This article suggests that, in building capacity in GHD, it is essential to educate both health and non-health actors on global health issues and to use a combination of formal and informal mechanisms to participate in GHD. And in developing sustainable capacity in GHD, it requires long term commitment and strong leadership from both health and non-health sectors.
Trade liberalization, especially its effects on price and access to medicines, has been at the core of GHD. Thailand is often cited as a positive example of a country that has achieved considerable trade and health policy coherence through, and as part of, GHD. Core lessons are for health actors to build their capacity over time, starting from the individual I to understand trade effects on health, the node N to establish the mechanisms to enhance health interests, the network N to advocate for health, and the enabling environment E to retain health officials and strengthen their capacities.
Although the definition of GHD is contested, there appears to be some consensus that GHD involves negotiation processes by which state and non-state actors interact concerning issues at the nexus of health and foreign policy; these may be in the use of health to serve foreign policy goals or foreign policy to serve health goals Drager and Fidler ; Fidler ; Kickbusch ; Lee and Smith ; Kevany Within this broad definition, this article is primarily concerned with GHD as it applies to trade issues, although it is recognized that there are wider aspects of GHD such as those concerning security, international relations and donor prestige of global health programmes.
It is also primarily concerned with how trade affects health, and less concerned with how health issues and diplomacy may impact on these other areas, such as security or investment. There is a work emerging linking foreign policy and GHD Kevany more generally. The interesting development in this work is making explicit the diplomatic and foreign policy criteria e.
For a country to engage successfully in GHD, capacity is required in two areas: 1 health agencies require the resources and ability to interact with the wider diplomatic system and 2 the diplomatic organization within a country requires an understanding and willingness to reflect health concerns within their wider diplomatic remit that is often focused on trade and security. To some extent these two areas of capacity can be developed simultaneously and in a complementary manner if systems are in place to encourage dialogue between health and other agencies.
Although there has been discussion of how such capacity may be developed at the supra-national level Chan et al. In this respect, Thailand provides an interesting case study. Literature on trade and health often cites Thailand as a leader in policy coherence between trade and health World Health Organization and World Trade Organization ; Blouin ; Helble et al.
This is because people tend to see the superficial, but the full picture is more rounded, nuanced and informative to developments in GHD. This study explores the relationship between trade and health spheres in more depth. Conflicting interests between trade and health sectors first became evident here some 30 years ago, when Thailand prohibited cigarettes imported from the USA on the grounds that they contained hazardous substances that were more harmful than those substances found in Thai cigarettes.
This case stimulated interest in the impact that international trade negotiation, and attendant agreements, could have on health outcomes. In the s, Thailand experienced an expansion of trade liberalization e. In response, the Ministry of Public Health MOPH established a number of inter-agency committees with representatives from government and non-governmental agencies in to develop an understanding of health-related trade issues and engage with the trade negotiation processes to address health concerns Pachanee and Wibulpolprasert ; Ministry of Public Health a.
There have been several further related activities. By , the new national constitution for Thailand stipulated that the government was to provide trade information to the public, have public consultations and parliamentary approval before engaging in trade negotiations with other countries Royal Thai Government The Ministry of Commerce was made responsible for national trade policy development and mandated to have stakeholder consultations before participating in trade negotiation processes.
As a consequence of these developments, the preparation processes for trade negotiations involved a wider degree of concerned agencies, including those representing health interests. The prior movements by the MOPH had allowed the development of significant capacity in the health sector and among CSOs to be able to participate actively in consultations from a health perspective Pachanee and Wibulpolprasert With the increased emphasis on trade negotiations by those within the broader health field, the experience of health engagement by Thailand with other interested parties before, during and after specific diplomatic activities related to trade negotiations, holds potential lessons for wider engagement at the national level, and in developing capacity more broadly in GHD.
This article utilizes three information sources: a review of key literature, interviews with key stakeholders and non-participant observation during related international meetings on trade-related health negotiations. With respect to interviews with key stakeholders, 20 interviews with those who engaged in the process of trade-related health negotiations were conducted in Thailand during November —February Due to the sensitive nature of the issue, many respondents asked not to be identified in this article.
This sample was determined by their roles within the process of trade-related health negotiations. Once interviews were underway, respondents were asked for suggestions of further people to interview. Towards the end of the interview process, it was felt that new issues were not being raised, leading the authors to some confidence that key issues have been uncovered.
The interviews were semi-structured, with questions following organically according to responses being made and information being shared, but were set to cover several broad topic areas: actors in trade negotiations, health actors engagement trade negotiations, networking among the actors and evaluation of health engagement in trade negotiations. All recordings were transcribed and translated by the first author.
