It is quite well known that globally, healthcare is threatened by powerful trends – increasing demand, rising costs, uneven quality, inequitable distribution and misaligned incentives. In India too, current health systems will be unsustainable if unchanged over the next decade. If ignored, they will overwhelm health systems, creating massive financial burdens and devastating health problems for fellow Indians.
What makes for a just health care system, even as an ideal, in India?
1) Universal access – through equitable distribution of healthcare products and services against a current ~30% population having access to modern medicine and quality healthcare.
2) Fair distribution of financial costs for access and a constant search for improvement to a more just system.
3) Creating easy availability to these services coupled with training and manning personnel who provide quality products and services.
4) Special attention to vulnerable groups such a children, women, disabled and the aged.
I have been amazed that despite knowing this, healthcare has never assumed its rightful place on the national agenda of the Indian government and even beyond. The fact that diseases that affect more than one nation (HIV/AIDS, swine flu SARS etc.) that afflict us has not even inspired a place on the global agenda. Nation states are still more likely to give security or trade considerations priority above health care. Healthcare, like climate change, is relegated to the sidelines.
The recent past has seen a growing acceptance of the concept of health security. But, there are major differences in understanding and use of the concept in different settings. Policymakers in industrialized countries emphasize protection of their populations especially against external threats, for example terrorism and pandemics; while health workers and policymakers in developing countries think of the term in a broader public health context. Indeed, the concept is used inconsistently across the world. Divergent understandings by different states, coupled with fears of hidden national security agendas, are leading to a breakdown of mechanisms for global cooperation. So much so that some developing countries are beginning to doubt that internationally shared health data is used in their best interests. Resolution of these incompatible understandings is a global priority.
This global context calls for one of India’s strongest and least used ‘weapon’ – soft power.
Soft power has always been a key element of diplomatic leadership. The power to attract—to get others to want what you want, to frame the issues, to set the agenda—has its roots in thousands of years of human experience. Skillful leaders have always understood that attractiveness stems from credibility and legitimacy. Power has never flowed solely from the barrel of a gun; even the most brutal dictators have relied on attraction as well as fear. India must exercise soft power to get for itself some of the best technologies, products, services and talent in healthcare. Overall, by leveraging its new found acceptance on the global stage, India must help its citizens gain access to a fundamental human right – quality healthcare.
Health Diplomacy is the chosen method of interaction between stakeholders engaged in public health and politics for the purpose of representation, cooperation, resolving disputes, improving health systems, and securing the right to health for vulnerable populations. Through health diplomacy, health priorities can take their rightful place on national and international agenda. This will merge health expertise with diplomatic skills to alleviate suffering, bring peace, prepare for disasters and help improve health care systems around the world.
India must follow Brazil’s example of using soft power to influence the global health agenda. Brazil’s national tobacco program proved critical for the formation of the Framework Convention on Tobacco Control (FCTC), a global war on tobacco under the aegis of the WHO. Despite its developing country status, Brazil also was the first country to offer Anti Retroviral (ARV) drugs free to its citizens for the treatment of HIV/AIDS. This proved helpful for mobilizing global support for the fight against HIV/AIDS.
The global health burden that is placed upon the international community demands effective transnational networks to provide sustainable solutions to the toughest challenges. Health diplomacy is a process and method that can help stakeholders effectively pursue their interests, overcome barriers to progress, and leverage the optimal benefit from international partnerships. In a world where disease is everybody’s tragedy and everybody’s nightmare, health diplomacy is in everyones’s interest.