., Dr.Sc., M.P.H.
UC San Francisco
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