Current debates concerning the rise of health diplomacy are polarized between competing international relations theories of realism, based on power politics, and constructivist approaches, which emphasize the norms, values, and identities shaping foreign policies. A case study of Brazil's health diplomacy over the past 10 years, focusing on issues related to pharmaceuticals, seeks to provide data to assess these theories. The country's intellectual property disputes, multilateral lobbying efforts, and foreign assistance programs are contrasted with those of the United States, Mexico, and other countries. Instead of viewing Brazilian efforts as a form of soft power, the evidence suggests that the origins of Brazil's involvement and continued efforts in this arena stem more from values based on human rights and social democratic principles. A close examination of domestic political considerations leads to a more nuanced understanding of the drivers behind a country's health diplomacy.
Get full access to this article
View all access options for this article.
References
1.
HortonR.Health as an instrument of foreign policy. Lancet369(9564): 806–807, 2007.
2.
KickbuschI.Global health diplomacy: Training across disciplines. Bull. World Health Organ. 85(12): 901–980, 2007.
3.
FeldbaumH., and MichaudJ.Health diplomacy and the enduring relevance of foreign policy interests. PLoS Med7(4): e1000226, 2010.
4.
FeldbaumH.LeeK., and MichaudJ.Global health and foreign policy. Epidemiol. Rev. April 7:mxq006v1, 2010.
5.
LabonteR., and GagnonM.Framing health and foreign policy: Lessons for global health diplomacy. Globalization and Health6(1): 14, 2010.
6.
NyeJ. S. J.Soft Power. Perseus, Cambridge, 2005.
7.
KatzensteinP. J.The Culture of National Security: Norms and Identity in World Politics. Columbia University Press, New York, 1996.
8.
HentzJ. J.The power of ideas: Across the constuctivist/realist divide? In Global Institutions and Development: Framing the World?Routledge, London, 2004.
9.
Ministers of Foreign Affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand. Oslo Ministerial Declaration—Global Health: A pressing foreign policy issue of our time. Lancet369(9570): 1373–1378, 2007.
10.
JonesK.New complexities and approaches to global health diplomacy: View from the U.S. Department of State. PLoS Med7(5): e1000276, 2010.
11.
RugerJ. P., and NgN. Y.Emerging and transition countries' role in global health. Saint Louis Univ. J. of Health Law & Policy3(2): 253–290, 2010.
12.
de LimaSoares M. R., and HirstM.Brazil as an intermediate state and regional power: Action, choice and responsibilities. Int. Affairs.82: 21–40, 2006.
LeeK., and GomezE.Brazil's ascendance: The soft power role of global health diplomacy. The European Business Rev. February 2011. www.europeanbusinessreview.com/?p=3400 (accessed February 4, 2011).
15.
AlmeidaC.Health sector reform in Brazil: A case study of inequity. Int. J. Health Serv. 30(1): 129–162, 2000.
16.
NunnA.The Politics and History of AIDS Treatment in Brazil. Springer, New York, 2008.
17.
HogerzeilH.Is access to essential medicines as part of the fulfillment of the right to health enforceable through the courts?Lancet368(9532): 305–331, 2006.
18.
BermudezJ., and OliveiraM. A.Intellectual Property in the Context of the WTO Trips Agreement: Challenges to Public Health. ENSP, Rio de Janeiro, 2004.
19.
FlynnM.Brazilian pharmaceutical governance: Globalization, institutions and AIDS. Dissertation, University of Texas at Austin, 2010.
20.
AttaranA., and ChampP.Patent rights and local working under the WTO TRIPS Agreement: An analysis of the U.S.-Brazil patent dispute. SSRN eLibrary. ssrn.com/sol3/papers.cfm?abstract_id=348660 (accessed February 11, 2001).
21.
TeixeiraP.Personal Interview, Director of National AIDS Program, 2000–2002. May 7, 2008.
22.
NunnA.FonsecaE., and GruskinS.Changing global essential medicines norms to improve access to AIDS treatment: Lessons from Brazil. Global Public Health: An International Journal for Research, Policy and Practice4(2): 131–149, 2009.
23.
GoverA.Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. United Nations Human Rights Council, Geneva, 2009.
24.
Knowledge Ecology International. Mexico's proposed deletion of consumer rights in the IGWG Text. November 8, 2007. keionline.org/node/112 (accessed September 22, 2010).
25.
ShadlenK.The politics of patents and drugs in Brazil and Mexico: The industrial bases of health policies. Comp. Polit.41(1): 41–58, 2009.
26.
World Health Organization. WHO Expert Report on R&D Financing. Geneva, 2010.
ViegasL. L.Personal Interview, Head of Division on Multilateral Themes, Office for Advisory on International Affairs, Ministry of Health, Brasilia. June 7, 2010.
37.
The Economist. Speak softly and carry a blank cheque. The Economist. July 15, 2010.
38.
SchlägerC.Challenges for International Development Cooperation: The Case of Brasil. Friedrich Ebert Stiftung Briefing Paper. March 3, 2007. www.nuso.org/upload/fes_pub/schlager.pdf (accessed February 17, 2011).
39.
IPEA/ABC. Cooperação brasileira para o desenvolvimento internacional: 2005–2009. Instituto de Pesquisa Econômica Aplicada, Agência Brasileira de Cooperação, Brasilia, 2010.
40.
IglesiasPuente C. A.A cooperação técnica horizontal brasileira como instrumento de política externa: A evolução da cooperação técnica com países em desenvolvimento—CTPD—no período 1995–2005. FUNAG, Brasilia, 2010.
41.
Brazil, Agência Brasileira de Cooperação. Cooperação Técnica Brasileira em Saúde. Ministry of Foreign Affairs, Brasilia, 2007.
42.
BussP. M., and LealM. D. C.Global health and health diplomacy. Cadernos da Saúde Pública. 25(12): 2541, 2009.
43.
ValliniJ.Personal Interview, Lawyer, International Coordination Advisory, National AIDS Programme, Ministry of Health, Brasilia, June 22, 2010.
44.
UNAIDS. Twenty-two of the most affected countries in sub-Saharan Africa have reduced new HIV infections by more than 25%. September 17, 2010. unaidstoday.org/?p=819#more-819 (accessed September 19, 2011).
LeeK.ChagasL. C., and NovotnyT. E.Brazil and the Framework Convention on Tobacco Control: Global health diplomacy as soft power. PLoS Med. April 20, 2010. dx.doi.org/10.1371/journal.pmed.1000232 (accessed June 11, 2010).
