Health imperatives in foreign policy: the case of Malaysia

Malaysia's global, regional and bilateral international health relations are surveyed against the historical backdrop of the country's foreign policy. Malaysia has always participated in multilateral agencies, most notably the World Health Organization, as such agencies are part of the longstanding fabric of "good international citizenship". The threats of infectious diseases to human health and economic activity have caused an intensification and an organizational formalization of Malaysian health diplomacy, both regionally and bilaterally. Such diplomacy has also established a basis for developing a wider set of cooperative relationships that go beyond responding to the threat of pandemics. As Malaysia approaches "developed" status, its health sector is becoming increasingly integrated into the global economy through joint research and development ventures and transnational investment. At the same time, it will have the technological, financial and human resources to play an expanded altruistic role in global and regional health.     

Health and foreign policy: influences of migration and population mobility

International interest in the relationship between globalization and health is growing, and this relationship is increasingly figuring in foreign policy discussions. Although many globalizing processes are known to affect health, migration stands out as an integral part of globalization, and links between migration and health are well documented. Numerous historical interconnections exist between population mobility and global public health, but since the 1990s new attention to emerging and re-emerging infectious diseases has promoted discussion of this topic. The containment of global disease threats is a major concern, and significant international efforts have received funding to fight infectious diseases such as malaria, tuberculosis and HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome). Migration and population mobility play a role in each of these public health challenges. The growing interest in population mobility's health-related influences is giving rise to new foreign policy initiatives to address the international determinants of health within the context of migration. As a result, meeting health challenges through international cooperation and collaboration has now become an important foreign policy component in many countries. However, although some national and regional projects address health and migration, an integrated and globally focused approach is lacking. As migration and population mobility are increasingly important determinants of health, these issues will require greater policy attention at the multilateral level.     

Health as foreign policy: harnessing globalization for health

This paper explores the importance for health promotion of the rise of public health as a foreign policy issue. Although health promotion encompassed foreign policy as part of 'healthy public policy', mainstream foreign policy neglected public health and health promotion's role in it. Globalization forces health promotion, however, to address directly the relationship between public health and foreign policy. The need for 'health as foreign policy' is apparent from the prominence public health now has in all the basic governance functions served by foreign policy. The Secretary-General's United Nations (UN) reform proposals demonstrate the importance of foreign policy to health promotion as a core component of public health because the proposals embed public health in each element of the Secretary-General's vision for the UN in the 21st century. The emergence of health as foreign policy presents opportunities and risks for health promotion that can be managed by emphasizing that public health constitutes an integrated public good that benefits all governance tasks served by foreign policy. Any effort to harness globalization for public health will have to make health as foreign policy a centerpiece of its ambitions, and this task is now health promotion's burden and opportunity.     

Health policy versus industrial policy in the pharmaceutical sector: the case of Canada

This paper analyses the trade-off between health policy and industrial policy objectives in the field of pharmaceuticals in the Canadian policy setting. In Canada pharmaceutical regulation is organized in two tiers. The federal government is responsible for the conduct of industrial policy for the pharmaceutical sector, including the patenting of new molecular entities, the registration and approval of pharmaceutical products, and the pricing of new products. At the province level, policy-makers are responsible for the reimbursement of the cost of medicines; the methodologies implemented for this purpose may be geared towards meeting the objective of cost containment within tight health budgets rather than addressing industrial policy objectives and, thereby, supporting the pharmaceutical industry. The reimbursement methodologies implemented may also be related with the strength of pharmaceutical presence in each province. The paper provides evidence from two such provinces, British Columbia and Ontario, and contrasts pharmaceutical policy-making at the provincial level with that at the federal level.     

Health promotion policy in Sweden: Means and methods in intersectoral action

In Sweden different commissions have been working on legislation,prevention programmes and financing, and have aimed at implementingthe Health For All strategy at national level. National programmesfor cardiovascular diseases, cancer, accidental injuries, etcwere established by parliamentary resolution in 1985. The roleof health education has been extended: from the earlier concernwith matters of individual lifestyle the focus has shifted towardsmotivating the community as a whole to take an active interestin its health. There is good public support in the areas oflegislation, knowledge and awareness, international development(WHO), and public policy. Despite the existence of legislation, strong official policyand a good organizational structure, strong efforts are stillneeded to turn health promotion into general practice. National,regional and local bodies as well as non-governmental and privateorganizations are showing an increasing interest in health promotion.Health promotion strategies are used in traditional fields suchas alcohol and smoking as well as other sectors such as education,employment, culture, social welfare, town and house planning,transport and environmental protection. There has never been such a positive basis for the further developmentof health promotion policy in Sweden though there are a numberof potential conflicts and problems related to knowledge, organization,attitudes, financing, distribution of power, etc. These areoutlined broadly as "The organizational trap", "Modificationor revolution?" and "Individual or public responsibility forhealth?".     

Health policy reform in tough times: the case of Portugal

The financial rescue plan for the Portuguese economy details a number of adjustments to be made in the National Health Service. We review the changes on user charges. The requirement of the rescue plan on user charges is twofold: structure of user charges and the levels of user charges. Adoption of measures occurred within the timeframe required. The first part, structure of user charges, is already present in the Portuguese NHS and has been for a decade. The crucial decisions are therefore on the level of user charges. Increases in levels of user charges were substantial (roughly doubling their previous levels) although exemptions also expanded considerably the fraction of the population that is not required to pay user charges. The net effect is not clearly predictable.     

