Examining success

The 10 examples presented briefly below can serve as an entry point for closer examination and an assessment of lessons learned from successful past negotiations in global health diplomacy.

Æ The SDGs, which were negotiated by the UN Member States with significant input from other actors, include almost 50 health-related targets, many of which require constant vigilance and negotiations at several different venues. Health, as a result, is widely seen both as a beneficia- ry of and contributor to almost all of the SDGs, not just the health-specific Goal 3. A key mea- sure of successful global health diplomacy is its contribution to progress towards the SDGs.

Several high-level meetings have helped to move this agenda forward.

Æ A major success in global health diplomacy over the past decade has been the way in which health issues were taken up by non-health forums at the UN, that is, by the General Assembly (noncommunicable diseases, tuberculosis, antimicrobial resistance, universal health coverage) and the Security Council (HIV/AIDS, health in conflict areas, Ebola). This success was facilitated to a great extent by pro-health statements by the G7 and the G20.

Æ At the UN General Assembly in September 2019, 12 multilateral health, development and hu- manitarian agencies launched a joint plan to support countries in making swifter progress to- wards the health-related SDG targets. The Global Action Plan for Healthy Lives and Well being for All, as it is entitled, is designed to help countries to identify their priorities and to plan and implement their work; it will also support efforts in key areas, such as primary health care.

Æ A UN high level meeting on 23 September 2019 resulted in the adoption of a landmark declara- tion on universal health coverage, which recognizes that it is not only access to health care services that matters but also access to a healthy lifestyle, information allowing one to make the right choices, health literacy, healthy food, transport, a healthier environment and other determinants of health.

More details of the negotiations leading to the Political declaration of the high-level meeting on universal health coverage (2019) are provided in Case Study 2.

Æ The world’s first-ever summit of Heads of State and Government on the prevention and control of noncommunicable diseases (NCDs) was convened by the Caribbean Community (CARICOM) in 2007, resulting in the Declaration of Port of Spain entitled “Uniting to stop the epidemic of chronic non communicable diseases”. The English-speaking Caribbean once had the highest per capita burden of chronic NCDs in the Americas region. Building on a long history of cooper-

ation in health among its member countries and on past successes in eliminating or reducing communicable diseases through collective action, CARICOM therefore decided to target NCDs and subsequently turned this approach into a global one by successfully campaigning for a first UN high-level meeting on NCDs.

Æ The 2014 outbreak of Ebola in western Africa posed a severe threat to human life in a globalized world in which pathogens are able to spread quickly. In the countries most affected, however, national capacities were inadequate to deal with the epidemic and leaders were reluctant to acknowledge its full implications. WHO declared a Public Health Emergency of International Concern in August 2014 to alert countries and trigger action. The epidemic was subsequently declared by the UN Security Council to be a global threat, which made it possible for the inter- national community to further bolster direct support to the countries concerned.

Æ The Seventy-second World Health Assembly in May 2019 adopted a landmark resolution urging Member States to introduce transparency policies and the Human Rights Council adopted a resolution on improving access to medicines in July 2019.

After nearly a decade of global health diplomacy, NGOs and professional organizations, supported by a group of Member States, succeeded in ensuring that the third UN high-level meeting on NCDs (2018) expanded the earlier meetings’ focus on four major NCDs (cardiovascular diseases, cancer, diabetes and respiratory diseases) and four risk factors (tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets). The result was the adoption of a “five-by-five”

approach, with mental health conditions now included as an NCD and air pollution as a risk factor.

Successes in this area (political commitments) are overshadowed by the impact of commercial determinants. The Political Declaration of the United Nations General Assembly on the Prevention and Control of NCDs in 2011 included a commitment from governments to explore the provision of adequate resources through, inter alia, domestic and bilateral channels. However, this goal has not been fulfilled. NCDs remain the largest, most internationally underfunded public health issue globally, where most lives could be saved or improved, because the political momentum was offset by the interference in international health policy-making of vested economic, market and commercial interest groups in donor countries. Unfortunately, most developed countries show limited interest in pursuing policy coherence and recognizing the interconnectedness of promot- ing a multilateral trading system under the WTO with promoting health in their international de- velopment policies as two sides of the same coin in terms of achieving the indivisible SDGs.

See Case Study 1 on the above mentioned World Health Assembly resolution.

Æ The adoption of the WHO Global Code of Practice on the International Recruitment of Health Personnel in May 2010, which created a global framework, including ethical norms and institu- tional and legal arrangements, to guide international cooperation on the critical problem of health worker migration. Mandated in 2004, it took six years in all to draw up the Code of Practice. The art of compromise proved to be essential during the long and tortuous negotia- tions in order to reach a satisfactory but non-binding agreement for both countries of origin of health worker migration and destination countries (Taylor & Dhillon, 2011). More on global health instruments can be found in Chapter 5.

Æ Since the entry into force of the FCTC in 2005, the biennial global progress reports prepared by the Convention Secretariat have provided a good overview of its implementation by the Parties.

Although the rate of progress differs considerably from country to country, it is a tremendous achievement that, despite the tobacco industry’s resistance, so many effective measures have already been taken to reduce the use of tobacco. Implementation has been most successful in the following three areas: the creation of smoke-free environments; the banning of misleading tobacco packaging and labelling; and education, communications and public awareness pro- grammes. In general, though the implementation of the Convention’s provisions has been quite uneven in many countries.

Æ The International Health Regulations, in their revised version from 2005, are the key internation- al legal instrument regulating the public health preparedness and response of countries to the international spread of disease. However, both the Ebola epidemic and the COVID-19 pandem- ic have highlighted a lack of preparedness. Many Member States have failed, for financial or political reasons, to build up adequate capacity and to honour their obligations to implement all the measures provided for in the IHR.