International Health Statecraft: The case of Peru's 1991 cholera epidemic.

摘要

The 1990s cholera pandemic in Latin America exemplifies a challenging crisis that emerged initially as a Peruvian problem, but suddenly became a regional health and foreign policy issue, requiring regional negotiation and cooperation. I address the question: Do international health (IH) phenomena, such as the cholera epidemic in Peru in 1991, influence international relations of the affected country?; The analytic model examines the interaction of domestic and international cultural, geographic, socioeconomic, political, and epidemiological variables. The model--designed to examine effects on health of political power differences among nation-states--helps policymakers manage determinants involved in the globalization of the health/disease process.; By incorporating the notion of the national and international realms in which IH phenomena are expressed, policymakers can better analyze the determinants of a health situation from a foreign policy perspective and identify causal links between the two realms. A health diplomacy initiative (HDI) establishes goals and involves decision-making, implementation, and evaluation of process and results. An International Health Statecraft (IHS) structure--that is, an intentional organizational policy, conducted from a high-level of decision-making--manages the HDI undertaking.; The ten-thousand deaths cholera caused in Latin America, and the reemergence of epidemics throughout the world, demand that IH become a priority in both domestic and foreign policies. The IHS is designed to empower Latin American decision-makers to deal with IH phenomena, while increasing their autonomy to defend their population's best interest and expand their global cooperation. The result is the development of far-reaching policies that anticipate and respond to pandemics, regional environmental toxicology disasters, and other phenomena.; The 1990's cholera epidemic reveals that policymakers in Peru and elsewhere could have prevented the crisis if they had been prepared with an International Health Statecraft. I conclude that, besides a high level of decision-making, political will, and intense societal participation, such statecraft should include strategic planning with a health intelligence system, coordination of agencies and resources, specific legislation for IH crises, and funding mechanisms to finance Health Diplomacy Initiatives.