Health promotion policy in Sweden: means and methods in intersectoral action.

In Sweden different commissions have been working on legislation, prevention programmes and financing, and have aimed at implementing the Health For All strategy at national level. National programmes for cardiovascular diseases, cancer, accidental injuries, etc were established by parliamentary resolution in 1985. The role of health education has been extended: from the earlier concern with matters of individual lifestyle the focus has shifted towards motivating the community as a whole to take an active interest in its health. There is good public support in the areas of legislation, knowledge and awareness, international development (WHO), and public policy. Despite the existence of legislation, strong official policy and a good organizational structure, strong efforts are still needed to turn health promotion into general practice. National, regional and local bodies as well as non-governmental and private organizations are showing an increasing interest in health promotion. Health promotion strategies are used in traditional fields such as alcohol and smoking as well as other sectors such as education, employment, culture, social welfare, town and house planning, transport and environmental protection. There has never been such a positive basis for the further development of health promotion policy in Sweden though there are a number of potential conflicts and problems related to knowledge, organization, attitudes, financing, distribution of power, etc. These are outlined broadly as "The organizational trap", "Modification or revolution?" and "Individual or public responsibility for health?".     

Health care policy and the Reagan administration: the case of family planning

In 1970 the Public Health Service Act was passed and Title X had a provision to establish and fund a national network of family planning clinics through the Office of Family Planning (OFP). The Reagan administration's policy towards family planning suffers from dilemmas and shortcomings that had an influence on the programs put in place by Title X. The attempts to reshape the philosophy of Title X have for the most part failed, but these attempts have had some negative effects none the less. This article examines the history of Title X and the attempts by the Reagan administration to change it. For the years 1985-86, the OFP had a budget of $142 million of which $135 million went to fund the clinics and the rest went to training, educational materials, and research and development of newer and better ways of getting family planning to the people. Before 1987 the Reagan administration tried to change the strategy of family planning from sex education, contraception and abortion to advocating abstinence, adoption counseling, infertility counseling, and natural contraception. This tactic failed because the Reagan administration was only able to divert $5 million towards these new goals. Congress was the administration's primary obstacle. Another unsuccessful tactic was to change the method of funding by moving the money to block grants which all states received from the federal government to do with basically as they pleased. But Congress went ahead and funded Title X directly in the usual manner. After 1986 the Reagan administration found a new avenue to accomplish its policy change. The "Superbill" as it is called would restrict funding to any clinics that refer for abortion, counsel for abortion or are closely overlapping fiscally or physically with abortion services. The administration also rail-roaded through new regulations to this effect in case Congress did not pass the Superbill. As of the writing of this article, pro-family planning organizations have gotten court injunctions to block the new regulations.     

Health information systems in humanitarian emergencies

Health information systems (HIS) in emergencies face a double dilemma: the information necessary to understand and respond to humanitarian crises must be timely and detailed, whereas the circumstances of these crises makes it challenging to collect it. Building on the technical work of the Health Metrics Network on HIS and starting with a systemic definition of HIS in emergencies, this paper reviews the various data-collection platforms in these contexts, looking at their respective contributions to providing what humanitarian actors need to know to target their intervention to where the needs really are. Although reporting or sampling errors are unavoidable, it is important to identify them and acknowledge the limitations inherent in generalizing data that were collected in highly heterogeneous environments. To perform well in emergencies, HIS require integration and participation. In spite of notable efforts to coordinate data collection and dissemination practices among humanitarian agencies, it is noted that coordination on the ground depends on the strengths and presence of a lead agency, often WHO, and on the commitment of humanitarian agencies to investing resources in data production. Poorly integrated HIS generate fragmented, incomplete and often contradictory statistics, a situation that leads to a misuse of numbers with negative consequences on humanitarian interventions. As a means to avoid confusion regarding humanitarian health statistics, this paper stresses the importance of submitting statistics to a rigorous and coordinated auditing process prior to their publication. The audit trail should describe the various steps of the data production chains both technically and operationally, and indicate the limits and assumptions under which each number can be used. Finally emphasis is placed on the ethical obligation for humanitarian agencies to ensure that the necessary safeguards on data are in place to protect the confidentiality of victims and minority groups in politically sensitive contexts.     

Translating nutrition research into action in humanitarian emergencies

Except for the management of severe malnutrition, there has been little research specifically conducted to support emergency food and nutrition programs. Lacking empirically based guidance regarding how accurately to identify problems and select the most effective means to achieve desired objectives, programming decisions have been based on extrapolations, anecdotal evidence and intuition, with hopes of doing the right thing. Consequently, donors, implementers and affected governments, who often hold contradictory opinions, expend time and resources on controversies about when and how to act. These controversies reveal inadequate knowledge for which research is urgently needed. Two past controversies are presented as illustrations: one related to ration energy requirements and the other to sales of food aid. Appropriate action depends on context and research to support emergency programming must encompass a broad range of sectors and disciplines. Furthermore, emergency contexts are characterized by extremes and dynamic change and investigations in such contexts demand special approaches and caution. Institutional structures need to be changed so that they can adequately support emergency nutrition research.