Posted on 25 June 2020
In early March, staff members of the WHO Collaborating Centre for Global Health Histories travelled to Colombo in Sri Lanka to take part in the Centre’s 146th seminar.
Dr Suranga Dolamulla, a Wellcome Trust Senior Fellow and the Director of Tertiary Care Services in Sri Lanka’s Ministry of Health, led the launch of the event on health diplomacy. Director of the Centre Professor Sanjoy Bhattacharya was the main speaker with Dr Lakshmi Somatunga, the Additional Secretary of Public Health Services in the Sri Lankan Ministry of Health.
Both speakers highlighted the importance of health diplomacy in bringing together governments and non-state actors to produce and implement policies for public health challenges. Dr Somatunga pointed to tobacco control as a strong example of Sri Lanka’s success in leading widespread local and international cooperation. The involvement of all stakeholders was essential, she said. Multiple governments, commercial producers, civil societies, legal organisations, and the media were involved in negotiating and ratifying the World Health Organisation Framework Convention on Tobacco Control. Sri Lanka was the first country in Asia to do so and the fourth in the world. Other successful initiatives also depended on a similar approach, she said. Trade negotiation, intellectual property rights and access to medicine work with the Global Fund to Fight AIDS, TB, and Malaria, and the 2012 London Summit for Family Planning all required comprehensive negotiation. For Dr Somatunga, these represent the great advantage of health diplomacy. In her words, it makes “difficult things possible.”
Professor Sanjoy Bhattacharya brought a historical perspective to the discussion. He said we need to investigate the complex negotiations between WHO’s Geneva-based headquarters and its regional and country offices. As he explained, WHO’s structure was designed for democracy and relies on extensive involvement of member states. Policies are only created and implemented if they are approved via a series of negotiations. Members vote at the annual World Health Assembly, the Secretariat implements approved policies, regional committees decide whether to accept these, and then they vote on strategies of implementation. Since WHO’s creation, health issues have been debated at all levels of its global structure and countries have discussed, manoeuvred and mobilised their allies towards certain policies.
A critical analysis of this process is essential, said Professor Bhattacharya, for understanding how countries contributed to health and development policy. He used Sri Lanka as an example. It played a foundational role in setting up the WHO, expanding the South-East Asia Office, and in WHO’s malaria programme and primary health care movement. However, this is not well-known because so often such information was not recorded in low- and middle-income countries. He encouraged his listeners to adopt a change in attitude; to record the work of the Sri Lankan Ministry of Health for future historical analysis, which will empower the country in future negotiations. This will depend to some extent on the decolonisation of global health, which he explained was a growing movement to recognise that low- and middle-income country actors are not merely recipients of health policy from high-income countries, but active participants in policy design, implementation and research.
A discussion with the audience followed both presentations. Topics covered grassroots involvement in health diplomacy, the importance of government frameworks and an “ethical compass” to guide non-state international actors, and the increasing open access trend of journals to make research more democratic.
The Centre for Global Health Histories at the University of York is indebted to our partners and the Wellcome Trust for making this seminar possible.
Find the full recording here.
Event report by Alexandra Bradbury. MA, Medical History student, University of York.