India-US strategic dialogue – Unhealthy diplomacy

The first India-US strategic dialogue is taking place amid the backdrop of incidents which see commonality of interests between the oldest and the largest democracies of the world.

Analysts believe that the botched Times Square bombing incident has been a real eye opener and a wake up call for the Obama administration to rethink and recalibrate its Pakistan policy. This gives more room to India to make its point on the perils of the export of terror from Pakistan and further validates New Delhi’s grave concern over the supply of sophisticated US arms to Pakistan. So, when US Secretary of State Hillary Clinton and External Affairs Minister S.M. Krishna meet in Washington on the 3rd June, this issue is likely to be discussed in great detail.

Amongst Pakistan, Iran, Israel, the European crisis and the oil spill, one key issue that will miss discussion is health and healthcare.

In all its diplomatic efforts, the part that gets missed or gets least publicity is health diplomacy. The importance of this form of diplomacy accrues from the fact that it defines the links between poor health and poverty, and good health and socio-economic progress. Health diplomacy ensures that health problems of the developing world are now talked about at levels ranging from political summits to interviews with tinsel world celebrities.  Unfortunately, health diplomacy has never received the attention it deserves.

Funding agencies, NGOs and other foundations have never given health much wealth. Yet, this wealth is claimed to be earmarked for the world’s sickest and poorest people. The soft power of health diplomacy creates optimistic times for public health. It recognizes that health issues are inherently political, and then tackles them at the political level. The head-on battle with big tobacco is a case in point.

A politically more delicate move, is engagement with the pharmaceutical industry. In the current healthcare context in India, health diplomacy can help seek common ground on such difficult issues as tiered pricing, intellectual property rights, and innovation, especially for neglected diseases, in this emerging market.

Its time health diplomats understood and leveraged the importance of infectious diseases as killers in their own right as also the special features of outbreaks of epidemics ranging from neglected diseases such as malaria and tuberculosis (TB) to HIV/AIDS, SARS, and the more recent avian and swine flu. For reasons well known, outbreaks attract political attention at levels far higher – and more powerful – than ministries of health. The Indian delegation must use the spotlight of public, press, and political concern to profile the power of these neglected diseases and the impact that it can have on public health. All of public health can benefit.

In India, as in other parts of the developing world, health systems and health personnel are fundamental challenges. Although we are making spectacular progress in some areas, such as childhood immunization, we are falling short in other ways. We are not reaching impoverished populations with essential care on a scale big enough to make a difference.

We face three main problems. For some diseases, we have no tools or only imperfect ones. In other cases, we have excellent tools, but high cost puts them beyond the reach of the poor who need them most. Third, we often have powerful interventions that are cheap or even free, but fail because we lack the systems and personnel for their delivery. These are life-and-death failures, and the perfect area for health diplomacy.

Despite such wide ranging healthcare issues and India’s new found position of strength on the global stage, health diplomacy continues to take a back seat during high profile meetings such as the Indo-US strategic dialogue. India will engage in assertive international health diplomacy, and we will have the best chance of winning support only when we appeal to national self-interest through a national debate.  After all, international solidarity on containing SARS, flu and HIV/AIDS peaked only when faced by the fearful impact that its spread would on global economy, well-being and security.

Diplomacy can work well not just to swing global public opinion but also to bring the best minds together to create path-breaking drugs and other healthcare services at prices that are affordable to the poor in India. If we want India to enforce health diplomacy, we need to find ways of using the power of public and political opinion to exert pressure. We have seen this work well with international outbreaks. And we have seen it work to get the prices down for antiretroviral drugs.

The US-India Business Council will be hosting its 35th annual meeting, which will be addressed by Obama’s top economic advisor Larry Summers and the education secretary. The strategic dialogue between India and the US will also be used as an opportunity to lay ground for the forthcoming visit of President Barack Obama to India which is expected to take place in October- November. The important issues of economic nature, like full and the practical implementation of the civil nuclear cooperation deal and the export of dual use technology, are also on the high priority list in the already overloaded agenda of the dialogue.

The question is will all this diplomacy turn out to be ‘healthy’ in the long run?

2 thoughts on “India-US strategic dialogue – Unhealthy diplomacy

  1. Very well articulated — you have the makings for a healthcare business journo — may your 2 cent effort one day turn into a money spinner a la Tom Freidman/Malcolm Gladwell.

    Like

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