The final source of information was from the observed discussions of health-related trade issues at the meetings held during November —February The analysis from each source was then triangulated to generate a holistic picture concerning the development of capacity for GHD within Thailand, and in particular: 1 the key actors involved in capacity building; 2 the model used by Thailand for capacity development and 3 key aspects related to the process of capacity development.
There are a number of institutional actors in Thailand that have a potential stake in issues relating to health and trade. These actors can be divided into two groups: health actors and trade actors, both align with two subgroups: state and non-state Box 1. The MOPH is the core national health agency responsible for disease prevention, health promotion and health protection.
Thai Medical Council, Dental Practitioner Council and Nursing Council who work under MOPH supervision and have a role in regulating and controlling health practitioners and their practices; the Thai Health Promotion Foundation ThaiHealth , an autonomous organization responsible for promoting public health with focusing on a reduction of health risk factors 2 ; the National Health Security Office NHSO , a semi-autonomous body established in to manage a national health insurance scheme.
The Private Hospital Association PHA , established to protect and enhance the mutual benefits of private hospitals, is also actively involved in such process. The ultimate responsibility lies with the MOC who will sign trade agreements, but other agencies have considerable influence in determining the outcome of negotiations.
In this respect, one may broadly categorize trade organizations as concerned with advancing the trade liberalization policies of Thailand, and the MOPH representing the major concerns of the health community of the potential negative impact of trade liberalization. We acted seriously against the amendment of the patent act from the late s to early s. Actors engaged with the process of trade negotiations clearly do not do so on an equal basis.
The level of their engagement and influence in such a process depends especially on three factors: 1 power to influence decision making; 2 legitimacy to be involved and 3 urgency in resolving the issue. These factors are often used to differentiate actors and to assess the level of their influence in the decision-making processes Mitchell et al. The MOC, possessing all of these factors, would be considered to be the most powerful actor in any trade-related health policy development process.
Trade issues initiated action by the MOPH to develop capacity for engaging with trade negotiations where there were felt to be significant health issues. This model covers four aspects of capacity building: Individual, Node, Network and Enabling environment. Scholars were recruited from ministries, universities and NGOs. They undertake on-the-job training, under close mentorship and work on global and regional health issues.
Debriefings after the meetings include discussion of the downstream process and steps in implementing the decision or resolutions. A number of nodes or key organizations were also established to accommodate the trained researchers. There is also an informal network of collaborations among health policy makers, health researchers, trade officers, trade negotiators, foreign policy officers, academic institutions, trade policy funding agencies, private sector and CSOs.
The importance of the informal network is discussed in more detail later. However, the Ministry has an official mandate to provide financial and non-financial incentives, establish organizations to accommodate health experts, and establish the Prince Mahidol Award Conference Ministry of Public Health as a venue for domestic scholars to engage in a global health policy and build a network with international health experts.
To complement capacity building of individual health officials and organizations, a variety of other mechanisms are used by MOPH to get health concerns on the trade negotiation agenda: institutional mechanisms, interagency committees and working groups, the NHC and NHA and informal processes. The administrative structure of ministries in Thailand is founded on hierarchy and authority, with co-ordination among ministries undertaken through institutional arrangements.
This leads to the common problem of co-ordination and engagement. The structure of the MOPH agencies, outlined in Figure 1 , contributes to a lack of oversight and coherence between those concerned with trade issues affecting health. The MOPH does not have a single office to cover all health related trade issues, but tasks a particular health-related issue office to a respective office Figure 1 that shares a rather defensive view of trade.
In this respect, an important feature of the Thai system for GHD is Article of the Constitution, which mandates the DTN to make the process of trade negotiations transparent to the public Royal Thai Government Prior to trade negotiations with other countries, DTN is required to consult concerned stakeholders, organize public hearings and submit the framework for negotiations to parliament for approval.
After negotiations conclude, the signed agreements are open for public access before being submitted to parliament for approval Figure 2 Vonkhorporn Concerned stakeholders are thus able to voice their concerns through both public consultations and public hearings. Preparatory process for trade negotiations in Thailand. Source : Vonkhorporn A working group to study the impact of the TRIPS-Plus provision found that it would have a significant impact on the cost of medicines and delay generic drug accessibility.
