China’s role in global health governance

Efficient global governance depends on an adequate supply of global public goods, but most global public goods follow a summation process. Put differently, all countries must contribute for the good to emerge. According to Kaul (2003), “global public goods thus can be seen as comprising national public goods plus international cooperation” (p. 284). National public goods, or national building blocks, are an essential part of global public goods. In the same vein, global public goods for health comprise national public health products plus international public health cooperation. A country’s responsibility therefore is reflected through its contribution to global health governance in the form of more global public goods. China’s active participation and consequent provision of global public goods for health are instantiations of its ideal to make the world a harmonious place. It has carried out different levels of health governance efforts. This chapter first describes the diplomatic process through which China participated in global health governance: it then examines problems regarding this participation.

China’s engagement in global health governance

Global health governance is achieved mainly through global health cooperation. Through coordinated efforts from countries around the world, global health governance can solve transnational public health security issues and produce global public goods for health. Specifically, global health governance uses public health diplomacy to overcome problems of collective action. The relevant norms and practices used by WHO and WTO, for example, are all results of diplomatic and collaborative efforts.

Although public health and diplomacy seem like quite different domains, this difference belies the deep connection between the two fields. In fact, with the emergence of public health crises, such as SARS, HIV/AIDS and the anthrax attacks, the two domains are becoming more intertwined than ever. Foreign policy and global health are “working together towards common goals” and are “protecting and promoting public health as part of the foreign policy agenda has taken special significance” (Chan et al., 2008). The securitisation of global health issues means global health issues have become more prominent in foreign policies. Public health diplomatic strategies are now increasingly popular concerns for

China's role in global health governance 195 policymakers. This is illustrated in the mission of the Foreign Policy and Global Health (FPGH), an initiative launched by the foreign ministers of Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand, seeks to promote the use of a health lens in formulating foreign policy to work together towards common goals. Global health diplomacy is a concept both old and young. It is old because public health diplomacy has been around since the mid-19th century; it is young because it was not long ago that it came to be analysed as a concept. Public health diplomacy involves political movement that can not only improve domestic and international health conditions but also maintain and improve international relations. Richard Horton, editor-in-chief of the well-known British medical journal The Lancet, believes public health is now the most important foreign policy issue of our tune. He identifies four advantages in using health as an instrument of foreign policy: Fust, health is strategically correct; second, focusing on health will produce unequivocally positive benefits—social cohesion, equity and a strengthened national infrastructure; third, focusing on health is a valuable diplomatic tool in its own right to promote good bilateral relations and to signal good leadership; finally, focusing on health will encourage trust between nations and across global multilateral organisations (Horton, 2006). In short, global health diplomacy refers to international cooperation conducted by a nation to safeguard the health of its own citizens and the health of other countries’ citizens. Global health diplomacy can encompass a broad range of actors, including governmental actors (e.g. ministries of foreign affairs, ministries of health), inter-governmental organisations and nongovernmental organisations. Global health diplomacy is also a collective joint governance initiative taken by countries worldwide to achieve global health security. China sees itself as a stakeholder in global health secruity and holds international public health cooperation in high regard. Public health security threats affect not only human safety, but also economic, political, environmental and social safety. All countries must figure out how to deal with these non-traditional security challenges. Public health diplomacy is a necessary path to achieve global health security. In the shared endeavours to achieve global health governance, China has emerged as an important contributor and leader. Dr Sue Desmond-Hellmann, CEO of the Bill & Melinda Gates Foundation, believes “China has shown extraordinary leadership in promoting global health security and the health and well-being of the poor”.1 Overall, China has used public health diplomacy to promote global health governance on three levels.

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