Health in All (Foreign) Policy: challenges in achieving coherence

Abstract

SUMMARYHealth in All Policies (HiAP) approach is generally perceived as an intersectoral approach to national or subnational public policy development, such that health outcomes are given full consideration by non-health sectors. Globalization, however, has created numerous 'inherently global health issues' with cross-border causes and consequences, requiring new forms of global governance for health. Although such governance often includes both state and non-state ( private, civil society) actors in agenda setting and influence, different actors have differing degrees of power and authority and, ultimately, it is states that ratify intergovernmental covenants or normative declarations that directly or indirectly affect health. This requires public health and health promotion practitioners working within countries to give increased attention to the foreign policies of their national governments. These foreign policies include those governing national security, foreign aid, trade and investment as well as the traditional forms of diplomacy. A new term has been coined to describe how health is coming to be positioned in governments' foreign policies: global health diplomacy. To become adept at this nuanced diplomatic practice requires familiarity with the different policy frames by which health might be inserted into the foreign policy deliberations, and thence intergovernmental/ global governance negotiations. This article discusses six such frames (security, trade, development, global public goods, human rights, ethical/moral reasoning) that have been analytically useful in assessing the potential for greater and more health-promoting foreign policy coherence: a 'Health in All (Foreign) Policies' approach.

The role of external actors in shaping migrant health insurance in Thailand

“…The interconnectedness of health and foreign policy and other policy domains, as well as the complexity of these nexus, has long been recognized [68][69][70][71][72][73] and the findings of this study add to the discussion. While foreign policy interests, especially national security and economic interests, often overshadow health objectives [68,70], these "selfserving motives for state action on health do not have to lead to poor outcomes" as stated in Feldbaum, Lee and Michaud [68] and illustrated by the case of Thailand's MHI.…”

Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review

“…1 Includes food access disparities; 2 This category encompasses all articles that address ethics in public health in general (e.g., ethical framework in public decision-making and that do not focus on nutrition-related interventions); 3 Including in food production; 4 These articles [ 12 , 22 – 26 ] are cited in this paper when relevant (most of them are classified in another field), but given their small number, there is no specific section about HIV and nutrition and nutrition-intervention in humanitarian aid in this paper; 5 Articles that could not be classified in one (at least) of the other fields. Several of these articles address conflict of interests, sponsorships and partnerships in public health and nutrition [ 27 – 30 ] . The other articles focus on behaviors, perceptions and food choice motives [ 31 – 33 ], nutritionism and the ethics of the commercialization of food [ 34 ], and the implications for public health of appropriate information to consumers and health claims linked to polyphenols [ 35 ].These articles are not discussed further in this paper, but are included in the statistics.…”

Are national policies on global health in fact national policies on global health governance? A comparison of policy designs from Norway and Switzerland

“…This means that health sector actors may be challenged to work with unfamiliar policy instruments unrelated to their area of expertise (eg, global health diplomacy) or be excluded from the implementation structures even if they were involved in developing NPGH with other sectors. Public health actors seeking to influence health and foreign policy are encouraged to discern ways health is framed in global health policy 60. A combination of a lack of familiarity, understanding or experience with diverse policy frames and instruments may limit public health actors' participation in implementation unless implementation rules in designs support a clearly defined role for them.…”