In the past decade, health issues have become more prominent in foreign policies of countries. (1-6) Health challenges now feature in national security strategies, appear regularly on the agenda of meetings of leading economic powers, affect the bilateral and regional political relationships between developed and developing countries, and influence strategies for United Nations reform. Although health has long been a foreign policy concern, such prominence is historically unprecedented.
The transformation in the relationship between health and foreign policy has resulted both from specific events and more general trends in world politics. The worsening of the HIV/AIDS pandemic, threats from emerging and re-emerging infectious diseases (e.g. SARS, avian influenza), fears about bioterrorism, and controversies involving trade and health (e.g. TRIPS and access to medicines) have forced foreign-policy-makers to grapple with issues and principles of public health. Globalization has also rendered foreign policy more relevant to health because the line between domestic and foreign impact has been blurred or obliterated, forcing countries to engage in foreign policy action across a greater range of health issues.
Developed and developing countries now find health increasingly important to the fulfilment of the governance functions traditionally served by foreign policy--security, national economic well-being, political and economic development of other nations, and the protection of human dignity. This reality produces the need for countries to pursue health as a foreign policy concern in its fullest sense. The development of health as foreign policy contrasts with health's historical place in foreign policy as a "mere humanitarian" endeavour subordinate to the national interests of survival, security, power, and influence.
The new relationship between health and foreign policy has significant implications for both policy areas. There has been a recent attempt to explore seriously what health as foreign policy means. These early efforts sense the impact of each policy area on the other. For example, the proliferation of efforts to conceptualize health threats as security challenges brings a classical concern of foreign policy to bear on public health nationally and globally. While this link between security and public health has raised the political profile of certain diseases, it has also worried some people who work on health policy because the security lens does not arise from, or produce, a commitment to "health for all."
At the same time, the need for foreign policy that addresses health seriously has forced policy-makers to confront the realities of an epidemio-logically interdependent world and the complexities of the global cooperation needed to protect and promote public health. Health concerns seriously affect and inform how countries perceive and formulate their national interests for foreign policy purposes.
Ministries of health and public health experts outside government need to become increasingly skilled at shaping health's new status in foreign policy. The growing links between health and the various aspects of foreign policy require recommendations and suggestions of possible policy directions and identification of appropriate opportunities and instruments to promote public health in this new policy environment. …