Global health diplomacy: At a time when the global health architecture stands at a precarious crossroads—underfunded, politically polarised, and increasingly unsafe for marginalised practitioners—conversations around collaboration and diplomacy in global health spaces are no longer optional. They are urgent.
The term collaboration here refers to any alliance among individuals or institutions aimed at improving health outcomes—be it called a partnership, alliance, consortium, or coalition. But what does collaboration truly mean when the global health space itself is shrinking under the weight of nationalist politics, budgetary disinvestment, and a resurgence of exclusionary ideologies?
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The need for collaboration amid complexity
Global health problems today—pandemics, climate-related illness, access inequities—are deeply interconnected. They defy linear solutions and demand collaboration across governments, international bodies, academia, civil society, and the private sector.
Theoretical models such as complexity theory offer an interpretive lens. This theory suggests that health outcomes are shaped by dynamic, non-linear relationships between political, environmental, and social systems. In this view, small actions can trigger disproportionate effects, making collaborative strategies essential, not optional.
Global health alliances like community-based networks and cross-sector partnerships attempt to embody this complexity. Yet, despite political support, their impact is often mixed. As a systematic review from the UK revealed, organisations tend to collaborate within silos, pointing to the urgent need for more integrated, inclusive frameworks.
The promise and challenge of transdisciplinarity
Transdisciplinary collaboration integrates insights from diverse fields to solve complex health challenges holistically. Models like One Health and Planetary Health have gained traction by emphasising the interconnectedness of human, animal, and environmental health. These approaches promote not only co-learning and reflexivity but also the incorporation of Indigenous and marginalised perspectives.
But transdisciplinary collaboration is only as effective as the power dynamics it recognises. For instance, the persistent North-South divide in health partnerships often reflects colonial legacies rather than equitable alliances. Knowledge hierarchies, funding asymmetries, and implicit biases continue to obstruct meaningful cooperation.
From models to practice: The Bergen Framework and beyond
One of the most compelling frameworks for understanding how collaborations function is the Bergen Model of Collaborative Functioning (BMCF). It evaluates partnerships through four key dimensions: inputs, processes, outputs, and feedback loops. Successful collaboration requires balanced power, shared governance, and transparency—features still elusive in many global health initiatives.
The BMCF has found practical application in global health education, local health governance, and multi-stakeholder responses to public health emergencies. Yet its success hinges on a willingness to engage in honest assessment and ongoing adaptation, especially in fragile or politically sensitive environments.
Health diplomacy for equity and security
Global health diplomacy is not merely about foreign policy or cross-border aid. At its best, it is a mechanism to promote universal health coverage, mitigate social determinants of illness, and create a more equitable international order. It aims to bridge gaps in global health access and harness health as a means of promoting peace and development.
Health diplomacy facilitates cooperation among diverse actors—governments, international organisations, the private sector, and civil society—to respond to crises, from pandemics to forced migration. In conflict zones, it has enabled ceasefires for immunisation campaigns and delivered essential supplies where state capacity has collapsed.
Yet the field is not immune to power imbalances. While institutions like WHO promote collaboration through cross-sector partnerships, studies have shown that knowledge transfer, leadership integration, and institutional bias continue to limit the effectiveness of these efforts—particularly from the standpoint of the Global South.
Governance, equity, and the diplomatic deficit
Global health governance is riddled with paradoxes. On paper, it’s inclusive. In practice, it often isn’t. Ilona Kickbusch’s seven dimensions of diplomacy—ranging from alliance-building and governance reforms to peace-making through health—offer a robust typology. But they fall short of acknowledging the exclusion experienced by Indigenous peoples, refugees, LGBTQ+ communities, and practitioners from low-income countries.
For instance, North-South academic partnerships, despite decades of critique, still operate on unequal terms. Donor relations skew influence, leaving southern partners in implementation roles rather than decision-making ones. Health diplomacy must move from rhetorical equality to operational equity.
Equally, more attention is needed to South-South cooperation—an underexplored but promising model for context-specific, community-driven diplomacy. Frameworks that emerge from low-resource settings can often be more agile, more sustainable, and more inclusive than top-down models imposed by multilateral bodies.
Measuring what matters
Measuring collaboration in global health requires more than metrics of service delivery. It involves assessing governance structures, stakeholder inclusion, and power-sharing mechanisms. Researchers have begun using methods like equity-informed interpretive synthesis, collaborative governance frameworks, and social network analysis to understand how collaborations form and function.
These tools not only reveal gaps in current practice but also help identify opportunities for more just and effective diplomacy. For example, network analysis can highlight key influencers and coordination gaps; qualitative case studies can surface lived experiences and tacit knowledge often missed by conventional indicators.
Collaboration with conscience
The terrain of global health diplomacy is increasingly contested—and increasingly critical. In a world buffeted by pandemics, inequality, and climate volatility, collaboration must go beyond formal alliances. It must centre on equity, mutual respect, and meaningful inclusion.
Kickbusch’s diplomatic dimensions need to be viewed through a decolonial lens. Governance reforms must prioritise participation from the margins. Collaborative research must embed ethics of reciprocity. And health diplomacy must put vulnerable populations—not geopolitical interests—at the heart of the agenda.
Ultimately, collaboration in global health will succeed not when every partner has a seat at the table, but when everyone’s voice carries equal weight. Anything less is not diplomacy—it’s dominion.