UC San Diego

ABSTRACT OF THE DISSERTATION

Applied Health Diplomacy: Advancing the Science, Practice, and Tradecraft of Global Health Diplomacy to Facilitate More Effective Global Health Action

by

Matthew D. Brown

Doctor of Philosophy in Public Health (Global Health)

University of California, San Diego, 2016

San Diego State University, 2016

Professor Thomas E. Novotny, Chair

Global Health Diplomacy (GHD) is a burgeoning field that bridges independent priorities in both global health and foreign affairs. Given the increasing need to mobilize the global community to respond to Public Health Emergencies of International Concern (PHEIC) such as Ebola or Zika, as well as forge new and expand existing collaborations to tackle public health challenges of mutual concern, effective and timely coordination and cooperation among actors is critical. Health Attachés are key diplomats who represent nation-states in these negotiations. Despite this diplomatic mandates, they are very few in numbers and little is published about this profession, preparation, and perspectives in field of GHD. Additionally, no institution has published a GHD core competency model to help standardize recruitment, training, and preparation of personnel changed with the practice of GHD, which can lead to confusion when trying to align actors and institutions to achieve effective global health action.

Objectives: (1) Update definitions and practice models in GHD related to the development and practice of Health Attachés; (2) Create a GHD core competency model to address gaps in training for global public health, foreign affairs, and other professionals; and (3) Present a profile of practicing Health Attachés accredited to the United States and foreign governments.

Methods: By synthesizing literature and definitions used in the field with an emphasis on practice, develop a framework for GHD and a tradecraft model for Health Attachés in the 21st Century (Chapter 2). Developed a core competency model for GHD by: (a) identifying core competency models from global public health and foreign affairs training institutions; (b) employing a priori word counts drawn from the foreign affairs literature, measure degrees of association and divergence between global public health and foreign affairs competency models; and (c) based on these comparisons, formulate an initial core competency model for GHD (Chapter 3). Utilize key informant interviews to qualitatively explore perspectives, preparation, best practices, and challenges in the field of GHD among Health Attachés accredited to the United States and foreign governments (Chapter 4).

Results: In Chapter 2, we introduce a Pyramid of Global Health Diplomacy, presenting three levels of GHD practice: core, multi-stakeholder, and informal, each with associated actors, definitions, and tools; and a Tradecraft Model of Global Health Diplomacy and Health Attachés, to map relations among stakeholders, counterparts, and institutions. In Chapter 3, we propose a Global Health Diplomacy Core Competency Model illustrating foreign affairs institutions need additional knowledge, skills, and abilities in: (a) heath communication, (b) public health analysis, and (c) public health ethics; and global public health institutions need additional knowledge, skills, and abilities in: (a) leadership, (b) foreign languages, and (c) foreign policy goals, objectives, and strategies. In Chapter 4, Health Attachés identified skills in diplomacy and negotiation, applied science, and cross cultural competency critical for success, and providing expanded communication protocols on health plans and counterparts, while on-the-job training and mentored experiences for practitioners is important for future actors in the field.

Conclusion: This dissertation provides needed advancements in the field of GHD, helping to advance the science, practice, and tradecraft of GHD. While models presented in this body of work need to be tested, evaluated, and refined with additional research, they serve as a collective practice framework for the field, to inform any profession or institutions who practices GHD. Additionally, findings may help professionalize the field of GHD, the practice of Health Attachés, and create a more effective bridge between the fields of foreign affairs and public health, by increasing cross-field competence, and fostering more effective global health action when maintaining, expanding, and initiating new global health collaborations.