Its main responsibility is to offer policy recommendations on health-related trade issues to the Prime Minister National Health Commission Composition of the national commission on trade and health appointed by the Prime Minister. Source : National Health Commission Of course, the development of these interagency committees and working groups is ad hoc, and it is not clear how productive or generalizable it was Pachanee and Wibulpolprasert Topics are proposed by stakeholders, based on its urgency and health impact National Health Commission Office Trade and health issues have received high attention since the first NHA in The NHA is a promising forum for stakeholders, particularly civil society, to discuss issues and find resolutions National Health Commission Office Nevertheless, NHA resolutions are endorsed by the cabinet and Prime Minister and have come into force for relevant authorities.
A more informal mechanism of health engagement with trade exists in personal relationships and networks. It is not unusual that the government appoints NGOs to represent the country at a global health negotiating body. Such activities are also the case at the international level. The WHA resolutions 31 related to trade issues, for example, were tabled and chaired by Thailand. These informal mechanisms are also important to bring health concerns onto the agenda of trade negotiations.
Overall, the processes of health engagement with trade negotiations have both strengths and weaknesses. The institutional mechanisms are essential, but slow to implement and in their operation due to hierarchies of governmental administration with involvement of several decision makers, thus not sufficient to advocate for health goals alone. The interagency committees help increase the understanding of trade and health among health and non-health actors, but most are ad hoc and lack the constant and consistent participation of their members.
The NHA is successful in terms of enabling the broad array of actors from health and non-health sectors to participate in discussion around NHA resolutions. However, not all resolutions concerning trade and health have been accepted by trade actors, 37 and may thus be seen as unsuccessful in terms of policy implementation , even if they may have been successful in terms of policy process.
It is also the case that informal mechanisms appear to help foster trust amongst actors, but assessment of their impact on policy coherence is unclear. This study refutes the literature citing that Thailand is a country that has achieved trade and health policy coherence. However, it confirms that the country has established important co-ordinating mechanisms between trade and health agencies to communicate a health position for trade considerations, which has influenced the process to some degree over recent years.
China has also The unabated growth of natural resource consumption raises risks that we will outstrip the capacities of ecosystems and governance institutions. At the same Innovate4Climate 22 May - 25 May Barcelona, Spain. Add to calendar View all events.
Any personal details collected as part of this newsletter subscription will be used for the purpose of processing the subscription and dealing with your enquiries.
The ip unreachables cannot share posts. Citrix Baitcasting Reel finding top notch environment for unwanted Files As the the mirror driver. Collaboration Accelerate teamwork. Droom also offers individual sellers the contaminated, regardless of their used vehicles Engine, make sure suite introduced, and wish to associate the best price. First, create a Zoom is available.
But the political benefits of an active trade diplomacy is not instantaneous, nor does its economic strength guarantee lasting political friendship with other States. The political force of a State does not rest solely and directly on its economic parameters. It is necessary to combine the ability to consistently trade with the operation in other fields, and all this must be coupled with greater social cohesion. It is the versatility and the synthesis of all these factors that provided the political weight of a State.
You are commenting using your WordPress. You are commenting using your Twitter account. You are commenting using your Facebook account. Notify me of new comments via email. Notify me of new posts via email. Compiled by Amb. Odeen Ishmael. Full credit to Amb. Manuel Morales Lama of the Dominican Republic. His articles in Spanish form the basis of most of these notes. Notes on Diplomatic Practice. Compiled by Odeen Ishmael. Economic and trade diplomacy 22 Mar Economic and trade diplomacy 1.
Share this: Twitter Facebook. Like this: Like Loading Comments 1 Comment Categories Uncategorized. Essential framework of public diplomacy. Leave a Reply Cancel reply Enter your comment here Fill in your details below or click an icon to log in:. Email required Address never made public. Name required. How customer reviews and ratings work Customer Reviews, including Product Star Ratings help customers to learn more about the product and decide whether it is the right product for them.
Learn more how customers reviews work on Amazon. Top reviews Most recent Top reviews. Top reviews from the United States. There was a problem filtering reviews right now. Please try again later. Verified Purchase. Great book, knew most of this stuff through personal research. Good to brush up on things though. One person found this helpful. See all reviews. Your recently viewed items and featured recommendations. Back to top. Get to Know Us.
Make Money with Us. Amazon Payment Products. Let Us Help You. Amazon Music Stream millions of songs. Amazon Advertising Find, attract, and engage customers. Amazon Drive Cloud storage from Amazon. Alexa Actionable Analytics for the Web. Sell on Amazon Start a Selling Account. AmazonGlobal Ship Orders Internationally.
ComiXology Thousands of Digital Comics. DPReview Digital Photography. Shopbop Designer Fashion Brands.